ATPIII：识别和治疗高危患者的新方法课件.ppt

ATP III: New Approaches in Identifying and Treating High-Risk PatientsSteven Haffner, MD Criteria for Accepting Cardiovascular Risk Factor Management as Similar in CHD Equivalents as in CHD Patients The risk of vascular disease is similar in CHD equivalents and in patients with CHD. Lipid interventions to reduce CHD can be equally effective in CHD equivalent and CHD patients. In diabetic patients, glycemia alone will not completely eliminate the excess CHD risk. New CHD Risk Equivalents 20% 10-year risk of CHD (Framingham projections) Diabetes Other forms of clinical atherosclerotic disease: – Peripheral arterial disease – Abdominal aortic aneurysm – Carotid artery disease Noncoronary Atherosclerosis: Overview Atherosclerotic disease in one region of the arterial tree is associated with and predicts disease in other arterial regions – Pathobiology and predisposing risk factors are similar for atherosclerosis in coronary, peripheral, and carotid arteries Thus, clinical atherosclerotic disease in noncoronary arteries is a powerful predictor of CHD Peripheral Arterial Disease (PAD) Studies of patients with atherosclerotic PAD support the concept that PAD, regardless of diagnosis by ABI, lower limb blood flow studies, or clinical symptoms, is a CHD risk equivalent Edinburgh Artery Study Ankle/brachial blood pressure index (ABI) in randomly selected population, 5-year follow-up 1592 men and women, 614 with CHD, aged 55–74 137 fatal and nonfatal CHD events during follow-up Abdominal Aortic Aneurysm (AAA) Study population: 300 men and 43 women (aged 45–89) operated on for AAA, separated into 4 groups based on preoperative CHD history and ECG Follow-up: 6–11 years Results: annual CHD mortality – 1.9% in persons with no symptoms, no prior history of CHD, and normal ECG (31%) – 2.0% in persons with no symptoms, but previous MI by ECG (33%) – 3.9% in persons with angina/prior MI (30%) Because the rate of CHD events is at least twice that of CHD mortality, patients with n