One chart measures cardiovascular risk over the next ten years

The European Society of Cardiology's annual meeting, held in Barcelona, Spain, from August 26 to 29, presented a number of recent findings on cardiovascular disease. Among them was the "first patient Guidelines for Cardiovascular disease prevention" (the "Guidelines"), which received a lot of attention. In particular, it was a chart tool for individuals to determine their risk of cardiovascular disease in the next 10 years.

ovascular departmt Peking University People's Hospital, said that before using the chart, one needs to know gender, age, smoking status, systolic blood pressure level and non-HDL cholesterol level (total cholesterol minus HDL cholesterol).

First of all, according to gender, smoking or not, in the four vertical data queue, find their corresponding data queue; Then according to the age, find their own corresponding data matrix; Then they determined their "risk points" based on their systolic blood pressure (the high pressure in blood pressure) on the vertical axis and their non-HDL cholesterol on the horizontal axis. Finally, the risk of cardiovascular disease in the next 10 years is understood according to the explanation at the bottom right of the chart.

Mr. Ma, for example, is 54 and a nonsmoker; At last check-up, blood pressure was 145/88 MMHG, total cholesterol was 5.39 mmol/l and HDL cholesterol was 1.32 mmol/L (non-HDL cholesterol level was 5.39-1.32=4.07). According to the chart, Mr. Ma's risk of cardiovascular disease in the next 10 years is 5%~10%, which belongs to the medium risk.

The guidelines state that assessing cardiovascular risk is the first step in prevention. People without the disease should follow "primary prevention", that is, to reduce the risk of cardiovascular clinical events by controlling smoking, hypertension, dyslipidemia, diabetes and other major cardiovascular risk factors before the occurrence of cardiovascular events. People who already have cardiovascular disease need to follow "secondary prevention," which means finding and controlling risk factors and continuing medication. For people without known cardiovascular disease, the risk can be classified as low, medium, or high. In addition to age, blood pressure, cholesterol levels and smoking status, a person's risk of cardiovascular disease is also closely related to economic, psychological and environmental factors. Patients can discuss with their doctors and work together to develop a more individualized treatment plan.

In response, Liu Fang, deputy director and chief physician of the Second Ward of the Department of Cardiovascular Medicine at the Aviation General Hospital, told the Global Times Health Client that if a high risk of cardiovascular disease is found in self-assessment, the patient should go to the hospital for evaluation and further stratification of risk. The doctor will recommend treatment based on the evaluation, including lifestyle changes and medication.

In addition, several interventions are highlighted in the First Patient Guidelines for Cardiovascular Disease Prevention. For all people, whether they have cardiovascular disease or co-existing diseases, it is important to quit smoking and follow the recommended lifestyle to reduce future risk, Liu said. The details are as follows:

1. All people should quit smoking, maintain a balanced diet, maintain a healthy weight, exercise moderately, and keep systolic blood pressure below 160 mm Hg.

2. All healthy adults should try to ensure at least 150 to 300 minutes of moderate intensity or 75 to 150 minutes of vigorous intensity exercise per week. If the recommended amount of time cannot be reached, spend as much time as possible exercising.

3. Eat healthy. Such as the Mediterranean diet or similar diet, through the consumption of olive oil, avocados, etc., moderately increase the intake of unsaturated fats, eat less fried fast food, limit the intake of saturated fat foods such as red meat, eat less sugar and salt, eat more whole grains, fruits, vegetables and nuts, eat fish at least once a week, and consume no more than 100 grams of alcohol per week.

4. People who already have cardiovascular disease, or are at very high risk of cardiovascular disease, are advised to continue taking relevant medications.

5. The higher the risk of cardiovascular disease, the higher the recommended treatment intensity, and the lower the control targets of blood pressure, blood sugar, blood lipids and so on.

6. Work toward treatment goals. Achieve recommended blood pressure and cholesterol levels through lifestyle improvements and medication, with the optimal goal of a systolic blood pressure of less than 130 MMHG (for those taking the drug), LDL cholesterol (bad cholesterol) of less than 1.8 mmol/l for those at high risk, and less than 1.4 mmol/l for those at very high risk.

7. Statin is used as the first-line treatment for lowering bad cholesterol. If there is discomfort in the process of taking statin, and the best dosage and the best drug effect are not achieved, it is recommended to use it in combination with non-statin drugs, such as ezetimibe and PCSK9 inhibitors.

8.Systolic blood pressure control targets are 120-130 MMHG for those under 70 years of age and 140 MMHG for those over 70 years of age; For diastolic blood pressure, 80 MMHG is recommended for all users. For elderly patients over 75 years old or patients with severe vascular lesions in the head and neck, Liu Fang emphasized that systolic blood pressure should not be controlled too low, at 140~150 mm Hg, to ensure the perfusion of blood flow to the brain.

9. For patients with diabetes, it is recommended that the treatment target be less than 7% HBA1c. Elderly diabetics can also relax their blood sugar control to avoid the risk of hypoglycemia, Liu said. Metformin is the first-line treatment for most diabetic patients without kidney disease. For patients with cardiovascular disease, glucagon-like peptide-1 receptor agonist (GLP-1RA) and sodium-glucose cotransporter 2 inhibitor (SGLT-2i) are recommended.