他汀药物临床应用指南.ppt

他汀的指南与循证 — 临床应用的再思考;冠心病的分型;各型冠心病指南的危险分层与他汀/血脂治疗原则;慢性稳定性心绞痛诊断和治疗指南;慢性稳定性心绞痛诊断和治疗指南 —他汀/血脂治疗原则;;LDL-C保持在100mg/dL以下，胆固醇不易流入斑块 ;LDL-C75mg/dL提示无斑块进展;;全球急性冠脉动脉事件注册（GRACE）危险评分系统;不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南 —他汀/血脂治疗原则;;;急性ST段抬高型心肌梗死诊断和治疗指南;冠状动脉及其他动脉硬化性血管病二级预防指南-2006 AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease;;;LDL-C水平与冠心病事件密切相关—— Lower is Better;《中国成人血脂异常防治指南》强调：严格分层治疗，降低心血管事件;慢性稳定性心绞痛诊断和治疗指南 —他汀/血脂治疗原则;ACC/ADA共同指出：血脂控制力度还需加大;2009《加拿大成人血脂异常及心血管疾病防治指南》;;血脂指南仍阻碍了他汀的正确应用？;LDL-C目标值？;;;;.;2008年ACC/ADA共识：为防治动脉粥样硬化,理论上所有人应控制LDL-C在50mg/dL;期待2011 AHA，in Nov. at Orlando, USA!;不论基线血脂水平如何，他汀治疗均显著改善预后（Jupiter 亚组分析）;多个试验纳入标准没有要求血脂异常;在控制危险因素的基础上控制动脉粥样硬化;More Intensive Therapy Beginning in 2001, when we began to understand the implications of our findings published in 2002, we implemented in our clinic a change to treating arteries rather than simply treating risk factor levels. By 2003, this change in approach had been fully implemented; the time required to implement the change was determined by the schedule of follow-up visits. Our approach to intensive therapy for accelerated atherosclerosis has previously been described. At baseline, therapy was intensified for those with a high plaque burden. During follow-up, therapy was intensified in patients in whom plaque was progressing despite treatment aimed at consensus targets for risk factors such as blood pressure and LDL cholesterol. This included using plaque measurements to motivate patients and to inform physicians about choices of medications; In patients with plaque progression, we increased the dose of statin to the maximum tolerated dose, regardless of LDL levels (eg, atorvastatin 80 mg or rosuvastatin 40 mg). In patients already at their maximum tolerated dose of statin, we added ezetimibe 10 mg daily. In those already using the maximum dose of statin and ezetimibe, we added niacin for patients who were not diabetic or adding fibrates fo