混合型血脂异常与糖尿病他汀治疗

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1、混合型血脂异常与糖尿病他汀治疗关注糖尿病患者LDL-C,HDL-C和TG的全面控制内容血脂异常与心血管风险2型糖尿病混合型血脂异常与心血管预后2型糖尿病混合型血脂异常他汀干预的终点证据2型糖尿病患者他汀治疗的安全性LDL-C:他汀临床研究关注的主要血脂指标AdaptedfromBallantyneCM.AmJCardiol.1998;82:3Q-12Q.二级预防-安慰剂二级预防-他汀一级预防-安慰剂一级预防-他汀0510152025308090100110120130140150160170180190200LDL-CAchieved(

2、mg/dL)AFCAPSAFCAPSWOSCOPSWOSCOPSCARECARELIPIDLIPID4S4SEventRate(%)HPSHPS辛伐他汀降低糖尿病合并冠心病且血脂异常三联症患者的心血管事件风险4S研究(LDL+LowHDL+HighTG)LDL=low-densitylipoprotein;HDL=high-densitylipoprotein;TG=triglycerides.CVEventRate(%)4037.524.235.5血脂异常三联症,糖尿病血脂异常三联症,非糖尿病非血脂异常三联症,糖尿病非血脂异常三联症,

3、非糖尿病3319718819221817941782n18.137.523.425.919.001020304050安慰剂辛伐他汀BallantyneCM.Circulation.2001;140:3046-3051BallantyneCM.Circulation.2001;104:3046-3051.LipidTriadGroup:Baseline:LDL-C=195mg/dL,TG=191mg/dL,HDL-C=33mg/dL;LipidTriadGroup:n=424;Sim:n=206;Placebo:n=218.35.7%si

4、mvastatinpatientsweretitratedfrom20to40mgat1year.辛伐他汀显著改善糖尿病合并冠心病患者血脂异常三联症4S研究低HDL-C：高冠心病危险TheindependenteffectofraisingHDL-Candloweringtriglyceridesontheriskofcoronaryandcardiovascularmorbidityandmortalityhasnotbeendetermined.Systolicbloodpressure=135mmHgLDL-CCHDrelati

5、verisk2.6mmol/L4.1mmol/L2.2mmol/L00.51.01.52.03.02.51.7mmol/L1.2mmol/L0.6mmol/L5.7mmol/LHDL-CFraminghamHeartStudyKannelWB.AmJCardiol.1987;59:80A–90A.TG与冠心病风险显著相关：29个研究荟萃分析*Individualsintopvsbottomthirdofusuallog-TGvalues,adjustedforatleastage,sex,smokingstatus,lipidconce

6、ntrations,andbloodpressure(most).N=262,52512CHDRiskRatio*(95%CI)1.72(1.56–1.90)AdjustedforHDLFastingstatusDurationoffollow-up5689No4469Yes2674Nonfasting7484Fasting1994Female7728Male4256<10years590210yearsCHDCasesGroupsSexSarwarNetal.Circulation.2007;115:450-458,内容血脂异常与心

7、血管风险2型糖尿病混合型血脂异常与心血管预后2型糖尿病混合型血脂异常他汀干预的终点证据2型糖尿病患者他汀治疗的安全性2型糖尿病：高TG和低HDL-C的常见共同病因低HDL-C血症的常见原因ElevatedtriglyceridesOverweightandobesityPhysicalinactivityCigarettesmokingVeryhighcarbohydrateintakesType2diabetesCertaindrugs(beta-blockers,anabolicsteroids,progestationalagen

8、ts)高甘油三酯血症的常见原因ObesityandoverweightPhysicalinactivityCigarettesmokingExcessalcoholintakeHighcarbohydrat