中国多省市心血管病趋势及决定因素的人群监测（中国MONICA？…

目的 探讨我国人群心血管病事件发病率和死亡率与危险因素强度和结构之间的联系。方法 对中国ＭＯＮＩＣＡ方案１０年心血管病监测有关资料进行单上关及多因素回归分析。结果（１）血清胆固醇水平是冠心病事件发病率的显著预测因素，但对冠心病死亡率无明显预测作用；（２）舒张压水平是脑卒中事件发病率和死亡率的显著预测因素；（３）采用多元回归建立的预测模型效果不尽理想；（４）人群危险因素水平趋势与疾病率趋势无显著一致     

我国多省市心血管病趋势及决定因素的人群监测(中国MONICA方案)Ⅰ.发病率和死亡率监测结果

为了解我国人群心血管病趋势及发病因素，北京心肺血管研究中心于１９８４年倡议组织了一项多省市心血管病人群监测协作研究，采用ＷＨＯＭＯＮＩＣＡ方案的方法和标准，总监测人口约５００万。经１９８５年～１９８６年２年试点后从１９８７年１月起正式开始收集研究资料，于１９９３年１２月底结束。主要结果如下：（１）我国人群冠心病事件发病率和死亡率低于国际平均水平。男性３５～６４岁年发病率最高为１０８．７／１０００００（１９８７～１９８９年），最低为３．３／１０００００，相差相当３２倍；（２）脑卒中事件年发病率和死亡率高于国际平均水平。男性３５～６４岁发病率最高为５５３．３／１０００００（１９８７年～１９８９年），最低为３３．０／１０００００，相差相当１６倍；（３）疾病率存在较显著的地区差异，北方省市普遍高于南方省市；（４）１９８７～１９９３年期间部分人群心血管病发病率和死亡率呈上升趋势，但多数无统计学显著性。     

我国多省市心血管病趋势及决定因素的人群监测

为了解我国人群心血管病趋势及发病因素，北京市肺血管研究中心于１９８４年倡议组织了一项多省市心血病人群监测协作研究。采用ＷＨＯ ＭＯＮＩＣＡ方案的方法和标准，总监测人口约５００万。经１９８５年￣１９８６年２年试点后从１９８７年１月起正式开始收集研究资料，于１９９３年１２月底结束。主要结果如下：（１）我国人群冠心病事件发病率和死亡率低于国际平均水平。男性３５－６４年发病率最高为１０８．７／１０００００     

北京地区70万人群急性冠心病事件发病死亡趋势八年（1985－1992）的城乡对比分析─MONICA方案研究结果

我中心自１９８４年起对北京地区７００，０００自然人群中急性冠心病事件发病率、死亡率进行了长期监测（ＭＯＮＩＣＡ方案）。其结果显示：在北京市城乡人群中急性冠心病事件的动态趋势并不完全一致。城市总发病率无明显变化，而农村呈现明显上升趋势；城市总死亡率呈下降趋势，农村呈上升趋势；在城乡、性别间也存在着差异，城市女性发病率、死亡率均呈下降趋势，农村女性发病率和死亡率均呈上升趋势；男性的发病率和死亡率普遍高于女性。     

北京地区1984—1997年急性冠心病事件发病率变化趋势（中国MO …

研究北京地区人群１９８４－１９９７年急性冠心病事件发病率变化趋势的方向、强度以及在不同性别、年龄人群中的特点。方法采用北京地区心血管病人群监测（ＭＯＮＩＣＡ研究）及后续研究的资料,按年度、性别、年龄分别计算急性冠心病事件发病粗率和（或）年龄标化率;用回归分析的方法计算急冠性病事件发病率的平均变经率和统计学显著性。结果１９８４－１９９３年北京地区急性冠心病事件标化发病率的年平均增长率为２．３％,１９     

缺血性脑血管病治疗进展

脑血管病是人类主要的死亡和致残原因 ,其中 3/ 4的脑血管病病人留有不同程度的后遗症。该病不但给病人和家属带来痛苦和沉重的经济负担 ,也给国家带来巨大的经济损失[1 ] 。ＷＨＯＭＯＮＩＣＡ研究报告显示 ,30余年来 ,欧美、日本等发达国家针对该病的危险因素采取了相应的预防措施 ,脑卒中事件发病率和死亡率呈稳定的下降趋势 ,但是在ＭＯＮＩＣＡ研究中 ,北京地区脑卒中的发病率较高 ,并且是少数呈上升趋势的地区之一[2 ] ,北京市城市人群 1 984年— 1 999年 1 6年间急性脑卒中事件的发作几率和首发发病率均呈明显的上升趋势 ,其增加幅度…     

1984～1993年北京城乡心血管病危险因素变化趋势的比较

目的：评价并对比北京城乡人群１９８４－１９９３年１０年中,心血管病危险因素的变化趋势。方法于１９８４－１９８５年,１９８８－１９８９年和１９９３年分别在北京７０万ＭＯＮＩＣＡ监测人群中进行了３次独立的心血管病危险因素调查。分别采用分层随机抽样方法抽取２５－６４岁,男女两性的独立样本。对收缩压、舒张压、高血压患病率、知晓率、治疗率、控制率、血清总胆固醇、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、体重指数）Ｂ     

中国11省市队列人群危险因素与不同类型心血管病发病危险的比较

目的描述在中国35—64岁人群中,不同类型心血管病（包括急性冠心病事件、急性缺血性脑卒中和出血性脑卒中事件）发病的特点。比较传统心血管病危险因素与冠心病和脑卒中（急性缺血性脑卒中和出血性脑卒中事件）发病危险的关系。方法以中国多省市前瞻性队列研究的数据为基础,该队列由1992年建立的11省市35～64岁27249人和1996年到1999年又加入的3129人所组成,共30378人。本研究基线危险因素水平和1992--2003年期间发生的心血管病（包括冠心病和脑卒中）事件的关系进行分析。结果（1）急性冠心病事件、急性缺血性脑卒中事件和急性出血性脑卒中事件的累积人年发病率分别为114／100000、209／100000和73／100000。（2）随访期间发生心血管病的亚组人群基线时有84％～89％的人伴有1个或1个以上的心血管病危险因素,高于无心血管病的亚组人群（64．7％,P〈0．01）。（3）危险因素对不同类型心血管病发病的影响及作用强度有所差别：对冠心病发病危险的影响因素根据强度依次为高血压、吸烟、高胆固醇血症和低高密度脂蛋白胆固醇血症;对缺血性脑卒中发病危险的影响因素依次为高血压、糖尿病、低高密度脂蛋白胆固醇血症、吸烟和肥胖;对出血性脑卒中发病危险的独立影响因素只有高血压。结论在心血管病的主要危险因素中,不同的危险因素对不同类型的心血管病发病危险的作用存在差别。我国人群不同危险因素的变化趋势将影响不同类型心血管。     

牡丹江市心血管病趋势及危险因素的人群调查

目的 探讨牡丹江市心血管病发病率和死亡率的变化趋势；危险因素和保护因素，为防治工作提供科学依据。方法 分析十万监测人群3年心血管病发病及死亡监测资料与1017人危险因素调查。结果 3年发病率和死亡率呈逐年上升趋势；危险因素各指标处于较高水平。结论 宣传教育，提高人群自我防病意识，使危险因素指标下降，是降低心脑血管病发病率和死亡率的重要途径。     

江苏省农村监测人群1985～1990年心血管病发病动态观察

按照ＷＨＯ－Ｍｏｎｉｃａ方案要求，对江苏省农村海门地区进行了心血管病的发病监测，结果显示１９８５～１９９０年间该地区２５～７４岁年龄段人群急性心肌梗塞年均发病率男女分别为３．６／１０万和０．９／１０万；脑卒中年均发病率分别为９８．３／１０万和６８．２／１０万；心血管病年均死亡率分别为１３９．９／１０万和１００．８／１０万，显示男性发病率、死亡率均较女性为高。该地区的心血管病发病情况在国内各监测区中处于低发之列，分析认为同该地区人群心血管病危险因素水平相对较低有关。     

Absolute and attributable risks of cardiovascular disease incidence in relation to optimal and borderline risk factors: comparison of African American with white subjects--Atherosclerosis Risk in Communities Study

BACKGROUND: Among white Americans, a large proportion of cardiovascular disease (CVD) events is explained by borderline or any elevated CVD risk factor levels. The degree to which this is true among African American subjects is unclear. METHODS: The Atherosclerosis Risk in Communities Study included 14 162 middle-aged adults who were free of recognized stroke or coronary heart disease and had baseline information on risk factors. Based on national guidelines, we categorized risk factors (blood pressure, cholesterol levels, diabetes, and smoking) into 3 categories, ie, optimal, borderline, and elevated. Incidence of CVD (composite of stroke and coronary heart disease) (n = 1492) and CVD mortality (n = 612) were identified for a 13-year period. RESULTS: The proportion of subjects with all optimal risk factor levels was lower in African American (3.8%) than in white (7.5%) subjects. Conversely, the proportion of subjects with at least 1 elevated risk factor was higher in African American (approximately 80%) than in white (approximately 60%) subjects. After adjustment for these risk factor differences and education level, African American and white subjects had virtually identical rates of CVD (relative hazard for African American subjects, 1.01; 95% confidence interval, 0.90-1.14). The proportion of CVD events explained by elevated risk factors was high in African American subjects (approximately 90%) compared with approximately 65% in white subjects. CONCLUSIONS: The higher CVD incidence rate in African American than in white subjects seems largely attributable to a high frequency of elevated CVD risk factors in African American subjects. Primary prevention of elevated CVD risk factors in African American subjects might greatly reduce CVD occurrence as much as it has for white subjects.     

Heart rate recovery after treadmill exercise testing and risk of cardiovascular disease events (The Framingham Heart Study)

A delayed heart rate (HR) recovery after graded exercise testing has been associated with increased all-cause mortality in clinic-based samples. No prior study has examined the association of HR recovery after exercise with the incidence of coronary heart disease (CHD) and cardiovascular disease (CVD) events. We evaluated 2,967 Framingham study subjects (1,400 men, mean age 43 years) who were free of CVD and underwent a treadmill exercise test (Bruce protocol) at a routine examination. We examined the relations of HR recovery indexes (decrease in HR from peak exercise) to the incidence of a first CHD or CVD event and all-cause mortality, adjusting for established CVD risk factors. During follow-up (mean 15 years), 214 subjects experienced a CHD event (156 men), 312 developed a CVD event (207 men), and 167 died (105 men). In multivariable models, continuous HR recovery indexes were not associated with the incidence of CHD or CVD events, or with all-cause mortality. However, in models evaluating quintile-based cut points, the top quintile of HR recovery (greatest decline in HR) at 1-minute after exercise was associated with a lower risk of CHD (hazards ratio vs bottom 4 quintiles 0.54, 95% confidence interval [CI], 0.32 to 0.93) and CVD (hazards ratio 0.61, 95% CI 0.41 to 0.93), but not all-cause mortality (hazards ratio 0.99, 95% CI 0.60 to 1.62). In our community-based sample, HR recovery indexes were not associated with all-cause mortality. A very rapid HR recovery immediately after exercise was associated with lower risk of CHD and CVD events. These findings should be confirmed in other settings.     

Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population.

AIMS: Chronic kidney disease (CKD) was found to be an independent risk factor for all-cause mortality as well as adverse cardiovascular disease (CVD) events in high-risk populations. Findings from population-based studies are scarce and inconsistent. We investigated the gender-specific association of CKD with all-cause mortality, cardiovascular mortality, and incident myocardial infarction (MI) in a population-based cohort. METHODS AND RESULTS: The study was based on 3860 men and 3674 women (aged 45-74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995. CKD was defined by an estimated glomerular filtration rate between 15 and 59 mL/min/1.73 m(2). Hazard ratios (HRs) were estimated from Cox proportional hazard models. In this study, 890 total deaths, 400 CVD deaths, and 321 incident MIs occurred in men up to 31 December 2002; the corresponding numbers in women were 442, 187, and 102. In multivariable analyses, the HR for women with CKD compared to women with preserved renal function was significant for incident MI [HR 1.67; 95% confidence interval (CI) 1.07-2.61] and CVD mortality (HR 1.60; 95% CI 1.17-2.18). In men, CKD was also significantly associated with incident MI (HR 1.51; 95% CI 1.09-2.10) and CVD mortality (HR 1.48; 95% CI 1.15-1.92) after adjustment for common CVD risk factors. In contrast, men and women with CKD had no significant increased risk of all-cause mortality. CONCLUSION: CKD was strongly associated with an increased risk of incident MI and CVD mortality independent from common cardiovascular risk factors in men and women from the general population.     

Association of European population levels of thrombotic and inflammatory factors with risk of coronary heart disease: the MONICA Optional Haemostasis Study.

AIMS: Classical risk factors do not fully explain international differences in risk of coronary heart disease (CHD). We therefore measured thrombotic and inflammatory markers in a substudy of the WHO MONICA project and correlated these with CHD event rates. METHODS AND RESULTS: We measured levels of fibrinogen (clottable and nephelometric), von Willebrand factor (vWf), tissue plasminogen activator antigen, plasminogen activator inhibitor activity, fibrin D-dimer, plasma viscosity, C-reactive protein, and total cholesterol in 12 MONICA populations (listed at the end of this paper), all but one European. Men and women aged 45-64 years were studied from 10 countries. All samples were collected using a carefully standardized protocol, and analysed centrally. Results were available for 3996 subjects (nephelometric fibrinogen and viscosity), 2378 subjects (other thrombotic assays), and 1757 subjects (C-reactive protein and total cholesterol). Significant differences in levels of thrombotic and inflammatory factors exist in MONICA populations mainly from European countries. These differences persist after adjustment for age, smoking habit, and body mass index. Cross-sectional correlations between coronary event rates and these thrombotic/inflammatory markers were significant for vWF antigen in both sexes, nephelometric fibrinogen in men, and D-dimer in women. CONCLUSION: In particular, vWF, nephelometric fibrinogen, and D-dimer should be examined in further research as potential risk factors which may help explain differences in coronary risk between European populations.     

中国35～64岁人群心血管病危险因素与发病危险预测模型的前瞻性研究

目的　探讨中国人群主要心血管病危险因素与心血管病发病绝对危险的关系 ,建立中国人群心血管病发病危险的预测模型。方法　采用前瞻性队列研究的方法 ,对 1992年建立的 11省市 35～ 6 4岁队列人群 [中国多省市队列研究 (ChinaMulti provincialCohortStudy ,CMCS) ]共 3172 8人基线危险因素水平和 1992～ 2 0 0 2年发生的心血管病事件 (包括急性冠心病事件和急性脑卒中事件 )进行单因素和多因素分析。结果　 (1) 10年累积平均急性冠心病事件发病率男性是 1 4 1% ,女性是 0 6 0 %。缺血性脑卒中事件的发病率男性是 2 0 2 % ,女性是 1 37%。 (2 )利用预测模型计算不同危险因素水平与缺血性心血管病发病概率 ,结果显示 :随着危险因素个数的增加心血管病发病的绝对危险增加 ,不同危险因素之间有协同作用 ,不同的危险因素组合对心血管病发病危险的作用强度有所差别。 (3)我国 35～ 6 4岁人群缺血性心血管病发病危险概率 <10 %者占 95 4 % ,发病危险概率≥ 10 %者占 4 6 % ,发病危险概率≥ 2 0 %者只占 0 8%。而缺血性心血管病事件的 2 5 5 %发生在发病危险概率≥ 10 %的人群中。结论　危险因素与心血管病发病绝对危险的评估比相对危险度具有更重要的公共卫生意义。在评价不同个体的心血管病危险时不应     

Serum uric acid for short-term prediction of cardiovascular disease incidence in the Gubbio population Study

OBJECTIVE: The Gubbio Study is an Italian population study measuring risk factors for and incidence of major cardiovascular diseases. This analysis investigates the association of serum uric acid with the incidence of coronary and cardiovascular events. METHODS: A population sample of 2469 men and women aged 35-74 years, free from major cardiovascular diseases and in whom serum uric acid was measured in 1983 along with other standard risk factors, were followed up for 6 years and the incidence of coronary heart disease (CHD) and all cardiovascular atherosclerotic (CVD) events, both fatal and non-fatal, was computed. Proportional hazards models were used for the prediction of these events. RESULTS: In six years 61 CHD hard criteria, 109 CHD any criterion and 149 CVD events were recorded. Age-adjusted rates per 1000 of the 3 event categories were computed in sex-specific quintiles (Q) of serum uric acid with 428 +/- 76 (Q5) and 198 +/- 42 (Q1) micromol/l, respectively. Although higher rates were seen in Q5 as compared to Q1 for all three first event categories considered (relative risks 6.2, 3.6 and 3.7, respectively), a statistically significant trend was seen only for CVD all criteria (t = 3.63, p < 0.036). These trends were borderline significant for CHD any criterion (t = 2.92, p < 0.06) and not significant for CHD hard criteria (t = 2.23, p < 0.11). In multivariate models, adjusted for 8 other risk factors, serum uric acid showed a statistically significant contribution to predict CVD incidence [relative risk (RR) for 92 micromol/l difference of 1.24 with 95% confidence intervals (CI) 1.05-1.45], whereas the statistical contribution to predict CHD any criterion (RR = 1.19 with CI 0.98-1.45) and CHD hard criteria (RR = 1.20 with CI 0.93-1.55) was not significant. Diuretic treatment and blood urea, as further confounders, were positively and significantly related to event incidence (RR ranging from 1.21 to 2.00) but serum uric acid maintained its independent and statistically significant role in the prediction of CVD events (RR = 1.18 with CI 1.00-1.39). Presence of specific treatments to lower serum uric acid levels (in 1.13% of the population), tested as final confounders, was not statistically contributory. CONCLUSIONS: Increased serum uric acid levels are independently and significantly associated with risk of CVD events in the 6-year follow-up of the Gubbio Study. Longer follow-up is needed before the contributory role of serum uric acid can be properly assessed to explain CHD incidence.     

Plasma total homocysteine and hospitalizations for cardiovascular disease: the Hordaland Homocysteine Study

BACKGROUND: Elevated total plasma homocysteine (tHcy) level is a risk factor for occlusive disease in the coronary, cerebral, and peripheral vessels and is related to several lifestyle factors associated with cardiovascular disease (CVD). OBJECTIVE: To examine the association of a single tHcy measurement on subsequent hospitalizations due to CVD. METHODS: A population-based prospective cohort study was conducted from April 1, 1992, to May 31, 1998 (mean follow-up, 5.3 years) in western Norway. The study included 17 361 individuals aged 40 to 42 or 65 to 67 years at baseline. Main outcome measure was CVD as the main hospital discharge diagnosis or coronary revascularization procedures (denoted "CVD hospitalizations") during follow-up (n = 1275). RESULTS: At baseline, participants with preexisting CVD had higher mean tHcy values than individuals without CVD. Risk of CVD hospitalizations increased significantly with increasing baseline tHcy only in the oldest age group. Here, multiple risk factor-adjusted hospitalization rate ratios in 5 tHcy categories (<9, 9-11.9, 12-14.9, 15-19.9, and >or=20 micromol/L [to convert tHcy to milligrams per liter, divide by 7.397]) were as follows: 1 (reference level), 1.00, 1.34, 1.67, and 1.94, respectively (P for trend <.001). The relation between tHcy level and CVD hospitalizations was significantly stronger among individuals with preexisting CVD than those without (hospitalization rate ratio per 5-micromol/L tHcy increment, 1.29 vs 1.10; P for interaction,.02). CONCLUSIONS: Plasma tHcy level is a strong predictor of CVD hospitalizations only in elderly individuals, and especially among those with preexisting CVD. Our findings are compatible with the theory that tHcy interacts with conventional CVD risk factors to provoke the acute event of CVD.     

Heart rate response to a timed walk and cardiovascular outcomes in older adults: the cardiovascular health study

Objectives: To determine the relationship between heart rate response during low-grade physical exertion (6-min walk) with mortality and adverse cardiovascular outcomes in the elderly. Methods: Participants in the Cardiovascular Health Study who completed a 6-min walk test were included. We used delta heart rate (difference between postwalk heart rate and resting heart rate) as a measure of chronotropic response and examined its association with (1) all-cause mortality and (2) incident coronary heart disease event, using multivariable Cox regression models. Results: We included 2,224 participants (mean age 77 ± 4 years; 60% women; 85% white). The average delta heart rate was 26 beats/min. Participants in the lowest tertile of delta heart rate (<20 beats/min) had higher risk-adjusted mortality [hazard ratio (HR) 1.18, 95% confidence interval (CI) 1.00-1.40] and incident coronary heart disease (HR 1.37, 95% CI 1.05-1.78) compared to subjects in the highest tertile (≥30 beats/min), with a significant linear trend across tertiles (p for trend <0.05 for both outcomes). This relationship was not significant after adjustment for distance walked. Conclusion: Impaired chronotropic response during a 6-min walk test was associated with an increased risk of mortality and incident coronary heart disease among the elderly. This association was attenuated after adjusting for distance walked.     

Intensive lifestyle modification: impact on cardiovascular disease risk factors in subjects with and without clinical cardiovascular disease

Intensive lifestyle modification programs are intended to stabilize or promote regression of coronary artery disease; however, clinical response is often nonuniform, complicating appropriate utilization of resources and prediction of outcome. This study assessed physiological and psychological benefits to 72 persons participating in a prospective, nonrandomized, fourcomponent lifestyle change program and compared response between patients with clinical cardiovascular disease (CVD) and patients with elevated risk factors for CVD but without clinical manifestations of disease. Subjects entering the program due to elevated risk factor levels alone demonstrated equal or greater benefit, in terms of improvement in primary CVD risk factors and reduction in measures of coronary disease risk developed in the Framingham Heart Study, than those with clinical CVD. These findings suggest that intensive lifestyle change programs may be important for primary prevention in individuals at increased risk of CVD.     

Exercise and cardiovascular outcomes by hypertensive status: NHANES I epidemiological follow-up study, 1971-1992

BACKGROUND: A favorable effect of exercise on cardiovascular longevity has been repeatedly demonstrated in the general population. The association of exercise and cardiovascular disease (CVD) outcome among persons with different blood pressure (BP) status is less well known. METHODS: We examined the epidemiologic follow-up of the First National Health and Nutrition Examination Survey (NHANES I) (1971-1992). Of 14,407 participants, 9791 subjects aged 25 to 74 years met inclusion criteria. All cause, CVD, and non-CVD mortality rates, as well as CVD incidence rates were determined. The associations of levels of exercise and outcomes by BP status were examined. Age- and gender-adjusted rates, as well as Cox proportional hazard models were determined. RESULTS: During 17 years of follow-up, there were 3069 deaths, 1465 of which were CVD. In addition, 2808 subjects had incident CVD events. Overall, CVD incidence and mortality rates increased as BP rose. The association of exercise with CVD events differed by BP status (normal, prehypertension, and hypertension). Age- and gender-adjusted CVD mortality rate per 1000 person-years for least, moderate, and most exercise were 5.0, 3.6, and 2.4 among normotensive subjects (P > .05), 6.3, 4.7, and 5.2 among prehypertensive subjects (P > .05), and 11.8, 9.8, and 8.7 among hypertensive subjects (P < .01), respectively. In fact, exercise was a significant independent predictor of reduced CVD event only among hypertensive subjects, after adjusting for other CVD risk factors. Among prehypertensive and normotensive subjects, where events were fewer, those who exercise more vigorously also had lower mortality, but these differences did not reach statistical significance. CONCLUSIONS: This study, consistent with previous observational data, demonstrates that increased exercise is associated with decreased CVD event. Interestingly, this effect is most robust among hypertensive subjects, whereas for prehypertensive and normotensive subjects, a significant benefit of exercise on CVD outcome, perhaps because of lack of power, was not found.