1、Slide SourceLipidsOnlineSlide SourceLipidsOnline1001602200.01.02.03.0Risk of CHDHDL-C(mg/dL)LDL-C(mg/dL)25Gordon T et al.Am J Med 1977;62:707-714.456585Slide SourceLipidsOnlineExpert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.JAMA 2001;285:2486-2497.Low HDL-C was
2、 redefined as 102 cm(40 in)88 cm(35 in)TG150 mg/dLHDL-C Men Women40 mg/dL50 mg/dLBlood pressure130/85 mm HgFasting glucose110 mg/dLSlide SourceLipidsOnlinenSmokenAre sedentarynAre obesenAre insulin resistant or diabeticnHave hypertriglyceridemianHave chronic inflammatory disordersLow HDL-C levels ar
3、e commonly found in patients who:Slide SourceLipidsOnlineSlide SourceLipidsOnlinenReduced initiation and progression of atherosclerosis in transgenic mice and rabbitsnRegression of pre-existing atherosclerosis in animalsSlide SourceLipidsOnlinenIncrease apo A-I productionnPromote reverse cholesterol
4、 transportnDelay catabolism of HDLSlide SourceLipidsOnlinenSmall molecule upregulation of apo A-I gene transcriptionnIntravenous infusion of recombinant protein(wild-type apo A-I,apo A-IMilano)nAdministration of peptides based on apo A-I sequencenSomatic gene transfer of apo A-I DNA(liver,intestine,
5、muscle,hematopoetic cells)Slide SourceLipidsOnlinenIncrease apo A-I productionnPromote reverse cholesterol transportnDelay catabolism of HDLSlide SourceLipidsOnlineA-ICEFCFCFCSlide SourceLipidsOnlineFCFCoxysterolsABCA1A-ISlide SourceLipidsOnlineLXR/RXRNew agentsA-IFCABCA1Slide SourceLipidsOnlinenInc
6、rease apo A-I productionnPromote reverse cholesterol transportnDelay catabolism of HDLSlide SourceLipidsOnlinenAntioxidant effectsnInhibition of adhesion molecule expressionnInhibition of platelet activationnProstacyclin stabilizationnPromotion of NO productionSlide SourceLipidsOnlineCEFCA-ISlide So
7、urceLipidsOnlineSlide SourceLipidsOnlineCEFCA-IFCCETGSlide SourceLipidsOnlineCEFCA-ICETGXSlide SourceLipidsOnline05101520253035Okamoto H et al.Nature 2000;406:203-207.%Aortic Lesion ControlSimvastatinJTT-705Slide SourceLipidsOnlineCEFCA-IFCCETGXSlide SourceLipidsOnlinenWeight reduction and increased
8、 physical activitynLDL-C is primary target of therapynNon-HDL-C is secondary target of therapy(if triglycerides 200 mg/dL)nConsider nicotinic acid or fibratesExpert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults.JAMA 2001;285:2486-2497.Slide SourceLipidsOnlinenTherap
9、eutic lifestyle changesnSmoking cessationnRegular aerobic exercisenWeight lossnAlcohol use?Slide SourceLipidsOnlinenTherapeutic lifestyle changesnPharmacologic therapynStatinsSlide SourceLipidsOnline05101520253035Patients with Events(%)Scandinavian Simvastatin Survival Study Group.Lancet 1995;345:12
10、74-1275.HDL-C(mg/dL)PlaceboSimvastatin383944455253RR=0.67RR=0.71RR=0.57RR=0.70Slide SourceLipidsOnline024681012141618Patients with Events(%)LIPID Study Group.N Engl J Med 1998;339:1349-1357.HDL-CPlaceboPravastatin39 mg/dL37 mg/dL37 mg/dLP=0.008P 0.001Slide SourceLipidsOnline01020304050607080Events(%
11、)Downs JR et al.JAMA 1998;279:1615-1622.HDL-C LevelsPlaceboLovastatin40 mg/dl404135Slide SourceLipidsOnlinenTherapeutic lifestyle changesnPharmacologic therapynStatinsnFibratesSlide SourceLipidsOnline0510152025Cumulative Incidence(%)0Rubins HB et al.N Engl J Med 1999;341:410-418.Copyright 1999,Massa
12、chusetts Medical Society.All rights reserved.123456YearPlaceboGemfibrozil22%reductionP=0.006Slide SourceLipidsOnline050100150200050100150200303132333435050100150200TC(mg/dL)012345YearLDL-C(mg/dL)Year012345HDL-C(mg/dL)YearTG(mg/dL)Year012345PlaceboGemfibrozil4%,P0.001No changeGemfibrozil&PlaceboPlace
13、boGemfibrozil+6%,P0.001012345PlaceboGemfibrozil31%,P0.001Rubins HB et al.N Engl J Med 1999;341:410-418.Copyright 1999,Massachusetts Medical Society.All rights reserved.Slide SourceLipidsOnlineVariable(Change)Risk Factor(95%CI)PDuring treatmentHDL-C(5.0 mg/dL)0.89(0.810.98).02Triglycerides(50 mg/dL)1
14、.03(0.951.11).48LDL-C(25 mg/dL)1.09(0.981.21).13Robins SJ et al.JAMA 2001;285:1585-1591.Copyright 2001,American Medical Association.Slide SourceLipidsOnlinenTherapeutic lifestyle changesnPharmacologic therapynStatinsnFibratesnNiacinSlide SourceLipidsOnline-50-40-30-20-100102030Change from Baseline25
15、00 mg3000 mgGoldberg A et al.Am J Cardiol 2000;85:1100-1105.2000 mg1500 mg1000 mg500mgHDL-CLDL-CLp(a)TG9%14%22%21%17%29.5%30%26%22%15%10%28%35%44%39%11%5%26%3%12%30%24%17%Slide SourceLipidsOnlinenLifestyle changes and secondary causesnPharmacologic therapynIf LDL-C elevated:statinnIf TG elevated:fib
16、ratenIf isolated low HDL-C:niacinnCombination therapySlide SourceLipidsOnline-30-20-100102030Change(%)Wolfe ML et al.Am J Cardiol 2001;87:476-479.Copyright 2001,Excerpta Medica Inc.Reprinted with permission.TCLDL-CHDL-CTGSlide SourceLipidsOnlineCV Events0510152025Event Rate(%)Brown BG et al.Circulat
17、ion 1998;98:I-635.Usual Care(n=101)DeathsLDL-C 188166 mg/dL;HDL-C 3840 mg/dL;TG 208220 mg/dLLDL-C 202106 mg/dL;HDL-C 4353 mg/dL;TG 210134 mg/dLTriple Therapy(n=75)19.818.81.3*p0.055.3*Slide SourceLipidsOnlinenLDL-C remains the primary target of lipid-altering therapiesnHDL-C is an important CHD risk
18、 factornEven small increases in HDL-C may confer substantial benefitnIntervention to raise HDL-C levels should be considered in high-risk patientsSlide SourceLipidsOnlinen48-year-old man with metabolic syndrome and CHDnAfter therapeutic lifestyle changes and a starting dose of statin:Cholesterol 179
19、 mg/dL Triglycerides 252 mg/dL LDL-C 97 mg/dL HDL-C 32 mg/dL Glucose 104 mg/dLSlide SourceLipidsOnline演讲完毕，谢谢观看！Thank you for reading!In order to facilitate learning and use,the content of this document can be modified,adjusted and printed at will after downloading.Welcome to download!汇报人：XXX 汇报日期：20XX年10月10日
