治疗性生活方式改变是控制血脂异常的基石——中国成人血脂异常防治指南解读

1指南具有中国特色自1997年提出《血脂异常防治建议》至今的9年间国内、外关于血脂异常的研究取得很大进展。根据我国现有的10年和20年流行病学前瞻性研究提供的人群监测随访结果证实心血管病是我国城乡人群第一位的死亡原因。近10余年来我国的心血管病的特点是以动脉粥样硬化为基础的缺血性的心脏病(冠心病)和脑卒中的发病率和死亡率逐步上升,同时我国人群队列研究也表明血清总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)升高是冠心病(CHD)和缺血性脑卒中发病的重要独立危险因素。随着中国社会     

上海市心脏健康研究:设计及意义

近30年来,我国人群心血管系统疾病的发病率和患病率逐年上升,发病年龄提前.这种上升趋势与人口老龄化以及人群心血管病的危险因素水平上升有关.最常见的心血管系统疾病包括脑卒中、动脉粥样硬化(包括冠状动脉性心脏病)和心力衰竭,它们有着很多共同的危险因素.迄今已知的心血管病危险因素有300多种,其中最常见、最重要的有十几种.在老年人群中,常出现同一个体有多种心血管病危险因素聚集,其致病作用相互协同,互为因果,加速心血管病的进程[1].     

内蒙古通辽市冠心病不同临床类型分布及影响因素研究

1 研究背景 冠心病发病率呈上升趋势,发病年龄越来越年轻,已成为我国城市和乡村人群的第1位死亡原因.近20余年来,冠心病发病率和病死率呈逐步上升趋势.目前已知冠心病可能的危险因素有高血压、糖尿病、血脂异常、吸烟、大量饮酒、肥胖、体力运动缺乏、心血管病家族史等.     

冠心病患者抑郁状况的调查

随着我国人民生活水平的提高,冠心病发病率逐年上升。与健康人相比,抑郁症者患有冠心病的相对危险系数为1．5～4．4,冠心病患者患有抑郁症的相对危险系数为1．76～2．38。大量证据表明,抑郁在心血管病患者中的发病率明显高于普通人群,是心血管疾病发生发展的危险因素。     

正确认识 规范达标——解读《选择性胆固醇吸收抑制剂临床应用中国专家共识（2011版）》

动脉粥样硬化性疾病已经成为全球人口第一位死亡原因,冠心病与脑卒中等心血管疾病是动脉粥样硬化的主要临床表现。在我国,心脑血管疾病发病率和病死率快速增长,高血压和血脂异常是造成近年来我国心血管病发病和死亡增加的两大主要危险因素,而人群胆固醇水平大幅提高是我国冠心病发病率和病死率增加的主要因素。     

农村心血管病发病和死亡动态分析

参照ＷＨＯＭｏｎｉｃａ方案，１９８３—１９８９年对江苏海门县３７万自然人群进行冠心病急性事件、脑卒中发病及其防治效果的连续七年监测，初步摸清了海门县主要心血管病的发病概况。结果发现海门监测人群急性心肌梗塞、冠心病猝死和脑卒中的年均发病率分别为２．５１／１０万６．１４／１０万和７７．４７／１０万。发病特点是男性高于女性，中老年高于青壮年。与地处北方的河北正定县监测人群比较，男女两性均处于较低的发病水平，这可能与海门县心血管病的危险因素水平较低有关。据此提出预防该县心血旨疾病应以脑卒中为重点。     

调脂药物的评价与选择

随着人们生活水平的提高和饮食结构改变,脑卒中、冠心病等心血管病已成为我国人群的第一位死亡原因,预示着以动脉粥样硬化为基础的缺血性心血管病(包括冠心病和缺血性脑卒中)发病率正在升高,而高脂血症是引起冠心病和缺血性脑卒中的独立危险因素之一。为此,如何防治高脂血症具有重要临床意义,本文对临床常用降脂药物进行分类评价,供合理选择用药参考。     

中国老年心血管病流行现状

我国人群的心血管病患病率、发病率及其危险因素水平呈不断上升的趋势,心血管病的死亡人数在人口总死亡人数中约占40%,每年全国死于此病者达200万人.随着我国人口老龄化趋势的加快,老年心血管病日益突出,并成为致残致死的首位原因.     

我国人群高血压及其危险因素流行病学研究进展

高血压是目前最为常见的心血管疾病,其中原发性高血压约占95％。同时,它也是导致冠心病、脑卒中、充血性心力衰竭和肾功能障碍的最主要危险因素。一、现状及流行趋势 1.发病率、患病率及流行趋势:①发病率我国有关高血压发病率的资料不多。我国心血管病流行病学多中心合作研究曾对我国部分地区10组人群进行了前瞻性研究,随访5年发现,35～59岁高血压〔SBP≥140mmHg(18.66kPa)和/     

抑郁与女性冠心病的研究进展

随着我国人民生活水平的提高,冠心病发病率呈逐年上升趋势。与健康人相比,抑郁症者患有冠心病的相对危险系数为1.5～4.4。男性冠心病患者的病死率已呈下降趋势,而女性冠心病的病死率却仍在上升,因此我们应该重视女性冠心病防治工作。最近研究发现,女性冠心病患者比男性更容易患抑郁症。抑郁作为冠心病独立危险因素对女性冠心病的危害大于男性,抑郁与女性冠心病的关系备受关注。本文就抑郁与女性冠心病研究进展综述如下。     

我国心血管病发病趋势预测及21世纪预防策略的研究

目的心血管病(CVD)已成为当今我国居民健康的主要威胁,如何有效地对其进行预防和控制已成为当务之急。本专题旨在“八五”研究的基础上继续监测我国丰要心血管病发病率、死亡率及其主要危险因素的变化趋势,以及一些传统和非传统的危险因素在心血管病发生中的作用,并对我国2010年各类人群CVD的发病水平做出合理的科学预测,在此基础上提出我国21世纪CVD预防策略。方法本专题采用的研究方法包括:疾病动态监测、危险因素动态监测、横断面研究、前瞻性观察、生态学比较和模型预测等流行病学方法。结果本专题阐明了我国近年来心血管病及其危险因素的变化趋势,以及危险因素上升可能带来的潜在威胁;并提出了我国人群血压、血脂和BMI的适宜水平,以及适合我国人群的,面向21世纪的CVD人群预防策略。结论通过本研究,为我国的心血管病预防和控制工作提供了丰富而翔实的资料,为制定适合我国国情的心血管病的预防策略提供了可靠的依据。     

北方农村人群心血管病一级预防筛查策略的评价

目的：在中国北方农村人群的前瞻性队列中,评估不同的心血管病筛查策略可获得的健康收益。方法：研究对象为6 221名基线未患心血管病的40~74岁北京房山农村人群。本研究比较的筛查策略包括：策略1,在40~74岁人群中采用《中国心血管病预防指南（2017）》推荐的筛查策略;策略2,采用中国动脉粥样硬化性心血管病风险预测研究（prediction for atherosclerotic cardiovascular disease risk in China,China PAR）风险评估模型的定量筛查策略在40~74岁人群中进行筛查;策略3,采用China PAR定量评估后在50~74岁人群中进行筛查。利用马尔科夫模型模拟将该人群根据上述不同的筛查策略进行心血管病危险分层,并根据指南中的推荐,对中危及以上人群采用生活方式干预,对高危人群额外进行药物治疗干预。比较不同筛查策略的健康收益,包括增额质量调整生命年（quality adjusted life year,QALY）、可预防的心血管病发病和死亡例数、每增加1个QALY（每预防1例心血管病发病或死亡）需筛查人数等。模型所需参数来源于本队列研究、公开发表的中国人群研究数据、Meta分析和系统综述。针对一般人群心血管病发病率的不确定性进行单因素敏感性分析,并针对风险比参数的不确定性进行概率敏感性分析。结果：与不筛查相比,采用策略1、2、3产生的增额QALY分别为498年（95%CI：103~894）、691年（95%CI：233~1 149）和654年（95%CI：199~1 108）,可预防的心血管病发病例数分别为298例（95%CI：155~441）、374例（95%CI：181~567）和346例（95%CI：154~538）。同时,采用China PAR定量评估的策略（策略2和策略3）较《中国心血管病预防指南（2017）》策略有显著的增额QALY（P<0.05）,可预防更多的心血管病发病和死亡（P<0.05）,且需筛查人数较少（策略3筛查50~74岁人群,3个指标P均<0.05;策略2筛查40~74岁人群,预防1例心血管病死亡需筛查人数这一指标P＜0.05）。采用China PAR定量的筛查策略在40~74岁人群和50~74岁人群筛查的健康收益相似。单因素敏感性分析和概率敏感性分析的结果与主要分析结果一致。结论：在北方农村人群中开展心血管病一级预防的筛查及干预是必要的,基于China PAR定量筛查的策略较《中国心血管病预防指南（2017）》推荐的筛查策略获得的健康收益更高,50岁起利用China PAR进行心血管病筛查较40岁起进行筛查可以减少筛查人数,获得相似的健康收益,适用于经济不发达地区开展筛查项目。     

Atherosclerosis, vascular aging and therapeutic strategies

<正>With the arrival of the era of global population aging,we strive for healthy aging and a healthy senior life rattier than simple prolongation of the physical age.For the past 50 years,cardiovascular diseases (CVD) have been the most common cause of death among the elderly people globally.In China,there has been an exponential increase in the incidence of heart disease and stroke in the elderly population.Atherosclerosis is the pathological change in the coronary artery disease,stroke,and peripheral vascular disease.Despite the significant benefit demonstrated,control of classic risk factors alone,such as lifestyle change or drug therapy, was shown to have limitations in reducing the incidence of cardiovascular events.Vascular aging has been shown to be an important independent predictor of CVD events.Interventions targeting vascular aging have emerged as a new paradigm in conjunction with control of risk factors for the prevention of CVD.Vascular aging and atherosclerosis are two distinct pathological changes and difficult to distinguish clinically.Recent research with Chinese medicine(CM) has shown encouraging observations,linking the clinical benefit of delaying vascular aging and treating atherosclerosis.These results demonstrate great potential of CM in the prevention and treatment of CVD.     

Impact of Cardiovascular Disease Deaths on Life Expectancy in Chinese Population

Objective We aimed to analyze the impact of cardiovascular disease （CVD） deaths on life expectancy （LE） in Chinese population and estimate the percentage reduction in CVD mortality needed to increase LE by 1 year from the current level, a national target of health improvement. Methods We used life tables, cause-elimination life tables, and age decomposition of LE with corrected mortality data from the National Disease Surveillance System in 2010. Results LE at birth of Chinese people was 73.24 years in 2010. Women had a longer LE than men, and urban population had a longer LE than rural population. CVD deaths resulted in a 4.79-year LE loss and premature deaths in people aged 25 to 64 years were responsible for a substantial part of LE loss from CVD. Death from ischemic heart disease and cerebrovascular diseases accounted for 69.2% of LE loss from CVD deaths and death from cerebrovascular diseases was the largest contributor. In rural men, 51.1% LE loss from CVD deaths was caused by cerebrovascular diseases. If there were no changes in mortality rates for all other diseases, a 27.4% reduction in CVD mortality would increase LE by i year in Chinese population. Conclusion There is a considerable impact of CVD deaths on LE. A 1-year LE increase in the future requires at least a 27.4% reduction in CVD mortality from the current level. Targeting the rural population and tackling cerebrovascular diseases are important for reaching the national goal of health improvement.     

《中国心血管健康与疾病报告2021》要点解读

随着社会经济的发展,国民生活方式的变化,尤其是人口老龄化及城镇化进程的加速,居民不健康生活方式问题日益突出,心血管疾病（CVD）危险因素对居民健康的影响更加显著,CVD患病率和发病率仍在持续增高。2019年农村和城市CVD死亡人数分别占总死亡人数的46.74%和44.26%,每5例死亡者中就有2例死于CVD。推算中国CVD现患人数为3.3亿,其中脑卒中1 300万,冠心病1 139万,心力衰竭890万,肺源性心脏病500万,心房颤动487万,风湿性心脏病250万,先天性心脏病200万,下肢动脉疾病4 530万,高血压2.45亿。2019年中国心脑血管疾病的住院总费用为3 133.66亿元。CVD负担持续加重,特别是农村地区。由于医疗资源配置的不平衡、对疾病的认识较低及治疗的顺从性较差等原因,近几年农村地区冠心病和脑血管病的死亡率持续超过城市地区。同时也应看到,中国在CVD的防控方面也在不断进步,吸烟率下降,高血压控制率不断上升,临床诊疗水平和基础研究也有大幅进步,社区防治工作取得了一定成果,疾病后的康复工作愈发受到重视,医疗器械研发处于高速发展阶段。     

同型半胱氨酸在慢性肾脏病心血管疾病发生发展中研究进展

同型半胱氨酸（Homocysteine,Hcy）是衍生于蛋氨酸代谢的一种含硫的非必需氨基酸,主要通过食物和内源蛋白质分解获取,在体内含量很少,许多因素会导致体内Hcy 的水平升高,如服用药物、蛋氨酸代谢酶的改变、维生素B12、B6、叶酸等缺乏,以及相关的肾脏损害。慢性肾脏病(Chronic kidney disease,CKD)在全世界范围内的发病率呈上升的趋势,已成为一个威胁人类健康的重要疾病。一项对44 个国家的患病率研究进行的荟萃分析估计,全球CKD 患病率为13.4%。研究表明,受CKD 影响的人群发生心血管疾病（Cardiovascular diseases,CVD）的危险性较一般人群显著增高,CKD 被认为是CVD 的独立危险因素,而CVD 是导致CKD 死亡的主要原因。由于各种传统危险因素无法完全解释这种增加的心血管风险,近年来,越来越多的研究表明非传统因素,如高同型半胱氨酸血症对CKD 患者发生心血管疾病起到了一定的作用。下面就其相关作用机制进行一系列阐述。     

Global and regional trends in incidence and mortality of female breast cancer and associated factors at national level in 2000 to 2019

Background: Female breast cancer (FBC) has become the most prevalent malignancy worldwide. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of FBC.Methods: FBC incidence and mortality in 60 selected countries by cancer registry data integrity in 2020 were estimated from the GLOBOCAN database, and their association with the human development index (HDI) was further evaluated. Trends of age-standardized rates of i...     

Long-term trends in Indigenous deaths from chronic diseases in the Northern Territory: a foot on the brake, a foot on the accelerator

OBJECTIVE: To examine trends in Northern Territory Indigenous mortality from chronic diseases other than cancer. DESIGN: A comparison of trends in rates of mortality from six chronic diseases (ischaemic heart disease [IHD], chronic obstructive pulmonary disease [COPD], cerebrovascular disease [CVD], diabetes mellitus [DM], renal failure [RF] and rheumatic heart disease [RHD]) in the NT Indigenous population with those of the total Australian population. PARTICIPANTS: NT Indigenous and total Australian populations, 1977-2001. MAIN OUTCOME MEASURES: Estimated average annual change in chronic disease mortality rates and in mortality rate ratios. RESULTS: Death rates from IHD and DM among NT Indigenous peoples increased between 1977 and 2001, but this increase slowed after 1990. Death rates from COPD rose before 1990, but fell thereafter. There were non-significant declines in death rates from CVD and RHD. Mortality rates from RF rose in those aged > or = 50 years. The ratios of mortality rates for NT Indigenous to total Australian populations from these chronic diseases increased throughout the period. CONCLUSIONS: Mortality rates from IHD and DM in the NT Indigenous population have been increasing since 1977, but there is evidence of a slower rise (or even a fall) in death rates in the 1990s. These early small changes give reason to hope that some improvements (possibly in medical care) have been putting the brakes on chronic disease mortality among Aboriginal and Torres Strait Islander peoples.     

Outline of the report on cardiovascular disease in China, 2010

Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens.     

绝经妇女心血管疾病发病风险相关因素的研究进展

心血管疾病(CVD)是导致女性死亡的主要原因。女性CVD的预防已经逐渐变成女性CVD危险因素的预防。绝经女性CVD发病风险相关的危险因素包括:糖尿病、吸烟、不健康饮食、体质量超标、高血压、高血脂等。CVD严重危害妇女健康,现就近年来国内外有关绝经妇女的CVD发病风险相关因素及预防策略予以综述。