高血压英文PPT精品课件CardiovascularDiseasePreventive

CAD: electrocardiogram: resting EKG as screen
ST depression, T wave inversion, Q waves, LVH may diagnose CAD. However, seldom CAD presents w/o symptoms; so EKG poor screen. E.g.in CAD occurs in 1-4 % of middle aged men w/o sympts; of those, 3%-15% developed symptomatic CAD over 5-15 years.
CAD: electrocardiogram: resting EKG as screen (2)
1-4 % of middle aged men have CAD w/o symptoms (angiographic proof); of those, 3%-15% developed symptomatic CAD over 5-15 years; Thus, at most, prevalence of CAD in asymptomatic males = 0.6% of middle aged men
acute MI or sudden death when followed over 4-13 years Addition of thallium scintigraphy scan proves more sensitive but less specific in low risk population.
Metabolic Syndrome X
Insulin resistance, hyperinsulinemia, incipient diabetes type II Hypertension Dyslipidemia: TC, LDLC, TGs,
HDLC
Criteria for metabolic syndrome X: any 3/5
Best application for Scanned Stress Testing
Diagnosis of chest pain (I.e. not a screening situation)
Criteria for CAD Screening I
The conditions must have a significant effect on the quality or quantity of life (YES).
1. Abdominal obesity: waist measurement > 102 cm (40 in.) in men, 88 (35 in.)cm in women. 2. Hypertrigyceridemia: 150 mg/dL (1.69 mmol/L) 3. Low HDL cholesterol: 40 mg/dL (1.04 mmol/L); < 50 mg/dL for women 4. “High” blood pressure: 130/85 mm Hg or hypertension under treatment 5. High fasting blood glucose: 110 mg/dL (6.1 mmol/L) or taking Rx for D/M
Screening versus Prevention (1)
Screening for CAD in general population is impractical (e.g. screening EKGs, stress testing, coronary angiograms) Resting EKGs not sensitive enough; EKG stress testing not sensitive enough in high risk populations; Thallium stress/EKG too sensitive in low risk populations; Coronary angiograms too risky and too expensive for screening
Acceptable methods of treatment must be available for the condition (YES).
The condition must have an asymptomatic period during which detection and treatment significantly reduce morbidity or mortality (YES).
Treatment in the asymptomatic phase must yield a therapeutic result superior to that obtained by delaying treatment until symptoms appear (not settled).
Atherosclerotic Vascular Disease
Risk Factors, Screening to Prevent
Atherosclerotic Disease
Coronary artery disease (CAD) Cerebrovascular disease CVD) Peripheral vascular disease (PVD) Reno-vascular dis. and renal failure (CRF) >> hypertension
CAD screening and (EKG) - (7)
Stress testing OK in higher risk states - e.g. out of shape middle aged ex-athletes before embarking on exercise program- usually EKG w/o, e.g. thallium Atypical chest pain w/ dyslipidemia, Obesity and/or hypertension, w/ thallium EKG is most useful in the acute situation
Risk factors for CAD (and other athero-
sclerotic vascular dis:
Controllable: Hypertension, diabetes, dyslipidemia, smoking, C-reactive protein, (emotional stress);
Screening versus Prevention (2)
Primary (and secondary) prevention of CAD through control of controllable risk factors: Screening is for risk factors: imperfect but cost effective and tolerable
Coronary Artery Disease (CAD)
1.5 million myocardial infarctions (MI)/year/US; 700,142 deaths from CAD 15% case fatality w/ acute MI; 30% case fatality w/ acute MIs as first indication of CAD; Risks=high BP, dyslipidemia, physical inactivity, diabetes mellitus, age. (obesity) Smoking Genetics
CAD screening and EKG (3)
EKG is neither very sensitive (only 29% of angiogram proven disease had ST,T or voltage changes) Nor specific - Nonspecific T ∆ common Resting EKG most useful for baseline and future comparison
Uncontrollable:ຫໍສະໝຸດ Baiduinheritance
Risk factors tend toward clusters: hypertension, diabetes, dyslipidemia;
Metabolic syndrome X and insulin resistance (strong assoc. w/ obesity; strongly familial but remediable)
Cardiovascular Disease; Preventive Medicine 2005
David R. Rudy, M.D., M.P.H.
Professor and Chairman Family and Preventive Medicine Chicago Medical School, RUMS
Obesity, diabetes, hypertension and dyslipidemia
80%-90% of type II diabetics are obese Prevalence of obesity and of diabetes type II have risen in parallel since 1980. 33% increase in prevalence of D/M between 1990 and 1998
CAD screening and EKG (4)
Stress testing (EKG only) more sensitive and specific than resting EKG, but many false + (not specific enough Still, only 1-11% w/ abnormalities suffered
CAD screening and EKG (5)
Only 1-11% w/ abnormalities suffered acute MI or sudden death when followed over 13 years
0.045% (4/10,000) of resting
EKGs will diagnose asymptomatic CAD
Executive Summary of the Third Report of the NCEP etc. (ATP III). JAMA 2001; 285:2486-2496
Relationship between diabetes and hypertension
Diabetics have a 50% prevalence of hypertension (compare to 15-20% of US population); even when corrected for weight Hypertensives have prevalence of glucose intolerance (abn BS patterns) = 15-18% (compare to 5-6% of adult US pop. w D/M) - a significantly larger percentage is assumed to have insulin resistance w/o glucose intolerance