IDEAL偱证研究-CHD篇.pptVIP

IDEAL 研究再次证实TNT、PROVE-IT的结论：立普妥?强化他汀治疗比“常规治疗”使冠心病患者获益更多 IDEAL再次证实立普妥?最高剂量80mg的安全性 IDEAL与TNT将进一步促进血脂指南的修订 * * * 4s研究得出了结论即随着总胆固醇和低密度脂蛋白的下降总死亡率冠心病的死亡率等都会有大幅度的降低，尤其是低密度脂蛋白胆固醇的降低与主要血管事件的大幅降低相关性非常大。这个里程碑似的研究证明了对于冠心病患者降低低密度脂蛋白胆固醇对于降低其冠脉疾病死亡率有着明显的益处。 * 这张幻灯片显示的是第一年的患者生存率与低密度脂蛋白胆固醇之间的关系。说明了越早采取降低低密度脂蛋白胆固醇的治疗，就可以越大程度的增加患者的生存率。 * * IDEAL is a multicenter randomized, open-label prescription study with stratified randomization carried out in blocks (the Prospective Randomized Open Blinded End-point Study—PROBE—design).1 The goal of the study is to determine whether additional clinical benefits can be achieved through greater percentage reductions in LDL-C levels with atorvastatin 80 mg/day than those achieved with standard treatment as administered in the 4S study.1 A total of 8888 patients were enrolled between March 31, 1999 and March 29, 2001 at 190 centers in Norway, Sweden, Finland, Denmark, Iceland, and the Netherlands. Eligibility criteria included men and?women aged 80 or younger who had been hospitalized or had a history of confirmed MI and who qualified?for statin therapy according to guidelines in place at the time of recruitment.1 After dietary counseling, all patients who fulfilled the eligibility criteria were randomized to receive atorvastatin 80 mg or simvastatin 20 mg, no drug-free period was required. The study protocol?permitted dosage of simvastatin to be increased to 40 mg/day at week 24 in those patients whose plasma TC level remained above 190 mg/dL (5.0 mmol/L). All patients were followed up 12 and 24 weeks after randomization. Follow-up was at 6-month intervals until the predetermined number of primary end points for?the study had been met, which was estimated to occur after a median duration of 5.5 years.1 The primary clinical end point is the time to first occurrence of a major coronary event, defined as nonfatal AMI?according to criteria of the Joint European Society of Cardiology/American College of Cardiology, coronary death, or resuscitated ca