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1、温州医学院附属第一医院心内科 张怀勤,无症状人群心血管病风险的评估,2009年中国卫生统计提要,心脑血管疾病是我国首位死亡原因,08年我国疾病死亡病因,心脏病 脑血管病,Risk factors for the development of atherosclerotic disease,Approximately 37% of American adults reported having 2 risk factors for CVD. 90% o f patients with coronary heart disease have at least 1 atherosclerotic r
2、isk factor. Approximately half of all coronary deaths are not preceded by cardiac symptoms or diagnoses,A Report of the American College of Cardiology2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults,一级预防 是降低心脑血管疾病危害的根本措施,脑卒中发生率,冠心病发生率,冠心病死亡率,8389%,7885%,6573%,7076
3、%,脑卒中死亡率,Lancet 2003, 362:271,改善高危因素显著降低了心脑血管事件的发生,我国人群心血管危险因素控制现况,高血压患者18亿人 吸烟者35亿人，被动吸烟者54亿人 血脂异常患者16亿人 糖尿病患者4000万人 肥胖患者6000万人，超重者2亿人 目前每年新增高血压或血脂异常人数1000万人,我国人群心血管危险因素控制不利,2002年调查资料显示，全国血压控制率仅为61 2006年:血脂控制率仅为50，高危、极高危人群 仅为49和38 2006年糖尿病调查表明，糖尿病患者糖化血红蛋白(HbAIc)达标(65)仅占25 吸烟者中只有26的人希望戒烟，戒烟成功率仅 为115
4、,心血管疾病一级预防中国专家共识 危险因素评估方法,Framingham SCORE PROCAM (Men) Reynolds (Women) Reynolds (Men) 中国缺血性心血管病危险评估模型 (KNOW your risk ),心血管病的危险因素,传统的危险因素： 年龄、性别、种族、家族史、高胆固醇血症、 吸烟、糖尿病、高血压、腹型肥胖、缺乏运动、饮食缺少蔬菜水果、精神紧张 “新”的危险因素： C反应蛋白、载脂蛋白a、纤维蛋白原、 同型半胱氨酸、尿酸,Risk factors for the development of atherosclerotic disease,CVD
5、was mentioned on the death certificates of 56% of decedents in 2005. It was listed as the underlying cause of death in 35.3% (864,480) of all deaths (2,448,017) in 2005 or 1 of every 2.8 deaths in the U.S. In every year since 1900 (except 1918), CVD accounted for more deaths than any other major cau
6、se of death in the United States ( 6). It is estimated that if all forms of major CVD were eliminated, life expectancy would rise by almost 7 years,A Report of the American College of Cardiology2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults,Assessment of Cardiov
7、ascular Risk,CLASS I Global risk scores (such as the Framingham Risk Score )that use multiple traditional cardiovascular risk factors should be obtained for risk assessment in all asymptomatic adults without a clinical history of CHD. These scores are useful for combining individual risk factor meas
8、urements into a single quantitative esti- mate of risk that can be used to target preventive interventions . (Level of Evidence: B ),Family History,CLASS I Family history of atherothrombotic CVD should be obtained for cardiovascular risk assessment in all asymptomatic adults . (Level of Evidence: B
9、) CLASS III: NO BENEFIT Genotype testing for CHD risk assessment in asymptomatic adults is not recommended . (Level of Evidence: B),A Report of the American College of Cardiology2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults,Other Circulating Blood Markers and A
10、ssociated Conditions,CLASS III: Measurement of natriuretic peptides is not recommended for CHD risk assessment in asymptomatic adults . (Level of Evidence: B) CLASS IIa In men 50 years of age or older or women 60 years of age or older with LDL cholesterol less than 130 mg/dL; not on lipid-lowering,h
11、ormone replacement, or immunosuppressant therapy; without clinical CHD, diabetes, chronic kidney disease, severe inflammatory conditions, or contraindications to statins,measurement of CRP canbe useful in the selection of patients for statin therapy . (Level of Evidence: B),Hemoglobin A1C (HbA1C),CL
12、ASS IIb 1. Measurement of hemoglobin A1C (HbA1C) may be reasonable for cardiovascular risk assessment in asymptomatic adults without a diagnosis of diabetes . ( Level of Evidence: B ),A Report of the American College of Cardiology2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymp
13、tomatic Adults,Microalbuminuria,CLASS IIa In asymptomatic adults with hypertension or diabetes, urinalysis to detect microalbuminuria is reasonable for cardiovascular risk as-sessment . ( Level of Evidence: B ) CLASS IIb In asymptomatic adults at intermediate risk without hypertension or diabetes, u
14、rinalysis to detect microalbuminuria might be reasonable for cardiovascular risk assessment . (Level of Evidence: B,Lp-PLA2,CLASS IIb Lipoprotein-associated phospholipase A2 (Lp-PLA2) might be reasonable for cardiovascular risk assessment in intermediate-risk asymptomatic adults . ( Level of Evidenc
15、e: B ),ECG,CLASS IIa A resting electrocardiogram (ECG) is reasonable for cardiovascular risk assessment in asymptomatic adults with hypertension or dia-betes . ( Level of Evidence: C ) CLASS IIb A resting ECG may be considered for cardiovascular risk assessment in asymptomatic adults without hyperte
16、nsion or diabetes (Level of Evidence: C ),Resting Echocardiography Transthoracic Echocardiography,CLASS IIb Echocardiography to detect LVH may be considered for cardiovascular risk assessment in asymptomatic adults with hypertension (Level of Evidence: B ) CLASS III: Echocardiography is not recommended for cardiovascular risk assessment of CHD in asymptomatic adults without hypertension. (Level of Evidence: C ),Carotid Intima-Media Thickness on Ultrasound,C
