高甘油三酯血症的治疗目标与措施.ppt

高甘油三酯血症的治疗目标与措施
The management of Hypertriglyceridemia
河北省人民医院郭艺芳Hebei General HospitalYifang Guo, MD
从 4S 到ASTEROID:他汀重要研究的12年历程
他汀研究的第二次浪潮
针对高危患者群
– ACS,老年人,糖尿病,高血压

不仅仅与安慰剂对照
–与常规治疗对照(ALLIANCE, ALL-HAT)
–与活性药物对照(PROVE IT, A to Z)
早期研究与安慰剂相比,证实他汀可降低死亡率和心血管事件发生率
1994 4S
1995 WOSCOPS
1996 CARE
1998 AFCAPS/TexCAPSLIPID
2001 MIRACL
2002 HPSPROSPERALL-HAT LLT
2003 ASCOT-LLA
2004 PROVE ITALLIANCECARDSA to Z
2005 TNTIDEAL
2006 ASTEROID
在已接受现代治疗的稳定性冠心病患者,更积极的他汀治疗能否进一步获益?
Overall Risk Reduction for Major Coronary Events by Age: A Meta-analysis
LaRosa JC, et al. JAMA. 1999;282:2340-2346.
No. of Events RRR, % ARR/1000 NNT P
³65 y 740 539 32 (23 to 39) 44 (30 to 58) <
4S 168 122 38 (19 to 53) 98 (43 to 154) 23 <
CARE 111 69 42 (20 to 57) 65 (27 to 103) (17-33) <
LIPID 349 270 25 (11 to 37) 42 (17 to 67)
AFCAPS 112 78 32 (8 to 49) 21 (5 to 38)
<65 y 1302 951 31 (24 to 36) 32 (24 to 40) <
4S 454 309 38 (27 to 47) 83 (55 to 110) <
CARE 163 143 14 (-9 to 32) 14 (-8 to 37) 31
LIPID 366 287 25 (12 to 37) 31 (13 to 48) (25-41) <
WOSCOPS 248 174 31 (16 to 44) 23 (11 to 34) <
AFCAPS 71 38 47 (22 to 63) 19 (8 to 31)
PI Statin (95% CI) (95% CI) (95% CI) Value
他汀类药物显著降低心血管死亡率与全因死亡率
LaRosa JC, et al. JAMA. 1999;282:2340-2346.
血脂不是动脉粥样硬化性疾病唯一的危险因素
胆固醇不是血脂谱中唯一的有害成分
他汀不是唯一的调脂药物
为全面控制心血管危险,仅仅他汀降胆固醇是不够的







50
100
150
200
250
300
350
400
Men
Women
RR
TG (mg/dL)
Castelli WP. Can J Cardiol. 1988;4:5A-10A.
Impact of TG Levels on Relative Risk of CHD: Framingham Heart Study
SHEEP: Risk Factors for Nonfatal MI in Men and Women
SHEEP=Stockholm Heart Epidemiology Program.
Reuterwall C et al. J Intern Med. 1999;246:161-174.
Risk FactorDiabetes High TC ( mmol/L) High TG ( mmol/L)HTN (170/95 mm Hg)Overweight (BMI 30 kg/m²)WHR ()Physical inactivitySmokingJob strain
Men
Women
0
1
2
3
4
5
6
7
8
Odds Ratio
Events/
1,000 in 8 yr
Assma