Early intervention and prevention of myocardial infarction.

Prem S Pais
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引用次数: 18

Abstract

Although there has been a decline in the incidence of ischaemic heart disease in Western Europe, North America and Australia/New Zealand, it remains a major cause of morbidity and mortality worldwide due to rapidly increasing incidences in developing countries. Prevention is key to reducing the burden of this disease. The INTERHEART study performed in 52 countries around the world has shown that the major risk factors are tobacco smoking, elevated apolipoprotein A, hypertension, diabetes mellitus, abdominal obesity, psychosocial factors, low fruit and vegetable intake, physical inactivity and alcohol consumption. Strategies for prevention by reducing risk factors are applicable universally. Individual healthcare providers can implement primary and secondary preventive measures to individual patients. Primary prevention involves the avoidance of disease in high-risk subjects free of disease, whereas the purpose of secondary prevention is to avoid recurrence of myocardial infarction. The general principle is to encourage improved and proven lifestyle measures and to prescribe evidence-based effective medications. Primary prevention requires greater investment and planning to identify people at high risk, plus the implementation of life-style intervention and pharmacological prevention. In both situations, strategies will have to be tailored to suit individual countries and economies. Life-style measures (i.e. sensible diet, physical exercise and smoking cessation) are effective and need to be promoted. Compliance with preventive measures is achievable. Primordial prevention, which involves reducing the prevalence of risk factors, rests mainly on public education, media, legislation and government policy, and is very dependent on individual governments' commitment and determination. It requires promoting a healthier life-style in the population as a whole by encouraging people to seek alternatives and making them available.

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心肌梗死的早期干预和预防。
尽管西欧、北美和澳大利亚/新西兰的缺血性心脏病发病率有所下降,但由于发展中国家的发病率迅速上升,它仍然是全世界发病率和死亡率的主要原因。预防是减轻这种疾病负担的关键。在全球52个国家进行的INTERHEART研究表明,主要风险因素是吸烟、载脂蛋白A升高、高血压、糖尿病、腹部肥胖、社会心理因素、水果和蔬菜摄入量低、缺乏体育活动和饮酒。通过减少危险因素进行预防的战略是普遍适用的。个别医疗保健提供者可针对个别患者实施初级和二级预防措施。一级预防的目的是避免无疾病的高危人群发病,而二级预防的目的是避免心肌梗死复发。总的原则是鼓励改善和证明的生活方式措施,并开出循证有效的药物。初级预防需要更多的投资和规划,以确定高危人群,并实施生活方式干预和药物预防。在这两种情况下,必须调整战略以适应各个国家和经济体。生活方式措施(即合理饮食、体育锻炼和戒烟)是有效的,需要加以推广。遵守预防措施是可以实现的。初级预防涉及减少风险因素的流行,主要依靠公共教育、媒体、立法和政府政策,并在很大程度上取决于各国政府的承诺和决心。它要求在全体人口中提倡一种更健康的生活方式,鼓励人们寻求替代办法并提供这些办法。
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