Hyperlipidemia高脂血症.ppt

* * Clinical Controversy ENHANCE trial (Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression) Familial hypercholesterolemia patients autosomal dominant LDL receptor mutation severely elevated LDL premature atherosclerosis 2 groups (n=720) simvastatin 80 mg + placebo simvastatin 80 mg + ezetimibe 10 mg * Kastelein JJ, Akdim F, Stroes ES, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Eng J Med 2008;358:1431-1443. Clinical Controversy ENHANCE 1? outcome: change in carotid intima-media thickness (CIMT) after 24 months no significant difference in CIMT between groups simvastatin + ezetimibe group: greater decreases in LDL C-reactive protein No differences in elevated liver enzymes, myopathy Limitations: prior lipid-lowering therapy (many patients had near normal CIMT at initiation); not designed to evaluate differences in incidence of vascular events * Kastelein JJ, Akdim F, Stroes ES, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Eng J Med 2008;358:1431-1443. Clinical Controversy SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) Simvastatin 40 mg + ezetimibe 10 mg vs placebo (n=1873) No change in clinical course of aortic stenosis Simvastatin + ezetimibe: increased incidence of cancer SHARP IMPROVE-IT trials in progress evaluating ezetimibe for vascular risk reduction interm analyses do not show increased cancer risk * Rosseb? AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Eng J Med 2008;359:1343-1356. Peto R, Emberson J, Landray M, et al. Analyses of cancer data from three ezetimibe trials. N Eng J Med 2008;359:1357-1366. ? Omega 3 Fatty Acids Diets rich in omega 3 fatty acids from oily fish decrease TC, TG, LDL, increase HDL decrease CV events Rx fish oil: Lovaza? lowers TG 14 to 30% raises HDL ~10% FDA approved as dietary adjunct for very high TG levels ( 500 mg/dL) Thrombocytopenia, ble