医学课件降胆固醇治疗获益的新证据SHARP研究的启示.ppt

更多医学精品尽在医学吧 /rayshiu 2010大规模荟萃分析： eGFR和蛋白尿与全因死亡及心血管死亡密切相关 基线血脂水平 慢性肾脏病患者降脂治疗临床研究小结 更多医学精品尽在医学吧 /rayshiu 风险比 95% CI 安慰剂 依折麦布/辛伐他汀 (n=4620) (n=4650) 非透析 (n=6247) 296 (9.5%) 373 (11.9%) 透析 (n=3023) 230 (15.0%) 246 (16.5%) 任何患者 526 (11.3%) 619 (13.4%) 16.5% SE 5.4 降低 (p=0.0022) 0.6 0.8 1.0 1.2 1.4 SHARP：主要动脉粥样硬化事件， 按随机时的肾功能状况 非透析或透析治疗患者之间无显著性差异 (p=0.25) 依折麦布/辛伐他汀 更好 安慰剂 更好 4%0.84-1.11(P=0.59) Rosuvastatin 10 mg/day 45.6 Time to a major cardiovascular event RCT n=2776, end-stage renal disease on maintenance hemodialysis AURORA3 17% 0.74 – 0.94 (p=0.002) Simvastatin 20 mg/day + ezetimibe or 10 mg/day vs placebo 4.9yrs Major arthrosclerosis events (coronary death, myocardial infarction, ischemic stroke and any revascularization procedure) RCT n=9438, predialysis and dialysis SHARP 8%0.77-1.10(P=0.37) Atorvastatin 20 mg/day 48 Cardiac death, fatal stroke, NFMI, or stroke RCT n=1255, diabetics on hemodialysis 4D2 Fluvastatin 40-80 mg/day Treatment 17%0.64-1.06(P=0.139) RRR95% CI Duration(Months) Primary Endpoint Design Population Study 60 Cardiac death, NFMI cardiac procedures RCT n=2102,renal transplant recipients ALERT1 1. Harper CR et al. J Am Coll Cardiol. 2008;51(25):2375–2384. 2。 Harper CR et al. J Am Coll Cardiol. 2008;51(25):2375–2384; 3. Fellstrom BC et al. N Engl J Med. 2009;360:1395–1407 0.5 0.75 1 1.5 2 Trial 事件(%患者) Allocated LDL-C reduction Allocated control Risk ratio (RR) per mmol/L LDL-C reduction p LDL-C reduction better Control better 99% or 95% CI SHARP和其他研究的综合分析:非致死性心肌梗死 4D 33 (1.91) 35 (2.02) AURORA 91 (1.97) 107 (2.33) ALERT 54 (1.03) 65 (1.24) SHARP 134 (0.71) 159 (0.85) c 3 2 = 0.3 (p = 0.96) 小计: 4 肾脏相关研究 312 (1.02) 366 (1.21) 0.83 (0.70 - 0.98) 0.03 23项其他研究 3307 (0.97) 4386 (1.29) 0.73 (0.70 - 0.76) 0.0001 所有研究 3619 (0.97) 4752 (1.29) 0.74 (0.70 - 0.77) 0.0001 肾脏相关研究和非肾脏相关研究的差别 c 1 2 = 2.2 (p = 0.14) 0.5 0.75 1 1.5 2 Trial 事件(%患者) Allocated LDL-C reduction Allocated control Risk ratio (