There are two secondary preventive measures for coronary heart disease, namely ABCDE (aspirin and anticoagulants, beta blockers and blood pressure, cholesterol and cigarettes, diet and diabetes, education and exercise), which are indispensable.
Beta blockers in the treatment of coronary heart disease are all class I recommendations and class A evidence. They are the first choice to improve symptoms and prognosis, and also the first choice of antihypertensive drugs for patients with coronary heart disease complicated with hypertension. The fat-soluble selective 1 receptor blocker metoprolol (betaloc) has no intrinsic sympathomimetic activity, and has significant cardioprotective effects in primary prevention, secondary prevention and long-term treatment after myocardial infarction.
The increase of LDL-C is the main risk factor of coronary heart disease. For the cardiovascular high-risk population, intensive lipid-lowering therapy with statins can greatly reduce LDL-C, thus effectively reducing the clinical events of cardiovascular diseases and delaying or even regressing the progress of atherosclerotic plaques. Rosuvastatin (Candine) is one of all statins with the indication of delaying the progression of atherosclerosis. The treatment of increasing HDL-C is still being explored. The new guidelines have more clear requirements for the treatment objectives of LDL-C, so we should be familiar with the guidelines in clinical work. By actively reducing LDL-C treatment, most patients can benefit more from meeting the treatment requirements of the guidelines.
Cardiovascular diseases are on the rise in developing countries. Intervention and treatment of risk factors can significantly reduce the death risk of coronary heart disease, and the preventive effect is obviously higher than that of treatment. Framingham scoring system and SCORE scoring system are widely used abroad. The Sino-US cooperative research established a scale for China population, which was verified in the China Multicenter Cooperative Cardiovascular Epidemiology (MUCA) cohort study, and it is more suitable for predicting the risk of China population 10. Compared with the ideal level rather than the average level, it is suggested that the minimum risk degree be divided into six stages, so that the relative risk degree can be predicted more objectively.
Adhering to the original intention of serving domestic readers, the series magazines of Chinese Medical Association cover all the issues that readers care about, giving priority to publishing all kinds of contending articles. With the goal of faster publication, higher quality and stronger influence, we are determined to become China Medical Journal Group.
Cardiovascular and cerebrovascular diseases among women in China are on the rise, which is the leading cause of death among women in China. The level of cardiovascular risk factors among women in China is high, among which obesity and diabetes are more serious than men. Exercise and healthy eating habits can effectively reduce the risk of cardiovascular disease in women. More attention should be paid to women's cardiovascular health.
Angiotensin Ⅱ analogue antihypertensive vaccine has been successfully tested in phase Ⅱ A clinical trial, and a new antihypertensive vaccine is being developed. It is no longer far away for therapeutic antihypertensive vaccines to be used in human dreams. Compared with traditional chemical synthetic drugs, antihypertensive vaccine has a long acting time, can maintain long-term stable and effective antihypertensive, and can improve treatment compliance. The technical problems to be solved in antihypertensive vaccine include the selection of immune targeting proteins, the determination of functional epitopes of target molecules, the selection of carrier molecules, the relationship between antibody expression and antihypertensive efficacy, etc.
Statins are considered to be the most effective anti-atherosclerosis drugs at present. For every 65,438+0 mmol/L decrease in low-density lipoprotein cholesterol (LDL-C), major coronary events in 65,438+0 years can be reduced by 23%, which is a statin effect. Statins should follow the principles of "the lower the better", "the longer the better", "the earlier the better", "the earlier the better" and "the cheaper the better". Under the same safety, it is a clinical choice to choose statins with strong curative effect, low price and little drug metabolism interaction. Rosuvastatin (Codine) is one of the most effective statins at present. Compared with other statins, its dosage is small and it has certain advantages in pharmacoeconomics.
Lowering blood pressure is the fundamental reason for the benefit of antihypertensive treatment. At present, the guidelines recommend the use of five antihypertensive drugs, but different drugs will have different benefits for some complications or some patients, and there are certain differences between different races. Generally speaking, dihydropyridine calcium antagonists (CCB) and diuretics may have stronger antihypertensive effects on East Asians and Africans. The risk of cardiovascular and cerebrovascular complications can be greatly reduced by choosing appropriate initial treatment drugs, reasonable combined antihypertensive treatment scheme and actively intervening various risk factors.
The multi-effect of CCB has established its wide application and important position in cardiovascular field. Evidence-based medicine suggests that CCB felodipine has high vascular selectivity, no negative inotropic effect, clear cardiovascular and cerebrovascular protection and safer use. National authoritative guidelines recommend that felodipine can be used safely in patients with heart failure, but CCB with low vascular selectivity is not recommended.
Cardiovascular disease is a disease with high morbidity and mortality. The organ structure and physiological function of the elderly are degraded, especially the liver and kidney function, which makes the absorption, distribution, metabolism and excretion of drugs, as well as the responsiveness, sensitivity and tolerance to drugs different from other people. The elderly patients with cardiovascular diseases often have atypical symptoms, complicated vascular diseases and conditions, and it is difficult to treat them. If the treatment is not timely, the condition will deteriorate sharply and even lead to death. The treatment of elderly patients should be individualized, pay attention to the benefit-risk ratio and improve the quality of life. We should pay attention to the influence of aging on cardiovascular diseases and the early prevention and treatment of cardiovascular diseases. Maintaining a healthy lifestyle and controlling related risk factors are all effective measures to prevent cardiovascular and cerebrovascular diseases.