高脂血症治疗目标高密度脂蛋白

Slide Source LipidsOnline HDL as a Therapeutic Target Daniel J. Rader, M.D. Slide Source LipidsOnline 100 160 220 Risk of CHD Low HDL-C is an Independent Predictor of CHD Risk Even When LDL-C is Low HDL-C (mg/dL) LDL-C (mg/dL) 25 Gordon T et al. Am J Med 1977;62:707-714. 4565 85 Slide Source LipidsOnline ATP III: New Definition of Low HDL-C Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497. Low HDL-C was redefined as 102 cm (40 in) 88 cm (35 in) TG 150 mg/dL HDL-C Men Women 37 mg/dL37 mg/dL P = 0.008 P 40 mg/dl 71 40 68 41 44 35 44% RR 40% RR 20% RR Slide Source LipidsOnline nTherapeutic lifestyle changes nPharmacologic therapy nStatins nFibrates Management of Low HDL-C Slide Source LipidsOnline VA-HIT: Major Coronary Events in Gemfibrozil vs. Placebo Groups Cumulative Incidence (%) 0 Rubins HB et al. N Engl J Med 1999;341:410-418. Copyright 1999, Massachusetts Medical Society. All rights reserved. 1 2 3 4 5 6 Year Placebo Gemfibrozil 22% reduction P = 0.006 Slide Source LipidsOnline VA-HIT: Lipid Concentrations According to Year of Study and Treatment Group TC (mg/ dL ) 0 1 2 3 4 5 Year LDL-C (mg/ dL ) Year 0 1 2 3 4 5 HDL-C (mg/ dL ) Year TG (mg/ dL ) Year 0 1 2 3 4 5 Placebo Gemfibrozil 4%, P0.001 No change Gemfibrozil 341:410-418. Copyright 1999, Massachusetts Medical Society. All rights reserved. Slide Source LipidsOnline VA-HIT: Changes in Plasma Lipids during Treatment as Predictors of Coronary Events Variable (Change) Risk Factor (95% CI) P During treatment HDL-C (5.0 mg/dL) 0.89 (0.810.98) .02 Triglycerides (50 mg/dL) 1.03 (0.951.11) .48 LDL-C (25 mg/dL) 1.09 (0.981.21) .13 Robins SJ et al. JAMA 2001;285:1585-1591. Copyright 2001, American Medical Association. Slide Source LipidsOnline nTherapeutic lifestyle changes nPharmacologic therapy nStatins nFibrates nNiacin Management of Low HDL-C Slide Source LipidsOnline Efficacy of Extended-Release Niacin Change from Baseline 2500 mg 3000 mg Goldberg A et al. Am J Cardiol 2000;85:1100-1105. 2000 mg 1500 mg 1000 mg 500 mg HDL-C LDL-C Lp(a) TG 9% 14% 22% 21% 17% 29.5%30% 26%22% 15%10% 28% 35% 44% 39% 11% 5% 26% 3% 12% 30% 24% 17% Slide Source LipidsOnline nLifestyle changes and secondary causes nPharmacologic therapy nIf LDL-C elevated: statin nIf TG elevated: fibrate nIf isolated low HDL-C: niacin nCombination therapy Management of Low HDL-C Slide Source LipidsOnline Change (%) Wolfe ML et al. Am J Cardiol 2001;87:476-479. Copyright 2001, Excerpta Medica Inc. Reprinted with permission. Addition of Extended-Release Niacin to a Statin because of Persistently Low HDL-C TC LDL-C HDL-C TG Slide Source LipidsOnline CV Events Event Rate (%) Brown BG et al. Circulation 1998;98:I-635. Familial Atherosclerosis Treatment Study (FATS): 10-Year Follow-up Results Usual Care (n=101) Deaths LDL-C 188166 mg/dL; HDL-C 3840 mg/dL ; TG 208220 mg/dL LDL-C 202106 mg/dL; HDL-C 4353 mg/dL; TG 210134 mg/dL Triple Therapy (n=75) 19.8 18.8 1.3* * p0.05 5.3* Slide Source LipidsOnline n LDL-C remains the primary target of lipid- altering therapies n HDL-C is an important CHD risk factor n Even small increases in HDL-C may confer substantial benefit n Intervention to raise HDL-C levels should be considered in high-risk patients Summary Slide Source LipidsOnline n 48-year-old man with metabolic syndrome and CHD n After t