Guize L
Service de Cardiologie A, Hôpital Broussais, Paris.
Ann Cardiol Angeiol (Paris). 1998 Nov;47(9):617-25.
Individualised cardiovascular prevention must primarily be applied to patients with coronary heart disease or another obvious atherosclerotic disease and to apparently healthy subjects, but presenting a high risk (which implies the detection of these subjects) and their close relatives. The European recommendations for the prevention of coronary heart disease in clinical practice have been recently up-dated. Calculation of the multifactorial absolute risk (probability of developing an event over a given period, taking into account all modifiable and non-modifiable risk factors) represents a decisional aid to intervene on lifestyle and drug prescription. However, the available tables and software require certain adjustments. Diet is a major determinant of the cardiovascular risk and has one of the most important, but most complex impacts on prevention. Restriction of saturated fats, a Mediterranean type of diet and caloric restriction in the case of obesity are the main objectives. Smoking cessation is essential. For all these measures, a specialist referral is too frequently neglected. Aerobic physical activity is recommended. Hypertension must be controlled regardless of age. The objective is to obtain blood pressure figures less than 140/90 mmHg, and even lower in the case of diabetes or renal disease. Evidence of the benefit of controlling hypercholesterolaemia has been reinforced and the objectives to be achieved have been redefined: in secondary prevention and in high-risk subjects, the target total cholesterol must be less than 1.90 g/l and LDL cholesterol must be less than 1.15 g/l. The control of all risk factors must be reinforced in diabetic patients and fasting blood glucose must be maintained between 0.91 and 1.20 g/l in insulin-dependent diabetic patients with coronary heart disease.
个体化心血管预防主要应适用于冠心病或其他明显动脉粥样硬化疾病患者以及看似健康但存在高风险（这意味着要检测出这些个体）的人群及其近亲。欧洲关于临床实践中冠心病预防的建议最近已更新。计算多因素绝对风险（考虑所有可改变和不可改变风险因素，在给定时间段内发生事件的概率）有助于在生活方式干预和药物处方方面做出决策。然而，现有的表格和软件需要进行某些调整。饮食是心血管风险的主要决定因素之一，对预防有着最重要但也是最复杂的影响。限制饱和脂肪摄入、采用地中海式饮食以及对肥胖者进行热量限制是主要目标。戒烟至关重要。对于所有这些措施，专科转诊常常被忽视。建议进行有氧运动。无论年龄大小，高血压都必须得到控制。目标是使血压值低于140/90 mmHg，对于糖尿病或肾病患者，血压目标值甚至更低。控制高胆固醇血症益处的证据得到了加强，并且重新定义了要达到的目标：在二级预防和高风险人群中，目标总胆固醇必须低于1.90 g/l，低密度脂蛋白胆固醇必须低于1.15 g/l。糖尿病患者必须加强对所有风险因素的控制，对于患有冠心病的胰岛素依赖型糖尿病患者，空腹血糖必须维持在0.91至1.20 g/l之间。
