动脉粥样硬化治疗的探索与展望摘要.ppt

他汀升高HDL-C的机制 他汀可以降低TG 他汀减少细胞内游离胆固醇含量，通过细胞内固醇调节元件的作用，刺激肝细胞表面LDL受体的数目增加。LDL受体除了与LDL-C结合，还与含载脂蛋白B的VLDL结合，加速其分解代谢，从而降低甘油三脂。 HDL-C与TG呈负相关 TG的减少，避免了形成富含甘油三酯的HDL，减慢HDL和载脂蛋白AⅠ的清除速率。 他汀可以增加体内载脂蛋白AⅠ的生物合成。  * * * ASTEROID is an open-label, multicentre study evaluating the effect of rosuvastatin 40 mg treatment on atherosclerotic disease as measured by IVUS in CAD patients undergoing coronary angiography. The study included 507 patients who had a baseline IVUS examination from 53 centres worldwide. 349 patients had evaluable serial IVUS examinations. The target coronary artery must have ≤50% reduction in lumen diameter throughout a segment of at least 40 mm in length. This vessel may be designated the target vessel if it is accessible to the IVUS catheter and if it has not undergone prior PCI or CABG, has not sustained a MI, is not currently a candidate for intervention or a likely candidate for intervention over the next 104 weeks, and is not a bypass graft. The same vessel will be reassessed by IVUS after 104 weeks of treatment with rosuvastatin 40 mg. There are two primary endpoints:- (1) the nominal change (end of treatment minus baseline) in Percent Atheroma Volume (PAV) in the entire 30–80 mm segment of the coronary artery assessed. (2) the change in Total Atheroma Volume (TAV) in the most severely diseased 10 mm segment of the coronary artery The secondary endpoints were the change in TAV within the entire segment (determined by IVUS) and the percentage change in lipid and lipoprotein levels from baseline. Reference Nissen, SE, Nicholls S et al. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis. The ASTEROID trial. JAMA?2006;295 (13):1556-1565. Abbreviations CAD=coronary artery disease; PCI=percutaneous coronary intervention; IVUS=intravascular ultrasound; CABG=coronary artery bypass graft; TAV=total atheroma volume; PAV=percent atheroma volume; MLD=minimum lumen diameter Rosuvastatin 40 mg was used in the ASTE