ACC205公布的临床试验的启示.pptVIP

Topics Womens Health Study: Design Use of aspirin for primary prevention in women (N Engl J Med 2005: published March 7th) 39 876 initially healthy women 45 years of age or older Randomized to 100 mg of aspirin on alternate days or placebo Monitored for first major CV event (nonfatal MI, nonfatal stroke, or death from CV causes) 10-year follow-up WHS: Cardiovascular end points WHS: Stroke end points WHS: Ambitious trial WHS: Surprising results Gender differences Gender differences WHS: Aspirin dose WHS: The guidelines WHS: Who gets aspirin? WHS: Not change practice New data about clopidogrel CLARITY (N Engl J Med 2005: published March 9, 2005) 3500 patients Clopidogrel improved infarct-related artery patency in MI patients receiving thrombolysis -Reduced occluded arteries by 36% -Reduced death, MI, or recurrent ischemia requiring revascularization at 30 days by 20% New data about clopidogrel CLARITY and COMMIT CLARITY and COMMIT Mechanisms CLARITY and COMMIT TNT: Design Lowering LDL cholesterol levels in stable CHD patients substantially below current guidelines (N Engl J Med 2005: published March 8, 2005) Parallel-group study randomizing 10 001 patients to atorvastatin 10 mg or 80 mg Patients included were men and women aged 35 years to 75 years with clinically evident CHD Primary end point was first major CV event (death from CHD, nonfatal MI, nonfatal and fatal stroke, or resuscitation after cardiac arrest) 5-year follow-up TNT: LDL cholesterol levels TNT: Primary efficacy outcomes TNT: What does it add? TNT: What does it add? Is it all about the LDL? Beyond the guidelines ACS vs stable CHD TNT: Safety issues TNT: Safety issues 99% of the patients didnt need any dose adjustment with atorvastatin 80 mg It seems to me that in the future we will start looking at LDL cholesterol levels after the patient is treated, rather than before. - Fuster Evolution of therapy Evolution of therapy Challenges A