血脂领域重大循证研究汇总
Gould AL et al. Circulation. 1998;97:946-952.
Clinical Benefits of Cholesterol Reduction
A recent meta-analysis of 38 trials demonstrated that for every 10% reduction in TC
CHD mortality decreased by 15% (P<0.001)
total mortality decreased by 11% (P<0.001)
Decreases were similar for all treatment modalities
Cholesterol reduction did not increase non-CHD mortality
PREMIER: Percentage of All Participants With Hypertension (6 mo)*
PREMIER Writing Group. JAMA. 2003;289:2083-2093.
*?BP 140/90 mm Hg or on antihypertensive medication; comparison with baseline hypertension status to assess persistent vs incident hypertension DASH=Dietary Approaches to Stop Hypertension
Advice Only Established Established + DASH (n=257) (n=251) (n=253)
%
P<0.001
P=0.01
P=0.12
PREMIER: Percentage of All Participants With Optimal Blood Pressure (6 mo)*
PREMIER Writing Group. JAMA. 2003;289:2083-2093.
*BP ?120/<80 mm Hg; comparison with baseline hypertension status DASH=Dietary Approaches to Stop Hypertension
Advice Only Established Established + DASH (n=257) (n=251) (n=253)
%
P<0.001
P=0.005
P=0.24
Lp(a): An Independent CHD Risk Factor in Men of the Framingham Offspring Cohort
RR=relative risk; HT=hypertension; GI=glucose intolerance.
Bostom AG et al. JAMA. 1996;276:544-548.
1.9
1.8
1.8
1.2
2.7
3.6
RR
0.1
1
10
2
5
0.2
0.5
Lp(a) TC HDL-C HT GI Smoking
AFCAPS/TexCAPS: RR of Acute Coronary Events—LDL-C and Homocysteine*
*Median LDL-C=149 mg/dL; median Hcy=11.27 mmol/L. ?Calculated on 5 patient-years at risk to prevent one event. RR=relative risk; Hcy=homocysteine; CI=confidence interval.
Data from Ridker PM et al. Circulation. 2002;105:1776-1779.
RR with 95% CI
0.0 0.5 1.0 1.5
Lovastatin (L) better
Placebo (P) better
No. Needed to Treat?
104
130
115
26
AFCAPS/TexCAPS: RR of Acute Coronary Events—TC:HDL-C Ratio and CRP Level*
*Median TC:HDL-C ratio=5.96; median CRP=0.16 mg/dL. ?Calculated on 5 patient-years at risk to prevent one event. RR=relative risk; CRP=C-reactive protein; CI=confidence interval.
Adapted from Ridker PM et al. N Engl J Med. 2001;344:1959-1965.
RR with 95% CI
0.0 0.5 1.0 1.5 2.0 2.5
Lovastatin (L) better
Placebo (P) better
No. Needed to Treat?
983
43
35
62
? 2001, Professional Postgraduate Services?
www.lipidhealth.org
PRINCE: Change in CRP Levels at 24 Weeks
*12-week data used for ~23% of patients in each arm. PRINCE=Pravastatin Inflammation/CRP Evaluation; CRP=C-reactive protein IQR=interquartile range. Adapted from Albert MA et al. JAMA. 2001;286:64-70.
? 2001, Professional Postgraduate Services?
www.lipidhealth.org
LRC Follow-up Study: CVD Mortality by Non–HDL-C and LDL-C in Men
LRC=Lipid Research Clinics; RR=relative risk; CI=confidence interval.
Adapted from Cui Y et al. Arch Intern Med. 2001;161:1413-1419.
0 0.25 0.50 0.75 1.00 1.25 1.50 1.75 2.00 2.25 2.50 2.75 3.00
RR with 95% CI
? 2001, Professional Postgraduate Services?
www.lipidhealth.org
LRC Follow-up Study: CVD Mortality by Non–HDL-C and LDL-C in Women
LRC=Lipid Research Clinics; RR=relative risk; CI=confidence interval.
Adapted from Cui Y et al. Arch Intern Med. 2001;161:1413-1419.
0 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00
RR with 95% CI
? 2001, Professional Postgraduate Services?
www.lipidhealth.org
ACCESS: Change in LDL-C, Non–HDL-C in All Patients at 54 Weeks
ACCESS=Atorvastatin Comparative Cholesterol Efficacy and Safety Study.
Data from Ballantyne CM et al. Am J Cardiol. 2001;88:265-269.
-42
-29
-36
-28
-36
-38
-26
-32
-26
-32
-50
-40
-30
-20
-10
0
10
20
LDL-C
Non–HDL-C
% D
Atorvastatin Fluvastatin Lovastatin Pravastatin Simvastatin (n=1,888) (n=474) (n=472) (n=461) (n=462)
? 2001, Professional Postgraduate Services?
www.lipidhealth.org
PDAY: Percentage of Right Coronary Artery Intimal Surface Affected With Early Atherosclerosis
PDAY= Pathobiological Determinants of Atherosclerosis in Youth.
Strong JP, et al. JAMA. 1999;281:727-735.
Fatty streaks
Raised lesions
White
15-19
20-24
25-29
30-34
0
10
20
30
Women
0
10
20
30
15-19
20-24
25-29
30-34
Black
Age (y)
0
10
20
30
White
15-19
20-24
25-29
30-34
Men
Black
Intimal surface (%)
PDAY: Prevalence of Lesions in LAD
McGill HC Jr, et al. Circulation. 2000;102:374-379.
20
0
40
60
80
100
15-19
Age (y) Prevalence (%)
30-34
25-29
60
60
40
40
20
20
0
0
0
1
2
3
4
5
0
20
40
60
20-24
0
1
2
3
4
5
AHA lesion grade
AHA lesion grade
Women
Men
Error bar=SE.
PDAY: Prevalence of Risk Factors
*Non–HDL-C=TC minus HDL-C; ?IGT=impaired glucose tolerance.
McGill HC Jr, et al. Circulation. 2000;102:374-379.
High non–HDL-C*
Low HDL-C
Smoking
Hypertension
Obesity
IGT?
%
PDAY: Prevalence of Lesions by Smoking and Non–HDL-C Status
McGill HC Jr, et al. Circulation. 2000;102:374-379.
40
50
30
20
10
0
15-19
20-24
25-29
30-34
40
50
30
20
10
0
15-19
20-24
25-29
30-34
40
50
30
20
10
0
15-19
20-24
25-29
30-34
40
50
30
20
10
0
15-19
20-24
25-29
30-34
Smoking
(%)
Non– HDL-C (%)
Normal non–HDL-C
High non–HDL-C
Grade 2-3 lesions
Grade 4-5 lesions
Age (y)
Age (y)
SHEEP: Risk Factors for Nonfatal MI in Men and Women
SHEEP=Stockholm Heart Epidemiology Program.
Reuterwall C et al. J Intern Med. 1999;246:161-174.
Risk Factor Diabetes High TC (?6.5 mmol/L) High TG (?6.3 mmol/L) HTN (?170/95 mm Hg) Overweight (BMI ?30 kg/m2) WHR (?0.85) Physical inactivity Smoking Job strain
Men
Women
Odds Ratio
Elevated TC Effects on Risk of CHD Death in Younger Men: A Meta-analysis
*The difference in absolute risk with high baseline TC vs risk with favorable levels (<200 mg/dL).
?As compared with men with TC <160 mg/dL.
MRFIT=Multiple Risk Factor Intervention Trial; CHA=Chicago Heart Association
Detection Project in Industry; PG=Peoples Gas Company.
Stamler J, et al. JAMA. 2000;19:311-318.
MRFIT CHA PG (37-53 y) (30-55 y) (32-66 y)
Absolute risk 15.5 54.2 154.0 (per 1,000) TC 3240 mg/dL
Absolute excess risk* 12.1 43.6 81.4 (per 1,000) TC 3240 mg/dL
Relative risk 8.09 11.93 8.06 TC 3280 mg/dL?
NHANES I Epidemiologic Follow-up Study: CHD Incidence and Survival in African-American Men and Women
Study cohort: 11,406 white and African-American persons aged 25 to 74 with no history of CHD
Age-adjusted risk for CHD
higher in African-American women aged 25 to 54 than in white women (RR: 1.76)
No significant differences in survival
Gillum RF et al. Ann Intern Med. 1997;127:111-118.
LDL-C target levels (mg/dL)
32 RF: <130
CHD: ￡100
National Center for Health Statistics. National Health and Nutrition Examination Survey (III); 1994. (Data collected 1991-1994.)
Pearson TA et al. Arch Intern Med. 2000;160:459