选择成功的降脂治疗.pptxVIP

选择成功的降脂治疗第1页/共32页 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497.Treatment Categories, LDL-C Goals and CutpointsRisk CategoryLDL-C GoalConsider Drug TherapyCHD or CHD risk equivalent100 mg/dL ?130 mg/dL*?2 Risk Factors 10-yr risk 10–20% 10-yr risk 10%130 mg/dL130 mg/dL?130 mg/dL?160 mg/dL2 Risk Factors160 mg/dL?190 mg/dL* 100–129 mg/dL = after TLC, consider statin, niacin, or fibrate therapy第2页/共32页 Treatment of HyperlipidemiaExpert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497.High LDL-CTherapeutic Lifestyle ChangeDrug TherapyTherapy of Choice: StatinAlternative: Resin or niacin第3页/共32页 Statins: Mechanism of ActionLDL receptor–mediated hepatic uptake of LDL and VLDL remnantsSerum VLDL remnantsSerum LDL-CCholesterol synthesisLDL receptor (B–E receptor) synthesisIntracellular CholesterolApo BApo EApo BSystemic CirculationHepatocyteReduce hepatic cholesterol synthesis, lowering intracellular cholesterol, which stimulates upregulation of LDL receptor and increases the uptake of non-HDL particles from the systemic circulation.LDLSerum IDLVLDLRVLDL第4页/共32页 The LDL-C–Lowering Efficacy of the Currently Available StatinsPhysician’s Desk Reference. 55th ed. Montvale, NJ: Medical Economics, 2001.DailyDoseAtorvaFluvaLovaPravaSimva10 mg–39%–22%–30%20 mg–43%–22%–27%–32%–38%40 mg–50%–25%–32%–34%–41%80 mg–60%–36%–42% –47%第5页/共32页 The Triglyceride-Lowering Effects of StatinsStein EA et al. Am J Cardiol 1998;81:66B-69B.Baseline TG (mg/dL)150150–250250 Lova 20 mg1%–9%–32% Prava 10 mg6%–11%–22% Simva 10 mg1%–20%–28%第6页/共32页 *Nonfatal MI or CHD death; **ischemic eventsDowns JR et al. JAMA 1998;279:1615-1622. | Shepherd J et al. N Engl J Med 1999;333:1301-1307. | Scandinavian Simvastatin Study Group. Lancet 1994;344:1383-1389. | Sacks FM et al. N Engl J Med 1996;335:1001-1009. | LIPID Study Group. N Engl J Med 1998;339:1349-1357. | Schwartz GG et al.