1、Use of Lipid-lowering Agent in Acute Coronary Syndrome and Ischemic Stroke in TaiwanYi-Heng Li, MD, PhDDepartment of Internal MedicineCollege of MedicineNational Cheng Kung University成功大學(xué)醫(yī)學(xué)院內(nèi)科李貽恆脂藥物在急性冠心癥及腦中風(fēng)的使用課件Liao JK. Am J Cardiol. 2005;96(suppl 1):24F-33F.MMPs = matrix metalloproteinases Platel

2、et activation Coagulation Endothelial progenitor cells Effects on collagen MMPs AT1 receptor VSMC proliferation Endothelin Macrophages Inflammation Immunomodulation Endothelial function Reactive oxygen species NO bioactivityPleiotropic effects of statinsStatinsLiao JK. Am J Cardiol. 2005;96Statin in

3、 Acute Coronary SyndromeStatin in Acute Coronary SyndrMIRACL StudyRelative risk = 0.84P = .048AtorvastatinPlacebo0510150481216Time Since Randomization (weeks)Cumulative Incidence (%)Time to first occurrence of:Death (any cause)Nonfatal MIResuscitated cardiac arrestWorsening angina with new objective

4、 evidence and urgent rehospitalization17.4%14.8%Primary Efficacy MeasureSchwartz GG, et al. JAMA. 2001;285:1711-1718.Very early benefitMIRACL StudyRelative risk = 0.Statin Use in ACS: NCKUH ExperienceInclusion criteria: - January 2000 December 2004- patients admitted to the NCKUH with their first ep

5、isode of acute coronary syndrome- Receive statin therapy before dischargeExclusion criteria:- Patients who received statin within 1 months before admission - Patients who did not receive statin after admission - loss f/u during one year Li et al ACC 2007; Int Heart J 2007;48:677Statin Use in ACS: NC

6、KUH ExperACS in NCKUH Total: 符合 ICD-9 code 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%Li et al 2007 ACC; Int Heart J 2007;48:677ACS in NCKUH Total: 符合 ICD-9 LDL Control Rate During One Year in ACS Patients ( N =202 ) 115 mg/dl 100 mg/dl 70 mg/dl LDL-C Patients achieving goal (%)24Ea

7、rly group Late group Li et al 2007 ACC; Int Heart J 2007;48:677LDL Control Rate During One Ye Event-Free Survival Analysis at 4 months follow up（） Event-Free Survival Analysis Statin in Acute Ischemic Stroke and Transient Ischemic AttackStatin in Acute Ischemic StrokStatin in Acute Ischemic Stroke a

8、nd Transient Ischemic AttackRecommendations from the American Heart Association (AHA)/American Stroke Association (ASA) suggest that statin therapy should be used in the vast majority of patients with a history of ischemic stroke or TIA.However, it remains unclear as to how soon statin should be ini

9、tiated after acute ischemic stroke. Statin initiation during hospitalization for first ischemic stroke of atherosclerotic origin is probably justified based on ACS trialsStatin in Acute Ischemic StrokTaiwan Stroke RegistryTaiwan Stroke Registry, launched on May 1, 2006 and engaging 37 hospitals arou

10、nd Taiwan, prospectively collected data of patients who developed acute stroke or TIA and were hospitalized within 10 days after onset. All patients were followed up for at least 6 months after discharge.Taiwan Stroke RegistryTaiwan STaiwan Stroke Registry 8,429 pts with ischemic stroke or TIA All p

11、atients Pts with LAA & SVO Pts with CAD Hx 23% 27% 12% Percentage of pts receiving LLT at discharge Li et al 2008 AHATaiwan Stroke Registry Li et al 2008 AHADistribution of the Composite End Point at 6 Months Follow-upOverallLLT use at dischargeNo LLT use at discharge(n = 8429)(n = 2001)(n = 6428)Co

12、mposite end points: 567 (7)91 (5)476 (7)* All-cause mortality348 (4)41 (2)307 (5) Ischemic heart disease13 (0.13)1 (0.05)12 (0.19) Stroke224 (3)52 (2)172 (3)Data are presented as numbers of patients (%); *p0.001. Li et al 2008 AHEvent-Free Survival Analysis at 6 months Follow-up Li et al 2008 AHAEvent-Free Survival Analysis aConclusionsHMGCoA reductase inhibitors (statins) are effective lipid-lowering drugs with clinical evidence to reduce vascular events.There was a in-hospital under-prescription of statin in our acute coronary syndro