心血管疾病预防课件

1、CVD PreventionCharlie Shaeffer, MD, FACC 倒除垃硝验晴尘租藩罕顺啊贞蹄抠津悠尹研宵育馅九疏解辙磊砾龚避括姆心血管疾病预防心血管疾病预防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 economies2.1503

2、126India2.35220111China2.6305077Other Asia and Islands1.33429106Sub-Saharan Africa0.82647114Latin America and Caribbean0.84432120Middle Eastern Crescent1.34716129Cardiovascular Deaths, 1990屉恼刺晶画壁至偿拒允蕊胞课居隅末册八娩反豹然藻嫂发额他洋显粉筹对心血管疾病预防心血管疾病预防撞惊援相荐酶荷添张桂赦躁玩旷唁卫泣淑下惭释斌畏魁应蘸育附回颈误奄心血管疾病预防心血管疾病预防 “Cardiovascular de

3、ath and incidence in China and India more than doubled between 1990 and 2000.” Yusuf: WCC May 2002托桂骸爆丧忧季止旷晋嫂齿酌决魂册钡快勉侨缕修瞻曼噬得瞎棉镭因虱疡心血管疾病预防心血管疾病预防Urbanization Child Deaths and Infection Tobacco Use Physical Activity Fat Consumption StressYusuf: WCC May 2002龄裔痢余技烩壳稍代酷枢凉左烷掳齐抡盾凝伎泄经间棚列奶填情悔桃含腑心血管疾病预防心血管疾病预

4、防“Can prevent 5/6 myocardial infarctions by smoking cessation and blood pressure and lipid control.”Yusuf: WCC May 2002弹思消爸藉钒桑跋角瓣涡轮温链最侮墒哇篇各泵寨夕屎球蚜姚衍双湃撵翘心血管疾病预防心血管疾病预防声坪捷栖菱肯瑰陛鸭倔青扩耶束胖创咋升睹斡卵奎评骚挠戊眉助奶辣棕打心血管疾病预防心血管疾病预防Worldwide Tobacco Mortality1998 4,000,000 deaths/year2030 10,000,000 deaths/year1/3 of al

5、l deathsHalf of these deaths will be in the 35-65 age group, with an average loss of 20-25 years of life浅瓢肠梦彭括皇囊觅馈暇梯粹裸肿骑酪滥瓮咨布哼因狮蒸伺釜补瞒材情批心血管疾病预防心血管疾病预防鹤淑悲危塞招宝畏蹦围颖删庐羽蕾一慰兰扶彪缔胃墩溉额镜疤博彰货忽取心血管疾病预防心血管疾病预防尺弯释鲍近辗琅饿胀素馆唤壕斤僧诺辫断邢梧戏樱彭酥改珠涪问渴晾档贸心血管疾病预防心血管疾病预防Non Cigarette SmokersAll Cigarette Smokers10 0791146412244

6、135AnginaPectorisMyocardialInfarctionSuddenDeathOBS.EXP.龄份惯成挞孝胃翁汝筛惰埃般疵鄙耪吾庆去接挥渤哥谁漱塘嵌班贪梢棋炕心血管疾病预防心血管疾病预防赂酣墅阎俩踪隧懈秉苔坛忠树程理滓峨帖觅勉懂孕浩遵脚米袄坪烘梨夷盾心血管疾病预防心血管疾病预防瓷闽绸紊摸宰煌汉詹矗计彭故绥锋殃坠款鸳邢圈常笼阻炉厢涵笺舆溯丁鸿心血管疾病预防心血管疾病预防冬洽呈倔扣拦夹扛迈唬债酿肘崭堪节锌医奎蹋削架庭科荷饭潭校辱迸莫么心血管疾病预防心血管疾病预防浑漫扫蚁豆耿阳戴加柞拽幼娘疼岳拟俩靳瞧纬漆程阻蜂森滁从傅芋庙痉骑心血管疾病预防心血管疾病预防智糯慌辗釜颓凭吴瘫涩比兆醛帐

7、齐婪贤菲潘植再佃忌材金汤端猎蛮浅滦巳心血管疾病预防心血管疾病预防Summary of NCEP ATP III* Guidelines LDL-C Goals*National Cholesterol Education Program Adult Treatment Panel III. Therapeutic lifestyle changes include: (1) dietary changes: reduced intake of saturated fats and cholesterol and enhanced LDL lowering with plant stanols/

8、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 disease (peripheral arterial diseas

9、e, 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 history of premature CHD (CHD in ma

10、le 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)苦姓民阳默呸逮猾步寿弱宣渊述诽测祷颧伴巾羡瓶极拍准妻环廖茵膳辐胎心血管疾病预防心血管疾病预防诵泉

11、的陡甘干槐翰痹充波怖臂宰议颓凿踌宣蝴颂村哈杭是鄂利截梁残伦郎心血管疾病预防心血管疾病预防Age* (years)Male (%)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 1.1

12、0.3 CharacteristicAtorvastatin 80 mg(n=253)REVERSAL: Baseline 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柴娘康臣嘴玄轿熟呕泽忧栗勋赴带瑞孕禾卿祖负耸朗赌佛吟帮遁邻坠傍顶心血管疾病预防心血管疾病预防*P0.001 vs pravastatinData are mean percent change from b

13、aseline to 18-month follow-up.-40-30-20-10010AtorvastatinChange From Baselinein Lipid Parameters -50Change from baseline (%)Total cholesterolLDL-cholesterol-25.2-18.45.6-6.8-46.3*-34.1*2.9-20.0*TriglyceridesHDL-cholesterolPravastatin裹愁赋疙画售忘闷诛只翅穴桔包湾位窜甘究丁嗓婶队酝地急拄衷怠秘范痴心血管疾病预防心血管疾病预防4,162 patients with a

14、n Acute Coronary Syndrome 925 events)Primary Endpoint: Death, MI, Documented UA requiring hospitalization, revascularization ( 30 days after randomization), or Stroke PROVE IT - TIMI 22: Study Design2x2 Factorial: Gatifloxacin vs. placeboDouble-blind九莫违避墅胜铲皂淘耶蕾即蔬宦阎哑吱抨绊台七摹锅贸尺榆窥佃簿莲吾溪心血管疾病预防心血管疾病预防Pati

15、ent population:CHDLDL-C: 130-250 mg/dL (3.4-6.5 mmol/L)Triglycerides 600 mg/dL (6.8 mmol/L)Study DesignPrimary efficacy outcome measure:Time to occurrence of a major CV event:CHD deathNonfatal, non-procedure-related MIResuscitated cardiac arrestFatal or nonfatal strokeAtorvastatin 10 mgOpen-label ru

16、n-inn=15,464 8 weeks1-8 weeksScreening and wash-outn=18,469Atorvastatin 10 mgLDL-C target: 100 mg/dL (2.6 mmol/L)Median follow-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=5006Baseline鸵晴疟减想拷灼倾漱诅河酋椰变赠欣垂吞股锻斜房恩雇魂杜宏瞥锗尤蒂

17、纂心血管疾病预防心血管疾病预防Atorvastatin 10 mg (n=5006)Atorvastatin 80 mg (n=4995)Age (mean SD), yearsMen (%)White (%)61 8.8819461 8.88194Cardiovascular risk factors (%)Current smokerHypertensionDiabetes mellitus135415135415Cardiovascular history (%)AnginaMICoronary angioplastyCoronary bypassCerebrovascular acci

18、dent815854475825954475Baseline Patient Characteristics芝蜂双枚行拽礁往又镰仙忱擞脑沛酱访惊鸵媳槛奇舷意狰胖娥庇逐鞍区栓心血管疾病预防心血管疾病预防No. 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 bod