hdl临床试验.pptVIP

HDL and Coronary Heart Disease Angiographic and Clinical Event Trials Angiographic Trials of Combination Therapy Cholesterol Lowering Atherosclerosis Study (CLAS)1 Diet and niacin + colestipol (vs diet and placebo) 188 men (aged 40–59 y), post-CABG Nonsmokers or former smokers, nondiabetic, nonhypertensive Total-C at entry: 185–350 mg/dL; drug responsive Familial Atherosclerosis Treatment Study (FATS)2 Lovastatin + colestipol, niacin + colestipol, or conventional therapy 146 men (aged ? 62 y) with CAD and family history of CAD ApoB ? 125 mg/dL Average stenosis: 34% 1. Blackenhorn DH et al. JAMA. 1987;257:3233–3240 2. Brown G et al. N Engl J Med. 1990;323:1289–1298 Angiographic Trials of Combination Therapy Effects on Lipids % change Trial LDL-C HDL-C TG CLAS Placebo (2 y)1 ? 5* ? 2 ? 5* Niacin + colestipol (2 y)1 ? 43* ? 37* ? 22* Niacin + colestipol (4 y)2 ? 40?? ? 37?? ? 18§ FATS (2.5 y)3 Conventional ? 7** ? 6** ? 15 Niacin + colestipol ? 32* ? 41* ? 29* Lovastatin + colestipol ? 45* ? 16? ? 9 Versus baseline: *P 0.001; ?P 0.01; ** P 0.05; Versus placebo: ??P 0.001; §P 0.03 1. Blankenhorn DH et al. JAMA 1987;257:3233–3240 2. Cashin-Hemphill L et al. JAMA 1990;264:3013–3017 3. Brown BG et al. N Engl J Med 1990;323:1289–1298 Cholesterol-Lowering Atherosclerosis Study (CLAS)Univariate Apo Predictors of Coronary Progression Mean (mg/dL) Predictor Progressor Nonprogressor P value Placebo (n = 82: 49 progressors, 33 nonprogressors) ApoB 128 116 0.03 ApoC-III (total) 12.4 10.3 0.03 ApoC-III (HS)* 5.9 4.9 0.03 Drug (n = 80: 31 progressors, 49 nonprogressors) ApoC-III (HS)* 6.4 7.5 0.05 *HS = heparin supernate (apoC-III in HDL) Blankenhorn DH et al. Circulation 1990;81:470–476 Familial Atherosclerosis Treatment Study (FATS)Univariate Predictors of Change in Proximal Stenosis Predictor r P value ApoB 0.38 0.0001 LDL-C 0.27 0.01