降脂治疗的循证与临床PPT课件.pptVIP

* PROVE IT is a double-blind, randomized trial that has enrolled 4,160 patients, at approximately 400 sites in the US, Europe, Canada, and Australia, who have experienced an acute coronary syndrome (Q wave and non-Q-wave MI or unstable angina) within the previous 10 days. Patients received either 40 mg of pravastatin or 80 mg of atorvastatin within 10 days of their event and were followed for a mean follow-up period of 2 years. To study the role of infection in ACS, one half of the patients in the trial also received gatifloxacin 400 mg in addition to either pravastatin or atorvastatin. Gatifloxacin was started on day 15 after the initial episode of ACS for a treatment period of 14 days. Gatifloxacin was subsequently given as a pulsed dose of 400mg per day for 10 days each month for a mean of 2 years. The other half of the patient population received an antibiotic placebo. ASA: Asprin Gatifloxacin: 加替沙星 * For all randomized patients, the event rates of the primary endpoint at 2 years were 26.3% in the standard dose pravastatin 40mg group versus 22.4% in the high-dose atorvastatin 80mg group (p=0.005) representing a 16% relative risk reduction favoring high-dose atorvastatin 80mg (CI, 5%-26%) The reduction in clinical events with the more intensive lipid-lowering therapy emerged as early as 30 days following the start of therapy These results support that among patients who have recently experienced an acute coronary syndrome event, those receiving the more intensive high-dose lipid lowering therapy had a greater protection from future cardiovascular events. These findings suggest that in this population, lipid lowering therapy to LDL-C concentrations substantially below current target levels is beneficial 治疗过程的监测 药物治疗 血脂、安全性检查(肌酶,肝酶) 4~8周复查 达标安全 6-12月复查 未达标 调整治疗 达标安全 6-12月复查 他汀不同类型、剂量中的相关事件风险(1)中重度肌病及急性肾衰 Hippisley-Cox J. BMJ. 2010 May 20;340:c2197. doi: 10.1136