心血管危险因素课件

HeartDiseaseisthemajorhealthchallengeofthe21stcentury.Unlesssomethingisdone,by2020,36outofevery100peoplewilldieofheartdiseaseandstroke.Therateofincreasewillbegreatestinlowandmiddleincomecountries,thosecountriesthatcanleastaffordit.“Heart disease and stroke are not inevitable.They are largely preventable.Preventive measures will reduce the incidence of death and disability.”Prof.Mario Maranho,Past-President,World Heart FederationSource:World Health Report 2002WORLDHEARTFEDERATIONHeartDiseaseisthemajorhea“SuperiorDoctorsPreventtheDisease.MediocreDoctorsTreattheDiseaseBeforeEvident.InferiorDoctorsTreattheFullBlownDisease.”-Huang Dee:Nai-Ching(2600 B.C.1st Chinese Medical Text)“SuperiorDoctorsPreventthePopulation6,000,000,000Totaldeathsperyear54,000,000(0.9%)Cardiovasculardeath17,000,000(31%)44%coronaryheartdisease31%stroke78%inlowincomecountriesAIDS3,000,000Tuberculosis1,000,000Malaria1,000,000(mostlyinAfrica)GlobalcausesofdeathPopulation6,000,000,000Oneoutofevery3deaths17milliondeathsworldwide1999estimatedtoreach25millionin2020SixtimesthecurrentnumberofdeathsfromHIV/Aids80%ofdeathsareinlow/middleincomecountriesSources:WHO World Health Report 2000,CVD infobaseWORLDWIDECVDFACTSOneoutofevery3deathsSourAtherothrombosis=majorcauseofdeathinthewesternworldAtherothrombosis=majorcauseATHEROSCLEROSIS:ASYSTEMICDISEASECADCAD21%21%CVACVA9%9%PADPAD8%8%8%8%5%5%9%9%3%3%ATHEROSCLEROSIS:ASYSTEMICDIATHEROSCLEROSISATHEROSCLEROSISChronologyofAtheroscleroticArteryDisease Atherosclerosis Plaque SCA Prevention Vulnerable SecondaryIschemicArtery Disease CoronaryCerebral PeripheralAntmanEMmodf.LibbyP.Circulation2001;104:365ChronologyofAtheroscleroticCardiovascularRiskFactorsProtecting your Heart CardiovascularRiskFactorsPrMaternalandchildrenundernutritionHIghRiskSexHighBloodPressureTobaccoSmokingAlcoholAbuseUnsafeWaterandlackofbasicsanitaryandhygieneHighCholesterolPollutionoftheairathomeIrondefficiencyObesityCausesof40%ofthe56millionsofdeathIntheworld.WHO10MOREIMPORTANTRISKS2002Causesof40%ofthe56milliSmokingHypertension(BP140/90mmHg)LowHDL-C(40mg/dL)EarlyFamilyHistoryatherosclerosis(1stgraderelatives55yearsformenand65forwomenAge(45yearsmales/55yearsfemales)AF*+CAD/relatives1stgrade(55anosmales/126mg/dL)CaracterizationoftheIndependentRiskFactorsforatherosclerosisSmokingCaracterizationoftheINDEPENDENTHypertensionTobaccoSmokingTotalCholesterol&HighLDL-CHDL-CDiabetesMelitusAgingMenopause CVDRiskFactorsforAtherosclerosisCONDITIONALTriglyceridesLDL type BHomocysteinLp(a)*FibrinogenInflammatory MarkersFAVOURINGObesityAbdominalObesidadePhysicalInactivityEarlyFamilyHistoryEthnicSocial&PsychologicFactorsINDEPENDENTCVDRiskFactorsfoObesityMetabolicSyndromePhysicalInactivityHighcholesterolandsaturatedfatdietNewRiskFactorsInflamatoryfactors(RCP+dehighsensibility)HomocysteinhighlevelsLp(a)+ProthromboticFactorsGlucoseintoleranceSub-clinicalAterosclerose(coronaryCa+,intimalthickness)PotentiationofRiskbytheFollowingFactorsObesityPotentiationofRiskbyPREVALENCEOFRISKFACTORSOVERWEIGHT/OBESITY-MCI 25Kg/m 41,0%SMOKING 32,9%DIABETES 7,6%HYPERTENSION-BRASIL IBGE 15,0%HIGH CHOLESTEROL 240mg 16,0%PREVALENCEOFRISKFACTORSOVERWorld-widesales/consumptionincreasing2/3youngmeninChinasmoke40%meninIndiauseTobaccoproducts50%womenunderage30inEastGermanysmoke(doubledin5years)Source:Sir Richard Peto/Bundeszentrale fr gesundheitliche AufklrungLIFESTYLETRENDS&CVDTOBACCOWorld-widesales/consumptioniSources:WHOWorldHealthReport2000,CVDinfobase600millionwithHypertensionatriskofheartattack,stroke,heartfailure180millionhighincomecountries 420million420millionfromlow/middleincomecountriesLIFESTYLETRENDS&CVDHYPERTENSIONSources:WHOWorldHealthRepoARTERIALBLOODPRESSURECLASSIFICATIONINADULTSClassClass NormalNormal Pre-HipertensionPre-Hipertension HiperHipert tension 1 stage ension 1 stage HiperHipert tension 2 stageension 2 stageSP*mmHg120120-139140-159160DPE80or80-89or90-99or100ARTERIALBLOODPRESSURECLASS GOAL General Population 140/90 High Risk Patients for CAD&Diabetes 110and126140LowGlucoseTolerance126and140and200DiabetesMellitus126or200or200 (classic symptoms)DIABETESMELLITUSDiagnosisCObjectives in the treatment of Diabetes MellitusFastingBloodGlucose(mg/dL)Post-PrandrialGlucose(2h)(mg/Dl)HbA1c(%)BMIOptimal110*1406,0*25Accept1261601,0aboveMAlsotrendinlow/middleincomecountriesKuwait44%women32%menBrazil12%women7%menPakistan(urban)20%women10%menSource:British Medical Journal,Report of WHO Nutrition 2000LIFESTYLETRENDS&CVDOBESITY300MillionobeseadultsglobMetabolic Syndrome:Risk FactorsMetabolic Syndrome:Risk FactorsMetabolic Syndrome:Risk FactorsAbdominal Obesity*Abdominal Obesity*Abdominal Obesity*(abdominal circunference)*(abdominal circunference)*(abdominal circunference)*RiskRiskRisk FactorsFactorsFactors Accepted LevelsAccepted LevelsAccepted Levels Man 102 cmMan 102 cmWoman 88 cmWoman 88 cmTriglycerides Triglycerides 150 mg/dL 150 mg/dL 150 mg/dL HDL-CholesterolHDL-CholesterolHDL-CholesterolMan 40 mg/dLMan 40 mg/dLWoman 50 mg/dLWoman 130/130/85mmHg85mmHg Fasting Glucose Fasting Glucose 110 mg/dL 110 mg/dLMetabolicSyndrome:RiskFactoLIFESTYLETRENDS&CVDDIABETES150MillionDiabetics(90%typeII)Incidenceprojectedtodoublein25yearsProjectedincreasehighestinIndiaandChinaIncreasedincidenceforyoungeragegroupsSource:Diabetes and Cardiovascular Disease,IDFLIFESTYLETRENDS&CVDDIABET 4 45 56 67 78 81 14 40 02 23 35 5 PoolingProject Framingham Study Israel prospective CAD Risk CAD Risk RatioRatioRelation between plasma cholesterol&Relation between plasma cholesterol&Relative risk for CADRelative risk for CADPlasma Cholesterol(mmol/L)Plasma Cholesterol(mmol/L)3.93.95.25.26.56.57.87.82.62.61.01.02.02.03.03.04.04.00.70.71.01.02.02.04.04.0CHDCHDRiskRiskRatioRatioSerum Cholesterol(mmol/L)Serum Cholesterol(mmol/L)CAD and Age:MRFIT StudyCAD and Age:MRFIT Study361.662 Men 361.662 Men(Ages 35-57)(Ages 35-57)3.95.26.57.82.61.02.03.04.Relation between LDL-c&Relation between LDL-c&CAD RiskCAD RiskLDL-LDL-cholesterolcholesterol 190 Very High Total Cholesterol Total Cholesterol 240 HighHDL-cholesterolHDL-cholesterol60 HighRelationbetweenLDL-c&LDL-Age Effect on Serum Lipoprotein Age Effect on Serum Lipoprotein LevelsLevelsmmo/lmmo/l mg/dl mg/dl 6.2 2406.2 240CholesterolCholesterol 3.6 1403.6 140 1.0 391.0 39010 20 30 40 50 60 70 80Total Total LDLLDLHDLHDLMen Men WomenWomenAgeAgeAgeEffectonSerumLipoproteiEffects of Age on TriglycerdeosEffects of Age on Triglycerdeos2.0 1771.8 1591.6 1421.4 1241.2 1061.0 8925-2930-3435-3940-4445-4950-5455-59mmo/l mg/dl mmo/l mg/dl MeanMeanplasma plasma TriglycerideTriglyceride(mmol/l)(mmol/l)AgeAgeMenMenWomenWomenEffectsofAgeonTriglycerdCAD in Diabetetic Patients:Mean Annual rateCAD in Diabetetic Patients:Mean Annual rateFramingham StudyFramingham StudyAge group(years)Age group(years)40-4940-4950-5950-5960-6960-6970-7970-79121224243636484800 Rate Rate per per 10001000MenMenDiabeticNon DiabeticCADinDiabeteticPatients:M0012122424363648486060Age group(years)Age group(years)40-4940-4950-5950-5960-6960-6970-7970-79 Rate Rate per per 10001000WomenWomenDiabeticNon DiabeticCAD in Diabetic Patients:Mean Annual RateCAD in Diabetic Patients:Mean Annual Rate Framingham Study Framingham Study01224364860Agegroup(years)40Secondary DyslipidemiaSecondary DyslipidemiaSecondary DyslipidemiaCAUSESCAUSES Diabetes MellitusDiabetes Mellitus HypothireoidismoHypothireoidismo ObesityObesity Nephrotic SyndromeNephrotic Syndrome Chronic Renal FailureChronic Renal Failure DrugsDrugs AlcoholAlcohol Hepatic DiseaseHepatic Disease Obstructive Biliary DiseasesObstructive Biliary Diseases Collagen DiseasesCollagen DiseasesSecondaryDyslipidemiaHIGHAbsoluteRisk20%in10yearsMEANAbsoluteRisk10a20%in10yearsLOWAbsoluteRisk20%10years(generallywithtwoormoreCVriskfactorsotherthancholesterol)RefertoFraminghanRiskTablesIndividualswithoutAtherosclerosisDiseasesEvidenceHIGHRISKPREVENTIONDiabetesmellitus(DM)IndividuAbsolute Risk for events 10%,but 20%in 10 yearsIndividuals with 2RF*(except DM)beyond cholesterol(LDL-c 160 mg/dL)Refer the Framinghan score for risk Use the absolute score of risk factors(Framinghan)for events in 10 yearsMEANRISKAbsoluteRiskforevents10%AbsoluteRiskofevents160mg/dL)orjusthighLDL-cItsnotnecessarytorefertothescoresofriskofFramingham.LOWRISKLOWRISKProposedGoalsforLipidsLevelsaccordingriskfactorsforCAD LDL-cHDL-cTG HIGH RISKPacientswithCAD,PVI*orsymptomaticcarotidatherosclerosis40150PacientswithDiabetes45150RiskforCADin10years20%4010%e20%40150LOWRISKRiskforCADin10years10%40150ProposedGoalsforLipidsLeveLIFESTYLECHANGESDIETEXERCISEWEIGHTSMOKINGLIFESTYLECHANGESDIETEXERCHEALTHY DIAT AND LIFE STYLE CHANGESHEALTHY DIAT AND LIFE STYLE CHANGESSaturated Fats 7%total cal.Poliunsaturated Fats up to 10%total cal.Monounsaturated Fats up to 20%total cal.Total Fat 25-30%of the total cal.Complex Carbohydrates 50-60%of the total cal.Fibers 20-30g/dailyProteins Approximately 15%of the total cal.Cholesterol 200 mg/dayPhytosterols 3-4g/dayFibers 20-30g/day(6g soluble)Total Calories Balance between energetic gain&losses daily to keep the ideal weight.NutrientsNutrients Recommended IntakeRecommended IntakeRecommended IntakeHEALTHYDIATANDLIFESTYLECHRelation Between CHD Events andRelation Between CHD Events andLDL Cholesterol in Recent Statin TrialsLDL Cholesterol in Recent Statin Trials%WithCHDEvent%WithCHDEvent0055101015152020252530309090110110130130150150170170190190210210MeanLDL-CLevelatFollow-up(mg/dL)MeanLDL-CLevelatFollow-up(mg/dL)4S-PI4S-PI4S-Rx4S-RxLIPID-RxLIPID-RxCARE-RxCARE-RxLIPID-PILIPID-PICARE-PICARE-PIAFCAPS/TexCAPS-RxAFCAPS/TexCAPS-RxAFCAPS/TexCAPS-PIAFCAPS/TexCAPS-PIWOSCOPS-RxWOSCOPS-RxWOSCOPS-PIWOSCOPS-PI1Prevention1Prevention2Prevention2PreventionRelationBetweenCHDEventsanLIFESTYLETRENDS&CVDWOMENWomenunawareoftheirCVDriskCVDaffectswomenaroundtheglobeCVDdeaths8timeshigherthanbreast/ovariancancersIndia,ChinaandLatinAmericaaccountfor48%ofdeaths.LIFESTYLETRENDS&CVDWOMENWoADDITIONALRISKFACTORSMentalstress,anxietyanddepression,aswellas,socialfactors.Depressionispresentupto45%ofcasesofacutemyocardialinfarction(AMI).Ifunknownoruntreated,depressionfavorsasecondMI(2-4timesmore),increasingthepossibilityofdeathupto5timesmore.ADDITIONALRISKFACTORSMentalDEPRESSIONASARISKFACTORFORCARDIOVASCULARDISEASESHIPPISLEY-COX,J.,FIELDING,K.,PRINGLE,M.Depressionasariskfactorforischaemicheartdiseaseinmen:populationbased-controlstudy.BRITISHMEDICALJOURNAL,1998;316:1714-1719DepressionandCardioVascularDiseasesCOFFEEHEARTSTUDYDepressionisanindependentriskfactorforcardiovasculardiseases(DCV)Analysisof“U.S.NationalHealthandNutritionExaminationSurvey(NHANES)”showedthatpatientswithdepressionhas2,5to4timesgreaterofriskofcoronaryarterydiseaseslikemyocardialinfarctionand5timesgreaterriskofsuddendeath.Depressionisabadmarkerforcardiovascularprognosisandsurvival.MaycoffeepreventdepressionandMyocardialInfarction?ReportfromWHO/WHFin2004.DepressionandCardioVascular演讲完毕，谢谢观看！Thankyouforreading!Inordertofacilitatelearninganduse,thecontentofthisdocumentcanbemodified,adjustedandprintedatwillafterdownloading.Welcometodownload!汇报人：XXX汇报日期：20XX年10月10日演讲完毕，谢谢观看！Thankyouforreadin