他汀在大血管并发症管理中的证据和机制课件.pptVIP

* 主要终点的临床获益与基线血脂水平无关。 从表中可以看出，就同一种脂质而言，无论患者基线时脂质水平高于或低于中位水平，均显著获益，且两亚组间获益程度无显著性差异。 Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): A multicentre randomised placebo-controlled trial. Lancet. 2004;364:685-696. * 2008年， Lancet上载文，专门论及糖尿病患者使用他汀获益的问题。该荟萃分析共计入选14个他汀治疗的随机试验，包括18686例糖尿病患者（其中2型糖尿病患者17220名）。在平均4.3年的随访期中，糖尿病患者LDL-C每下降1mmol/L，全因死亡减少9%（P = 0.02），血管性死亡减少13%（P = 0.008），卒中减少21%（P = 0.0002），同时非血管性死亡无显著变化(P = 0.7)。研究者经过分析还发现，5年内他汀治疗1000例糖尿病患者，可预防42例主要心血管事件。 Lipid/Metabolic All diabetics over 40 should be on statins, EASD told October 1, 2010 | Stockholm, Sweden - All people over the age of 40 with diabetes—type 1 or type 2—should be taking statins to reduce their risk of stroke or coronary events, one expert stressed to diabetes doctors at the European Association for the Study of Diabetes (EASD) 2010 Meeting last week. Dr John Betteridge (University College London, UK) outlined the evidence base for statins in diabetes and stressed their safety, as long as they are appropriately used and drug interactions are avoided. He told the meeting that the plaque burden is increased in diabetes and that LDL cholesterol in diabetics is particularly atherogenic. Trials such as CARDS have proven the benefit of statins in type 2 diabetics, he explained; in this study, 10 mg of atorvastatin (Lipitor, Pfizer) reduced LDL cholesterol by 40% and was associated with a 37% reduction in cardiovascular events and a dramatic halving of the stroke rate over four years, something that came as a surprise, he noted. These data were further strengthened by the results from the Cholesterol Treatment Trialists Collaboration, he noted, which showed that women and type 1 diabetics also benefited equally from statins, although he warned that there is little evidence to guide statin therapy in people under 40 with type 1 diabetes. To me,