课件：中国成人血脂异常防治指南解读22.pptVIP

* * Several investigators have examined the question of which types of lesions cause myocardial infarction (MI). They concluded that although severely stenotic lesions are more likely to progress to complete occlusion, mild-to-moderate lesions are more common and hence give rise to MI more frequently. Furthermore, occlusion of severely stenosed vessels may be clinically less harmful than thrombogenic rupture of small plaques, because larger plaques may be associated with the development of protective collateral vessels that circumvent the area of blockage. Reductions in clinical events observed in recent lipid-lowering trials could result from stabilization of rupture-prone lesions. Although coronary artery bypass surgery and angioplasty provide appropriate and effective therapies for fixed, high-grade stenosis, these treatments may not be appropriate for the less stenotic but rupture-prone plaque. Lesion composition, rather than degree of stenosis, may account for the sizable clinical benefits seen in regression trials that reported modest changes in vessel blockage. * * * * * Meta-analysis of angiographic statin trials, weighted by sample size, has demonstrated that percentage reduction in LDL-cholesterol correlates well with atherosclerotic progression, as measured by change in minimum lumen diameter.1 1. Ballantyne CM. Clinical trial endpoints: Angiograms, events and plaque instability. Am J Cardiol 1998:82:5M-11M. * * * ESTABLISH研究是在日本进行的一项随机、开放、单中心研究，其结果更能代表亚洲人群的情况。 研究入选70名ACS患者，随机接受立普妥20mg治疗或常规治疗，常规治疗组采用降LDL-C饮食治疗，若治疗后LDL-C仍150mg/dL则加用胆固醇吸收抑制剂，主要终点为IVUS检测的斑块体积变化百分比。研究共随访6个月。 * 从这一IVUS图像可以看出，对照组治疗前斑块面积为7.6mm2，管腔面积为6.2mm2。 治疗6个月后，斑块还在继续进展，斑块面积增长为9.0mm2，管腔面积减少为3.9mm2。 * * * * * * * The same posthoc analysis found no effect of 4-month LDL-C level on total mortality. However, there was a trend towards lower rates of MI in the low LDL-C groups1 These data suggest that patients with ACS who achieve LDL-C levels below recommended targets (80 to 100 m