高脂血症的一级预防和二级预防

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1、PrimaryandSecondaryPreventionofDyslipidemia:EstablishedTherapiesandEmergingParadigmsSidneyC.Smith,Jr.MDProfessorofMedicineDirector,CenterforCardiovascularScienceandMedicineUniversityofNorthCarolinaatChapelHillMostMIsAriseFromSmaller,Nonflow-limitingStenoses68%18%14%020406080<50%

2、50%–70%>70%%StenosisPercentofMIPatientsAdaptedfromFalketal.Circulation1995;92:657–671.PCICABGEffectsofStatinsonCoronaryDisease:Primary&SecondaryPreventionStudyLDLLDLRxRRRARRNNT4S188122(-35%)34%*8.5%12CARE13998(-32%)24%*3.0%34LIPID150113(-25%)23%*3.4%30WSCPS192159(-26%)29%*2.2%46A

3、FCAPS150113(-25%)36%^1.8%56*=NFMI/CHDmort.^=NF/FMI,UAP%**†‡§*Confidenceinterval(CI)notreported.†95%CI,14%-41%.‡95%CI,16%-37%.§95%CI,12%-31%.HebertPRetal.JAMA.1997;278:313-321.ImpactofLoweringLDL-ConCVDEventsandTotalMortalityNonfatal/fatalCHDCVDmortality4S:MajorCHDEventReduction

4、inaSubgroupofPatientsWithDiabetesPyöräläKetal.DiabetesCare.1997;20:614-620.ProportionwithoutmajorCHDeventYrsincerandomization-P=0.002-P=0.0001Diabetic,simvastatinDiabetic,placeboNondiabetic,simvastatinNondiabetic,placebo32%55%4S:TreatmentBenefitinSubgroupWithImpairedFastingGluc

5、ose(FG110-125mg/dL)HaffnerSMetal.Diabetes.1998;(suppl1):A54.Abstract.TotalmortalityCoronarymortalityMajorcoronaryeventsRevas-culari-zationsinevents(%)P=0.005P=0.001P=0.010ClinicalTrialFindings:TheStatinsStatinsLDL-Cby25%-35%BenefitsatvariousLDL-Clevels;evidentsoonafterthe

6、rapyinLDL-CrequiredforinCHDmorbidity/mortalityinall-causemortalityin2°preventionandincardiovascularmortalityin1°preventionStudiessupporttreatmentinvariouspatientgroupswomenelderlydiabeticsLipidLoweringTherapyforthePreventionofVascularDiseaseWhenShouldLipidLoweringTherapybestar

7、ted?WhatshouldbetheTreatmentGoal?FindingsoftheHPSStudy.ShouldHDL–CholesterolbeaTarget?WhentoStartCholesterolLoweringTherapyinPatientswithCoronaryHeartDisease“Thecardiovascularspecialistorattendingphysicianshouldberesponsibleforstartingsomeformofcholesterolloweringtherapyinpatient

8、supondischargefromthehospitalafteracutec