冠心病（CHD）危险因素的相互作用课件.ppt

《冠心病（CHD）危险因素的相互作用课件.ppt》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

1、ForAFixedLDL-C,IncreasedHDL-CCorrelatesWithAReducedCHDIncidenceFraminghamStudyRelativeRiskofCHDSource:AdaptedfromKannelWB,CarterBL.AmHeartJ118:1021,1989HDL250.65350.90(mg/dl)(mmol/L)451.16551.42651.68751.94852.204SWOSCOPSAFCAPSCoronaryEvents(%)40<34523843<43LIPID3

2、9<39AdaptedfromBallantyneCMetal.Circulation1999;99:736-743.EventReductionwithStatinTherapyinPatientswithLowvs.HighHDL-C退伍军人高密度脂蛋白胆固醇干预试验(VA-HIT)研究背景：患者-2531名男性冠心病患者年龄-<74岁血脂水平-HDL-C40mg/dl(1.0mmol/l)LDL-C140mg/dl(3.6mmol/l)TG300mg/dl(3.4mmol/l)研究时间-平均随访时间为5.1年用药-安慰

3、剂-1267吉非贝齐-1264(1200mg/天)H.B.Rubinsetal.NEng.JMed.vol341no.6:410-418,1999退伍军人高密度脂蛋白胆固醇干预试验(VA-HIT)主要结果：血脂变化：HDL-C：+6%(达至0.9mmol)LDL-C：与安慰剂组无统计学差异(达至2.9mmol)TC:-4%(达至4.4mmol)TG：-31%(达至1.3mmol)H.B.Rubinsetal.NEngJMed1999;341:410-418VA-HITStudy:SummaryofRiskReductionResu

4、ltsCoronaryDeath-11%NS-22%NS-22%p<0.006-23%p<0.02NonfatalMINumberofPatients1Deathfromcoronarydiseaseandnon-fatalheartattacksTotalDeathPrimaryEvents1RubinsNEngJMed(1999)CORRELATIONOFLIPIDCHANGESTOCHDEVENTREDUCTIONIN4SLipidVariableRiskReductionP-ValueLDLcholesterol1.7<0.

5、00001HDLcholesterol0.80.039Triglycerides0.20.37Relationshipof1%changeinlipidcomponentfrombaselinetoyear1andtheincidenceofmajorcoronaryevents.UKProspectiveDiabetesStudyImpactofMajorCHDRiskFactorsSystolicBP10mmHg15%HbA1C1%11%LDLcholesterol1mmol/l57%HDLcholesterol0

6、.1mmol/l15%BMJ1998:316:823-8UKProspectiveDiabetesStudyOrderofPrioritiesforCHDRiskReduction1.LDLcholesterol2.DiastolicBP3.Smoking4.HDLcholesterol5.HbA1CTurnerRCetal.BMJ1998;316:823-82822.615.9/13.27.92.8PlaceboMIrateper100subjectsper5yearsWOS:NEJM1995;333:1301-1307CAR

7、E:NEJM1996;335:1001-1009LIPID:NEJM1998;339:1349-13574S:Lancet1994;344:1383-1389TexCAPS:JAMA1998;279:1615-1622MajorHMG-CoATrialsCAREn=4,159TC5.4mmol/lLIPIDn=9,014TC5.6mmol/lWOSn=6,595TC7.0mmol/l4Sn=4,444TC6.8mmol/lWithCHD+highcholesterolWithCHD+normalcholesterolWithoutC

8、HD+highcholesterolTexCAPSn=6,605TC5.7mmol/lWithoutCHD+lowHDLSTATINS冠心病二级预防试验4SCARELIPIDN444441599014TC(mmol/l)5.5-8<6