心血管预防指南英文课件.pptx

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1、Dr 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 death: both sexes.(United States: 2004).

2、 Source: NCHS and NHLBI. Causes of Death-US57% of deaths due to CV diseasesIn 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 included:Tobacco UsageHigh Blood PressureHigh CholesterolPhysical In

3、activityIn 2001, Obesity and Diabetes were added as risk factors.Our goal is to achieve a 0% growth rate in Obesity and Diabetes by 2010.22.8%18.8% Lifestyle modification Blood pressure control Lipid management Diabetes management Antithrombotic treatment Renin-Angiotensin-Aldosterone system blockad

4、e blockers Influenza vaccination Smoking-complete cessation, avoid environmental exposure Physical 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 women Patients with implantable devices Class I

5、 and II heart failure patients Patients with coronary artery disease after complete revascularization Patients with stable angina with satisfactory medical control Patients with valvular heart disease after surgical treatment Goal: 140/90mmHg or 130/80mmHg if patient has diabetes or chronic kidney d

6、isease Lifestyle modification As tolerated, add BP medication, treating initially with blockers and/or ACEI, with addition of other drugs such as thiazidesLaRosa JC, Grundy SM, Waters DD et al. Intensive lipid lowering with atorvastatinIn patients with stable coronary disease. NEJM 2005;352:1425-351

7、0001 pts with CHDAnd LDL130mg/dlMedian FU 4.9yearsMean LDL 77 vs 101LaRosa JC, Grundy SM, Waters DD et al. Intensive lipid lowering with atorvastatinIn patients with stable coronary disease. NEJM 2005;352:1425-35Primary endpoint:First major CV event, defined asDeath from CHD,Nonfatal MICardiac arres

8、t survivorFatal or nonfatal strokeLiver derangement:1.2% vs 0.2% (p0.001)Pedersen TR, Faergeman O, Kastelein JJ et al. High-dose atorvastatin vs usual-dose Simvastatin for secondary prevention after myocardial infarction. JAMA 2005;294:2437-454439 (high dose) vs 4449 ptsWith history of MIPrimary end

9、point:Major coronary event defined asCoronary death, nonfatal AMI, orCardiac arrest survivorNo difference in CV or All-cause mortality80mg Atorvastatin20mg SimvastatinPedersen TR, Faergeman O, Kastelein JJ et al. High-dose atorvastatin vs usual-dose Simvastatin for secondary prevention after myocard

10、ial infarction. JAMA 2005;294:2437-45Shephard 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 CHD9656 with renal data3107 CKD (GFR60ml/min/1.73m2vs 6549 normal GFR Diet

11、 therapy LDL-C 100mg/dL, further reduction of LDL-C to 70mg/dL is reasonable If TG 200-499mg/dL, non-HDL-C should be 130mg/dL If TG 500mg/dL, prevent pancreatitis with fibrate or niacin before LDL lowering Lipid-lowering medications: statin, fibrate, niacin, bile acid sequestrants, ezetimibe Lifesty

12、le modification and pharmacotherapy Goal: HbA1c7% Lifelong aspirin 75-162mg/d Aspirin 100-325mg/d within 48h of SVG, higher dose for 1 year Aspirin 325mg/d postPCI (1 month BMS, 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)

13、 Warfarin with INR 2-3 for PAF, CAF or flutterBraunwald E, Domanski MJ, Fowler SE et al. Angiotensin-converting enzymeInhibition in stable coronary artery disease. NEJM 2004;351:2058-69P=0.438290 pts randomized4mg trandolapril or placeboPrimary endpoint:Death from CV causes, MI,Or coronary revascula

14、rization ACEI-LVEF40%, HT, DM, or CKD-Low-risk, normal LVEF, optional ARB-ACEI intolerant-Combination with ACEI in systolic heart failure Aldosterone blockade-post-MI patients, on ACEI and blocker, either DM or heart failure, LVEF40% MI, 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 years FU383 men and 227 womenDeveloped CHD12 European cohort205178 subjects18 years FU7934 CV deathsMortality ratePer 100,000?