心血管治疗-药物篇.ppt

* This slide shows the comparative effects of the six currently available statins on lipid parameters. All reduce LDL cholesterol and triglycerides, and increase HDL cholesterol. Reference 1. Knopp RH. N Engl J Med 1999;341:498–511. * Epidemiological studies have shown that the incidence of CHD increases with an increase in serum total cholesterol and LDL cholesterol concentrations. These observations led investigators to determine whether cholesterol-lowering therapies, in particular statins, can reduce morbidity and mortality associated with CHD. A number of key studies have been undertaken since the results of the Scandinavian Simvastatin Survival Study (4S)1, published in 1994, showed that treatment with simvastatin improved survival in patients with CHD. These include the West of Scotland Coronary Prevention Study (WOSCOPS)2 in 1995, the Cholesterol and Recurrent Events study (CARE)3 in 1996, the Long term Intervention with Pravastatin in Ischaemic Disease study (LIPID)4 and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) 5, both in 1998. 4S, CARE and LIPID were secondary prevention trials in patients with existing CHD, and WOSCOPS and AFCAPS/TexCAPS were primary prevention studies in patients with no history or symptoms of CHD. The trials were all large, randomised, double-blind, placebo-controlled studies lasting approximately 5 years. References 1. The Scandinavian Simvastatin Survival Study Group. Lancet 1994;344:1383–9. 2. Shepherd J et al. N Engl J Med 1995;333:1301–7. 3. Sacks FM et al. N Engl J Med 1996;335:1001–9. 4. The Long-term Intervention with Pravastatin in Ischaemic Disease Study Group. N Engl J Med 1998;339:1349–57. 5. Downs JR et al. J Am Med Assoc 1998;279:1615–22. * Five landmark trials have investigated the use of statin therapy in patients at varying degrees of risk of CHD events and death, and with different ranges of serum cholesterol levels. The patients at least risk were included in AFCAPS/TexCAPS.