缺血性卒中和短暂性脑缺血发作的二级预防

缺血性卒中和短暂性脑缺血发作的二级预防

TIA 160 140 120 100 80 60 135

150 76.1 40 20 0 3 Stroke. 2006;37:63-68 World Health Organization. Atlas of Heart Disease and Stroke. http://www.who.int/cardiovascular_diseases/resources/atlas/en/

/10 200 165 200 150 100 50 165 77 51

0 3 n=1091 8.8 13.0 58.5 56.0

13.0 16.3 22.0 17.9 29.0 41.5 /TIATIA 20.0 16.9

21.0 0.0 10.0 20.0 30.0 40.0

50.0 60.0 70.0

TIA TIA 10mmHg, 49% 5mmHg, 46% TIA 7 RCT

TIA 140/TIA90mmHg 130/TIA80mmHg

1. 2. 3. 1mmol/TIAL 25% : 1. 2.

LDL-C LDL VLDL 1 2 /TIATIA 2010 TIA - TIA

TIA CE (I) (II)II)

(II) LDL-C LDL-C <2.1mmol/TIAL 80mg/TIAdl

>2.1mmol/L 80mg/dl >2.6mmol/L 100mg/dl SPARCL >40% <2.6mmol/TIAL 100mg/TIAdl

30-40% . 2008;47(10) CEA TIA - TIA

TIA CE (I) (II)II) (II)

LDL-C LDL-C <2.1mmol/TIAL 80mg/TIAdl >2.1mmol/L 80mg/dl

>2.6mmol/L 100mg/dl >40% <2.6mmol/TIAL 100mg/TIAdl 30-40% / . . 2007;46(1):81-8 TIA

LDL-C 2.6mmol/L(100mg/dL) LDL-C 2.6mmol/L(100mg/ dL) , /TIA / / / , LDL-C 2.07mmol/L(80mg/ dL) , - TIA , LDLC<80mg/dl LDL-C 40% Yes LDL-C No

LDL-C Because 1. 20 2. LDL-C 1.8-2.1mmol/TIAL 3. 4.

1. 14 90056 CTT LDL-C 1mmol/TIAL 2. HPS : 3. TNT : LDL-C 2.7mmol/TIAL 1..7mmol/TIAL

SPARCL /TIA 4-8 612 1 3

CK CK 5 CK CK 2010

IDF 2010 34400 47200 IGT http://www.diabetesatlas.org/content/global-burden 66% n=557 , 2008, 12:824-827. :77% n 216 Ivey FM, et al. Cerebrovasc Dis 2006;22:368371.

n=25 72h MRI NIHSS mSR Baird TA, et al. Stroke 2003, 34:22082214. 286 238 P 0.001 mRS mRS 0-1 % NIHSS NIHSS

P 0.001 Matz K, et al. Diabetes Care, 2006, 29:792-797. 286 238 P<0.001 Matz K, et al. Diabetes Care, 2006, 29:792-797. HbA1c 1mmol/TIAL HR UKPDS 597 UKPDS 66 HbA1c 1mmol/L 17%

37% P=0.0071 P=0.0144 Diabetes Care,2004, 27:201207. 2 1mmol/L HR 2 38 2h 1mmol/L 17% Diabetologia. 2008 July; 51(7): 11231126.

5 HR 2 Wilterdink JL, Easto JD. Arch Neurol, 1992, 49(8):857863. OGTT : (IFG) IGT) (DM)) IGT 50% IFG IGT

mmol/ L 7.0 6.1 IFG+IGT IFG 5.6 IGT 7.8 11.1

OGTT2 mmol/L ADA IFG 5.6mmol/L 6.1mmol/L American Diabetes Association. Diabetes Care, 2010, 33:S11-S61. . 2 2007 . , 2008, 88(18):1227-1245. 2 2007 . 2 2007 . , 2008, 88(18):1227-1245. /TIA -------- REACH R: Risk factors managements E: Early detection

A: All-sides glucose control C: Combination rationality H: Hypoglycemia prevention R 1 -- 2 <130/TIA80mmHg, ACEI or ARB SPARCL R

ADA LDL-C <70mg/TIAdl 1.8mmol/TIAL LDL-C 30%-40% E /TIATIA oral glucose tolerance test OGTT IGR 1998-2001 5,628 6.87% IGR 8.53%

OGTT 49% 75% IGR IFG IFG+IGT IGT IGR J WP.Diabetologia,2007 Feb;50(2):286-292. OGTT (%)

80 100 80 60 20 0 80 60 40

3513 (%) 25 5 100 2/3 OGTT 40

OGTT OGTT 20 0 OGTT

2 European Heart Journal (2004) 25, 18801890. Da-Yi Hu, et al. European Heart Journal 2006;27:2573-2579. OGTT OGTT 89% IGR 14% n=557 IFG IGT+IFG IGT OGTT OGTT

, 2008, 12:824-827. ESC/EASD OGTT CVD OGTT B 2

OGTT A European Heart Journal .2007 (28):88136. WHO/IDF OGTT OGTT IGT FPG 6.1-6.9mmol/Lmmol/L OGTT

Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia: Report of a WHO/IDF Consultation OGTT 0 30 60 120 180 1985 WHO OGTT 75g 2 World Health Organ Tech Rep Ser. 1985;727:1-113.

A HbA1c 1. 3 2. 3. HbA1c6.5%6.5% 2004 woerle 64% HbA1c<7% 94% HbA1c HbA1c C 1. 2.a-

3. 4.- 5. H 2.8mmol/Lmmol/L 3.9mmol/Lmmol/L 1. 2. 3. /TIA /TIA /TIA /TIA /TIA

TIA FPG FPG 7mmol/TIAL OGTT / /TIA 10mmom/ L 10mmom/L

8.3mmom/L FPG 7.0mmom/L 7.0mmom/L* OGTT + IGT

IFG * 2010 /TIA 2 50-325mg/TIAd 25mg 200mgbid

75mg/TIAd 75mg/TIAd 50-325mg/TIAd I A I A ADP GPIIb/TIAIIIa

- 2010 Lancet 13% ASA 1.Hankey GJ,et al. Lancet Neurol,2010; 9: 27384

24 RR 95 CI 0.75 (0.71-0.81) 25 0.62 (0.55-0.71) 38

0.62 (0.51-0.75) 38 0.62 (0.48-0.80) 38 0 2007 24 2004 0.5 1

79439 30 55 24 Long-term Aspirin Use and Mortality in Women ARCH INTERN MED/VOL 167, MAR 26, 2007 562 /TIA 1000 0 2 4 6

8 10 12 14 16 55,462 108 273mg/TIAday 37 He J, et al. JAMA 1998;280:19305 75-150mg/TIAd (%) ( mg/d) 500 1500 14.5

17.2 (%) 19 3 160 325 11.5 14.8 26 3 75 150 10.9 15.2 32 6

<75 17.3 19.4 13 8 12.9 16.0 23 2 0 ATC Antithrombotic Trialists Collaboration. BMJ. 2002;324:71-86.

0.5 1.0 1.5 2.0 P<.0001 CAPRIE: RRR 14.9% p=0.045 * (%)

12 10 RRR 8.7% 10.2% 8.8% p=0.043 8 6 5.8% 5.3% 4

2 0 ASA CAPRIE (n=19,099) MI (n=4496) *MI, ; 1.6 1. Ringleb PA et al. Stroke 2004; 35: 528532. + Relative Risk (95% CI) Caneschi*

0.64 (0.15-2.72) Guiraud-Chaumeil 0.27 (0.03-2.37) AICLA 0.98 (0.50-1.91) ACCSG 0.83 (0.55-1.26) ESPS-2 0.74 (0.60-0.91) ESPRIT 0.79 (0.61-1.01)

Summary 0.77 (0.67-0.89) Favours aspirin + dipyridamole 0.01 * Data for stroke alone endpoint only 0.03 0.10 0.32 Favours aspirin 1.00 3.50

Risk Ratio (95% CI) Verro et al. Stroke 2008; 39: 13581363. ASA+ ASA+ PRoFESS 2 <=10 <72h 15.0 39.6%

6.6% 140 120 15.0 100 6.8% 80 28.3% 60 40.0% 28.8%

1.8% 1.8% ( lacune) 52.0% 52.1% 2.0% 2.1% n

TOAST ASA+ER -DP 10181 10151 40 20 PRoFESS <72h 121 (18%) ASA+ER- DP(n=672) P=0.006 75mg(n=688)mg(n=688) 86 (12.5%

) 36 ( ) 3 0 90 15.4% 15.6% PRoFESS 1360 <72h NIHSS=2.8 + (ASA+ER-DP)30 ASA+ER-DP ASA+ER-DP 36 3

1.Bath PMW, et al.Stroke.2010;41 4 :732-8 2. Sacco RL, et al. N Engl J Med. 2008;359:1238-1251 ASA+ 75mg/dmg/d % * * 25mg/d0 ICH 128

N Engl J Med, 2008 359:1238-1251 5%-85% Alberts MJ, et al. Stroke. 2004;35:175-178 1. ESSEN 2. 3.

Essen Essen 2010 73 Essen3 Essen<3 74 4.2% 95%CI 3.0%-5.5% 7.4% 95%CI 4.9%-9.8% P=0.001

Weimar C, et al. Stroke 2010;41(3):487-93 REACH:ESSEN ESSEN3 70% 14.0 12.0 /TIA %

10.0 8.0 ESSEN<3 30% 6.0 4.0 2.0 0.0 0 1 2 3 4

5 6 >6 ESSEN REACH 15,605 /TIATIA ( ) 1 ESSEN Christian Weimar, et al. The Essen Stroke Risk Score Predicts Recurrent Cardiovascular Events. Stroke, 2009, 40:350-354. ESSEN3 CAPRIE ESSEN 12 75mg

325mg 10 8 6 /TIA 4 (%) 2 0 0 1 2

3 4 5 6 ESSEN CAPRIE 6431 ESSEN >6 ( 96 1.4%) - Diener HC, et al. Clopidogrel for the secondary prevention of stroke. Expert Opin Pharmacother, 2005,6(5):755-764. ESSEN ESSEN3 <3

ESSEN /TIA 25mg(n=688) 23 20 20 % 15mg(n=688) 0.584) 14 AUC

0.571 (0.559- 0.575 (0.5640.586) 12 10 5mg(n=688) 0 ESSEN<3( ) ESSEN 3- 9mmol/L( ) NSAIDs

530 1 CYP2C19*2 CYP2C19 PPI PPI P450 CYP 2CY19 PPI

PPI Maximum Platelet Aggregation Intensity Induced by ADP 5 M, after M, after 5 Days of Clopidogrel Repeated Dosing (Mean SEM) 100 MAI(%) Induced by ADP 5 M 90 Treatment: Clopidogrel Alone Clopidogrel + Omeprazole 80 mg

80 70 Estimates of treatment difference (90% CI) = 8.00 (4.71 to 11.28) 60 50 40 30 20 10 0 D1 D2 Pre-dose Pre-dose D5 T2

Time (in Day) D5 T4 D5 T6 Mean inhibition of platelet aggregation (IPA) was diminished by 47% (24 hours) and 30% (Day 5) when Plavix and omeprazole were administered together Data on file FDA2010 10 New PPI , PPI PPI CYP2C19

PPI CYP2C19 1 * 1000 60.1

60 61.4 40 18.3 20 12.6 3.5 10

Coronary heart disease prevention: insights from modelling incremental cost effectiveness BMJ 327;1264 ESSEN

Recently Viewed Presentations

  • Siemens Corporate Design PowerPoint-Templates

    Siemens Corporate Design PowerPoint-Templates

    Then ask for ideas about how a steady flow of water, large enough to turn a big water wheel and power a large generator might be achieved. Show picture of Craigside, point out the raised lake and explain that this...
  • Stormwater Stewards Project 2018-2019

    Stormwater Stewards Project 2018-2019

    In this project we learned that urban areas make more dangerous types of waste that can affect the biosphere in worse ways. Another thing we learned is that humans make a ... small aquarium rocks, and large gravel inside the...
  • Providing Feedback - Jackson County Schools

    Providing Feedback - Jackson County Schools

    What is the purpose of providing feedback? Feedback Informs Learning "Actionable" feedback tells students what they are doing right or what they need to rethink or correct Marzano refers to this as "corrective" feedback Feedback is based on observations of...
  • DVA Budget 2019-20 THIS YEARS BUDGET AND WHAT

    DVA Budget 2019-20 THIS YEARS BUDGET AND WHAT

    2020 Anzac Day commemorative dawn service in France ($2.7 million) managing security and attendance at overseas commemorativeservices ($0.4 million), and a scoping study for a commemorative site on the Island of Lemnos, Greece ($0.5 million) to commemorate the role of...
  • Life Cycle of Stars

    Life Cycle of Stars

    Life Cycle of Stars 2005 K.Corbett 2005 K.Corbett 3 categories of stars Sun-sized stars (up to 6 times the size of the sun) Huge stars (6 - 30 times the size of the sun) Giant Stars (over 30 times the...
  • Somatotypes - what you should know

    Somatotypes - what you should know

    Somatotype. Sports. Reason. Throwing, Rugby (forward), Sumo Wrestling. Grouped in sports that require power. Extra body fat means more body weight, which means the performer can get more momentum or force behind their actions
  • CZMA Overview - NOAA Office for Coastal Management

    CZMA Overview - NOAA Office for Coastal Management

    goals. Your work furthers local, state, and national coastal management goals, including efforts to ... The coast was under pressure from population growth and economic development. There were increasing and competing demands for using coastal lands and waters. ... CZMA,...
  • Chapter 11, continued Barriers to International Trade and ...

    Chapter 11, continued Barriers to International Trade and ...

    Chapter 12, continued Barriers to International Trade and Investment Trade offsets differences in factor endowments, and factor movements reduce these differences However, barriers exist: Management (limited ambition, ignorance of opportunities, lack of skills, fear, inertia)