ACS降脂治疗.pptx

急性冠脉综合症的降脂治疗Lipid-loweringtreatmentofacutecoronarysyndrome,1,Contents,ChangpingChinesetraditionalmedicalhospital,ACS病理基础,ChangpingChinesetraditionalmedicalhospital,ACS病理基础,ChangpingChinesetraditionalmedicalhospital,ACS斑块特征,大脂池（脂质核心占40%）大量炎性细胞浸润易损性（vulnerability）血中血脂异常增高内皮细胞功能损伤局部炎症血液动力学异常,李娇娇.心血管病防治知识(下半月),2013,12:150-153,ChangpingChinesetraditionalmedicalhospital,ACS与血脂状态,有报道ACS患者应激状态下，血脂浓度有较大波动。AMI发生24h后，TC、LDL-C、HDL-C、apoA1和apoB均有明显下降，TG却增加。45d后变化最为明显，23个月后可回到基线状态。此时LDL和HDL颗粒性质发生了变化。作者认为，对于ACS患者，无论基线血脂浓度如何，都需要积极地应用他汀类药物进行强化降脂治疗。,xx,ChangpingChinesetraditionalmedicalhospital,ACS血脂状态,有人对59例ACS患者急性期24h内的血脂6项指标（TC、TG、HDL-C、LDL-C和ApoB、apoA1）与47例健康人的水平进行了比较,ChangpingChinesetraditionalmedicalhospital,结果,结论：TC、TG、LDL-C、ApoB水平升高和HDL-C、ApoA1水平降低可能是ACS发病的危险因素，血脂6项指标联合检测有助于预测ACS的发生并监控病情的变化。,丁玲新等.海南医学院学报,2011,11:1476-1478,ChangpingChinesetraditionalmedicalhospital,ACS与血脂状态,另一篇报道：经冠脉造影诊断为CHD的367例患者，其中男性261例，女性106例，年龄2989(59.511.0)岁。268例ACS患者，99例非ACS患者作为对照，对两组患者的Lp(a)、HDL-C、ApoAl、TC、TG、LDL-C以及ApoB水平进行观察。,ChangpingChinesetraditionalmedicalhospital,结果,ChangpingChinesetraditionalmedicalhospital,结论,Lp(a)、HDL-C和ApoAl的水平在ACS患者和对照组患者中差异有统计学意义，提示我们在重视降低患者的TC,TG和LDL-C水平的同时，也应该关注HDL-C,ApoA1和Lp(a)水平的影响,曲环.中国心血管病研究,2008,6(6):410-412,ChangpingChinesetraditionalmedicalhospital,ACS与血脂状态,另一项研究纳入333例ACS患者，男性232例（69.7%），女性101例（30.3%），年龄6210.63岁。其中UA257例（77.2%），NSTEMI50例，STEMI26例（7.8%），在发病期对患者血浆血脂浓度进行检测。,ChangpingChinesetraditionalmedicalhospital,结果,ChangpingChinesetraditionalmedicalhospital,结论,1.在ACS患者中，血脂异常较为常见2.大于50%是HDL-C1.0mmol/L,xx,ChangpingChinesetraditionalmedicalhospital,ChangpingChinesetraditionalmedicalhospital,Effectsofatorvastatinonearlyrecurrentischemiceventsinacutecoronarysyndromes:theMIRACLstudy:arandomizedcontrolledtrial.,Arandomized,double-blindtrial1997.5to1999.9follow-up16weeks122clinicalcentersinEurope,NorthAmerica,SouthAfrica,andAustralasia.,ChangpingChinesetraditionalmedicalhospital,Atotalof3086adultsaged18yearsorolderwithunstableanginaornon-Q-waveacutemyocardialinfarction.Todeterminewhethertreatmentwithatorvastatin80mg/datorvastatin,initiated24to96hoursafteranacutecoronarysyndrome,ChangpingChinesetraditionalmedicalhospital,Primaryendpoint:death,nonfatalacutemyocardialinfarction,cardiacarrestwithresuscitation,orrecurrentsymptomaticmyocardialischemiawithobjectiveevidenceandrequiringemergencyrehospitalization.,ChangpingChinesetraditionalmedicalhospital,Rulst,ChangpingChinesetraditionalmedicalhospital,ChangpingChinesetraditionalmedicalhospital,Conclusion,Forpatientswithacutecoronarysyndrome,lipid-loweringtherapywithatorvastatin,80mg/d,reducesrecurrentischemiceventsinthefirst16weeks,mostlyrecurrentsymptomaticischemiarequiringrehospitalization.,SchwartzGG，etal.JAMA.2001Apr4;285(13):1711-8.,ChangpingChinesetraditionalmedicalhospital,EarlyIntensivevsaDelayedConservativeSimvastatinStrategyinPatientsWithAcuteCoronarySyndromesPhaseZoftheAtoZTrial,JAMA.2004;292(11):1307-1316.doi:10.1001/jama.292.11.1307.,ChangpingChinesetraditionalmedicalhospital,AtoZ(theAggrastattoZocor）,Time:December29,1999,andJanuary6,2003Design:patients(n=2265)withACSreceiving40mg/dofsimvastatinfor1monthfollowedby80mg/dpatients(n=2232)withACSpatientsreceivingplacebofor4monthsfollowedby20mg/dofsimvastatin,ChangpingChinesetraditionalmedicalhospital,Follow-up:624months.Theprimaryendpoint:CardiovasculardeathNonfatalmyocardialinfarctionReadmissionforACSStroke,ChangpingChinesetraditionalmedicalhospital,ChangpingChinesetraditionalmedicalhospital,simvastatin,ChangpingChinesetraditionalmedicalhospital,AmongpatientswithACS,theearlyinitiationofanaggressivesimvastatinregimenresultedinafavorabletrendtowardreductionofmajorcardiovascularevents.,Conclusions,ChangpingChinesetraditionalmedicalhospital,ARMYDATrial,PasceriV,etalCirculation2004;110:674-8,AtorvastatinforReductionofMyocardialDamageDuringAngioplasty,ChangpingChinesetraditionalmedicalhospital,153patientsscheduledforelectivePCIirrespectiveofbaselinelipidlevelsRandomized,double-blind,Atorvastatin40mg/dn=76,Placebon=77,ChangpingChinesetraditionalmedicalhospital,ChangpingChinesetraditionalmedicalhospital,EndPoints,Theprimaryendpoint：occurrenceofmyocardialinfarction（CK-MB2times）Secondaryendpoints：othermarkersofmyocardialinjury（CK-MB,troponinIandmyoglobin）uppernormallimitsmeanpeakvaluesofCK-MB,troponinIandmyoglobinafterinterventionoccuringadversecardiacevents(death,myocardialinfarction,orneedforunplannedrevascularization)Withinamonth,ChangpingChinesetraditionalmedicalhospital,ARMYDATrial,Primaryendpointofpost-procedureMI(CKMB2xULN)inatorvastatingroupvsplacebo(Figure)Presenceofmarkers1xULNalsoinatorvastatinarm:CKMB12%vs35%,p=0.001;troponinI20%vs48%p=0.0004;myoglobin22%vs51%,p=0.0005,Circulation2004;110:674-8,Post-procedureMI(2xULN)p=0.025,34,ARMYDATrial,Circulation2004;110:674-8,PeakvaluesofCK-MB,troponinI,andmyoglobininstatinvsplacebogroup.DataaremeanSEM.,35,pretreatmentwithatorvastatinsignificantlyreducedriskofperiproceduralmyocardialinfarction(OR0.19,95%CI0.05to0.57).Useof-blockers,glycoproteinIIb/IIIainhibitors,orACEinhibitorswasnotassociatedwithriskreduction.,ChangpingChinesetraditionalmedicalhospital,ARMYDATrial,AmongpatientsundergoingelectivePCI,pre-treatmentwithatorvastatinwasassociatedwithareductioninmarkersofmyocardialinjurypost-procedureMechanismmayberelatedtoanti-inflammatoryeffectofstatins,ChangpingChinesetraditionalmedicalhospital,国内研究,68例血脂正常ACS患者被随机分为常规治疗组（34例，仅常规治疗），和辛伐他汀组（34例，常规治疗基础上加用辛伐他汀20mg/d），疗程6个月。于治疗前、后8周检测血浆BNP、hsCRP水平。所有患者每3个月随访一次，平均随访观察6个月，以住院或观察期间的心血管事件为终点。,ChangpingChinesetraditionalmedicalhospital,ChangpingChinesetraditionalmedicalhospital,ChangpingChinesetraditionalmedicalhospital,结论,血脂正常的ACS患者，早期应用辛伐他汀干预可以显著降低血浆BNP、hs-CRP水