多重心血管风患者管理.ppt

US population at high risk Development and progression of CVD Synergistic interaction of traditional multiple risk factors on CVD risk Development and progression of CVD Traditional CVD risk factors Selected emerging biomarkers  LDL infiltration triggers inflammatory response Role of ox-LDL in macrophage recruitment Hypertension increases atherogenic lipoprotein content of arterial vessel walls AT1 and LOX-1 receptor cross-talk promotes adhesion molecule expression  Lipoprotein-associated phospholipase A2 (Lp-PLA2) Studies demonstrating association of Lp-PLA2 with incident CHD EPC number/function correlates with endothelial function EPC number has prognostic importance Arterial stiffness: Cause and consequence of atherosclerosis Correlation between number of risk factors and arterial distensibility Peripheral arterial stiffness is associated with subclinical atherosclerosis Pleiotropic effects of statins High-dose statin treatment reduces Ox-LDL markers Statin treatment reduces Lp-PLA2 Statins increase circulating EPCs Intensive lipid lowering improves arterial compliance Comparative effects of statin and ezetimibe on EPCs and endogenous antioxidant system Neuroprotection with statins in stroke model Pleiotropic effects of BP-lowering agents Statin metabolite and CCB show additive antioxidant effect Additive effects of statin + CCB on fibrinolytic balance Beneficial effect of statin + ACEI on endothelial function Approaches to CVD prevention Lifestyle changes reduce need for drug therapy Lifestyle change goals Weight reduction of ≥ 7% initial body weight via low-fat, low-calorie diet Moderate-intensity physical activity ≥ 150 min/week New lifestyle guidelines: More exercise, fruits and vegetables Exercise reduces CV and all-cause mortality Diet reduces mortality in primary prevention trials Potential cardioprotective mechanisms of dietary components Omega-3 fatty acids Antiarrhythmic Antithrombogenic Antiinflammatory Antihypertensive Improved endo