从ACCORD研究看糖尿病血脂管理之他汀主旋律_.pptVIP

ACCORD血脂试验亚组分析结果显示：TG≥ 204 mg/dl 和 HDL≤ 34 mg/dl水平的血脂异常患者的主要心血管事件发生率非诺贝特类联合组为12.37%，辛伐他汀组为17.32%；而其它水平，非诺贝特类联合组和辛伐他汀组均为10.11%（P=0.06），低于既往5.4年的4S研究的23.5%。 备注： 4S研究是为充分论证辛伐他汀的高脂作用及对缺血性心血管事件的影响而设计实施。该研究采用安慰剂对照的随机化双盲设计，共入选4,444例冠心病患者，其血清胆固醇水平为5.5-8.0mmol/L，随机分为两组，在饮食控制基础上分别应用辛伐他汀20-40mg/d或安慰剂治疗，中位数随访时间为5.4年。 * ADA:联合使用他汀类和贝特类或他汀类和烟酸可有效控制血脂三联症，但危险增加，包括转氨酶水平升高，肌炎、横纹肌溶剂，肾功能不全的情况下使用高剂量他汀发生横纹肌溶解的风险增加，他汀类联合贝特类较联合吉非贝齐发生横纹肌溶解的风险较低 * 不良反应发生率（%） * * 糖尿病患者的血脂紊乱特点是以TG升高，LDL-升高、HDL-C水平降低为特点。由于混合型血脂紊乱使心血管疾病风险增加，因此治疗进需要LDL-C、HDL-C、TG三者兼顾，降低LDL-C和TG，升高HDL-C 。 * * 单纯使用辛伐他汀是否能兼顾LDL-C、HDL-C和TG三者？是否能达到糖尿病患者的血脂异常的治疗目标？是否还需要和其它药物联合应用，以满足糖尿病血脂紊乱患者全面调脂的需求？辛伐他汀单用还是联合用药？ACCORD研究揭开了辛伐他汀用药治疗糖尿病血脂异常的冰山一角。 * * * * * * The annual rate of the primary outcome was 2.2% in the fenofibrate group, as compared with 2.4% in the placebo group (hazard ratio in the fenofibrate group, 0.92; 95% confidence interval [CI], 0.79 to 1.08; P = 0.32 after adjustment for monitoring). Hazard ratios for the secondary outcomes, including the individual components of the primary outcome, ranged from 0.82 to 1.17 (P≥0.10 for all comparisons). Annual rates of death from all causes were 1.5% in the fenofibrate group and 1.6% in the placebo group (hazard ratio, 0.91; 95% CI,0.75 to 1.10; P = 0.33 for the adjusted comparison).Specific causes of death and enlarged versions of the Figure 2 insets are presented in Sections 17 and 18 in Supplementary Appendix 1. * The annual rate of the primary outcome was 2.2% in the fenofibrate group, as compared with 2.4% in the placebo group (hazard ratio in the fenofibrate group, 0.92; 95% confidence interval [CI], 0.79 to 1.08; P = 0.32 after adjustment for monitoring). Hazard ratios for the secondary outcomes, including the individual components of the primary outcome, ranged from 0.82 to 1.17 (P≥0.10 for all comparisons). Annual rates of death from all causes were 1.5% in the fenofibrate group and 1.6% in the placebo group (hazard ratio, 0.91; 95% CI,0.75 to 1.10; P = 0.33 for the adjust