最新Cardiovascular Risk Factors：心血管疾病的危险因素PPT课件

hyperlipidaemia ◦ People aged 75 or older should also be considered at
increased risk of CVD, particularly if hypertensive or smokers.
CV Risk Assessment
Early menopause
Age
Ethnic group
Smoking
Sedentary lifestyle
Obesity
Salt/diet
Alcohol
Hypertension
Cholesterol
triglycerides
diabetes
Chronic kidney disease
Hypertension
Hypertension
Is it a disease? Is it an illness? Is it a condition? Is it a syndrome? What is it?
Hypertension
Hypertension is the one of the most important preventable causes of morbidity and mortality in the UK It is a major risk factor for cardiovascular disease At least one quarter of adults (and more than half of those are above 60) in the UK have high blood pressure 2mmHg rise in systolic BP causes 7% increased risk of mortality in IHD and 10% increased risk of mortality from stroke The NHS spent £ 1 billion on drug costs alone on blood pressure management in 2006
Body mass index (height and weight).
Systolic blood pressure (use current not pre-treatment value).
Total and HDL cholesterol.
Ethnicity. Rheumatoid arthritis. Chronic kidney
cardiovascular risk factors:心血管疾病的危险因素 whythey?re important whichrisk factors? riskassessment curriculumstatements healthypeople, promoting health preventingdisease 15.1cardiovascular problems thosepatients newdiagnosis hypertension(excluding those pre-existing chd, diabetes, stroke tia)recorded between 31march: patientsaged 30 74years who have had face-to-facecardiovascular risk assessment diagnosis(within initialdiagnosis) using agreedrisk assessment tool diseaseprevalence warmfuzzy feeling knowledgeyou savingpeople?s lives reducing10 year cardiovascular end point incidence) lifestylefactors you can change factorsyou can?t change familyhistory extremebaldness earlymenopause ethnicgroup sedentarylifestyle chronickidney disease anyoneage 40-74 who highrisk calculaterisk dataalready available (nice) anyoneover 40 (jbs2) followingpatients should riskcalculated, consideredalready highenough risk justifylifestyle otherinterventions atheroscleroticcvd. hypertension(160/100 mm hg) targetorgan damage. diabetesmellit
8 Points Disease Prevalence
Why do I care?
That warm fuzzy feeling that comes in the knowledge you are saving people’s lives (by reducing 10 year cardiovascular end point incidence)
Who should we consider assessing?
Anyone age 40-74 who is likely to be at high risk – calculate risk with data already available (NICE)
Anyone over 40 (JBS2)
disease. Atrial fibrillation.
Let’s play
/doctor/PrimaryCardiovascular-Risk-Calculator.htm


Lifestyle, Hypertension
Measuring Blood Pressure
Adequate initial training and periodic review Automated devices regularly recalibrated. Do not use automated devices if there is pulse irregularity Standardize environment. Patient should be quiet and seated, with an outstretched and supported arm For postural hypotension patient should be stood for at least 1 minute before BP measurement (If SBP falls by ≥20mmHg – Review medication/Specialist referral)
Diagnosing Hypertension (Again!!!)
If clinic BP is ≥140/90, offer ABPM to confirm diagnosis of HTN Clinic BP Measure BP in both arms (Use arm with higher reading), if BP ≥140/90mmHg repeat BP. If substantially different repeat a third time. Record the lower of the last 2 measurements as clinic BP ABPM At least 2 measurements per hour during waking hours Use the average value of at least 14 measurements taken during usual waking hours HBPM For each BP reading, two consecutive measurements are taken, at least 1 minute apart and with the person seated Record twice daily, ideally morning and evening Record for at least 4 days, ideally 7 days (Discard first day’s readings)
Use a validated tool to calculate estimated 10 year risk.
Discuss lifestyle modification Start/change treatment
Which tool
Framingham with JBS2 adjustments QRisk2
The following patients should not have their risk calculated, as they are considered already to be at high enough risk to justify lifestyle and other interventions
QRisk2
Patient age (30-84). Patient gender. Current smoker
(yes/no). Diabetic. Family history of
heart disease aged <60 (yes/no). Treatment with blood pressure agent . Postcode (Townsend score)
Type 2 diabetes (early on)
◦ UKPDS
Framingham
Framingham
Framingham
Tends to overestimate UK population risk
Underestimates risk of socially deprived/south asian/female populations
Introduction
Why they’re important Which risk factors? Risk assessment
Why do I care?
Curriculum statements
◦ 5 Healthy people, promoting health and preventing disease
Age (30-74) Smoking Status Sex Glucose LVH
BP Central Obesity Total Cholesterol South Asian Origin HDL Cholesterol Family History of
CVD (Men <55 and women <65 years) Total /HDL Ratio Serum TG mmol/L
◦ Patients with atherosclerotic CVD. ◦ Hypertension (≥160/100 mm Hg) with target organ
damage. ◦ Patients with type 1 or type 2 diabetes mellitus. ◦ Renal dysfunction (including diabetic nephropathy). ◦ Familial hypercholesterolaemia, familial combre CV risk factors?
Lifestyle factors you can change Factors you can’t change Factors that can be treated
Family History
Male
Age
Extreme baldness
◦ 15.1 Cardiovascular problems
Why do I care?
QOF - In those patients with a new diagnosis of hypertension (excluding those with preexisting CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March: the percentage of patients aged 30 to 74 years who have had a face-to-face cardiovascular risk assessment at the outset of diagnosis (within 3 months of the initial diagnosis) using an agreed risk assessment tool
Diagnosing Hypertension
140/90? 135/85? 160/100? 180/110???
Defining Hypertension
Stage 1 Hypertension: Clinic blood pressure is 140/90mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure of135/85mmHg or higher Stage 2 Hypertension: Clinic blood pressure is 160/100mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure of 150/95mmHg or higher Severe Hypertension: Clinic systolic BP is 180mmHg or higher, or clinic diastolic BP is 110mmHg or higher