稳定性心绞痛的合理药物治疗 (1).ppt

诱因 劳累 情绪激动 饱食 受寒 急性循环衰竭 * * * * 心绞痛分级。 一级：一般体力活动不引起心绞痛。 二级：日常体力活动轻微受限。如快速行走或上楼。 三级：日常体力活动明显受限。如平地100-200米或上一层楼。 四级：轻微活动或休息时出现心绞痛。 Establish研究结果显示，阿托伐他汀可有效降低LDL-C水平，Juppeter研究显示可定有强效的降脂作用，10mg相当于立普妥40mg的降脂效果。 1.ACTION试验亚组分析有52%的合并高血压的冠心病患者中，一级终点2相对危险下降13%。 2.所有的钙拮抗剂都有外周水肿、便秘、心悸、面部潮红、低血压、头痛头晕、虚弱无力等副作用。 纳入标准 Male or female 18 years of age Documented coronary disease Not scheduled for revascularisation No clinical signs of heart failure Patient flow Completed 6 107 Completed 6 108 Perindopril 6 110 Placebo 6 108 Randomised 12 218 Not randomised 1 437 Registered 13 655 424 centres : 12 218 patients Primary endpoint % CV death, MI or cardiac arrest Placebo annual event rate: 2.4% Perindopril Placebo p = 0.0003 RRR: 20% Years 0 2 4 6 8 10 12 14 0 1 2 3 4 5 Fatal and non fatal MI Perindopril Placebo 0 2 4 6 8 10 0 1 2 3 4 5 Years (%) p 0.001 RRR: 24% Hospitalisation for heart failure Perindopril Placebo 5 0 1 2 3 4 Years p = 0.002 RRR: 39% 0.0 0.5 1.0 1.5 2.0 (%) EUROPA试验 钙拮抗剂 * * 治疗 目标：降低死亡率和发病率、减轻症状 * 从1988年到2005年进行了许多阿司匹林用于一级预防的研究，研究显示阿司匹林可以使健康男性和女性、高血压和糖尿病患者心脑血管事件发生率下降。 * 2002ATC荟萃分析是对287项临床研究进行了荟萃分析，结果显示阿司匹林可以使各种心脑血管疾病的心血管事件下降，因此二级预防阿司匹林的疗效毋庸置疑。 Conclusions Aspirin (or another oral antiplatelet drug) is protective in most types of patient at increased risk of occlusive vascular events, including those with an acute myocardial infarction or ischaemic stroke, unstable or stable angina, previous myocardial infarction, stroke or cerebral ischaemia, peripheral arterial disease, or atrial fibrillation. Inclusion criteria Randomised trials of an antiplatelet regimen versus control or of one antiplatelet regimen versus another in high risk patients (with acute or previous vascular disease or some other predisposing condition) from which results were available before September 1997. Trials had to use a method of randomisation that precluded prior knowledge of the next treatment to be allocated and comparisons had to be unconfounded—that is, have study groups that dif