心血管风险(一级预防)

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1、IntegratingAggressiveCVRiskManagementinPrimaryCareHighprevalenceofmultipleCVriskfactorsinUSadultsCDC.MMWR.2005;54:113-40.BehavioralRiskFactorSurveillanceSystem,2003≥2ofhypertension,hypercholesterolemia,diabetes,smoking,physicalinactivity,obesity40.0%–46.2%36.0%–39.9%33.0%–35.9%27.0%–32

2、.9%INTERHEART:ExponentialriseinCVdiseasewithaddedriskfactorsOddsratiofor1stMI*(99%CI)6451216122561283284Smk(1)DM(2)HTN(3)ApoB/A1ratio(4)1+2+3All4All4+ObesAll4+PsAll9riskfactors2.92.41.93.313.042.368.5182.9333.7YusufSetal.Lancet.2004;364:937-52.Smk=smoking;DM=diabetes;HTN=hype

3、rtension;Obes=obesity;Ps=psychosocialfactors*Plottedonadoublingscale3-fold26-foldINTERHEART:AnysmokingincreasesCVriskTeoKKetal.Lancet.2006;368:647-58.*vsneversmokedN=27,098from52countries1–23–45–67–89–1011–1213–1415–1617–1819–20OddsratioforfirstMI*Cigarettessmoked(n/day)Never≥21-0.75

4、1248LifetimeCVDriskestimateandriskfactorburden70605040302010050607080906950463656050403020100Men(n=3564)Women(n=4362)AdjustedcumulativeincidenceofCVD(%)5060708090≥2MajorRFs1MajorRF≥1ElevatedRF≥1NotoptimalRFAlloptimalRFs705039278Attainedage(years)Lloyd-JonesDMetal.Circulation.2006;113

5、:791-8.2-foldinhigheragegroupAdditiveriskofagewithhypertension+hypercholesterolemiaWongNDetal.AmJCardiol.2006;98:204-8.NHANES2001-2002;N=286426.552.743.121.4ClinicalmanifestationsofobesityInsulinresistanceGlucotoxicityLipotoxicityAdiponectinLeptinAtherosclerosisCourtesyofSelwynAP,We

6、issmanPN.2006.Type2diabetesandglycemicdisordersFFAsDyslipidemiaLowHDLSmall,denseLDLHypertriglyceridemiaHypertensionEndothelialdysfunction/inflammation(hsCRP)ImpairedthrombolysisPAI-1MetabolicconsequencesofvisceralobesityVisceral/abdominalobesityCorrelatesmorestronglywithinsulinresis

7、tancethanlowerbodyobesityIsassociatedwithplasmalevelsoffattyacidsandaccompanyingTGInsulinresistanceAlteredhepaticfataccumulationandmetabolismDyslipidemiaProinflammatoryadipokines(insulinresistance,riskforCVdisease)Visceralfatcorrelatesmorestronglywithinsulinresistanceth