多重心血管风险患者管理.pptxVIP

多重心血管风险患者管理第1页/共126页 US population at high riskAHA. Heart Disease and Stroke Statistics–2005 Update.Hajjar I and Kotchen TA. JAMA. 2003;290:199-206.Ford ES et al. Circulation. 2003;107:2185-9.CDC. /diabetes/pubs/pdf/ndfs_2005.pdf.*Total-C ≥200 mg/dL ?BP ≥140/90 mm Hg ?FBG ≥126 mg/dLDiabetes? 14.6 million diagnosed 6.2 million undiagnosed Hypercholesterolemia* 106.9 million 94 million not treatedPatients with CHD/stroke: 18.4 million/yDirect: $105.7 billion/y Indirect: $93.2 billion/y  Total cost: $198.9 billion/yHypertension? 65 million 27 million not treated第2页/共126页 Adapted from Pepine CJ. Am J Cardiol. 2001;88(suppl):5K-9K.Development and progression of CVDRisk factors? Oxidative stressFunctional alterationsStructural alterationsClinical sequelaeAge, gender, smoking, inactivity, obesity,cholesterol, BP, glucoseGenetic factors? Endothelial function? EPCsEPCs = endothelial progenitor cells第3页/共126页 ObesityHypertensionDiabetesSTROKE / MIGENESGENESENVIRONMENTInadequateMedical CareGENESInactivity Diet Psychosocial Stress CultureGenetics augment effects of environmental risk factors第4页/共126页 Cardiovascular risk factors, adults 55–64 yearsPrevalence (%)HypertensionObesityHigh cholesterolOne or more risk factorsHypertensionObesityHigh cholesterolOne or more risk factorsMen020406080100Women19882002CDC. /nchs/ppt/hus/HUS2005.ppt.第5页/共126页 Jackson R et al. Lancet. 2005;365:434-41.Synergistic interaction of traditional multiple risk factors on CVD risk0Reference5-year CVD risk per 100 peopleTC = 270 mg/dLSmokerHDL = 39 mg/dLMaleDiabetes60 yearsof age102030405044%33%24%18%12%6%3%110SBP (mm Hg)1201301401501601701801%TC = total cholesterolAdditive risk factors第6页/共126页 Obesity decreases life expectancy regardless of smoking Framingham Heart Study Peeters A et al. Ann Intern Med 2003;138:24-32.Obesity and smoking risks are equivalentFemale nonsmokersFemale smokers0102030401.00.20.0ProportionaliveFollow-up (years)BMI 18.5–24.9 kg/m2BMI 2