危险因素到管理动脉粥样硬化要点.pptVIP

（点击动画）我们看，这是既往他汀类药物的适应症，从这张表格可以看到，（点击动画）既往他汀类药物适应症范围为高胆固醇血症或冠心病合并高胆固醇血症。 既往冠心病患者启动他汀治疗均受胆固醇水平限制。 * 我们知道，中国冠心病患者他汀治疗不尽如人意。影响冠心病患者他汀治疗的现实瓶颈有哪些呢？ （点击动画）首先，高胆固醇没有任何症状，患者不容易察觉，不像高血压会有一些不适症状，会被及时察觉并受到重视。 （点击动画）另外，以LDL-C评估冠心病他汀治疗容易造成一些临床误解。主要包括，冠心病患者LDL-C达标后经常停用他汀；另外，冠心病LDL-C水平正常的患者启动他汀治疗时面临着超适应症的尴尬。 * 成年男性60岁以前冠心病发病随年龄的增加而增加，女性绝经期后发生冠心病的危险显著增加，接近男性。 * * 在这项研究中，作者还分析了导致CHD死亡下降的原因。结果发现，约47%的下降可以归因于治疗，包括心梗或血运重建后的二级预防（11%）、急性心梗或不稳定性心绞痛后的起始治疗（10%）、对心衰的治疗（9%）、慢性心绞痛的血运重建（5%）和其它治疗（12%）。同时，有约44%的下降可以归因于危险因素的改变，其中总胆固醇下降（24%）、收缩期血压（20%）、吸烟的下降（12%）和体育运动（5%）。另外，我们还可以看到体重（8％）和糖尿病（10%）位于坐标轴的下方，这表明它们是作为导致死亡增加的负向因素。 在这篇文献的结论中，作者专门指出“美国人群CHD死亡的下降可以归因于遵循循证证据，控制危险因素“两大重要因素。 RESULTS From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively). CONCLUSIONS Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies. 一项来自国外的研究，对1686名来自动脉粥样硬化防治诊所的患者，使用B超检测其颈动斑块，观察斑块面积与心脑血管事件的关系，平均随访2.5±1.3年。其中1085名每年超过1次