AHA2003：LDL和HDL对粥瘤的影响PPT课件.ppt

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1、AHA2003:TacklingLDLandHDLforatheromaregressionValentinFusterMDDirector,CardiovascularInstituteMountSinaiMedicalCenterNewYork,NYSteveNissenMDProfessorofMedicineClevelandClinicFoundationCleveland,OHScottGrundyMDDirector,CenterforHumanNutritionUTSouthwesternMedicalCenterDallas,TXREVER

2、SALEffectsofatorvastatinvspravastatinonatherosclerosisprogressionApoA-1MilanoEffectofanHDLmimiconatherosclerosisprogressionTopicsREVERSingAtherosclerosiswithLipitorREVERSALREVERSAL:Design654patientsrandomizedat24UScenters,withindicationforatheroscleroticdisease,stenosisof>20%,andLD

3、Llevelsbetween125and210mg/dLIntensiveatorvastatin(80mgdaily)vsmoderatepravastatin(40mgdaily)therapyPrimaryendpoint:percentchangeincoronaryplaquevolume,asmeasuredbyIVUSbetweenbaselineand18monthsOutcomePravastatin(n=249)Atorvastatin(n=253)pFinalLDLlevel11079<0.001%changeinatheromavolu

4、me+2.7(progression)-0.4(nochange)0.02REVERSAL:ResultsAHA2003REVERSAL:TypeofstatinPravastatin:40mg/dayisthehighestdoseapprovedbytheFDAThiswasnottheidealdosetousetocompareeffectsonthelipidprofileWhydidyounotcomparetwodifferentdosagesofatorvastatin?FusterREVERSAL:LoweringLDLNissenQues

5、tion:DoesloweringLDLbelowtargetlevelshaveameasurableeffectonatherosclerosisprogressionrate?ObjectiveinREVERSAL:Group1withLDLaround100,group2withmuchlowerLDLlevels"Itwasreallydesignedasan'is-lower-better?'trial."REVERSAL:Howlow?ATPIIIguidelines:LevelsofLDLshouldbebelow100TNT,SEARCH

6、,IDEALAddresstheissueofhowlowtogoREVERSALFirststudytotestthisquestion"Theresults,inmyopinion,lookverypromising."GrundyREVERSAL:SurprisedInthepravastatingroup,176patientshadLDL<100,withameanLDLof88TheystillshowedhighlysignificantprogressionDifferentprogressionratesforeveryLDLlevelbe

7、tweengroups"Wewereverysurprisedbythisoutcome."NissenAHA2003REVERSAL:Cholesterolreductionp<0.0001p<0.0001BaselineLDL:150Slightlyhigherthannormal(135-140)AverageLDLreductionsof30%wererightontarget"Thoseresultsweretotallypredictable."GrundyAHA2003REVERSAL:AdverseeventsREVERSAL:IVUSPlaq

8、uevolumemeasuredbyI