z强化降脂治疗-1-课 课件.pptVIP

临床试验中这些患者被列入排除标准 排除标准 PROVE IT TNT IDEAL 生命预期少于2年 √ 合并抑制CYP3A4药物,影响他汀代谢的药物 √ √ 近期接受PCI或CABG √ √ 有QT间期延长因素或心功能衰竭 √ √ 梗阻性肝病或严重肝病 √ 不能解释的CK升高≥3-6 X ULN √ √ 血肌酐＞2.0 mg/dl √ 活动性肝病或AST/ALT ＞1.5-2 ULN √ √ 肾病综合症 √ √ 未控制的糖尿病 √ √ 长期使用免疫抑制剂 √ 甲状腺功能减退 √ √ 酗酒 √ Cannon CP,et al: N Eng J Med 2004;350, Waters DD et al. Am J Cardiol 2004;93:154-158 Perdersons et al:JAMA2005;294:2437-2445 总 结 他汀类是冠心病治疗有效而且安全的调脂药物 对高危患者积极的个体化调脂治疗，减少血管事件的发生 IVUS研究表明积极降低LDL-C延缓/逆转冠脉斑块进展 对某些特定人群，他汀类引起肌病的危险性增高（尤其是高龄、肝肾功能不全、多种合并用药）在考虑安全性的前提下合理调脂 * * * * * Summary (I) In patients at high or moderately risk, therapeutic lifestyle change is an integral part of risk reduction. If an LDL-C–lowering drug is used, the intensity of therapy should achieve an additional LDL-C reduction of at least 30–40% beyond diet. 总结 (I) 对于高危或中高危患者, 治疗性生活方式改变是降低风险必不可少的部分。如果应用降LDL-C药物, 其治疗强度应该在饮食基础上至少使 LDL-C再降低30–40% 。 * * * * * * * * * * * * * * * * * * * * * Slide 23. How low to lower LDL-C in high-risk patients? While the ATP III guidelines did not recommend LDL-C–lowering therapy for individuals whose LDL-C level is 100 mg/dL, the results of HPS and PROVE IT support the initiation of drug therapy in these individuals. Additional information on the optimal level of LDL-C for risk reduction should be provided by ongoing trials that compare different intensities of LDL-C lowering. Treating to New Targets (TNT) is comparing atorvastatin 80 mg vs. 10 mg, Incremental Decrease in Events through Aggressive Lipid Lowering (IDEAL) is comparing atorvastatin 80 mg vs. simvastatin 20 or 40 mg, and the Study of the Effectiveness of Additional Reductions of Cholesterol and Homocysteine (SEARCH) is comparing simvastatin 80 mg vs. 20 mg. Keywords: ATP III, drug therapy, guidelines, HPS, IDEAL, LDL cholesterol, PROVE IT, SEARCH, TNT, treatment Slide type: graph CTT汇总研究 Lancet, 2005 冠脉事件下降23% 血管事件减少21% 长期使用他汀类药物的临床益处 临床试验的时间，年 BMJ, 2003 58个他汀类临床试验(n=76,359) LDL-C每降低1mmol/L 缺血性心脏病危险下降的幅度，% LDL-C降低对IHD危险性的影响 LDL –C降低程度 (mmol/L) 时间，年 0.2 –