HDL和LDL风险评估与治疗课件.ppt

The Pyramid of Recent TrialsRelative Size of the Various Segments of the Population Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) (1998) Evaluated the effects of lovastatin on first acute major coronary event in 6605 men and women without any coronary or vascular disease and with TC 180-254 mg/dl HDL-C ?45 mg/dl in men and ?47 mg/dl in women LDL-C 130-190 mg/dl, or LDL-C 125-129 mg/dl with TC/HDL-C ratio 6 Randomized to lovastatin 20 mg vs. placebo with titration to 40 mg with goal of LDL-C ?110 mg/dl Mean follow-up 5 years AFCAPS/TexCAPS Results AFCAPS/TexCAPS Tertiary Endpoint Analysis: Mortality NCEP Adult Treatment Panel II Guidelines CARE: Is There a Lower Threshold? On-Treatment LDL Levels and Correlation with Major Coronary Events in 4S AVERT: Study Design Results - Intent to Treat Time to First Ischemic Event:Intent-to-Treat Analysis Summary of Lipid Parameters Clinical Event Rates by LDL-C Achieved in Statin Trials How Low Should You Go? SEARCH: Study of the Effectiveness of Additional Reductions of Cholesterol and Homocysteine Simvastatin 20 mg vs. 80 mg TNT: Treating to New Targets Atorvastatin 10 mg vs. 80 mg Clinical Judgment The NCEP ATP II guidelines recommend the use of clinical judgment in deciding whether to initiate drug therapy in Patients with CHD and LDL-C 100–129 mg/dl Patients without CHD who have ?2 risk factors and LDL-C 130–159 mg/dl Middle-aged and older patients without CHD who have 2 risk factors and LDL-C 160–189 mg/dl NHANES III Adult Population Estimatesby ATP II Risk Category LDL-C Distribution in U.S. Adults Data from NHANES III, 1988–1994 US Adults Requiring Drug Therapy Assuming 10% LDL-C Reduction with Diet Effect of Statin Therapy on CHD: Clinical Events Trials LDL and HDL Impact on CHD RiskA Compounded Rather Than Additive Impact HDL is a major factor in predicting CAD HDL-C Distribution in US Adults HDL-C in Clinical Practice Risk assessment Routinely measured in all adult patients HDL