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UseofLipid-loweringAgentinAcuteCoronarySyndromeandIschemicStrokeinTaiwanYi-HengLi,MD,PhDDepartmentofInternalMedicineCollegeofMedicineNa

tionalChengKungUniversity成功大學醫學院內科李貽恆LiaoJK.AmJCardiol.2005;96(suppl1):24F-33F.MMPs=matrixmetalloprot

einasesPlateletactivationCoagulationEndothelialprogenitorcellsEffectsoncollagenMMPsAT1receptorVSMCproliferationEndothelinMacrop

hagesInflammationImmunomodulationEndothelialfunctionReactiveoxygenspeciesNObioactivityPleiotropiceffects

ofstatinsStatinsStatininAcuteCoronarySyndromeMIRACLStudyRelativerisk=0.84P=.048AtorvastatinPlacebo0510150481216TimeSinceRandomizati

on(weeks)CumulativeIncidence(%)Timetofirstoccurrenceof:•Death(anycause)•NonfatalMI•Resuscitatedcardiaca

rrest•Worseninganginawithnewobjectiveevidenceandurgentrehospitalization17.4%14.8%PrimaryEfficacyMeasureSchwartzGG,etal.JAMA.2001;285:1711-1718.Very

earlybenefitStatinUseinACS:NCKUHExperience⚫Inclusioncriteria:-January2000~December2004-patientsadmittedtotheNCKUHwiththeirfirstep

isodeofacutecoronarysyndrome-Receivestatintherapybeforedischarge⚫Exclusioncriteria:-Patientswhoreceivedstatinwithin1monthsbeforeadmission-Patientswho

didnotreceivestatinafteradmission-lossf/uduringoneyearLietalACC2007;IntHeartJ2007;48:677ACSinNCKUH050100150200250300350200020012002200320

04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%Lietal2007

ACC;IntHeartJ2007;48:677LDLControlRateDuringOneYearinACSPatients(N=202)010203040<115mg/dl<100mg/dl<70mg/dlLDL-CPatientsachievinggoal(%

)24EarlygroupLategroupLietal2007ACC;IntHeartJ2007;48:677Event-FreeSurvivalAnalysisat4monthsfollowup（）StatininAcuteIschemicStrokeandT

ransientIschemicAttackStatininAcuteIschemicStrokeandTransientIschemicAttack⚫RecommendationsfromtheAmericanHeartAssociation(AHA)/AmericanSt

rokeAssociation(ASA)suggestthatstatintherapyshouldbeusedinthevastmajorityofpatientswithahistoryofischemicstrokeorTIA.⚫How

ever,itremainsunclearastohowsoonstatinshouldbeinitiatedafteracuteischemicstroke.⚫Statininitiationduri

nghospitalizationforfirstischemicstrokeofatheroscleroticoriginisprobablyjustifiedbasedonACStrialsTaiwa

nStrokeRegistry⚫TaiwanStrokeRegistry,launchedonMay1,2006andengaging37hospitalsaroundTaiwan,prospectivelycollecteddataofpatientswhodevelopedacutest

rokeorTIAandwerehospitalizedwithin10daysafteronset.⚫Allpatientswerefollowedupforatleast6monthsafterdischarge.TaiwanStrokeRegistry8,429ptswithischemic

strokeorTIA051015202530AllpatientsPtswithLAA&SVOPtswithCADHx23%27%12%PercentageofptsreceivingLLTatdischargeLietal2

008AHALietal2008AHADistributionoftheCompositeEndPointat6MonthsFollow-upOverallLLTuseatdischargeNoLLTuseatdischarge(n=8429)(n=2001)(n=6428)Composit

eendpoints:567(7)91(5)476(7)*All-causemortality348(4)41(2)307(5)Ischemicheartdisease13(0.13)1(0.05)12(0.19)Stroke224(3)52(2)17

2(3)Dataarepresentedasnumbersofpatients(%);*p<0.001.1160561060946428LLT(-)337180019242001LLT(+)180906030DaysafterdischargeNumbersatri

skDaysafterdischargeLog-ranktestP<0.0001LLTatdischargeyesno03060901201501800.800.850.900.951.00Probabilityofevent-freeDays

afterdischargeEvent-FreeSurvivalAnalysisat6monthsFollow-upLietal2008AHAConclusions⚫HMGCoAreductaseinhibitors(stati

ns)areeffectivelipid-loweringdrugswithclinicalevidencetoreducevascularevents.⚫Therewasain-hospitalunder-prescriptionofstatininouracutecoronarysy

ndrome(ACS)andischemicstroke(IS)patients.⚫MoreaggressivetreatmentofLDLisnecessaryinourACSandISpatients.ThankYouforYourAttention