稳定型缺血性心脏病

• What are the effects of exercise-based cardiac rehabilitation in people with coronary heart disease?
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• What are the effects of participating in exercise, psychological or educational rehabilitation regimens compared with no participation in people with coronary heart disease?
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• What are the effects of patient education on management of coronary heart disease?
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证据评分

证据 A 戒烟：有高质量证据表明，在没有冠脉疾病证据的患者中，戒烟可使心脏事件的风险降低 7% 至 47%。[92]Rose G, Hamilton PJ, Colwell L, et al. A randomised controlled trial of anti-smoking advice: 10-year results. J Epidemiol Community Health. 1982 Jun;36(2):102-8.http://www.ncbi.nlm.nih.gov/pubmed/7119652?tool=bestpractice.com[93]Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial. Risk factor changes and mortality results. JAMA. 1982 Sep 24;248(12):1465-77.http://www.ncbi.nlm.nih.gov/pubmed/7050440?tool=bestpractice.com[94]Hjermann I, Velve Byre K, Holme I, et al. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet. 1981 Dec 12;2(8259):1303-10.http://www.ncbi.nlm.nih.gov/pubmed/6118715?tool=bestpractice.com 此外，前瞻性队列研究显示，急性心肌梗死后继续吸烟的患者再梗死和死亡的风险比戒烟患者增高 22％ 至 47％。[95]US Department of Health and Human Services. The health benefits of smoking cessation: a report of the Surgeon General. 1990 [internet publication].https://profiles.nlm.nih.gov/NN/B/B/C/T/_/nnbbct.pdf 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

戒烟：有高质量证据表明，在没有冠脉疾病证据的患者中，戒烟可使心脏事件的风险降低 7% 至 47%。[92]Rose G, Hamilton PJ, Colwell L, et al. A randomised controlled trial of anti-smoking advice: 10-year results. J Epidemiol Community Health. 1982 Jun;36(2):102-8.http://www.ncbi.nlm.nih.gov/pubmed/7119652?tool=bestpractice.com[93]Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial. Risk factor changes and mortality results. JAMA. 1982 Sep 24;248(12):1465-77.http://www.ncbi.nlm.nih.gov/pubmed/7050440?tool=bestpractice.com[94]Hjermann I, Velve Byre K, Holme I, et al. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet. 1981 Dec 12;2(8259):1303-10.http://www.ncbi.nlm.nih.gov/pubmed/6118715?tool=bestpractice.com 此外，前瞻性队列研究显示，急性心肌梗死后继续吸烟的患者再梗死和死亡的风险比戒烟患者增高 22％ 至 47％。[95]US Department of Health and Human Services. The health benefits of smoking cessation: a report of the Surgeon General. 1990 [internet publication].https://profiles.nlm.nih.gov/NN/B/B/C/T/_/nnbbct.pdf

证据 A 抗血小板治疗和减少心肌梗死的风险：有优质证据表明，阿司匹林可降低慢性稳定型心绞痛患者心肌梗死的风险。[98]Ridker PM, Manson JE, Gaziano JM, et al. Low-dose aspirin therapy for chronic stable angina. A randomized, placebo-controlled clinical trial. Ann Intern Med. 1991 May 15;114(10):835-9.http://www.ncbi.nlm.nih.gov/pubmed/2014943?tool=bestpractice.com 有优质证据表明，在降低高危患者的心血管事件的风险上，氯吡格雷（75 mg/天）与阿司匹林（325 mg/天）是等效的（心血管事件的年度风险：5.32％ 至 5.83％）。[99]CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events. Lancet. 1996 Nov 16;348(9038):1329-39.http://www.ncbi.nlm.nih.gov/pubmed/8918275?tool=bestpractice.com 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

抗血小板治疗和减少心肌梗死的风险：有优质证据表明，阿司匹林可降低慢性稳定型心绞痛患者心肌梗死的风险。[98]Ridker PM, Manson JE, Gaziano JM, et al. Low-dose aspirin therapy for chronic stable angina. A randomized, placebo-controlled clinical trial. Ann Intern Med. 1991 May 15;114(10):835-9.http://www.ncbi.nlm.nih.gov/pubmed/2014943?tool=bestpractice.com 有优质证据表明，在降低高危患者的心血管事件的风险上，氯吡格雷（75 mg/天）与阿司匹林（325 mg/天）是等效的（心血管事件的年度风险：5.32％ 至 5.83％）。[99]CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events. Lancet. 1996 Nov 16;348(9038):1329-39.http://www.ncbi.nlm.nih.gov/pubmed/8918275?tool=bestpractice.com