心血管预防指南英文

心血管预防指南英文第1页/共28页

GuidelinesForCardiovascularPrevention第2页/共28页CVDandothermajorcausesofdeath:bothsexes.

(UnitedStates:2004).Source:NCHSandNHLBI.

CausesofDeath-US57%ofdeathsduetoCVdiseases第3页/共28页SettingtheGoal:

AHistoryIn1998,theAHABoardofDirectorsadopteda2010ImpactGoal:By2010,toreducecoronaryheartdisease,strokeandriskby25%.Riskfactorstobemeasuredincluded:TobaccoUsageHighBloodPressureHighCholesterolPhysicalInactivityIn2001,ObesityandDiabeteswereaddedasriskfactors.Ourgoalistoachievea0%growthrateinObesityandDiabetesby2010.第4页/共28页CoronaryHeartDiseaseMortality22.8%↓第5页/共28页StrokeMortality18.8%↓第6页/共28页AHA/ACCGuidelinesforSecondaryPreventionforPatientsWithCoronaryandOtherAtheroscleroticVascularDisease:2006UpdateLifestylemodificationBloodpressurecontrolLipidmanagementDiabetesmanagementAntithrombotictreatmentRenin-Angiotensin-Aldosteronesystemblockadeβ–blockersInfluenzavaccination第7页/共28页LifestylemodificationSmoking -completecessation,avoidenvironmentalexposurePhysicalactivity -30minutes,7daysperweek(minimum5daysperweek)Weightmanagement -BMI18.5-24.9kg/m2,waistcircumference<40inchesformen,<35inchesforwomen第8页/共28页One-for-allCommunity-BasedPhase2.5CardiacRehabilitationforLow-riskPatientsPatientswithimplantabledevicesClassIandIIheartfailurepatientsPatientswithcoronaryarterydiseaseaftercompleterevascularizationPatientswithstableanginawithsatisfactorymedicalcontrolPatientswithvalvularheartdiseaseaftersurgicaltreatment第9页/共28页第10页/共28页第11页/共28页BloodPressureControlGoal:<140/90mmHgor<130/80mmHgifpatienthasdiabetesorchronickidneydiseaseLifestylemodificationAstolerated,addBPmedication,treatinginitiallywithβ–blockersand/orACEI,withadditionofotherdrugssuchasthiazides第12页/共28页NewLipidTarget(1)LaRosaJC,GrundySM,WatersDDetal.IntensivelipidloweringwithatorvastatinInpatientswithstablecoronarydisease.NEJM2005;352:1425-3510001ptswithCHDAndLDL<130mg/dlMedianFU4.9yearsMeanLDL77vs101第13页/共28页NewLipidTarget(2)LaRosaJC,GrundySM,WatersDDetal.IntensivelipidloweringwithatorvastatinInpatientswithstablecoronarydisease.NEJM2005;352:1425-35Primaryendpoint:FirstmajorCVevent,definedasDeathfromCHD,NonfatalMICardiacarrestsurvivorFatalornonfatalstrokeLiverderangement:1.2%vs0.2%(p<0.001)第14页/共28页NewLipidTarget(3)PedersenTR,FaergemanO,KasteleinJJetal.High-doseatorvastatinvsusual-doseSimvastatinforsecondarypreventionaftermyocardialinfarction.JAMA2005;294:2437-454439(highdose)vs4449ptsWithhistoryofMIPrimaryendpoint:MajorcoronaryeventdefinedasCoronarydeath,nonfatalAMI,orCardiacarrestsurvivorNodifferenceinCVorAll-causemortality80mgAtorvastatin20mgSimvastatin第15页/共28页NewLipidTarget(4)PedersenTR,FaergemanO,KasteleinJJetal.High-doseatorvastatinvsusual-doseSimvastatinforsecondarypreventionaftermyocardialinfarction.JAMA2005;294:2437-45第16页/共28页NewLipidTarget(4)ShephardJ,KasteleinJJP,BittnerVetal.IntensivelipidloweringwithatrovastatininpatientsWithcoronaryheartdiseaseandchronickidneydisease.JACC2008;51:1448-5410001ptswithCHD9656withrenaldata3107CKD(GFR<60ml/min/1.73m2vs6549normalGFR第17页/共28页LipidManagementDiettherapyLDL-C<100mg/dL,furtherreductionofLDL-Cto<70mg/dLisreasonableIfTG200-499mg/dL,non-HDL-Cshouldbe<130mg/dLIfTG≥500mg/dL,preventpancreatitiswithfibrateorniacinbeforeLDLloweringLipid-loweringmedications:statin,fibrate,niacin,bileacidsequestrants,ezetimibe第18页/共28页DiabetesManagementLifestylemodificationandpharmacotherapyGoal:HbA1c<7%第19页/共28页AntithromboticTherapyLifelongaspirin75-162mg/dAspirin100-325mg/dwithin48hofSVG,higherdosefor1yearAspirin325mg/dpostPCI(1monthBMS,3monthsSES,6monthsPES)+Clopidogrel75mg/dupto12monthsforACS,postPCI(≥1monthBMS,≥3monthsSES,≥6monthsPES)WarfarinwithINR2-3forPAF,CAForflutter第20页/共28页Angiotensin-Converting-EnzymeInhibitioninStableCoronaryArteryDiseaseBraunwaldE,DomanskiMJ,FowlerSEetal.Angiotensin-convertingenzymeInhibitioninstablecoronaryarterydisease.NEJM2004;351:2058-69P=0.438290ptsrandomized4mgtrandolaprilorplaceboPrimaryendpoint:DeathfromCVcauses,MI,Orcoronaryrevascularization第21页/共28页Renin-Angiotensin-AldosteroneSystemBlockadeACEI -LVEF≤40%,HT,DM,orCKD -Low-risk,normalLVEF,optionalARB -ACEIintolerant -CombinationwithACEIinsystolicheartfailureAldosteroneblockade -post-MIpatients,onACEIandß–blocker,eitherDMorheartfailure,LVEF≤40%第22页/共28页β-BlockersMI,ACS,orLVDwithorwithoutheartfailuresymptoms(I,A)Allotherpatientswithcoronaryorothervasculardiseaseordiabetes(IIa