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Universidade de So PauloFaculdade de Medicina Instituto do Corao (InCor)

Colesterol um vilo cujo controle depende de vocesJose Antonio F. Ramires Professor Titular de Cardiologia

jramires@incor.usp.br jramires3@yahoo.com pubmed : Ramires J A

2 Sets of Lipoproteins0.95 Density (g/mL) 1.006 1.02 1.06 1.10 1.20MAL

ApoA1

Apo B

5

10

20 60 240 Diameter (nm)

80

1000

Atherogenic Cholesterol Load0.95 Density (g/ml) 1.006 1.02 1.06 1.10 1.20 5MAL

10 20

40 60 Diameter (nm)3

80

1000

Non HDL Cholesterol0.95 Density (g/ml) 1.006 1.02 1.06 1.10 1.20 5MAL

10 20

40 60 Diameter (nm)4

80

1000

Atherogenic Lipoparticles0.95 Density (g/ml) 1.006 1.02Apo B48 Apo B100

1.06 1.10 1.20 5 10 20 40 60 Diameter (nm)5

80

1000

MAL

Translating Todays Science into Clinical PracticeOn-Treatment LDL-C is Closely Related to CHD Events in Statin Trials

MAL

6

Erhardt L. Atherosclerosis 2006;185:12-20

MAL

7

Amer.Men Hazda Inuit Ikung Pygmy San 50 70 90 110 (LDL50)

ATEROSCLEROSEMean Total Cholesterol (mg/dL)130 (LDL70) 150 170 190 210

Pygmy 100

Ikung 120Hazda 110

American men 208

San 120

Inuit 140

METABOLISMO do COLESTEROL Sintese Diaria de um Adulto800 mg

Local de Sintesefigado 75 a 95%Intestino 5 a 25%

Reduo do risco relativo de morte por DAC/ eventos coronarianos nos Estudos de Preveno Primria ou Secundria com vastatinasAFCAPS/ TexCAPS+ 0REDUO RELATIVA DO RISCO (%)

WOSCOPS

CARE

HPS

4S

LIPID

TNT

10 20 20% 30 40 50 28% 37%PREVENO PRIMRIA

-24%

24%

22%

42%PREVENO SECUNDRIA

Estudos independentes, no comparativos, com populaes diferentes de pacientes AFCAP/TEXCAPS= Air Force/texas Coronary Atherosclerosis Prevention Study; WOSCOPS= West of Scotland Coronary Prevention Study; CARE= Cholesterol AFCAP/TEXCAPS= WOSCOPS= CARE= and Recurrent Events; HPS= Heart Protection Study; 4S= Scandinavian Simvastatin Survival Study; LIPID= Long-term Intervation with Pravastatin in HPS= 4S= LIPID= Ischemic Disease; TNT= Treating to New Targets. TNT=+

Principais eventos coronarianos; morte relacionada DAC em todos os outros estudos.

Downs JR et al JAMA 1998;279(20):16151622; Sheperd J et al N Engl J Med 1995;333(20):13011307; Sacks FM et al N Engl J Med 1996;335:1001 1009; Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebo-controlled trial. Lancet 2002;360: 7-22. 4S study group Lancet 1994;344:13831389; LIPID study group N Engl J Med 1998;339(19):13491357; LaRosa JC et al. N Engl J Med 2005;352:1-11.

Metas de LDL-C do ATP III revisadas e pontos de corte para o tratamentoLDL-C (mg/dL) CATEGORIA DE RISCOAlto risco:DAC ou equivalente de risco de DAC (risco em 10 anos >20%)

META

NVEL P/ INICIAR MEV

NVEL P/ CONSIDERAR TRATAMENTO FARMACOLGICO