atpiii2004修订版：近期数项临床研究启示.pptVIP

Considerations and Limitations for Achieving Very Low LDL-C Levels Dangers from very low LDL-C (unlikely) Side effects of high drug doses (still under study) High baseline LDL-C levels (150 mg/dL) Maximum drug lowering: about 50% ASCOT results for patients at moderately high risk The results of ASCOT suggest that patients with moderately high risk (2 or more risk factors and estimated 10-year risk of 10–20%) receive benefit from LDL-C–lowering drug therapy even if baseline LDL-C is 130 mg/dL. Reference: Sever PS, Dahl?f B, Poulter NR, et al., for the ASCOT Investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003;361:1149-1158. * What’s new for high-risk patients? On the basis of clinical trial evidence published since the ATP III guidelines, recommended modifications to the ATP III treatment algorithm for high-risk patients (CHD or CHD risk equivalent) include an optional LDL-C goal of 70 mg/dL for very high risk patients, simultaneous initiation of LDL-C–lowering drug therapy with therapeutic lifestyle changes in patients with LDL-C 100 mg/dL or greater, and the option of LDL-C–lowering drug therapy in patients with LDL-C 100 mg/dL at baseline. In high-risk patients with high triglycerides or low HDL-C, a fibrate or nicotinic acid may be considered in combination with an LDL-C–lowering drug. * What’s new for moderately high risk patients? On the basis of clinical trial evidence published since the ATP III guidelines, recommended modifications to the ATP III treatment algorithm for patients with moderately high risk (2 or more risk factors and estimated 10-year risk of 10–20%) include initiation of LDL-C–lowering drug therapy if LDL-C remains 130 mg/dL or greater with diet therapy (with an LDL-C goal of 130 mg/dL as in ATP