降脂治疗与管理新理念.ppt

**Framingham心脏研究是第一个揭示HDL－C与CHD具有负相关性的大规模流行病学研究。研究结果显示，无论是在男性还是女性，随着HDL－C水平降低，CHD危险性呈明显上升趋势。*Torcetrapib为CETP抑制剂，CETP（胆固醇酯转运蛋白）从HDL转送胆固醇酯（CE）至含apo-B的脂蛋白、VLDL和LDL，CETP对HDL的代谢起重要作用**随访2年时，两组患者的主要终点事件发生率分别为：普伐他汀组26.3％，立普妥组22.4％，立普妥组主要终点事件发生率下降了16％,P=0.005。(事件发生率为Kaplan－Meier事件率。)Reference1. CannonCP,etal.NEnglJMed.2004;350:1495-504.**除了降低LDL-C，他汀还通过改善内皮功能，抗炎，抗氧化，稳定/逆转斑块等多种机制，抗动脉粥样硬化。**一系列的大规模国际临床实验证实，LDL的降低可以预测大部分他汀的疗效，LDL的降低可以带来事件率相应的下降，可以通过观察基线和治疗后的LDL-C的值来预测事件率，而无需知道是哪一种他汀。从图上可以看到，LDL值越低，无论是一级预防结果还是二级预防结果，事件率均与LDL值呈正比，每一个LDL降低值都对应一个事件率降低值。*CoreslideJUPITERisarandomised,double-blind,placebo-controlled,multicentre,phaseIIIstudyofrosuvastatin20mgintheprimarypreventionofcardiovasculareventsamongpatientswithlowlevelsofLDL-C(?3.36mmol/L[130mg/dL])andelevatedlevelsofCRP(?2.0mg/L).Thisstudyisbeingconductedinapproximately15000maleandfemalepatientsrecruitedfrom24countries.Patientswillberandomised(1:1)toreceiveeitherrosuvastatin20mgorplacebooncedaily.Thestudywillcontinueuntil520cardiovasculareventshaveoccurred,whichisexpectedtobeafterapproximately3–4years.Theprimaryendpointisthetimetothefirstoccurrenceofamajorcardiovasculareventafterrandomisation(cardiovasculardeath,stroke,MI,hospitalizationforunstableanginaorarterialrevascularisation).Secondaryendpointsare: totalmortality noncardiovascularmortality developmentofdiabetesmellitus developmentofvenousthromboembolicevents(deepveinthrombosisorpulmonary

embolism) bonefractures discontinuationofstudymedicationduetoadverseeffects.ReferenceRidkerPM.Rosuvastatinintheprimarypreventionofcardiovasculardiseaseamongpatientswithlowlevelsoflow-densitylipoproteincholesterolandelevatedhigh-sensitivityC-reactiveprotein:rationaleanddesignoftheJUPITERtrial.Circulation2003;108:2292–2297.AbbreviationsCAD=coronaryarterydisease;LDL-C=