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GII THIU CAC TAI NGHIN CU KHOA HOC TAI HI NGHI NI KHOA TOAN QUC TAI THANH PH H CHI MINH THANG 7/ 2011
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=> Cham soc y te cho benh tim mach rat hao ton
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Hypercoagulable states Life-style (e.g., Homocysteinaemia smoking, diet, Hyperlipidaemia lack of exercise) Insulin resistance
Diabetes
Obesity Hypertension Genetics
Infection? Age
Atherosclerosis
Gender
American Heart Association. Heart and Stroke Facts: 1997 Statistical Supplement; Wolf. Stroke 1990;21(suppl 2):II4II-6; Laurila et al. Arterioscler Thromb Vasc Biol 1997;17:2910-2913; Grau et al. Stroke 1997;28:1724-1729; DEMA-CVN.COM Graham et al. JAMA 1997;277:1775-1781; Brigden. Postgrad Med 1997;101(5):249-262.
1.Grundy SM et al. Circulation. 2004; 110: 22739. 2.Gordon DJ, Probstfield JL, Garrison JD et al. Circulation 1989; 79: 8-15. 3.Boden W. American Journal of Cardiology 2000; 86 (suppl): 19L-22L. 4.Manninen V, Elo O, Frick MH et al. JAMA 1988; 260:641-651. 5.Rubins HB, Robins S, Collins D et al. N Engl J Med 1999; 341:410-418
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NC tien cu, ngau nhien, so sanh cheo (simvastatin vi gia dc). co tim mach cho oi tng co nguy c cao. gay t vong va khong gay t vong.
Muc tieu NC: Simvastatin co lam giam ty le t vong va cac bien Tieu ch chnh: Ty le t vong chung, Ty le cac bien co tim mach Thi gian theo doi trung bnh : 5 nam
Simvastatin 40 mg
Nguy c BMV
Simvastatin 40 mg
60
100
LDL-C (mg/dL)
TNT Trial
10,003 benh nhan benh M vanh on nh Tuoi 35-75 , LDL t 130 - 250 mg/dL, triglyceride 600 mg/dL 19% la n, tuoi trung bnh 60.3 Tat ca c dung atorvastatin 10 mg trong 8 tuan au
Atorvastatin 80 mg n=4,995
Atorvastatin 10 mg n=5,006
Primary Endpoint: Bien co tim mach chnh : t vong do benh M vanh ,NMCT khong t vong, ngng tim c hoi sc, ot qu gay t vong hoac khong t vong . Theo doi 4.9 nam.
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randomised to atorvastatin 80 mg/d (n = 4439), or simvastatin 20 mg/d (n = 4449), with a median followup of 4.8 years.
Primary endpoint was occurrence of a major coronary
event (coronary death, confirmed nonfatal acute MI, or cardiac arrest with resuscitation).
12
IDEAL
Major coronary event in 463 on simvastatin (10.4%) and 411
on atorvastatin (9.3%) P = 0.07 (not significant); nonfatal MI in 321 (7.2%) and 267 (6.0%) (P = 0.02).
No differences in cardiovascular or all-cause mortality.
13
PROVE-IT
The Pravastatin or Atorvastatin Evaluation and Infection Therapy trial (PROVE-IT/TIMI-22)
14
reduction in nonfatal MI and CHD death beyond treatment with pravastatin 40 mg.
Extrapolation of the event rate: approximate
additional 22% reduction in major CHD events in the atorvastatin group at 5 years.
15
25
Secondary Prevention
20
4S - Rx
LIPID - Pl
15
LIPID - Rx CARE - Rx HPS - Rx TNT Atv10 PROVE-IT - Pra CARE - Pl HPS - Pl
10
0 40 (1.0) 60 (1.6) 80 (2.1) 100 (2.6) 120 (3.1) 140 (3.6) 160 (4.1) 180 (4.7) 200 (5.2)
MCAEs (%)
18 16
15.9
14
12 10 8 6 4 2 0
6.7
Rosuvastatin
Control
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Placebo
70 0
0.0
Subjects at risk (% survival) Fluvastatin Placebo
0.5
3.5
4.0
MACE, major adverse cardiac event. Serruys PW. Presented at: ACC 51st Annual Scientific Session; March 20, 2002; Atlanta, GA.
A large number of clinical events occur in those with below average cholesterol levels
Total Cholesterol Distribution: CHD vs Non-CHD Population Framingham Heart Study26-Year Follow-up
No CHD
CHD
6.5
7.7
Outcomes
placebo (n=3293)
pravastatin (n=3302)
RRR (%)
p-value
Nonfatal MI/CHD death* CHD death Nonfatal MI PCTA/CABG Stroke All cardiovascular deaths Total mortality#
248
174
31
<0.001
52 204 80 51 73
135
38 143 51 46 50
106
28 31 37 11 32
22
* primary endpoint # study not powered to detect differences in this endpoint RRR relative risk reduction
Shepherd J et al. N Engl J Med 1995;333:13011307.
10
8 6 4 2 0
3
Years
AFCAPS/TexCAPS
6605 patients. Average TC and LDL-C levels (Mean TC 5.71
mmol/L, LDL-C 3.89 mmol/L, mean HDL-C level 0.94 mmol/L and median (SD) TG levels were 1.78 (0.86) mmol/L).
placebo lovastatin
0.04
0.03 0.02 0.01 0.00 0.0
>5
Years of follow-up
Statin and Usual Care in Hypertensive Patients with Average Cholesterol Levels: ALLHAT-LLT
Number of events
Outcomes
All-cause mortality CVD deaths Non-CVD deaths Cause unknown Fatal CHD and nonfatal MI All stroke Heart failure
RR relative risk
pravastatin (n=5170)
631 295 302 34 380 209 243
RR
p-value
ALLHAT
Pravastatin did not reduce either all-cause mortality or CHD significantly when compared with usual care in older participants with well-controlled hypertension and moderately elevated LDL-C. The results may be due to the modest differential in total cholesterol (9.6%) and LDL-C (16.7%) between pravastatin and usual care compared with prior statin trials supporting cardiovascular disease prevention.
(Average cholesterol)
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ASCOT-LLA: Anglo-Scandinavian Cardiac Outcomes Trial Lipid Lowering Arm - RESULTS continued Nonfatal MI and fatal CHD
Proportion of patients (%) 4
2 1
0 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Years after randomization
Atorvastatin
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JUPITER - Objective
The primary objective: Long-term rosuvastatin 20 mg decreases the rate of first major cardiovascular events compared with placebo in patients with low to normal LDL-C + elevated CRP levels
No history of CAD men 50 yrs women 60 yrs LDL-C <130 mg/dL CRP 2.0 mg/L
Rosuvastatin 20 mg (n=8901)
Placebo
run-in
Placebo (n=8901)
Visit: Week:
1 6
2 4
3 0
4 13
6-monthly
Final
Lead-in/ eligibility
Randomisation
CAD=coronary artery disease; LDL-C=low-density lipoprotein cholesterol; CRP=C-reactive protein; HbA1c=glycated haemoglobin Ridker P et al. N Eng J Med 2008;359: 2195-2207
Placebo
44%
Cumulative Incidence
0.06
0.04
Rosuvastatin 20 mg
0.00 0
Number at Risk Rosuvastatin Placebo 8,901 8,901 8,631 8,621 8,412 8,353 6,540 6,508
0.02
Follow-up (years)
3,893 3,872 1,958 1,963 1,353 1,333 983 955 544 534 157 174
Nghin cu Phng nga th pht 1994 1996 1998 2002 2004 4S CARE LIPID HPS TNT
Thuc
S bnh nhn
2005
JUPITER
17,802
44%
Ket luan
Statin la thuoc hieu qua trong phong nga bien co M vanh hau nh tat ca cac dang lam sang cua benh. iem noi bat trong nhng nam gan ay la phong nga tien phat cho nhng oi tng nguy c benh M vanh khong cao
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