北京大学深圳医院吴淳. Intraduction-- European Guidelines,HPS In low risk of vascular disease Neuroprotective Effects Atrial Fibrillation After CABG Renal

北京大学深圳医院吴淳

Intraduction-- European Guidelines,HPS In low risk of vascular disease Neuroprotective Effects Atrial Fibrillation After CABG Renal function and CKD Systolic HF Atherosclerosis (Atorvastatin Versus

Rosuvastatin) Residual Vascular Risk

combination (sitagliptin /ezetimibe) Discontinuation was side effects(62%) New-Onset Diabetes, Muscular side effects Non-every day statin administration A Sex-Based Meta-analysis Early statin therapy for ACS Recommendations on management of

hyperlipidaemia

Increased plasma cholesterol and LDL cholesterol are among the main risk factors for CVD.

Hypertriglyceridaemia and low HDL cholesterol are independent CVD risk factors.

Statin therapy has a beneficial effect on atherosclerotic CVD outcomes.

European Heart Journal doi:10.1093/eurheartj/ehs092

In a population at 2% average coronary event risk per year, cholesterol, apolipoprotein, and particle measures of LDL were strongly correlated and had similar predictive values for incident major occlusive vascular events.

It is unclear whether the associations between HDL particle numbers and other cardiac events represent a causal or reverse-causal effect.

此项为期 5.3 年的随访性随机辛伐他汀 - 安慰剂心脏保护试验入组了 20,000 例患者，共计 5,000 项血管事件

(Circulation. 2012;125:2469-2478.)

(Circulation. 2012;125:2469-2478.)

Statin reduced the risk of major vascular events irrespective of age, sex, baseline LDL cholesterol or previous vascular disease

No evidence that reduction of LDL cholesterol with a statin increased cancer incidence, cancer mortality, or other non-vascular mortality.

Each 1 mmol/L reduction in LDL cholesterol produced an absolute reduction in major vascular events of about 11 per 1000 over 5 years. 。meta-analysis of individual data from 27 randomised trials

Cholesterol Treatment Trialists’ (CTT) Collaborators Published Online May 17, 2012

Our recommendation would be start a statin as soon as the patient passes a dysphagia screen.

Based on the results of the Heart Protection Study and the SPARCL trial, either simvastatin 40 mg or atorvastatin 80 mg are appropriate alternatives.

Clinical trials are needed to demonstrate unequivocal efficacy of improved outcome and to determine if lower doses may have this effect.

Additionally,improved outcome needs to be established in cardioembolic stroke patients before routine use of statins in this stroke subtype can be recommended.

Current Treatment Options in Cardiovascular Medicine (2012) 14:252–259

Current Treatment Options in Cardiovascular Medicine (2012) 14:252–259

12,689 patients with ischemic stroke over a 7-year period at 17 hospitals

Statin use is strongly associated with improved discharge disposition after ischemic stroke.

Neurology 2012;78:1678–1683

Neurology 2012;78:1678–1683

Neurology 2012;78:1678–1683

Studied 1,839 consecutive patients (1,177 men [73.2%]) who underwent CABG

Atorvastatin pretreatment significantly reduced the occurrence of AF after bypass grafting;

The difference between the beneficial effects of intensive and routine atorvastatin treatments was not significant.

International Journal of Cardiology xxx (2012) xxx–xxx


Cholesterol reduction is very important in people with GFR values >15 ml/min who are not on dialysis.

In the PREVEND- IT trial, subjects with microalbuminuria were treated with pravastatin No effect on the rate of cardiovascular events

The 4D study and AURORA trial did not differ in the resultant rates of cardiovascular events.

The SHARP trial ， there was a significant 17% risk reduction for the primary outcome of a major atherosclerotic event ， Of 3,023 study patients on dialysis, there were no differences

23 trials enrolling 29,147 participants were included

A significant reduction in GFR was detected in placebo-treated

No significant difference in GFR was detected in 5 head-to-head studies

In 9 studies, R treatment significantly increased the risk of proteinuria

A and R show similar reno-protective effects in patients at high cardiovascular risk, with comparable rates of new onset proteinuria when commonly used doses are considered

Contrib Nephrol. Basel, Karger, 2012, vol 178, pp 100–105





Atorvastatin and rosuvastatin comparably

reduce the decline of renal function in patients at high cardiovascular risk without chronic kidney disease

Atorvastatin improves renal function in high-risk patients with chronic kidney disease.


Of 10,001 TNT participants, 9,376 had estimated glomerular filtration rate (eGFR) measurements at baseline and 1 year.

Little change in eGFR occurred over 1 year in the atorvastatin 10-mg group, whereas eGFR improved in the 80-mg group by 1.48 ml/min/1.73 m2

This suggests that improvement in kidney function may be related to the beneficial effect of high-dose atorvastatin on HF hospitalization.( 大剂量阿托伐他汀的使用改善了肾脏功能从而使得心衰住院率下降。 )

)

(Am J Cardiol 2012;109:1761–1766

Patients with systolic HF of ischaemic aetiology who have galectin-3 values <19.0 ng/mL may benefit from rosuvastatin treatment.

However, the data from this post hoc analysis should be interpreted with caution since the overall results of the CORONA study did not show a significant effect on the primary endpoint

European Heart Journal Advance Access published May 7, 2012



ARTMAP Trial

Atherosclerosis

Atorvastatin Versus Rosuvastatin

Am J Cardiol 2012;109:1700–1704)

ARTMAP TrialAm J Cardiol 2012;109:1700–1704)

J Am Coll Cardiol. 2012; 59 (13) Suppl Sxxx SATURN 研究分析：降脂幅度与斑块逆转

Atherosclerosis Atorvastatin Versus Rosuvastatin

p<0.0001 p<0.0001 p<0.028 p=0.01 p<0.0001

N=1039

P=0.01

SATURN 研究分析：降脂幅度与斑块逆转整个队列的 TAV变化与各项血脂生化指标之间的关联度

指标 r （相关系数） p

LDL-C 0.11 0.0007

non-HDL-C 0.1 0.002

LDL-C/HDL-C 0.09 0.002

Apo B 0.09 0.004

Apo B/A-I 0.07 0.03

HDL-C -0.01 0.79

Apo A-I 0.02 0.55

“ 与具有保护性的脂质相比，致动脉粥样硬化性的脂质水平对斑块体积变化更密切。这一发现让我们洞见了为什么瑞舒伐他汀组实现了更佳的斑块逆转。Achieved levels of atherogenic lipid levels associate more closely with changes in atheroma volume compared with changes in protective lipid variables. These findings provide mechanistic insight into the greater degree of regression observed in rosuvastatin-treated patients.“

——Stephen J. Nicholls

J Am Coll Cardiol. 2012; 59 (13) Suppl Sxxx

In this primary prevention trial of nondiabetic individuals with low LDL-C and elevated high-sensitivity C-reactive protein,on-treatment LDL-C was as valuable as non–HDL-C, apolipoprotein B, or ratios in predicting residual risk.

In contrast, on-treatment triglycerides showed no association with CVD

(JUPITER—Crestor 20mg Versus Placebo in Prevention of Cardiovascular [CV] Events; NCT00239681)

(J Am Coll Cardiol 2012;59:1521–

8)

Recent clinical trials with statins have confirmed that reducing LDL cholesterol to low levels results in improved outcomes in both primary and secondary prevention.

Trials with fibrates, omega-3 fatty acids, niacin, ezetimibe, and CETP inhibitors additionally have sought to reduce residual cardiovascular risk beyond the effects of statin therapy.

Ongoing research will help clarify the specific roles of inflammation, HDL cholesterol, and triglycerides

(J Am Coll Cardiol 2012;59:1521–8)

In CARDS, atorvastatin has proven its remarkable efficacy in improving lipid profile and reducing CVD events in patients with T2DM.

some recent data suggested that atorvastatin, like other statins, may slightly deteriorate glucose control and increase new-onset diabetes.

DPP-4 inhibitors (gliptins) improve fasting and postprandial glucose levels, without promoting hypoglycemia or weight gain (two adverse events that may increase the CVD risk).

Atorvastatin and sitagliptin are not prone to PK drug—drug interactions.

Expert Opin. Drug Metab. Toxicol. (2012) 8(6)

A total of 136 patients Undergoing Elective Vascular

Surgery assigned to RSV and 126 to RSV/EZT completed the study protocol.

Our findings indicate that statin therapy intensified by ezetimibe may reduce the incidence of cardiovascular events within the first 12 months after vascular surgery.

Nonetheless, whether the use of ezetimibe as an add-on therapy to reduce cardiovascular risk in these patients needs to be tested in larger future studies.

J CARDIOVASC PHARMACOL THER published online 9 May 2012

J CARDIOVASC PHARMACOL THER published online 9 May 2012

Participants (mean age 61 years) were predominantly white (92%), female (61%), of middle, and had health insurance (93%).

The primary reason for switching by current users was cost (32%) and the primary reason for discontinuation was side effects(62%).

Although70% reported that their physicians had explained the importance of cholesterol levels for their heart health former users were less satisfied with the discussions(65% vs. 83%, P <05)

Journal of Clinical Lipidology (2012) 6, 208–215

Nutrition, Metabolism & Cardiovascular Diseases (2012) xx, 1e5


A survey in real life, 10,409 French subjects.

Muscular symptoms were reported by 104 (10%) statin treated patients and led to discontinuation in 30% of the symptomatic patients.

Approximately 38% of patients reported that their symptoms prevented even moderate exertion, while 42% of patients suffered major disruption to their everyday life.

Muscular symptoms have a greater impact than usually thought



Alternate day regimens An LDL-C level <100 mg/dl was achieved by 57.6% of diabetic patients treated with a mean dose of 5.6 mg atorvastatin,while 70% achieved with rosuvastatin at a mean dose of 10 mg

Twice weekly regimens Once a week regimens Non-every day statins combined with

other lipid-lowering agent regimensEuropean Journal of Internal Medicine 23 (2012) 474–478

European Journal of Internal Medicine 23 (2012) 474–478

阿托伐他汀与瑞舒伐他汀隔日治疗可被对于他汀治疗不耐受的病患。

但是，这些治疗方法对于心血管事件是由有效仍不清楚。

European Journal of Internal Medicine 23 (2012) 474–478

Eleven trials representing 43 193 patients were included in the analysis.

Statin therapy is an effective intervention in the secondary prevention of cardiovascular events in both sexes.

But there is no benefit on stroke and all cause

mortality in women.Arch Intern Med. 2012;172(12):909-919

Arch Intern Med. 2012;172(12):909-919

Arch Intern Med. 2012;172(12):909-919

对于男性以及女性，他汀对于心血管事件二级预防有效，但他汀治疗对于女性卒中及全因死亡并无益处。

Arch Intern Med. 2012;172(12):909-919

Meta-analysis of 18 randomized trials involving over 14,000 Ps

Risk ratios for the combined endpoint of death, myocardial infarction, and stroke of early statin therapy compared to control were 0.93 (P=0.34) at 1 month and 0.93 (P=0.27) at 4 months

Unstable angina with a risk ratio of 0.76 ( P=0.02) at 4 months

International Journal of Cardiology 158 (2012)93–100

International Journal of Cardiology 158 (2012)93–100

在 ACS 发病内 14 天使用他汀治疗能够获益，但随后的 4 个月中，死亡率、心肌梗死率、卒中并无明显下降，而不稳定型心绞痛发生率可以降低。 International Journal of Cardiology 158

(2012)93–100

European Heart Journal (2012) 33, 1635–1701European Heart Journal 2011;32:1769–1818 CV-1209-CR-0173 有效期至 2013

年 9 月

D A Wood. 2012 ESC presented. http://spo.escardio.org/SessionDetails.aspx?id=402425

CV-1209-CR-0173 有效期至 2013年 9 月

欧洲目前使用他汀的现状- 有多少真正需要他汀的人服用了他汀

欧洲人通常服用他汀 6 个月后，只有一半能坚持

Marazzi G. 2012 ESC presented. http://spo.escardio.org/SessionDetails.aspx?id=402424CV-1209-CR-0173 有效期至 2013年 9 月

终止治疗的中位时间一级预防： 3.4 年二级预防： 3.7 年

数据来源：美国中西部大学附属医院 1998.1 至 2001.11 共 2544 例一级预防、 2258 例二级预防的患者。

Marazzi G. 2012 ESC presented. http://spo.escardio.org/SessionDetails.aspx?id=402424

二级预防平均停药时间 3.7 年，一级预防平均停药时间 3.4年

CV-1209-CR-0173 有效期至 2013年 9 月

Belgium

Slovenia

Italy

Ireland

Germany

Netherlands

UK

Czech Republic

Finland

Latvia

Poland

Russia

Lithuania

France

Croatia

Spain

Romania

Greece

Cyprus

Hungary

Bulgaria

Turkey

K Kotseva Eur J Cardiovasc Prev Rehabilitation 2009; 16:121-37D A Wood. 2012 ESC presented. http://spo.escardio.org/SessionDetails.aspx?id=402425

EUROASPIRE III

22 个国家， 8966 名冠状动脉疾病患者关于

生活方式、危险因素、心血管药物治疗的调查

CV-1209-CR-0173 有效期至 2013年 9 月

22.9%

20.1%

16.3%

13.4%

29.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

GermanyLatvia

Bulgaria

Russian FederationLithuania

All patients: 34.1%Men 37.8% , Women 23.1%

55.7%

51.3%

49.7%

* Total cholesterol < 4 mmol/L among patients using lipid-lowering drugs

41.7%

35.6%

35.2%

46.6%

45.9%

42.6%

34.6%

33.9%

33.8%

31.8%

31.4%

31.1%

30.8%

29.5%

CroatiaBelgiumHungary

CyprusItaly

Poland

United KingdomFinlandIreland

The NetherlandsTurkey

GreeceFrance

Romania

SpainSlovenia

Czech Republic

EUROASPIRE III

通过滴定法，总胆固醇达到目标的比例 *


CV-1209-CR-0173 有效期至 2013年 9 月

* Total cholesterol < 4 mmol/L among patients using lipid-lowering drugs

7.7%

6.6%

6.6%

24.9%

19.8%

17.9%

13.6%

12.1%

9.1%

8.2%

8.0%

7.8%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Bulgaria

Romania

Latvia

UK

Slovenia

Finland

Spain

Italy

Belgium

Croatia

Germany

Poland

All patients: 13.2%Men 19.1% , Women 8.8%

EUROASPIRE III- Primary Care （一级预防）通过滴定法，总胆固醇达到目标的比例 *


CV-1209-CR-0173 有效期至 2013年 9 月

Yang W.Y., et al. Circulation. 2012;125:2212-2221.

中国 46239 成人的胆固醇治疗的知晓率、治疗率和控制率

连续入选在2011 年 3 月至 12 月期间， 19 个省84 家医院心内科门诊，共计 12244 例患者

2012 年中国门诊患者血脂达标率现况调查REALITY-CHINA SURVEY

Zhou YJ, et al. 2012 ACC presented on March 26,2012 ， at Chicago

危险分层与 LDL-C 达标率

2012 年中国门诊患者血脂达标率现况调查REALITY-CHINA SURVEY

Zhou YJ, et al. 2012 ACC presented on March 26,2012 ， at Chicago

按照低危，中危，高危和极高危分层后，门诊患者的达标率分别为38.1% ， 29.7% ， 19.9% 和 21.1% ，尤其高危和极高危患者达标率反而是最不理想的。

CV-1209-CR-0173 有效期至 2013年 9 月

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)

谢谢

Documents

北京大学深圳医院 吴淳. Intraduction-- European Guidelines,HPS In low risk of vascular disease Neuroprotective Effects Atrial Fibrillation After CABG Renal

北京大学深圳医院吴淳. Intraduction-- European Guidelines,HPS In low risk of vascular disease Neuroprotective Effects Atrial Fibrillation After CABG Renal