高脂血症的一级预防和二级预防

4S: Treatment Benefit in Subgroup With
Impaired Fasting Glucose (FG 110-125mg/dL)
Total mortality 0
Coronary mortality
Major coronary
events
Revascularizations
0
%
-10
-20
-30
-30 * -40
-33 *
-29 †
-28 ‡
-22 §
*Confidence interval (CI) not reported. †95% CI, 14%-41%. ‡95% CI, 16%-37%. §95% CI, 12%-31%.
Hebert PR et al. JAMA. 1997;278:313-321.
-10
-20
in events -30 (%)
-40
-50
-46
-60
-56
P=0.005
Haffner SM et al. Diabetes. 1998;(suppl 1):A54. Abstract.
-40 P=0.001
-43 P=0.010
Clinical Trial Findings: The Statins
When to Start Cholesterol Lowering Therapy in Patients with Coronary Heart Disease
“ The cardiovascular specialist or attending physician should be responsible for starting some form of cholesterol lowering therapy in patients upon discharge from the hospital after acute coronary events……….The cardiovascular specialist thus should insure that appropriate therapy is initiated and maintained.”
University of North Carolina at Chapel Hill
Most MIs Arise From Smaller, Non flow-limiting Stenoses
80
68%
60
Percent of MI 40
Patients
20
18%
PCI CABG
14%
0 <50%
wk.baidu.com
4S: Major CHD Event Reduction in a Subgroup of Patients With Diabetes
15.00
04..9000
Proportion without
major CHD event
03..8000
0.70 2.00
0.60 1.00 0.50 0.00
1. When Should Lipid Lowering Therapy be started?
2. What should be the Treatment Goal? Findings of the HPS Study.
3. Should HDL – Cholesterol be a Target?
Primary and Secondary Prevention of Dyslipidemia: Established Therapies
and Emerging Paradigms
Sidney C. Smith, Jr. MD
Professor of Medicine Director, Center for Cardiovascular Science and Medicine
cardiovascular mortality in 1° prevention • Studies support treatment in various patient groups
– women – elderly – diabetics
Lipid Lowering Therapy for the Prevention of Vascular Disease
* = NFMI/CHD mort. ^ = NF/FMI, UAP
Impact of Lowering LDL-C on CVD Events and Total Mortality
Nonfatal/
CVD
Total
LDL-C fatal CHD Stroke mortality mortality
50%–70%
% Stenosis
>70%
Adapted from Falk et al. Circulation 1995; 92:657–671.
Effects of Statins on Coronary Disease: Primary & Secondary Prevention
Study 4S
• Statins LDL-C by 25%-35% • Benefits at various LDL-C levels; evident soon after therapy • in LDL-C required for in CHD morbidity/mortality • in all-cause mortality in 2° prevention and in
CARE LIPID
LDL LDL Rx RRR ARR NNT 188 122(-35%) 34%* 8.5% 12 139 98(-32%) 24%* 3.0% 34 150 113(-25%) 23%* 3.4% 30
WSCPS 192 159(-26%) 29%* 2.2% 46 AFCAPS 150 113(-25%) 36%^ 1.8% 56
0
Diabetic, simvastatin
Diabetic, placebo
- P=0.002
Nondiabetic, simvastatin
Nondiabetic, placebo
- P=0.0001
1
2
3
4
5
Yr since randomization
32% 55%
6
Pyörälä K et al. Diabetes Care. 1997;20:614-620.