高胆固醇血症讲解.pptVIP

* * 汇总既往他汀类药物研究结果发现，使用他汀类药物可使LDL-C降低30％，同时使非致死性/致死性冠心病发生率下降了33％，脑卒中发生率下降了29％，心血管疾病死亡率下降了28％，总死亡率下降了22％。这充分证实了他汀类药物显著的降LDL-C作用和显著的心血管益处。 这是在既往的临床应用与研究中，已被证实的他汀类药物在治疗方面的显著疗效。其中，他汀类药物的使用，使患者LDL－C水平下降了30％，非致死性/致死性冠心病发生率下降了33％，脑卒中发生率下降了29％，心血管疾病死亡率下降了28％，总死亡率下降了22％。因为他汀类药物能够最有效的降低总胆固醇和低密度脂蛋白胆固醇水平，因此在临床使用上占主导地位。 * * Five major morbidity and mortality statin studies in primary or secondary prevention populations have been completed. This pyramid ranks the studies according to the type of patients that were included in each study. It begins with AFCAPS/TexCAPS, a primary prevention study in patients at low risk of CHD and moves to a smaller group of high-risk CHD patients in 4S, a secondary prevention study. In between the two extremes, covering the majority of patients with and at risk of CHD, are WOS, CARE, and LIPID. The Cholesterol and Recurrent Events (CARE) and Long-Term Intervention With Pravastatin in Ischaemic Disease (LIPID) studies are representative of the majority of patients with CHD, because patients in these trials had cholesterol levels that were, in general, considered to be in the average range (similar to those of the general population) rather than elevated.  * * Nonfatal coronary events:非致死性心梗 * * * * 2021/3/23 * LIPID研究－冠心病死亡主要终点研究 累积冠心病致死率（％） 安慰剂 普伐他汀 24% p0.001 随机化后年数 N Engl J Med 1998;339:1345-57. 0 5 10 0 1 2 3 4 5 6 7 2021/3/23 * 治疗组冠心病死亡相对危险下降24%,总死亡率的相对危险下降23%,并可显著降低脑卒中的发生率。 LIPID终点结果: 2021/3/23 * -20 -26 5 -33 -22 -31* -35 -30 -25 -20 -15 -10 -5 0 5 10 Shepherd J et al. N Engl J Med. 1995;333:1301-1307. * P0.0005. ? P=0.042. ? P=0.051. 对象: 6,595 men 年龄范围: 45-64 yr 基线平均 TC: 272 mg/dL 基线平均 LDL-C: 192 mg/dL 观察期: 5 yr 干预治疗: 普伐他汀  40 mg/day ? TC LDL-C HDL-C Nonfatal MI/CHD death CHD death All-cause mortality WOSCOPS: 西苏格兰冠心病一级预防试验 ? %+ 2021/3/23 * AFCAPS/TexCAPS: 退伍军人/德州冠心病一级预防试验 % ? TC LDL-C HDL-C MI CHD UA RV 对象: 6,605 85% 男性, 45-73 yr 15% 女性, 55-73 yr 基线血脂: TC: 221 mg/dL LDL-C: 150 mg/dL HDL-C: 男性, 36 mg/dL