4S糖尿病亚组研究-课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Haffner SM, Alexander CM, Cook TJ, Boccuzzi SJ, Musliner TA, Pedersen TR, Kjekshus J, Pyorala K for the 4S Group,Reduced Coronary Events in Simvastatin-Treated Subjects with CHD and Diabetes or Impaired Fasting Glucose: Subgroup Analyses in the Scandinavian Simvastatin Survival Study,Arch Intern Med,1999;159:2661-2667,Haffner SM, Alexander CM, Cook,Expanded 4S Diabetes Analysis,Diabetes Mellitus by History,202 Subjects (Original 4S Diabetes Subgroup),FG 126 mg/dl, but No History of Diabetes,281 Subjects,Impaired Fasting Glucose (FG 110-125 mg/dl),678 Subjects,Normal (FG ,126 mg/dl),New Category of IFG,(FG 110-125 mg/dl),Goals,Confirm previous data,Perform analysis of 4S subjects with IFG,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,Rationale & GoalsRationaleHaff,Baseline Characteristics,NormalIFGDM-FGDM - Hx,n3237678281202,Age59595960,Male (%)80848978,SBP138139141147,Tot-C261261261259,LDL-C189189186189,HDL-C46454444,TG130137142153,FG95117136175,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,Baseline CharacteristicsNorma,Percent Change in Lipids and Lipoproteins in 4S,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,Percent Change in Lipids and L,Incidence of Major CHD Events by Glucose Status in the 4S Placebo Group,NFG,(n=1631),IFG,(n=335),DM-FG,(n=135),DM-history,(n=97),Baseline Glucose Status,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,Incidence of Major CHD Events,4S Major Coronary Heart Disease Events,RR = 0.68 0.62 0.58,p value = 0.001 0.003 0.001,n = 1631/1606 335/343 232/251,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,4S Major Coronary Heart Dise,4S & Revascularizations,RR = 0.67 0.57 0.52,p value = 0.001 0.01 0.005,n = 1631/1606 335/343 232/251,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,4S & RevascularizationsRR =,4S Total Mortality,RR = 0.72 0.57 0.79,p value = 0.005 0.02 0.34,n = 1631/1606 335/343 232/251,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,4S Total MortalityRR =,IFG Subjects (n=678),0.0,0.2,0.4,0.6,0.8,1.0,1.2,1.4,Relative Risk,MCE,Revascularization,Tot Mortality,CHD Mortality,p=0.003,p=0.009,p=0.02,p=0.007,0.62,0.57,0.57,0.45,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,IFG Subjects (n=678)0.00.20.40,Diabetic Subjects (n=483),0.0,0.2,0.4,0.6,0.8,1.0,1.2,1.4,Relative Risk,MCE,Revascularization,Tot Mortality,CHD Mortality,p=0.001,p=0.005,p=0.34,p=0.26,0.58,0.52,0.79,0.72,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,Diabetic Subjects (n=483)0.00.,Major CHD Events,NFG Simvastatin,NFG Placebo,IFG Simvastatin,IFG Placebo,DM Simvastatin,DM Placebo,Arch Intern Med,1999;159:2661-2667,Major CHD EventsNFG Simvast,Effects of Simvastatin on Major Coronary Events by Glucose Status Stratified by Level of Lipid Parameters,Arch Intern Med,1999;159:2661-2667,Effects of Simvastatin on Majo,Absolute and Relative Risk Benefit of Simvastatin Therapy by Glucose Status for Major Coronary Events,NFGIFGDM,Simvastatin group, No. (%) 299/1606 (18.6) 67/343 (19.5) 59/251 (23.5),Placebo group, No. (%) 428/1631 (26.2) 102/335 (30.5) 87/232 (37.5),Relative risk 0.680.620.58,P relative risk0.0010.0030.001,Absolute benefit (Kaplan-Meier year,6 estimate) 8.02/100 cases 12.11/100 cases 13.85/100 cases,Number needed to treat1287,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,Absolute and Relative Risk Ben,Summary - Diabetes Mellitus,Higher event rate in diabetes group, by history, compared to other groups,In combined DM group (by history and fasting glucose):,Major Coronary Events were reduced by 42% (p=0.001),Revascularizations were reduced by 48% (p=0.005),Total and coronary mortality were reduced, but reductions not significant due to small sample size,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,Summary - Diabetes MellitusHig,Summary - Impaired Fasting Glucose,Reduced total mortality by 43% (p=0.02),Reduced coronary mortality by 55% (p=0.007),Reduced major coronary events by 38% (p=0.003),Reduced the need for revascularization procedures by 43% (p=0.009),Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,Summary - Impaired Fasting Glu,Conclusions,This analysis confirms and extends the benefit of cholesterol lowering with simvastatin in an expanded cohort of patients with diabetes and overt CHD,CHD patients with impaired fasting glucose (FG 110 to 125 mg/dL) benefit from treatment with simvastatin by significant & substantial reductions in total and coronary mortality, major CHD events and revascularizations.,Haffner SM, et al.,Arch Intern Med,1999;159:2661-2667,ConclusionsThis analysis confi,