1、.,1,調(diào)脂在冠心病一二級(jí)預(yù)防的地位十個(gè)常見問題及答案探討,心內(nèi)科 常炳習(xí),.,2,Q 81:1721-1733.Am J Med.1984;76:4-12.,11,.,12,動(dòng)脈粥樣硬化與危險(xiǎn)因子的關(guān)系,12,At lowrisk of CAD,At moderate risk of CAD,At high risk of CAD,The cascade risk factors of AS,Major risk factors,.,13,Q 9(2):269-79. LaRosa JC, et al. N Engl J Med. 2005;352(14):1425-35. Nakamura

2、 H, et al. Lancet. 2006;368(9542):1155-63.,For CAD LDL-C the lower, the better,22,.,23,他汀循證的啟示及指南策略,23,.,24,Q 364(9436):771-7,兩組的差異與吸煙、年齡、性別、基線時(shí)診斷無關(guān)（心肌梗死、高血壓、 PCI/CABG、糖尿病、間歇性跛行等無關(guān)），但是與血脂水平有關(guān),延長期,延長期,延長期,35,.,36,Q 97suppl:77C81C),Are elevated in serum aminotransferase level associated with Statin th

3、erapy? Response: Yes Confidence/level of evidence: IA,Are statin-associated elevation in aminotransferase leveles indicate of liver damage or dysfubction? Response: No Confidence/level of evidence: 2C,43,.,44,Q & A 問題與答案,問 題 10,選擇何種他?。?-利益與學(xué)術(shù)的博弈,44,.,45,臨床藥物的選擇原則,45,.,46,里程碑式他汀類試驗(yàn)的臨床意義,4S （辛伐他?。?ccs

4、ps (洛伐他汀),LIPID CARE （普伐他汀）,WOSCOPS （普伐他?。?AFCAPS/TexCAPS （洛伐他汀）,二級(jí)預(yù)防,一級(jí)預(yù)防,高危冠心病患者,大多數(shù)冠心病患者,高危易患冠心病的患者,低危易患冠心病的患者,安慰劑組每100例5年的心肌梗死發(fā)生率,2.8,7.9,15.9 13.2,22.6,危險(xiǎn)性,46,.,47,10 Steps before You Refer for: Lipids,1. Repeat the Measurement 2. Identify the Pattern of Lipoprotein Abnormality 3. Exclude a Sec

5、ondary Cause 4. Confirm Need for Treatment 5. Take a Family History 6. Check Adherence to Lifestyle and Medication 7. Maximize Treatment to Target 8. Repeat Liver Function Tests if Raised 9. Check Creatine Kinase (CK) if Myalgia 10. Communicate Therapies Already Tried and their Outcomes,47,.,48,調(diào)脂治療的10個(gè)步驟,1、重復(fù)測量結(jié)果 2、判斷血脂異常類型 3、排除繼發(fā)性原因 4、確定是否需要治療 5、采集家族史 6、核查生活方式及藥物的依從性 7、盡可能治療到靶目標(biāo) 8、如果肝功異常復(fù)查 9、檢查激酶如果出現(xiàn)肌痛 10、交流收益與風(fēng)險(xiǎn),48,.,49,Summary 總結(jié),健康長壽及防治心血管疾病的基