降脂逆转动脉粥样硬化进展

强化降脂逆转 动脉粥样硬化进展天坛医院神经内科赵性泉主任泡沫细胞脂质条纹中间阶段损伤 动脉粥样化动脉粥样化纤维纤维斑块斑块复合病变破裂复合病变破裂从十几岁开始 从 30岁开始 从 40岁开始动脉粥样硬化的进程动脉粥样硬化的进程主要为脂肪积聚主要为脂肪积聚 平滑肌细胞平滑肌细胞和胶原和胶原栓塞栓塞 出血出血内皮功能不全Modified from Pepine, CJ, Am J Card, 1998动脉粥样硬化 进展性和全身性血管疾病正常正常 脂肪条纹脂肪条纹 纤维斑块纤维斑块 动脉粥样斑块动脉粥样斑块斑块破裂斑块破裂 /血栓形成血栓形成 急性心肌梗死急性心肌梗死缺血性中风缺血性中风 /短暂性脑缺血短暂性脑缺血周围血管周围血管疾病疾病无临床症状无临床症状心脏猝死心脏猝死 吸烟吸烟 , 高血压高血压 , 胆固醇升高 糖尿病糖尿病 , 年龄等年龄等稳定性心绞痛稳定性心绞痛不稳定心绞痛不稳定心绞痛高危患者临床终点研究显示了他汀对动脉粥样硬化疾病的疗效他汀降脂治疗减少主要冠脉事件的发生-38*0-20-40 -38*-31*-36-27 -25* -25一级预防 高危患者 二级预防AF/TexCAPS 6605 27%WOS 6595 20%ASCOT 10305 26%HPS 20,536 29%4S 4444 38%LIPID 9014 25%CARE 4159 28%试验减少（）*P0.001; P0.0006; P0.0001; P0.002HPS Collaborative Group. Lancet. 2002;380:7-22; Lapota et al. JAMA. 1999;282:2343-2346, Sever et al. Lancet. 2003;381:1148-1158.他汀既往的替代终点研究：延缓动脉粥样硬化的进展斑块消退检测方法 (1) 定量冠脉造影试验 颈动脉斑块和内中膜厚度 (IMT)检测 冠脉内超声检查Lipid Lowering and Plaque Regression: Monotherapy StudiesNHLBI II D + R 31 33STARS D + R 36 7.7(0.01) 89Heidelberg D + E 8 4.0 (0.05) -27*CCAIT D + L 29 1.2 (0.039) MARS D + L 38 0.6 BECAIT D + F 3 2.55 77LCAS D + Fl 24 2.0 (0.043) 33Post-CABG D + L 14 5.4 (0.001) * A -27% reduction means a 27% increase (NS). D=diet; R=resin; E=exercise program; F=fibrate-typedrug; Fl=fluvastatin; L=lovastatin.Levine GN et al. N Engl J Med. 1995;332:512-521.Brown BG, Fuster V. In Fuster V et al, eds. Atherosclerosis andCoronary Artery Disease. Philadelphia, Lippincott-Raven, p. 194.Jukema JW et al. Circulation. 1995;91:2528-2540.Post-CABG Investigators. N Engl J Med. 1997;336:153-162.Treatment group D% Stenosis %Event StudyRegimen LDL-C (P ) reductionLipid Lowering and Plaque Regression: Combination Therapy StudiesCLAS I D + R + N 43 25POSCH (5y) D + PIB R 42 35 (62)Lifestyle V + M + E 37 2.2 (0.001) FATS (N+C) D + R + N 32 0.9 (0.005) 80FATS (L+C) D + R + L 46 0.7 (0.02) 70CLAS II D + R + N 40 43USCF-SCOR D + R + N L 39 1.5 (0.04) SCRIP D+(R+N+L+F)+E, BP 21 50HARP D+P+N+C+F 41 2.1 33Post-CABG D+L+C 37-40 0.054 29Treatment group D% Stenosis % EventStudy Regimen LDL (P ) r