全科医学 冠心病.ppt

Evidence-based Medicine Therefore, in this case, the patient using the β receptor antagonist medicine is safe and useful. Because the patient‘s blood pressure is still higher than normal after oral metoprolol，in order to control blood pressure and reduce the risk of cardiovascular disease，combination with ACEI is appropriate Evidence-based Medicine For this patient, what‘s the goal to lower cholesterol? Statins can reduce the recurrence of cardiovascular events of acute coronary syndrome patients of and all cause mortality. Recent research shows: compared with standard therapy, the treatment to lower lipid can reduce all-cause mortality of acute coronary syndrome patients. As a result, some experts claim that all of the CHD patients should use statins. In the study of LIPID, compared with the placebo group, pravastatin reduced CHD and all cause mortality, and also reduced?the incidence of cardiovascular events to?the different starting lipid levels of myocardial infarction or unstable angina patients Evidence-based Medicine For the secondary prevention of CHD：LDL-C100mg/dl ( 2. 59mmol/L) For high risk patients，LDL-C70mg/dl When LDL-C 130mg/dl，in addition to lifestyle changes, lipid-lowering drugs also should be added According to the above evidence, the patient‘s treatment goals: changing lifestyle and statin treatment.LDL-C70mg/dl is required) Evidence-based Medicine After PTCA or stent implanted, how long should continue taking clopidogrel? ACC recommended ?that combination of clopidogrel and aspirin should keep over 12 months after?acute cardiac events or PCI In this case, the patient, who is similar to the patients in the study, recently had a heart attack and will benefit from?the use of clopidogrel. Moreover, the patient has implanted the two stents, clopidogrel is indications for the treatment of 12 months after surgery. Evidence-based Medicine In the treatment of the patient, what is the role of aspirin? Aspirin therapy (81-162 mg a day) can make