高脂血癥的一級(jí)預(yù)防和二級(jí)預(yù)防-ppt課件

1、68%18%14%020406080PCICABG-30-33-29-28-22-40-30-20-100LDL-CStrokeTotalmortality% *Confidence interval (CI) not reported.95% CI, 14%-41%.95% CI, 16%-37%.95% CI, 12%-31%.Hebert PR et al. JAMA. 1997;278:313-321.Nonfatal/fatal CHDCVDmortalityPyrl K et al. Diabetes Care. 1997;20:614-620.0.500.600.700.800.

2、901.000.001.002.003.004.005.000123456Proportionwithoutmajor CHD eventYr since randomization- P=0.002- P=0.0001Diabetic, simvastatinDiabetic, placeboNondiabetic, simvastatinNondiabetic, placebo32%55%Haffner SM et al. Diabetes. 1998;(suppl 1):A54. Abstract.-46-56-40-43-60-50-40-30-20-100Totalmortality

3、CoronarymortalityMajorcoronaryeventsRevas-culari-zations inevents(%)P=0.005P=0.001P=0.010Acute coronaryeventNo history of CADAcute Coronary Syndromest=0Randomization:CARE - 320 moLIPID - 336 moRandomization:6 moStable CAD71249-275-16-50-40-30-20-1001020TCHDL-CTGPlaceboAtorvastatin 80 mg% Data from S

4、chwartz GG et al. JAMA. 2001;285:1711-1718.Additional data courtesy of GG Schwartz.unstable anginaor nonQ-wave MI3,086randomized2496 hafter admissionFollowed 16 weeks0510150481216Time since randomization (wk)Cumulativeincidence(%)RR = 0.84(95% CI, 0.70-1.00) P = 0.048AtorvastatinPlacebo17.414.8*Deat

5、h (any cause), nonfatal MI, resuscitated cardiac arrest, recurrent symptomatic myocardial ischemia with objective evidence requiring emergency rehospitalization.Schwartz GG et al. JAMA. 2001;285:1711-1700.751.001.252.00Relative riskDeathNonfatal MIResuscitatedcardiac arrestNo. (%) of event

6、s*Adapted from Schwartz GG et al. JAMA. 2001;285:1711-1718.0.00.51.01.52.00481216Time since randomization (wk)RR = 0.50(95% CI, 0.26-0.99)P = 0.045Placebo1.6Cumulativeincidence(%)Data from Schwartz GG et al. JAMA. 2001;285:1711-1718.19,599 men and women 80 yo discharged post AMI, 58 Swedish Hospital

7、s, 1995-19985528 (28%) statin rx vs 14071 (72%) no statin rx, highest hospital rates of use 48%; lowest 12% Stenestrand JAMA 2001;285;430-436RR 0.75 (0.63-0.89)P=0.001 25% Risk ReductionHeeschen C et al. Circulation. 2002;105:1446-1452.051015202530181614121086420Follow-up (day)Event rates (%) Statin

8、s discontinuedNo statinsStatins continued507090110130150170190210TNT 80mgTNT 10 mgCARE-SLIPID-S4S-SCARE-PLIPID-PTNT Entry4S-PAVERT 80mg: LDL=77 mg/dL13.4% Event RateIIIa IIbIII=ACC/AHA Practice GuidelinesACC/ AHAUA/ NSTEMIGuidelines 2002Risk ratio and 95% CISTATINPLACEBOBaselinefeature(10269)(10267)

9、STATIN betterSTATIN worseSTATIN worsePrevious MI10071255Other CHD (not MI)452597No prior CHD CVD182215PVD332427Diabetes279369SE 2.6(2P0.00001)1.01.21.4Risk ratio and 95% CISTATINPLACEBOBaselinefeature(10269)(10267)STATIN betterSTATIN worseLDL (mg/dl)Hetc22= 0.8 100 130670881 13010875ALL PAT

10、IENTS20422606(19.9%)(25.4%)SE 2.6(2P0.00001)1.01.21.4(2.6 mmol/l)(3.4 mmol/l)01020300123456Proportion withevent (%)Years of follow-upBenefit/1,000 (SE)5 (3)20 (4)35 (5)46 (5)54 (7)60 (18)Logrank P 0.0001PlaceboSimvastatin 2002 Thomson Professional Postgraduate SHPS Col

11、laborative Group. Lancet. 2002;360:7-22.ARR=absolute risk reduction; NNT=number needed to treat. 2002 Thomson Professional Postgraduate SHPS Collaborative Group. Lancet. 2002;360:7-22.HPS enrolled high-risk primary- and secondary-prevention patients.HPS. Lancet. 2002;360:7. Dow

12、ns. JAMA. 1998;279:1615.LIPID. N Engl J Med. 1998;339:1349. Sacks. N Engl J Med. 1996;335:1001. 4S. Lancet. 1995;345:1274. Shepherd. N Engl J Med. 1995;333:1301. % with CHD eventMean LDL-C level at follow-up (mg/dL)05101520253090110130150170190210CARE-RxLIPID-Rx4S-RxCARE-PILIPID-PI4S-PI2 Prevention1

13、 PreventionWOSCOPS-PIWOSCOPS-RxAFCAPS-RxAFCAPS-PIHPS-PlHPS-RxHPS-RxHPS-Plw/revasc+stroke CHD onlyPI=placebo Rx=treatment70 2002 Thomson Professional Postgraduate SDowns JR, et al. JAMA. 1998;279:1615.012345678LovastatinPlacebo 34 403539HDL-C Tertile (mg/dL)Events, % *P0.01; P=0

14、.006; P=0.05P=placebo group; Rx=treated group.Presented by HB Rubins at the 71st annual AHA Scientific Sessions; Dallas, Texas.Subjects: 2,531 menAge: 74 (avg 64) yrMean baseline LDL-C: 111 mg/dLMean baseline HDL-C: 32 mg/dLMean baseline TG: 161 mg/dLDuration: 7 yrIntervention: Gemfibrozil 600 mg bid47.5-24.5-22-21-27-10-30-25-20-15-10-50510%+*LDL-CHDL-CTGNonfatal MI/CHD deathCHDdeathAll-causemortalityStrokeBrown BG, et al. N Engl J Med. 2001;345:1521.414.3051015202589%Reduction*P .05 vs placeboPlacebo S + NAVS + N + AVPearson TA, et al. Arch Intern Med. 2000;160:459.04080P