Gohlke Helmut, Albus Christian, Gysan Detlef Bernd, Hahmann Harry W, Mathes Peter
1Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
Herz. 2009 Feb;34(1):4-14. doi: 10.1007/s00059-009-3196-7.
Preventive efforts should be guided by the patient's global cardiovascular (CV) risk. A risk stratification should be done in every person > age 35 with more than a single risk factor. Recommendations for improved lifestyle are applicable to all persons with CV risk factors: smoking cessation, daily exercise, normal body mass index, Mediterranean diet, blood pressure < 140 mmHg systolic, and LDL cholesterol < 130 mg/dl are beneficial. If the 10-year risk is > or = 20% for CV events or > or = 5% for CV death, additional drug interventions are usually necessary: acetylsalicylic acid 100 mg daily, statins to lower LDL cholesterol to < 100 mg/dl or, in diabetics with coronary artery disease, to < 70 mg/dl, blood pressure should be < 130 mmHg systolic, e.g., in patients with diabetes or renal disease. After bare-metal stent implantation clopidogrel should be given for > or = 4 weeks and after drug-eluting stents for > or = 6 months. In patients after myocardial infarction with an ejection fraction of < 40%, ACE inhibitors and beta-blocker should be started. Influenza vaccination improves prognosis in high-risk patients.
预防措施应以患者的整体心血管（CV）风险为指导。对于每一位年龄大于35岁且具有不止一个风险因素的人，都应进行风险分层。改善生活方式的建议适用于所有具有CV风险因素的人：戒烟、日常锻炼、正常体重指数、地中海饮食、收缩压<140 mmHg以及低密度脂蛋白胆固醇<130 mg/dl都是有益的。如果10年CV事件风险≥20%或CV死亡风险≥5%，通常需要额外的药物干预：每日服用100 mg乙酰水杨酸、使用他汀类药物将低密度脂蛋白胆固醇降至<100 mg/dl，或者对于患有冠状动脉疾病的糖尿病患者，降至<70 mg/dl，收缩压应<130 mmHg，例如糖尿病或肾病患者。在植入裸金属支架后，应给予氯吡格雷≥4周，在植入药物洗脱支架后，应给予≥6个月。对于心肌梗死后射血分数<40%的患者，应开始使用ACE抑制剂和β受体阻滞剂。流感疫苗接种可改善高危患者的预后。
