Güleç Sadi
Department of Cardiology, Medicine Faculty of Ankara University, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2009 Mar;37 Suppl 2:1-10.
The management of diseases arising from a single cause is straightforward. However, with regard to the clinical manifestations of atherosclerotic disease (coronary heart disease, stroke, peripheral vascular disease, and aneurysms) the situation is more complex, since atherosclerosis represents the product of multiple interacting risk factors. The modern approach to managing cardiovascular risks is to reduce an individual's total or global risk, rather than grading risk by individual risk factors alone. Recent guidelines stress the need for total risk estimation and recommend the use of risk charts like Framingham or SCORE before treating risk factors like dyslipidemia. One should keep in mind that treatment should be directed to those at greatest risk and management decisions based on a single risk factor may be misleading. For instance, a male smoker with a cholesterol level of 200 mg/dl and systolic blood pressure of 160 mmHg can be at four times higher risk than a female non-smoker with a cholesterol level of 300 mg/dl and systolic blood pressure of 120 mmHg, indicating a higher global risk and priority for the treatment of dyslipidemia. If risk assessment is based on the cholesterol alone, then this woman would have a higher priority than the man due to the higher cholesterol level. In this review, global risk management strategies will be discussed in detail.
由单一病因引起的疾病管理较为简单直接。然而，就动脉粥样硬化性疾病（冠心病、中风、外周血管疾病和动脉瘤）的临床表现而言，情况更为复杂，因为动脉粥样硬化是多种相互作用的风险因素共同作用的结果。现代管理心血管风险的方法是降低个体的总体或综合风险，而不是仅依据单个风险因素来分级风险。近期的指南强调了进行总体风险评估的必要性，并建议在治疗血脂异常等风险因素之前，使用如弗明汉或SCORE等风险图表。应当牢记，治疗应针对风险最高的人群，基于单一风险因素做出的管理决策可能会产生误导。例如，一名胆固醇水平为200毫克/分升且收缩压为160毫米汞柱的男性吸烟者，其风险可能比一名胆固醇水平为300毫克/分升且收缩压为120毫米汞柱的女性非吸烟者高出四倍，这表明前者具有更高的总体风险以及治疗血脂异常的更高优先级。如果仅基于胆固醇进行风险评估，那么由于胆固醇水平较高，这名女性的优先级会高于该男性。在本综述中，将详细讨论总体风险管理策略。
