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现代脂质三联治疗
药物相互作用
现代脂质三联治疗涉及的药物可能与其他药物发生相互作用 ，特别是与抗凝药物、降压药物等。因此，在治疗前应详细 询问患者的用药史，避免潜在的药物相互作用。
注意事项
在使用脂质三联治疗时，需遵循医嘱，按时按量服药。同时 ，患者应定期监测血脂、肝功能等指标，以及时调整治疗方 案。
副作用识别与处理建议
脂质三联治疗的核心策略是针对不同患者的脂质代谢异常类型和程度，制定个体 化的治疗方案，旨在实现脂质代谢的全面优化和心血管健康的长期保障。
脂质代谢与疾病关系
01
脂质代谢异常与动脉粥样硬化
脂质代谢异常，特别是低密度脂蛋白胆固醇（LDL-C）水平升高，是动
脉粥样硬化的主要危险因素之一。通过降脂治疗可以降低LDL-C水平，
03
现代脂质三联治疗药物介绍
他汀类药物
药物作用
他汀类药物是一类降脂药物，主 要通过抑制HMG-CoA还原酶， 减少胆固醇合成，从而降低血清
胆固醇水平。
常用药物
常用的他汀类药物有阿托伐他汀、 瑞舒伐他汀、辛伐他汀等。
适应症
主要用于治疗高胆固醇血症、冠心 病等心血管疾病。
贝特类药物
药物作用
贝特类药物是一类降脂药物，主要通过激活过氧化物酶体 增殖物激活受体α（PPARα），促进脂肪酸氧化和胆固醇 排泄，从而降低血清甘油三酯和胆固醇水平。
现代脂质三联治疗
• 引言 • 脂质三联治疗原理及作用机制 • 现代脂质三联治疗药物介绍 • 临床应用及适应症分析 • 安全性评估与副作用管理策略 • 总结与展望
01
引言
脂质三联治疗概述
脂质三联治疗是指通过联合应用降脂药物、改善脂质代谢的药物以及针对脂质代 谢异常相关疾病的特异性治疗，达到全面调控脂质代谢、降低心血管疾病风险的 目的。
现代脂质三联治疗涉及的药物可能与其他药物发生相互作用 ，特别是与抗凝药物、降压药物等。因此，在治疗前应详细 询问患者的用药史，避免潜在的药物相互作用。
注意事项
在使用脂质三联治疗时，需遵循医嘱，按时按量服药。同时 ，患者应定期监测血脂、肝功能等指标，以及时调整治疗方 案。
副作用识别与处理建议
脂质三联治疗的核心策略是针对不同患者的脂质代谢异常类型和程度，制定个体 化的治疗方案，旨在实现脂质代谢的全面优化和心血管健康的长期保障。
脂质代谢与疾病关系
01
脂质代谢异常与动脉粥样硬化
脂质代谢异常，特别是低密度脂蛋白胆固醇（LDL-C）水平升高，是动
脉粥样硬化的主要危险因素之一。通过降脂治疗可以降低LDL-C水平，
03
现代脂质三联治疗药物介绍
他汀类药物
药物作用
他汀类药物是一类降脂药物，主 要通过抑制HMG-CoA还原酶， 减少胆固醇合成，从而降低血清
胆固醇水平。
常用药物
常用的他汀类药物有阿托伐他汀、 瑞舒伐他汀、辛伐他汀等。
适应症
主要用于治疗高胆固醇血症、冠心 病等心血管疾病。
贝特类药物
药物作用
贝特类药物是一类降脂药物，主要通过激活过氧化物酶体 增殖物激活受体α（PPARα），促进脂肪酸氧化和胆固醇 排泄，从而降低血清甘油三酯和胆固醇水平。
现代脂质三联治疗
• 引言 • 脂质三联治疗原理及作用机制 • 现代脂质三联治疗药物介绍 • 临床应用及适应症分析 • 安全性评估与副作用管理策略 • 总结与展望
01
引言
脂质三联治疗概述
脂质三联治疗是指通过联合应用降脂药物、改善脂质代谢的药物以及针对脂质代 谢异常相关疾病的特异性治疗，达到全面调控脂质代谢、降低心血管疾病风险的 目的。
现代脂质三联治疗学习课件PPT
现代脂质三联治疗
Part I
Introduction
Efficacy - The Power to Reach Target
Key Factor:
LDL Reduction
+
Differentiators:
TG HDL LDL/HDL Ratio
The Lipid Triad
The LDL/HDL Ratio - Our Strength, Our Story!!
PROCAM Heart Study
3 2.5 2 1.5
1
0.5 0
25 45 65 85 220 160 100 LDL Cholesterol (mg/dL)
CASTELLI WP. Am J Cardiol 1998; 82:60-65
Helsinki Heart Study
Incidence for cardiac events vs lipid parameter
4
2 0
24 46 32 36 34 45 22 39 38 53 18 29
LDL<=5 LDL>5
HDL>=1.08 HDL<1.08
LDL/HDL<=5 LDL/HDL>5
MANNINEN V, Leena T, Koskinen P et al. Circulation 1992; 85: 37-45
0
100 130 160 190 LDL - Cholesterol mg / dl
GORDON DJ et al. Circulation 1989; 79: 8 - 15.
Hale Waihona Puke Framingham Heart Study
Part I
Introduction
Efficacy - The Power to Reach Target
Key Factor:
LDL Reduction
+
Differentiators:
TG HDL LDL/HDL Ratio
The Lipid Triad
The LDL/HDL Ratio - Our Strength, Our Story!!
PROCAM Heart Study
3 2.5 2 1.5
1
0.5 0
25 45 65 85 220 160 100 LDL Cholesterol (mg/dL)
CASTELLI WP. Am J Cardiol 1998; 82:60-65
Helsinki Heart Study
Incidence for cardiac events vs lipid parameter
4
2 0
24 46 32 36 34 45 22 39 38 53 18 29
LDL<=5 LDL>5
HDL>=1.08 HDL<1.08
LDL/HDL<=5 LDL/HDL>5
MANNINEN V, Leena T, Koskinen P et al. Circulation 1992; 85: 37-45
0
100 130 160 190 LDL - Cholesterol mg / dl
GORDON DJ et al. Circulation 1989; 79: 8 - 15.
Hale Waihona Puke Framingham Heart Study
现代脂质三联治疗
34 45 22 39
38 53 18 29
0
LDL<=5 LDL>5
HDL>=1.08 HDL<1.08 LDL/HDL<=5 LDL/HDL>5
MANNINEN V, Leena T, Koskinen P et al. Circulation 1992; 85: 37-45
AFCAPS/TEXCAPS
65 55 45 35
GORDON DJ et al. Circulation 1989; 79: 8 - 15.
Framingham Heart Study
CAD risk as a function of LDL-C and HDL-C in men (50 to 70 y)
3
2.5
2
1.5
1
CHD Development (n = 186)
251.8 39.5 176.2 4.72 163.0
No CHD Development (n = 4221)
222.9 45.2 147.1 3.4 134.5
ASSMANN G; Lipid Metabolism Disorders and CHD; MMV Medizin Verlag, 1993: 41
LDL as CHD risk factor showed 177 events
in men aged 40 - 60 years, ( n = 4263)
140
120
120
100
80
60
54
40
20
16
0 135
31 30
135 - 154
155 - 195
现代脂质三联治疗精品文档
LDL/HDL Ratio as Therapeutic Success
Event Rate per 100 Patient-Years of Risk Event Rate per 100 Patient-Years of Risk
Apo B/A1 Tertiles
1.6
1.4 1.2
1
LDL-C/HDL-C Tertiles
The Lipid Triad - Expert Comments
LDL as CHD risk factor showed 177 events
in men aged 40 - 60 years, ( n = 4263)
140
120
120
100
80
60
54
40
20
16
0 135
31 30
135 - 154
155 - 195
LDL-C (mg/dL)
195
PROCAM Heart Study
Incidence of CAD vs LDL/HDL ratio by TG level (n = 4559)
CAD cases per 1,000 subjects in 6 years
300 245
250
200
150
116
100
50
24
31
0
<= 5
LDL / HDL - Ratio
CHD Development (n = 186)
251.8 39.5 176.2 4.72 163.0
No CHD Development (n = 4221)
222.9 45.2 147.1 3.4 134.5
Event Rate per 100 Patient-Years of Risk Event Rate per 100 Patient-Years of Risk
Apo B/A1 Tertiles
1.6
1.4 1.2
1
LDL-C/HDL-C Tertiles
The Lipid Triad - Expert Comments
LDL as CHD risk factor showed 177 events
in men aged 40 - 60 years, ( n = 4263)
140
120
120
100
80
60
54
40
20
16
0 135
31 30
135 - 154
155 - 195
LDL-C (mg/dL)
195
PROCAM Heart Study
Incidence of CAD vs LDL/HDL ratio by TG level (n = 4559)
CAD cases per 1,000 subjects in 6 years
300 245
250
200
150
116
100
50
24
31
0
<= 5
LDL / HDL - Ratio
CHD Development (n = 186)
251.8 39.5 176.2 4.72 163.0
No CHD Development (n = 4221)
222.9 45.2 147.1 3.4 134.5
现代质三联治疗
34 45 22 39
38 53 18 29
0
LDL<=5 LDL>5
HDL>=1.08 HDL<1.08 LDL/HDL<=5 LDL/HDL>5
MANNINEN V, Leena T, Koskinen P et al. Circulation 1992; 85: 37-45
AFCAPS/TEXCAPS
1.6
1.4
Placebo
1.2
1
Statin
0.8 0.6 0.4 0.2
0 0.8889 0.8898- 1.0252 1.0205
GOTTO A et al. Circulation 2000; 101: 477-484
0.8 0.6 0.4 0.2
0 3.7742 3.7744- .4101 4.4096
LDL/HDL Ratio as Therapeutic Success
Event Rate per 100 Patient-Years of Risk Event Rate per 100 Patient-Years of Risk
Apo B/A1 Tertiles
1.6
1.4 1.2
1
LDL-C/HDL-C Tertiles
The Lipid Triad - Expert Comments
Risk Ratio
2.3 2.8 3.7 3.3 3.9 6.4
Predictive Power %
7.5 8.3 12.0 7.1 11.0 16.5
ASSMANN G; Lipid Metabolism Disorders and CHD; MMV Medizin Verlag, 1993: 43
现代质三联治疗
1.6
1.4
Placebo
1.2
1
Statin
0.8 0.6 0.4 0.2
0 0.8889 0.8898- 1.0252 1.0205
GOTTO A et al. Circulation 2000; 101: 477-484
0.8 0.6 0.4 0.2
0 3.7742 3.7744- .4101 4.4096
LDL
HDL
TG
The Ratio
Additional risk factor, especially in diabetics
Part II
The Lipid Triad and Strategic Rationale
• No scientific evidence • Evidence contradicting this statement • A marketing hypothesis to build their LDL story • Creating the perception of the statin with the
0.5
0
220
160
100
LDL Cholesterol (mg/dL)
CASTELLI WP. Am J Cardiol 2019; 82:60-65
25 45 65 85
Incidence of cardiac events (per 1000 person-years)
Helsinki Heart Study
The Lipid Triad - Expert Comments
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, University Medical Center, Boston “Landmark statin trials have shown consistent benefits on CHD reduction after raising HDL by 5 - 10% irrespective of LDL levels” Christie Ballantyne, Baylor College of Medicine, Houston
1.4
Placebo
1.2
1
Statin
0.8 0.6 0.4 0.2
0 0.8889 0.8898- 1.0252 1.0205
GOTTO A et al. Circulation 2000; 101: 477-484
0.8 0.6 0.4 0.2
0 3.7742 3.7744- .4101 4.4096
LDL
HDL
TG
The Ratio
Additional risk factor, especially in diabetics
Part II
The Lipid Triad and Strategic Rationale
• No scientific evidence • Evidence contradicting this statement • A marketing hypothesis to build their LDL story • Creating the perception of the statin with the
0.5
0
220
160
100
LDL Cholesterol (mg/dL)
CASTELLI WP. Am J Cardiol 2019; 82:60-65
25 45 65 85
Incidence of cardiac events (per 1000 person-years)
Helsinki Heart Study
The Lipid Triad - Expert Comments
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, University Medical Center, Boston “Landmark statin trials have shown consistent benefits on CHD reduction after raising HDL by 5 - 10% irrespective of LDL levels” Christie Ballantyne, Baylor College of Medicine, Houston
高等院校医药类课件 现代脂质三联治疗
The Lipid Triad - Expert Comments
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, University Medical Center, Boston “Landmark statin trials have shown consistent benefits on CHD reduction after raising HDL by 5 - 10% irrespective of LDL levels” Christie Ballantyne, Baylor College of Medicine, Houston
60
40
30
21
20
0 35
35 - 55
55
HDL-C (mg/dL)
ASSMANN G; Lipid Metabolism Disorders and CHD; MMV Medizin Verlag, 1993: 59
CHD Incidence per 1, 000 in 6 years
PROCAM Heart Study
>5
Triglycerides <200 mg/dl Triglycerides >= 200 mg/dl
ASSMANN G and SCHULTE H; Am J Cardiol 1992; 70: 733-737
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LDL
HDL
TG
The Ratio
Additional risk factor, especially in diabetics
Part II
The Lipid Triad and Strategic Rationale
• No scientific evidence • Evidence contradicting this statement • A marketing hypothesis to build their LDL story • Creating the perception of the statin with the
PROCAM Heart Study
Incidence of CAD vs LDL/HDL ratio by TG level (n = 4559)
34 45 22 39
38 53 18 29
0
LDL<=5 LDL>5
HDL>=1.08 HDL<1.08 LDL/HDL<=5 LDL/HDL>5
MANNINEN V, Leena T, Koskinen P et al. Circulation 1992; 85: 37-45
AFCAPS/TEXCAPS
-20
22% reduction in combined fatal
and non-fatal MI
-25
-30
-35
-31
RUBINS HB et al. New Engl J Med 2019; 341:410
HDL - Cholesterol as Risk Factor for CHD
LRC - CPPT (Placebo) Incidence rate of CHD
Incidence for cardiac events vs lipid parameter
Gemfibrozil Placebo
LDL-C Tertiles (mmol/L) HDL-C Tertiles (mmol/L) LDL-C/HDL-C Tertiles
16
14
12
10
8
6
4
2 24 46 32 36
Fit with our product profile
Clear positioning for Lipobay
Differentiation to Atorvastatin
A new perception of efficacy
The Lipid Triad - Overview The Lipid Triad
CAD Mortality per Quartiles of Increases in HDL-Cholesterol 12
10
8
% Mortality
6
4
2
0
Placebo
Q1
Q2
(low HDL-increase)
KJEKSHUS J & PEDERSEN T (unpublished)
Q3
Q4
LDL/HDL Ratio as Therapeutic Success
Event Rate per 100 Patient-Years of Risk Event Rate per 100 Patient-Years of Risk
Apo B/A1 Tertiles
1.6
1.4 1.2
1
LDL-C/HDL-C Tertiles
现代脂质三联治疗
Part I
Introduction
Efficacy - The Power to Reach Target
Key Factor:
LDL Reduction
+
Differentiators:
TG
HDL
LDL/HDL Ratio
The Lipid Triad
The LDL/HDL Ratio - Our Strength, Our Story!!
12
10
8
6
4
2
0 100 130 160 190 LDL - Cholesterol mg / dl
MRFIT (usual care) Incidence rate of CHD 12
10
8
6
4
2
0 100 130 160 190 LDL - Cholesterol mg / dl
HDL - C [mg / dl]
65 55 45 35
GORDON DJ et al. Circulation 1989; 79: 8 - 15.
Framingham Heart Study
CAD risk as a function of LDL-C and HDL-C in men (50 to 70 y)
3
2.5
2
1.5
1
(high HDL-increase)
HDL Intervention Trial (VA-HIT)
Percent change compared to placebo at 1 year
Cholesterol LDL-C 10
5
0
0
HDL-C Triglycerides
6
-5
-4
-10
-15
Secondary Prevention in 2531 men with low HDL-C & LDL-C showed a
strongest efficacy
The Lipid Triad - The GP’s Perspective
It’s logical
It’s measurable
It’s practicable
Part III
Supporting Data from Landmark Studies
4S - Study
0.5
0
220
160
100
LDL Cholesterol (mg/dL)
CASTELLI WP. Am J Cardiol 2019; 82:60-65
25 45 65 85
Incidence of cardiac events (per 1000 person-years)
Helsinki Heart Study
1.6
1.4
Placebo
1.2
1
Statin
0.8 0.6 0.4 0.2
0 0.8889 0.8898- 1.0252 1.0205
GOTTO A et al. Circulation 2000; 101: 477-484
0.8 0.6 0.4 0.2
0 3.7742 3.7744- .4101 4.4096