预防中风的他类药物:失望和希望
Pierre Amarenco1, Andrew M Tonkin
1Department of Neurology and Stroke Center, Bichat University Hospital and Medical School, Denis Diderot University-Paris VII, 46 rue Henri Huchard, 75018 Paris, France. amarenco@ccr.jussieu.fr
Circulation
|June 17, 2004
概括
在冠状动脉心脏病 (CHD) 患者中,他类药物降低了中风风险,在5年内每1000名患者中预防了9次中风. 然而,它们对一般人群或预防复发性中风的益处尚未得到证实.
科学领域:
- 心血管医学 心血管医学
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 脑卒中发生率随着年龄的增长而上升,不成比例地影响老年人,他们也有更高的冠状动脉疾病 (CHD) 风险.
- 在流行病学研究中,胆固醇水平与所有中风原因没有明确的关联.
- 长期他类药物试验表明,已确诊或高风险心血管疾病的患者中风发生率降低.
研究的目的:
- 评估他类药物在减少中风发病率方面的有效性.
- 探索他类药物对中风影响的潜在非降胆固醇机制.
- 评估全球心血管风险在治疗策略中的作用.
主要方法:
- 对9项大型长期他类药物试验的元分析,涉及70070名患者.
- 用他类药物降低中风风险的比较与抗血小板药物.
- 审查现有的流行病学和观察数据.
主要成果:
- 在冠状动脉疾病患者群体中,他类药物显示了21%的相对和0.9%的绝对降低中风风险.
- 在CHD患者中,每1000名接受他类药物治疗5年的患者中,有9例中风被预防.
- 在一般人群中,他类药物并没有证明能降低中风风险,也没有证明能预防复发性中风.
结论:
- 类药物有效降低已确诊或高风险心脏病患者中风的发生率.
- 非降胆固醇效应可能有助于他类药物的脑保护作用.
- 建议以全球心血管风险为重点的治疗策略;需要在典型的中风人群中进行进一步的研究.
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