抗动脉粥样硬化治疗基石.pptVIP

胆固醇升高是心脑血管疾病的致病性危险因素 降LDL-C：他汀与冠心病一级预防 降LDL-C：他汀与冠心病二级预防 2001年 NCEP ATPIII 丰富循证依据表明： 应用他汀类药物治疗明确获益 减少主要冠脉事件 减少冠心病死亡率 减少冠脉手术(PTCA/CABG)需求 减少中风 减少总死亡率 1.他汀抗动脉粥样硬化作用 斑块研究的证据 他汀可延缓、阻断甚至逆转动脉粥样硬化的进展 他汀与冠脉粥样硬化进展QCA研究:LDL-C降低30-40%可延缓进展，但未阻断或逆转进展 REVERSAL：主要终点(斑块体积百分比变化) 2.他汀显著降低各种心血管事件 3.强化他汀降脂高危患者进一步获益 TNT主要终点：进一步降低22% 积极他汀治疗显著降低稳定性冠心病和ACS患者的事件 对他汀认识的不断深化：从降胆固醇药物到抗动脉粥样硬化药物 在动脉粥样硬化血管疾病的处理方面，他汀类药减少主要血管事件，如死亡、心肌梗死和中风的疗效已超越所有其他类的药物 LDL-C＜70mg/dl----冠心病极高危LDL-C↓30%～40%----冠心病高危或中高危 单一药物LDL-C不能达标时 他汀＋胆固醇吸收抑制剂 他汀＋烟酸 他汀＋树脂 他汀类+胆酸螯合剂(考来烯胺 )或 依折麦布+烟酸 　　　　 总 结 胆固醇升高是冠心病致病性危险因素 降低胆固醇能有效减少冠心病事件风险 他汀是目前最强效降低胆固醇药物 冠心病及其高危者需充分应用他汀 3.高危患者风险更高，降脂治疗的获益更大。众多证据证实高危患者使用他汀进行 降脂治疗能更多获益。 标准 强化 3. 高危患者风险更高，降脂治疗的获益更大。众多证据证实高危患者使用他汀进行 降脂治疗能更多获益。 正确答案： B. 强化 Whilst it is acknowledged that there are limitations in comparing data and results from different studies, this slide summarises the data from several IVUS studies and provides insight into the relationship between the LDL-C level achieved and PAV (Percent Atheroma Volume). The line of best-fit suggests there is a correlation between mean LDL-C achieved in the various studies and the progression rate for the most robust IVUS endpoint, PAV. This graph suggests that no apparent LDL-C threshold exists beyond which benefits of LDL-C reduction apply and that to achieve regression, lower is better. ?ASTEROID and REVERSAL investigated active statin treatment; A-PLUS, ACTIVATE AND CAMELOT investigated non-statin therapies but included placebo arms in which a considerable proportion of patients received background statin therapy (62%, 80% and 84% respectively). ACTIVATE: ACAT Intravascular Atherosclerosis Treatment Evaluation1 A-Plus: Avasimibe and Progression of Lesions on UltraSound2 ASTEROID: A Study to Evaluate the Effect of Rosuvastatin On Intravascular Ultrasound-Derived Coronary Atheroma Burden3CAMELOT: Comparison of Amlodipine vs Enalapril to Limit Occurrences of Thrombosis4REVERSAL: Reversal of Atherosclero