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1、Guidelines For Cardiovascular PreventionDr 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
2、death: both sexes.(United States: 2004). Source: NCHS and NHLBI. Causes of Death-US57% of deaths due to CV diseasesSetting the Goal:A HistoryIn 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 in
3、cluded:Tobacco UsageHigh Blood PressureHigh CholesterolPhysical InactivityIn 2001, Obesity and Diabetes were added as risk factors.Our goal is to achieve a 0% growth rate in Obesity and Diabetes by 2010.Coronary Heart Disease Mortality22.8%Stroke Mortality18.8%AHA/ACC Guidelines for Secondary Preven
4、tion for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 UpdateLifestyle modificationBlood pressure controlLipid managementDiabetes managementAntithrombotic treatmentRenin-Angiotensin-Aldosterone system blockade blockersInfluenza vaccinationLifestyle modificationSmoking-compl
5、ete cessation, avoid environmental exposurePhysical 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 womenOne-for-all Community-Based Phase 2.5 Cardiac Rehabilitation for Low-risk PatientsPatients
6、 with implantable devicesClass I and II heart failure patientsPatients with coronary artery disease after complete revascularizationPatients with stable angina with satisfactory medical controlPatients with valvular heart disease after surgical treatmentBlood Pressure ControlGoal: 140/90mmHg or 130/
7、80mmHg if patient has diabetes or chronic kidney diseaseLifestyle modificationAs tolerated, add BP medication, treating initially with blockers and/or ACEI, with addition of other drugs such as thiazidesNew Lipid Target (1)LaRosa JC, Grundy SM, Waters DD et al. Intensive lipid lowering with atorvast
8、atinIn patients with stable coronary disease. NEJM 2005;352:1425-3510001 pts with CHDAnd LDL130mg/dlMedian FU 4.9yearsMean LDL 77 vs 101New Lipid Target (2)LaRosa JC, Grundy SM, Waters DD et al. Intensive lipid lowering with atorvastatinIn patients with stable coronary disease. NEJM 2005;352:1425-35
9、Primary endpoint:First major CV event, defined asDeath from CHD,Nonfatal MICardiac arrest survivorFatal or nonfatal strokeLiver derangement:1.2% vs 0.2% (p0.001)New Lipid Target (3)Pedersen TR, Faergeman O, Kastelein JJ et al. High-dose atorvastatin vs usual-dose Simvastatin for secondary prevention
10、 after myocardial infarction. JAMA 2005;294:2437-454439 (high dose) vs 4449 ptsWith history of MIPrimary endpoint:Major coronary event defined asCoronary death, nonfatal AMI, orCardiac arrest survivorNo difference in CV or All-cause mortality80mg Atorvastatin20mg SimvastatinNew Lipid Target (4)Peder
11、sen TR, Faergeman O, Kastelein JJ et al. High-dose atorvastatin vs usual-dose Simvastatin for secondary prevention after myocardial infarction. JAMA 2005;294:2437-45New Lipid Target (4)Shephard J, Kastelein JJP, Bittner V et al. Intensive lipid lowering with atrovastatin in patientsWith coronary hea
12、rt disease and chronic kidney disease. JACC 2008;51:1448-5410001 pts with CHD9656 with renal data3107 CKD (GFR60ml/min/1.73m2vs 6549 normal GFRLipid ManagementDiet therapyLDL-C 100mg/dL, further reduction of LDL-C to 70mg/dL is reasonableIf TG 200-499mg/dL, non-HDL-C should be 130mg/dLIf TG 500mg/dL
13、, prevent pancreatitis with fibrate or niacin before LDL loweringLipid-lowering medications: statin, fibrate, niacin, bile acid sequestrants, ezetimibeDiabetes ManagementLifestyle modification and pharmacotherapyGoal: HbA1c7%Antithrombotic TherapyLifelong aspirin 75-162mg/d Aspirin 100-325mg/d withi
14、n 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)Warfarin with INR 2-3 for PAF, CAF or flutterAngiotensin-Converting-Enzyme Inhibition in Stable Coronary
15、 Artery DiseaseBraunwald 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 revascularizationRenin-Angiotensin-Aldos
16、terone System BlockadeACEI-LVEF40%, HT, DM, or CKD-Low-risk, normal LVEF, optionalARB-ACEI intolerant-Combination with ACEI in systolic heart failureAldosterone blockade-post-MI patients, on ACEI and blocker, either DM or heart failure, LVEF40% -BlockersMI, ACS, or LVD with or without heart failure
17、symptoms (I, A)All other patients with coronary or other vascular disease or diabetes (IIa, C)Framingham Heart Study2489 men and 2856 women30-74 yo12 years FU383 men and 227 womenDeveloped CHD12 European cohort205178 subjects18 years FU7934 CV deathsCardiovascular Diseases-Mortality Rate in Hong KongMortality ratePer 100,000?
