联合治疗：《PI术后患者长期血脂管理》.pptVIP

总 结 PCI术后人群需要关注血脂的长期管理 依折麦布联合他汀双重抑脂机制具有良好的降脂疗效及安全性 IMPROVE IT研究证实了依折麦布联合他汀较他汀单药治疗显著降低极高危患者的心血管风险，其CV获益与CTT研究一致 谢 谢 * * * 影响PCI术后患者心血管预后的因素众多，其中有一些是人为主观的因素，需要多方面的评估和努力，也有一些客观的指标，那么，血脂异常，就是可量化，可治疗，可评估的客观指标 * * 那么，血脂异常对PCI术后患者的影响有哪些呢？首先，我们知道，LDL颗粒在动脉粥样硬化发生发展过程中有重要的病理作用，它是动脉粥样硬化斑块形成的始动因素 纵观整个动脉粥样硬化的进展过程，LDL在起始、进展、并发症等阶段均起重要作用。在起始阶段，LDL进入动脉壁后被氧化，形成氧化LDL，穿过血管内皮进入血管壁，释放趋化因子，吸引单核细胞进入动脉壁，引发炎症，使内皮功能降低；在进展阶段，LDL持续进入动脉壁，巨噬细胞吞噬氧化LDL形成泡沫细胞，泡沫细胞死亡后释放大量游离的LDL，形成脂质核心，平滑肌细胞移行、增生形成纤维帽。随着炎症加剧，脂质核心增大，平滑肌细胞和纤维组织减少，斑块变为易损斑块，易损斑块破裂，形成急性血栓，引发各种事件。 * 在这个大型研究中（LIPS）研究，受试均选择的PCI术后人群（包括stable与ACS），我们发现，通过调脂干预，随访4年，治疗组较对照组中位LDL-C改变差异为26mg/dl，终点MACE事件风险下降22% ， Over 4 years of follow-up in LIPS, time to the first major adverse cardiac event (MACE) was significantly longer in the fluvastatin group compared with the placebo group (P=0.0127, log-rank test). The Kaplan-Meier curve for the primary endpoint indicates a separation of the fluvastatin and placebo curves, beginning at approximately 1 year and continuing to diverge up to the study termination at 4 years. Data from LIPS demonstrated that fluvastatin is the first statin with proven efficacy in the post–percutaneous coronary intervention (PCI) population and supported early initiation of therapy after PCI (mean, 2.7 days from procedure to randomization; range, 0 to 22 days). The positive outcome of this trial means that physicians should now recognize that, similar to prescribing beta blockers for patients who have had a myocardial infarction, fluvastatin should be prescribed following PCI, regardless of lipid levels or other risk factors. Note that the lines begin to diverge at around the 1-year time point. On this slide, “Subjects at risk (% survival)” explains the derivation of the points on the line graph at study initiation and at 1, 2, 3, and 4 years. For example, at 4 years, 78.3% of 250 subjects in the fluvastatin group who were still being followed at that time point had not experienced a MACE. Serruys PW. A double-blind