课件：冠心病防治中降低LDLC为首要目标.ppt

* * * * In the HPS, the significantly reduced relative risk of total stroke with simvastatin 40 mg per day (RR=25%, p0.0001) was similar to the 24% RR for any major vascular event (p0.0001).4 Stroke occurred in 444 of 10,269 patients (4.3%) in the simvastatin group, compared with 585 of 10,267 patients (5.7%) in the placebo group. Respective numbers of patients with incidents of ischemic stroke were 290 (2.8%) among recipients of simvastatin and 409 (4.0%) among those receiving placebo.4 Incidence of hemorrhagic stroke was 0.5% in both patient groups receiving placebo (53/10,267) and simvastatin (51/10,269).4 Stroke of unknown origin occurred in 103 patients (1.0%) taking placebo and 134 patient (1.3%) treated with simvastatin.4 * In the HPS, similar reductions in absolute risk of major vascular events with simvastatin extended over a range of baseline cholesterol levels. At a baseline LDL-C 100 mg/dl, the optimal target set by the National Cholesterol Education Program ATP III,8 major vascular events occurred in 358 patients on placebo (21.0% five-year absolute risk), compared with 282 patients taking simvastatin (16.4% five-year absolute risk), resulting in a 4.6% absolute risk reduction with simvastatin.9 Respective five-year absolute risks of major vascular events among patients receiving simvastatin and placebo were 24.7% (871 patients) and 18.9% (668 patients) for baseline LDL-C ?100 130 mg/dl* and 26.9% (1356 patients) and 21.6% (1083 patients) for baseline LDL-C ?130 mg/dl,* corresponding with absolute risk reductions of 5.8% for intermediate baseline LDL-C and 5.3% for high baseline LDL-C. The projected 10-year absolute risk in HPS patients stratified by baseline LDL-C would exceed 20% (which corresponds to a 10% absolute CHD risk over five years, assuming a linear increase in risk over time), even among patients with the lowest LDL-C levels. The Joint European Societies Guidelines currently recommend drug therapy if absolute CHD risk exceeds 20% ov