综合干预对老年人血脂异常状况的影响

目的探讨综合干预对老年人血脂异常状况的影响，降低心血管疾病事件的发生率。方法采用国际标准化心血管流行病学调查方法，对辖区内离退休老干部进行心血管危险因素调查；对该人群进行健康教育，并对每一个体进行危险评估、个体化用药指导，并跟踪随访。结果本研究人群是多重危险因素高度聚集的心血管疾病群体，冠心病及等危症者占69．81％；经过3年的综合干预，他汀类药物的服用率由14．48％上升到22．32％，提高了54．45％；高总胆固醇（TC）血症治疗达标率由27．00％上升至63．78％，提高了136．22％：低密度脂蛋白胆固醇（LDL-C）控制率由19．79％上升到63．65％，提高了221．63％；TC与LDL-C的达标率均有显著性的增高（P〈0．01），其中冠心病组达标率提高幅度大于危险因素组；TG的达标率无显著变化（P〉0．05）。结论健康教育和根据危险分层确定个体化治疗方案相结合的综合干预，能够明显提高高胆固醇血症患者的血脂达标率．有效地控制血脂水平必将使该人群的心血管事件发生率显著降低。     

健康教育对心血管疾病患者调脂治疗依从性的影响

目的通过强化健康教育提高军队老干部血脂异常患者的治疗依从性。方法调查辖区内离退休老干部及部分在职干部心血管危险因素中血脂异常者他汀类药物治疗的依从情况,根据该人群不依从的原因结合出现的问题进行强化健康教育,方式有定期集体授课、分片教育、面对面交流,利用多媒体、卡通片、发放健康手册及医学知识宣传资料。结果经过3年有效的强化健康教育及综合干预,该人群他汀类药物治疗率由13.40%增加到37.76%;TC的平均水平下降了18.38%,P<0.01;TG的平均水平下降了10.78%,P<0.05;高TC治疗达标率由28.45%上升至63.78%。结论依从性对多重心血管病危险因素高度聚集的军队老干部群体,血脂异常的综合治疗必不可少,强化健康教育可以明显提高其治疗依从性。     

专科门诊对无症状成人心血管危险的评估与综合干预观察

选取到专科门诊及体检中心进行身体检查的无症状成人168例,对其进行心血管危险评估。将中危、高危人群按自愿原则分为两组,对照组采用接受普通治疗或观察,综合干预组进行个体化综合治疗加健康教育、改善生活方式,电话咨询,长期随访。观察期为两年。比较并观察两组人群心血管事件,危险因素控制,血脂变化情况。结果综合干预组心血管事件发生率明显低于对照组,且综合干预组对危险因素的控制明显优于对照组,综合干预组干预后血脂水平明显低于干预前,统计学上有意义（P〈0.05）。对无症状成人心血管的危险因素进行评估并对其进行综合干预,可以减少心血管事件的发生,对危险因素进行有效控制,维持血脂平衡,为心血管疾病防控提供新的可操作依据。     

青壮年女性四肢瘫痪患者的血脂紊乱特点

目的:通过流行病学调查了解青壮年四肢瘫痪女性血脂浓度的特点,探讨绝对缺乏运动的生活方式对青壮年女性血脂浓度的影响。方法:对中国康复研究中心因脊髓损伤致四肢瘫痪入院进行康复治疗的女性患者100例进行入院状态调查,对其血脂指标甘油三酯(TG),总胆固醇(TC),低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白胆固醇(HDL-C)浓度进行分析。结果:100例患者TG浓度显著高于女性全国平均水平,HDL浓度显著低于女性全国平均水平;TC、LDL-C平均浓度与女性全国平均水平比较差异无统计学意义。年龄与TG、TC、LDL-C显著正相关(P0.05,0.01);与HDL无显著相关。血脂异常发生率68%,低HDL血症发生率58%。结论:青壮年四肢瘫痪女性患者血脂异常发生率高,与年龄正相关;与病程无相关性;患者均存在心血管健康隐患,有必要给予关注和早期干预。     

德阳地区体检人群血脂水平及特点分析

目的了解德阳地区人群血脂水平、分布特点以及血脂异常率的情况,为该地区心血管疾病的防控提供理论依据。方法收集2017年10月至2018年10月德阳地区32 487例健康体检人员的血脂资料,并作详细分层统计分析。结果德阳地区男女性血脂总体水平均不同。男性血脂水平(TG、TC、LDL-C)总趋势是随年龄增长先升高后降低;女性血脂水平(TG、TC、LDL-C)在70岁前总趋势是随年龄增长而升高;HDL-C水平随年龄增长变化幅度相对较小。总人群血脂异常检出率从高到低依次为高TG血症(15.53%)、低HDL-C血症(12.47%)、高TC血症(5.74%)、高LDL-C血症(3.22%);中老年男性血脂异常主要表现为高TG血症、低HDL-C血症,中老年女性血脂异常主要表现为高TC血症、高TG血症;70岁以上人群血脂异常检出率有所下降。结论德阳地区人群血脂水平存在明显的性别差异和年龄差异,血脂异常的分布情况差异也较大,应针对中老年男性和绝经后女性积极采取血脂干预措施,降低心血管疾病发生风险。     

西安市体检人群高脂血症和高糖血症患病率的调查

目的 调查西安市体检人群高血脂、高血糖的患病率及特点.方法 调查对象为随机抽取1 200例在该院健康体检的人群,对其空腹静脉血的血脂、血糖结果进行统计.结果 调查人群中,高脂血症及高糖血症中至少患有1种疾病者426例,检出率为35.5%,其中高脂血症患病率为 32.25%,高糖血症患病率为7.25%,高脂血症伴高糖血症4.0%;高TG、低HDL-C血症与性别差异有统计学意义(P<0.01),高TC、高LDL-C血症及高糖血症与年龄差异有统计学意义(P<0.01).结论 西安市体检人群高脂血症及高血糖血症患病率较高.因此,在人们生活水平提高的同时应强化健康体检的意识.     

高尿酸血症患病率调查及临床影响分析

目的探讨高尿酸血症(hyperuricemia)在健康体检人群与高危人群中的患病率及HUA与相关影响因素之间的关系。方法健康体检人群300例,冠心病640例,2型糖尿病人484例,慢性肾病58例,用相同的方法检测其血清中的UA、TC、TG、HDL-C、LDL-C、UREA、CRE、GLU,并进行比较分析。结果此次调查健康体检人群中HUA患病率为11.67%(35/300),男性患病率15.31%(30/196);女性患病率4.81%(5/104);冠心病合并HUA患病率13.75%;2型糖尿病合并HUA患病率14.88%;慢性肾病合并HUA患病率31.03%。冠心病和2型糖尿病HUA患病率比体检组略高,慢性肾病HUA患病率比体检组明显偏高。冠心病HUA组与尿酸正常组比较TC、TG、HDL-C、LDL-C、UREA、CER有显著差异(P<0.05);2型糖尿病HUA组与尿酸正常组比较TG、UREA、CRE有显著差异(P<0.05);慢性肾病HUA组与尿酸正常组比较UREA、CRE、GLU有显著差异(P<0.05)。结论HUA患病率较高,以男性占比例更多;HUA是冠心病、2型糖尿病、慢性肾病的独立危险因素;UA与血脂、血糖、肾功联合检测对疾病的预防和治疗具有重要意义。     

青年无症状高尿酸血症和血脂相关性研究

目的调查北京高校大学生群体无症状高尿酸血症情况,并分析其与肥胖、血脂之间的关系。方法对6400名2015年大学生健康体检数据进行处理,分析无症状高尿酸血症患病率,采用Logistic多因素回归模型分析无症状高尿酸血症与肥胖、肝功能、血脂等因素的关系。结果无症状高尿酸血症患病率男生34.87%,女生患病率为11.42%。男生无症状高尿酸血症组的总胆固醇(TC)(4.49±1.01mmol/L)、甘油三酯(TG)(1.22±0.99mmol/L)、低密度脂蛋白(LDL-C)(3.00±0.90mmol/L)、载脂蛋白B(Apo-B)(0.80±0.25g/L)显著高于尿酸正常组(P0.01),而高密度脂蛋白(HDL-C)(2.67±0.93mmol/L)显著低于尿酸正常组(P0.01);女生无症状高尿酸血症组只有LDL-C(2.54±0.64mmol/L)、Apo-B(0.68±0.17g/L)显著高于尿酸正常组(P0.05)。Logistic多因素回归分析结果显示,TG(OR=2.04)、LDL-C(OR=2.39)可能是高尿酸血症的危险因素,性别为女性(OR=0.30)是高尿酸血症的保护性因素。结论男生是无症状高尿酸血症组的高发人群,高TG、LDL-C是青年大学生无症状高尿酸血症的危险因素,应早期重视这部分人群的尿酸和血脂水平异常情况,降低日后中老年阶段发展为痛风和代谢综合征、心血管疾病的风险。     

延续性自我管理教育在冠心病介入治疗患者心脏康复中的应用

目的探讨延续性自我管理教育在冠心病介入治疗患者心脏康复过程中的作用。方法选取接受经皮冠状动脉介入治疗(PCI)的冠心病患者124例,随机分为干预组和对照组。两组均接受常规健康教育,干预组在此基础上接受综合自我管理教育,包括4期心脏康复训练和冠心病危险因素控制。观察出院6个月、12个月及24个月时,两组冠心病康复知识知晓情况及二级预防行为、冠心病危险因素达标率及心脏事件发生情况。结果冠心病康复知识及二级预防行为得分:干预组在6个月、12个月及24个月明显高于对照组(P<0.01)。冠心病危险因素达标率比较:6个月时干预组低密度脂蛋白(LDL-C)、运动达标率好于对照组(P<0.05);12个月和24个月时冠心病危险因素达标率均好于对照组(P<0.05);与入院时比较,干预组6个月、12个月及24个月戒烟和运动达标率均显著增高(P<0.05),而对照组仅6个月时戒烟达标率增加明显(P<0.05)。PCI治疗后2年,干预组急性心肌梗死、不稳定性心绞痛和符合介入治疗或搭桥手术指征的患者少于对照组(P<0.05)。结论延续性自我管理教育有助于提高患者健康知识水平和疾病自我管理能力,从而防止和减少临床事件的发生,是PCI术后一种安全、有效、依从性高的心脏康复模式。     

社区居民心血管危险因素综合管理效果研究

目的探讨社区居民心血管危险因素综合管理的模式,并观察干预前、干预后的效果。方法选择自愿参加本研究的社区居民205例,干预前、后使用统一的心血管危险因素、生活方式与心血管危险因素相关行为调查问卷,用SPSS进行数据分析,进行心血管危险因素综合管理的干预模式,对于心血管危险因素知晓率、健康行为的改变进行效果评价。结果205人干预前、后心血管危险因素相关知识知晓率明显提高(P<0.01),吸烟率显著下降(χ2=18.30,P<0.01);干预前、后咸食摄入率、定期体检率的差异有统计学意义(χ2=57.25,9.64,均P<0.01);干预前、后肥胖率差异无统计学意义(P>0.05);高脂摄入率干预后没有明显减少(P>0.05);居民平均危险因素减少(t=7.12,P<0.01)。结论社区居民心血管危险因素综合管理,对改善社区人群健康心血管疾病的认识、改善行为是有效的、可行的,对危险因素的减少是有效的。     

Coronary heart disease risk equivalence in diabetes depends on concomitant risk factors

OBJECTIVE: Diabetes has been defined as a coronary heart disease (CHD) risk equivalent, and more aggressive treatment goals have been proposed for diabetic patients. RESEARCH DESIGN AND METHODS: We studied the influence of single and multiple risk factors on the 10-year cumulative incidence of fatal and nonfatal CHD and cardiovascular disease (CVD) in diabetic and nondiabetic men and women, with and without baseline CHD or CVD, in a population (n = 4,549) with a high prevalence of diabetes. RESULTS: In both sexes, diabetes increased the risk for CHD (hazard ratio 1.99 and 2.93 for men and women, respectively). Diabetic men and women had a 10-year cumulative incidence of CHD of 25.9 and 19.1%, respectively, compared with 57.4 and 58.4% for nondiabetic men and women with previous CHD. The pattern was similar when only fatal events were considered. Diabetic individuals with one or two risk factors had a 10-year cumulative incidence of CHD that was only 1.4 times higher than that of nondiabetic individuals (14%). However, the 10-year incidence of CHD in diabetic subjects with multiple risk factors was >40%, and the incidence of fatal CHD was higher in these subjects than in nondiabetic subjects with previous CHD. Data for CVD showed similar patterns, as did separate analyses by sex. CONCLUSIONS: Our results and comparisons with other available data show wide variation in the rate of CHD in diabetes, depending on the population and existing risk factors. Most individuals had a 10-year cumulative incidence >20%, but only those with multiple risk factors had a 10-year cumulative incidence that was equivalent to that of patients with CHD. Until more data are available, it may be prudent to consider targets based on the entire risk factor profile rather than just the presence of diabetes.     

An epidemiological study of ischemic heart disease, vascular brain diseases and their risk factors in an open population of 25- to 64-year olds in Novosibirsk]

To study the incidence of coronary heart disease (CHD), cerebrovascular diseases (CVD), combined pathology (CHD and CVD), and their risk factors such as arterial hypertension (AH), overweight (OW), hypercholesterolemia (HC), and tobacco smoking in the same population, a random representative sample of male and female populations were examined in three districts of Novosibirsk. AH and tobacco smoking were found predominant among men, whereas OW and HC among women. It turned out that almost every fourth person out of the men and almost every second woman suffered from cardiovascular diseases. In the men, the CHD/CVD ratio was 1:1, that in the women, was 1:7. In the men and women, suffering from combined pathology, AH occurred more frequently as compared to those with CHD or CVD alone. OW promoted the development of CVD and combined pathology in women to a greater degree, whereas HC favoured the development of CHD and CVD in men.     

老年冠心病及其高危患者生活方式干预的效果

目的对老年冠心病及其高危患者进行生活方式干预,观察干预对象的生活方式、血脂水平变化情况以及心脑血管事件发生情况。方法选取2002年6月至2006年12月接受强化生活方式干预,且基线TC水平未达标的军队老年冠心病及其高危患者232例,作为观察组;同期从未进行生活方式干预的干休所中选取冠心病及其高危患者221例,作为对照组。结果与对照组比较,生活方式干预结束时,观察组控制饮食者提高了34.14%(P<0.01),体质量指数(BMI)均值减少了0.78 kg/m2(P<0.01),饮酒者减少了5.76%(P<0.05);总胆固醇(TC)、低密度脂蛋白-胆固醇(LDL-C)分别下降了10.54%、10.89%(P<0.01),高密度脂蛋白-胆固醇(HDL-C)高3.21%(P<0.05);缺血性脑卒中危险性降低了13.79%,心肌梗死、不稳定性心绞痛危险性降低了18.90%(P>0.05)。结论强化生活方式干预能显著降低老年冠心病及其高危患者的血脂水平,减少心脑血管事件的发生。     

Primary and secondary prevention in dyslipidemia in the elderly

Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of disability in advanced age. The relationship between coronary heart disease (CHD) and dyslipoproteinaemia is well known. The fact, however, that atherosclerosis is a systemic disease leads also to the consideration that patients suffering from cerebrovascular and peripheral arterial disease should benefit similarly from lipid lowering therapy as do patients with CHD. There is already growing evidence that the incidence of stroke may be markedly decreased by statin therapy. Though overall, the clinical significance of hypercholesterolaemia seems to decrease with increasing age, patients at age 65 to 75 tend to benefit even more than younger patients when elevated LDL-cholesterol is treated effectively. It should be noticed that prevention or postponement of cardiovascular events may also prevent premature functional limitations and disability in old age. Hence, it is suggested to screen elderly people with CVD for dyslipoproteinaemia and to treat elevated cholesterol levels by means of life style changes, nutritional therapy, and drug therapy. Treatment regimes should be considered depending upon complete risk stratification and geriatric assessment. Chronological age alone cannot be an argument to withhold a proven effective therapy from a growing segment of the population at risk.     

Alcohol consumption and its connection with mortality from cardiovascular diseases in 40-59 years old men (data from 21.5 year prospective study)

AIM: To study contribution of alcohol consumption (AC) to mortality of coronary heart disease (CHD), cerebral stroke (CS), cardiovascular diseases (CVD), overall mortality (OM) in a random population of working males. MATERIAL AND METHODS: The results are available of a 21.5 year cohort study of mortality in a random population of 7,815 male citizens of Moscow and St-Petersburg aged 40-59 years. RESULTS: The attributive risk of AC for mortality of CHD, CS, CVD and OM was 16.6, 14.8, 7.7 and 11.9%, respectively. The lowest relative risk to die of CHD, CVD and OM among the cohort studied was observed in males taking alcohol 168.0 ml per week maximum. CONCLUSION: It is necessary to approach differentially to assessment of AC effects on development of many diseases and further investigations are needed to reveal fine mechanisms of action of different alcohol drinks on human organism.     

Mortality rates after multifactorial primary prevention of cardiovascular diseases

Eleven-year mortality rates were studied in middle aged men who had participated in a randomised 5-year multifactorial primary prevention trial on cardiovascular diseases during 1974-1980. The men were given health education advice before the study. The 5-year trial markedly improved the risk factor status in the men in the intervention group (n = 612), but their 5-year incidence of total coronary events tended to be higher than in the randomised non-treated control group (n = 610) and significantly higher than in an non-randomised, non-treated low risk group (n = 593). During the six years following the discontinuation of the trial, 11 deaths from cardiovascular disease occurred both in the intervention and in the control groups and three in the non-randomised low risk group. Thus, the cumulative eleven-year cardiovascular mortality rates and their 95% confidence intervals (Cl95) were 2.45% (Cl95: 1.38, 3.67) in the intervention group and 1.97% (Cl95: 1.01, 3.34) in the randomised high risk control group. In the non-randomised low risk group the mortality rate was 0.51 (Cl95: 0.01, 1.46). Multiple logistic regression analysis showed that overweight and hypercholesterolaemia, and smoking in the high risk controls, were the initial risk factors associated with the 11-year cardiovascular mortality. The latter was not accumulated in any treatment measure during the prevention period. Furthermore, despite the unfavourable effect of beta-blocking agents on total cardiac events during the intervention, beta-blockers were not associated with cardiac deaths in the 11-year follow up.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of low-dose pravastatin in metabolic syndrome for primary prevention of cardiovascular disease in Japan: a post hoc analysis of the MEGA study

The Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study demonstrated the beneficial effect of low-dose pravastatin treatment (10-20 mg/d) on cardiovascular disease (CVD) in Japanese patients with mild-to-moderate hypercholesterolemia. However, it is not known whether mild lipid modification is effective even for patients at high risk. In this study, we evaluated low-dose pravastatin treatment in patients with metabolic syndrome in the MEGA Study. Metabolic syndrome (MetSyn) was defined according to the modified US National Cholesterol Education Program criteria. There were 72 coronary heart disease (CHD) events and 130 CVD events in 2636 patients with MetSyn, and 70 CHD events and 125 CVD events in 5196 patients without MetSyn (hazard ratios 1.85 and 1.90, respectively). No significant risk reduction in CHD was found in the diet plus pravastatin group compared with the diet group patients with MetSyn (hazard ratio .78, P = .29). On the other hand, there was a significant 36% CVD risk reduction (P = .01) in the diet plus pravastatin group compared with the diet group patients with MetSyn, with a small number needed to treat (45). These results indicate that low-dose pravastatin provides a substantial beneficial effect for the prevention of CVD in Japanese patients with MetSyn without known CVD, a population at proportionally high risk in primary prevention.     

Proprotein convertase subtilisin kexin 9 inhibitors: next generation in lipid-lowering therapy

Introduction: Statins reduce low-density lipoprotein cholesterol (LDL-C) and are currently the mainstay in the treatment of hyperlipidaemia and subsequently the prevention of atherosclerotic cardiovascular disease (CVD). Nevertheless, there is a need to further lower LDL-C, especially in subjects with severe forms of hypercholesterolaemia despite maximum doses of conventional drugs and/or in those intolerant to existing therapies.

Areas covered: Emerging therapeutic approaches to lowering LDL-C involve blocking LDL-receptor degradation by serum proprotein convertase subtilisin kexin 9 (PCSK9). Human monoclonal antibodies that target PCSK9 and its interaction with the LDL-receptor (AMG145, REGN727 and RN316) have been tested in Phase I – III clinical trials for the treatment of hyperlipidaemia in patients at high CVD risk.

Expert opinion: These new agents are administered subcutaneously and have been shown to have major LDL-C and apoB lowering effects either alone or in combination with statins. These novel agents are generally well tolerated and once long-term safety data are available they appear promising therapeutic platforms for the treatment of patients with hypercholesterolaemia at risk for or with CVD not controlled by conventional therapies.     

Comparative approaches to risk reduction of coronary heart disease in Tecumseh non-insulin-dependent diabetic population

Analysis of 182 Tecumseh residents with non-insulin-dependent diabetes mellitus (NIDDM) and 364 controls matched for age and sex demonstrates increased levels of relative weight, blood pressure, and cholesterol in the diabetic group but similar smoking habits for the two groups. Consequently, the risk for acquiring coronary heart disease (CHD) in the next 8 yr calculated by the Framingham logistic regression equation shows a marked increase in risk for both men and women with diabetes (relative risk = 1.3 and 1.9, respectively). This calculated risk for CHD incidence predicts actual deaths from CHD, cardiovascular disease, and all causes in diabetic individuals in the succeeding 15 yr. Baseline levels of cholesterol, blood pressure, and smoking in the NIDDM population were hypothetically reduced according to results achieved in recent coronary-risk intervention trials. Average population risk for CHD incidence was recalculated and compared with new risk estimates calculated by hypothetically eliminating diabetes in various proportions of the population. Crude estimates suggest that realistic attempts to lower one, two, or three coronary risk factors in the population would reduce calculated CHD risk equivalent to eliminating diabetes in 20, 40, and 60% of the population, respectively.     

Prevalence of hypercholesterolaemia and coronary heart disease risk factors among Southeast Asian refugees in a primary care clinic

The National Cholesterol Education Program's guidelines for the detection, evaluation, and treatment of high serum cholesterol in adults were employed in screening 155 Southeast Asian refugees in a primary care clinic in Seattle, Washington. In order to determine the need for a therapeutic intervention, information also was collected on the presence of other coronary heart disease (CHD) risk factors. Male gender (39%), cigarette smoking (27%) and hypertension (26%) were the most common CHD risk factors; diabetes mellitus, obesity, a family or prior history of CHD or cerebral/peripheral vascular disease were each noted in less than 10%. The mean serum total cholesterol was 194 mg/dl. Thirty–seven (24%) patients required further lipoprotein analysis based on cholesterol level, history of CHD and risk factors for CHD. Twenty–one (66%) of 32 patients who underwent lipoprotein analysis (14% of all patients) were candidates for a therapeutic intervention for hypercholesterolaemia. Additionally, 14 (44%) patients undergoing lipoprotein analysis had depressed high–density lipoprotein levels (< 35 mg/dl). We conclude that CHD risk factors including hypercholesterolaemia are common in Southeast Asian refugee clinic patients and that in many, a therapeutic intervention may well be justified. Southeast Asian refugees should be routinely screened for hypercholesterolaemia and other CHD risk factors in accordance with the National Cholesterol Education Program's guidelines.