课件：CI患者的他汀治疗策略.ppt

* Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg. 2004 May;39(5):967-75; discussion 975-6. * * Ward RP, Leeper NJ, Kirkpatrick JN, et al. The effect of preoperative statin therapy on cardiovascular outcomes in patients undergoing infrainguinal vascular surgery. Int J Cardiol. 2005;104(3):264-8. * * * * * * 肝脏的安全性是临床使用他汀的过程中比较关注的项目。这是他汀类药物降低低密度脂蛋白胆固醇的效力和肝酶上升的比例之间联系对比。 我们可以看到：可定在治疗剂量范围内，其降低LDL-C的效果显着，而且出现肝酶指数上升的患者比例相对较低(但不具统计差异)，也就是说在肝脏副作用的评价上可定的效益/风险比是最佳的。 * Elevations in liver transaminase levels are an infrequent but recognised complication of treatment with statins. Incidence of clinically significant increases in serum transaminases* with rosuvastatin 10–40 mg in clinical trials was low (0.3%) which is similar to that seen with other currently marketed statins.1,2 As with other statins: it is recommended that liver function tests be carried out prior to initiation and periodically thereafter rosuvastatin should be used with caution in patients who consume excessive quantities of alcohol and/or have a history of liver disease rosuvastatin is contraindicated in patients with active liver disease or unexplained persistent transaminase elevations.  *ALT 3 x ULN on 2 successive occasions Reference Brewer HB. Benefit-risk assessment of rosuvastatin 10 to 40 milligrams. Am J Cardiol 2003;92(Suppl):23K–29K Shepherd J et al. Safety of rosuvastatin. Am J Cardiol 2004;94:882-888 * PROSPER研究:同时伴随应用的药物治疗 在这个老年人群中，同时伴随应用药物治疗的情况十分普遍。 PROSPER研究中，平均情况下患者同时正应用大约4种药物治疗，一个患者可能同时最多应用16种药物治疗。 * * 用药过多和年老: 潜在药物间相互作用的预测因素 在众多决定药物间相互作用风险的因素之中，主要的一个预测因素是患者正在同时应用的治疗药物数量。超过75岁的患者有将近一半至少同时应用5种药物。其它药物间相互作用的预测因素如疾病的严重性和慢性病也随着年龄的增加而增加。 所有处方药物中，超过50％通过细胞色素P450 3A4通路代谢。* 普伐他汀在有临床意义的程度上不经过细胞色素P450酶系统代谢，因此发生这种类型药物间相互作用的可能性很小。 * Bottorff M. Fire and forget – pharmacological consideration in coronary care. Atherosclerosis. 1999; 147(Suppl 1): S23 - S30. * PCI术前、术后他汀治疗获益的机制 针对动脉粥样硬化病变