【文档说明】降血脂药物在急性冠心症及脑中风的使用详解课件.ppt，共(16)页，2.313 MB，由小橙橙上传

转载请保留链接：https://www.ichengzhen.cn/view-234884.html

以下为本文档部分文字说明：

UseofLipid-loweringAgentinAcuteCoronarySyndromeandIschemicStrokeinTaiwanYi-HengLi,MD,PhDDepartmentofInternalMedicineCollegeofMe

dicineNationalChengKungUniversityLiaoJK.AmJCardiol.2005;96(suppl1):24F-33F.MMPs=matrixmetalloproteinas

esPlateletactivationCoagulationEndothelialprogenitorcellsEffectsoncollagenMMPsAT1receptorVSMCproliferationEndothelinMacrophagesInf

lammationImmunomodulationEndothelialfunctionReactiveoxygenspeciesNObioactivityPleiotropiceffectsofstati

nsStatinsStatininAcuteCoronarySyndromeMIRACLStudyRelativerisk=0.84P=.04895%CI0.701-0.999AtorvastatinPl

acebo0510150481216TimeSinceRandomization(weeks)CumulativeIncidence(%)Timetofirstoccurrenceof:•Death(anycause)•NonfatalMI•Resuscitatedcardi

acarrest•Worseninganginawithnewobjectiveevidenceandurgentrehospitalization17.4%14.8%PrimaryEfficacyMeasureSchwartzGG,etal.JAMA.2001;285:1711-

1718.VeryearlybenefitStatinUseinACS:NCKUHExperience⚫Inclusioncriteria:-January2000~December2004-patien

tsadmittedtotheNCKUHwiththeirfirstepisodeofacutecoronarysyndrome-Receivestatintherapybeforedischarge⚫Exclu

sioncriteria:-Patientswhoreceivedstatinwithin1monthsbeforeadmission-Patientswhodidnotreceivestatinaf

teradmission-lossf/uduringoneyearLietalACC2007;IntHeartJ2007;48:677ACSinNCKUH05010015020025030035020002001200220032004符合ICD-9(

人）住院有用statin(人）★Total:符合ICD-9code共1248人次其中住院期間有用statin共480人次11.1%42.7%39.6%48.9%42.1%Lietal2007ACC;IntHe

artJ2007;48:677LDLControlRateDuringOneYearinACSPatients(N=202)010203040<115mg/dl<100mg/dl<70mg/dlLDL-CPa

tientsachievinggoal(%)35.530.22426.46.33.8EarlygroupLategroupLietal2007ACC;IntHeartJ2007;48:677Event-FreeSurvivalAnalysisat4monthsfollowupp=0

.238RR1.73（95%CI0.69-4.33）StatininAcuteIschemicStrokeandTransientIschemicAttackStatininAcuteIschemicStrokeandTransientIsche

micAttack⚫RecommendationsfromtheAmericanHeartAssociation(AHA)/AmericanStrokeAssociation(ASA)suggestthatstatintherapyshouldbeusedinthevastmajorityofpa

tientswithahistoryofischemicstrokeorTIA.⚫However,itremainsunclearastohowsoonstatinshouldbeinitiatedafteracuteischemicstroke.⚫Statininitiationdurin

ghospitalizationforfirstischemicstrokeofatheroscleroticoriginisprobablyjustifiedbasedonACStrialsTaiwanStrokeR

egistry⚫TaiwanStrokeRegistry,launchedonMay1,2006andengaging37hospitalsaroundTaiwan,prospectivelycollecteddataofpatientswh

odevelopedacutestrokeorTIAandwerehospitalizedwithin10daysafteronset.⚫Allpatientswerefollowedupforatleast6monthsaf

terdischarge.TaiwanStrokeRegistry8,429ptswithischemicstrokeorTIA051015202530AllpatientsPtswithLAA&SVOPtswithCADHx23%27%12%Percentag

eofptsreceivingLLTatdischargeLietal2008AHALietal2008AHADistributionoftheCompositeEndPointat6MonthsFollow-upOvera

llLLTuseatdischargeNoLLTuseatdischarge(n=8429)(n=2001)(n=6428)Compositeendpoints:567(7)91(5)476(7)*All-cause

mortality348(4)41(2)307(5)Ischemicheartdisease13(0.13)1(0.05)12(0.19)Stroke224(3)52(2)172(3)Dataarepre

sentedasnumbersofpatients(%);*p<0.001.1160561060946428LLT(-)337180019242001LLT(+)180906030DaysafterdischargeNumbersatriskDaysafterd

ischargeLog-ranktestP<0.0001LLTatdischargeyesno03060901201501800.800.850.900.951.00Probabilityofevent-freeDaysafterdischargeEvent-FreeSurvivalAnaly

sisat6monthsFollow-upLietal2008AHAConclusions⚫HMGCoAreductaseinhibitors(statins)areeffectivelipid-loweringdrugswithclinicalevidenceto

reducevascularevents.⚫Therewasain-hospitalunder-prescriptionofstatininouracutecoronarysyndrome(ACS)andischemicstroke(IS)patients.⚫Mo

reaggressivetreatmentofLDLisnecessaryinourACSandISpatients.ThankYouforYourAttention