心血管预防指南.ppt

Guidelines For Cardiovascular Prevention Dr Chan, Ngai Yin, MBBS(HK), MRCP(UK), FRCP(Edin), FACC, FAHA, Associate Consultant, Director, Cardiac Pacing Services, Princess Margaret Hospital Setting the Goal:A History In 1998, the AHA Board of Directors adopted a 2010 Impact Goal: By 2010, to reduce coronary heart disease, stroke and risk by 25%. Risk factors to be measured included: Tobacco Usage High Blood Pressure High Cholesterol Physical Inactivity In 2001, Obesity and Diabetes were added as risk factors. Our goal is to achieve a 0% growth rate in Obesity and Diabetes by 2010. Coronary Heart Disease Mortality Stroke Mortality AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update Lifestyle modification Blood pressure control Lipid management Diabetes management Antithrombotic treatment Renin-Angiotensin-Aldosterone system blockade β –blockers Influenza vaccination Lifestyle modification Smoking -complete cessation, avoid environmental exposure Physical activity -30 minutes, 7 days per week (minimum 5 days per week) Weight management -BMI 18.5-24.9kg/m2, waist circumference 40 inches for men, 35 inches for women One-for-all Community-Based Phase 2.5 Cardiac Rehabilitation for Low-risk Patients Patients with implantable devices Class I and II heart failure patients Patients with coronary artery disease after complete revascularization Patients with stable angina with satisfactory medical control Patients with valvular heart disease after surgical treatment Blood Pressure Control Goal: 140/90mmHg or 130/80mmHg if patient has diabetes or chronic kidney disease Lifestyle modification As tolerated, add BP medication, treating initially with β –blockers and/or ACEI, with addition of other drugs such as thiazides New Lipid Target (1) New Lipid Target (2) New Lipid Target (3) New Lipid Target (4) New Lipid Target (4) Lipid Management Diet therapy LDL-C 100mg/dL, further reduction of LDL-C t