ldl-c目标值与调脂策略_杨国君
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*Median change in PAV from ASTEROID and REVERSAL; LS mean change in PAV from A-PLUS, ACTIVATE AND CAMELOT
1 Nissen S et al. N Engl J Med 2006;354:1253-1263. 2 Tardif J et al. Circulation 2004;110:3372-3377. 3 Nissen S et al. JAMA 2006;295 (13):1556-1565 4 Nissen S et al. JAMA 2004;292: 2217–2225. 5 Nissen S et al. JAMA 2004; 291:1071–1080
≤204 205-234 235-264 265-294 ≥295
血清胆固醇 (mg/dl) 总胆固醇水平升高1% 冠心病危险性增加2%
Gotto AM Jr, et al. Circulation. 1990;81:1721-1733. Castelli WP. Am J Med. 1984;76:4-12.
LDL-C目标值与调脂策略
宁波大学医学院附属医院 杨国君
ATPIII明确指出高危患者LDL-C的治疗目标值 依据来源于多项流行病学研究
Keys A, Arvanis C, Blackburn H. Seven countries: a multivariate analysis of death and coronary heart disease. Cambridge, MA: Harvard University Press, 1980; 381. Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ 1994;308:367-72. Law MR. Lowering heart disease risk with cholesterol reduction: evidence from observational studies and clinical trials. Eur Heart J Suppl 1999;(suppl S):S3-S8. Grundy SM, Wilhelmsen L, Rose G, Campbell RWF, Assmann G. Coronary heart disease in high-risk populations: lessons from Finland. Eur Heart J 1990;11:462-71. People’s Republic of China-United States Cardiovascular and Cardiopulmonary Epidemiology Research Group. An epidemiological study of cardiovascular and cardiopulmonary disease risk factors in four populations in the People's Republic of China: baseline report from the P.R.C.-U.S.A. Collaborative Study. Circulation 1992;85:1083-96. Law MR, Thompson SG, Wald NJ. Assessing possible hazards of reducing serum cholesterol. BMJ 1994;308:373-9. Law MR, Wald NJ, Wu T, Hackshaw A, Bailey A. Systematic underestimation of association between serum cholesterol concentration and ischaemic heart disease in observational studies: data from the BUPA study. BMJ 1994;308:363-6.
LDL-C治疗目标值存在的依据 他汀临床研究的证据
Event Rate (%)
LDL-C治疗目标存在的依据:观察性研究证据
10年冠心病死亡率
(死亡数/1000)
每1000人中冠心病发病数
多重危险因素干预试验(n=361,662)
50
40
30
20
10
150
200
Fra Baidu bibliotek
250
300 0
血清胆固醇 (mg/dl)
总胆固醇水平减少1% 冠心病危险性减少2%
弗明汉研究 (n=5209)
No Image
LDL-C治疗目标值存在的依据 替代终点研究的证据
2
1.5
PAV
1
的变化*
(%)
0.5
0 50
-0.5
CAMELOT4
placebo
ACTIVATE1
placebo
REVERSAL5
atorvastatin
A-Plus2
placebo
60
70
80
90
100
Mean LDL-C (mg/dL)
REVERSAL5
pravastatin
Progression
Regression
110
120
ASTEROID3
-1
rosuvastatin
ASTEROID and REVERSAL investigated active statin treatment; A-PLUS, ACTIVATE AND CAMELOT investigated non-statin therapies but included placebo arms who received background statin therapy (62%, 80% and 84% respectively).
1 Nissen S et al. N Engl J Med 2006;354:1253-1263. 2 Tardif J et al. Circulation 2004;110:3372-3377. 3 Nissen S et al. JAMA 2006;295 (13):1556-1565 4 Nissen S et al. JAMA 2004;292: 2217–2225. 5 Nissen S et al. JAMA 2004; 291:1071–1080
≤204 205-234 235-264 265-294 ≥295
血清胆固醇 (mg/dl) 总胆固醇水平升高1% 冠心病危险性增加2%
Gotto AM Jr, et al. Circulation. 1990;81:1721-1733. Castelli WP. Am J Med. 1984;76:4-12.
LDL-C目标值与调脂策略
宁波大学医学院附属医院 杨国君
ATPIII明确指出高危患者LDL-C的治疗目标值 依据来源于多项流行病学研究
Keys A, Arvanis C, Blackburn H. Seven countries: a multivariate analysis of death and coronary heart disease. Cambridge, MA: Harvard University Press, 1980; 381. Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ 1994;308:367-72. Law MR. Lowering heart disease risk with cholesterol reduction: evidence from observational studies and clinical trials. Eur Heart J Suppl 1999;(suppl S):S3-S8. Grundy SM, Wilhelmsen L, Rose G, Campbell RWF, Assmann G. Coronary heart disease in high-risk populations: lessons from Finland. Eur Heart J 1990;11:462-71. People’s Republic of China-United States Cardiovascular and Cardiopulmonary Epidemiology Research Group. An epidemiological study of cardiovascular and cardiopulmonary disease risk factors in four populations in the People's Republic of China: baseline report from the P.R.C.-U.S.A. Collaborative Study. Circulation 1992;85:1083-96. Law MR, Thompson SG, Wald NJ. Assessing possible hazards of reducing serum cholesterol. BMJ 1994;308:373-9. Law MR, Wald NJ, Wu T, Hackshaw A, Bailey A. Systematic underestimation of association between serum cholesterol concentration and ischaemic heart disease in observational studies: data from the BUPA study. BMJ 1994;308:363-6.
LDL-C治疗目标值存在的依据 他汀临床研究的证据
Event Rate (%)
LDL-C治疗目标存在的依据:观察性研究证据
10年冠心病死亡率
(死亡数/1000)
每1000人中冠心病发病数
多重危险因素干预试验(n=361,662)
50
40
30
20
10
150
200
Fra Baidu bibliotek
250
300 0
血清胆固醇 (mg/dl)
总胆固醇水平减少1% 冠心病危险性减少2%
弗明汉研究 (n=5209)
No Image
LDL-C治疗目标值存在的依据 替代终点研究的证据
2
1.5
PAV
1
的变化*
(%)
0.5
0 50
-0.5
CAMELOT4
placebo
ACTIVATE1
placebo
REVERSAL5
atorvastatin
A-Plus2
placebo
60
70
80
90
100
Mean LDL-C (mg/dL)
REVERSAL5
pravastatin
Progression
Regression
110
120
ASTEROID3
-1
rosuvastatin
ASTEROID and REVERSAL investigated active statin treatment; A-PLUS, ACTIVATE AND CAMELOT investigated non-statin therapies but included placebo arms who received background statin therapy (62%, 80% and 84% respectively).