心血管风险(一级预防).ppt

* Statin added to CCB-based therapy significantly reduced fatal CHD and nonfatal MI 53% (CI 0.32–0.69, P = 0.001) relative to CCB therapy alone. Statin added to beta-blocker–based therapy demonstrated a nonsignificant 16% reduction in fatal CHD/nonfatal MI (CI 0.60–1.17, P = 0.30) vs beta-blocker therapy alone. ASCOT: Integration of antihypertensive regimens with statin * Statin added to CCB-based therapy significantly reduced CV events and procedures 27% (CI 0.60–0.88, P = 0.001) relative to CCB therapy alone; while statin added to beta-blocker therapy showed a nonsignificant 15% reduction in CV events and procedures (CI 0.71–1.02, P = 0.08) vs beta-blocker therapy alone. In summary, ASCOT demonstrated that a new antihypertensive regimen was superior to an older regimen for BP lowering and in combination with a statin. ASCOT: Total CV events and procedures * These two trials demonstrated that high-risk patients can develop coronary atherosclerosis at levels of LDL-C not conventionally deemed elevated and that lipid lowering is associated with clinical benefit in these patients. The trial results provide further support for the importance of global risk assessment in directing treatment. References used in slide:HPS Collaborative Group. Lancet. 2003;361:2005-16.Sever PS et al. Circulation. 2005;112(suppl II):II-134.Sever PS et al. American Heart Association Scientific Sessions. November 2005. HPS, ASCOT: Summary and implications * Two studies tested the hypothesis that intensive lipid lowering would be associated with better clinical outcomes than less-intensive treatment in patients with stable CAD. Treating to New Targets (TNT) study subjects (N = 10,0001) received open-label atorvastatin 10 mg for 8 weeks and then were randomized to a double-blind phase, either continuing on that dose or receiving an 80-mg dose. In the Incremental Decrease in End points through Aggressive Lipid lowering (IDEAL) trial, subjects (N = 8888) were randomized to open-label simvas