《PROVE-IT TIMI-22A to Z RIO-EUROPE研究PPT课件》由会员分享，可在线阅读，更多相关《PROVE-IT TIMI-22A to Z RIO-EUROPE研究PPT课件（48页珍藏版）》请在金锄头文库上搜索。
1、Heartbeat ESC 2004 ESC 2004 ESC 2004: Learning as a journey Valentin Fuster MD Director, Cardiovascular Institute Mount Sinai Medical Center New York, NY Christopher Cannon MD Staff cardiologist Brigham and Womens Hospital Boston, MA James Ferguson MD Associate Director, Cardiology St Lukes Episcopa
2、l Hospital and Texas Heart Institute Houston, TX Michael Weber MD Professor of Medicine SUNY Downstate College of Medicine Brooklyn, NY Heartbeat ESC 2004 ESC 2004 PROVE-IT TIMI-22 Pravastatin or atorvastatin evaluation and infection therapy A to Z Aggrastat to Zocor RIO-EUROPE Rimonabant in Obesity
3、 - Europe Topics Heartbeat ESC 2004 ESC 2004 Pravastatin or Atorvastatin Evaluation and Infection Therapy PROVE-IT TIMI-22 Heartbeat ESC 2004 ESC 2004 PROVE-IT: Background Previous studies have shown that patients with high titers of Chlamydia pneumoniae at greater risk of MI PROVE-IT TIMI-22 and AC
4、ES presented at ESC 2004 Heartbeat ESC 2004 ESC 2004 PROVE-IT: Design Long-term study of antibiotic therapy against Chlamydia pneumoniae on the occurrence of cardiovascular events in patients with coronary heart disease 4162 patients with ACS (3X upper limit of normal) 0.04 0.4 (n=9; all on simvasta
5、tin 80 mg) Rhabdomyolysis (CK10 000 units/L)-3 of 9 myopathy cases De Lemos J et al. JAMA 2004 Heartbeat ESC 2004 ESC 2004 A to Z: Safety profile “It is a useful reminder to all of us that we do have to keep safety on the radar screen. We cant put this in the drinking water.” Careful in using simvas
6、tatin 80 mg, whereas 40 mg dose looks fine - Cannon Heartbeat ESC 2004 ESC 2004 A to Z: Case study In a patient with unstable angina, are you concerned about lipid levels during the acute phase? Are you using a statin during the acute phase? If yes, what statin will you use, and what dose? Fuster He
7、artbeat ESC 2004 ESC 2004 A to Z: Three questions I care about the lipid levels, but Im not going to treat elevated lipid levels in the acute phase Data still soft on benefit during the acute phase of treatment Once stable, I would start with high-dose atorvastatin Ferguson Heartbeat ESC 2004 ESC 20
8、04 A to Z: Three questions “Weve learned that there doesnt seem to be any benefit from super-early treatment of high lipid levels.” Once stable, then start statin therapy Based on evidence, I would start with high-dose atorvastatin Weber Heartbeat ESC 2004 ESC 2004 A to Z: Three questions Start stat
9、in, on admission, across the board In ACS patients, start statin therapy aggressively and early Aim to lower LDL levels to 60 or 70 mg/dL as shown in PROVE-IT Atorvastatin 80 mg, but more cautious with simvastatin 80 mg Cannon Heartbeat ESC 2004 ESC 2004 A to Z: Switching statins In a patient with u
10、nstable angina who is currently taking simvastatin 40 mg, would you switch to atorvastatin? Fuster Heartbeat ESC 2004 ESC 2004 A to Z: Switching statins “On the one hand you say this guys already been on simvastatin and its let him down.” Not good enough for this patient Absolute event rate in A to
11、Z still quite low Weber Heartbeat ESC 2004 ESC 2004 A to Z: Switching statins I would not reflexively switch from product X to product Y Depends on the LDL number and if patient is at goal Ferguson Heartbeat ESC 2004 ESC 2004 Rimonabant in Obesity Europe RIO-Europe Heartbeat ESC 2004 ESC 2004 RIO-Eu
12、rope: Rational Obesity a world wide epidemic The so-called “pleasure center” may generate appetite and tobacco addiction A new drug, rimonabant, blocks the CB1 receptor The question is, can taking this drug decrease appetite and help stop smoking at the same time? Heartbeat ESC 2004 ESC 2004 RIO-Eur
13、ope: Design and Results 1500 overweight patients Randomized to rimonabant 20 mg, rimonabant 5 mg, or placebo One year follow-up Patients in the 20 mg dose lost 6.6 kg, those on the 5 mg dose lost 3.4 kg, and those on placebo lost 1.8 kg In patients on the 20 mg dose: HDL increased by 27%, triglyceri
14、des decreased by 10%, and proportion of patients with metabolic syndrome decreased by 50% Heartbeat ESC 2004 ESC 2004 RIO-Europe: Results “It seems to me that we are dealing with something quite striking.” Fuster Heartbeat ESC 2004 ESC 2004 RIO-Europe “I am excited about this, I think that this is a
15、bsolutely fascinatingbut you gotta worry a little bit about a drug thats a pleasure-center blocker.” Significant clinical applications No quick fix, no magic pill Ferguson Heartbeat ESC 2004 ESC 2004 RIO-Europe HDL and triglycerides linked to insulin sensitivity In early phase of weight loss: a shar
16、p improvement in insulin sensitivity HDL: One of the most difficult things to manipulate anything that can increase HDL is exciting “I am a bit concerned . . . What happens when you stop this drug?” - Weber Heartbeat ESC 2004 ESC 2004 RIO-Europe Smoking cessation aid is desperately needed Reduction in CRP also promising “Its a fascinating, multifactorial agent.” - Cannon Heartbeat ESC
