.

. , MD, PhD
-


1. (1/1.000.000)
2.
. (1/1.000.000)
. (1/500)
3.
. (1/300)
. (1/10.000)
4.

The Framingham Study:

Relationship Between Cholesterol
and CHD Risk
CHD incidence per 1000

150
125

100
75
50

25
0
<204
(<5.3)

205-234
(5.3-6.1)

235-264
(6.1-6.8)

265-294
(6.8-7.6)

>295
(>7.6)

Serum total cholesterol, mg/dL (mmol/L)

Castelli WP. Am J Med. 1984;76:4-12

Benefits of Cholesterol Lowering

Meta-analysis of 38 primary and secondary intervention trials

Mortality log odds ratio

-0.0

-0.2

-0.4

-0.6

Total mortality (p=0.004)

CHD mortality (p=0.012)

-0.8

-1.0

12

16

20

24

28

32

36

40

% in cholesterol reduction
Gould AL et al. Circulation. 1998;97:946-952

Platelet Adhesion and Aggregation

Platelet Thrombus Formation

Activation of the coagulation cascade

Mackman N. J Clin Invest. 2012; 122: 2331-36

Role of Endothelium in Coagulation

The Fibrinolytic System

Marn F, et al. Thrombosis Research 109 (2003) 233 240


FH

Elisaf M, Tselepis AD. Platelets 10: 124, 1999


LDL FH

Elisaf M, Tselepis AD. Platelets 10: 124, 1999

 LDL
LDL
LDL

LDL

Relou IAM, et al. CMLS, Cell Mol Life Sci. 60: 961, 2003

Effect of CM and VLDL remnants

on platelets

Platelet activation in
Hypertriglyceridemic patients

Mochizuki M, et al. Thromb Res. 1996;81:583-593

De Man FH, et al. Atherosclerosis. 2000;152:407-414

CM
VLDL
LDL
Lp(a)
Lp(a)

 Lp(a)

HDL anti-atherothrombotic effects

Badimon L. Ann. N.Y. Acad. Sci. 1254 (2012) 1832

 HDL

Calabresi L, et al. ATVB. 23: 1724, 2003

Ex Vivo Platelet Function is Attenuated by

RecHDL in patients with 2DM

Calkin AC, et al. Circulation. 2009;120:2095-2104

Thrombus formation is attenuated by rHDL in

patients with T2DM

Calkin AC, et al. Circulation. 2009;120:2095-2104

Properties of Dense LDL

Elevation of plasma sdLDL concentration in patients with STEMI

Chan H-C, et al. Blood. 2013;122(22):3632-3641

sdLDL-induced platelet aggregation and adhesion

Chan H-C, et al. Blood. 2013;122(22):3632-3641

sdLDL-mediated Endothelial Cell dysfunction

Chan H-C, et al. Blood. 2013;122(22):3632-3641

sdLDL-mediated Endothelial Cell dysfunction

Chan H-C, et al. Blood. 2013;122(22):3632-3641


LDL

 oxLDL

 oxLDL
oxLDL

oxLDL
oxL
DL

Relou IAM, et al. CMLS, Cell Mol Life Sci. 60: 961, 2003

Morphological changes in the platelets induced by ox-LDL

Yang S-H, et al. Thromb Res. 132 (2013) 702711

The mechanism of action of statins

Skrlin S, et al. Semin Cardiothorac Vasc Anesth. 2010; 14: 283

Statins as antiplatelet drugs

Violi F, et al. Circulation. 2013;127:251-257

Statins as anticoagulant drugs

Violi F, et al. Circulation. 2013;127:251-257

Statins Reduce Atherothrombosis

Silverstein RL. J Clin Invest. 2012;122:481484

Potential beneficial effects of statins

during and after PCI

Angeli F, et al. Ther Adv Cardiovasc Dis 2012; 6: 163

Main characteristics of the randomized clinical trials

comparing early statin therapy with placebo or
usual care in patients with ACS

Angeli F, et al. Ther Adv Cardiovasc Dis 2012; 6: 163

Impact of statin therapy on all-cause mortality in

randomized clinical trials comparing early statin therapy
with placebo or usual care in patients with ACS

Angeli F, et al. Ther Adv Cardiovasc Dis 2012; 6: 163

 -
Platelet aggregation

Modified from Mitsios, JV et al. Circulation. 2004;109:13352004;109:1335-1338

Pharmacodynamic Studies That Evaluated the

possible Clopidogrel-Atorvastatin Interaction

Clinical studies that evaluated the possible

Clopidogrel-Atorvastatin Interaction

Bates ER. J Am Coll Cardiol 2011;57:125163

9

9

9 ASC
,