现代脂质三联治疗ppt课件

现代脂质三联治疗现代脂质三联治疗现代脂质三联治疗现代脂质三联治疗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1IntroductionIntroductionPart I现代脂质三联治疗课件2IntroductionPart I现代脂质三联治疗课件2Efficacy -The Power to Reach TargetKey Factor:Key Factor:+Differentiators:Differentiators:LDL ReductionTGHDLLDL/HDL RatioThe Lipid Triad 现代脂质三联治疗课件3Efficacy -The Power to ReachThe LDL/HDL Ratio-Our Strength,Our Story!Clear positioningfor LipobayA new perception of efficacyDifferentiation to AtorvastatinFit with our product profile现代脂质三联治疗课件4The LDL/HDL Ratio-Our StrengLDLHDLAdditional risk factor,especially in diabeticsThe Lipid Triad-OverviewTGThe Lipid TriadThe Ratio现代脂质三联治疗课件5LDLHDLAdditional risk factor,TThe Lipid Triad The Lipid Triad and Strategic Rationale and Strategic Rationale Part II现代脂质三联治疗课件6The Lipid Triad Part II现代脂质三联治 No scientific evidence Evidence contradicting this statement A marketing hypothesis to build their LDL story Creating the perception of the statin with the strongest efficacyThelower.Thelower.thebetter?.thebetter?现代脂质三联治疗课件7 No scientific evidence The lo Its logicalIts measurableIts practicableThe Lipid Triad -The GPs Perspective现代脂质三联治疗课件8 Its logicalIts measurablHDLLDL现代脂质三联治疗课件9HDLLDL现代脂质三联治疗课件9Supporting Data Supporting Data from Landmark Studiesfrom Landmark StudiesPart III现代脂质三联治疗课件10Supporting Data Part III现代脂质三联121086420%MortalityPlacebo Q1 Q2 Q3 Q4(low HDL-increase)(high HDL-increase)4S-StudyCAD Mortality per Quartiles of Increases in HDL-CholesterolKJEKSHUS J&PEDERSEN T(unpublished)现代脂质三联治疗课件1112%MortalityPlacebo HDL Intervention Trial(VA-HIT)RUBINS HB et al.New Engl J Med 1999;341:41006-31-4-35-30-25-20-15-10-50510Cholesterol LDL-C HDL-C TriglyceridesPercent change compared to placebo at 1 yearSecondary Prevention in 2531 menwith low HDL-C&LDL-C showed a22%reduction in combined fataland non-fatal MI现代脂质三联治疗课件12HDL Intervention Trial(VA-HITHDL-Cholesterol as Risk Factor for CHDLRC-CPPT(Placebo)MRFIT(usual care)Incidence rate of CHDIncidence rate of CHD121086420100 130 160 190GORDON DJ et al.Circulation 1989;79:8-15.HDL-Cmg/dl65554535LDL-Cholesterol mg/dlLDL-Cholesterol mg/dl121086420100 130 160 190现代脂质三联治疗课件13HDL-Cholesterol as Risk Fact00.511.522.53Framingham Heart StudyCAD risk as a function of LDL-C and HDL-C in men(50 to 70 y)CASTELLI WP.Am J Cardiol 1998;82:60-65220 160 10085654525HDL-Cholesterol(mg/dl)LDL Cholesterol(mg/dL)现代脂质三联治疗课件1400.511.522.53Framingham Heart 0246810121416LDL5HDL=1.08 HDL1.08LDL/HDL5Incidence of cardiac events(per 1000 person-years)GemfibrozilPlaceboLDL-C Tertiles(mmol/L)HDL-C Tertiles(mmol/L)LDL-C/HDL-C Tertiles244632 3634 4522 3938 5318 29Incidence for cardiac events vs lipid parameterHelsinki Heart StudyMANNINEN V,Leena T,Koskinen P et al.Circulation 1992;85:37-45现代脂质三联治疗课件150246810121416LDL5HDL=1AFCAPS/TEXCAPS Apo B/A1 Tertiles LDL-C/HDL-C Tertiles 1.61.41.210.80.60.40.201.61.41.210.80.60.40.20Event Rate per 100 Patient-Years of RiskEvent Rate per 100 Patient-Years of Risk 0.88890.8898-1.02051.0252 3.77423.7744-4.40964.4101GOTTO A et al.Circulation 2000;101:477-484LDL/HDL Ratio as Therapeutic SuccessPlaceboStatin 现代脂质三联治疗课件16AFCAPS/TEXCAPS Apo B/A1 Tertil2411631245050100150200250300 5LDL/HDL-RatioTriglycerides=200 mg/dlCAD cases per 1,000 subjects in 6 yearsASSMANN G and SCHULTE H;Am J Cardiol 1992;70:733-737Incidence of CAD vs LDL/HDL ratio by TG level(n=4559)PROCAM Heart Study 现代脂质三联治疗课件172411631245050100150200250300=0501001502002503003 4 567LDL/HDL ratioCHD Incidence/1000 in 6 yearsCHD risk according to LDL/HDL ratio at baselineASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:435HighCHD riskMediumMediumCHD riskCHD riskLow Low CHD riskCHD risk3-53PROCAM Heart Study 现代脂质三联治疗课件180501001502002503003 4 5Mean values for developing atherosclerotic CHD within 6 yearsVariable CHD Development No CHD Development (n=186)(n=4221)TC(mg/dl)251.8222.9HDL-C(mg/dl)39.5 45.2LDL-C(mg/dl)176.2 147.1LDL/HDL ratio 4.72 3.4TG(mg/dl)163.0134.5ASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:41PROCAM Heart Study 现代脂质三联治疗课件19Mean values for developing athPredictive value of risk factors for developing atheroscleroticCHD within 6 yearsVariable Risk RatioPredictive Power%TG 200 mg/dl2.3 7.5TC 250(mg/dl)2.8 8.3LDL-C 195(mg/dl)3.7 12.0LDL-C 155(mg/dl)3.3 7.1HDL-C 35(mg/dl)3.911.0LDL/HDL ratio 56.416.5ASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:43PROCAM Heart Study 现代脂质三联治疗课件20Predictive value of risk factoHDL as CHD risk factor showed 186 events,in men aged 40-60 years(n=4407)CHD Incidence per 1,000 in 6 years020406080100120140160 35 35-55 55HDL-C(mg/dL)1103021ASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:59PROCAM Heart Study 现代脂质三联治疗课件21HDL as CHD risk factor showed LDL as CHD risk factor showed 177 eventsin men aged 40-60 years,(n=4263)CHD Incidence per 1,000 in 6 years020406080100120140 135135-154 155-195 195LDL-C(mg/dL)54301631120ASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:60PROCAM Heart Study 现代脂质三联治疗课件22LDL as CHD risk factor showed Expert OpinionsExpert OpinionsPart IV现代脂质三联治疗课件23Expert OpinionsPart IV现代脂质三联治疗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 LDL alone”Paul Ridker,Brigham Institute for Womens Hospital,Boston现代脂质三联治疗课件24The Lipid Triad-Expert CommeACCP,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 CHDreduction after raising HDL by 5-10%irrespective of LDL levels”Christie Ballantyne,Baylor College of Medicine,Houston The Lipid Triad-Expert Comments 现代脂质三联治疗课件25ACCP,March 2000The Lipid TriaHelsinki Heart Study“The LDL/HDL ratio was the best single predictor of cardiac events”Manninen V,Leena T,Koskinen P et al.Circulation 1992;85,1:37“Patients in the placebo group with triglyceride levels of 200 mg/dland an LDL/HDL ratio of 5.0 had by far the highest incidence ofcardiac events”Gerd Assmann,Lipid Metabolism Disorders and Coronary Heart Disease,MMV Medizin Verlag,1993The Lipid Triad-Expert Comments 现代脂质三联治疗课件26Helsinki Heart StudyThe Lipid PROCAM“The greatest difference,in relative terms,between the groupswith and without major coronary events was seen in theLDL/HDL-ratio”Assmann G,Cullen P and Schulte H;Eur Heart Journal 1998,19 A2-A11“For practical purposes it appears advisable to base predictions for atherosclerotic CAD and treatment decision on a full lipid profile,(cholesterol,triglycerides,LDL and HDL cholesterol)rather than cholesterol or LDL cholesterol determinants alone”Gerd Assmann,Lipid Metabolism Disorders and Coronary Heart Disease,MMV Medizin Verlag,1993The Lipid Triad-Expert Comments 现代脂质三联治疗课件27PROCAMThe Lipid Triad-ExpertState of the Art Conference,Berlin April 2000“The Lipid Triad should form the bases of diagnostic and therapeutic decisions in lipid therapy”Markolf Hanefeld,Institute for Metabolism Disorders and Research,Dresden“By just using high LDL as a criterion for prescription,some patients are receiving statin treatment who do not need it,and those with low HDL andhigh LDL who do need the treatment are not getting it!”Gerd Assmann,Institute of Clinical Chemistry and Lab Medicine,Mnster,GermanyThe Lipid Triad-Expert Comments 现代脂质三联治疗课件28State of the Art Conference,BThe ImpactThe Impactof Guidelinesof GuidelinesPart V现代脂质三联治疗课件29The ImpactPart V现代脂质三联治疗课件29The Lipid Triad-What the NCEP*Guidelines Say HDL Cholesterol 35 mg/dl(0.9 mmol/l)LDL Cholesterol 100 mg/dl(2.6 mmol/l)TG 200 mg/dl(2.3 mmol/l)*National Cholesterol Education Program targets for secondary prevention现代脂质三联治疗课件30The Lipid Triad-What the NCEThe LDL/HDL Ratio-What the Guidelines say Secondary Prevention GuidelinesNCEP(USA)LDL/HDL 2.8Association of Cardiology(Germany)LDL/HDL 2.5Society of Lipid Therapy(Germany)LDL/HDL 5HighCHD riskMediumCHD riskLow CHD risk8%60%32%90%9%1%3-55HighMedLDL-C (mean%changefrom baseline after 24 weeks)10-40-30-20-100-50-44.4%Men(n=200)Women(n=102)-37.0%LDL Cholesterol Reduction From BaselineOSE et al.Curr Med Res&Opinion 1999;15(3):231-43LDL Reduction with 0.4 mg of Cerivastatin现代脂质三联治疗课件37LDL-C (mean%change10-40-30-908070605040302010029.787.470.749.5 30 35 40 45Cumulative%of respondentsLDL Responder Rates with 0.4 mg LDL%reduction rates in patients aged 60 to 65 years(n=156)Data on file现代脂质三联治疗课件38908070605040302010029.787.470.0,02,04,06,08,010,012,014,016,018,0504050%HDL increaseData on file0.4 mg responder rate at 8 weeks6.510.317.98.2现代脂质三联治疗课件390,02,04,06,08,010,012,014,016,9080706050403020100 1023.39.381.465.155.8 20 30 40 50TG responder rates for 0.4 mg TG%reduction rates from baseline 300 mg/dl at 8 weeks(n=43)Cumulative%of respondentsData on file现代脂质三联治疗课件409080706050403020100 1023.39.3Triglyceride mean%change from baseline after 8 weeks-20-100-30-405placebo0.3mg0.4mgBaseline triglycerides250 mg/dl0.1mg0.2mg10-35-25-155TG Reduction STEIN E et al.Atherosclerosis 1999;144(S 1):A 37现代脂质三联治疗课件41Triglyceride mean%change froApo B/Apo A1(LS-Means%Change with minimum 8 weeks treatment)-20,0-10,00,0-30,0-40,05Placebo-35,0-25,0-15,05,0Apo B/Apo A1 Cerivastatin Pooled DataData on file0.1mg0.2mg0.3mg0.4mg0.8mgn=588n=259n=265n=573n=658n=5992,0-18.5-22.4-26.8-29.1-36.0现代脂质三联治疗课件42Apo B/Apo A1(LS-Means%ChangPatient GroupCerivastatinPlacebo100m mg 200m mg 300m mg 400m mg 800m mg-18.5-16.9-21.0-19.6-17.2-21.9-20.5-22.8-22.4-20.6-24.9-23.0-21.2-26.0-24.9-26.6-26.8-25.9-28.3-25.5-26.0-29.5-28.7-30.3-29.1-28.0-30.6-23.2-29.1-30.7-27.5-33.2-36.0-35.3-37.1-32.3-35.9-37.1-36.0-38.5AllMaleFemale 40 Years 40-65 Years 65 YearsElderly patients-male-female2.02.21.7-0.52.71.11.21.0Cerivastatin Studies 8 Weeks Minimum TreatmentApo B/Apo A1(%change at week 8)Data on file现代脂质三联治疗课件43Patient GroupCerivastatinPlaceSales supporting activitiesActively creatingdata and informationGaining consensus from OLLeading instead of Following现代脂质三联治疗课件44Sales supporting Actively creaDatabase LDL/HDL ratioOpinion LeadersPrivate CardiologistsGPsSpreading the Story-EffectivelyPress Internet Publications现代脂质三联治疗课件45Database LDL/HDL ratioOpinion