脂药物在急性冠心症及脑中风的使用.pptVIP

Statin in Acute Coronary Syndrome Statin in Acute Ischemic Stroke and Transient Ischemic Attack Recommendations from the American Heart Association (AHA)/American Stroke Association (ASA) suggest that statin therapy should be used in the vast majority of patients with a history of ischemic stroke or TIA. However, it remains unclear as to how soon statin should be initiated after acute ischemic stroke. Statin initiation during hospitalization for first ischemic stroke of atherosclerotic origin is probably justified based on ACS trials Taiwan Stroke Registry Taiwan Stroke Registry, launched on May 1, 2006 and engaging 37 hospitals around Taiwan, prospectively collected data of patients who developed acute stroke or TIA and were hospitalized within 10 days after onset. All patients were followed up for at least 6 months after discharge. * * Use of Lipid-lowering Agent in Acute Coronary Syndrome and Ischemic Stroke in Taiwan Yi-Heng Li, MD, PhD Department of Internal Medicine College of Medicine National Cheng Kung University 成功大學醫學院內科 李貽恆 Liao JK. Am J Cardiol. 2005;96(suppl 1):24F-33F. MMPs = matrix metalloproteinases ? Platelet activation ? Coagulation ? Endothelial  progenitor cells ? Effects on collagen ? MMPs ? AT1 receptor ? VSMC proliferation ? Endothelin ? Macrophages ? Inflammation ? Immunomodulation ? Endothelial function ? Reactive oxygen  species ? NO bioactivity Pleiotropic effects of statins Statins MIRACL Study Relative risk = 0.84P = .048 95% CI 0.701-0.999 Atorvastatin Placebo 0 5 10 15 0 4 8 12 16 Time Since Randomization (weeks) Cumulative Incidence (%) Time to first occurrence of: Death (any cause) Nonfatal MI Resuscitated cardiac arrest Worsening angina with new objective evidence and urgent rehospitalization 17.4% 14.8% Primary Efficacy Measure Schwartz GG, et al. JAMA. 2001;285:1711-1718. Very early benefit Statin Use in ACS: NCKUH Experience Inclusion criteria: - January 2000 ~ December 2004 - patients admitted to the NCKUH with