Hoffmann U, Leu A J
Abteilung Angiologie, Department für Innere Medizin, Universitätsspital Zürich.
Praxis (Bern 1994). 1996 Sep 24;85(39):1201-5.
Secondary prevention of arteriosclerosis tries to inhibit progression of the atherosclerotic process. Therapeutic measures focus on modification of cardiovascular risk factors and antithrombotic treatment. Hypercholesterolemia is the main risk factor for coronary artery disease. The risk of a coronary event is correlated to the plasma cholesterol level. Lowering plasma cholesterol results in reduction of vascular morbidity and mortality. Cigarette smoking is the predominant risk factor for peripheral arterial occlusive disease (PAOD). Smoking cessation reduces progression of PAOD and lowers cardiovascular morbidity and mortality. The preventive effect of antihypertensive therapy in hypertensive patients is most pronounced for cerebrovascular events. Antihypertensive measures improve prognosis after stroke and myocardial infarction. The increased cardiovascular risk in diabetics is in part explained by hyperglycemia and hyperinsulinemia, but also depends on coexisting dyslipidemia and hypertension. Intensive treatment of elevated blood glucose levels, dyslipidemia and hypertension are important preventive measures. Aspirin is highly effective in secondary prevention of vascular events. For the coronary arteries, low-dose aspirin is well established. Whether low-dose aspirin is equally effective for reducing progression of arteriosclerosis in the cerebrovascular and in the peripheral vessels is questionable. Ticlopidine serves as an alternative to aspirin; however, neutropenia may occur, which requires supervision of the patient.
动脉粥样硬化的二级预防旨在抑制动脉粥样硬化进程的发展。治疗措施主要集中在改善心血管危险因素和抗血栓治疗。高胆固醇血症是冠状动脉疾病的主要危险因素。冠状动脉事件的风险与血浆胆固醇水平相关。降低血浆胆固醇可降低血管疾病的发病率和死亡率。吸烟是外周动脉闭塞性疾病（PAOD）的主要危险因素。戒烟可减缓PAOD的发展，并降低心血管疾病的发病率和死亡率。抗高血压治疗对高血压患者预防脑血管事件的效果最为显著。抗高血压措施可改善中风和心肌梗死后的预后。糖尿病患者心血管疾病风险增加部分归因于高血糖和高胰岛素血症，但也取决于并存的血脂异常和高血压。强化治疗血糖升高、血脂异常和高血压是重要的预防措施。阿司匹林在血管事件的二级预防中非常有效。对于冠状动脉，小剂量阿司匹林已被广泛应用。小剂量阿司匹林在预防脑血管和外周血管动脉硬化进展方面是否同样有效尚存在疑问。噻氯匹定可作为阿司匹林的替代药物；然而，可能会出现中性粒细胞减少症，因此需要对患者进行监测。
