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,按一下以編輯母片標題樣式,*,按一下以編輯母片,第二層,第三層,第四層,第五層,按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,Use of Lipid-lowering Agent in Acute Coronary Syndrome and Ischemic Stroke in Taiwan,Yi-Heng Li, MD, PhD,Department of Internal Medicine,College of Medicine,National Cheng Kung University,降血脂药物在急性冠心症及脑中风的使用详解课件,Liao JK.,Am J Cardiol,. 2005;96(suppl 1):24F-33F.,MMPs = matrix metalloproteinases,Platelet activation,Coagulation,Endothelial progenitor cells,Effects on,collagen,MMPs,AT,1,receptor,VSMC proliferation,Endothelin,Macrophages,Inflammation,Immunomodulation,Endothelial function,Reactive oxygen species,NO bioactivity,Pleiotropic effects of statins,Statins,Liao JK. Am J Cardiol. 2005;96,Statin in Acute Coronary Syndrome,Statin in Acute Coronary Syndr,MIRACL Study,Relative risk = 0.84,P,= .048,95% CI 0.701-0.999,Atorvastatin,Placebo,0,5,10,15,0,4,8,12,16,Time Since Randomization (weeks),Cumulative Incidence (%),Time to first occurrence of:,Death (any cause),Nonfatal MI,Resuscitated cardiac arrest,Worsening angina with new objective evidence and urgent rehospitalization,17.4%,14.8%,Primary Efficacy Measure,Schwartz,GG, et al.,JAMA,. 2001,;,285,:,1711-1718.,Very early benefit,MIRACL StudyRelative risk = 0.,Statin Use in ACS:,NCKUH Experience,Inclusion criteria:,-,January 2000 December 2004,- patients admitted to the NCKUH with,their first episode,of acute coronary syndrome,-,Receive statin therapy before discharge,Exclusion criteria:,- Patients who received statin within 1 months before admission,- Patients who did not receive statin after admission,- loss f/u during one year,Li et al ACC 2007; Int Heart J 2007;48:677,Statin Use in ACS: NCKUH Exper,ACS in NCKUH,Total,:,符合,ICD-9 code,共,1248,人次,其中住院期間有用,statin,共,480,人次,11.1%,42.7%,39.6%,48.9%,42.1%,Li et al 2007 ACC; Int Heart J 2007;48:677,ACS in NCKUH Total: 符合 ICD-9,LDL Control Rate During One Year in ACS Patients ( N =202 ),115 mg/dl 100 mg/dl 70 mg/dl,LDL-C,Patients achieving goal (%),35.5,30.2,24,26.4,6.3,3.8,Early group,Late group,Li et al 2007 ACC; Int Heart J 2007;48:677,LDL Control Rate During One Ye,Event-Free Survival Analysis at 4 months follow up,p=0.238,RR 1.73,（,95% CI 0.69-4.33,）,Event-Free Survival Analysis,Statin in Acute Ischemic Stroke and Transient Ischemic Attack,Statin in Acute Ischemic Strok,Statin in Acute Ischemic Stroke and Transient Ischemic Attack,Recommendations from the American Heart Association (AHA)/American Stroke Association (ASA) suggest that statin therapy should be used in the vast majority of patients with a history of ischemic stroke or TIA.,However, it remains unclear as to how soon statin should be initiated after acute ischemic stroke.,Statin initiation during hospitalization for first ischemic stroke of atherosclerotic origin is probably justified based on ACS trials,Statin in Acute Ischemic Strok,Taiwan Stroke Registry,Taiwan Stroke Registry, launched on May 1, 2006 and engaging 37 hospitals around Taiwan, prospectively collected data of patients who developed acute stroke or TIA and were hospitalized within 10 days after onset.,All patients were followed up for at least 6 months after discharge.,Taiwan Stroke RegistryTaiwan S,Taiwan Stroke Registry,8,429 pts with ischemic stroke or TIA,All patients Pts with LAA & SVO Pts with CAD Hx,23% 27% 12%,Percentage of pts receiving LLT at discharge,Li et al 2008 AHA,Taiwan Stroke Registry,Li et al 2008 AHA,Distribution of the Composite End Point at 6 Months Follow-up,Overall,LLT use at discharge,No LLT use at discharge,(n = 8429),(n = 2001),(n = 6428),Composite end points:,567 (7),91 (5),476 (7)*,All-cause mortality,348 (4),41 (2),307 (5),Ischemic heart,disease,13 (0.13),1 (0.05),12 (0.19),Stroke,224 (3),52 (2),172 (3),Data are presented as numbers of patients (%);,*p0.001.,Li et al 2008 AH,Event-Free Survival Analysis at 6 months Follow-up,Li et al 2008 AHA,Event-Free Survival Analysis a,Conclusions,HMGCoA reductase inhibitors,(statins),are effective lipid-lowering drugs with clinical evidence to reduce vascular events.,There was a in-hospital,under-prescription,of statin in our acute coronary syndrome (ACS) and ischemic stroke (IS) patients.,More aggressive,treatment of LDL is necessary in our ACS and IS patients.,ConclusionsHMGCoA reductase in,Thank You for Your Attention,Thank You for Your Attention,
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