降血脂药物在急性冠心症及脑中风的使用剖析.ppt

Use of Lipid-lowering Agent in Acute Coronary Syndrome and Ischemic Stroke in Taiwan Yi-Heng Li, MD, PhD Department of Internal Medicine College of Medicine National Cheng Kung University Liao JK. Am J Cardiol. 2005;96(suppl 1):24F-33F. MMPs = matrix metalloproteinases ? Platelet activation ? Coagulation ? Endothelial  progenitor cells ? Effects on collagen ? MMPs ? AT1 receptor ? VSMC proliferation ? Endothelin ? Macrophages ? Inflammation ? Immunomodulation ? Endothelial function ? Reactive oxygen  species ? NO bioactivity Pleiotropic effects of statins Statins Statin in Acute Coronary Syndrome MIRACL Study Relative risk = 0.84P = .048 95% CI 0.701-0.999 Atorvastatin Placebo 0 5 10 15 0 4 8 12 16 Time Since Randomization (weeks) Cumulative Incidence (%) Time to first occurrence of: Death (any cause) Nonfatal MI Resuscitated cardiac arrest Worsening angina with new objective evidence and urgent rehospitalization 17.4% 14.8% Primary Efficacy Measure Schwartz GG, et al. JAMA. 2001;285:1711-1718. Very early benefit Statin Use in ACS: NCKUH Experience Inclusion criteria: - January 2000 ~ December 2004 - patients admitted to the NCKUH with their first episode of acute coronary syndrome - Receive statin therapy before discharge Exclusion criteria: - Patients who received statin within 1 months before admission - Patients who did not receive statin after admission - loss f/u during one year Li et al ACC 2007; Int Heart J 2007;48:677 ACS in NCKUH ★ Total: 符合 ICD-9 code 共 1248 人次 其中住院期間有用 statin 共 480 人次 11.1% 42.7% 39.6% 48.9% 42.1% Li et al 2007 ACC; Int Heart J 2007;48:677 LDL Control Rate During One Year in ACS Patients ( N =202 ) 115 mg/dl 100 mg/dl 70 mg/dl LDL-C Patients achieving goal (%) 35.5 30.2 24 26.4 6.3 3.8 Early group Late group Li et al 2007 ACC; Int Heart J 2007;48:677 Event-Free Survival Analysis at 4 months follow up p=0.238 RR 1.73（95% CI 0.69-4.33） Statin in