文档介绍:高血压合并多重危险因素及靶器官损害患者的治疗指南BMJ  2003;326:1419Astrategytoreducecardiovasculardiseasebymorethan80%减少心血管疾病80%以上的策略 polypill策略:同时针对四种危险因素:lowdensitylipoproteincholesterolbloodpressureserumhomocysteineplateletfunction)方法:meta-analysesofrandomisedtrialsandcohortstudiesandameta-analysisof15trialsoflowdose(50-125mg/day)aspirin结果:Polypill组成:(forexample,atorvastatin(dailydose10mg)orsimvastatin(40mg));(forexample,athiazide,ablocker,andanangiotensinconvertingenzymeinhibitor),eachathalfstandarddose;();(75mg).估计:Polypill减少缺血性心脏病88%(84%to91%).减少中风80%(71%to87%).+抗动脉粥样硬化:降低心血管病超过80%;326:14190%20%40%60%80%100%0%20%40%60%80%100%风险降低(%)缺血性心脏病46%降压药他汀阿司匹林叶酸总计卒中降压药他汀阿司匹林叶酸总计61%32%16%88%63%17%16%24%80%风险降低(%)该论文意义在于提出了多重危险因素干预的概念(multifactorialinterventions)多重危险因素干预的理由主要有:1、心血管疾病的主要敌人是动脉粥样硬化2、心血管危险因素有聚集性3、干预单一危险因素效果并不理想MostPatientsHaveOverlappingCVRiskFactorsOfallHypertensives65%havedyslipidemia16%havetype2diabetes45%areoverweight/obeseOfallDyslipidemics48%havehypertension14%havetype2diabetes35%areoverweight/obeseOfallType2Diabetics60%havehypertension60%havedyslipidemia90%areoverweight/orbiditiesincreasesrisk400-700%1 BasedonFraminghamrisk高血压人群中,动脉粥样硬化的发生率更高PreventionandControl(2005)1,3–15PDAY研究(PathobiologicalDeterminantsofAtherosclerosisinYouthStudy)全球15个国家的18个临床中心1277名因外伤死亡的人群(年龄15-34岁)P<<<(1996):%%%%%