欧洲esc指南.pptxVIP

2011年欧洲血脂异常管理指南解读2011年6月28日，欧洲心脏病学会（European Society Of Cardiology，ESC）和欧洲动脉粥样硬化学会（European Atherosclerosis Society，EAS）携手发布了欧洲首个血脂异常管理指南（以下称2011 ESC/EAS血脂指南）该指南汲取了当前多项循证医学研究的成果，与2007年《中国成人血脂异常防治指南》相比，具有以下亮点取消“血脂合适范围”的描述，强调根据危险分层指导治疗策略血脂异常是冠心病和缺血性脑卒中的独立危险因素，因而血脂检查成为判断血脂是否异常和评价治疗效果的重要手段在既往2007年《中国成人血脂异常防治指南》 中，将血脂水平分为“合适范围、正常、边缘升高、升高、极高、减低”等多个层次， 2001 NCEP ATP Ⅲ指南中也有类似描述取消“血脂合适范围”的描述，强调根据危险分层指导治疗策略大规模前瞻性流行病学研究结果显示，患有心血管疾病的危险性不仅取决于个体具有某一危险因素的严重程度，更取决于个体同时具有危险因素的数目，而仅仅依靠血脂化验并不能真实反映出被检查者的血脂健康水平根据CVD发病的综合危险大小来决定血脂干预的强度，已成为国内外相关指南所共同采纳的原则取消“血脂合适范围”的描述，强调根据危险分层指导治疗策略2011 ESC/EAS血脂指南取消了“血脂合适范围”的描述，更加强调根据危险分层指导治疗策略该指南明确提出血脂达标值要因人而异，“一刀切”的“合适范围值”有可能掩盖卒中、冠心病、心肌梗死等风险因素导致罹患、或者再次复发心肌梗死、卒中等CVD的概率建议采用SCORE系统将患者的心血管风险分为极高危、高危、中危或低危，以此指导治疗策略的制定取消“血脂合适范围”的描述，强调根据危险分层指导治疗策略risk assessment can be defined as follows:Those withknown CVDtype 2 diabetes or type 1 diabetes with microalbuminuriavery high levels of individual risk factorschronic kidney disease (CKD) are automatically at VERY HIGH or HIGH TOTAL CARDIOVASCULAR RISK and need active management of all risk factorsFor all other people, the use of a risk estimation system such as SCORE is recommended to estimate total CV risk because many people have several risk factors which, in combination, may result in unexpectedly high levels of total CV risk取消“血脂合适范围”的描述，强调根据危险分层指导治疗策略SCORE differs from earlier risk estimation systems in several important ways, and has been modified somewhat for the present guidelinesThe SCORE system estimates the 10-year risk of a first fatal atherosclerotic event, whether heart attack, stroke, or other occlusive arterial disease, including sudden cardiac death Risk estimate shave been produced as charts for high and low risk regions in Europe (see Figs. 1 and 2). All International Classification of Diseases (ICD) codes that could reasonably be assumed to be atherosclerotic are included. Most other systems estimate CAD risk onlyLDL-C是首要目标，HDL-C不作为干预靶点2011 ESC/EAS血脂指南推荐可根据血脂具体情况进行多个靶点的干预LDL-C作为血脂管理的首要靶标（证据级别：Ⅰ