他汀治疗之优选美百乐镇40mg详解.ppt

The benefits observed, with high-dose atorvastatin 80mg, were consistent among individual components of the primary endpoint, except stroke. There were no significant difference in stroke rates between the two lipid lowering therapies, however, the percentage of strokes occurring in this trial (1% in each) was too small to detect meaningful differences. The benefits observed, with high-dose atorvastatin 80mg, were consistent across most major subgroups A greater benefit appeared to be seen among patients with a baseline LDL cholesterol of greater than or equal to 125 mg/dL, a pre-specified subgroup, with a 34 percent relative risk reduction, as compared with a 7 percent relative risk reduction in patients with a baseline LDL cholesterol below 125 mg/dL (p interaction = 0.02). Median C-reactive protein levels fell from 12.3 mg per liter at base line in each group to 2.1 mg per liter in the pravastatin group and 1.3 mg per liter in the atorvastatin group (P0.001). As anticipated, among the 990 patients who had previously received statin therapy (25 percent), LDL cholesterol levels were essentially unchanged from base line (during statin therapy) in the pravastatin group, whereas they fell by an additional 32 percent in the atorvastatin group (P0.001). 他汀治疗之优选——美百乐镇40mg降脂达标，安全获益 第一三共制药（上海）有限公司 －从WOSCOPS到MEGA 从西方到东方 美百乐镇----循证医学的典范 WOSCOPS(1995) CARE(1996) LIPID(1998) PROSPER(2002) PROVE-IT(2004) MEGA(2005) 二级预防 MEGA Study (7,832) Holicos-PAT (2,039) PATE(665) CLIP (2,529) LISK(1,085) KLIS (3,853) PCS(329) PROVE -IT(4,162) LIPID (9,014) CARE (4,159) PROSPER (5,804) WOSCOP (6,595) 一级预防 西 方 东 方 第一个他汀类药物一级预防研究 总死亡率 非致死心梗/冠心病死亡 非致死心梗 心血管病死亡 血管重建 - 22% P=0.051 - 31% P0.001 - 31% P0.001 - 32% P=0.033 WOSCOPS（西苏格兰冠心病预防研究）在6595名男性高 胆固醇血症患者中比较普伐他汀和安慰剂，平均随 访4.9年，证实 普伐他汀一级预防效益显著 -40 -35 -30 -25 -20 -15 -10 -5 0 - 37% P=0.009 J Shepherd et al . N Engl J Med 1995; 333:1301 日本成年人群胆固醇增高的一级预防研究Management of Elevated Cholesterol in the Primary Preven