从降脂领域进展重新审视他汀应用.ppt

Topic(s):Secondary cardiovascular prevention: interventions and outcomesCitation: European Heart Journal ( 2010 ) 31 ( Abstract Supplement ), 374 Purpose: High-density lipoprotein cholesterol (HDL-C) levels are a strong inverse predictor of cardiovascular events. We investigated the significance of HDL-C level after stain therapy on the outcomes of patients who underwent drug eluting stent (DES) implantation for coronary artery disease. Method: 764 patients who underwent DES deployment were prospectively enrolled from September 2003 to December 2006. We were able to obtain lipid panel of 378 patients after statin therapy for 6 months and compare clinical outcomes according to HDL-C level at 6 months. Low HDL cholesterol level was defined as HDL-C level under 40 mg per deciliter for men or 50 mg per deciliter for women. The primary end point was composite of major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and target vessel revascularization. Results: Mean follow-up duration was 651±233 days. 201 patients had low HDL-C level and 177 patients had high HDL-C level. High HDL-C after statin therapy was a significant independent inverse predictor of MACE (adjusted hazard ratio 0.390, 95% confidence interval[CI] 0.179 to 0.850, p=0.018). Furthermore, every 10-mg/dl increase in HDL-C at 6 months was associated with 40% (95% CI 9% to 61%, p=0.016) decrease of MACE after adjustment for other risk factors. Conclusions: HDL-C level after statin therapy is associated with cardiovascular events in patients with DES implantation, suggesting next therapeutic target for coronary artery disease. * * DECREASE III 是2008年9月在欧洲心脏病学会上发布的研究结果，正式论文尚未发表。 DECREASE III 是一个前瞻、双盲、安慰剂对照研究旨在探讨血管手术围手术期应用他汀的意义。 * 研究背景：欧洲每年非心脏手术人数约4千万，其中0.3%的病人因心脏原因围手术期死亡。在非心脏血管手术中，围手术 期心源性死亡的发生率高达2%. * 入选患者随机后即开始干预（术前干预中位天数是37天），术后持续30天。 主要排除标准：目前应用他汀治疗，他汀治疗禁忌症，手术干扰心电图的持续描记，左主干疾病 主要终点：术后心肌缺血的判断方法：手术后连续72小时动态心电监测，第1、3、7和30天测量肌钙蛋白T，第7和30天记录心电图 * 1.主要终点：术后30天内心肌缺血的发生,氟伐他汀组较安慰剂组减