现代脂质三联治疗课件

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,现代脂质三联治疗,现代脂质三联治疗现代脂质三联治疗,IntroductionPart IEfficacy -The Power to Reach TargetKey Factor:+Differentiators:,LDL ReductionTG,HDL,LDL/HDL Ratio,The Lipid Triad,情亲,Introduction,Part I,Efficacy -The Power to Reach Target,Key Factor:,+,Differentiators:,LDL Reduction,TG,HDL,LDL/HDL Ratio,The Lipid Triad,The LDL/HDL Ratio-Our Strength,Our Story!,Clear positioning,for Lipobay,A new perception of efficacy,Differentiation to Atorvastatin,Fit with our product profile,LDL,HDL,Additional risk factor,especially in diabetics,The Lipid Triad-Overview,TG,The Lipid Triad,The Ratio,The Lipid Triad,and Strategic Rationale,Part II,No scientific evidence,Evidence contradicting this statement,A,marketing hypothesis,to,build their,LDL story,Creating the perception,of,the statin with the,strongest efficacy,The lower.,.the better?,Its logical,Its,measurable,Its,practicable,The Lipid Triad -The GPs Perspective,HDL,LDL,Supporting Data,from Landmark Studies,Part III,12,10,8,6,4,2,0,%,Mortality,Placebo Q1 Q2 Q3 Q4,(low HDL-increase)(high HDL-increase),4,S-Study,CAD Mortality per Quartiles of Increases in HDL-Cholesterol,KJEKSHUS J&PEDERSEN T(unpublished),HDL Intervention Trial(VA-HIT),RUBINS HB et al.New Engl J Med 2019;341:410,0,6,-31,-4,-35,-30,-25,-20,-15,-10,-5,0,5,10,Cholesterol LDL-C HDL-C Triglycerides,Percent change compared,to placebo at 1 year,Secondary Prevention in 2531 menwith low HDL-C&LDL-C showed a22%reduction in combined fataland non-fatal MI,HDL-Cholesterol as Risk Factor for CHD,LRC-CPPT(Placebo),MRFIT(usual care),Incidence rate of CHD,Incidence rate of CHD,12,10,8,6,4,2,0,100 130 160 190,GORDON DJ et al.Circulation 1989;79:8-15.,HDL-C,mg/dl,65,55,45,35,LDL-Cholesterol mg/dl,LDL-Cholesterol mg/dl,12,10,8,6,4,2,0,100 130 160 190,0,0.5,1,1.5,2,2.5,3,Framingham Heart Study,CAD risk as a function of LDL-C and HDL-C,in men(50 to 70 y),CASTELLI WP.Am J Cardiol 2019;82:60-65,220 160 100,85,65,45,25,HDL-Cholesterol,(mg/dl),LDL Cholesterol(mg/dL),0,2,4,6,8,10,12,14,16,LDL5,HDL=1.08,HDL1.08,LDL/HDL5,Incidence of cardiac events,(,per 1000 person-years),Gemfibrozil,Placebo,LDL-C Tertiles(mmol/L),HDL-C Tertiles(mmol/L),LDL-C/HDL-C Tertiles,24,46,32,36,34,45,22,39,38,53,18,29,Incidence for cardiac events vs lipid parameter,Helsinki Heart Study,MANNINEN V,Leena T,Koskinen P et al.Circulation 1992;85:37-45,AFCAPS/TEXCAPS,Apo B/A1 Tertiles,LDL-C/HDL-C Tertiles,1.6,1.4,1.2,1,0.8,0.6,0.4,0.2,0,1.6,1.4,1.2,1,0.8,0.6,0.4,0.2,0,Event Rate per 100 Patient-Years of Risk,Event Rate per 100 Patient-Years of Risk,0.8889,0.8898-,1.0205,1.0252,3.7742,3.7744-4.4096,4,.4101,GOTTO A et al.Circulation 2000;101:477-484,LDL/HDL Ratio as Therapeutic Success,Placebo,Statin,24,116,31,245,0,50,100,150,200,250,300,5,LDL/HDL-Ratio,Triglycerides=200 mg/dl,CAD cases per 1,000 subjects in 6 years,ASSMANN G and SCHULTE H;Am J Cardiol 1992;70:733-737,Incidence of CAD vs LDL/HDL ratio by TG level(n=4559),PROCAM Heart Study,0,50,100,150,200,250,300,3,4,5,6,7,LDL/HDL ratio,CHD Incidence/1000 in 6 years,CHD risk according to LDL/HDL ratio at baseline,ASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:43,5,High,CHD risk,Medium,CHD risk,Low,CHD risk,3-5,3,PROCAM Heart Study,Mean values for developing atherosclerotic CHD within 6 years,Variable CHD Development No CHD Development,(n=186)(n=4221),TC(mg/dl)251.8222.9,HDL-C(mg/dl)39.5 45.2,LDL-C(mg/dl)176.2 147.1,LDL/HDL ratio 4.72 3.4,TG(mg/dl)163.0134.5,ASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:41,PROCAM Heart Study,Predictive value of risk factors for developing atherosclerotic,CHD within 6 years,Variable Risk RatioPredictive Power%,TG,200,mg/dl2.3 7.5,TC,250,(mg/dl)2.8 8.3,LDL-C,195(mg/dl)3.7 12.0,LDL-C,155(mg/dl)3.3 7.1,HDL-C,35,(mg/dl)3.911.0,LDL/HDL ratio,56.416.5,ASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:43,PROCAM Heart Study,HDL as CHD risk factor showed 186 events,in men aged 40-60 years(n=4407),CHD Incidence per 1,000 in 6 years,0,20,40,60,80,100,120,140,160,35 35-55,55,HDL-C(mg/dL),110,30,21,ASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:59,PROCAM Heart Study,LDL as CHD risk factor showed 177 events,in men aged 40-60 years,(n=4263),CHD Incidence per 1,000 in 6 years,0,20,40,60,80,100,120,140,135,135-154 155-195,195,LDL-C(mg/dL),54,30,16,31,120,ASSMANN G;Lipid Metabolism Disorders and CHD;MMV Medizin Verlag,1993:60,PROCAM Heart Study,Expert Opinions,Part IV,The Lipid Triad-Expert Comments,AHA,November 2019,“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,ACCP,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,Univer