5-病例讨论 M先生 在你所诊治的患者中发现糖尿病和心血管疾病的风险并将之分层.pptVIP

与肥胖相关的多种因素导致心血管疾病风险的增加 异常的血脂代谢 弗莱明翰心脏研究甘油三酯水平和冠心病的风险 伴心血管代谢风险和脂蛋白异常的成人血脂治疗目标 整体风险评估 在治疗异常脂蛋白血症时: 大多数情况需要他汀类药物 检测和治疗Apo-B, LDL-C,和非HDL-C 需要进一步研究降低致动脉粥样硬化性异常脂蛋白血症药物的安全性和性价比 生活方式改变 Key Points This time Jill is correct. In patients whose waist circumference is large, increased risk that might not have been identified solely with BMI is more evident. If you’ve already looked at your patients BMI – in addition to other CMR factors – you could use waist circumference in place of BMI – or: measure both. Klein S et al. Waist Circumference and Cardiometabolic Risk. Diabetes Care 2007;30:1647-52. Key Points Tell your students that they need to help their patients with individualized diet plan that will affect not only their weight loss efforts but improve BP, cholesterol and blood glucose. Patients should be strongly but gently reminded to reduce their intake of energy and increase their level of physical activity. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2007;30:S4-41. Key Points A healthy diet includes carbohydrates in the form of fruits, vegetables, grains and low-fat dairy products. Diets emphasizing low-carb intake of less than 130 grams per day are not recommended. Fat and protein must also be a part of a healthy diet. American Diabetes Association. Nutrition Principles and Recommendations in Diabetes. Diabetes Care 2004;27(1):S36-S47. Key Points Alcohol intake should be limited to 1 drink or less for women each day, 2 drinks for less for men. Sodium should be limited to less than 2300 mg per day. Except in a case of underlying deficiency, there is no evidence to support the use of vitamin and mineral supplements. American Diabetes Association. Nutrition Principles and Recommendations in Diabetes. Diabetes Care 2004;27(1):S36-S47. Key Points Exercise can be easily incorporated into a daily routine with some of the suggestions noted here. The benefits of exercis