1、现代脂质三联治疗现代脂质三联治疗执教教师：XXXIntroductionIntroductionPart IEfficacy - The Power to Reach TargetKey Factor:Key Factor: + +Differentiators:Differentiators:LDL ReductionTGHDLLDL/HDL RatioThe Lipid Triad The LDL/HDL Ratio - Our Strength, Our Story!Clear positioningfor LipobayA new perception of efficacyDiffe
2、rentiation to AtorvastatinFit with our product profileLDLHDLAdditional risk factor,especially in diabeticsThe Lipid Triad - OverviewTGThe Lipid TriadThe RatioThe Lipid Triad The Lipid Triad and Strategic Rationale and Strategic Rationale Part II No scientific evidence Evidence contradicting this sta
3、tement A marketing hypothesis to build their LDL story Creating the perception of the statin with the strongest efficacy Its logicalIts measurableIts practicableThe Lipid Triad - The GPs PerspectiveSupporting Data Supporting Data from Landmark Studiesfrom Landmark StudiesPart III121086420% Mortality
4、Placebo Q1 Q2 Q3 Q4(low HDL-increase) (high HDL-increase)4S - StudyCAD Mortality per Quartiles of Increases in HDL-CholesterolKJEKSHUS J & PEDERSEN T (unpublished) HDL Intervention Trial (VA-HIT)RUBINS HB et al. New Engl J Med 1999; 341:41006-31-4-35-30-25-20-15-10-50510Cholesterol LDL-C HDL-C Trigl
5、yceridesPercent change compared to placebo at 1 yearSecondary Prevention in 2531 menwith low HDL-C & LDL-C showed a22% reduction in combined fataland non-fatal MIHDL - Cholesterol as Risk Factor for CHDLRC - CPPT (Placebo)MRFIT (usual care)Incidence rate of CHDIncidence rate of CHD121086420100 130 1
6、60 190GORDON DJ et al. Circulation 1989; 79: 8 - 15.HDL - Cmg / dl65554535LDL - Cholesterol mg / dlLDL - Cholesterol mg / dl121086420100 130 160 19000.511.522.53Framingham Heart StudyCAD risk as a function of LDL-C and HDL-C in men (50 to 70 y)CASTELLI WP. Am J Cardiol 1998; 82:60-65220 160 10085654
7、525HDL-Cholesterol(mg/dl)LDL Cholesterol (mg/dL)0246810121416LDL5HDL=1.08 HDL1.08LDL/HDL5Incidence of cardiac events (per 1000 person-years)GemfibrozilPlaceboLDL-C Tertiles (mmol/L)HDL-C Tertiles (mmol/L)LDL-C/HDL-C Tertiles244632 3634 4522 3938 5318 29Incidence for cardiac events vs lipid parameter
8、Helsinki Heart StudyAFCAPS/TEXCAPS Apo B/A1 Tertiles LDL-C/HDL-C Tertiles 1.6 1.4 1.210.8 0.6 0.4 0.2 0 1.6 1.4 1.210.8 0.6 0.4 0.2 0 Event Rate per 100 Patient-Years of RiskEvent Rate per 100 Patient-Years of Risk 0.88890.8898-1.02051.0252 3.77423.7744-4.40964.4101LDL/HDL Ratio as Therapeutic Succe
9、ssPlaceboStatin 2411631245050100150200250300 5LDL / HDL - RatioTriglycerides = 200 mg/dlCAD cases per 1,000 subjects in 6 yearsIncidence of CAD vs LDL/HDL ratio by TG level (n = 4559)PROCAM Heart Study 0501001502002503003 4 567LDL/HDL ratioCHD Incidence/1000 in 6 yearsCHD risk according to LDL/HDL r
10、atio at baseline5HighCHD riskMediumMediumCHD riskCHD riskLow Low CHD riskCHD risk3-53PROCAM Heart Study Mean values for developing atherosclerotic CHD within 6 yearsVariable CHD Development No CHD Development (n = 186)(n = 4221)TC (mg/dl)251.8222.9HDL-C (mg/dl) 39.5 45.2LDL-C (mg/dl) 176.2 147.1LDL/
11、HDL ratio 4.72 3.4TG (mg/dl)163.0134.5PROCAM Heart Study Predictive value of risk factors for developing atheroscleroticCHD within 6 yearsVariable Risk RatioPredictive Power %TG 200 mg/dl2.3 7.5TC 250 (mg/dl)2.8 8.3LDL-C 195 (mg/dl) 3.7 12.0LDL-C 155 (mg/dl) 3.3 7.1HDL-C 35 (mg/dl) 3.911.0LDL/HDL ra
12、tio 56.416.5PROCAM 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 years020406080100120140160 35 35 - 55 55HDL-C (mg/dL)1103021PROCAM Heart Study LDL as CHD risk factor showed 177 eventsin men aged 40 - 60 years, ( n = 4263)CHD
13、Incidence per 1, 000 in 6 years020406080100120140 135135 - 154 155 - 195 195LDL-C (mg/dL)54301631120PROCAM Heart Study Expert OpinionsExpert OpinionsPart IVThe Lipid Triad - Expert Comments AHA, November 1999“Evaluating the risk on the bases of LDL alone, is naive” Valentin Fuster, Mount Sinai Medic
14、al 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, BostonACCP, March 2000“Low HDL is a better indicator of CHD than high LDL as seen in epidemiological studies such as the Framingham Study and recentl
15、y the VA-HIT Study.”Sander Robins, University Medical Center, Boston“Landmark statin trials have shown consistent benefits on CHDreduction after raising HDL by 5 - 10% irrespective of LDL levels”Christie Ballantyne, Baylor College of Medicine, Houston The Lipid Triad - Expert Comments Helsinki Heart
16、 Study“The LDL/HDL ratio was the best single predictor of cardiac events”Manninen V, Leena T, Koskinen P et al. Circulation 1992;85, 1: 37“ Patients in the placebo group with triglyceride levels of 200 mg/dland an LDL/HDL ratio of 5.0 had by far the highest incidence ofcardiac events”Gerd Assmann, Lipid Metabolism Disorders and Coronary Heart Disease,MMV Medizin Verlag, 1993The Lipid Triad - Expert Comments PROCAM“The greatest difference, in relative terms, between the groupswith and without maj
