Cardiovascular Risk Factors：心血管疾病的危险因素.ppt

A few key points Support, advice, “stop date” “blips vs “failure” Intensive support service Pharmacotherapy NRT vs NNRT (varenicline, bupropion – MHRA warning) 1 go every 6 months How much to prescribe Patches 5, 10, 15 mg/16 hr (Nicorette?); 7, 14, 21 mg/24 hr (NiQuitin?) Gum (2 mg, 4 mg) Nasal spray (0.5 mg per puff) Inhalation cartridge (10 mg cartridge plus mouthpiece) Lozenges (1 mg, 2 mg, 4 mg) Sublingual tablets (2 mg) Decide on a quit date - the date you intend to stop smoking. Start taking the tablets one week before the quit date. Start on 0.5 mg daily for three days. Then 0.5 mg twice daily on days four to seven. Then, 1 mg twice daily for 11 weeks. Take each dose with a full glass of water, preferably after eating. One tablet (150 mg) each day for six days. Then increase to one tablet twice a day Aim to stop smoking completely on day eight of treatment. Continue the tablets for a further seven weeks A, 48 year old male Clinic reading 142/92 Home readings 136/86 CV risk 6% B, 52 year old white female Home readings 136/86 LVH C, 48 year old white male, Clinic reading 162/106 ABPM 136/86 CV risk 25% D, 48 year old black male, Clinic reading 162/106 ABPM 136/86 CV risk 25 % E 50 year old black male Home readings 155/98 On amlodipine F, 65 year old Asian female Home readings 152/96 On ramipril and felodipine G, 55 year old black female New patient taking diclofenac for knees for the last year. Feels well BP 184/114 ECG LVH + blood on urine dip Fundoscopy normal/abnormal Cardiovascular events include myocardial infarction, onset of angina, transient ischaemic attack, and stroke * How many people in UK died before 75th birthday due to CVD? * Can’t change – but if present should point to doing a risk assessment. * If over or close to 20% Prioritise people aged 40-74 who are likely to be at high risk Should we work out rsk for diabetes? – no, already high risk The following patients should not have their risk calculated, as they are considered already to be