冠心病高危因素综合防治.ppt

零级预防新理念 零级预防是1978年Strasser最初引入的概念。其理论基础是人群干预，预防整个社会发生危险因素的流行，而不是有了危险因素再预防心血管事件，提高整个人群的心血管健康是终极目标。 《保卫心脏》，伊丽莎白·克洛达斯曾讲一个魔鬼故事。 降压治疗 高血压故事 * Adapted from J.P. DesprésQuébec Heart Institute, Laval Hospital Research Center, Québec, CanadaThe metabolic syndrome is largely caused by our sedentary affluent environment where our population is exposed to a diet dense in calories (fat and/or refined sugar). This “toxic” environment produces a positive energy balance and weight gain, which explains the epidemic proportions reached by type 2 diabetes and obesity worldwide. In this context, the metabolic syndrome has become a major issue because of its impact on cardiovascular disease risk. Hyperglycaemia does not appear to be the main culprit responsible for the increased cardiovascular disease risk in this population. Rather, a cluster of metabolic abnormalities which includes an atherogenic dyslipidaemic state, an impaired glucose/insulin homeostasis, a prothrombotic/inflammatory profile as well as an endothelial dysfunction substantially increases the risk of coronary heart disease in type 2 diabetic patients independently from the level of glycaemic control. Furthermore, even non-diabetic patients with the features of the metabolic syndrome are at increased risk of coronary heart disease. The epidemic proportions reached by the metabolic syndrome will require integration of medical specialties for the proper evaluation and management of this condition. * 1 * 1 * * 传统治疗心脑血管疾病的方法是单一因素的控制，只单一针对高血压、血脂异常或糖尿病进行降压、降脂、降糖等治疗，现在大量研究结果发现，各种危险因素之间存在相互影响的关系，仅单一治疗的效果并不理想。新的治疗模式考虑了各种危险因素，进行整体干预，让治疗升到了一个新的台阶，因此减少整体心脑血管风险已经成为目前的主要治疗模式。 关键信息：针对美国冠心病近10年死亡率的下降的原因，一项研究评估了危险因素的控制、药物和手术治疗对死亡率下降的贡献。结果47％的下降得益于基于循证医学的治疗，包括心梗后的二级预防治疗或血管重建（11%），心梗和不稳定心绞痛的起始药物治疗（10%）等。44%的死亡率下降归功于对危险因素的干预。其中降低总胆固醇贡献最大，为24.2%。 背景信息： BACKGROUND Mortality from coronary heart disease in the United States has decreased substantially in recent decades. We conducted a study to determine how much of this decrease could