社区医生如何开展冠心病及风险管理.ppt

* * * * * 参考答案：啤酒250克略小于250ml，即常见普通瓶装啤酒的小半瓶，或易拉罐的2/3罐 * * 参考答案：个人“控盐” 没必要也没办法弄得太机械。世界卫生组织把日荐摄盐量降低1克主要还是为了向人们传达一个限盐和低钠饮食的理念。在短期之内，让人们每日摄盐限制在5克以内不太现实，但至少大家应该有这个意识，去无限地接近这个目标。 * * 毛主席：“基本吃素，提倡走路” * * * * * * * 这是2000年发表的一份关于中国心脑血管病分死亡原因的死亡人数的调研报告（1991－2000年全国疾病检测系统资料）。 可以看到，脑血管病死亡人数远远高于冠心病，中国脑卒中与心肌梗死的比例在5-8：1左右，而西方国家的比例为1：1，说明我国的脑卒中的危害的确非常大，高血压又是脑卒中的主要危险因素，中国高血压防治的重点是预防脑卒中。 * 脑卒中的危险因素已经非常明确，控制这些危险因素对于脑卒中的预防非常重要。这张幻灯显示在美国每年大约有700000脑卒中，假如有效控制高血压可以预防50%脑卒中，可见控制高血压的重要性。 References 1. Gorelick PB. Stroke prevention. Arch Neurol. 1995;52:347-355. 2. Gorelick PB. Stroke prevention therapy beyond antithrombotics: unifying mechanisms in ischemic stroke pathogenesis and implications for therapy. Stroke. 2002;33:862-875. * * Emberson J et al, used estimates of the relative risk reductions from meta-analyses of randomised trials in combination with data from a prospective observational study of CVD (the British Regional Heart Study) to analyse the impact of different risk reduction strategies in primary prevention. The study examined the effects of prevention strategies based on single risk factor assessment or total risk assessment. They concluded that assessment of overall risk leads to more effective intervention than assessment based on single risk factors. Furthermore, multiple interventions have considerably greater benefits than interventions based on targeting single risk factors. Ten percent reductions in long-term mean blood cholesterol and BP could have reduced major CVD by 45%. Jackson R et al, conducted a review of the randomised trials of BP or blood cholesterol lowering treatments and outlined the rationale for targeting BP and blood cholesterol lowering therapy to patients at high absolute CV risk. They concluded that separate management guidelines for raised BP and blood cholesterol need to be replaced by integrated CV risk management guidelines. They also posited that because CV risk factors interact with each other, moderate reductions in several risk facto