Hypertension and hyperlipidemia are the most important risk factors for atherosclerotic cardiovascular disease (ASCVD), which seriously affect the life safety of the majority of patients and effectively control blood pressure , blood lipid levels, can further reduce the incidence of cardiovascular and cerebrovascular events in ASCVD patients. The theme of this year’s 18th “World Hypertension Day” (May 17) is “Precise Measurement, Effective Control, Healthy Longevity”. Around this year’s World Hypertension Day, in order to further improve the compliance rate of blood pressure and blood lipid levels in my country, and popularize the importance of blood pressure and lipid regulation in preventing ASCVD events, Hanhui Pharmaceutical specially held a series of activities of “2022 Blood Pressure and Blood Lipid Week” during this period. It mainly invites many well-known experts in the field of cardiovascular disease diagnosis and treatment in my country to review and share the key points and valuable experience of ASCVD risk stratification, blood pressure and lipid lowering goals, drug selection principles, and strategies for improving compliance. The invited experts in this issue are the Department of Cardiology, Peking University First HospitalProfessor Huo Yong.
The current status of ASCVD management is not optimistic, and risk assessment and stratification must be strengthened
Outpatient Clinic:With the deepening of clinical awareness of atherosclerotic cardiovascular disease (ASCVD), risk factor stratification and individualized patient management of ASCVD are becoming more and more important. For patients with high risk and above, what is the significance of emphasizing the double compliance of blood pressure and blood lipids?
Professor Huo Yong:ASCVD is an atherosclerotic disease involving the blood vessels of the heart, brain, kidney, limbs and other organs, mainly including acute myocardial infarction, Acute coronary syndrome, chronic angina pectoris, stroke, ischemic encephalopathy, chronic renal insufficiency and peripheral atherosclerotic disease, etc. At present, the incidence and mortality of ASCVD in my country are still in a stage of continuous growth. In 2018, the causes of CVD deaths in rural and urban areas accounted for 46.66% and 43.81%, respectively, and 2 out of every 5 deaths were due to CVD. The prevention and treatment of cardiovascular disease still faces severe challenges. During the diagnosis and treatment of ASCVD patients, it is necessary to combine clinical diagnosis, imaging diagnosis, and the main risk factors such as the patient’s age, gender, blood pressure, blood lipids, etc. In addition, it is also necessary to evaluate the function and anatomy of the patient’s blood vessels. state, such as the degree of stenosis, ischemia, etc.; and further determine the functional state of the heart, brain, kidney, limbs and other organs, and comprehensively assess individual ASCVD risk factors. In the follow-up treatment process, in addition to taking into account the compliance of blood pressure and blood lipids, it is also necessary to actively intervene in various risk factors. These indicators are of great significance for the assessment of ASCVD risk, the determination of patient treatment plans, and the evaluation of prognosis.
Individualized ASCVD Prevention and Control Strategies
< em>Outpatient Clinic: The risk factor stratification and individualized patient management of ASCVD are becoming more and more important. For patients with high risk and above, what is the significance of emphasizing that both blood pressure and blood lipids are reached?
Professor Huo Yong:The ultimate goal of ASCVD treatment is to reduce the occurrence of cardiovascular events caused by ASCVD. It is important to note that drug therapy is appropriate for all types of patients, including primary and secondary prevention of ASCVD. The treatment of ASCVD mainly emphasizes both lipid-lowering and anti-hypertensive treatment. At the same time, blood sugar, smoking and other risk factors should also be considered for active control. The current new guidelines also begin to focus on lipid management in “patients with very high risk ASCVD”. The 2018 AHA/ACC guidelines separate very high risk ASCVD from ASCVD, that is, multiple previous severe ASCVD events or one severe ASCVD event. ASCVD events combined with multiple high-risk factors are extremely high-risk ASCVD. In terms of specific recommendations, the 2017 AACE/ACE cholesterol management guidelines and the 2018 AHA/ACC cholesterol management guidelines both proposed lower LDL-C target levels for “very high risk ASCVD”. Although early meta-analysis showed that the longer the intensive statin cholesterol-lowering treatment, the greater the benefit, but even if receiving high-intensity statins, some patients still cannot reach the blood lipid target. Six” principle and other issues, most guidelines in my country recommend the Chinese population to use moderate doses of statins. From the mechanism point of view, multi-drug combination can interfere with cholesterol metabolism in multiple links, and the curative effect is better. A number of non-statin drugs, such as the newly marketed Class 1 drug Hybromab, have also consistently confirmed that statin combined with cholesterol absorption inhibitor therapy can synergistically reduce LDL-C and further reduce the risk of cardiovascular events. Haibo Maibu is a cholesterol absorption inhibitor independently developed by China. It has 100% Chinese population evidence and is very suitable for combined lipid-lowering therapy for Chinese patients.
Single-piece compound preparation helps blood pressure and blood lipids “double target”
Outpatient Clinic: High-risk/very-high-risk ASCVD patients with hypertension, diabetes and other risk factors still have a high risk of recurrence after interventional PCI; how do you think this group of people should do related secondary prevention? What are the advantages of the combination model for primary and secondary prevention of ASCVD?
Professor Huo Yong:For high-risk/very-high-risk atherosclerotic heart disease Although patients with vascular disease have received revascularization therapy such as balloon dilation and stent implantation, these patients still have a high risk of recurrence. It is very important to actively do secondary prevention for these patients. Secondary prevention strategies include not only preventing the formation of in-stent restenosis after intervention, but also delaying atherosclerosis through further lipid-lowering therapy, blood sugar control, blood pressure control, weight loss, and smoking cessation. The simultaneous implementation of both can effectively reduce the risk of recurrence of cardiovascular events in patients after PCI.
For hypertensive patients, combined antihypertensive treatment regimens can be used initially, such as RAS blocker-based antihypertensive combination, mainly including RAS blockers and CCB/diuretics. Combined use can not only improve the blood pressure control rate and achieve the target blood pressure faster, but also effectively reduce the occurrence of cardiovascular events in hypertensive patients. For patients after PCI, on the basis of intensive statin therapy, the clinical blood lipid management of patients with high ischemia risk often requires the combination of lipid-lowering drugs with multiple mechanisms.
ASCOT and other studies have shown that, compared with simple blood pressure reduction, the combined application of statins and other drugs to reduce blood lipid levels can be more effective in preventing ASCVD and reducing blood pressure. Significantly reduces the incidence of cardiovascular events. The current domestic relevant guidelines also clearly recommend that all hypertensive patients with high, very high and ultra-high risk of ASCVD should immediately start antihypertensive combined with LDL-C lowering drug therapy at the same time, so as to achieve both blood pressure and blood lipid targets as soon as possible, and maintain them for a long time. achieve greater cardiovascular benefit. Paying attention to and strengthening the dual management of blood pressure and blood lipids is the focus of current hypertension management; the application of single-piece compound preparations is becoming more and more popular. The comprehensive prevention and control of multiple risk factors can provide assistance, which can effectively improve the compliance of patients during long-term medication.
It is worth mentioning that the theme of this year’s World Hypertension Day is “Precise Measurement, Effective Control, Health and Longevity”, which not only emphasizes the need to achieve “double compliance” of blood pressure and blood lipids. ”, which further highlights that only through the comprehensive prevention and treatment of multiple risk factors can the occurrence of cardiovascular events in patients be minimized.
“2022 Blood Pressure and Lipid Week Special Activities”, which mainly focuses on the prevention and treatment of ASCVD, and emphasizes the comprehensive control of multiple risk factors with the main goal of reducing cardiovascular events. Achieving simultaneous compliance of cholesterol and hypertension in hypertensive patients. There is a long way to go in the prevention and treatment of chronic diseases. We should bring together various forces to continuously promote multi-faceted, full-process, and full-cycle management of chronic diseases. I wish Hanhui Pharmaceutical’s 2022 Blood Pressure and Lipid Week a complete success!
Read More p>More good fats are beneficial to the heart | Professor Ma Changsheng: Comprehensive management of blood pressure and blood lipids, early compliance, early benefits
0 img>
The content of this article is the original content of “Outpatient Clinic” magazine
Reprinted with permission and please indicate the source.
New Vision for Clinic Clinic span>｜WeChat: ClinicMZ
Long press, identify the QR code, and follow