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Guideline
心血管疾病的预防及戒烟   CARDIOVASCULAR DISEASE - PREVENTION AND SMOKING CESSATION
动脉粥样硬化性心血管疾病(ASCVD,包括冠心病、缺血性卒中、外周动脉疾病)严重危害人体健康,发病率和病死率均较高,有必要对特定人群进行危险程度评估,识别ASCVD的高危人群,以便尽早干预,一级预防用以降低发生ASCVD的危险,二级预防用以预防心、脑血管事件复发。

心血管疾病的主要危险因素包括吸烟、高血压、血脂异常、糖尿病、心理社会因素、不健康饮食和缺乏体育锻炼等。
戒烟可降低心血管疾病发病和死亡风险,戒烟的长期获益优于目前常用的冠心病二级预防药物(如阿司匹林和他汀类),戒烟也是挽救生命最经济有效的干预手段。
  查阅疾病用药指南
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医药新闻
2018年1月, Pearl Toh
Meta分析显示,现有证据尚不足以证实使用可穿戴式生物传感器实施远程患者监测可改善血压、体质指数、体重等临床结局。
2017年12月, Jairia Dela Cruz
停用阿司匹林可能对长期用药者产生不良影响。最近一项研究显示,在没有大手术或出血的情况下停药可增加心血管事件风险。
2017年11月
一项新研究显示,电子烟可改变气道分泌物中固有防御蛋白谱。电子烟曾被认为是纸烟较为健康的替代品,而这一发现可能导致对电子烟的质疑。
2017年9月, Naomi Rodrig
在巴塞罗那召开的2017欧洲心脏病学会年会上发布的FOURIER试验二次分析显示,使用前蛋白转化酶枯草杆菌蛋白酶-9抑制剂Evolocumab积极降低LDL-胆固醇与心血管事件进行性减少相关,且不影响动脉粥样硬化疾病患者的用药安全性。
2017年9月, Naomi Rodrig
在巴塞罗那召开的2017欧洲心脏病学会年会上披露的最新数据显示,关节炎患者中,布洛芬升高血压的作用显著大于塞来昔布或萘普生,可能增加心血管(CV)事件风险。
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药物信息

科素亚 Cozaar  [  默沙东 MSD   ]  氯沙坦 Losartan
适应症: 原发性高血压。
MIMS药理分类 血管紧张素II受体拮抗剂 Angiotensin II Antagonists  
Cozaar tab 100 mg5a8a6883-be47-4b19-b5cc-a0fd00f39e75.GIF
海捷亚 Hyzaar  [  默沙东 MSD   ]  氯沙坦+氢氯噻嗪 Losartan + Hydrochlorothiazide
适应症: 高血压,适用于联合用药治疗的患者。
MIMS药理分类 血管紧张素II受体拮抗剂 Angiotensin II Antagonists  
Hyzaar tab 100 mg_12.5 mg0322e895-d501-48fd-bc64-a8b6010a8123.GIF
葆至能 Vytorin  [  默沙东 MSD   ]  辛伐他汀 + 依折麦布 Simvastatin + Ezetimibe
适应症: 原发性(杂合子家族性或非家族性)高胆固醇血症或混合性高脂血症;纯合子家族性高胆固醇血症。
MIMS药理分类 调脂药物 Dyslipidaemic Agents  
Vytorin tab 10 mg_ 20 mgdaf0a648-1396-412d-b798-a09900f2d560.GIF
舒降之 Zocor  [  默沙东 MSD   ]  辛伐他汀 Simvastatin
适应症: 高血脂症、冠心病、杂合子家族性高胆固醇血症儿童患者。
MIMS药理分类 调脂药物 Dyslipidaemic Agents  
Zocor filcotab 40 mgc546b3d4-2c3f-472b-b528-a099010be5b8.GIF
雅施达 Acertil  [  施维雅 SERVIER   ]  培哚普利 Perindopril
适应症: 高血压和充血性心衰。
MIMS药理分类 血管紧张素转换酶及肾素抑制剂 ACE Inhibitors/Direct Renin Inhibitors  
Acertil tab 4 mg24ed5698-afcc-48ca-9022-9fcb01885b3c.GIF
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参考文献
  1. β肾上腺素能受体阻滞剂在心血管疾病应用专家共识,中华医学会心血管病分会、中华心血管病杂志编辑委员会-中华心血管病杂志,2009年3月第37卷第3期
  2. 中国女性心血管疾病预防专家共识,中国女性心血管疾病预防专家共识组-中国心血管病研究,2012年5月第10卷第5期,321-328页
  3. 中国心血管病预防指南,中华医学会心血管病学分会、中华心血管病杂志编辑委员会-中华心血管病杂志,2011年1月第39卷第1期,3-21页
  4. 国人缺血性心血管病发病危险的评估方法及简易评估工具的开发研究-国家“十五”攻关“冠心病、脑卒中综合危险度评估及干预方案的研究”课题组,中华心血管病杂志,2003年12月第31卷第12期,893-901页
  5. 心血管疾病一级预防中国专家共识,中国医师协会心血管内科医师分会,中华内科杂志编辑委员会-中华内科杂志,2010年2月第49卷第2期,174-185页
  6. 心血管疾病戒烟干预中国专家共识,中国医师协会心血管病分会-中华内科杂志,2012年2月,第51卷第2期,第168-173页
  7. 阿司匹林在动脉硬化性心血管疾病中的临床应用:中国专家共识(2005),中华医学会心血管病学分会、中华心血管病杂志编辑委员会-中华心血管病杂志,2006年3月第34卷第3期
  8. AHA; ACC; National Heart, Lung, and Blood Institute, Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol. 2006 May;47(10):2130-2139. PMID: 16697342
  9. American Academy of Family Physicians. Information for your family doctor: using nicotine patch, nicotine gum, nicotine nasal spray or nicotine inhaler. American Family Physician. http://www.aafp.org/afp/2001/0601/p2251.html. Jun 2001. Accessed 24 Apr 2002
  10. Aveyard P, West R. Managing smoking cessation. BMJ. 2007 Jul;335(7609):37-41. PMID: 17615224
  11. Bartra A. Treatment of tobacco dependence. Dtsch Arztebl Int. 2011 Aug;108(33):555-564. doi: 10.3238/arztebl.2011.0555. PMID: 21912578
  12. British Cardiac Society; British Hypertension Society; Diabetes UK; HEART UK; Primary Care Cardiovascular Society; Stroke Association. JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart. 2005 Dec;91(Suppl 5):v1-v52. PMID: 16365341
  13. Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2007 Jan;30(1):162-172. PMID: 17192355
  14. Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. U.S. Department of Health and Human Services. http://www.ahrq.gov/. May 2008.
  15. Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by r. Eur J Cardiovasc Prev Rehabil. 2007 Sep;14(Suppl 2):E1-40. PMID: 17726406
  16. Ministry of Health Malaysia. Prevention of cardiovascular disease in women. http://www.acadmed.org.my. 2008.
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  18. National Institute for Health and Care Excellence. NICE technology appraisal guidance 123. Varenicline for smoking cessation. NICE. http://www.nice.org.uk/. Jul 2007.
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  21. Redberg RF, Benjamin EJ, Bittner V, et al; American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; Preventive Cardiovascular Nurses Association. AHA/ACCF [corrected] 2009 performance measures for primary prevention of cardiovascular disease in adults: a report of the American College of Cardiology Foundation/American Heart Association task force on performance measures (writing committee to develop performance measures for primary prevention of cardiovascular disease): developed in collaboration with the American Academy of Family Physicians; American Association of Cardiovascular and Pulmonary Rehabilitation; and Preventive Cardiovascular Nurses Association: endorsed by the American College of Preventive Medicine, American College of Sports Medicine, and Society for Women's Health Research. Circulation. 2009 Sep;120(13):1296-1336. doi: 10.1161/CIRCULATIONAHA.109.192617. PMID: 19770388
  22. U.S. Food and Drug Administration. FDA Drug safety communication: Chantix (varenicline) drug label now contains updated efficacy and safety information. http://www.fda.gov/Drugs/DrugSafety/ucm264436.htm. 22 Jul 2011. Accessed 26 Sep 2011
  23. US Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009 Mar;150(6):396-404. PMID: 19293072
  24. Varenicline-guidance for health professionals on a new prescription-only stop smoking medication. ASH. http://newash.org.uk/files/documents/ASH_447.pdf. Jul 2007. Accessed 04 Sep 2007
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  26. Zwar N, Richmond R, Borland R, et al. Smoking cessation: a guide for health professionals. The Royal Australian College of General Practicioners. http://www.racgp.org.au/. 2011
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