<International Circulation>: On to the use of statins.  What about when it comes to using the statins after， in terms of therapy， after PCI post surgery and multi vessel disease?

　　Prof. Patrick: That is a field that I know quite well because as a matter of fact I did the first study with the use of statins post PCI and it turns out that we reduce the mortality and it reduce the mortality independent of the level of the LDL so even the people with low LDL saw their mortality improve and from there it becomes a guideline that post PCI you have to use statin.  You have proof that you have atherosclerosis and you need a secondary prevention.  Now the first that was tested for that indication was the fluvastatin (Lescol)， and of course in the meantime there are much more powerful statins.  One of the most powerful is rosuvastatin (Crestor)， and we know that that in the last study from Cleveland that the rosuvastatin can really induce regression of the plaque by about 6 cubic mm so theoretically， it is the best statin after that I would say that it is the Lipitor (atorvastatin) which is second best and it is in general well tolerated but you still find in the literature and in the major， that people were criticizing the statin.  At one time people thought that it can induce cancer， it can induce depression， suicide， cataracts， pancreatitis， etc so it is important to realize that all the studies with statins are collated and in a regular basis， we are publishing the pooling of all these patients， 180，000 patients， and so far we have clearly can eliminate a lot of claim.  I think the next one we have to check is diabetes and whether statins can induce diabetes， and can statins induce pancreatitis， which is the next question.  But clearly it reduces the mortality and in a substantial way.  One of the last papers in the Lancet is interaction between exercise and statin.  It was a 10 year follow up in 10，000 patients and the mortality in the population after 10 years starting at the age of 58 was 26% and 17% so almost around 10% difference in mortality， that is very important.

　　《国际循环》:对于PCI术后及多支病变的患者应如何使用他汀药物？

　　Patrick 教授 : 这是我熟知的一个领域，因为我的首个研究就是关于PCI后如何使用他汀，结果显示，他汀可减少患者死亡率，且这一效果独立于患者的LDL水平。即使是低LDL水平的患者使用他汀也能有效降低死亡率，因此指南也推荐PCI术后患者应使用他汀治疗。动脉粥样硬化且需要接受冠心病二级预防的患者首选氟伐他汀（来适可）治疗，当然也可以选用效果更佳的他汀。罗素伐他汀（瑞舒伐他汀）是效果最好的他汀之一，近期来自克利夫兰的研究显示罗素伐他汀能真正的逆转约6m3的斑块。其次是（立普妥）阿托伐他汀，它的耐受性良好，但仍有一些文章对其提出批评。有一段时间，人们认为立普妥可以诱发癌症、抑郁症、自杀、白内障及胰腺炎等疾病。因此意识到应对所有有关他汀的研究进行核对是非常重要的。我们整理了所有患者的资料，约有180 000位，迄今我们能明确的排除许多相关的索赔。我认为下一步是核实他汀能否诱导糖尿病和胰腺炎的发生。但有一点很明确，他汀能多方位降低患者死亡率。近期柳叶刀上的一篇文章阐述了运动与他汀的对比研究，这是一项针对10000例患者的10年随访研究 ，10年后，运动组和他汀组的58岁患者的死亡率分别为26%和17%，两组间存在10%的差异，这是非常重要的。