Smith Sidney C
Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7075, USA.
Am J Cardiol. 2006 Jan 16;97(2A):28A-32A. doi: 10.1016/j.amjcard.2005.11.013. Epub 2005 Dec 1.
Coronary artery disease (CAD) prevention has moved beyond the secondary prevention of CAD events to the early identification and treatment of individuals thought to be at risk. Risk categories may be linked to the presence of other diseases, such as diabetes mellitus or noncoronary atherosclerotic disease, or to the finding of multiple risk factors on global risk assessment. Global risk assessment is now recommended as standard practice in cardiovascular disease prevention, and therapeutic strategies ranging from individuals at high risk (aggressive risk factor management) to those at low risk (periodic monitoring) are relatively straightforward. Further risk stratification appears to carry its greatest benefit for the large segment of the population comprising individuals who are asymptomatic and have "intermediate" risk on the basis of current global risk measures. Noninvasive techniques for assessing vascular wall status or cardiovascular function are useful in some of these individuals because they will enable a more accurate assessment of risk and thereby result in the risk status of the patient being raised to "high."
冠状动脉疾病（CAD）的预防已从CAD事件的二级预防扩展到对被认为有风险的个体进行早期识别和治疗。风险类别可能与其他疾病的存在有关，如糖尿病或非冠状动脉粥样硬化疾病，或者与全球风险评估中发现的多个风险因素有关。现在推荐将全球风险评估作为心血管疾病预防的标准做法，从高风险个体（积极的风险因素管理）到低风险个体（定期监测）的治疗策略相对简单明了。进一步的风险分层似乎对很大一部分人群带来最大益处，这些人无症状且根据当前全球风险测量处于“中等”风险。评估血管壁状态或心血管功能的非侵入性技术对其中一些个体有用，因为它们将能够更准确地评估风险，从而使患者的风险状态提升至“高”。
