高血脂症治疗之新趋势课件.ppt

Prospective Cardiovascular Münster Study Steps for Evaluation of Hypercholesterolemia National Cholesterol Education Program (NCEP): The Third Report in Adult Treatment Panel (ATP III) Step 1 Determine Lipoprotein Levels Obtain complete lipoprotein profile (total cholesterol, LDL, HDL, triglyceride) after 9- to 12-hour fast In all adults aged 20 years or older, a fasting lipid profile should be obtained once every 5 years Step 2 Identify Presence of CHD or CHD Risk Equivalent Clinical Coronary heart disease (CHD) Symptomatic carotid artery disease Peripheral arterial disease Abdominal aortic aneurysm Diabetes Step 3 Determine Presence of Major Risk Factors Cigarette smoking Hypertension Low HDL (40 mg/dl) Family history of premature CHD CHD in male first degree relative 55 years CHD in female first degree relative 65 years Age (men ?45 years; women ?55 years) HDL ?60 mg/dl counts as a negative factor Selection of Lipid-Lowing Drugs Effective Safe Evidence Effects beyond lipid-lowering Beyond Cholesterol Lowering Effects of Statins Improved Endothelial Function Plaque stabilization Anti-inflammation Decreased lipoprotein oxidation Decreased blood coagulation Monitoring statin use Headache, dyspepsia Muscle soreness, tenderness and pain Evaluate muscle symptoms and CK before starting therapy, at 6-12 wks after therapy and at each visit. GOT, GPT Evaluate GOT/GPT initially, 12 weeks after therapy and annually or more frequently if necessary. JACC 2002;40:567 Summary Well control of hyperlipidemia can reduced CAD LDL level is the first target to treat HMGCoA reductase inhibitors are effective lipid-lowering drugs with clinical evidence Early administration of statin in acute coronary syndrome can reduce ischemic events * * 高血脂症治療之新趨勢 成大醫院 心臟內科 李貽恆 N Engl J Med. 1997;337:408–416. Importance of Cholesterol in Atherosclerosis CHD Risk According to LDL Cholesterol Incidence (p