他汀治疗的6原则.pptVIP

* * This is data from the ACCESS study in which patients with coronary heart disease were titrated to the maximum dose available over one year. Results showed that even with titration to the maximum dose of atorvastatin, the proportion of patients reaching their treatment goal was only 70% and with simvastatin even more patients failed to achieve their treatment goals. This study confirms that even at the maximum dose of a highly effective statin such as atorvastatin, there is still room for improvement. CHD Patient numbers: Statin Number Number (%) at LDL goal Atorvastatin 1286 926 (72.0) Simvastatin 303 156 (51.5) Lovastatin 332 145 (43.7) Fluvastatin 322 97 (30.1) Pravastatin 300 74 (24.7) Reference 1. Ballantyne CM et al. Correlation of non-high-density lipoprotein cholesterol with apolipoprotein B: effect of 5 hydroxymethylglutaryl coenzyme A reductase inhibitors on non-high-density lipoprotein cholesterol levels. Am J Cardiol 2001;88:265–269 STELLAR研究是迄今为止最大规模的、头对头的、他汀类药物疗效与安全性的对照研究。 这是一项多中心、随机开放、平行研究，比较了各剂量可定与阿伐他汀、辛伐他汀和普伐他汀降低LDL胆固醇水平的疗效。 共有2431名患者（＞18岁、LDL-C 160- 250 mg/dL）入选，经6周的饮食导入期后，随机接受瑞舒伐他汀 10、20、40或80 mg/天，或阿托伐他汀 10、20、40或80 mg/天，或辛伐他汀 10、20、40或80 mg/天，或普伐他汀 10、20或40 mg/天治疗。 与其他他汀类相比，瑞舒伐他汀在各个剂量范围内降低LDL-C的作用更为显著。6周后，可定?起始剂量10mg/天即可使LDL-C水平降低46％，显著优于阿托伐他汀10-20 mg/天、辛伐他汀10-80 mg/天和普伐他汀10-40 mg/天。可定? 10mg降低LDL-C的疗效显著优于同等剂量或更高剂量的其他他汀类药物。 备注：他汀类药物的降脂作用与其剂量并不呈线性相关。因为每1倍的剂量，LDL-C 仅多降低约6%，并非加倍效应。进一步强调起始治疗剂量的重要性。 * * 如图：他汀起始剂量的降脂效力是达标的独立预测因子。横坐标：由左至右：他汀的降脂效力逐渐增强。 图表来源于下述研究： Current status of cholesterol goal attainment after statin therapy among patients with hypercholesterolemia in Asian countries and region: the Return on Expenditure Achieved for Lipid Therapy in Asia (REALITY-Asia) study OBJECTIVE: To examine treatment patterns, goal attainment, and factors influencing treatment among patients in 6 Asian countries who were taking statins. METHODS: A retrospective cohort study w