心血疾病预防

1、cardiovascular deaths by region in 1990:global burdon of disease study, 1990predicteddue to chddue to strokeincrease by 2002no. (x 106)(%)(%)(%)established market economies3.2532515former socialist economies2.1503126india2.35220111china2.6305077other asia and islands1.33429106sub-saharan africa0.826

2、47114latin america and caribbean0.84432120middle eastern crescent1.34716129cardiovascular deaths, 1990 “cardiovascular death and incidence in china and india more than doubled between 1990 and 2000.” urbanizationyusuf: wcc may 2002“can prevent 5/6 myocardial infarctions by smoking cessation and bloo

3、d pressure and lipid control.”yusuf: wcc may 2002worldwide tobacco mortalitysummary of ncep atp iii* guidelines*national cholesterol education program adult treatment panel iii. therapeutic lifestyle changes include: (1) dietary changes: reduced intake of saturated fats and cholesterol and enhanced

4、ldl lowering with plant stanols/sterols and increased soluble fiber; (2) weight reduction; and (3) increased physical activity.coronary heart disease.chd risk equivalents comprise: diabetes, multiple risk factors that confer a 10-year risk for chd 20%, and other clinical forms of atherosclerotic dis

5、ease (peripheral arterial disease, abdominal aortic aneurysm, and symptomatic carotid artery disease).?major risk factors (exclusive of ldl-c) that modify ldl-c goals include cigarette smoking, hypertension (bp 140/90 mmhg or on antihypertensive medication), low hdl cholesterol (40 mg/dl), family hi

6、story of premature chd (chd in male first-degree relative 55 years; chd in female first-degree relative 20%)100100130(100129: drug optional)2+ risk factors ?(10-year risk 20%)13013010-year risk 10%20%: 13010-year risk 10%: 16001 risk factor160160190(160189: ldl-clowering drug optional)age* (years)ma

7、le (%)white (%)body mass index* (kg/m3)current smoker (%)diabetes (%)hypertension (%)tc* (mg/dlmmol/l)ldl-c* (mg/dlmmol/l)tg* (mg/dlmmol/l)hdl-c* (mg/dlmmol/l)55.89.8719030.56.5262068231.834.2 6.00.9150.227.9 3.90.7197.295.7 2.21.242.39.9 1.10.3 characteristicatorvastatin 80 mg(n=253)reversal: basel

8、ine characteristics56.69.2738730.55.6271870232.634.1 6.00.9150.225.9 3.90.7197.7105.6 2.21.142.911.4 1.10.3 pravastatin 40 mg(n=249)*meansd*p0.001 vs pravastatindata are mean percent change from baseline to 18-month follow-up.-40-30-20-10010atorvastatinchange from baselinein lipid parameters -50chan

9、ge from baseline (%)total cholesterol ldl-cholesterol-25.2-18.45.6-6.8-46.3*-34.1*2.9-20.0*triglycerides hdl-cholesterolpravastatinprove it - timi 22: study designpatient population: chd ldl-c: 130-250 mg/dl (3.4-6.5 mmol/l) triglycerides 600 mg/dl ( 6.8 mmol/l)study designprimary efficacy outcome m

10、easure: time to occurrence of a major cv event: chd death nonfatal, non-procedure-related mi resuscitated cardiac arrest fatal or nonfatal strokeatorvastatin 10 mgopen-label run-inn=15,464 8 weeks1-8 weeksscreening and wash-outn=18,469atorvastatin 10 mgldl-c target: 100 mg/dl (2.6 mmol/l)median foll

11、ow-up = 4.9 yearsatorvastatin 80 mgldl-c target: 75 mg/dl (1.9 mmol/l)double-blind periodn=10,001ldl-c 130 mg/dl (3.4 mmol/l)n=4995n=5006baselineatorvastatin 10 mg (n=5006)atorvastatin 80 mg (n=4995)age (mean sd), yearsmen (%)white (%)61 8.8819461 8.88194cardiovascular risk factors (%)current smoker

12、hypertensiondiabetes mellitus135415135415cardiovascular history (%)anginamicoronary angioplastycoronary bypasscerebrovascular accident815854475825954475baseline patient characteristicsno. of patients (%)atorvastatin 10 mg (n=5006)atorvastatin 80 mg (n=4995)all-cause mortality282 (5.6)284 (5.7)cardiovascularchd deathstroke deathhemorrhagic stroke death155 (3.1)127 (2.5)8 (0.2)2 (0.0)126 (2.5)101 (2.0)7 (0.1)3 (0.1)noncardiovascularcancertraumaother127 (2.5)75 (1.5)9 (0.2)43 (0.9)158 (3.2)85 (1.7)15 (0.3)58 (1.2) no single cause of death (by body system, or pathological process) and no s