冠心病的诊治与他汀的安全性研究缺血性心脏病.pptVIP

北欧辛伐他汀生存研究(Scandinavian Simvastatin Survival Study ，4S) 是首次稳定型冠心病的二级预防试验。4444例年龄为35～70岁冠心病患者,治疗组服用辛伐他汀20-40mg/d,平均随访5.4年（4.9-6.3年）。结果为常规剂量的辛伐治疗使TC、LDL-C与TG分别平均下降25％、35％与10％，HDL-C上升8％。临床上所有冠心病死亡相对危险减少42%，总死亡相对危险减少30%。该研究的结论是，对于稳定型冠心病患者，应用常规剂量的辛伐他汀治疗，能有效降低胆固醇和LDL-C，并可显著减少冠心病的死亡率和致残率，且不增加包括癌症、自杀等非心血管疾病的危险。 CIRCULATION 8月正式发表了最新美国ACC/AHA 不稳定心绞痛和非ST段抬高心肌梗死治疗指南。这一指南是对2002年指南的更新与补充。 Rationale For Statins In ACS ACS consist of unstable angina or acute MI and are associated with a high risk of early recurrent ischemic events, despite medical and interventional therapies. Revascularization procedures do not modify the underlying pathophysiology and only modestly reduce the risk of subsequent events. Statins contribute to plaque stability and/or regression through a number of lipid-dependent and -independent (pleiotropic) mechanisms, such as reducing inflammation. Notably, statins have been shown to reduce circulating markers of inflammation earlier after an ACS event. In the context of ACS, small differences in therapeutic efficacy can result in significant differences in events. Randomized Trials Of Statins In ACS Six randomized, controlled trials of statins in ACS have been conducted: MIRACL evaluated atorvastatin 80 mg/d for 4 months, Fluvastatin On Risk Diminishment After Acute Myocardial Infarction (FLORIDA) evaluated fluvastatin 80 mg/d for 1 year, PROVE-IT evaluated atorvastatin 80 mg vs pravastatin 40 mg daily for 2 years, A-to-Z evaluated simvastatin 40 mg/dfor 1 month followed by simvastatin 80 mg/d for 2 years versus placebo for 4 months followed by simvastatin 20 mg for 2 years, Pravastatin in Acute Coronary Treatment (PACT) evaluated pravastatin 20 to 40 mg/d for 1 month, and Prevention of Re-Infarction by Early Treatment of Cerivastatin Study (PRINCESS) evaluated cerivastatin 0.4 mg/d for 3 months. Two of these studies (MIRACL and PROVE-IT) will be reviewed in the following slides. Slide 16 Between 24 and 96 hours after hospital admission, eligible pat