從降脂到調(diào)脂–他汀治療策略進(jìn)展課件

CurrentStrategyofStatinTreatment從降脂到調(diào)脂一他汀治療策略進(jìn)展解放軍總醫(yī)院葉平從降脂到調(diào)脂–他汀治療策略進(jìn)展CurrentStrategyofStatinTreatment從降脂到調(diào)脂一他汀治療策略進(jìn)展解放軍總醫(yī)院葉平他汀類治療降低LDLCSecondarypreventionPrimaryprevention4s-pL4S-RXLIPID-■CARE-PI15LIPID-RCARE-RXWOSCOPS-PLWOSCOPS-RXAFCAPS-PLAFCAPS-Rx1501701LDL-C(mg/Dl)PL:安慰劑組:Rx:治療組MedConNorthAm2000:84:23-42目標(biāo)到底是什么?是低一些更好嗎?CurrentStrategyofStatinTre1他汀類治療降低LDLCSecondarypreventionPrimaryprevention4s-pL4S-RXLIPID-■CARE-PI15LIPID-RCARE-RXWOSCOPS-PLWOSCOPS-RXAFCAPS-PLAFCAPS-Rx1501701LDL-C(mg/Dl)PL:安慰劑組:Rx:治療組MedConNorthAm2000:84:23-42他汀類治療降低LDLC2目標(biāo)到底是什么?是低一些更好嗎?目標(biāo)到底是什么?3PROVE-IT/TIMI22:普伐他汀40mg和阿托伐他汀80mg12040mgofpravastatin80mgofatorvastatinBaseline30Days4Mo8Mo16MoFinalTimeofvisit患者人數(shù)普伐他汀197318441761164714451883阿托伐他汀200318561758164514611910CannonCP,etal.N.EnglJ.Med.2004,350.1495-1504PROVE-IT/TIMI22:4PROVE-IT/TIMI22:普伐他汀40mg和阿托伐他汀80mg普伐他汀40mgLDLC降低中位為10%LDLC降至95mg/dL1600RR事件發(fā)生率26.3P=0.00阿托伐他汀8omgLDLC降低中位數(shù)為420LDLC降至62mg/dL件發(fā)生率22.4903691215121242730隨訪月份數(shù)存在危險(xiǎn)的志者人數(shù)普伐他汀2063168815361423810138阿托伐他汀209917361591148584233CannonCP,etal.NEna.JMed.2004:3501495-1504PROVE-IT/TIMI22:5PROVE-IT/TIMI-22亞組:所有原因?qū)е碌乃劳雎屎椭饕难苁录慕档?DiabetesNoDiabetesAge<65PriorstatinNoPriorstatin75LDL-C≥125→LDLC<125P=002A‖Interaction=Ns0.50.75101.251.50exceptasnoted同托伐他訂80mg組益處更大伐他訂4mg組益處更大CannonCP,etal.N.EnglJMed.2004,350PROVE-IT/TIMI-22亞組:所有原因?qū)?TNT試驗(yàn):LDLc降低LIPITOR10mgLIPITOR80mg看一2.0creening0243660FinalTime(months)LaRosaCJ,etal.NEnglJMed2005,352TNT試驗(yàn):LDLc降低7TNT主要終點(diǎn)一主要心血管事件Primaryendpoint-majorCVevents0.15LIPITOR10mgLIPITOR80mg三0.100.05HR:0.78(0.69-0.89)Pc0.001LIPITOR10mg50064886473845964562304LIPITOR80mg49962314LaRosaCJ,etal.NEnglJMed2005,352TNT主要終點(diǎn)一主要心血管事件8DEAL試驗(yàn):主要終點(diǎn)主要冠心病事件的主要聯(lián)合終點(diǎn)*(%)p=0.0710.4主要冠心病事件的主要聯(lián)合終點(diǎn)問(wèn)托伐他汀組93%辛伐他汀10.49%定義為冠心病導(dǎo)致的死亡,由于非致死性M而入院或心臟驟停而復(fù)蘇成功AtorvastatinSimvastatinPresentedatAHA2005DEAL試驗(yàn):主要終點(diǎn)9次要終點(diǎn):非致死性心肌梗死顯著降低,P=0.0210辛伐他汀阿托伐他汀P=0.02HR,0.83:95%Cl,0.71-09;P=.02時(shí)間(年P(guān)edersenTRetal.JAMA2005:2437-2444次要終點(diǎn):10從降脂到調(diào)脂–他汀治療策略進(jìn)展課件11從降脂到調(diào)脂–他汀治療策略進(jìn)展課件12從降脂到調(diào)脂–他汀治療策略進(jìn)展課件13從降脂到調(diào)脂–他汀治療策略進(jìn)展課件14從降脂到調(diào)脂–他汀治療策略進(jìn)展課件15從降脂到調(diào)脂–他汀治療策略進(jìn)展課件16從降脂到調(diào)脂–他汀治療策略進(jìn)展課件17從降脂到調(diào)脂–他汀治療策略進(jìn)展課件18從降脂到調(diào)脂–他汀治療策略進(jìn)展課件19從降脂到調(diào)脂–他汀治療策略進(jìn)展課件20從降脂到調(diào)脂–他汀治療策略進(jìn)展課件21從降脂到調(diào)脂–他汀治療策略進(jìn)展課件22從降脂到調(diào)脂–他汀治療策略進(jìn)展課件23從降脂到調(diào)脂–他汀治療策略進(jìn)展課件24從降脂到調(diào)脂–他汀治療策略進(jìn)展課件25從降脂到調(diào)脂–他汀治療策略進(jìn)展課件26從降脂到調(diào)脂–他汀治療策略進(jìn)展課件27從降脂到調(diào)脂–他汀治療策略進(jìn)展課件28從降脂到調(diào)脂–他汀治療策略進(jìn)展課件29從降脂到調(diào)脂–他汀治療策略進(jìn)展課件30從降脂到調(diào)脂–他汀治療策略進(jìn)展課件31從降脂到調(diào)脂–他汀治療策略進(jìn)展課件32從降脂到調(diào)脂–他汀治療策略進(jìn)展課件33從降脂到調(diào)脂–他汀治療策略進(jìn)展課件34從降脂到調(diào)脂–他汀治療策略進(jìn)展課件35從降脂到調(diào)脂–他汀治療策略進(jìn)展課件36從降脂到調(diào)脂–他汀治療策略進(jìn)展課件37從降脂到調(diào)脂–他汀治療策略進(jìn)展課件38從降脂到調(diào)脂–他汀治療策略進(jìn)展課件39從降脂到調(diào)脂–他汀治療策略進(jìn)展課件40從降脂到調(diào)脂–他汀治療策略進(jìn)展課件41從降脂到調(diào)脂–他汀治療策略進(jìn)展課件42從降脂到調(diào)脂–他汀治療策略進(jìn)展課件43從降脂到調(diào)脂–他汀治療策略進(jìn)展課件44從降脂到調(diào)脂–他汀治療策略進(jìn)展課件45CurrentStrategyofStatinTreatment從降脂到調(diào)脂一他汀治療策略進(jìn)展解放軍總醫(yī)院葉平從降脂到調(diào)脂–他汀治療策略進(jìn)展CurrentStrategyofStatinTreatment從降脂到調(diào)脂一他汀治療策略進(jìn)展解放軍總醫(yī)院葉平他汀類治療降低LDLCSecondarypreventionPrimaryprevention4s-pL4S-RXLIPID-■CARE-PI15LIPID-RCARE-RXWOSCOPS-PLWOSCOPS-RXAFCAPS-PLAFCAPS-Rx1501701LDL-C(mg/Dl)PL:安慰劑組:Rx:治療組MedConNorthAm2000:84:23-42目標(biāo)到底是什么?是低一些更好嗎?CurrentStrategyofStatinTre46他汀類治療降低LDLCSecondarypreventionPrimaryprevention4s-pL4S-RXLIPID-■CARE-PI15LIPID-RCARE-RXWOSCOPS-PLWOSCOPS-RXAFCAPS-PLAFCAPS-Rx1501701LDL-C(mg/Dl)PL:安慰劑組:Rx:治療組MedConNorthAm2000:84:23-42他汀類治療降低LDLC47目標(biāo)到底是什么?是低一些更好嗎?目標(biāo)到底是什么?48PROVE-IT/TIMI22:普伐他汀40mg和阿托伐他汀80mg12040mgofpravastatin80mgofatorvastatinBaseline30Days4Mo8Mo16MoFinalTimeofvisit患者人數(shù)普伐他汀197318441761164714451883阿托伐他汀200318561758164514611910CannonCP,etal.N.EnglJ.Med.2004,350.1495-1504PROVE-IT/TIMI22:49PROVE-IT/TIMI22:普伐他汀40mg和阿托伐他汀80mg普伐他汀40mgLDLC降低中位為10%LDLC降至95mg/dL1600RR事件發(fā)生率26.3P=0.00阿托伐他汀8omgLDLC降低中位數(shù)為420LDLC降至62mg/dL件發(fā)生率22.4903691215121242730隨訪月份數(shù)存在危險(xiǎn)的志者人數(shù)普伐他汀2063168815361423810138阿托伐他汀209917361591148584233CannonCP,etal.NEna.JMed.2004:3501495-1504PROVE-IT/TIMI22:50PROVE-IT/TIMI-22亞組:所有原因?qū)е碌乃劳雎屎椭饕难苁录慕档?DiabetesNoDiabetesAge<65PriorstatinNoPriorstatin75LDL-C≥125→LDLC<125P=002A‖Interaction=Ns0.50.75101.251.50exceptasnoted同托伐他訂80mg組益處更大伐他訂4mg組益處更大CannonCP,etal.N.EnglJMed.2004,350PROVE-IT/TIMI-22亞組:所有原因?qū)?1TNT試驗(yàn):LDLc降低LIPITOR10mgLIPITOR80mg看一2.0creening0243660FinalTime(months)LaRosaCJ,etal.NEnglJMed2005,352TNT試驗(yàn):LDLc降低52TNT主要終點(diǎn)一主要心血管事件Primaryendpoint-majorCVevents0.15LIPITOR10mgLIPITOR80mg三0.100.05HR:0.78(0.69-0.89)Pc0.001LIPITOR10mg50064886473845964562304LIPITOR80mg49962314LaRosaCJ,etal.NEnglJMed2005,352TNT主要終點(diǎn)一主要心血管事件53DEAL試驗(yàn):主要終點(diǎn)主要冠心病事件的主要聯(lián)合終點(diǎn)*(%)p=0.0710.4主要冠心病事件的主要聯(lián)合終點(diǎn)問(wèn)托伐他汀組93%辛伐他汀10.49%定義為冠心病導(dǎo)致的死亡,由于非致死性M而入院或心臟驟停而復(fù)蘇成功AtorvastatinSimvastatinPresentedatAHA2005DEAL試驗(yàn):主要終點(diǎn)54次要終點(diǎn):非致死性心肌梗死顯著降低,P=0.0210辛伐他汀阿托伐他汀P=0.02HR,0.83:95%Cl,0.71-09;P=.02時(shí)間(年P(guān)edersenTRetal.JAMA2005:2437-2444次要終點(diǎn):55從降脂到調(diào)脂–他汀治療策略進(jìn)展課件56從降脂到調(diào)脂–他汀治療策略進(jìn)展課件57從降脂到調(diào)脂–他汀治療策略進(jìn)展課件58從降脂到調(diào)脂–他汀治療策略進(jìn)展課件59從降脂到調(diào)脂–他汀治療策略進(jìn)展課件60從降脂到調(diào)脂–他汀治療策略進(jìn)展課件61從降脂到調(diào)脂–他汀治療策略進(jìn)展課件62從降脂到調(diào)脂–他汀治療策略進(jìn)展課件63從降脂到調(diào)脂–他汀治療策略進(jìn)展課件64從降脂到調(diào)脂–他汀治療策略進(jìn)展課件65從降脂到調(diào)脂–他汀治療策略進(jìn)展課件66從降脂到調(diào)脂–他汀治療策略進(jìn)展課件67從降脂到調(diào)脂–他汀治療策略進(jìn)展課件68從降脂到調(diào)脂–他汀治療策略進(jìn)展課件69從降脂到調(diào)脂–他汀治療策略進(jìn)展課件70從降脂到調(diào)脂–他汀治療策略進(jìn)展課件71從降脂到調(diào)脂–他汀治療策略進(jìn)展課件72從降脂到調(diào)脂–他汀治療策略進(jìn)展課件73從降脂到調(diào)脂–他汀治療策略進(jìn)展課件74從降脂到調(diào)脂–他汀治療策略進(jìn)展課件75從降脂到調(diào)脂–他汀治療策略進(jìn)展課件76