讲题3妥会议幻灯老年强化降脂2007周志明

1、Statins Reduce LDL-C and CHD EventsPrimary and Secondary Prevention RCTs (n=51,353)HPS. Lancet. 2002;360:7; Downs. JAMA. 1998;279:1615; LIPID. N Engl J Med. 1998;339:1349; Sacks. N Engl J Med. 1996;335:1001. 4S. Lancet. 1994;344:1383. Shepherd. N Engl J Med. 1995;333:1301.Mortality increased with ag

2、e30 day mortality in pts with AMI%= 75 yr65 74 yr 65 yrWomen75 Men75 Uppsala Clinical Research Centre 2005: From Mar 2011 to Dec 2011, consecutive patients visiting outpatient clinics in 19 provinces, involving 84 centers, around China were screened. 12244 eligible patients with complete data were a

3、nalyzed. Participants were stratified into risk categories according to the cumulative number of risk factors and the Framingham risk score, as reported by the NCEP ATP-III guidelines. The following data were obtained on enrolment day: medical history, weight, height, fasting plasma glucose, systoli

4、c and diastolic blood pressure and fasting blood lipids6N=8419 provinces, 84 centers around China were selected7Cardiac risk factors N=12244A：HypertensionB：DiabetesC：Coronary artery diseaseD：Symptomatic peripheral atherosclerosisE：Chronic renal disease F: Lipid disorder（66.9%66.9%）（16.7%16.7%）（37.3%

5、37.3%）（12.0%12.0%）（86.3%86.3%）N=122448240 mg/dl160mg/dlN=122449200 mg/dl60 mg/dl40-60 mg/dlN=1224410Sex differences on LDL-C target attainmentP0.0001P0.0001TotalMaleFemale Monitoring of blood lipid (%)41.340.742.2Monitoring of creatine kinase a n d L i v e r enzyme (%)30.830.930.6Adverse effect (%)1

6、.51.51.5Myalgia (%)0.3 0.3 0.3 Elevation of Liver enzyme (%)Elevation of creatine kinase (%)0.040.060.02Liver safety is still a big concern since liver diseases are highly prevalent in ChinaIn 1992, a serum epidemiological survey for hepatitis in China found that the positive rate of HBsAg

7、in the population aged 1-59 years was 9.8%, indicating that approximately 120 million Chinese people were HBsAg carriers, and 20 million Chinese people suffered from chronic hepatitis B.CDC. MMWR Morb Mortal Wkly Rep 2012; 61(1):6-9.age (years) Chinese Epidemiological Survey on Hepatitis in 2006Resu

8、lts of GRACE hepatic function subgroup：statins significantly reduced cardiovascular endpoint events in NAFLD patientsLancet 2010, 6376:1916Number of CV endpoint events/100 patient-yearHepatic insufficiency groupNormal hepatic function groupNo statinsStatins39%（p0.001） 68%（p0.001）Cardiovascular endpo

9、int events include all-cause mortality, CHD death or events (non-fatal MI, revascularization, UA and congestive heart failure) and strokes.P=0.0074Intensive statins (eg. atorvastatin 80/mg/d) are 100 times safer than low dose aspirin*.Intensive statin therapySafety concerns*JACC. 2009;54(15):1434-14

10、37*Indian Heart J 2011; 63: 211-227Intensive statin therapy in Asian:Safety concernsHowever, no large data is available on the safety of intensive statins in Asian population.NCT 01646307Intensive statin group:Atorvastatin 80mg 12h prior PCI; then 40 mg/d x 30dStandard care group: Atorvastatin 20 mg/d R 1:1Clinical FU at 30 days, 6 months,1 year.Efficacy Outcomes:MACCE: Death, MI, TVR, stroke, Stent ThrombosisSafety Outcomes:Adverse effects: hepatotoxicity,