动脉粥样斑块破裂进展炎症、信号转导与他汀.pptVIP

Statin Therapy: CRP水平与死亡率 Horne BD et al. J Am Coll Cardiol 2000;36:1774-1780. CRP Tertiles Statins Low Mortality (%) CRP Tertiles No Statins Medium High Low Medium High P Trend = 0.94 P Trend 0.0001 Withdrawal of statins:  增加ACS患者近期心血管事件发生率 Circulation 2002; 105:1446-1542 冠心病何时开始他汀类药物治疗? Stating Time Time From Coronary Event (months) 1 2 3 4 5 6 4S (n=4444) L-CAD (n=135) MIRACL (n=3086) PROSPER (n=5804) HPS (n=20536) PACT (n=3408) A to Z (n=4500) CARE (n=4159) LIPID (n=9014) PROVE-IT (n=4160; before March 8, 2004) Ongoing Completed AVERT (n=341) FLORIDA (n=540) hs-CRP (mg/L) Statin：6周治疗CRP 水平变化 Jialal I et al. Circulation 2001;103:1933-1935. 6 5 4 3 2 1 0 Baseline * * * Prava(40 mg/d) Simva(20 mg/d) Atorva(10 mg/d) *p0.025 vs. Baseline 短期强化他汀治疗降低CRP 适应症：急性冠脉综合征 意义： 发病后0-10天使用他汀类药物 尽早使血脂水平达标，降低LDL -C，有助于保护血管内皮发挥 他汀类的非降脂作用 短期强化降脂对血CRP的影响 ______________________________________ Median CRP (mg/dl) Mean CRP(mg/ml) Time ------------------------ ----------------------- 20mg 40mg 20mg 40mg ————————————————————————————— Day 0 0.13 0.14 0.36 0.39 Day 14 0.11* 0.11* 0.28** 0.30** Change (%) 0.02(15.4) 0.03(21.5) 0.08(22.3) 0.09(23.1) ____________________________________________________ *p0.01 compared with day 0; ** p0.001 compared with day 0 Li JJ, et al. Clin Cardiol 2003;26:506-511. 短期强化降脂对血CRP的影响 Li JJ, et al. Clin Cardiol 2003;26:506-511. 短期强化降脂临床研究 Changes in mean lipid levels after simvastatin therapy over time ______________________________________________________________________ TC HDL-C LDL-C TG