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

Table 31–6
Assessing 10-Year Risk of CVD Events a (continued)
WOMEN
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
≤ −3 <120
–2 60+
–1 50-59 <120
0 30-34 45-49 <160 120-129 No No
1 35-44 160-199 130-139
2 35-39 <35 140-149 120-129
3 200-239 130-139 Yes
4 40-44 240-279 150-159 Yes
5 45-49 280+ 160+ 140-149
6 150-159
7 50-54 160+
8 55-59
9 60-64
10 65-69
11 70-74
12 75+
ESTIMATED CVD RISK
POINTS RISK POINTS RISK POINTS RISK
≤–2 <1% 6 3.3% 14 11.7%
–1 1.0% 7 3.9% 15 13.7%
0 1.2% 8 4.5% 16 15.9%
1 1.5% 9 5.3% 17 18.5%
2 1.7% 10 6.3% 18 21.5%
3 2.0% 11 7.3% 19 24.8%
4 2.4% 12 8.6% 20 28.5%
5 2.8% 13 10.0% 21+ >30%
a
D’Agostino et al., 2008. CVD, cardiovascular disease; HDL, high-density lipoproteins; SBP, systolic blood pressure.
Reproduced, with permission, from D’Agostino RB Sr, Vasan RS, Pencina MJ et al. General cardiovascular risk profile for use in primary care: The
Framingham Heart Study. Circulation, 2008, 117:743–753.
restrictions include <7% of calories from saturated and trans fatty
acids, <200 mg of cholesterol daily, up to 20% of calories from
monounsaturated fatty acids, up to 10% of calories from polyunsaturated
fat, and total fat calories ranging between 25% and 35% of all
calories. Two oily fish meals/week are especially important for
post–myocardial infarction patients to provide a substantial reduction
in the risk of sudden cardiac death. Patients with CHD or a CHD
equivalent (symptomatic peripheral or carotid vascular disease,
abdominal aortic aneurysm, >20% 10-year CHD risk, or diabetes
mellitus) should immediately start appropriate lipid-lowering drug
therapy irrespective of their baseline LDL-C level. Patients without
CHD or CHD equivalent should be managed with lifestyle advice
(diet, exercise, weight management) for 3-6 months before drug therapy
is implemented.
Before drug therapy is initiated, secondary causes of hyperlipidemia
should be excluded. Most secondary causes (Table 31–7)
can be excluded by ascertaining the patient’s medication history and
by measuring serum creatinine, liver function tests, fasting glucose,
and thyroid-stimulating hormone levels. Treatment of the disorder
causing secondary dyslipidemia may preclude the necessity of treatment
with hypolipidemic drugs.
Arterial Wall Biology
and Plaque Stability
More effective lipid-lowering agents and a better understanding
of atherogenesis have helped to prove that