他汀的联合降脂治疗课件

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1、SlideSourceLipidsOnlinewww.lipidsonline.orgnNeedforcombinationlipid-alteringdrugtherapynEzetimibeandstatinsnBileacidsequestrantsandstatinsnPPARagonistsandstatinsnFishoilsandstatinsnNiacinandstatinsSlideSourceLipidsOnlinewww.lipidsonline.orgCHDorCHDRiskEquivalents<100(10-yearrisk

2、>20%)2+RiskFactors<130(10-yearrisk20%)0–1RiskFactor<160NCEPATP=NationalCholesterolEducationProgramAdultTreatmentPanel.LDL-C=low-densitylipoproteincholesterol.ExpertPanelonDetection,Evaluation,andTreatmentofHighBloodSlideSourceCholesterolinAdults.JAMA2001;285:2486-2497.LipidsOnl

3、inewww.lipidsonline.org100%70%80%60%40%39%(40%%18%)20%0%PLowRiskHighRiskCHDAllPatientsatien=8611,9241,3524,137nDrtugtherapyincludedstatins(fluvastatin,lovastatin,pravastatin,simvastatin),sgemfibrozil,bileacidsequestrants,niacin,psylliumfiber,andcombinationdrugtherapy.ASlideSourc

4、eAdcaptedfromPearsonTAetal.ArchInternMed2000;160;459-467.LipidsOnlinehwww.lipidsonline.orgievingGoal0%-10%28%10mg38%-20%20mg-30%35%40mg41%B-40%46%80mgase51%-50%lin54%Me-60%ea*MneanbaselineLDL-C.†A%tthetimeofthisstudy,themaximumdoseforsimvastatinwas40mg.SlideSourceAdCaptedfromJon

5、esPetal.AmJCardiol1998;81:582-587.LipidsOnlinewww.lipidsonline.orghangefromArteriallumenCEIntestineSkinexcretion(esterificationOvaryAtheroscleroticplaque/foamcells)MuscleHDLFreecholesterolAdrenalHDLCMSR-B1LiverLDL/apoB–EReceptorLDLLDLAtheroscleroticplaqueHealthierarterywithdecre

6、asedplaqueArterywithincreasedplaqueSlideSourceBaysHetal.ExpertOpinPharmacother2003;4:779-790.LipidsOnlinewww.lipidsonline.orgCholesterylestersexcretion(esterification)FreecholesterolSlideSourceBaysHetal.ExpertOpinPharmacother2003;4:779-790.LipidsOnlinewww.lipidsonline.orgnEzetim

7、ibeselectivelyinhibitsintestinalcholesterolabsorptionnintestinaldeliveryofcholesteroltothelivernexpressionofhepaticLDLreceptorsncholesterolcontentofatherogenicparticlesnEzetimibeanditsactiveglucuronidemetabolitecirculateenterohepaticallynDeliversagentbacktothesiteofactionPhot

8、ocourtesyofHarryR.Davis,PhDnLimitssystemicexpos