2级预防的研究组织的前提.ppt

STROKE: SECONDARY PREVENTION THE WHO PREMISE STUDYMARGARITA E. DíAZCENTRE FOR ACADEMIC MEDICAL RESEARCHMontevideo Uruguay DEFINITION IS STROKE A FREQUENT PHENOMENON? WORLDWIDE PERCENTAGES OF DEATHS Stroke and other leading causes 2002 WORLDWIDE CONSEQUENCES OF STROKE Stroke is the 3rd most common cause of death 50 million have suffered a stroke 5 million die each year because of a stroke PREVALENCE OF RECURRENT STROKE OBJECTIVES OF THE WHO PREMISE STUDY PHASE 1 To assess current practice patterns related to secondary prevention of coronary heart disease and cerebrovascular disease (CeVD) in primary, secondary and tertiary health care settings Learn about patient behaviour and compliance in the 3 years after an event Implement strategies to strengthen the health care system with interventions based in primary care and community based action CRUDE PREVALENCE OF STROKE IN THE PARTICIPATING COUNTRIES IN THE WHO-PREMISE STUDYn=10 855 NON-MODIFIABLE RISKFACTORS FOR STROKE Age sex Heredity Ethnicity Previous stroke RATES of MORTALITY for CEREBROVASCULAR DISEASE by age and sex group, Canada PREDICTORS OF DEATH FROM STROKE IN ITALY Percentage increased risk of death from stroke in people aged 65 years and above, 2001Number of deaths from Stroke in 2002 : 69.075 REPORTED HISTORY OF RISK FACTORS IN PERCENTAGES AMONG ALL CVD PATIENTS CLUSTERING OF RISK FACTORS IN PERCENTAGES AMONG ALL CVD PATIENTS LYFESTYLE CHANGES HAVE A MAJOR IMPACT ON SECONDARY PREVENTON ANTIHYPERTENSIVE TREATMENT IS 5–10 TIMES MORE SUCCESSFUL IN ELDERLY PATIENTS THAN IN MIDDLE-AGED PATIENTS WITH MILD HYPERTENSION PERCENTAGE OF PATIENTS WITH STROKE TAKING MEDICATIONS IN ALL CeVD PATIENTS n =10 855 RISK REDUCTION IN HYPERTENSIVE VS NORMOTENSIVE PATIENTS Randomized, double-blind placebo-control trial of 4 years duration No blood pressure (BP) entry criteria 762 patients received ACE-inhibitor perindopril (±diuretic: indapamide) 758 patients on placebo Baseline mean BP was reduced