稳定性冠心病-.ppt

* 相比等效降低LDL-c剂量的阿托伐他汀,辛伐他汀可以更显著升高代表HDL功能的Apo A-I.而且阿托伐他汀随剂量上升,升高apo a-1能力不升反降。舒降之不但能有效降低LDL－C，还能更好的改善HDL的功能。这对终点证据意味着什么呢？ * 究其原因， 现有的一篇动物实验的结果也许可以试着解释阿托伐他汀随着剂量增加，升高HDL-C的幅度反而变小这一现象。是因为阿托伐他汀使肝脏ApoA1合成增加2倍，同时在肝脏中ApoA1的降解增加3倍，最终导致HDL-C和ApoA1的浓度下降。 * 单用他汀的研究可以看到降低心血管事件风险20-40%, 但还有60-80%的风险没有解决. HATS和FATS研究提示在使用他汀降低LDL-C基础上, 加用烟酸升高HDL-C可以进一步降低心血管事件风险. The statins mainly affect levels of LDL-C or other lipoproteins containing apo B.1 Compared with placebo, statin monotherapy reduced cardiovascular endpoints by approximately 20% to 40% in major clinical trials.1–7 By deduction, this means that 60% to 80% of the risk for cardiovascular events remains, despite the use of statin monotherapy. Increases in HDL-C of approximately 30% to 40% were observed in angiographic outcome trials such as the HDL Atherosclerosis Treatment Study (HATS),8 the Familial Atherosclerosis Treatment Study (FATS),9 and the Cholesterol Lowering Atherosclerosis Study (CLAS-I).10 These trials used combination regimens based on adding nicotinic acid to a statin. Importantly, the effectiveness in reducing the risk of cardiovascular events of these combination treatments, which increase HDL-C and reduce LDL-C simultaneously, was greater than the effectiveness in other studies of treatment based on a statin alone, which mainly reduces LDL-C.6,7 Relative risk reductions of approximately 70% to 90% were observed in these trials. The substantially greater risk reductions suggest a potential benefit of therapy that both reduces LDL-C and increases HDL-C.1,8,9 References Chapman J. Beyond LDL-cholesterol reduction: the way ahead in managing dyslipidemia. Eur Heart J Suppl. 2005;7(suppl F):F56–F62. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–1389. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering