高血压代谢危险因素控制面临的困惑与启示_祝之明.ppt
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1、高血压代谢危险因素控制面临的困惑与启示,祝之明 第三军医大学全军高血压代谢病中心 重庆大坪医院高血压内分泌科 重庆市高血压研究所,Dyslipidemia,Abdominal Obesity,Diabetes,Uric acid,Renal lesion,Endothelium damage,Hypertensive Syndrome - Constellations of Cardiometabolic Risk Factors,Hypertension 80%,高血压,危险因素,CVD事件,Abdominal obesity Waist circumference 102cm (M), 8
2、8cm (W) Dyslipidaemia TC5.0 mmol/l (原为6.1) or LDL-C 3.0 mmol/l (原为4.0) or HDL-C:M 1.7 mmol/l (150 mg/dL) IFG & IGT Fasting plasma glucose 5.6-6.9 mmol/L(102-125 mg/dL) Abnormal glucose tolerance test,ESC/ESH 2007高血压指南,Metabolic syndrome the cluster of three out of 5 risk factors among abdominal obes
3、ity, altered fasting plasma glucose, BP130/85mmHg, low HDL-cholesterol and high TG (as defined above) Diabetes Mellitus Fasting plasma 7.0 mmol/l (126 mg/dL) on repeated measurements, or Postload plasma glucose 11.0 mmol/l (198 mg/dL),(J Hypertens 2007, 25:1105),ESC/ESH 2007关注高血压伴发的代谢异常,(J Hypertens
4、 2007, 25:1105),如何评估高血压的代谢危险性,Diabetes Vasc Dis Res 2008;5:914,心血管代谢危险性评估,1. Framingham score (USA) Age, Sex, SBP, TC, Smoking, HDL-c 2. The UKPDS risk engine (UK) Age, Sex, SBP, Smoking, TC/HDL-c, HbA1c 3. PROCAM score (Germany) Age, LDL-c, TC, smoking, HDL-c, SBP, FH of MI,DM, TG 4. ICVD (China) A
5、ge, Sex, SBP, BMI, TC, Smoking, DM,危险分层: ESC/ESH,靶器官损害的评价,干预高血压相关的代谢危险因素能显著降低心脑血管事件吗?,Lower blood pressure Yes (30%-60%) Lower lipids Yes (17%-43%) Lower body weight Paradox Lower glucose Uncertain,BMI and WC vs fat parameters,肥胖与心血管危险存在U形关系,Gu DF, et al.JAMA. 2006;295:776-783,肥胖与心衰 Paradox prognosi
6、s: excess body weight have a paradoxical protective role ?,Enchaiah S, et al. N Engl J Med 2002; 347:305-13.,DIAMOND study group Gustafsson1 F,Eur Heart J,2005, 26:5864,肥胖与AMI,Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study Yusuf S, et al.
7、 Lancet 2005; 366: 1640,Nicoletti I, et al. Inter J Cardiol, 2006,107 :395399,Paradox prognosis: excess body weight have a paradoxical protective role ?,生活方式改变的局限,BMI不能反映内脏脂肪的实际变化,腹型肥胖的类型与代谢综合征的关系,MS 43%,MS 78%,MS 89%,中华医学杂志 2008,Proposed mechanisms by which visceral obesity, as the most dangerous f
8、orm of obesity, could be linked to the athero-thrombotic-inflammatory abnormalities of insulin resistance.,ATVB, 2008,微血管并发症,心肌梗死,HbA1c,37%,14%,强化降糖与减少CVD事件面临的困惑,糖尿病相关的死亡,21%,1%,Stratton IM, et al. BMJ 2000; 321:405412.,糖尿病作为冠心病的等危症是有条件的 Diabetes and Coronary Risk Equivalency,糖尿病不合并其他危险因素,其心血管危险不高,也
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- 关 键 词:
- 高血压 代谢 危险 因素 控制 面临 困惑 启示
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