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1、SlideSourceLipidsOnlinewww.lipidsonline.orgnNeedforcombinationlipid-alteringdrugtherapynEzetimibeandstatinsnBileacidsequestrantsandstatinsnPPARagonistsandstatinsnFishoilsandstatinsnNiacinandstatinsSlideSourceLipidsOnlinewww.lipidsonline.orgCHDorCHDRiskEquivalen
2、ts<100(10-yearrisk>20%)2+RiskFactors<130(10-yearrisk?20%)0–1RiskFactor<160NCEPATP=NationalCholesterolEducationProgramAdultTreatmentPanel.LDL-C=low-densitylipoproteincholesterol.ExpertPanelonDetection,Evaluation,andTreatmentofHighBloodSlideSourceCholesterolinAdu
3、lts.JAMA2001;285:2486-2497.LipidsOnlinewww.lipidsonline.org100%70%80%60%40%39%(40%%18%)20%0%PLowRiskHighRiskCHDAllPatientsatien=8611,9241,3524,137nDrtugtherapyincludedstatins(fluvastatin,lovastatin,pravastatin,simvastatin),sgemfibrozil,bileacidsequestrants,niac
4、in,psylliumfiber,andcombinationdrugtherapy.ASlideSourceAdcaptedfromPearsonTAetal.ArchInternMed2000;160;459-467.LipidsOnlinehwww.lipidsonline.orgievingGoal0%-10%28%10mg38%-20%20mg-30%35%40mg41%B-40%46%80mgase51%-50%lin54%Me-60%ea*MneanbaselineLDL-C.?A%tthetimeof
5、thisstudy,themaximumdoseforsimvastatinwas40mg.SlideSourceAdCaptedfromJonesPetal.AmJCardiol1998;81:582-587.LipidsOnlinewww.lipidsonline.orghangefromArteriallumenCEIntestineSkinexcretion(esterificationOvaryAtheroscleroticplaque/foamcells)MuscleHDLFreecholesterolA
6、drenalHDLCMSR-B1LiverLDL/apoB–EReceptorLDLLDLAtheroscleroticplaqueHealthierarterywithdecreasedplaqueArterywithincreasedplaqueSlideSourceBaysHetal.ExpertOpinPharmacother2003;4:779-790.LipidsOnlinewww.lipidsonline.orgCholesterylestersexcretion(esterification)Free
7、cholesterolSlideSourceBaysHetal.ExpertOpinPharmacother2003;4:779-790.LipidsOnlinewww.lipidsonline.orgnEzetimibeselectivelyinhibitsintestinalcholesterolabsorptionn?intestinaldeliveryofcholesteroltothelivern?expressionofhepaticLDLreceptorsn?cholesterolcontentofat
8、herogenicparticlesnEzetimibeanditsactiveglucuronidemetabolitecirculateenterohepaticallynDeliversagentbacktothesiteofactionPhotocourtesyofHarryR.Davis,PhDnLimitssystemicexpos
