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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 oth
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