acc2005公布临床试验启示.pptVIP

TNT: What does it add? PROVE-IT showed that lower is better in ACS patients, but did it apply to stable CHD patients? Yes! Confirms and supports that lower LDL cholesterol is better, but also expands the principle to more than 30 million US patients Cannon TNT: What does it add? Baseline LDL cholesterol levels low in TNT No longer good enough to simply put a statin in the drinking water Level of LDL cholesterol matters— need to get it down even further than we thought we did Is it all about the LDL? Looking down the road to tease out benefit What happens when patients are stratified by LDL cholesterol levels coming into the study? Is it all LDL? What happens above and beyond LDL lowering? Ferguson Beyond the guidelines Patient with angina and prior MI Goal to bring LDL cholesterol level to 70 mg/dL Do I start treatment at the maximum 80-mg dose of atorvastatin? Fuster ACS vs stable CHD In ACS patients, start with a high-dose statin, as PROVE-IT showed benefit emerged after 10 days In stable CHD patients, slower titration is an option, but getting control of LDL and CRP is key Cannon TNT: Safety issues 1.2% of patients treated with atorvastatin 80 mg had a persistent elevation in alanine aminotransferase, aspartate aminotransferase, or both, compared with 0.2% of patients receiving atorvastatin 10 mg (p0.001) TNT: Safety issues 99% of the patients didnt need any dose adjustment with atorvastatin 80 mg It seems to me that in the future we will start looking at LDL cholesterol levels after the patient is treated, rather than before. - Fuster Evolution of therapy Changing patient populations for aspirin, clopidogrel, and statin therapy If a drug works, it works. - Cannon Evolution of therapy The chronic treatment arena is a whole different scenario . . . Side effects, drug interactions, tolerance, and compliance become issues Time will tell as we begin to get experience. Fergu