新指南安全性推荐解读.pptxVIP

2013 ACC/AHA 降低成人动脉粥样硬化性心血管风险胆固醇治疗指南安全性推荐解读;2013 AHA/ACC 新指南推荐大部分4类他汀获益人群使用高强度他汀;;新指南对他汀安全性的推荐;新指南针对他汀安全性的推荐;2.Safety Recommendations for Statins ;Safety Recommendations for Statins ;Safety Recommendations for Statins ; If mild to moderate muscle symptoms develop 轻中度肌肉症状加重 Discontinue the statin until the symptoms can be evaluated. 停药 Evaluate the patient for other conditions that might increase the risk for muscle symptoms检查加重肌肉症状的其他疾病 If muscle symptoms resolve, and if no contraindication exists, give the patient the original or a lower dose of the same statin to establish a causal relationship between the muscle symptoms and statin therapy.停药后若肌肉症状消失，且无明确禁忌，则给予低剂量相同他汀类药物，以明确是否存在因果关系。 If a causal relationship exists, discontinue the original statin. Once muscle symptoms resolve, use a low dose of a different statin.若因果关系存在，则停药，待肌肉症状缓解后换用低剂量其他种类他汀;Once a low dose of a statin is tolerated, gradually increase the dose as tolerated. 若因果关系不存在，患者可耐受低剂量他汀类药物，则逐渐加量至所能耐受的最大剂量。 If, after 2 months without statin treatment, muscle symptoms or elevated CK levels do not resolve completely, consider other causes of muscle symptoms. 停药2个月后肌肉症状未完全缓解，CK水平未降至正常，则需考虑其他引起肌肉症状的原因。 If persistent muscle symptoms are determined to arise from a condition unrelated to statin therapy, or if the predisposing condition has been treated, resume statin therapy at the original dose. 确定肌肉症状与他汀类药物无关或增加肌肉症状风险的疾病已被治疗后，继续服用初始剂量他汀类药物;Safety Recommendations for Statins ;Nonstatin Safety Recommendations ;3.6.Safety of Fibrates ?贝特类 3.6.1. Gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. III, B 不建议吉非罗齐与他汀类药物联用 3.6.2. Fenofibrate may be considered concomitantly with a low- or moderate-intensity statin only if the benefits from ASCVD risk reduction or triglyceride lowering when triglycerides are 500 mg/dL, are judged to outweigh the potential risk for adverse effects. IIb, C 只有当TG＞5.6mmol/L或在降低ASCVD事件方面的获益超过潜在风险时，可考虑