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1、HDL and Coronary Heart DiseaseAngiographic and Clinical Event TrialsAngiographic Trials of Combination TherapynCholesterol Lowering Atherosclerosis Study (CLAS)1nDiet and niacin + colestipol (vs diet and placebo)n188 men (aged 4059 y), post-CABGnNonsmokers or former smokers, nondiabetic, nonhyperten
2、sivenTotal-C at entry: 185350 mg/dL; drug responsivenFamilial Atherosclerosis Treatment Study (FATS)2 nLovastatin + colestipol, niacin + colestipol, or conventional therapyn146 men (aged 62 y) with CAD and family history of CADnApoB 125 mg/dLnAverage stenosis: 34% 1. Blackenhorn DH et al. JAMA. 1987
3、;257:323332402. Brown G et al. N Engl J Med. 1990;323:12891298Angiographic Trials of Combination Therapy Effects on Lipids % changeTrial LDL-CHDL-C TGCLAS Placebo (2 y)1 5* 2 5* Niacin + colestipol (2 y)1 43* 37* 22* Niacin + colestipol (4 y)2 40 37 18 FATS (2.5 y)3 Conventional 7* 6* 15 Niacin + co
4、lestipol 32* 41* 29* Lovastatin + colestipol 45* 16 9Versus baseline: *P 0.001; P 0.01; * P 0.05; Versus placebo: P 0.001; P 0.03 1. Blankenhorn DH et al. JAMA 1987;257:323332402. Cashin-Hemphill L et al. JAMA 1990;264:301330173. Brown BG et al. N Engl J Med 1990;323:12891298Cholesterol-Lowering Ath
5、erosclerosis Study (CLAS)Univariate Apo Predictors of Coronary Progression Mean (mg/dL)PredictorProgressorNonprogressorP valuePlacebo (n = 82: 49 progressors, 33 nonprogressors)ApoB1281160.03ApoC-III (total) 12.410.30.03ApoC-III (HS)*5.9 4.9 0.03Drug (n = 80: 31 progressors, 49 nonprogressors)ApoC-I
6、II (HS)* 6.4 7.5 0.05*HS = heparin supernate (apoC-III in HDL)Blankenhorn DH et al. Circulation 1990;81:470476Familial Atherosclerosis Treatment Study (FATS)Univariate Predictors of Change in Proximal StenosisPredictorr P valueApoB0.38 0.0001LDL-C0.270.01HDL-C-0.330.001ApoA-I-0.28Not reportedBrown G
7、 et al. N Engl J Med 1990;323:12891298Angiographic Trials of Fibrate TherapynBezafibrate Coronary Atherosclerosis Intervention Trial (BECAIT)1nBezafibrate vs placebon92 male survivors of MI, aged 45 y at time of eventnCoronary angiography at baseline and after 2 and 5 ynLopid Coronary Angiography Tr
8、ial (LOCAT)2nGemfibrozil vs placebon395 men, post-CABGnCoronary angiography at baseline and after 32 mos1. Ericsson CG et al. Lancet 1996;347:8498532. Frick MH et al. Circulation 1997;96:21372143Bezafibrate Coronary Atherosclerosis Intervention Trial (BECAIT) Effect on Lipid Levels at 5 YearsChange
9、from baseline: *P 0.001; P = 0.551; *P = 0.020Bez = bezafibrate 200 mg TID (n = 42); Plac = placebo (n = 39)Ericsson CG et al. Lancet 1996;347:849853-14.0*-3.58.6*-26.3*-5.6-2.2-0.82.7-30-25-20-15-10-50510Total-CLDL-CHDL-CTotal-TG Bez Plac(266) (267)Medianbaseline (mg/dL): Bez Plac(180) (179)BezPlac
10、(34) (39) Bez Plac(216) (175)Median % change from baseline15-35Lopid Coronary Angiography Trial (LOCAT)Effect on Lipid Levels at 1 Year*P 0.001 for between-group difference and for change from baselineFrick MH et al. Circulation 1997;96:21372143-5.5*-4.5*21*-36*5.15.37.04.6-40-30-20-100102030Total-C
11、LDL-CHDL-CTGGemfibrozilPlaceboMean % change from baselineAngiographic Trial of Statin TherapynLipoprotein and Coronary Atherosclerosis Study (LCAS)nFluvastatin versus placebo in patients with low versus higher HDL-C nAngiographic data from 339 patients:n 68 with baseline HDL-C 35 mg/dLn 271 with bas
12、eline HDL-C 35 mg/dLBallantyne CM et al. Circulation 1999;99:736743Lipoprotein and Coronary Atherosclerosis Study (LCAS) Benefit of Statin Therapy in Patients With Low HDL-C0.300.250.200.150.100.050HDL-C 35 mg/dLHDL-C 35 mg/dLFluvastatinPlaceboDecrease in minimum lumen diameter (mm)P = 0.09P = 0.000
13、4P for interaction = 0.01Ballantyne CM et al. Circulation 1999;99:736743-0.065-0.274-0.036-0.083Lipoprotein and Coronary Atherosclerosis Study (LCAS)Event-Free Survival2.51.000.750.500.250.00012Probability of event-free survival1.000.750.500.250.000122.5Probability of event-free survivalFluvastatinF
14、luvastatinPlaceboPlaceboHDL-C 35 mg/dLHDL-C 35 mg/dLP = 0.002P = 0.232Time (y)Time (y)Ballantyne CM et al. Circulation 1999;99:736743Angiographic Trials in Patients With Low HDL-CEffects on LipidsTrial (pts with Agent Baseline (mg/dL) % changeevaluable angiography) (dosage)LDL-C HDL-CLDL-C HDL-CBECA
15、IT (N = 81)Bezafibrate180 34 3.5 9(600 mg/d)LOCAT (N = 372)Gemfibrozil138 31 4.5 21(1,200 mg/d)LCAS (N = 339)Fluvastatin146 43 25 9 (40 mg/d)LCAS (HDL-CFluvastatin143 32 25 16 35 mg/dL)(40 mg/d)(N = 68)Ballantyne CM et al. Circulation 1999;99:736743Helsinki Heart StudynPrimary-prevention, placebo-co
16、ntrolled trial to determine whether increasing HDL-C levels and decreasing LDL-C levels would reduce incidence of CHDn4,081 dyslipidemic men, aged 4055 ynSubjects randomized to gemfibrozil (600 mg BID) or placebonStudy duration: 5 yFrick MH et al. N Engl J Med. 1987;317:12371245Helsinki Heart StudyIncidence of CHD EventsNumbers inside bars indicate number of cardiac events in each subgroupManninen V et al. Circulation. 1992;85:3745Incidence of cardiac events(per 1,000 person-years)05101520HDL-C
