缺血性脑血管病危险分层下的他汀类药物达标剂量

目的 探讨国人缺血性卒中/短暂性脑缺血发作(TIA)危险分层下的他汀类药物达标剂量.方法 纳入2007年1-12月在暨南大学附属第一医院神经内科102例患者,将起病<6个月的缺血性卒中/TIA患者使用不同剂量阿托伐他汀(10～80 mg/d)分为常规、强化和常规剂量非达标3组.观察12周内LDL-C达标率、卒中复发及其他血管事件,阿托伐他汀与LDL-C降幅的最效关系.结果 102例患者中,极高危患者达56%.常规和强化剂量达标组2～12周LDL-C达标率为77%～85%,显著高于常规剂量非达标组(10%～15%,P<0.001).3组99例随访12周内再发卒中/其他血管事件、安全性指标差异无统计学意义.2～12周阿托伐他汀10、20、40和80 mg/d的LDL-C降幅分别为32%～35%,46%～49%,51%～52%和印%～65%.结论 半数以上缺血性卒中/TIA患者需要强化他汀类药物治疗,临床应采用危险分层下的他汀类药物达标剂量.国人阿托伐他汀与LDL-C降幅的量效关系与国外研究结果基本一致.

The statin dosage for achieving goal of cholesterol-lowering based on risk stratification in patients with ischemic cerebrovascular diseases

Objective To explore statin dosages for targeting goal of LDL-C lowering on the basis of stroke risk stratification and the dosage-effective relation of statin and LDL-C lowering in Chinese patients with ischemic stroke and transient ischemic attack (TIA).Methods This is a prospective and open clinical trial patients with ischemic stroke/TIA within 6 months were enrolled and the dosages of atorvastatin were calculated based on risk stratification according to "Chinese Consensus for Prevention of Ischemic Stroke/TIA with Statin" (Chinese Consensus).A dose of 10 mg of atorvastatin daily to target LDL-C goal was takenas the standard dosage targeting goal (SDTG).Patients taking this dosage of atorvastatin constituted a SDTG group.Those who needed a daily dose of 20 mg or more of atorvastatin were randomized into an intensive dosage targeting goal (IDTG) group ( atorvastatin 20-80 mg/d) and a standard dosage non-targeting goal (SDNTG) group (atorvastatin 10 mg/d without targeting goal).All patients took atorvastatin for 12 weeks.The primary outcome was the rate of targeting goal for LDL-C lowering at 2,4 and 12 weeks,respectively and the secondary outcome was the occurence of recurrent stroke and other vascular events within 12 weeks.The main safety endpoint was serial adverse events including symptomatic intracranial hemorrhage.Results Altogether 102 cases were enrolled and 99 cases were followed up for 12 weeks.According to the Chinese Consensus,the rate of high risk,very high risk- Ⅰ and very high risk- Ⅱ was 44% ,28% and 28%,respectively.Targeting rate for LDL-C lowering was 77% -85% at each time point in the SDTG and IDTG groups ,being significantly higher than those in the SDNTG group ( 12% -16%,P < 0.01 ).No significant difference was found concerning the occurrence of recurrent stroke,other vascular events and safety endpoints among the three groups.The amplitude of LDL-C lowering was 32%-35% ,46%-49% ,51%-52% and 60%-65% with corresponding to daily dosage of 10 mg,20 mg,d0 mg and 80 mg atorvastatin.Conclusions At least more than half of the patients after iscbemic stroke/TIA need intensive statin therapy to target the LDL-C lowering goal.The dosage- effective relation of atorvastatin and LDL-C lowering in Chinese is similar to the reported data in other races.