调脂抗动脉粥样硬化的降LDLC与升课件.pptVIP

调脂抗动脉粥样硬化的降LDL-C与升HDL-C LDL作为治疗目标的光辉时代 他汀里程碑临床试验 HPS: 低基线胆固醇水平病人也受益 ASCOT: 主要终点(非致死心梗/致死冠心病) MIRACL: 主要疗效评定 ALLIANCE 设计不同的他汀研究 机制研究 降脂作用:主要作用  非降脂作用: 抗炎作用 治疗的目标水平是否越低越好? EditorialLancet Volume 363, Number 9422，22 May?2004OTC statins: a bad decision for public health From July, simvastatin will be available without a prescription in the UK. The Department of Health has accepted the advice of the Committee on Safety of Medicines (CSM) that simvastatin 10 mg can be sold through pharmacies to people at moderate risk of coronary heart disease. The UK is the first country to make a statin available over the counter (OTC). The decision followed a 10-week public consultation with 100 responses referred to the CSM. The reclassification summary concludes The overall risk to benefit to the community of Pharmacy availability of Zocor Heart-Pro 10 mg tablets (simvastatin) is regarded as favourable. Lets examine the facts. There are no trials of OTC statins for primary prevention of heart disease. There are no data on compliance with OTC statins, which for products that need to be taken daily longterm is a concern. Will those who buy simvastatin also stop smoking, lose weight, and do more exercise, or will they substitute drug use for lifestyle modification? Will pharmacists have the time to determine the individuals risk of coronary heart disease before selling the drug and also to give lifestyle advice? All these are unknowns, which is unfortunate for the UK public, who will be the guineapigs in this large-scale OTC experiment. Americans have escaped this role, with two applications for OTC statins (pravastatin 10 mg and lovastatin 10 mg) being rejected in 2000 because of insufficient evidence that either drug could be used safely and effectively in an OTC setting.  Ezetimibe:与多种剂量阿托伐他汀合用对 LDL-C 的作用 Ezetimibe: 与多种剂量辛伐他汀合用对 LDL-C 的作用 Ezetimibe: 与阿托伐他汀或辛伐他汀合用对甘油三酯和 HDL-C 的作用 如何将临床试验中得到的信息转化为临床实践？ 临床试验中为增大他汀类的防治能力，采用较大剂量的较新他汀 关