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1、现代脂质三联治疗课件,1,现代脂质三联治疗,现代脂质三联治疗课件,2,Introduction,Part I,现代脂质三联治疗课件,3,Efficacy - The Power to Reach Target,Key Factor: +Differentiators: LDL ReductionTG HDL LDL/HDL Ratio The Lipid Triad,现代脂质三联治疗课件,4,The LDL/HDL Ratio - Our Strength, Our Story!,A new perception of efficacy,现代脂质三联治疗课件,5,LDL,HDL,Additio
2、nal risk factor, especially in diabetics,The Lipid Triad - Overview,TG,The Lipid Triad,The Ratio,现代脂质三联治疗课件,6,The Lipid Triad and Strategic Rationale,Part II,现代脂质三联治疗课件,7,No scientific evidence Evidence contradicting this statement A marketing hypothesis to build their LDL story Creating the percept
3、ion of the statin with the strongest efficacy,The lower. .the better?,现代脂质三联治疗课件,8,Its logical,Its measurable,Its practicable,The Lipid Triad - The GPs Perspective,现代脂质三联治疗课件,9,HDL,LDL,现代脂质三联治疗课件,10,Supporting Data from Landmark Studies,Part III,现代脂质三联治疗课件,11,12 10 8 6 4 2 0,% Mortality,Placebo Q1 Q
4、2 Q3 Q4 (low HDL-increase) (high HDL-increase),4S - Study,CAD Mortality per Quartiles of Increases in HDL-Cholesterol,KJEKSHUS J 341:410,0,6,-31,-4,-35,-30,-25,-20,-15,-10,-5,0,5,10,Cholesterol LDL-C HDL-C Triglycerides,Percent change compared to placebo at 1 year,Secondary Prevention in 2531 menwit
5、h low HDL-C 79: 8 - 15.,HDL - C mg / dl 65 55 45 35,LDL - Cholesterol mg / dl,LDL - Cholesterol mg / dl,12 10 8 6 4 2 0,100 130 160 190,现代脂质三联治疗课件,14,0,0.5,1,1.5,2,2.5,3,Framingham Heart Study,CAD risk as a function of LDL-C and HDL-C in men (50 to 70 y),CASTELLI WP. Am J Cardiol 1998; 82:60-65,220
6、160 100,85,65,45,25,HDL-Cholesterol (mg/dl),LDL Cholesterol (mg/dL),现代脂质三联治疗课件,15,0,2,4,6,8,10,12,14,16,LDL=5,LDL5,HDL=1.08,HDL1.08,LDL/HDL=5,LDL/HDL5,Incidence of cardiac events,(per 1000 person-years),Gemfibrozil,Placebo,LDL-C Tertiles (mmol/L),HDL-C Tertiles (mmol/L),LDL-C/HDL-C Tertiles,Incidenc
7、e for cardiac events vs lipid parameter,Helsinki Heart Study,MANNINEN V, Leena T, Koskinen P et al. Circulation 1992; 85: 37-45,现代脂质三联治疗课件,16,AFCAPS/TEXCAPS,Apo B/A1 Tertiles,LDL-C/HDL-C Tertiles,1.6,1.4,1.2,1,0.8,0.6,0.4,0.2,0,1.6,1.4,1.2,1,0.8,0.6,0.4,0.2,0,Event Rate per 100 Patient-Years of Risk
8、,Event Rate per 100 Patient-Years of Risk, 0.8889,0.8898- 1.0205,1.0252, 3.7742,3.7744-4.4096,4.4101,GOTTO A et al. Circulation 2000; 101: 477-484,LDL/HDL Ratio as Therapeutic Success,Placebo,Statin,现代脂质三联治疗课件,17,24,116,31,245,0,50,100,150,200,250,300,= 5, 5,LDL / HDL - Ratio,Triglycerides 200 mg/dl
9、,Triglycerides = 200 mg/dl,CAD cases per 1,000 subjects in 6 years,ASSMANN G and SCHULTE H; Am J Cardiol 1992; 70: 733-737,Incidence of CAD vs LDL/HDL ratio by TG level (n = 4559),PROCAM Heart Study,现代脂质三联治疗课件,18,0,50,100,150,200,250,300,3,4,5,5,6,7,LDL/HDL ratio,CHD Incidence/1000 in 6 years,CHD ri
10、sk according to LDL/HDL ratio at baseline,ASSMANN G; Lipid Metabolism Disorders and CHD; MMV Medizin Verlag, 1993: 43,5,High CHD risk,Medium CHD risk,Low CHD risk,3-5,3,PROCAM Heart Study,现代脂质三联治疗课件,19,Mean values for developing atherosclerotic CHD within 6 years,Variable CHD Development No CHD Deve
11、lopment (n = 186)(n = 4221) TC (mg/dl)251.8222.9 HDL-C (mg/dl) 39.5 45.2 LDL-C (mg/dl) 176.2 147.1 LDL/HDL ratio 4.72 3.4 TG (mg/dl)163.0134.5,ASSMANN G; Lipid Metabolism Disorders and CHD; MMV Medizin Verlag, 1993: 41,PROCAM Heart Study,现代脂质三联治疗课件,20,Predictive value of risk factors for developing
12、atherosclerotic CHD within 6 years,Variable Risk RatioPredictive Power % TG 200 mg/dl2.3 7.5 TC 250 (mg/dl)2.8 8.3 LDL-C 195 (mg/dl) 3.7 12.0 LDL-C 155 (mg/dl) 3.3 7.1 HDL-C 35 (mg/dl) 3.911.0 LDL/HDL ratio 56.416.5,ASSMANN G; Lipid Metabolism Disorders and CHD; MMV Medizin Verlag, 1993: 43,PROCAM H
13、eart Study,现代脂质三联治疗课件,21,HDL as CHD risk factor showed 186 events, in men aged 40 - 60 years (n = 4407),CHD Incidence per 1, 000 in 6 years,0,20,40,60,80,100,120,140,160, 35 35 - 55 55,HDL-C (mg/dL),110,30,21,ASSMANN G; Lipid Metabolism Disorders and CHD; MMV Medizin Verlag, 1993: 59,PROCAM Heart St
14、udy,现代脂质三联治疗课件,22,LDL as CHD risk factor showed 177 events in men aged 40 - 60 years, ( n = 4263),CHD Incidence per 1, 000 in 6 years,0,20,40,60,80,100,120,140, 135135 - 154 155 - 195 195,LDL-C (mg/dL),54,30,16,31,120,ASSMANN G; Lipid Metabolism Disorders and CHD; MMV Medizin Verlag, 1993: 60,PROCAM
15、 Heart Study,现代脂质三联治疗课件,23,Expert Opinions,Part IV,现代脂质三联治疗课件,24,The Lipid Triad - Expert Comments,AHA, November 1999 “Evaluating the risk on the bases of LDL alone, is naive” Valentin Fuster, Mount Sinai Medical Center, New York “The LDL/HDL ratio is a much stronger predictor for the CHD risk than
16、LDL alone” Paul Ridker, Brigham Institute for Womens Hospital, Boston,现代脂质三联治疗课件,25,ACCP, March 2000 “Low HDL is a better indicator of CHD than high LDL as seen in epidemiological studies such as the Framingham Study and recently the VA-HIT Study.” Sander Robins, University Medical Center, Boston “Landmark statin trials have shown consistent benefits on CHD reduction after raising HDL by 5 - 10% irrespective of LDL levels” Christie Ballantyne, Baylor College of Medicine, Houston,The Lipid Triad
