【醫(yī)學(xué)課件】選擇正確的降脂治療方案ppt課件-資料下載頁(yè)
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【正文】 acid Mechanism of Action: Increase peripheral lipolysis and decrease hepatic TG production Efficacy: Decrease TG 25–50% LDLC decreases, remains the same, or increases Increase HDLC 15–25% in hypertriglyceridemia Side Effects: GI upset (8%), cholelithiasis, myositis, abn LFTs Contraindications: Hepatic or renal dysfunction Preexisting gallbladder disease Intervention Trials: HHS, VAHIT, BIP, LOCAT, BECAIT, DAIS Effects of Fenofibrate on Plasma Lipids Hypercholesterolemia (%) Mixed HPL (%) Feno n=92 Plb n=88 Feno n=24 Plb n=22 Total Cholesterol – – – + LDLC – + – – HDLC + – + – Total Triglycerides – – – + LDLC/HDLC – – – VLDLC – – – + DoubleBlind, Multicenter, 24Week Study in Patients with Primary Hypercholesterolemia or Mixed Hyperlipidemia (HPL) p except for LDLC in Type IIb, where p Brown WV et al. Arteriosclerosis 1986。6:670678. ?1999 Lippincott Williams amp。 Wilkins. Trials of Fibrates: Effects on Cardiac Events Frick MH et al. N Engl J Med 1987。317:12371245. | Manninen V et al. Circulation 1992。85:3745. | BIP Study Group. Circulation 2021。102:2127. | Rubins HB et al. N Engl J Med 1999。341:410418. * Post hoc analysis of subgroup with TG 200 mg/dL and HDLC 42 mg/dL. ** Post hoc analysis of subgroup with TG ?200 mg/dL and HDLC 35 mg/dL. *** Difference between placebo and Rx for primary endpoint was statistically significant (p ). 051015202530% CHD Death/Nonfatal MI Rx Placebo *** *** 66% 34% 9% 42% 22% PRIMARY PREVENTION SECONDARY PREVENTION HHS HHS (Post Hoc)* BIP BIP (Post Hoc)** VAHIT Deaths Da Col PG et al. Curr Ther Res Clin Exp 1973。53:473482. | Ellen RL et al. Am J Cardiol 1998。81:60B65B. Statin + Fibrate 6 0 5 0 4 0 3 0 2 0 1 00102030Simva + Gemfibrozil –50% –39% 16% 22% –41% –28% Prava/Simva + Fenofibrate 230 332 38 191 166 LDLC TG HDLC LDLC TG HDLC Percent Change 34 Steps to Minimize the Risk of Muscle Toxicity with Fibrate–Statin Combination Therapy ? Use statin alone for nonHDLC goals ? Use fish oils or niacin rather than fibrates ? Keep the doses of the statin and fibrate low ? Dose the fibrate in the AM and the statin in the PM ? Avoid (or cautiously use) bo in renal impairment ? Assure no interactions ? Teach the patient to recognize muscle symptoms ? Discontinue therapy if muscle symptoms are present and CK is 10 times the upper limit of normal Guidelines that aren’t implemented don’t work
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