HỘI NGHỊ TĂNG HUYẾT ÁP VIỆT NAM LẦN THỨ HAI Hà nội - 5/2016 ĐÁNH GIÁ VÀ KIỂM SOÁT NGUY CƠ TIM MẠCH Ở NGƯỜI CÓ BỆNH ĐỘNG MẠCH NGOẠI VI TS.BS.Nguyễn Thị Thu Hoài Viện Tim Mạch Quốc Gia Việt Nam Prevalence of PAD increases with age Rotterdam Study (ABI Test 200 mg/dL • Physical activity – Minimum 30 minutes days per week – Cardiac rehabilitation for high risk patients – Recent acute coronary syndrome, congestive heart failure, or revascularization – Medically supervised program for high risk patients (cardiac rehabilitation) • Anti-platelet/anti-coagulation – – – – ASA 81-162 mg/day Clopidogrel P2Y12 receptor antagonist Warfarin for A-fib and LV thrombus • Renin-angiotensin-aldosterone system blockers – ACE-inhibitor if EF  40% or hypertension, diabetes, or chronic kidney disease – Consider for all patients; optional for low risk patients with normal LVEF and good risk factor control – ARB if ACE-intolerant – Aldosterone blockade in post–myocardial infarction patients without significant renal dysfunction or hyperkalemia already receiving therapeutic doses of an ACE inhibitor and ßblocker with a left ventricular ejection fraction 40% and either diabetes or heart failure • Beta blockers – Post-MI or acute coronary syndrome or LV dysfunction – Consider for all patients • Influenza vaccination – For all patients with cardiovascular disease • Patients covered by these guidelines include those with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease, and carotid artery disease Medications Statin Ezetimibe Beta blocker Calcium channel blocker Aspirin Diuretic Clopidogrel Ticagrelor Metformin 10 TZD 11 Cilostazol 12 Pentoxiphylline 13 Varenicline 14 Bupoprion 15 Nicotine replacement ATP IV - Hướng dẫn ghi rõ liều dùng statin Statin Cường độ cao ↓ LDL-C ≥50% Cường độ trung bình Cường độ thấp ↓ LDL-C : 30–50% ↓ LDL-C