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1、ATPIII:NewApproachesinIdentifyingandTreatingHigh-RiskPatientsStevenHaffner,MDHospitalizationforMIHasNotDeclinedHospitalizationforMI(per1,000)**Age-adjusted19871989199019921988199319941991RosamondWDetal.NEnglJMed1998;339:861-867.©1998MassachusettsMedic
2、alSociety.Allrightsreserved.MenWomenCriteriaforAcceptingCardiovascularRiskFactorManagementasSimilarinCHDEquivalentsasinCHDPatientsTheriskofvasculardiseaseissimilarinCHDequivalentsandinpatientswithCHD.LipidinterventionstoreduceCHDcanbeequallyeffectivei
3、nCHDequivalentandCHDpatients.Indiabeticpatients,glycemiaalonewillnotcompletelyeliminatetheexcessCHDrisk.NewCHDRiskEquivalents>20%10-yearriskofCHD(Framinghamprojections)DiabetesOtherformsofclinicalatheroscleroticdisease:–Peripheralarterialdisease–Abdom
4、inalaorticaneurysm–CarotidarterydiseaseExpertPanelonDetection,Evaluation,andTreatmentofHighBloodCholesterolinAdults.JAMA2001;285:2486-2497.NoncoronaryAtherosclerosis:OverviewAtheroscleroticdiseaseinoneregionofthearterialtreeisassociatedwithandpredicts
5、diseaseinotherarterialregions–Pathobiologyandpredisposingriskfactorsaresimilarforatherosclerosisincoronary,peripheral,andcarotidarteriesThus,clinicalatheroscleroticdiseaseinnoncoronaryarteriesisapowerfulpredictorofCHDPeripheralArterialDisease(PAD)Stud
6、iesofpatientswithatheroscleroticPADsupporttheconceptthatPAD,regardlessofdiagnosisbyABI,lowerlimbbloodflowstudies,orclinicalsymptoms,isaCHDriskequivalentEdinburghArteryStudyAnkle/brachialbloodpressureindex(ABI)inrandomlyselectedpopulation,5-yearfollow-
7、up1592menandwomen,614withCHD,aged55–74137fatalandnonfatalCHDeventsduringfollow-up>1.11.1–1.011.0–0.910.9–0.71<0.7ABICHDEventOutcomes perYear(%)LengGCetal.BMJ1996;313:1440-1444.1.4%3.8%AbdominalAorticAneurysm(AAA)Studypopulation:300menand43women(aged45
8、–89)operatedonforAAA,separatedinto4groupsbasedonpreoperativeCHDhistoryandECGFollow-up:6–11yearsResults:annualCHDmortality–1.9%inpersonswithnosymptoms,nopriorhistoryofCHD,andnormalECG(31%)–2.0%inpersonswithnosymptoms,butpreviousMIbyECG(33%)–3.9
