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#1
09.11.2008, 20:16
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JUPITER
Paul M Ridker et al.
Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. NEJM 2008. Background Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events. Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol, we hypothesized that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin treatment. Methods We randomly assigned 17,802 apparently healthy men and women with low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to rosuvastatin, 20 mg daily, or placebo and followed them for the occurrence of the combined primary end point of myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes. Results The trial was stopped after a median follow-up of 1.9 years (maximum, 5.0). Rosuvastatin reduced LDL cholesterol levels by 50% and high-sensitivity C-reactive protein levels by 37%. The rates of the primary end point were 0.77 and 1.36 per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio for rosuvastatin, 0.56; 95% confidence interval [CI], 0.46 to 0.69; P<0.00001), with corresponding rates of 0.17 and 0.37 for myocardial infarction (hazard ratio, 0.46; 95% CI, 0.30 to 0.70; P=0.0002), 0.18 and 0.34 for stroke (hazard ratio, 0.52; 95% CI, 0.34 to 0.79; P=0.002), 0.41 and 0.77 for revascularization or unstable angina (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.00001), 0.45 and 0.85 for the combined end point of myocardial infarction, stroke, or death from cardiovascular causes (hazard ratio, 0.53; 95% CI, 0.40 to 0.69; P<0.00001), and 1.00 and 1.25 for death from any cause (hazard ratio, 0.80; 95% CI, 0.67 to 0.97; P=0.02). Consistent effects were observed in all subgroups evaluated. The rosuvastatin group did not have a significant increase in myopathy or cancer but did have a higher incidence of physician-reported diabetes. Conclusions In this trial of apparently healthy persons without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels, rosuvastatin significantly reduced the incidence of major cardiovascular events. (ClinicalTrials.gov number, NCT00239681 [Ссылки доступны только зарегистрированным пользователям ] .) Применение статинов наиболее эффективно при высоком риске развития сердечно-сосудистых осложнений. Авторы исследования Jupiter поднимают вопрос о "первичном" приеме статинов у пациентов с высоким уровнем С-реактивного белка. В исследование было включено более 17 тыс. пациентов, качество работы высокое. Уважаемые коллеги, считаете ли Вы, что данные этого исследования реально изменят Вашу клиническую практику: 1. Будете ли Вы теперь чаще брать кровь на СРБ? 2. При СРБ более 2, будете ли Вы рекомендовать прием статинов? 
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#3
11.11.2008, 08:48
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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction
[Ссылки доступны только зарегистрированным пользователям ] ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy [Ссылки доступны только зарегистрированным пользователям ]
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#5
14.11.2008, 23:57
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Лень - это не только российский менталитет.
Специальная образовательная программа для родственников больных с CVD показала низкую приверженность к рекомендациям у здоровых.
[Ссылки доступны только зарегистрированным пользователям ]
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#6
18.11.2008, 20:21
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Randomized Clinical Trials and Observational Studies: Guidelines for Assessing Respective Strengths and Limitations
J. Am. Coll. Cardiol. Intv. 2008;1;211-217 Edward L. Hannan [Ссылки доступны только зарегистрированным пользователям ]
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Комбинированный вид
