他汀药物临床应用指南详解.pptVIP

当前第28页\共有52页\编于星期六\21点 当前第29页\共有52页\编于星期六\21点 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 JACC 2008;51(15):1512-1524 动物和人体的饮食和药物干预试验显示，LDL-C降低的幅度与动脉粥样硬化病变的稳定和逆转有关，这进一步支持了LDL-C“低一点，好一些”的观点，特别是在已经明确CVD的患者中。 理论上，所有人都应该将LDL-C维持在50mg/dL的“新生儿”水平，以预防动脉粥样硬化，CVD患者也应该控制在类似低的水平。 当前第30页\共有52页\编于星期六\21点 期待2011 AHA，in Nov. at Orlando, USA! 当前第31页\共有52页\编于星期六\21点 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） 当前第32页\共有52页\编于星期六\21点 多个试验纳入标准没有要求血脂异常 Asteroid研究：不设基线血脂水平，基线LDL-C130.4mg/dl；以20%管腔狭窄50%入排； Care研究：4159名，基线LDL-C139mg/dl，普伐他汀40mg治疗5年，冠心病+平均血脂水平，心血管事件显著减少； LIPID研究：冠心病血脂基本正常者长期使用他汀显著减少严重不良心血管事件 。。。。。。 他汀不仅仅是治疗高脂血症的降脂药！ 他汀抗动脉粥样硬化作用 —多效性；稳定/逆转斑块 而目前所有指南仍然强调100/70（80）。。。。。。 当前第33页\共有52页\编于星期六\21点 在控制危险因素的基础上控制动脉粥样硬化 控制危险因素达标（遵循指南） 管理AS 当前第34页\共有52页\编于星期六\21点 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 当前第35页\共有52页\编于星期六\21点 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 st