课件：强化降脂在临床实践中的益处.ppt

* * When major vascular events were examined individually, simvastatin significantly reduced the relative risk of CHD events, stroke, and revascularizations. Incidences of CHD events (898 [8.7%] for simvastatin vs. 1212 [11.8%] for placebo), stroke (444 [4.3%] vs. 585 [5.7%]), and combined coronary and noncoronary revascularizations (939 [9.1%] vs. 1205 [11.7%]) all favored simvastatin over placebo.4 Furthermore, relative risk reductions for CHD events, stroke, and revascularizations (27%, 25%, and 24%; all p0.0001) were significant and similar to the risk reduction for all vascular events.4 * In the HPS, the significantly reduced relative risk of total stroke with simvastatin 40 mg per day (RR=25%, p0.0001) was similar to the 24% RR for any major vascular event (p0.0001).4 Stroke occurred in 444 of 10,269 patients (4.3%) in the simvastatin group, compared with 585 of 10,267 patients (5.7%) in the placebo group. Respective numbers of patients with incidents of ischemic stroke were 290 (2.8%) among recipients of simvastatin and 409 (4.0%) among those receiving placebo.4 Incidence of hemorrhagic stroke was 0.5% in both patient groups receiving placebo (53/10,267) and simvastatin (51/10,269).4 Stroke of unknown origin occurred in 103 patients (1.0%) taking placebo and 134 patient (1.3%) treated with simvastatin.4 * Owing to increased use of statins in the placebo group, benefits seen with simvastatin in the HPS are probably underestimated.4 Changes in medical practice patterns and patients’ conditions over time account for the increased use of statins in the placebo group. Simvastatin or placebo could be continued if the nonstudy statin dose was equivalent in lipid-lowering potency to the daily simvastatin dose of 40 mg.4 Overall, an average of 17% of participants allocated to placebo were given a nonstudy statin, and the rate for such prescriptions increased throughout the study (4% at the end of the first year of follow-up to 32% at the end of the fifth year).