从ascot研究看高血压的调脂治疗

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1、从ASCOT研究看高血压的调脂治疗山西医科大学第一医院吕吉元构筑心血管全面防线、应对心血管疾病浪潮****WorldHealthReport2002全球导致死亡的危险因素DevelopedregionsDevelopingregionsNeatonJDandWentworthD,fortheMultipleRiskFactorInterventionTrialResearchGroup.ArchInternMed.1992;152:56–64.142+125-131<4.74.7-5.25.2-5.75.7-6.3Totalcholesterolquintile(m

2、mol/L)SBPquintile(mmHg)<118118-124132-1413421136231281061811964178863Deaths/10,000Patient-Years>6.3145631217n=316,099AgeadjustedCHDdeathratesper10,000personyearsbylevelofserumcholesterolandSBPfornon-smokersintheMRFITtrial高血压高血脂并存使病人风险大大增加警告！中国心脑血管疾病的第二次浪潮！中国心脑血管疾病的第二次浪潮！中风发病率居高不下！脑出血减少：

3、高血压防治出现成效缺血性中风增加：高血压“三率”仍低，胆固醇重视和防治不够心肌梗死发病率显著上升胆固醇是最重要因素心脑血管疾病年轻化84－99年北京市成年人TC增加24％（40mg/dL)35-44岁男性心肌梗死死亡率增加156％中国心脑血管疾病的第二次浪潮！肥胖增加！6000万！超重2亿！糖尿病增加！甜蜜的杀手！3000万！2020年，中国糖尿病患者翻倍！成为世界第二大糖尿病国家！代谢综合征高血压人群增加！悄悄的杀手！1.6亿胆固醇水平上升！高胆固醇血症人群增加！无声的杀手！1.6亿血脂异常CurrentGuidelinesRecognizetheRelationshi

4、pAmongRiskFactorsTheEuropeanJointTaskForceguidelines1:lowerBPandlipidgoalsforpatientsathightotalCVriskorwithdiabetes,CVDTheESH/ESC3guidelines:SBP/DBPandotherriskfactors,suchasdiabetes,contributorstoapatient’sriskstratificationandsubsequentprognosisTheWHO/ISHguidelines2:comprehensiverisk

5、-factorassessmentforpatients1.DeBackeretal.EurJCardiovascPrevRehabil.2003;10(suppl1):S1-S78;2.WorldHealthOrganization,InternationalSocietyofHypertensionWritingGroup.JHypertens.2003;21:1983-1992;3.EuropeanSocietyofHypertensionGuidelinesCommittee.JHypertens.2003;21:1011-1053.NationalGuide

6、linesonHypertensionandDyslipidaemia:ImportanceofMultipleRiskFactorManagementJNC7:assessapatient’sotherCVriskfactorsthatmayaffectprognosisandguidetreatmentNCEPATPIII:majorriskfactors(exclusiveofLDL-C)modifylipidgoalsInpatientswithhypertension,assessforotherCVriskfactorsChobanianetal.JAMA

7、.2003;289:2560-2572;ExpertPanelonDetection,Evaluation,andTreatmentofHighBloodCholesterolinAdults.JAMA.2001;285:2486-2497.“Attentionshouldbemovedfromknowingone’sBPandcholesterolconcentrationstoknowingone’sabsoluteCVriskanditsdeterminants.”–J.Embersonetal.Embersonetal