降脂治疗及管理新理念.pptVIP

这就是美国Framingham研究冠心病危险评分方法。虽然目前研究中认为与冠心病有关的因素多达200余种，但经过大样本前瞻性研究和临床试验证实的危险因素却不多。因此，1998年Framinham仅采用了公认的、作用明确的年龄、性别、胆固醇、血压、吸烟及糖尿病几个经典的危险因素来评估10年冠心病危险。这也就是目前所倡导的循证医学。 * Framingham心脏研究是第一个揭示HDL－C与CHD具有负相关性的大规模流行病学研究。研究结果显示，无论是在男性还是女性，随着HDL－C水平降低，CHD危险性呈明显上升趋势。 Torcetrapib为CETP抑制剂，CETP（胆固醇酯转运蛋白）从HDL转送胆固醇酯（CE）至含apo-B的脂蛋白、VLDL和LDL，CETP对HDL的代谢起重要作用 * 随访2年时，两组患者的主要终点事件发生率分别为：普伐他汀组26.3％，立普妥组22.4％，立普妥组主要终点事件发生率下降了16％,P=0.005。(事件发生率为Kaplan－Meier事件率。) Reference 1. Cannon CP, et al. N Engl J Med. 2004;350:1495-504. * 除了降低LDL-C，他汀还通过改善内皮功能，抗炎，抗氧化，稳定/逆转斑块等多种机制，抗动脉粥样硬化。 * 一系列的大规模国际临床实验证实，LDL的降低可以预测大部分他汀的疗效，LDL的降低可以带来事件率相应的下降，可以通过观察基线和治疗后的LDL-C的值来预测事件率，而无需知道是哪一种他汀。从图上可以看到，LDL值越低，无论是一级预防结果还是二级预防结果，事件率均与LDL值呈正比，每一个LDL降低值都对应一个事件率降低值。 Core slide JUPITER is a randomised, double-blind, placebo-controlled, multicentre, phase III study of rosuvastatin 20 mg in the primary prevention of cardiovascular events among patients with low levels of LDL-C (?3.36 mmol/L [130 mg/dL]) and elevated levels of CRP (?2.0 mg/L). This study is being conducted in approximately 15 000 male and female patients recruited from 24 countries. Patients will be randomised (1:1) to receive either rosuvastatin 20 mg or placebo once daily. The study will continue until 520 cardiovascular events have occurred, which is expected to be after approximately 3–4 years. The primary endpoint is the time to the first occurrence of a major cardiovascular event after randomisation (cardiovascular death, stroke, MI, hospitalization for unstable angina or arterial revascularisation). Secondary endpoints are: total mortality noncardiovascular mortality development of diabetes mellitus development of venous thromboembolic events (deep vein thrombosis or pulmonary embolism) bone fractures discontinuation of study medication due to adverse effects. Reference Ridker PM. Rosuvastatin in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high-sens