心血管預(yù)防指南-英文課件

1、Guidelines For Cardiovascular PreventionDr Chan, Ngai Yin, MBBS(HK), MRCP(UK), FRCP(Edin), FACC, FAHA,Associate Consultant,Director, Cardiac Pacing Services,Princess Margaret Hospital10th South China International Congress in Cardiology, Guangzhou, China, April 12, 2008CVD and other major causes of

2、death: both sexes.(United States: 2004). Source: NCHS and NHLBI. Causes of Death-US57% of deaths due to CV diseasesSetting the Goal:A HistoryIn 1998, the AHA Board of Directors adopted a 2010 Impact Goal:By 2010, to reduce coronary heart disease, stroke and risk by 25%.Risk factors to be measured in

3、cluded:Tobacco UsageHigh Blood PressureHigh CholesterolPhysical InactivityIn 2001, Obesity and Diabetes were added as risk factors.Our goal is to achieve a 0% growth rate in Obesity and Diabetes by 2010.Coronary Heart Disease Mortality22.8%Stroke Mortality18.8%AHA/ACC Guidelines for Secondary Preven

4、tion for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 UpdateLifestyle modificationBlood pressure controlLipid managementDiabetes managementAntithrombotic treatmentRenin-Angiotensin-Aldosterone system blockade blockersInfluenza vaccinationLifestyle modificationSmoking-compl

5、ete cessation, avoid environmental exposurePhysical activity-30 minutes, 7 days per week (minimum 5 days per week)Weight management-BMI 18.5-24.9kg/m2, waist circumference 40 inches for men, 35 inches for womenBlood Pressure ControlGoal: 140/90mmHg or 130/80mmHg if patient has diabetes or chronic ki

6、dney diseaseLifestyle modificationAs tolerated, add BP medication, treating initially with blockers and/or ACEI, with addition of other drugs such as thiazidesNew Lipid Target (1)LaRosa JC, Grundy SM, Waters DD et al. Intensive lipid lowering with atorvastatinIn patients with stable coronary disease

7、. NEJM 2005;352:1425-3510001 pts with CHDAnd LDL130mg/dlMedian FU 4.9yearsMean LDL 77 vs 101New Lipid Target (4)Shephard J, Kastelein JJP, Bittner V et al. Intensive lipid lowering with atrovastatin in patientsWith coronary heart disease and chronic kidney disease. JACC 2008;51:1448-5410001 pts with

8、 CHD9656 with renal data3107 CKD (GFR60ml/min/1.73m2vs 6549 normal GFRLipid ManagementDiet therapyLDL-C 100mg/dL, further reduction of LDL-C to 70mg/dL is reasonableIf TG 200-499mg/dL, non-HDL-C should be 130mg/dLIf TG 500mg/dL, prevent pancreatitis with fibrate or niacin before LDL loweringLipid-lo

9、wering medications: statin, fibrate, niacin, bile acid sequestrants, ezetimibeDiabetes ManagementLifestyle modification and pharmacotherapyGoal: HbA1c7%Antithrombotic TherapyLifelong aspirin 75-162mg/d Aspirin 100-325mg/d within 48h of SVG, higher dose for 1 year Aspirin 325mg/d postPCI (1 month BMS

10、, 3 months SES, 6 months PES)+Clopidogrel 75mg/d up to 12 months for ACS, postPCI (1 month BMS, 3 months SES, 6 months PES)Warfarin with INR 2-3 for PAF, CAF or flutterRenin-Angiotensin-Aldosterone System BlockadeACEI-LVEF40%, HT, DM, or CKD-Low-risk, normal LVEF, optionalARB-ACEI intolerant-Combina

11、tion with ACEI in systolic heart failureAldosterone blockade-post-MI patients, on ACEI and blocker, either DM or heart failure, LVEF40% -BlockersMI, ACS, or LVD with or without heart failure symptoms (I, A)All other patients with coronary or other vascular disease or diabetes (IIa, C)Framingham Heart Study2489 men and 2856 women30-74 yo12 ye