中国人舒降之40mg治疗的疗效和安全性的荟萃分析PPT.ppt

更新的指南认为对高危患者来说，胆固醇水平越低越有利，NCEP的专家小组建议: 1. 冠心病高危患者（确诊为冠心病或脑血管病、糖尿病或者有两个以上心血管病危险因素的人（10年内发生冠心病的风险20%） ）LDL胆固醇的治疗目标是100mg/dl。 2.对极高危患者（确诊冠心病并合并多个危险因素，包括糖尿病、代谢综合征或严重的未控制的危险因素）来说，建议的胆固醇控制目标更低，LDL胆固醇应控制在70mg/dl的水平。即使极高危患者LDL胆固醇水平100mg/dl，指南也建议将它降到70mg/dl以下。 ? 3.对中危患者——有两个或以上冠心病危险因素的患者（10年发生冠心病的风险是10%～20%）——NCEP将LDL胆固醇控制目标保持在130mg/dl，但是医生可以将治疗目标定在100mg/dl。 Grundy SM et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.Circulation. 2004 Jul 13;110(2):227-39. In the HPS, similar reductions in absolute risk of major vascular events with simvastatin extended over a range of baseline cholesterol levels. At a baseline LDL-C 100 mg/dl, the optimal target set by the National Cholesterol Education Program ATP III,8 major vascular events occurred in 358 patients on placebo (21.0% five-year absolute risk), compared with 282 patients taking simvastatin (16.4% five-year absolute risk), resulting in a 4.6% absolute risk reduction with simvastatin.9 Respective five-year absolute risks of major vascular events among patients receiving simvastatin and placebo were 24.7% (871 patients) and 18.9% (668 patients) for baseline LDL-C ?100 130 mg/dl* and 26.9% (1356 patients) and 21.6% (1083 patients) for baseline LDL-C ?130 mg/dl,* corresponding with absolute risk reductions of 5.8% for intermediate baseline LDL-C and 5.3% for high baseline LDL-C. The projected 10-year absolute risk in HPS patients stratified by baseline LDL-C would exceed 20% (which corresponds to a 10% absolute CHD risk over five years, assuming a linear increase in risk over time), even among patients with the lowest LDL-C levels. The Joint European Societies Guidelines currently recommend drug therapy if absolute CHD risk exceeds 20% over 10 years.7 Absolute CHD risk defined by the Joint European Societies includes nonfatal CHD and coronary death. In the HPS, major vascular events included CHD (nonfatal MI and coronary