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HeartDiseaseisthemajorhealthchallengeofthe21stcentury.
Unlesssomethingisdone,by2020,36outofevery100peoplewilldieofheartdiseaseandstroke.Therateofincreasewillbegreatestinlowandmiddleincomecountries,thosecountriesthatcanleastaffordit.“Heartdiseaseandstrokearenotinevitable.Theyarelargelypreventable.Preventivemeasureswillreducetheincidenceofdeathanddisability.”Prof.MarioMaranhão,Past-President,WorldHeartFederationSource:WorldHealthReport2002WORLDHEARTFEDERATIONHeartDiseaseisthemajorhea“SuperiorDoctorsPreventtheDisease.MediocreDoctorsTreattheDiseaseBeforeEvident.InferiorDoctorsTreattheFullBlownDisease.”-HuangDee:Nai-Ching(2600B.C.1stChineseMedicalText)“SuperiorDoctorsPreventthePopulation
6,000,000,000Totaldeathsperyear
54,000,000(0.9%)Cardiovasculardeath
17,000,000(31%) 44%coronaryheartdisease 31%stroke 78%inlowincomecountriesAIDS 3,000,000Tuberculosis 1,000,000Malaria 1,000,000(mostlyinAfrica)GlobalcausesofdeathPopulation 6,000,000,000
Oneoutofevery3deaths17milliondeathsworldwide1999estimatedtoreach25millionin2020SixtimesthecurrentnumberofdeathsfromHIV/Aids80%ofdeathsareinlow/middleincomecountries
Sources:WHOWorldHealthReport2000,CVDinfobaseWORLDWIDECVDFACTSOneoutofevery3deathsSourAtherothrombosis=majorcauseofdeathinthewesternworldAtherothrombosis=majorcauseATHEROSCLEROSIS:ASYSTEMICDISEASECAD21%CVA9%PAD8%8%5%9%3%ATHEROSCLEROSIS:ASYSTEMICDIATHEROSCLEROSISATHEROSCLEROSISChronologyofAtheroscleroticArteryDisease
AtherosclerosisPlaqueSCAPreventionVulnerableSecondaryIschemicArteryDiseaseCoronaryCerebralPeripheralAntmanEMmodf.LibbyP.Circulation2001;104:365ChronologyofAtheroscleroticCardiovascularRiskFactors
ProtectingyourHeart
CardiovascularRiskFactors
Pr
MaternalandchildrenundernutritionHIghRiskSexHighBloodPressureTobaccoSmokingAlcoholAbuseUnsafeWaterandlackofbasicsanitaryandhygieneHighCholesterolPollutionoftheairathomeIrondefficiencyObesityCausesof40%ofthe56millionsofdeathIntheworld.WHO–10MOREIMPORTANTRISKS2002Causesof40%ofthe56milliSmokingHypertension(BP≥140/90mmHg)LowHDL-C(<40mg/dL)EarlyFamilyHistoryatherosclerosis(1stgraderelatives<55yearsformenand<65forwomenAge(≥45yearsmales/≥55yearsfemales)AF**+CAD/relatives1stgrade(<55anosmales/<65anosfemales)Diabetesmelitus(glucose>126mg/dL)CaracterizationoftheIndependentRiskFactorsforatherosclerosisSmokingCaracterizationoftheINDEPENDENTHypertensionTobaccoSmokingTotalCholesterol&HighLDL-CHDL-CDiabetesMelitusAgingMenopause
CVDRiskFactorsforAtherosclerosisCONDITIONALTriglyceridesLDLtypeBHomocysteinLp(a)*FibrinogenInflammatoryMarkersFAVOURINGObesityAbdominalObesidadePhysicalInactivityEarlyFamilyHistoryEthnicSocial&PsychologicFactors
INDEPENDENTCVDRiskFactorsfoObesityMetabolicSyndromePhysicalInactivityHighcholesterolandsaturatedfatdietNewRiskFactorsInflamatoryfactors(RCP+dehighsensibility)HomocysteinhighlevelsLp(a)++ProthromboticFactorsGlucoseintoleranceSub-clinicalAterosclerose(coronaryCa+,intimalthickness)PotentiationofRiskbytheFollowingFactorsObesityPotentiationofRiskbyPREVALENCEOFRISKFACTORSOVERWEIGHT/OBESITY-MCI≥25Kg/m²41,0%SMOKING32,9%
DIABETES7,6%
HYPERTENSION-BRASILIBGE15,0%
HIGHCHOLESTEROL≥240mg16,0%PREVALENCEOFRISKFACTORSOVERWorld-widesales/consumptionincreasing2/3youngmeninChinasmoke40%meninIndiauseTobaccoproducts~50%womenunderage30inEastGermanysmoke(doubledin5years)Source:SirRichardPeto/BundeszentralefürgesundheitlicheAufklärungLIFESTYLETRENDS&CVDTOBACCOWorld-widesales/consumptioniSources:WHOWorldHealthReport2000,CVDinfobase600millionwithHypertensionatriskofheartattack,stroke,heartfailure180millionhighincomecountries420millionfromlow/middleincome countriesLIFESTYLETRENDS&CVDHYPERTENSIONSources:WHOWorldHealthRepoARTERIALBLOODPRESSURECLASSIFICATIONINADULTSClassNormalPre-HipertensionHipertension1stageHipertension2stageSP*mmHg<120120-139140-159≥160DPE<80or80-89or90-99or≥100ARTERIALBLOODPRESSURECLASS
GOALGeneralPopulation<140/90HighRiskPatientsforCAD&Diabetes<130/85HYPERTENSION
150MillionDiabetics(90%typeII)Incidenceprojectedtodoublein25yearsProjectedincreasehighestinIndiaandChinaIncreasedincidenceforyoungeragegroupsSource:DiabetesandCardiovascularDisease,IDFLIFESTYLETRENDS&CVDDIABETES150MillionDiabetics(90%tyDIABETESMELLITUS
Diagnosis
Categoriesfasting2HAfter75gCasual ofglucose
FastingHighGlycemicLevels>110and<126<140LowGlucoseTolerance<126and≥140and<200
DiabetesMellitus≥126or200or
≥200(classicsymptoms)DIABETESMELLITUS
DiagnosisCObjectivesinthetreatmentofDiabetesMellitusFastingBloodGlucose(mg/dL)Post-PrandrialGlucose(2h)(mg/Dl)HbA1c(%)BMI
Optimal<110*<140<6,0*<25Accept<126<160<1,0above<27ObjectivesinthetreatmentofNormal
Lessthan25Overweight25to30Obesity30to40MorbidObesity
Morethan40BODYMASSINDEX(BMI)NormalLessthan25Overweight
300MillionobeseadultsgloballyObesityinhighincomecountriesdoubledinUK1980-1999:8-21%women6-19%menUS30%overweightadults:15%obeseF>MAlsotrendinlow/middleincomecountries Kuwait 44%women32%men Brazil 12%women7%men Pakistan(urban)20%women10%menSource:BritishMedicalJournal,ReportofWHONutrition2000LIFESTYLETRENDS&CVDOBESITY300MillionobeseadultsglobMetabolicSyndrome:RiskFactorsAbdominalObesity*(abdominalcircunference)**
Risk
Factors
AcceptedLevels
Man>102cmWoman>88cmTriglycerides>150mg/dL
HDL-CholesterolMan<40mg/dLWoman<50mg/dLBloodPressure>130/>85mmHgFastingGlucose>110mg/dLMetabolicSyndrome:RiskFactoLIFESTYLETRENDS&CVDDIABETES150MillionDiabetics(90%typeII)Incidenceprojectedtodoublein25yearsProjectedincreasehighestinIndiaandChinaIncreasedincidenceforyoungeragegroupsSource:DiabetesandCardiovascularDisease,IDFLIFESTYLETRENDS&CVDDIABET
45678140235
PoolingProject
FraminghamStudyIsraelprospective
CADRiskRatioRelationbetweenplasmacholesterol&RelativeriskforCADPlasmaCholesterol(mmol/L))
2.03.04.00.71.02.04.0CHDRiskRatioSerumCholesterol(mmol/L)CADandAge:MRFITStudy361.662Men(Ages35-57)2.03.04.RelationbetweenLDL-c&CADRiskLDL-cholesterol<100Optimal100-129NearOptimal130-159MildHigh160-189High>190VeryHighTotalCholesterol<200Desirable200-239SlightHigh>240HighHDL-cholesterol<40Low>60HighRelationbetweenLDL-c&LDL-AgeEffectonSerumLipoproteinLevelsmmo/l
mg/dl
6.2240Cholesterol
3.6140
1.03901020304050607080TotalLDLHDLMenWomenAgeAgeEffectonSerumLipoproteiEffectsofAgeonTriglycerídeos2.01771.81591.61421.41241.21061.08925-2930-3435-3940-4445-4950-5455-59mmo/lmg/dl
MeanplasmaTriglyceride(mmol/l)AgeMenWomenEffectsofAgeonTriglycerídCADinDiabeteticPatients:MeanAnnualrateFraminghamStudyAgegroup(years)40-4950-5960-6970-79122436480
Rateper1000MenDiabeticNonDiabeticCADinDiabeteticPatients:M01224364860Agegroup(years)40-4950-5960-6970-79
Rateper1000WomenDiabeticNonDiabeticCADinDiabeticPatients:MeanAnnualRateFraminghamStudy01224364860Agegroup(years)40SecondaryDyslipidemia
CAUSESDiabetesMellitusHypothireoidismoObesityNephroticSyndromeChronicRenalFailureDrugsAlcoholHepaticDiseaseObstructiveBiliaryDiseasesCollagenDiseasesSecondaryDyslipidemia
HIGH
AbsoluteRisk>20%in10years
MEANAbsoluteRisk>10a20%in10years
LOW
AbsoluteRisk<10%in10yearsCardiovascularRisksforCADHIGHCardiovascularRisksCoronaryArteryDisease(CAD)CerebrovascularDiseaseSynptomaticCarotidAtheroma,CVA*,
TiA+,CerebrovascularInsufficiencyPeripheralVascularInsufficiency(PVI)CADCLINICALLYMANIFESTED:
PREVENTIONOFHIGHRISKCoronaryArteryDisease(CAD)CDiabetesmellitus(DM)Individualsinprimarypreventionwithabsoluteriskofevents>20%10years(generallywithtwoormoreCVriskfactorsotherthancholesterol)
RefertoFraminghanRiskTablesIndividualswithoutAtherosclerosisDiseasesEvidence
HIGHRISKPREVENTIONDiabetesmellitus(DM)IndividuAbsoluteRiskforevents>10%,but20%in10yearsIndividualswith2RF**(exceptDM)beyondcholesterol(LDL-c>160mg/dL)
RefertheFraminghanscoreforriskUsetheabsolutescoreofriskfactors(Framinghan)foreventsin10yearsMEANRISKAbsoluteRiskforevents>10%AbsoluteRiskofevents<10%,Individualswith1RF**(exceptforDM)beyondcholesterol(LDL-c>160mg/dL)orjusthighLDL-c
It’snotnecessarytorefertothescoresofriskofFramingham.LOWRISKLOWRISKProposedGoalsforLipidsLevelsaccordingriskfactorsforCAD
LDL-cHDL-cTG
HIGHRISKPacientswithCAD,PVI*orsymptomaticcarotidatherosclerosis<100>40<150PacientswithDiabetes<100>45<150RiskforCADin10years≥20%<100>40<150
MEANRISKRiskforCADin10years>10%e<20%<130>40<150
LOWRISK
RiskforCADin10years<10%<130*>40<150ProposedGoalsforLipidsLeveLIFESTYLECHANGESDIET
EXERCISE
WEIGHT
SMOKINGLIFESTYLECHANGESDIET
EXERCHEALTHYDIATANDLIFESTYLECHANGESSaturatedFats<7%totalcal.PoliunsaturatedFatsupto10%totalcal.MonounsaturatedFatsupto20%totalcal.TotalFat
25-30%ofthetotalcal.ComplexCarbohydrates
50-60%ofthetotalcal.Fibers20-30g/dailyProteins
Approximately15%
ofthetotalcal.Cholesterol<200mg/dayPhytosterols3-4g/dayFibers20-30g/day(6gsoluble)TotalCalories
Balancebetweenenergeticgain&lossesdailytokeeptheidealweight.
Nutrients
RecommendedIntakeHEALTHYDIATANDLIFESTYLECHRelationBetweenCHDEventsand
LDLCholesterolinRecentStatinTrials%WithCHDEvent05101520253090110130150170190210MeanLDL-CLevelatFollow-up(mg/dL)4S-PI4S-RxLIPID-RxCARE-RxLIPID-PICARE-PIAFCAPS/TexCAPS-RxAFCAPS/TexCAPS-PIWOSCOPS-RxWOSCOPS-PI1°Prevention2°PreventionRelationBetweenCHDEventsanLIFESTYLETRENDS&CVDWOMENWomenunawareoftheirCVDriskCVDaffectswomenaroundtheglobeCVDdeaths8timeshigherthanbreast/ovariancancersIndia,ChinaandLatinAmericaaccountfor48%ofdeaths.LIFESTYLETRENDS&CVDWOMENWoADDITIONALRISKFACTORSMentalstress,anxietyanddepression,aswellas,socialfactors.Depressionispresentupto45%ofcasesofacutemyocardialinfarction(AMI).Ifunknownoruntreated,depressionfavorsasecondMI(2½-4timesmore),increasingthepossibilityofdeathupto5timesmore.ADDITIONALRISKFACTORSMental
DEPRESSIONASARISKFACTORFORCARDIOVASCULARDISEASESHIPPISLEY-COX,J.,FIELDING,K.,PRINGLE,M.Depressionasariskfactorforischaemicheartdiseaseinmen:populationbased-controlstudy.BRITISHMEDICALJOURNAL,1998;316:1714-1719
DepressionandCardioVascularDiseasesCOFFEEHEARTSTUDY
Depressionisanindependentriskfactorforcardiovasculardiseases(DCV)
Analysisof“U.S.NationalHealthandNutritionExaminationSurvey(NHANES)”showedthatpatientswithdepressionhas2,5to4timesgreaterofriskofcoronaryarterydiseaseslikemyocardialinfarctionand5timesgreaterriskofsuddendeath.
Depressionisabadmarkerforcardiovascularprognosisandsurvival.
MaycoffeepreventdepressionandMyocardialInfarction?ReportfromWHO/WHFin2004.DepressionandCardioVascular演讲完毕，谢谢观看！Thankyouforreading!Inordertofacilitatelearninganduse,thecontentofthisdocumentcanbemodified,adjustedandprintedatwillafterdownloading.Welcometodownload!汇报人：XXX汇报日期：20XX年10月10日演讲完毕，谢谢观看！ThankyouforreadinHeartDiseaseisthemajorhealthchallengeofthe21stcentury.
Unlesssomethingisdone,by2020,36outofevery100peoplewilldieofheartdiseaseandstroke.Therateofincreasewillbegreatestinlowandmiddleincomecountries,thosecountriesthatcanleastaffordit.“Heartdiseaseandstrokearenotinevitable.Theyarelargelypreventable.Preventivemeasureswillreducetheincidenceofdeathanddisability.”Prof.MarioMaranhão,Past-President,WorldHeartFederationSource:WorldHealthReport2002WORLDHEARTFEDERATIONHeartDiseaseisthemajorhea“SuperiorDoctorsPreventtheDisease.MediocreDoctorsTreattheDiseaseBeforeEvident.InferiorDoctorsTreattheFullBlownDisease.”-HuangDee:Nai-Ching(2600B.C.1stChineseMedicalText)“SuperiorDoctorsPreventthePopulation
6,000,000,000Totaldeathsperyear
54,000,000(0.9%)Cardiovasculardeath
17,000,000(31%) 44%coronaryheartdisease 31%stroke 78%inlowincomecountriesAIDS 3,000,000Tuberculosis 1,000,000Malaria 1,000,000(mostlyinAfrica)GlobalcausesofdeathPopulation 6,000,000,000
Oneoutofevery3deaths17milliondeathsworldwide1999estimatedtoreach25millionin2020SixtimesthecurrentnumberofdeathsfromHIV/Aids80%ofdeathsareinlow/middleincomecountries
Sources:WHOWorldHealthReport2000,CVDinfobaseWORLDWIDECVDFACTSOneoutofevery3deathsSourAtherothrombosis=majorcauseofdeathinthewesternworldAtherothrombosis=majorcauseATHEROSCLEROSIS:ASYSTEMICDISEASECAD21%CVA9%PAD8%8%5%9%3%ATHEROSCLEROSIS:ASYSTEMICDIATHEROSCLEROSISATHEROSCLEROSISChronologyofAtheroscleroticArteryDisease
AtherosclerosisPlaqueSCAPreventionVulnerableSecondaryIschemicArteryDiseaseCoronaryCerebralPeripheralAntmanEMmodf.LibbyP.Circulation2001;104:365ChronologyofAtheroscleroticCardiovascularRiskFactors
ProtectingyourHeart
CardiovascularRiskFactors
Pr
MaternalandchildrenundernutritionHIghRiskSexHighBloodPressureTobaccoSmokingAlcoholAbuseUnsafeWaterandlackofbasicsanitaryandhygieneHighCholesterolPollutionoftheairathomeIrondefficiencyObesityCausesof40%ofthe56millionsofdeathIntheworld.WHO–10MOREIMPORTANTRISKS2002Causesof40%ofthe56milliSmokingHypertension(BP≥140/90mmHg)LowHDL-C(<40mg/dL)EarlyFamilyHistoryatherosclerosis(1stgraderelatives<55yearsformenand<65forwomenAge(≥45yearsmales/≥55yearsfemales)AF**+CAD/relatives1stgrade(<55anosmales/<65anosfemales)Diabetesmelitus(glucose>126mg/dL)CaracterizationoftheIndependentRiskFactorsforatherosclerosisSmokingCaracterizationoftheINDEPENDENTHypertensionTobaccoSmokingTotalCholesterol&HighLDL-CHDL-CDiabetesMelitusAgingMenopause
CVDRiskFactorsforAtherosclerosisCONDITIONALTriglyceridesLDLtypeBHomocysteinLp(a)*FibrinogenInflammatoryMarkersFAVOURINGObesityAbdominalObesidadePhysicalInactivityEarlyFamilyHistoryEthnicSocial&PsychologicFactors
INDEPENDENTCVDRiskFactorsfoObesityMetabolicSyndromePhysicalInactivityHighcholesterolandsaturatedfatdietNewRiskFactorsInflamatoryfactors(RCP+dehighsensibility)HomocysteinhighlevelsLp(a)++ProthromboticFactorsGlucoseintoleranceSub-clinicalAterosclerose(coronaryCa+,intimalthickness)PotentiationofRiskbytheFollowingFactorsObesityPotentiationofRiskbyPREVALENCEOFRISKFACTORSOVERWEIGHT/OBESITY-MCI≥25Kg/m²41,0%SMOKING32,9%
DIABETES7,6%
HYPERTENSION-BRASILIBGE15,0%
HIGHCHOLESTEROL≥240mg16,0%PREVALENCEOFRISKFACTORSOVERWorld-widesales/consumptionincreasing2/3youngmeninChinasmoke40%meninIndiauseTobaccoproducts~50%womenunderage30inEastGermanysmoke(doubledin5years)Source:SirRichardPeto/BundeszentralefürgesundheitlicheAufklärungLIFESTYLETRENDS&CVDTOBACCOWorld-widesales/consumptioniSources:WHOWorldHealthReport2000,CVDinfobase600millionwithHypertensionatriskofheartattack,stroke,heartfailure180millionhighincomecountries420millionfromlow/middleincome countriesLIFESTYLETRENDS&CVDHYPERTENSIONSources:WHOWorldHealthRepoARTERIALBLOODPRESSURECLASSIFICATIONINADULTSClassNormalPre-HipertensionHipertension1stageHipertension2stageSP*mmHg<120120-139140-159≥160DPE<80or80-89or90-99or≥100ARTERIALBLOODPRESSURECLASS
GOALGeneralPopulation<140/90HighRiskPatientsforCAD&Diabetes<130/85HYPERTENSION
150MillionDiabetics(90%typeII)Incidenceprojectedtodoublein25yearsProjectedincreasehighestinIndiaandChinaIncreasedincidenceforyoungeragegroupsSource:DiabetesandCardiovascularDisease,IDFLIFESTYLETRENDS&CVDDIABETES150MillionDiabetics(90%tyDIABETESMELLITUS
Diagnosis
Categoriesfasting2HAfter75gCasual ofglucose
FastingHighGlycemicLevels>110and<126<140LowGlucoseTolerance<126and≥140and<200
DiabetesMellitus≥126or200or
≥200(classicsymptoms)DIABETESMELLITUS
DiagnosisCObjectivesinthetreatmentofDiabetesMellitusFastingBloodGlucose(mg/dL)Post-PrandrialGlucose(2h)(mg/Dl)HbA1c(%)BMI
Optimal<110*<140<6,0*<25Accept<126<160<1,0above<27ObjectivesinthetreatmentofNormal
Lessthan25Overweight25to30Obesity30to40MorbidObesity
Morethan40BODYMASSINDEX(BMI)NormalLessthan25Overweight
300MillionobeseadultsgloballyObesityinhighincomecountriesdoubledinUK1980-1999:8-21%women6-19%menUS30%overweightadults:15%obeseF>MAlsotrendinlow/middleincomecountries Kuwait 44%women32%men Brazil 12%women7%men Pakistan(urban)20%women10%menSource:BritishMedicalJournal,ReportofWHONutrition2000LIFESTYLETRENDS&CVDOBESITY300MillionobeseadultsglobMetabolicSyndrome:RiskFactorsAbdominalObesity*(abdominalcircunference)**
Risk
Factors
AcceptedLevels
Man>102cmWoman>88cmTriglycerides>150mg/dL
HDL-CholesterolMan<40mg/dLWoman<50mg/dLBloodPressure>130/>85mmHgFastingGlucose>110mg/dLMetabolicSyndrome:RiskFactoLIFESTYLETRENDS&CVDDIABETES150MillionDiabetics(90%typeII)Incidenceprojectedtodoublein25yearsProjectedincreasehighestinIndiaandChinaIncreasedincidenceforyoungeragegroupsSource:DiabetesandCardiovascularDisease,IDFLIFESTYLETRENDS&CVDDIABET
45678140235
PoolingProject
FraminghamStudyIsraelprospective
CADRiskRatioRelationbetweenplasmacholesterol&RelativeriskforCADPlasmaCholesterol(mmol/L))
2.03.04.00.71.02.04.0CHDRiskRatioSerumCholesterol(mmol/L)CADandAge:MRFITStudy361.662Men(Ages35-57)2.03.04.RelationbetweenLDL-c&CADRiskLDL-cholesterol<100Optimal100-129NearOptimal130-159MildHigh160-189High>190VeryHighTotalCholesterol<200Desirable200-239SlightHigh>240HighHDL-cholesterol<40Low>60HighRelationbetweenLDL-c&LDL-AgeEffectonSerumLipoproteinLevelsmmo/l
mg/dl
6.2240Cholesterol
3.6140
1.03901020304050607080TotalLDLHDLMenWomenAgeAgeEffectonSerumLipoproteiEffectsofAgeonTriglycerídeos2.01771.81591.61421.41241.21061.08925-2930-3435-3940-4445-4950-5455-59mmo/lmg/dl
MeanplasmaTriglyceride(mmol/l)AgeMenWomenEffectsofAgeonTriglycerídCADinDiabeteticPatients:MeanAnnualrateFraminghamStudyAgegroup(years)40-4950-5960-6970-79122436480
Rateper1000MenDiabeticNonDiabeticCADinDiabeteticPatients:M01224364860Agegroup(years)40-4950-5960-6970-79
Rateper1000WomenDiabeticNonDiabeticCADinDiabeticPatients:MeanAnnualRateFraminghamStudy01224364860Agegroup(years)40SecondaryDyslipidemia
CAUSESDiabetesMellitusHypothireoidismoObesityNephroticSyndromeChronicRenalFailureDrugsAlcoholHepaticDiseaseObstructiveBiliaryDiseasesCollagenDiseasesSecondaryDyslipidemia
HIGH
AbsoluteRisk>20%in10years
MEANAbsoluteRisk>10a20%in10years
LOW
AbsoluteRisk<10%in10yearsCardiovascularRisksforCADHIGHCardiovascularRisksCoronaryArteryDisease(CAD)CerebrovascularDiseaseSynptomaticCarotidAtheroma,CVA*,
TiA+,CerebrovascularInsufficiencyPeripheralVascularInsufficiency(PVI)CADCLINICALLYMANIFESTED:
PREVENTIONOFHIGHRISKCoronaryArteryDisease(CAD)CDiabetesmellitus(DM)Individualsinprimarypreventionwithabsoluteriskofevents>20%10years(generallywithtwoormoreCVriskfactorsotherthancholesterol)
RefertoFraminghanRiskTablesIndividualswithoutAtherosclerosisDiseasesEvidence
HIGHRISKPREVENTIONDiabetesmellitus(DM)IndividuAbsoluteRiskforevents>10%,but20%in10yearsIndividualswith2RF**(exceptDM)beyondcholesterol(LDL-c>160mg/dL)
RefertheFraminghanscoreforriskUsetheabsolutescoreofriskfactors(Framinghan)foreventsin10yearsMEANRISKAbsoluteRiskforevents>10%AbsoluteRiskofevents<10%,Individualswith1RF**
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