调脂在冠心病一二级预防的地位ppt课件

1、.,1,调脂在冠心病一二级预防的地位十个常见问题及答案探讨,心内科 常炳习,.,2,Q 81:1721-1733.Am J Med.1984;76:4-12.,11,.,12,动脉粥样硬化与危险因子的关系,12,At lowrisk of CAD,At moderate risk of CAD,At high risk of CAD,The cascade risk factors of AS,Major risk factors,.,13,Q 9(2):269-79. LaRosa JC, et al. N Engl J Med. 2005;352(14):1425-35. Nakamura

2、 H, et al. Lancet. 2006;368(9542):1155-63.,For CAD LDL-C the lower, the better,22,.,23,他汀循证的启示及指南策略,23,.,24,Q 364(9436):771-7,两组的差异与吸烟、年龄、性别、基线时诊断无关（心肌梗死、高血压、 PCI/CABG、糖尿病、间歇性跛行等无关），但是与血脂水平有关,延长期,延长期,延长期,35,.,36,Q 97suppl:77C81C),Are elevated in serum aminotransferase level associated with Statin th

3、erapy? Response: Yes Confidence/level of evidence: IA,Are statin-associated elevation in aminotransferase leveles indicate of liver damage or dysfubction? Response: No Confidence/level of evidence: 2C,43,.,44,Q & A 问题与答案,问 题 10,选择何种他汀？ -利益与学术的博弈,44,.,45,临床药物的选择原则,45,.,46,里程碑式他汀类试验的临床意义,4S （辛伐他汀） ccs

4、ps (洛伐他汀),LIPID CARE （普伐他汀）,WOSCOPS （普伐他汀）,AFCAPS/TexCAPS （洛伐他汀）,二级预防,一级预防,高危冠心病患者,大多数冠心病患者,高危易患冠心病的患者,低危易患冠心病的患者,安慰剂组每100例5年的心肌梗死发生率,2.8,7.9,15.9 13.2,22.6,危险性,46,.,47,10 Steps before You Refer for: Lipids,1. Repeat the Measurement 2. Identify the Pattern of Lipoprotein Abnormality 3. Exclude a Sec

5、ondary Cause 4. Confirm Need for Treatment 5. Take a Family History 6. Check Adherence to Lifestyle and Medication 7. Maximize Treatment to Target 8. Repeat Liver Function Tests if Raised 9. Check Creatine Kinase (CK) if Myalgia 10. Communicate Therapies Already Tried and their Outcomes,47,.,48,调脂治疗的10个步骤,1、重复测量结果 2、判断血脂异常类型 3、排除继发性原因 4、确定是否需要治疗 5、采集家族史 6、核查生活方式及药物的依从性 7、尽可能治疗到靶目标 8、如果肝功异常复查 9、检查激酶如果出现肌痛 10、交流收益与风险,48,.,49,Summary 总结,健康长寿及防治心血管疾病的基