ĐIỀU TRỊ RỐI LOẠN CHUYỂN HOÁ LIPID

ĐIỀU TRỊ RLCHLIPID PGS TS CHÂU NGỌC HOA ĐẠI HỌC Y DƯỢC TP.HCM Russel Ross (1976) Xơ vữa động mạch  Định nghĩa  Thay đổi nội mạc ĐM lớn vừa có tích tụ lipid, glucid, mô xơ, lắng đọng calci làm biến đổi trung mạc  Mảng xơ vữa : vùng lõi lipid + vỏ xơ SINH BỆNH HỌC XVĐM SINH BỆNH HỌC XVĐM SINH BỆNH HỌC XVĐM Yếu tố ảnh hưởng lên lớp nội mạc Lipids CVD – Các hướng dẫn Dịch tễ học Multiple Risk Factor Intervention Trial (n=5.209) (MRFIT) (n=356.222) 150 Cardiovascular Events per 1.000 patients Deaths for Coronary Disease 10 year-rate per 1.000 patients 16 Framingham 12 140 180 220 260 Cholesterol (mg/dL) 300 125 100 75 50 25 ≤204 206-234 235-264 265-294 Cholesterol (mg/dL) ≥295 Stamler J et al JAMA 1986; 256:2823-2828 Castelli WP et al JAMA 1986; 256:2835-2838 Potential Time Course of Statin Effects LDL-C lowered* Inflammation reduced Endothelial function restored Days * Time course established Ischemic episodes reduced Vulnerable plaques stabilized Cardiac events reduced* Years 30 No more LDL-C goals “There is no evidence to support continued use of specific LDL-C cut points The appropriate intensity of statin therapy should be used to reduce risk in those most likely to benefit.” Stone NJ et al Circulation 2014; 129:S1-45 A systematic review and meta-analysis on the therapeutic equivalence of statins 70 60 LDL  % 50 40 30 20 10 A10 A20 A40 A80 F20 F40 F80 L10 L20 L40 L80 P10 P20 P40 S10 S20 S40 S80 R5 R10 R20 R40 P1 P2 P4 ATOR FLUVA LOVA PRAVA SIMVA Weng TC, et al J Clin Pharm Ther 2010;35;139-151 Mukhtar RY, et al Int J Clin Pract 2005;59(2):239-252 www.escardio.org/guidelines European Heart Journal (2011) 32, 1769–1818 ROSU PITA Intensity of Statin Therapy Table High-1\lloclerate- and Low-Intensity Starin Therapy (Used in the RCTs r'eviewed by the Expert Panel)* High-Intensity Statin Therapy Moderate-Intensity Statin Therapy Daily dose lowers LDL-C 011 average, by approximately 2:50% Daily dose lowers LDL-C average, by approxitnately