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1、血脂相关剩留血管风险的治疗策略何为剩留血管事件风险?尽管很多患者接受了当前心血管疾病的标准治疗,包括降低LDL-C达标,加强控制血压和血糖等,但仍剩留明显的大血管事件和微血管并发症风险。此定义由R3i国际指导委员会委员发布。血脂相关剩留血管事件风险的治疗策略1,他汀时代的剩留大血管事件风险2,血脂相关因素与剩留大血管事件风险3,他汀时代的小或微血管事件风险4,致AS血脂异常与小或微血管事件风险5,剩留血管事件风险的治疗策略他汀临床试验中剩留的心血管风险4S,ScandinavianSimvastatinSurvivalStudy;HPS,HeartProt
2、ectionStudy;WOSCOPS,WestofScotlandCoronaryPreventionStudy;AFCAPS/TexCAPS,AirForce/TexasCoronaryAtherosclerosisPreventionStudy.14SGroup.Lancet.1994;344:1383-1389;2LIPIDStudyGroup.NEnglJMed.1998;339:1349-1357;3SacksFMetal.NEnglJMed.1996;335:1001-1009.4HPSCollaborativeGroup.Lancet.20
3、02;360:7-22;5ShepherdJetal.NEnglJMed.1995;333:1301-1307;6DownsJRetal.JAMA.1998;279:1615-1622.LDLN4444415920,536659566059014–35%–28%–29%–26%–25%–25%SecondaryHighRiskPrimaryPatientsExperiencingMajorCHDEvents,%4S1LIPID2CARE3HPS4WOSCOPS5AFCAPS/TexCAPS6CHDeventsoccurinpatientstreatedw
4、ithstatinsPROVEIT-TIMI22,PravastatinorAtorvastatinEvaluationandInfectionTherapy–ThrombolysisInMyocardialInfarction22;IDEAL,IncrementalDecreaseinEndPointsThroughAggressiveLipidLowering;TNT,TreatingtoNewTargets.*MeanormedianLDL-Caftertreatment.1SuperkoHR.BrJCardiol.2006;13:131-136;2
5、CannonCPetal.NEnglJMed.2004;350:1495-1504;3PedersenTRetal.JAMA.2005;294:2437-2445;4LaRosaJCetal.NEnglJMed.2005;352:1425-1435.他汀强化治疗后,剩留心血管风险仍高PatientsExperiencingMajorCVDEvents,%PROVEIT-TIMI222IDEAL3TNT4NLDL-C,*mg/dL4162888810,0019562104811017784%80%88%血脂相关剩留血管事件风险的治疗策略1,他汀时代的剩留大血
6、管事件风险2,血脂相关因素与剩留大血管事件风险3,他汀时代的小或微血管事件风险4,致AS血脂异常与小或微血管事件风险5,剩留血管事件风险的治疗策略他汀治疗后,甘油三酯水平与心血管事件风险CAREandLIPID*CHDdeath,nonfatalMI,CABG,PTCA.CARE,CholesterolandRecurrentEvents;LIPID,long-termInterventionwithPravastatininIschemicDisease.ReprintedfromSacksFMetal.Circulation.2000;102:189
7、3-1900,withpermissionfromLippincottWilliams&Wilkins(www.lww.com).N=13,173CVDEventRate*PlaceboPravastatin<9899-126127-158159-207>207TGLevel,mg/dLSlope=0.018P=0.02Slope=0.029P<0.001甘油三酯是大血管剩留风险重要原因之一1–MillerMetal.JAmCollCardiol2008;51:724-30.PROVEIT-TIMI22study:尽管予以大剂量他汀,达到了LDL-C<70
8、mg/dL(1.8mmol/L),但TG≥200mg/dL(2.3