ACEI干预动脉粥样硬化病理生理链.ppt

高血压是心血管事件链的始动危险因素 * 对于PCI术后患者的二级预防，培哚普利是唯一经循证研究证实，可以显著降低患者终点事件的ACEI。 经EUROPA血运重建患者亚组分析证实：培哚普利可显著降低 PCI术后患者心血管死亡、心肌梗死、可复苏心脏骤停 一级复合终点达17.3%。 所有证据证明ACEI可以减少伴有动脉粥样硬化患者（无论是否有左室功能不全）的死亡率。减少心肌梗死、中风，充血性心衰的危险性。 * 不同的ACEI,循证研究结果不同. 雅施达在治疗高血压,糖尿病,卒中后及急性心肌梗死后等广泛人群中拥有超过50,000例循证医学研究证据,而且结果高度一致阳性. 不同于其他ACEI. 1. HOPE Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular high-risk patients. N Engl J Med. 2000;342:145-153.2. EUROPA Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: Randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003;362:782-788.3. PEACE Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med. 2004;351:2058-68.4. Pitt B, O’Neill B, Feldman R, Ferrari R, Schwartz L, Mudra H, et al, for the QUIET Study Group. The Quinapril Ischemic Event Trial (QUIET): Evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function. Am J Cardiol. 2001;87:1058-1063.5. Pitt B. ACE inhibitors for patients with vascular disease without left ventricular dysfunction–May they rest in PEACE? N Engl J Med. 2004;351:2115-2117. Four major trials have been conducted in high-risk CAD patients with normal LV function. HOPE demonstrated the benefit of ramipril 10 mg in high-risk stable CAD patients without LV dysfunction or heart failure. The primary outcome (CV death, MI, and stroke) was reduced 15% after 1 year and 22% at the end of the study.1 EUROPA, conducted in lower-risk patients with stable CAD and no heart failure, demonstrated a 20% reduction with perindopril 8 mg in the primary outcome (CV death, MI, and cardiac arrest).2 Thus, HOPE and EUROPA demonstrated comparable benefits with long-term treatment. In contrast, PEACE demonstrated a neutral effect of trandolapril 4 mg on the primary outcome