DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

Table 31–6
Assessing 10-Year Risk of CVD Events a
MEN
RISK FACTORS AND CVD POINTS
TOTAL SBP NOT SBP
HDL CHOLESTEROL TREATED TREATED
POINTS AGE (mg/dL) (mg/dL) (mm Hg) (mm Hg) SMOKER DIABETIC
–2 60+ <120
–1 50-59 0
0 30-34 45-49 <160 120-129 <120 No No
1 35-44 160-199 130-139
2 35-39 <35 200-239 140-159 120-129
3 240-279 160+ 130-139 Yes
4 280+ 140-159 Yes
5 40-44 160+
6 45-49
7
8 50-54
9
10 55-59
11 60-64
12 65-69
13
14 70-74
15 75+
ESTIMATED CVD RISK
POINTS RISK POINTS RISK POINTS RISK
≤ −3 <1% 5 3.9% 13 15.6%
–2 1.1% 6 4.7% 14 18.4%
–1 1.4% 7 5.6% 15 21.6%
0 1.6% 8 6.7% 16 25.3%
1 1.9% 9 7.9% 17 29.4%
2 2.3% 10 9.4% 18+ >30%
3 2.8% 11 11.2%
4 3.3% 12 13.2%
(Continued)
include reducing total calories from fat to <30% and
saturated fat to <7% to avoid trans fat; consuming
<300 mg of cholesterol/day, a variety of oily fish twice
a week or more often, and oils/foods rich in α-linolenic
acid (canola, flaxseed, and soybean oils; flaxseed; and
walnuts); and restricting sugary beverages to <36 oz/week
for a person consuming 2000 Kcal daily.
The patient-based approach to manage dyslipidemia
is designed for primary and secondary prevention,
requires a risk assessment as described earlier
(Table 31–6), and focuses on lowering LDL-C and
non-HDL-C (Grundy et al., 2004b). Non-lipid risk factors,
if present, should be treated appropriately (Table 31–5).
For patients with elevated levels of total cholesterol,
non-HDL-C, LDL-C, or triglycerides, or reduced HDL-
C values, further treatment is based on the patient’s
risk-factor status (Table 31–5), LDL-C and non-HDL-
C levels (Table 31–3), and calculation of the general
CHD Framingham risk score (Table 31–6) of primary
prevention patients with two or more risk factors.
All patients who meet the criteria for lipid-lowering therapy
should receive instruction about therapeutic lifestyle change. Dietary