PHYSICIANS' HEALTH STUDY
A randomized, double-blind, placebo controlled trial designed to test the effects of low-dose aspirin and beta-carotene in the primary prevention of CVD and cancer among 22,071 US male physicians, aged 40 to 84 at baseline in 1982. Baseline blood specimens were collected and frozen for later analyses from 14,916 participants.
ANTIPLATELET AGENTS
ASA
– Physicians’ Health Study – Swedish Angina Pectoris Trial
TICLOPIDINE CLOPIDOGREL
– CAPRI – CURE
Receptor GP IIb-IIIa: The Final Common Pathway to Platelet Aggregation
Treatment of Chronic Stable Angina

Medical
Revascularization
PCI
ACBG
MEDICAL THERAPY
ANTIPLATELETS BETA BLOCKERS NITRATES CALCIUM ANTAGONIST ACEI STATINS NEW THERAPIES
Pharmacotherapy for Chronic
Stable Angina (class I)
1. Aspirin in the absence of contraindications A
2. Beta-blockers as initial therapy in the absence of contraindications in patients with prior myocardial infarction or without prior myocardial infarction A,B
The trial's Data and Safety Monitoring Board stopped the aspirin arm of the PHS several years ahead of schedule because it was clear that aspirin had a significant effect on the risk of a first myocardial infarction. As reported in the July 20, 1989 New England Journal of Medicine, aspirin reduced the risk of first myocardial infarction by 44% (P less than 0.00001). There were too few strokes or deaths upon which to base sound clinical judgment regarding aspirin and stroke or mortality
慢性稳定性心绞痛的治疗（英文）
The Goals of Therapy in CAD
To improve quality of life (symptoms) To reduce mortality To reduce morbidity To reduce progression of disease and induce regression.
High-dose heparin stimulates PAF which activates platelets
White HD. Am J Cardiol 1997; 80:2B-10B. Schafer A. J Clin Invest 1986; 78:73-79. DeJong MJ, et al. Critical Care Nursing Clin of N Am 1999; 11:355-371. Moser M, et al. J Cardiovasc Pharmacol 2003;41:586-592. Phillips DR, Scarborough RM. Am J Cardiol 1997;80(4A):11B-20B.
PHYSICIANS' HEALTH STUDY
Primary Endpoints
• Total cancer • Prostate cancer • Cardiovascular disease • Eye disease
ä Cataract ä Macular degeneration
PHYSICIANS' HEALTH STUDY
Using a 2x2 factorial design:
• 325 mg of aspirin (Bufferin, supplied by Bristol-Myers Products on alternate days)
• 50 mg of beta-carotene (Lurotin, supplied by BASF AG on alternate days)
• GP IIb-IIIa inhibitors displace fibrinogen in existing thrombi to disaggregate thrombus and prevent further platelet crosslinking and thrombosis
• GP IIb-IIIa inhibitors prevent platelet activation by blocking GP IIb-IIa (outsidein signaling)