近期临床试验对ATPIII的启示PPT课件.ppt
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High-Risk Persons
• Recommended LDL-C goal is <100 mg/dL
– If baseline LDL-C is <100 mg/dL, institution
of an LDL-lowering drug to achieve an LDL-C level <70 mg/dL is a therapeutic option on the basis of available clinical trial evidence
3.7
2.9
Relative Risk 2.2 for Coronary Heart Disease 1.7 (Log Scale) 1.3
1.0
40 70 100 130 160 190 LDL-Cholesterol (mg/dL)
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
Moderately High-Risk Persons
• Recommended LDL-C goal is <130 mg/dL – An LDL-C goal <100 mg/dL is
LDL-lowering drug optional)
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
5 major clinical trials of statin therapy with clinical end points have been published
• These trials addressed issues that were
not examined in previous clinical trials of cholesterol-lowering therapy
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
High-Risk Persons
Implications of Recent Clinical Trials for the National Cholesterol Education Program
Adult Treatment Panel III Guidelines
Scott M. Grundy; James I. Cleeman; C. Noel Bairey Merz; H. Bryan Brewer, Jr.; Luther T. Clark; Donald B. Hunninghake; Richard C. Pasternak; Sidney C. Smith, Jr.; Neil J. Stone; for the Coordinating Committee of the National Cholesterol Education Program
Moderately high risk: 2+ risk factors (10-year risk 10% to 20%)
<130 mg/dL 130 mg/dL
Moderate risk: 2+ risk factors (10 year risk <10%)
Lower risk: 0-1 risk factor
Overview of Recommendations
• Therapeutic lifestyle changes (TLC) remain
an essential modality in clinical management
• TLC have the potential to reduce CV risk
‡ For rosuvastatin, doses available up to 40 mg; the efficacy for 5 mg is estimated by subtracting 6% from the FDA reported efficacy at 10 mg
Grundy, S. et al., Circulation 2004;110:227-39.
Grundy, S. et al., Circulation 2004;110:227-39.
Implications of Recent Clinical Trials for the NCEP ATP III Guidelines
Objective
• To review the results of these recent trials
a therapeutic option on the basis of available clinical trial evidence
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
and assess their implications for cholesterol management
Grundy, S. et al., Circulation 2004;110:227-39.
Log-Linear Relationship Between LDL-C Levels and Relative Risk for CHD
• Recommended LDL-C goal is <100 mg/dL
– If a high-risk person has high triglycerides
or low HDL-C, consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug
Risk Category
LDL-C Goal
Initiate TLC
Consider Drug Therapy
High risk:
<100 mg/dL 100 mg/dL
CHD or CHD risk equivalents (optional goal:
(10-year risk >20%)
<70 mg/dL)
Doses of Currently Available Statins Required to Attain an Approximate 30% to 40% Reduction
of LDL-C Levels (Standard Doses)
Drug Atorvastatin Lovastatin Pravastatin Simvastatin Fluvastatin Rosuvastatin
ATP III LDL-C Goals and Cutpoints for TLC and Drug Therapy in Different Risk Categories and Proposed Modifications Based on Recent Clinical Trial Evidence
Moderately High-Risk Persons
• Recommended LDL-C goal is <100 mg/dL – When LDL-C level is 100 to 129 mg/dL,
at baseline or on lifestyle therapy, initiation of an LDL-lowering drug to achieve an LDL-C level <100 mg/dL is a therapeutic option on the basis of available clinical trial evidence
Grundy, S. et al., Circulation 2004;110:227-39.
Implications of Recent Clinical Trials for the NCEP ATP III Guidelines
Background
• Since the pubLeabharlann ication of ATP III,
– If LDL-C is 100 mg/dL, an LDL-lowering drug
is indicated simultaneously with lifestyle changes
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
Implications of Recent Clinical Trials for the NCEP ATP III Guidelines
Background
• The Adult Treatment Panel (ATP III) of the
National Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001
through several mechanisms beyond LDL lowering
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
Dose, mg/d 10 † 40 † 40 † 20-40 † 40-80 5-10 ‡
LDL Reduction, %
39 31 34 35-41 25-35 39-45
† All of these are available at doses up to 80 mg. For every doubling of the dose above the standard dose, an approximate 6% decrease in LDL-C level can be obtained.
<130 mg/dL 130 mg/dL <160 mg/dL 160 mg/dL
100 mg/dL (<100 mg/dL: consider drug
options) 130 mg/dL (100-129 mg/dL: consider drug
options) 160 mg/dL
190 mg/dL (160-189 mg/dL:
– When triglycerides are 200 mg/dL, non-HDL-C
is a secondary target of therapy, with a goal 30 mg/dL higher than the identified LDL-C goal
Grundy, S. et al., Circulation 2004;110:227-39.
High-Risk Persons
• Recommended LDL-C goal is <100 mg/dL
– An LDL-C goal of <70 mg/dL is
a therapeutic option on the basis of available clinical trial evidence, especially for patients at very high risk
• Recommended LDL-C goal is <100 mg/dL
– If baseline LDL-C is <100 mg/dL, institution
of an LDL-lowering drug to achieve an LDL-C level <70 mg/dL is a therapeutic option on the basis of available clinical trial evidence
3.7
2.9
Relative Risk 2.2 for Coronary Heart Disease 1.7 (Log Scale) 1.3
1.0
40 70 100 130 160 190 LDL-Cholesterol (mg/dL)
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
Moderately High-Risk Persons
• Recommended LDL-C goal is <130 mg/dL – An LDL-C goal <100 mg/dL is
LDL-lowering drug optional)
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
5 major clinical trials of statin therapy with clinical end points have been published
• These trials addressed issues that were
not examined in previous clinical trials of cholesterol-lowering therapy
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
High-Risk Persons
Implications of Recent Clinical Trials for the National Cholesterol Education Program
Adult Treatment Panel III Guidelines
Scott M. Grundy; James I. Cleeman; C. Noel Bairey Merz; H. Bryan Brewer, Jr.; Luther T. Clark; Donald B. Hunninghake; Richard C. Pasternak; Sidney C. Smith, Jr.; Neil J. Stone; for the Coordinating Committee of the National Cholesterol Education Program
Moderately high risk: 2+ risk factors (10-year risk 10% to 20%)
<130 mg/dL 130 mg/dL
Moderate risk: 2+ risk factors (10 year risk <10%)
Lower risk: 0-1 risk factor
Overview of Recommendations
• Therapeutic lifestyle changes (TLC) remain
an essential modality in clinical management
• TLC have the potential to reduce CV risk
‡ For rosuvastatin, doses available up to 40 mg; the efficacy for 5 mg is estimated by subtracting 6% from the FDA reported efficacy at 10 mg
Grundy, S. et al., Circulation 2004;110:227-39.
Grundy, S. et al., Circulation 2004;110:227-39.
Implications of Recent Clinical Trials for the NCEP ATP III Guidelines
Objective
• To review the results of these recent trials
a therapeutic option on the basis of available clinical trial evidence
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
and assess their implications for cholesterol management
Grundy, S. et al., Circulation 2004;110:227-39.
Log-Linear Relationship Between LDL-C Levels and Relative Risk for CHD
• Recommended LDL-C goal is <100 mg/dL
– If a high-risk person has high triglycerides
or low HDL-C, consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug
Risk Category
LDL-C Goal
Initiate TLC
Consider Drug Therapy
High risk:
<100 mg/dL 100 mg/dL
CHD or CHD risk equivalents (optional goal:
(10-year risk >20%)
<70 mg/dL)
Doses of Currently Available Statins Required to Attain an Approximate 30% to 40% Reduction
of LDL-C Levels (Standard Doses)
Drug Atorvastatin Lovastatin Pravastatin Simvastatin Fluvastatin Rosuvastatin
ATP III LDL-C Goals and Cutpoints for TLC and Drug Therapy in Different Risk Categories and Proposed Modifications Based on Recent Clinical Trial Evidence
Moderately High-Risk Persons
• Recommended LDL-C goal is <100 mg/dL – When LDL-C level is 100 to 129 mg/dL,
at baseline or on lifestyle therapy, initiation of an LDL-lowering drug to achieve an LDL-C level <100 mg/dL is a therapeutic option on the basis of available clinical trial evidence
Grundy, S. et al., Circulation 2004;110:227-39.
Implications of Recent Clinical Trials for the NCEP ATP III Guidelines
Background
• Since the pubLeabharlann ication of ATP III,
– If LDL-C is 100 mg/dL, an LDL-lowering drug
is indicated simultaneously with lifestyle changes
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
Implications of Recent Clinical Trials for the NCEP ATP III Guidelines
Background
• The Adult Treatment Panel (ATP III) of the
National Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001
through several mechanisms beyond LDL lowering
Grundy, S. et al., Circulation 2004;110:227-39.
Recommendations for Modifications to Footnote the ATP III Treatment Algorithm for LDL-C
Dose, mg/d 10 † 40 † 40 † 20-40 † 40-80 5-10 ‡
LDL Reduction, %
39 31 34 35-41 25-35 39-45
† All of these are available at doses up to 80 mg. For every doubling of the dose above the standard dose, an approximate 6% decrease in LDL-C level can be obtained.
<130 mg/dL 130 mg/dL <160 mg/dL 160 mg/dL
100 mg/dL (<100 mg/dL: consider drug
options) 130 mg/dL (100-129 mg/dL: consider drug
options) 160 mg/dL
190 mg/dL (160-189 mg/dL:
– When triglycerides are 200 mg/dL, non-HDL-C
is a secondary target of therapy, with a goal 30 mg/dL higher than the identified LDL-C goal
Grundy, S. et al., Circulation 2004;110:227-39.
High-Risk Persons
• Recommended LDL-C goal is <100 mg/dL
– An LDL-C goal of <70 mg/dL is
a therapeutic option on the basis of available clinical trial evidence, especially for patients at very high risk