冠心病合并糖尿病调脂策略.ppt

冠心病合并糖尿病降脂治疗的绝对益处大于单纯冠心病HPS: 辛伐他汀治疗的绝对获益比较 危险降低(SE): RRR 绝对数/1000 P值 单纯阻塞性动脉 病变 兼有糖尿病与 阻塞性动脉病变 发生首次主要心血管事件的比例(%) 32.9% (9.1) 44 (12) 0.0003 24.5% (3.1) 62 (8) 0.0001 18.4% (5.7) 66 (21) 0.002 S=辛伐他汀组P=安慰剂组 40 单纯糖尿病 S S S P P P 30 20 10 0 9% 13% 20% 25% 31% 36% Lancet. 2003;361:2005-2016. 给予辛伐他汀治疗对5年内发生首次主要心血管事件比例的绝对效果 ASPEN: 出人意料的结果 Diabetes Care 29:1478–1485, 2006 The Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in Non-Insulin-Dependent Diabetes Mellitus (ASPEN) ASPEN研究显示阿托伐他汀10mg在LDL-C降幅达到30％的前提下对糖尿病一级和二级预防的主要血管事件没有任何治疗益处 PROVE-IT亚组*：糖尿病患者无显著获益 0.5 0.75 1.0 1.25 1.5 2 年事件率 RR Atorva 80 Prava 40 13.7% 23.0% 26.2% 24.8% 20.3% 27.0% 19.1% 28.8% 34.6% 16.1% 21.0% 24.6% 4.2% 28.1% 29.5% 21.2% 20.1% 25.0% 4.8% 27.5% 28.9% 20.8% 20.6% 25.5% 21.4% 21.7% 26.7%  11.2% 23.1% 26.0% 34.1% 20.1% 28.2%  7.0% 23.5% 25.6% 阿托伐他汀80 mg 更好 普伐他汀 40 mg 更好 *本次试验中对各亚组的设计方案均是事前制定。 Cannon CP et al. N Engl J Med. 2004;350:1495-1504. 男性 女性 糖尿病 无糖尿病 年龄 65 年龄 65 曾用他汀类 未曾用他汀类 HDL-C 40 HDL-C 40 LDL-C 125 LDL-C 125 内容介绍 冠心病合并糖尿病患者的心血管风险 2型糖尿病患者血脂特点及影响预后的因素 冠心病合并糖尿病患者降脂治疗证据 冠心病合并糖尿病患者的治疗策略 * 对糖尿病患者的所有危险因素都应该进行治疗： 由Steno 2临床试验获得的经验 * 强化治疗组只是在TC, 收缩压指标上达到了统计学差异, 但对预后有重要影响. Efficacy of multiple risk factor intervention in high-risk subjects (type 2 diabetes with microalbuminuria): Steno-2 The Steno-2 study showed the effect of a multiple risk factor intervention strategy in 160 subjects with type 2 diabetes with microalbuminuria. Although all these subjects had type 2 diabetes, the results suggest that multiple risk factor intervention may also be highly beneficial in subjects with the metabolic syndrome. Subjects in the intensive therapy group were to follow a reduced-fat diet and exercise regularly, were offered smoking cessation counselling, were prescribed an ACE inhibitor or