强化降脂治疗1课课件.pptVIP

* * * * * * * * * * * * * * * * * * * * Slide 23. How low to lower LDL-C in high-risk patients? While the ATP III guidelines did not recommend LDL-C–lowering therapy for individuals whose LDL-C level is 100 mg/dL, the results of HPS and PROVE IT support the initiation of drug therapy in these individuals. Additional information on the optimal level of LDL-C for risk reduction should be provided by ongoing trials that compare different intensities of LDL-C lowering. Treating to New Targets (TNT) is comparing atorvastatin 80 mg vs. 10 mg, Incremental Decrease in Events through Aggressive Lipid Lowering (IDEAL) is comparing atorvastatin 80 mg vs. simvastatin 20 or 40 mg, and the Study of the Effectiveness of Additional Reductions of Cholesterol and Homocysteine (SEARCH) is comparing simvastatin 80 mg vs. 20 mg. Keywords: ATP III, drug therapy, guidelines, HPS, IDEAL, LDL cholesterol, PROVE IT, SEARCH, TNT, treatment Slide type: graph * * * * * * * * 该结果不符合提前设定的等效条件，但符合证明强化治疗优越的条件。 该活性药物对照研究时间曲线在30天时既发生分离。而安慰剂对照研究-4S、HPS等约在12-18个月后才分离。这种曲线的迅速分离和安慰剂对照研究MIRACL，以及以前的观察性研究相一致。 其中约3/4的患者进行了早期介入治疗，而且大部分病人正在服用多种药物(抗血小板、ACEI)进行二级预防。尽管如此曲线仍在早期迅速分离。 其临床益处可持续到AS的慢性阶段 For all randomized patients, the event rates of the primary endpoint at 2 years were 26.3% in the standard dose pravastatin 40mg group versus 22.4% in the high-dose atorvastatin 80mg group (p=0.005) representing a 16% relative risk reduction favoring high-dose atorvastatin 80mg (CI, 5%-26%) The reduction in clinical events with the more intensive lipid-lowering therapy emerged as early as 30 days following the start of therapy These results support that among patients who have recently experienced an acute coronary syndrome event, those receiving the more intensive high-dose lipid lowering therapy had a greater protection from future cardiovascular events. These findings suggest that in this population, lipid lowering therapy to LDL-C concentrations substantially below current target levels is beneficial * Sl