一、二级预防中冠状动脉心脏病风险的评估

Risk evaluation of primary and secondary prevention of coronary heart disease

目的 通过经济发达地区社区人群冠状动脉心脏病 (CHD)风险评估 ,筛选CHD一、二级预防的对象。方法 以中国心血管健康多中心合作研究中苏南经济发达地区城市和农村两社区人群中心血管危险因素资料 ,引入美国胆固醇教育计划第 3次报告 (ATPⅢ )对CHD危险状态的评估和胆固醇处理的原则和方法。结果 根据CHD危险因素数量 ,将危险状态分为 3类。城市、农村社区中 ,CHD等危症组分别占 14 32 %和 7 70 % ;2个及以上危险因素组的对象通过Framindham积分 ,分别有 6 2 4 4 %和 5 1 5 8%的患者 10年风险超过 10 %。在CHD等危症组 ,城市和农村社区分别有 6 2 5 0 %和 4 3 75 %患者高于低密度脂蛋白胆固醇 (LDL -C)标准值 (LDL -C≥ 2 5 9mmol/L) ;2个及以上危险因素组中 ,分别有 2 4 17%和 10 4 1%的患者超过目标值 (LDL -C≥ 3 36mmol/L) ;0～ 1个危险因素组分别有 5 2 5 %和5 82 %的患者超过目标值 (LDL -C≥ 4 14mmol/L)。此外 ,城市和农村社区代谢综合征的患病率分别有 30 4 0 %和18 11%。结论 经济发达地区城市、农村社区人群通过ATPⅢ的评估 ,有一定比例的人口具有较高的CHD风险 ,代谢综合征患病率也处于较高的水平。鉴于ATPⅢ是一份以大量科学事实。

Objective To screen the subjects for primary and secondary prevention of coronary heart disease(CHD)in the population in the economy developed region.Methods Based on the data of two community population in South Jiangsu province from Chinese Multicenter Cardiovascular Health Cooperative Project,appling ATPⅢ to assess the risk of CHD and the principle and methods of hadling cholesterol.Results The risk status was divided into three groups according to the risk factors of CHD.In urban and suburb population the highest risk group accounted for 14 32% and 7 70% respectively.In the group with two or more risk factors,according to Framingham score,62 44% in urban and 51 58% in suburb population had more than 10% risk of CHD in 10 years.In the highest risk group of CHD,the proportion of LDL-C≥2 59?mmol/L was 62 50% in urban and 43 75% in suburb population.In the group with two or more risk factors,the proportion of LDL-C≥3 36?mmol/L was 24 17% in urban and 10 41% in suburb population.In the group with 0-1 risk factors,the proportion of LDL-C≥4 14?mmol/L was 5 25% in urban and 5 82% in suburb population.In addition,the prevalence of metabolic syndrome was 30 40% in urban and 18 11% in suburb population.Conclusion Using ATPⅢ assessment,suggested,in this economy developed region,a relatively higher proportion of the population had CHD risk and there was a higher prevalence of metabolic syndrome.ATPⅢ was well validated tool which may be used to screen the subjects for primary and secondary prevention of CHD.