心血管疾病预防

CVDPrevention CharlieShaeffer MD FACC CardiovascularDeathsbyRegionin1990 GlobalBurdonofDiseaseStudy 1990 PredictedDuetoCHDDuetoStrokeIncreaseby2002No x106 Establishedmarketeconomies3 2532515Formersocialisteconomies2 1503126India2 35220111China2 6305077OtherAsiaandIslands1 33429106Sub SaharanAfrica0 82647114LatinAmericaandCaribbean0 84432120MiddleEasternCrescent1 34716129 CardiovascularDeaths 1990 CardiovasculardeathandincidenceinChinaandIndiamorethandoubledbetween1990and2000 Yusuf WCCMay2002 Urbanization ChildDeathsandInfection TobaccoUse PhysicalActivity FatConsumption Stress Yusuf WCCMay2002 Canprevent5 6myocardialinfarctionsbysmokingcessationandbloodpressureandlipidcontrol Yusuf WCCMay2002 WorldwideTobaccoMortality 1998 4 000 000deaths year2030 10 000 000deaths year1 3ofalldeathsHalfofthesedeathswillbeinthe35 65agegroup withanaveragelossof20 25yearsoflife NonCigaretteSmokers AllCigaretteSmokers 100 79 114 64 122 44 135 AnginaPectoris MyocardialInfarction SuddenDeath OBS EXP SummaryofNCEPATPIII Guidelines LDL CGoals NationalCholesterolEducationProgramAdultTreatmentPanelIII Therapeuticlifestylechangesinclude 1 dietarychanges reducedintakeofsaturatedfatsandcholesterolandenhancedLDLloweringwithplantstanols sterolsandincreasedsolublefiber 2 weightreduction and 3 increasedphysicalactivity Coronaryheartdisease CHDriskequivalentscomprise diabetes multipleriskfactorsthatconfera10 yearriskforCHD 20 andotherclinicalformsofatheroscleroticdisease peripheralarterialdisease abdominalaorticaneurysm andsymptomaticcarotidarterydisease Majorriskfactors exclusiveofLDL C thatmodifyLDL Cgoalsincludecigarettesmoking hypertension BP 140 90mmHgoronantihypertensivemedication lowHDLcholesterol 40mg dL familyhistoryofprematureCHD CHDinmalefirst degreerelative 55years CHDinfemalefirst degreerelative 65years age men 45years women 55years HDLcholesterol 60mg dLcountsasa negative riskfactor itspresenceremoves1riskfactorfromthetotalcount Age years Male White Bodymassindex kg m3 Currentsmoker Diabetes Hypertension TC mg dL mmol L LDL C mg dL mmol L TG mg dL mmol L HDL C mg dL mmol L 55 8 9 8719030 5 6 5262068231 8 34 2 6 0 0 9 150 2 27 9 3 9 0 7 197 2 95 7 2 2 1 2 42 3 9 9 1 1 0 3 Characteristic Atorvastatin80mg n 253 REVERSAL BaselineCharacteristics 56 6 9 2738730 5 5 6271870232 6 34 1 6 0 0 9 150 2 25 9 3 9 0 7 197 7 105 6 2 2 1 1 42 9 11 4 1 1 0 3 Pravastatin40mg n 249 Mean SD P 0 001vspravastatin Dataaremeanpercentchangefrombaselineto18 monthfollow up 40 30 20 10 0 10 Atorvastatin ChangeFromBaselineinLipidParameters 50 Changefrombaseline Totalcholesterol LDL cholesterol 25 2 18 4 5 6 6 8 46 3 34 1 2 9 20 0 Triglycerides HDL cholesterol Pravastatin 4 162patientswithanAcuteCoronarySyndrome 10days ASA StandardMedicalTherapy StandardTherapy Pravastatin40mg IntensiveTherapy Atorvastatin80mg Duration Mean2yearfollow up 925events PrimaryEndpoint Death MI DocumentedUArequiringhospitalization revascularization 30daysafterrandomization orStroke PROVEIT TIMI22 StudyDesign 2x2Factorial Gatifloxacinvs placebo Double blind Patientpopulation CHDLDL C 130 250mg dL 3 4 6 5mmol L Triglycerides 600mg dL 6 8mmol L StudyDesign Primaryefficacyoutcomemeasure TimetooccurrenceofamajorCVevent CHDdeathNonfatal non procedure relatedMIResuscitatedcardiacarrestFatalornonfatalstroke Atorvastatin10mg Open labelrun inn 15 464 8weeks Atorvastatin10mgLDL Ctarget 100mg dL 2 6mmol L Medianfollow up 4 9years Atorvastatin80mgLDL Ctarget 75mg dL 1 9mmol L Double blindperiodn 10 001LDL C 130mg dL 3 4mmol L n 4995 n 5006 Baseline BaselinePatientCharacteristics Nosinglecauseofdeath bybodysystem orpathologicalproce