esc guidelines metafrasi kardiologia 2010 book web
TRANSCRIPT
-
ESC GUIDELINES DESK REFERENCE
CARDIOVASCULAR MEDICINE
COMPENDIUM OFABRIDGED ESC GUIDELINES
2010
ESC Committee for Practice GuidelinesTo improve the quality of clinical practice and patient care in Europe
For more informationwww.escardio.org/guidelines
2010
-
Distribution of this Compendium has been made possible through an unrestricted educational grant from Sanofi Aventis
-
2010
-
Published by Springer Healthcare, 236 Grays Inn Road, London, WC1X 8HL, UK.Copyright European Society of Cardiology 2010 - All Rights Reserved.
The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to ESC, Practice Guidelines Department, 2035, route des Colles - Les Templiers - BP179 - 06903 Sophia, Antipolis Cedex - France.
Disclaimer: The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health professionals are encouraged to take them fully into account when exercising their clinical judgment. The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patients guardian or carer. It is also the health professionals responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.
ESC Staff involved in the publication of this document:
Claire Bramley, Head of Education DepartmentVeronica Dean, Head of Practice Guidelines Department Catherine Desprs, Scientific Research Analyst, Practice Guidelines Department Contact e-mail: [email protected]
ISBN: 978-1-907673-00-9
British Library Cataloguing-in-Publication Data:A catalogue record for this book is available from the British Library.
Production: Marina MaherIndex: Laurence ErringtonPrinted in the UK by Butler, Tanner & Dennis
-
ESC Committee for Practice Guidelines(CPG 20082010)
Alec Vahanian (Chairperson) FranceAngelo Auricchio, SwitzerlandJeroen Bax, The Netherlands
Claudio Ceconi, ItalyVeronica Dean, France
Gerasimos Filippatos, GreeceChristian Funck-Brentano, France
Richard Hobbs, UKPeter Kearney, IrelandTheresa McDonagh, UK
Bogdan A. Popescu, RomaniaZeljko Reiner, Croatia
Udo Sechtem, GermanyPer Anton Sirnes, Norway
Michal Tendera, PolandPanos Vardas, Greece
Petr Widimsky, Czech Republic
Address for correspondence:
Practice Guidelines Department2035 Route des CollesLes Templiers BP 179
06903 Sophia Antipolis CedexFrance
E-mail: [email protected]://www.escardio.org/guidelines
-
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Alec Vahanian
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Roberto Ferrari
Guidelines overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
: . . . . . . . . . . . . . . . . . . . 1
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ; . . . . . . . . . . . . . . . . . . . . . . . . 5 ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . . 5 ; . . . . . . . . . . . . . . . . . . . . . . . . 5 ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ; . . . . 6 ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 : ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 SCORE ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 SCORE: . . . . . . . . . . . 810 . . . . . . . . . . . . . . . . 810 . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ; . . . . . . . . . . . . . . . . . . . . 9 : - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 ; . . . . . . . . . . . . . . . . . . . . . 10 , ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 ; . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2024 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
-
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . . . . 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . . . . . . . . . . . . . . . . 31
: . . . . . . . . . . . . . . . . 33
1. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36, . . . . . . . . . . . 38 , IGH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 . . . . . . . . . . . . . . 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
IV: . . . . . . . . . . . . . . . . . . . . . . . . . 53
1. ST . . . . . . . . . 55 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
2. ST . . . . . . . . . . . . 71 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
-
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 : . . . . . . . . . . . . . . . . 95
4. (PCI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 PCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 PCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 PCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Stent (DES) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
V: . . . . . . . . . . . . . . . . . . . . . . . . 107
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 . . . . . . . . . . . . . . . . . . . 111 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114CM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
VI: . . . . . . . . . . . . . . . . . . . . 117
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 : . . . . . . . . . . . . 129 ( Dressler) . . . . . . 129 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
V: . . . . . . . . . . . . . . . . . . . . . 133
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
-
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
VIII: . . . . . . . . . . . . . . . . . . . . . 177
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Marfan . . . . . . . . . . . . . . . . 181 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
IX: . . . . . . . . . . . . . . . . . . . . . . . . . 185
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1996 . . . . . . . . . . . . . . . . . . . . . . . . . 200
: . . . . . . . . . . . . . . . . . . . . . 203
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
() . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 () . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 (CDRIE) . . . . . . . . . . . . . . . . . . . . 215 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
XI: . . . . . . . . . . . . . . . . . . . . . . 217
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 ( 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
-
( 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
( 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 / ( 3) . . . . . . . . . . . . . . . . . . . . . 232 ( 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 . . . . . . . . . . . . . . . . . . 233
XII: . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
1. () . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
2. () . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275, , ,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276 , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290 . . . . . . . . . . 290
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3025. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 . . . . . . . . . . . . . . . 311
: . . . . . . . . . . . . . . . . . . . . 313
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316 . . . . . . . . . . . . . 317 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
-
. . . . . . . . . . . . . . . . . . . . . 319 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
XIV: . . . . . . . . . . . . . . . . . . . . . . . 321
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323 , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
XV: . . . . . . . . . . . . . . . . . . . . . . 333
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 & . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 & . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349 & . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352 & . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
XVI: . . . . . . . . . . . . . . . . . . . . 361
1. - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363 . . . . . . . . . . . . . . . . . . . . . 364 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
-
In recent years there has been an increasing tenden-cy towards optimization of medical practice through the application of Evidence-Based Medicine. One of the consequences of this approach is an enormous increase in the number of clinical trials thus creating an environment in which keeping abreast of clinical advances, even within a single medical subspecialty, is an extremely demanding task. In this setting, cli-nicians have become increasingly reliant on clinical practice guidelines to help them decide on the diag-nostic procedures and treatment options, which are most appropriate for the management of their pa-tients.
The ESC is committed to reduce the burden of car-diovascular diseases in Europe and therefore con-siders that the development of Clinical Practice Guidelines is a strategic step to achieve this goal.
The production of ESC Clinical Practice Guidelines is coordinated by the Committee for Practice Guide-lines (CPG). This committee is the body responsi-ble for the nomination of the Task Forces, which are appointed to produce the different guidelines. The Committee selects the Task Force Members ensur-ing the recruitment of leading scientific experts in each field and the participation of representatives from ESC Working Groups, Associations and Coun-cils.
The approval process for the documents includes the validation of each scientific statement by expert reviewers and ESC Board Members. In this respect, the recommendations included in the Guidelines re-flect the official position of the European Society of Cardiology. ESC Guidelines are produced with the goal of covering all major topics defined in the ESC Core Curriculum.
All ESC Guidelines documents are posted on the ESC web site (http://www.escardio.org/guidelines). The original English parent document version of these guidelines are published in the European Heart Jour-nal and are linked to an accredited Continuous Medical Education programme that allows physicians to earn CME credits online to show that they have achieved the learning objectives set for each published guidelines.
The ESC Guidelines are endorsed, translated and ad-opted by most of the ESC National Societies. The im-plementation of the Guidelines is ensured through an active partnership between the ESC and its Work-ing Groups, Associations, Councils and National So-cieties.
The ESC Pocket Guidelines are a concise summary of the fundamental recommendations made in the parent guidelines documents. These pocket guide-lines are highly appreciated by medical profession-als and have become an important guidelines dis-semination tool. In view of the utility of these docu-ments and the strong demand for a compilation of all of the available pocket guidelines, the Commit-tee for Practice Guidelines commissioned the pro-duction of this ESC Guidelines Compendium 2010.
It is my hope and that of the Committee for Prac-tice Guidelines 20082010, that this new version of the Compendium of abridged ESC Guidelines will be of help to clinicians to follow the most recent rec-ommendations in the practice of our rapidly evolving field of medicine.
Alec Vahanian; MD, FRCPChairperson of the
ESC Committee for Practice Guidelines (CPG20062008 and 20082010
Preface
-
It is with great pleasure that the European Society of Cardiology has updated the ESC Guidelines Com-pendium, a compilation of all current ESC Pocket Guidelines titles.
ESC Pocket Guidelines have been published as indi-vidual booklets for a few years but as the list of titles grew it became apparent that a compilation of all of the titles would be very useful to healthcare profes-sionals as a resource to assist in clinical decision making at the point of care.
By definition, pocket guidelines can provide only the most important recommendations extracted from extensive and scientifically well grounded full text
guidelines. In some cases the clinician may still need to go back to these source documents in order to make a proper diagnostic or therapeutic decision.
The 2008 edition of the ESC Guidelines Compendi-um has been so successful that we are delighted to now produce the 2010 compendium.
We hope that you will find the ESC Guidelines Com-pendium useful in achieving the mission to reduce the burden of cardiovascular disease in Europe.
Roberto FerrariPresident of the European Society of Cardiology
(20082010)
Foreword
-
Guidelines aim to present management recommen-dations based on all of the relevant evidence on a particular subject. This is done in order to help phy-sicians select the best possible management strat-egies for the individual patient suffering from a spe-cific condition, taking into account the impact on outcome and also the risk:benefit ratio of a partic-ular diagnostic or therapeutic procedure. Numerous studies have demonstrated that patient outcomes improve when guideline recommendations, based on the rigorous assessment of evidence based re-search, are applied in clinical practice.
A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) and also by other organizations or related so-cieties. The profusion of documents can put at stake the authority and credibility of guidelines, particularly if discrepancies appear between different documents on the same issue, as this can lead to confusion in the mind of physicians. In order to avoid these pitfalls, the ESC and other organizations have issued recom-mendations for formulating and issuing Guidelines. The ESC recommendations for guidelines production can be found on the ESC website [http://www.escar-dio. org/guidelines]. It is beyond the scope of this pre-amble to recall all but the basic rules.
In brief, the ESC appoints experts in the field to carry out a comprehensive review of the literature, with a view to making a critical evaluation of the use of diagnostic and therapeutic procedures, and assessing the risk:benefit ratio of the therapies recommended for management and/or prevention of a given condition. Estimates of expected health outcomes are included, where data exists. The strength of evidence for or against particu-lar procedures or treatments is weighed, according to predefined scales for grading recommendations and levels of evidence, as outlined below.
The Task Force members of the writing panels, as well as the document reviewers, are asked to pro-vide disclosure statements of all relationships they may have which might be perceived as real or po-tential conflicts of interest. These disclosure forms are kept on file at the European Heart House, head-quarters of the ESC, and can be made available by written request to the ESC President. Any changes in conflicts of interest that arise during the writing pe-riod must be notified to the ESC.
Guidelines and recommendations are presented in formats that are easy to interpret. They should help physicians to make clinical decisions in their daily routine practice, by describing the range of generally acceptable approaches to diagnosis and treatment. However, the ultimate judgement regarding the care of an individual patient must be made by the physi-cian in charge of his/her care.
The ESC Committee for Practice Guidelines (CPG) supervises and coordinates the preparation of new Guidelines produced by Task Forces. The Commit-tee is also responsible for the endorsement of these Guidelines by its National Society Member countries. Once the document has been finalized and approved by all the experts involved in the Task Force, it is sub-mitted to outside specialists for review. In some cas-es, the document can be presented to a panel of key opinion leaders in Europe, specialists in the relevant condition at hand, for discussion and critical review. If necessary, the document is revised once more and finally approved by the CPG and selected members of the Board of the ESC and subsequently published.
After publication, dissemination of the message is of paramount importance. Publication of execu-tive summaries, the production of pocket-sized and PDA-downloadable versions of the recommenda-
Guidelines Overview: Review of 2010
-
tions are helpful. However, surveys have shown that the intended end-users are often not aware of the existence of guidelines or simply dont put them into practice. Implementation programmes are thus nec-essary and form an important component of the dis-semination of knowledge. Meetings are organized by the ESC, and directed towards its member Na-tional Societies and key opinion leaders in Europe. Implementation meetings can also be undertaken at a national level, once the guidelines have been en-dorsed by the ESC member societies and translated into the local language as required.
The task of writing Guidelines documentation not only involves the integration of the most recent re-search, but also the creation of educational tools and implementation programmes forth recommen-dations. The cyclical nature of clinical research, writ-ing of guidelines and implementing them into clinical practice can then only be completed if surveys and registries are organized to verify that actual clini-cal practice is in keeping with what is recommend-ed by the guidelines. Such surveys and registries al-so make it possible to check the impact of strict im-plementation of the guidelines on patient outcome.
Classes of Recommendations Definition
Class I Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective.
Class II Conflicting evidence and/or a divergence of opinion about the useful-ness/efficacy of the given treatment or procedure.
Class IIa Weight of evidence/opinion is in favour of usefulness/efficacy.
Class IIb Usefulness/efficacy is less well established by evidence/opinion.
Class III Evidence or general agreement that the given treatment or procedure is not useful/effective, and in some cases may be harmful.
Level of Evidence A Data derived from multiple randomized clinical trials or meta-analyses.
Level of Evidence B Data derived from a single randomized clinical trial or large non-random-ized studies.
Level of Evidence C Consensus of opinion of the experts and/or small studies, retrospective studies, registries.
-
1 :
1.
-
3 :
1
*2007
(), , , .
, , - .
-,
: Ian Graham (ESC)
Adelaide and Meath
Tallaght, Dublin 24, Ireland.: +35 (3) 1 414 4105: +35 (3) 1 414 3052
E-mail: [email protected]
* ESC . (European Heart Journal 2007) European Journal of Cardiovascu- European Journal of Cardiovascu-lar Prevention and Rehabilitation 2007: 4 ( 2)..
:1. Dan Atar, , (ESC)2. Knut Borch-Johnsen Gentofte, (EASD/IDF-Europe)3. Gudrun Boysen, , (EUSI)4. Gunilla Burell, , (ISBM)5. Renata Cifkova, , (ESH)6. Jean Dallongeville, , (ESC)7. Guy De Backer, , (ESC)8. Shah Ebrahim, , (ESC/ )9. Bjorn Gjelsvik, , (ESGP/FM/Wonca)10. Christoph Herrmann-Lingen, , (ISBM)11. Arno W. Hoes, , (ESPG/FM/Wonca)12. Steve Humphries, , (ESC)
13. Mike Knapton, , ()14. Joep Perk, Oskarshamn, (EACPR)15. Silvia G. Priori, , (ESC)16. Kalevi Pyorala, , (ESC)17. Zeljko Reiner, , (EAS)18. Luis Ruilope, , (ESC)19. Susana Sans-Menendez, , (ESC)20. Wilma Scholte Op Reimer, , 21. Peter Weissberg, , ()22. David Wood, , (ESC)23. John Yarnell, , (EACPR)24. Jose Luis Zamorano, , (ESC/CPG)
:1. Marie-Therese Cooney, , 3. Tony Fitzgerald, , 2. Alexandra Dudina, , 4. Edmond Walma, Schoonhoven, (ESPG/FM/Wonca)
: (EASD), (IDF-Europe), (EAS), (EHN), (ESH), (), / (ESGP/GM/Wonca), (EUSI), (ISBM), (EACPR)
ESC:1. Keith McGregor, , 2. Veronica Dean, ,
3. Catherine Despres, ,
-
1:
4
- - .
2 1 -
- - - -
SCORE 5%
SCORE < 5%
;
: ; o SCORE , , -
, :
- - .
-
140/90 TC 5 mmol/L LDL 3 mmol/L : . .
25 kg/m2 - 30 kg/m2
80-88 cm 94-102 cm .: 88 cm 102 cm .30 - . - -
: -, , - , ( -), , -
( -).
-
- -
: , - , -,
: (), , - , , , , (), ().
: . (LDL HDL , -), ,
- -
CRP , (), , -,
SCORE 5% 10% . , 10% .
-
:
5
:
0 3 5 140 5 3 00
3 3 km 30
5
140 140
5 < 5 mmol/L
3 LDL < 3 mmol/L
0
;
.
:
(5% 10 )
2 1 -
-
- -.
;
() . - .
- .
- , .
, .
, .
;
, .
, , , , - .
- - , , -, .
-
1:
6
;
1. .
2. :
: 30
< 25 kg/m2
< 140/90 mm Hg
< 5 mmol/L (~190 mg/dL)
LDL < 3 mmol/L (~115 mg/dL)
< 6 mmol/L (~110 mg/dL)
3. , - :
130/80 mm Hg
< 4,5 mmol/L (~175 mg/dL) < 4 mmol/L (~155 mg/dL),
LDL < 2,5 mmol/L (~100 mg/dL) < 2 mmol/L (~80 mg/dL),
< 6 mmol/L (~110 mg/dL) HbA1c < 6,5%
4. .
;
. , :
. , . , . . . ,
SCORE -, .
;
. -
. , .
, - .
-
:
7
;
: 2 1
.
, SCORE : , , - .
: ;
: , , , - , .
: , , , , , ( ), , .
: , . - , , (LDL HDL , ), .
. . , : CRP -
, -(), , .
SCORE ;
1. *, , *, , -, *, . .*, , -, , , , .
2. , , - , - .
3. .
4. 10 .
. . , - .
-
1:
8
SCORE:
, .
, - .
, . -, , . - 10 .
, : , . . . . 5 3
. HDL . ,
.
Risk estimation using SCORE: Qualifiers
10 year risk of fatal CVD in high risk regions of Europe
8
Chapter 1: Cardiovascular Disease Prevention in Clinical Practice
The charts should be used in the light of the clinicians knowledge and judgement, especially with regard to localconditions.
As with all risk estimation systems, risk will be over estimated in countries with a falling CVD mortality rate, andunder estimated if it is rising.
At any given age, risk appears lower for women than men. This is misleading since, ultimately, more womenthan men die from CVD. Inspection of the charts shows that their risk is merely deferred by 10 years.
Risk may be higher than indicated in the chart in:- Sedentary or obese subjects, especially those with central obesity- Those with a strong family history of premature CVD- The socially deprived- Subjects with diabetes - risk may be 5 fold higher in women with diabetes and 3 fold higher in men with
diabetes compared to those without diabetes- Those with low HDL cholesterol or high triglycerides- Asymptomatic subjects with evidence of pre-clinical atherosclerosis, for example a reduced ankle-brachial index
or on imaging such as carotid ultrasonography or CT scanning
180
160
140
120
180
160
140
120
55
50
40
60
65
Age
180
160
140
120
180
160
140
120
180
160
140
120
4 5 6 7 8 4 5 6 7 8 4 5 6 7 8 4 5 6 7 8
Women Men
Smoker Smoker
Syst
olic
blo
od pre
ssure
(m
mH
g)
Cholesterol (mmol/L)
high CVD risk
10-year risk of
fatal CVD in
populations at
15% and over10% - 14%5% - 9%3% - 4%2%1%< 1%
Non-smoker Non-smoker
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 1 1 1
0 1 1 1 1
1 1 1 1 1
1 1 1 2 2
1 1 2 2 2
2 2 2 3 3
2 3 3 4 5
4 4 5 6 7
2 2 3 3 4
2 2 3 3 4
1 1 2 2 2
2 2 2 3 3
3 3 4 4 5
4 5 5 6 7
2 3 3 4 4
3 4 5 5 6
5 6 7 8 9
4 5 5 6 7
4 4 5 6 7
7 8 9 10 12
5 5 6 7 8
3 3 4 5 6
2 2 3 3 4
13 15 17 19 22
9 10 12 13 16
6 7 8 9 11
14 16 19 22 26
9 11 13 15 16
6 8 9 11 13
4 5 6 7 9
26 30 35 41 47
18 21 25 29 34
13 15 17 20 24
9 10 12 14 17
18 21 24 28 33
12 14 17 20 24
8 10 12 14 17
6 7 8 10 12
9 11 13 15 18
6 7 9 10 12
4 5 6 7 9
3 3 4 5 6
6 7 8 10 12
4 5 6 7 8
3 3 4 5 6
12 13 16 19 22
8 9 11 13 16
5 6 8 9 11
4 4 5 6 8
3 3 3 4 5
2 2 2 3 3
1 1 2 2 2
8 9 10 11 13
2 2 3 3 4
1 2 2 2 3
1 1 1 1 2
1 2 2 2 3
1 1 1 1 2
1 1 1 1 1
1 1 1 1 1
1 1 1 2 2
1 1 1 1 1
0 1 1 1 1
0 0 1 1 1
1 1 1 1 1
20
07
ESC
c
150 200 250 300mg/dl
1 1 1 2 2
1 2 2 2 3
2 2 3 3 4
2 3 3 4 5
3 4 5 6 7
5 6 7 8 10
7 8 10 12 10
0 0 0 0 0
0 0 0 0 0
0 0 0 1 1
Section I - 1 pp1-14:Section I - 1 Prevention-new 10/03/2010 16:21 Page 8
(m
m H
g)
(mmol/L)
15% 10%-14%5%-9%3%-4%2%1%
-
:
9
, - , - . , , .
;
- .
- .
.
10 year risk of fatal CVD in low risk regions of Europe
9
Section I: Prevention of Cardiovascular Disease
0 0 0 1 10 0 0 0 0
0 0 0 0 0
0 0 0 1 1
0 1 1 1 1
0 1 1 1 1
1 1 1 1 1
1 1 1 2 2
1 1 2 2 2
2 2 2 3 3
2 3 3 4 5
4 4 5 6 72 2 3 3 4
1 1 1 2 2
1 2 2 2 3
2 2 3 3 4
3 4 4 5 6
5 6 7 8 9
3 4 5 5 6
2 3 3 4 4
2 2 2 3 3 3 4 4 5 6
5 5 6 7 9
7 8 9 11 13
10 11 13 15 18
15 17 20 23 26
10 12 14 16 19
8 9 10 12 149 9 11 12 14
6 6 7 8 10
4 4 5 6 7
3 3 3 4 41 1 2 2 2
2 2 2 3 3
3 3 4 4 5
4 5 6 6 7
3 3 3 4 4
2 2 2 2 3
1 1 1 2 2
1 1 1 1 1
1 1 2 2 2
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
0 0 1 1 1
0 0 0 1 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 1 1 1
1 1 1 2 2
2 2 2 3 3
3 3 3 4 4
1 2 2 2 3
2 2 3 3 4
5 5 6 7 8
3 4 4 5 5
1 1 2 2 2
0 0 1 1 1
5 6 7 8 10
4 4 3 6 7
2 3 3 4 5 5 5 6 8 9
7 8 9 11 13
2 2 3 3 4
3 3 4 5 6
4 5 6 7 8
6 7 8 10 12
1 1 2 2 2
1 1 1 1 2
1 1 1 1 1
150 200 250 300mg/dl
20
07
ESC
c
180
160
140
120
180
160
140
120
Age
65
60
55
50
40
15% and over10% - 14%5% - 9%3% - 4%2%1%< 1%
10-year risk of
fatal CVD in
populations at
low CVD risk
180
160
140
120
180
160
140
120
180
160
140
120
4 5 6 7 8 4 5 6 7 84 5 6 7 84 5 6 7 8
Cholesterol (mmol/L)
Syst
olic
blo
od
pre
ssure
(m
mH
g)
Women
Non-smokerNon-smoker Smoker Smoker
Men
Relative Risk Chart
This chart may be used to show younger people at lowtotal risk that, relative to others in their age group, theirrisk may be many times higher than necessary. This mayhelp to motivate decisions about avoidance of smoking,healthy nutrition and exercise, as well as flagging thosewho may become candidates for medication.
How do I manage the components oftotal CVD risk?
1 1 1 2 2
SmokerNon-Smoker
1 2 2 2 3
2 3 3 4 4
3 3 4 5 6 6 7 8 10 12
4 5 6 7 8
3 3 4 5 6
2 2 3 3 4
20
07
ESC
c
180
160
140
120
Cholesterol (mmol/L)
Syst
olic
Blo
od
Pre
ssure
(m
mH
g)
4 5 6 7 8 4 5 6 7 8
The patient and the doctor agree that a riskassessment is indicated, and the patient isinformed that the result may lead tosuggestions regarding life style change and thepossibility of life long medication.
There are time and resources to discuss andfollow up advice and treatment.
The doctor should be aware of and respect thepatients own values and choices.
Section I - 1 pp1-14:Section I - 1 Prevention-new 10/03/2010 16:21 Page 9
(mmol/L)
(m
m H
g)10 year risk of fatal CVD in low risk regions of Europe
9
Section I: Prevention of Cardiovascular Disease
0 0 0 1 10 0 0 0 0
0 0 0 0 0
0 0 0 1 1
0 1 1 1 1
0 1 1 1 1
1 1 1 1 1
1 1 1 2 2
1 1 2 2 2
2 2 2 3 3
2 3 3 4 5
4 4 5 6 72 2 3 3 4
1 1 1 2 2
1 2 2 2 3
2 2 3 3 4
3 4 4 5 6
5 6 7 8 9
3 4 5 5 6
2 3 3 4 4
2 2 2 3 3 3 4 4 5 6
5 5 6 7 9
7 8 9 11 13
10 11 13 15 18
15 17 20 23 26
10 12 14 16 19
8 9 10 12 149 9 11 12 14
6 6 7 8 10
4 4 5 6 7
3 3 3 4 41 1 2 2 2
2 2 2 3 3
3 3 4 4 5
4 5 6 6 7
3 3 3 4 4
2 2 2 2 3
1 1 1 2 2
1 1 1 1 1
1 1 2 2 2
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
0 0 1 1 1
0 0 0 1 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 1 1 1
1 1 1 2 2
2 2 2 3 3
3 3 3 4 4
1 2 2 2 3
2 2 3 3 4
5 5 6 7 8
3 4 4 5 5
1 1 2 2 2
0 0 1 1 1
5 6 7 8 10
4 4 3 6 7
2 3 3 4 5 5 5 6 8 9
7 8 9 11 13
2 2 3 3 4
3 3 4 5 6
4 5 6 7 8
6 7 8 10 12
1 1 2 2 2
1 1 1 1 2
1 1 1 1 1
150 200 250 300mg/dl
20
07
ESC
c
180
160
140
120
180
160
140
120
Age
65
60
55
50
40
15% and over10% - 14%5% - 9%3% - 4%2%1%< 1%
10-year risk of
fatal CVD in
populations at
low CVD risk
180
160
140
120
180
160
140
120
180
160
140
120
4 5 6 7 8 4 5 6 7 84 5 6 7 84 5 6 7 8
Cholesterol (mmol/L)
Syst
olic
blo
od
pre
ssure
(m
mH
g)
Women
Non-smokerNon-smoker Smoker Smoker
Men
Relative Risk Chart
This chart may be used to show younger people at lowtotal risk that, relative to others in their age group, theirrisk may be many times higher than necessary. This mayhelp to motivate decisions about avoidance of smoking,healthy nutrition and exercise, as well as flagging thosewho may become candidates for medication.
How do I manage the components oftotal CVD risk?
1 1 1 2 2
SmokerNon-Smoker
1 2 2 2 3
2 3 3 4 4
3 3 4 5 6 6 7 8 10 12
4 5 6 7 8
3 3 4 5 6
2 2 3 3 4
20
07
ESC
c
180
160
140
120
Cholesterol (mmol/L)
Syst
olic
Blo
od
Pre
ssure
(m
mH
g)
4 5 6 7 8 4 5 6 7 8
The patient and the doctor agree that a riskassessment is indicated, and the patient isinformed that the result may lead tosuggestions regarding life style change and thepossibility of life long medication.
There are time and resources to discuss andfollow up advice and treatment.
The doctor should be aware of and respect thepatients own values and choices.
Section I - 1 pp1-14:Section I - 1 Prevention-new 10/03/2010 16:21 Page 9
(mm
Hg)
(mmol/L)
15% 10%-14%5%-9%3%-4%2%1%
-
1:
10
: - -
, , , - .
, - ( , ), - - .
.
. ,
.
. .
. -
- .
.
. -
.
; : -
, - - , - .
: - - .
: - .
: , .
- .
.
.
5 :
-ASK():
.
-ASSESS():
- .
A-ADVISE():
,
A-ASSIST():
- - , -, - / .
A-ARRANGE():
-
- . -, . : . -
, . : , , -
, ( ), , .
< 30% , 1/3 - .
- - . - , -, .
-
:
11
. -. , - .
.
30 .
.
, .
.
- , - , - HDL .
- ( 30 kg/m2) ( 25 < 30 kg/m2).
94-102 cm - 80-88 cm . - 102 cm - 88 cm - .
- -. - - .
, - . , < 130/80, . - , - SCORE. - - .
-
(SCORE)
-
-
1:
12
- SCORE
< 5%
-
- -
- SCORE
5%
- SCORE - -
5%
< 5 mmol/L LDL
< 3 mmol/L SCORE
-
:
13
, ;
SCORE > 10%, .
- - .
- .
, .
;
, -, .
;
, . . (
, - ) - .
- .
-
15
:
1.
-
17
:
1
*2007
* 2007 (European Heart Journal 2007, 1462-1536).
:1. Renata Cifkova, , 2. Anna Dominiczak, , 3. Robert Fagard, Leuven, 4. Giuseppe Germano, , 5. Guido Grassi, , 6. Anthony M. Heagerty, , 7. Sverre E. Kjeldsen, , 8. Stephane Laurent, , 9. Krzysztof Narkiewicz, , 10. Luis Ruilope, , 11. Andrzej Rynkiewicz, ,
12. Roland E. Schmieder, Erlangen, 13. Harry A.J. Struijker Boudier, , 14. Alberto Zanchetti, ,
ESC:1. Keith McGregor, , 2. Veronica Dean, , 3. Catherine Despres, ,
Jose L. Rodicio Diaz .
:Giuseppe Mancia (ESH)Ospedale San GerardoUniversit Milano BicoccaVia Pergolesi, 3320052 Monza Milano, Italy.: +39 039 233 33 57: +39 039 32 22 74E-mail: [email protected]
:Guy De Backer (ESC)University HospitalGhent UniversityDe Pintelaan 1859000 Gent, Belgium.: +32 9 240 36 27: +32 9 240 49 94E-mail: [email protected]
- - - .
- , - - , .
- -, -
-. ESH ESC .
1.
() - - . -, - - 1. , , - - .
ESH-ESC (ESH) (ESC)
-
1:
18
. - .
- 10 . , - - - . , . , , .
- (.. > 20% 10 ) - .
3.
1, - . , , - 10 - . - . ( ) , , .
1. (mm Hg)
-
:
19
4.
( ) ( >55 , >65 )
TC>5.0 mmol/L (190 mg/dL)
LDL-C >3,0 mmol/L (115 mg/dL)
HDL-C: A 102 cm
(A), >88 cm ())
( 2440 mm/ms)
- * (LVMI 125 g/m2, 110 g/m2)
(IMT >0,9 mm) -
- >12 m/sec
< 0,9
: 115-133 mol/L (1,3-1,5 mg/dL)
: 107-124 mol/L (1,2-1,4 mg/dL)
**(133, >124 mol/L), - (>300 mg/24 h)
:
,
: , : , * , **= MDRD, ***= Cockroft-Gault, - / 0,42., =
-
1:
20
. , -,
1 5 , - -
( 30 sec).
7. 24
24
, 24 - - .
24 - :
.
- - .
.
.
, - .
.
-.
24 - - ,
-
:
21
8. :
1.
2.
3.
4.
5. (-, )
6. , ,
1.
2.
3.
9.
LDL
HDL
( Cockroft-Gault) ( MDRD)
( - )
( )
( > 5.6 mmol/L (100 mg/dL)
24
( )
( )
, , . .
, : , , -, , -, , -,
. - :
, - .
.
- 24 .
- :
.
- .
- -, < 130-135 mm Hg
-
1:
22
(spot urine) .
- . , . -, - .
, - , - -. - , . , .
2 , - .
2. , ( 1 4 )
-,
-
-
-
- (stiffness) ( / - - / - -
+++++++++++
+++?
?
++?
+++
+++
++++++++++
+
++++
+
+++
++++
++++
+++++++
+++++
++
++
+++++++
+
+
10. - , - - , .
- , strain , . - - , - . - , - . Doppler.
- . - ( ) - . , . - .
. - - ( MDRD , ) ( Cockroft-Gault, ), - . - . - , (-)
-
:
23
:
3 1 2, .
1 2 , , 1 . , - , - .
- , - . , , - , . , - - . , - .
2.
11.
- . - - , -, - , () -.
- , ( ) - . ( - ) - - (, ) .
- , , - , - - .
- , .. - , .
12.
:
1. .
2.
2, - - - .
(mmHg)
,
120-129
80-84
130-139
85-89
1
140-159
90-99
2
160-179 100-109
3 180
1102
+
1-2
+
3 ,
,
+
+
+
+
+
+
+
+
+
+
+
+
-
1:
24
- - - .
- , - , .
15.
- .
-, , - , , - - , . -, - , - - .
, . , .
- :
1. - .
2. - - .
3. , - , , - .
4. - .
13.
, - .
- - .
140/90 mm Hg (/) , .
< 130/80 mm Hg , , , , -.
-, < 140 mm Hg
-
:
25
17. -
-
( 2 3)
-
-
(-)
(, )
( 2 3)
- -
-
(- -)
5. - .
6. , - . , -, .
- , . , .
24 . 24 .
- 24 - , .
16. :
LVH
ACEI, CA, ARBCA, ACEIACEI, ARBACEI, ARB
ESRD/
- , ACEI, ARB
BB, CA, , ACEI, ARB,
ARB, ACEIBB, CA BBACEI, ARB, CAACEI
ISH () ACEI
, CAACEI, ARB, CAACEI, ARBCA, , , CABBARB
LVH = , ISH = , ESRD = , ACEI = , ARB = -, CA = , BB = -.
-
1:
26
, - . - ,
19.
20. - . , , - .
20.1
, , - , -, - . - - , - .
18.
, - .
- - . - .
- - , .
- . - - - 2 3 .
.
- 2 3
/
2-3
2-3
. /
-
-
. - .
-
:
27
- -. - .
- - , - .
-, .
20.3
- .
- : ) (1 g/), ) - - .
-, ( ).
, , .
- - - , . , .
(-, ) , , , - .
20.4
- , -
- , .
- , < 140/90 mm Hg , - . -
-
1:
28
, . , - -, , - . .
-. - - .
20.6
- . - , .
- .
- , - .
- .
, - (-, -, ) - .
21.
. , - -, - .
, - .
. -
-
:
29
- .
, - . , .
22.
, - , . - .
-, . - - .
, - . - 24 .
. , - , . - - , , - - . .
- - . - - .
-, . --
- , - . - , - .
- - , -, , , , . - .
, , - .
(- ) - 140-149 mm Hg - 90-95 mm Hg. - ( ), - > 140/90 mm Hg. 170 - 110 mm Hg - .
, , - ( ) -.
, - . - .
, - . - - . - ,
-
1:
30
, - - .
23.
:
140/90 mm Hg - ( ) - ( - - ).
:
-:
()
(, , , -, .)
-
:
, , .
24.
, LSD,
ecstasy
25.
- 2 - , LDL < 4,5 mmol/L (175 mg/dL) < 2,5 mmol/L (100 mg/dL) , .
- - (20% 10 ) - , LDL .
, , - , .
- , - 50 - . , /- ( - ).
-
:
31
, - .
- .
, - < 6 mmol/L (108 mg/dL) < 6,5%.
26.
- , .
, - . , - - , - -, .
- 1 - 6 , - -. . - - .
- , --. - , , .
- , - , . - - - , .
27.
.
.
.
, , -, .
/ - .
- .
( ) - , -.
.
.
-
-
33
:
1. ,
-
35
:
1
, *2007
Lars Rydn ESC K Karolinska, SolnaSE-171 76 , : + 46 (8) 5177 2171: + 46 (8) 34 49 64E-mail: [email protected]
Eberhard Standl EASD GSFD-85764, euherberg, .: + 49 (89) 3081 733: + 49 (89) 3187 2971-mail: [email protected]
:
1. Malgorzata Bartnik, 2. Greet Van den Berghe, 3. John Betteridge, 4. Menko-Jan de Boer, 5. Francesco Cosentino, 6. Bengt Jnsson,
7. Markku Laakso, 8. Klas Malmberg, 9. Silvia Priori, 10. Jan stergren, 11. Jaakko Tuomilehto, 12. Inka Thrainsdottir,
ESC:
1. Keith McGregor, Sophia Antipolis, 2. Veronica Dean, Sophia Antipolis,
3. Catherin Desprs, Sophia Antipolis,
1.
(CPG) (ESC) - , - . - - - - . - , ESC. , .
- , - - , , , -/ .
/ - , - .
* , ESC. (European Heart Journal (2007), 28: 88-136) (European Heart Journal 2007, 9 (Suppl. C): 1-74 http://www.easd.org)
(ESC) (EASD),
-
1: ,
36
2.
(CVD) -. (DM) - , , - - . , - , - - - . - , , - , (. 1) - . -- , - -, . , , - . - , 1.
/ - , - /
a
b
/ - -/ . / /- . / /.
-/ -, , - .
- -
- -
/ , ,
1. (CAD) (DM)
CAD DM
DM CAD
CAD DM
CAD , -, -
CAD , -
, , , -
DM OGTT
HbA1c ACS
-
DM
(HbA1c > 7%)
-
. : -
-
DM IGT
-,
-
:
37
1.
/ (mm Hg) < 130/80
>1 g/24 h
< 125/75
HbA1c (%)* 6,5
( , mmol/L) mg/dL
() 1 2
< 6,0 (108)
7,5 - 9,0 (135-160)< 7,5 (135)
(mmol/L) (mg/dL)
< 4,5 (175)
LDL 1,8 (70)
HDL
> 1,0 (40)> 1,2 (46)
** < 1,7 (150)
/HDL ** < 3
(min/) > 30-45
(kg/m2)
-
1: ,
38
2 - .
, . , - - - .
, - , , - . - - .
: 1, 2, - , MODY ( ), , .. .
( 2) - (WHO) (ADA). - WHO -
3. ,
-
-
- .
2 - - (OGTT), 2 .
2 - OGTT -OGTT - - .
-, - -, , - , - . - 1 , -
mmol/L (mg/dL)
(NGR) WHO FPG < 6,1 (110)+ 2 h PG < 7,8 (140)
ADA (1997) FPG< 6,1 (110) ADA (2003) FPG < 5,6 (100)
(IFG) WHO FPG 6,1 (100)
-
:
39
- . - - , , .
(OGTT) , - . - - , OGTT.
, -, , - , GTT -. - 3.
, . , 75 gr .
OGTT -OGTT - - . 2, FPG PG -, .
(HbA1c) - . (- ). H HbA1c . - , .
- :
1. , - .
2. , - -, - .
3. - 2.
2. . FPG, 2 h PG, 2 h ( DECODE).
FPG
n= 613
FPG 2 h PG
n= 431
2 h PGn= 473
1. 0 . 45 2 . 45 - 54 3 . 55 - 64 4 . 64
2. 0 . 25 kg/m2
1 . 25-30 kg/m2
3 . 30 kg/m2
3. ( ) 0 . 94 cm 80 cm3 . 94-102 cm 80-88 cm4 . 102 cm 88 cm
4. 30 min - / ( );0 . 2 .
5. , ;0 . 1 .
6. - ;0 . 2 .
7. - (.. -, );0 . 5 .
8. ( 1 2);0 . 3 . : /, ,
(, , , , )
5 . : , ,
3. (FINDRISC). www.diabetes.fi/english
2
.
2 10
7 : 100 -
7-11 : 25 -
12-14 : 6
15-20 : 3
20 : 2 -
Jaakko Tuomilehto. , , . Jaana Lindstrm, FS, .
-
1: ,
40
- (CAD). -CAD). -). - . 2 - . . , . , , - IGT . - , - - , . , . - , , - . - , -- .
- , - .
5. -
-
- CVD , -, - ( , ).
- , - .
2 - - .
, - CVD OGTT.
- 2 , - , . CVD.
- - .
4. , IGH -
-
CVD . - HbA1c 1% CVD.
CVD - - .
( ) CVD , - - .
- - -, - .
IIa B
( 4). 30-40%. , 15% - 35-40% .
,
-
30-39 40-49 50-59 60-69 70-79 80-89
45
40
35
30
25
20
15
10
5
0
45
40
35
30
25
20
15
10
5
0 30-39 40-49 50-59 60-69 70-79 80-89
(
%)
DMFDMF DMPDMP
()
4. 13 - - DECODE.DMF, FPG 7,0 mmol/L 2 h < 11,1 mmol/L, DMP, 2 h 11,1 mmol/L FPG < 7,0 mmol/L, DMF DMP, FPG 7,0 mmol/L 2 h - 11,1 mmol/L, , . * < 0,05 ** < 0,001 .
-
:
41
- - , - , . -, , 2. - . - (- 3). . , - - . -, , .
3. :
( 94 cm 80 cm -cm - - ) -:
TG: 1,7 mmol/L (150 mg/dL) - .
HDL: < 1,03 mmol/L (40 mg/dl) < 1,29 mmol/L (50 mg/dL) .
: 130 85 mm Hg .
(FPG) 5,6 mmol/L (100 mg/dL) 2.
5,6 mmol/L 100 mg/dL, -mmol/L 100 mg/dL, -/L 100 mg/dL, -L 100 mg/dL, - 100 mg/dL, -mg/dL, -/dL, -dL, -, - OGTT, -OGTT, -, - .
- - . (Eu-Eu-ropean Heart Score) (1) -) (1) - . , , - . FI-FIN-DRISC ( 3) - ( 3) - 2 , - , , , - .
, - , 2 . - - , . . ( 4) , - 2 .
, . -: , . - - - , - - (number needed to treat) 50% . -, .
4. , 2 .
(kg/m2) () RRR (%) RR (5) NNT
Malm 217 26,6 5 63 18 28
DPS 523 31,0 3 58 12 22
DPP 2161* 34,0 3 58 15 21
Da Quing 500 25,8 6 46 27 25RRR=Relative risk reduction ( ), ARR= absolute risk reduction ( )/100 -, = num-=Relative risk reduction ( ), ARR= absolute risk reduction ( )/100 -, = num-Relative risk reduction ( ), ARR= absolute risk reduction ( )/100 -, = num- risk reduction ( ), ARR= absolute risk reduction ( )/100 -, = num-risk reduction ( ), ARR= absolute risk reduction ( )/100 -, = num- reduction ( ), ARR= absolute risk reduction ( )/100 -, = num-reduction ( ), ARR= absolute risk reduction ( )/100 -, = num- ( ), ARR= absolute risk reduction ( )/100 -, = num-ARR= absolute risk reduction ( )/100 -, = num-= absolute risk reduction ( )/100 -, = num-absolute risk reduction ( )/100 -, = num- risk reduction ( )/100 -, = num-risk reduction ( )/100 -, = num- reduction ( )/100 -, = num-reduction ( )/100 -, = num- ( )/100 -, = num-num-bers needed to treat ( ) 12 .
* .
-
1: ,
42
, - / .
, - . .
1, -, HbA1c 7%. - , - . - 2, - . 5 - , 1 .
( / ) - , - . - - - . 80% , - ( 6 7).
5.
- , - , -, -
, - , , - -
, , -
, , -
6. -
-
- - .
- - .
.
(HbA1c 6,5%*) .
- 1 -.
2.
a
- 2, - .
IIb C
- - 2.
IIa B
* DCCT.
, - 1, , . - , HbA1c 1,0-1,5% - .
HbA1c - - 1 2. - HbA1c 1,0% 25%, , HbA1c 7,5%.
-
:
43
-
-
LDL HDL () -.
A
LDL -.
A
, LDL, - < 1,8-2,0 mmol/L ( 3,5 mmol/L (> 135 mg/dL), LDL 30-40%.
IIb B
- , 40 1. 18-39 ( 1 2), , - , .. -, , -, , -, - - .
IIb C
- > 2 mmol/L (177 mg/dL), LDL , , HDL . -, - , , .
IIb B
- . -, -, - . 2 - , HDL -HDL - - . - LDL -LDL - - , , LDL , - .
6. 2
HbA1c (%)
- 0,5-1,0
1,0-1,5
0,5-1,5
1,0-1,5
1,0-2,0
1,0-1,5
7. 2
*
, , ,
, -
, ,
,
, , , -
-
,
*
-
1: ,
44
- . , - HDL . , , HDL (< 1 mmol/L (39 mg/dL) < 1,2 mmol/L (46 mg/dL) -mmol/L (46 mg/dL) -/L (46 mg/dL) -L (46 mg/dL) - (46 mg/dL) -mg/dL) -/dL) -dL) -) -) > 1,7 mmol/L (151 mg/dL) -mg/dL) -/dL) -dL) -) -.
> 2,0 mmol/L (>177 mg/dL) LDL , HDL -HDL - - ( HDL), 0,8 mmol/L (31 mg/dl) LDL. -LDL. -. - , .
8.
(%)
(%)
.
4S Diabetesn= 202
-
1927
2345
32 55
4S n= 483
-
1926
2438
32 42
HPS Diabetesn= 3050
-, -
2025
3136
24 18
CARE Diabetesn= 586
-
1215
1923
23 25
LIPID Diabetesn= 782
, - ,
1925
2937
24 19
LIPS Diabetesn= 202
, - ,
2125
2238
22 47
GREACE Diabetesn= 313
, - , -
, , ,
1225
1330
51-
58-
, - , . -, (number need-number need-ed to treat) . ( 8). -) . ( 8). - LDL , - 1. - > 3,5 mmol/L (>135 mg/dL), LDL 30-40% .
-
:
45
7.
-
-
- - (ACS).
Ia C
1 - ACS.
Ia C
- .
Ia
, ACS .
IIa B
- ACS. IIa B
- .
IIa B
(ADP) () - ACS .
IIa C
- - - .
I A
, - .
IIa B
(ACS) . , 7-18% 30 15-34% , , 1,3 5,4, - , - -. , - . , .., - . - . ,
-
-
, - < 130/80 mm Hg.
. .
A
- - - .
-- - .
I A
- - , , 1 2.
I A
, - 1. - . , . -, , . --- - . - - -/ -.
-
1: ,
46
- .
- , - . . - / . - - (- ).
( 10) - , - ( - ).
10.
,
,
( )
-
- ..
- ( -, - Hol-ter, dop pler, - , - , - ST, stress echo)
, , , , - , -. , - .
- - , , - - -, 9.
9.
, - -
, , ,
. -, , .
- , , , .
(ASA) - . , , ASA -ASA - - - .
.
-
:
47
(PCI). . , , , .
PCI CABG . - , - post-hoc -post-hoc --hoc -hoc - - PCI CABG. , - CABG. , -CABG. , -. , - ( 11), - ( 2), - PCI. BARI, - .
11.
(n)
-
()
(%)
CABG PCI
p
BARI 353 7 23,6 44,3 0,05
EAST 59 8 24,5 39,9 >0,05
-
BARI
339 5 14,9 14,4 >0,05
- PCI . -, - - , - - 80% - . , -
. - , , .
- , 1.
, - , - - .
-
-
- (PCI).
Ia A
PCI, - llb/llla.
PCI , - (DES)
Ia B
PCI - - EM.
I A
- - (CABG) . -
12. (stent)
(n)
()
(%) (%)
p
ARTS 208 3 4,2 7,1 8,4 41,1 0,39
SoS 150 1 0,8 2,5 >0,05
AWESOME 144 5 34 26 0,27
-
1: ,
48
- , - , -. (2), , -. , .
9. ,
-
-
- - , .
C
- , INR 2-3 - , .
Ia C
, - , , - .
C
H - .
I C
-, - . -/ / - (3), - >75, , (
-
:
49
.
-