脉搏波传导速度在健康体检中的应用价值及其危险因素分析

目的:探讨沈阳地区臂踝脉搏波传导速度(baPWV)在健康体检中的应用价值及其危险因素。方法:选择在沈阳军区总医院健康管理中心接受定期健康体检符合入选条件的人员1610例,测定其双侧baPWV及其他相关指标,使用Logistic回归分析评估baPWV与年龄、人体质量指数(BMI)、动脉血压及血生化指标的关系。结果:1610例受检者中,男性baPWV值明显高于女性[(1397.93±239.08)cm/s比(1361.03±244.72)cm/s,P=0.003]。同时,无论男性还是女性,baPWV均随年龄增加而增长。与baPWV正常组(1400cm/s)比较,baPWV升高组(≥1400cm/s)年龄[(45.57±8.95)岁比(57.07±10.50)岁]明显较大,BMI[(25.25±6.82)kg/m2比(26.14±3.44)kg/m2]、空腹血糖[FBG,(4.88±1.73)mmol/L比(5.43±2.02)mmol/L]、低密度脂蛋白-胆固醇[LDL-C,(2.67±0.82)mmol/L比(2.84±0.77)mmol/L]、总胆固醇[TC,(4.88±0.99)mmol/L比(5.13±0.98)mmol/L]、甘油三酯[TG,(1.73±1.65)mmol/L比(2.15±1.91)mmol/L]、收缩压[SBP,(116.72±12.04)mmHg比(136.87±16.21)mmHg]、舒张压[DBP,(76.99±9.01)mmHg比(86.34±10.84)mmHg]及脉压[PP,(39.72±8.32)mmHg比(50.53±14.17)mmHg]显著升高(P均0.01)。多变量Logistic回归显示,年龄、FBG、TG、SBP、DBP、PP水平是baPWV升高的独立危险因素(OR=1.549~5.943,P0.05或0.01)。结论:沈阳地区健康体检人群的baPWV与心血管危险因素密切相关,在心血管疾病风险筛查中具有较好的应用价值。     

中老年正常高值血压水平与冠状动脉性心脏病相关

目的探讨中老年正常高值血压人群血压水平与冠状动脉性心脏病(冠心病)的相关性。方法选取316例50岁以上接受冠状动脉造影检查的正常高值血压者,按照冠状动脉造影结果分为冠心病组(n=129)和非冠心病组(n=187)。对所有对象进行血压、身高、体质量测量,检测血脂指标。结果冠心病组舒张压低于非冠心病组[(73.1±8.9)比(77.0±8.0)mmHg],脉压高于非冠心病组[(55.9±10.5)比(51.2±9.5)mmHg]。对性别、年龄等常见冠心病危险因素调整后,较高的收缩压(≥130mmHg)、较低的舒张压(≤85mmHg)以及较大的脉压(≥60mmHg)与冠心病的发生相关,OR(95%CI)分别为1.60(1.04～2.46)、1.52(1.07～2.16)、1.90(1.06～3.39),均P<0.05。多因素Logistic逐步回归分析发现脉压≥60mmHg是冠心病的独立危险因素。结论在中老年正常高值血压人群中,较高的收缩压、较低的舒张压以及脉压增大与冠心病发生风险相关联,脉压≥60mmHg是冠心病的独立危险因素。     

高胆固醇血症和高血压对冠心病发病的联合作用

流行病学研究发现,随着血胆固醇和血压的升高,CHD的发病也随之升高.进一步研究发现高胆固醇血症与高血压对CHD的发生既有单独作用,亦有协同作用,二者作用的联合不是单纯的叠加效应,而是放大效应或乘积效应.多危险因素干预研究(MRFIT)结果揭示了吸烟与高血压和血TC水平三种危险因素与5年内CHD发生危险的相互关系.排除吸烟危险因素后,血TC＜6.47 mmol/L者,DBP＜90 mmHg 时CHD发生率(例数/1000人)为2.40,DBP＞90 mmHg 时CHD发生率为3.86;血TC＞6.47 mmol/L者,DBP＜90 mmHg 时CHD发生率为6.12,DBP＞90 mmHg 时CHD发生率为9.86.     

北京社区老年人群脑卒中危险因素随访观察

目的　随访干预和对照队列 (≥ 60岁 )人群 ,探讨脑卒中危险因素水平变化及干预措施的延续性效果。方法　对 1 0年前两组队列人群进行横断面追踪调查。结果　随访干预和对照人群分别为 2 2 4 4人 (83 % ) ,2 0 64人 (74% )。对照队列易诱发脑卒中相关疾病 :TIA明显高出干预组。危险因素水平 :血压均值 (干预组 1 32 / 78mmHg、对照组 1 34/ 84mmHg)、体重指数、食盐摄入量增加、纤维素摄入量不足等方面与对照组比较有明显差别 (P <0 0 5)。卫生健康教育和健康促进的延续性效果明显。结论　社区人群脑卒中危险因素干预持续性效果明显 ,但有效降低脑卒中死亡率还需要更长时间的验证     

高胆固醇血症和高血压对冠心病发病的联合作用

流行病学研究发现 ,随着血胆固醇和血压的升高 ,CHD的发病也随之升高。进一步研究发现高胆固醇血症与高血压对CHD的发生既有单独作用 ,亦有协同作用 ,二者作用的联合不是单纯的叠加效应 ,而是放大效应或乘积效应。多危险因素干预研究(MRFIT)结果揭示了吸烟与高血压和血TC水平三种危险因素与 5年内CHD发生危险的相互关系。排除吸烟危险因素后 ,血TC <6 4 7mmol/L者 ,DBP <90mmHg时CHD发生率 (例数 / 10 0 0人 )为 2 4 0 ,DBP >90mmHg时CHD发生率为 3 86 ;血TC >6 4 7mmol/L者 ,DBP <90mmHg时CHD发生率为6 12 ,DB…     

白细胞增多与冠心病的联系

经常的白细胞计数增多(≥9×10~(?)/L)与冠心病发病率呈正相关,是随后发生心肌梗塞的先兆。循环血白细胞计数每减少1000/mm~3,冠心病的死亡危险就降低约14%.白细胞数增多与冠心病的标准危险因素——血清胆固醇升高、血压升高及吸烟等三者同样重要,可作为补充危险因素。对发生急性心肌梗塞的病人,持续每日检测白细胞计数,可作为监察病情的指标之一.     

青岛市城阳街道脑卒中高危人群筛查结果分析

目的对青岛市城阳街道脑卒中高危人群进行筛查,分析该地区脑卒中发病的危险因素分布情况。方法对青岛城阳街道4 438例居民进行脑卒中高危人群筛查,高危人群判定标准为高血压、糖尿病、血脂升高(甘油三酯≥2.26 mmol/L)、房颤、肥胖、缺乏锻炼、吸烟、脑卒中家族史8项中满足3项及以上;或出现短暂性脑缺血发作(TIA)、有脑卒中史2项中满足1项。分析该地区脑卒中发病危险因素的分布情况。结果 4 438例中,共筛查出666例脑卒中高危者,其中脑卒中患者60例(1.35%),TIA患者204例(4.6%)。所占比例较高的危险因素依次为高血压(77.93%)、血脂升高(52.70%)、肥胖(48.80%)和糖尿病(35.00%)。结论青岛市城阳街道脑卒中发病危险因素主要为高血压、血脂升高、肥胖和糖尿病。     

慢性阻塞性肺疾病急性加重期住院患者死亡相关因素分析

目的了解慢性阻塞性肺疾病急性加重期(AECOPD)住院患者病死率及死亡相关因素。方法采用回顾性分析,收集北京大学第三医院2007年1月至2008年12月呼吸科收住的AECOPD患者138例。总结患者特点,并采用单因素及多因素Logistic回归进行分析。结果 AECOPD住院患者院内病死率为21.7%。单因素分析发现下列因素与AECOPD住院死亡相关:年龄、住院时间长短、PASP、入住ICU、合并肺炎、贫血、肾功能不全、Ⅱ型呼吸衰竭、心房颤动、休克、气胸。多因素Logistic回归分析提示肺炎(OR=42.488)、高PASP(≥45mmHg)(OR=15.914)、贫血(OR=7.693)、心房颤动(OR=6.215)以及入住ICU(OR=4.927)是AECOPD患者住院死亡的独立危险因素。结论 AECOPD住院患者病死率高,肺炎、高PASP(≥45mmHg)、贫血、心房颤动以及入住ICU是AECOPD患者住院死亡的独立危险因素。     

老年糖尿病周围神经病变临床特征及其影响因素

目的观察老年糖尿病患者周围神经病变临床特征,并分析导致该疾病发生的危险因素。方法回顾性分析149例老年糖尿病患者临床资料。将伴发周围神经病变患者107例纳入A组,未发生周围神经病变患者42例纳入B组,观察A组临床特征,经χ~2检验与非条件多项Logistic回归分析找出导致老年糖尿病患者发生周围神经病变的危险因素。结果将经χ~2初次检验证实有差异的自变量纳入,并经非条件多项Logistic回归分析进行多因素分析证实,合并高血压、体重指数升高(≥24 kg/m~2)、糖化血红蛋白升高(≥7%)、眼底视网膜病变均是导致老年糖尿病患者发生周围神经病变的危险因素(OR1,P0.05)。结论针对合并高危因素的老年糖尿病患者应提高警惕,并及时给予防治措施,降低周围神经病变的发生。     

高血压等多重危险因素与冠状动脉狭窄的相关性

目的 评估高血压等多重危险因素与冠状动脉狭窄的相关性.方法 回顾总结965例行冠脉造影者的临床资料,以血压作为主要因素单独分析,按血压水平分为正常血压组[收缩压(SBP)＜ 120 mmHg和舒张压(DBP) ＜80 mmHg]、正常高值组[SBP 120-129 mmHg和(或)DBP80 ～ 89 mmHg]、轻度高血压组[SBP 140 ～ 159 mmHg和(或)DBP 90～99 mmHg]、中度高血压组[SBP 160～179 mmHg和(或)DBP 100 ～ 109 mmHg]和重度高血压组[ SBP≥180 mmHg和(或)DBP≥110 mmHg],按合并其他危险因素(年龄、吸烟、血脂、高尿酸血症及糖尿病)的个数分为6个亚组:0组(未合并其他危险因素)、1组(合并1个其他危险因素)、2组(合并2个其他危险因素)、3组(合并3个其他危险因素)、4组(合并4个其他危险因素)及5组(合并5个其他危险因素),不同血压水平组合并危险因素情况与冠脉狭窄的相关性分析采用x2检验以及Pearson相关.结果 在各血压分组中冠脉狭窄与合并其他危险因素均有正关联(正常血压组r=0.675,P＜0.01;正常高限组r=0.708,P＜0.01;轻度高血压组r=0.731,P＜0.01;中度高血压组r=0.824,P＜0.01;重度高血压组r=0.886,P＜0.01).不同血压级别和合并其他危险因素与冠脉狭窄的r值有线性正相关(rp=0.972,P=0.006).结论 高血压是发生冠状动脉粥样硬化的独立危险因素,年龄、吸烟、血脂异常、高尿酸血症及糖尿病等其他危险因素也不可忽视,尤其多重危险因素对冠脉狭窄的协同作用更明显.     

High attributable risk of elevated C-reactive protein level to conventional coronary heart disease risk factors: the Third National Health and Nutrition Examination Survey

BACKGROUND: C-reactive protein (CRP), a marker of systemic inflammation, is predictive of coronary heart disease (CHD) events. However, the extent to which high CRP levels (>3 mg/L) may be attributable to high cholesterol levels and other CHD risk factors has not been well defined. METHODS: The prevalence of high CRP levels in the third National Health and Nutrition Examination Survey (n = 15 341) was studied using CHD risk-factor cut points designated as abnormal (total cholesterol values, >or=240 mg/dL [>or=6.22 mmol/L]; fasting blood glucose levels, >or=126 mg/dL [>or=6.99 mmol/L]; blood pressure, >or=140/90 mm Hg; body mass index [BMI], >or=30 kg/m(2); high-density lipoprotein cholesterol values, <40 mg/dL [<1.04 mmol/L] for men and <50 mg/dL [<1.30 mmol/L] for women; triglyceride levels, >or=200 mg/dL [>or=2.26 mmol/L]; current smoking status) or borderline (total cholesterol values, 200-239 mg/dL [5.18-6.19 mmol/L]; fasting blood glucose levels, 100-125 mg/dL [5.55-6.94 mmol/L]; blood pressure, 120-139/80-89 mm Hg; BMI, 25.0-29.9 kg/m(2), and triglyceride values 150-199 mg/dL [1.70-2.25 mmol/L], former smoking status), or normal. RESULTS: Weighted multiple logistic regression analysis demonstrated that high CRP level was significantly more common with obesity (odds ratio [OR], 3.78; 95% confidence interval [CI], 3.28-4.35]), overweight (OR, 1.88; 95% CI, 1.62-2.18), and diabetes (OR, 1.91; 95% CI, 1.54-2.38) and that high CRP level was rare in the absence of any borderline or abnormal CHD risk factor in men (4.4%) and women (10.3%). Overall, the risk of elevated CRP level attributable to the presence of any abnormal or borderline CHD risk factor was 78% in men and 67% women. CONCLUSIONS: These data suggest that elevated CRP levels in the general population are in large measure attributable to traditional CHD risk factors. Moreover, CRP level elevation is rare in the absence of borderline or abnormal risk factors. As such, CRP measurements may have limited clinical utility as a screening tool beyond other known CHD risk factors.     

血栓弹力图评价老年心血管病患者阿司匹林抵抗的发生率及危险因素

目的评价老年心血管病患者阿司匹林抵抗的发生率及可能的潜在危险因素。方法选择老年心血管病患者454例,分为阿司匹林抵抗组111例,阿司匹林敏感组343例。口服阿司匹林(≥75 mg)>1个月,采用血栓弹力图法进行血小板聚集功能检测。结果与阿司匹林敏感组比较,阿司匹林抵抗组女性患者较多,P选择素、空腹血糖、TG、LDL-C明显增高,服用硝酸酯类药物的比例明显降低,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,空腹血糖(OR=1.211.95%CI:1.047～1.402,P=0.010)、P选择素(OR=1.010,95%CI:1.002～1.01 9,P=0.019),服用硝酸酯类药物(OR=0.524,95%CI:0.309～0.890,P=0.017)与阿司匹林抵抗相关。结论老年心血管病患者阿司匹林抵抗发生率较高,空腹血糖、P选择素为阿司匹林抵抗的危险因素,硝酸酯药物为其保护性因素。     

The association between circulating white blood cell count, triglyceride level and cardiovascular and all-cause mortality: population-based cohort study

OBJECTIVES: To examine the individual and combined relationship between elevated white blood cell count (WBC), triglyceride level and cardiovascular and all-cause mortality among older Australians. DESIGN: Prospective population-based cohort study. SETTING: Community in Blue Mountains region, Australia. PARTICIPANTS: 2904 individuals, aged 49-84 years, free of cardiovascular disease and cancer at the baseline examination. MAIN OUTCOME MEASURES: Cardiovascular (n=242) and all-cause mortality (n=575). RESULTS: Elevated WBC count and triglyceride level were found to be associated with cardiovascular and all-cause mortality, independent of several important confounders. Multivariable relative risk [RR] (95% confidence interval [CI]) comparing fourth (6.8 x 10(9) cells/L and above) versus first quartile (4.8 x 10(9) cells/L and below) of WBC count was 2.01 (1.40-2.90) for cardiovascular mortality and 1.68 (1.35-2.09) for all-cause mortality. Multivariable RR (95% CI) comparing fourth (1.98 mmol/L and above) versus first quartile (0.95 mmol/L and below) of triglyceride level was 1.58 (1.08-2.30) for cardiovascular mortality and 1.40 (1.11-1.77) for all-cause mortality. Furthermore, a combined exposure to the fourth quartiles of both WBC count and triglyceride level was found to be related to more than three-fold risk of cardiovascular mortality (RR [95% CI]: 3.15 [2.17-4.57], p-interaction=0.01), independent of traditional risk factors. CONCLUSIONS: Elevated WBC count and triglyceride level were associated with cardiovascular and all-cause mortality among older Australians. These data provide new epidemiological evidence regarding cardiovascular risk stratification using simple, inexpensive, and routinely available measures, suggesting that a combined exposure to both high WBC count and triglyceride level is related to more than three-fold risk of cardiovascular mortality, independent of traditional risk factors.     

Lipoprotein(a) further increases the risk of coronary events in men with high global cardiovascular risk

OBJECTIVES: This prospective population study was conducted to assess the role of elevated lipoprotein(a) [Lp(a)] as a coronary risk factor. BACKGROUND: The role of elevated Lp(a) as a risk factor for coronary heart disease is controversial. In addition, little attention has been paid to the interaction of Lp(a) with other risk factors. METHODS: A total of 788 male participants of the Prospective Cardiovascular Münster (PROCAM) study aged 35 to 65 years were followed for 10 years. Both Lp(a) and traditional cardiovascular risk factors (e.g., age, low density lipoprotein [LDL] cholesterol, high density lipoprotein [HDL] cholesterol, triglycerides, systolic blood pressure, cigarette smoking, diabetes mellitus, angina pectoris, and family history of myocardial infarction) were evaluated in 44 men who suffered from myocardial infarction, and in 744 men who survived without major coronary events or stroke. A multiple logistic function algorithm was used to estimate global cardiovascular risk by the combined effects of traditional risk factors. RESULTS: Overall, the risk of a coronary event in men with an Lp(a) > or =0.2 g/liter was 2.7 times that of men with lower levels (95% confidence interval [CI]: 1.4 to 5.2). This increase in risk was most prominent in men with LDL cholesterol level > or =4.1 mmol/liter (relative risk [RR]: 2.6; 95% CI: 1.2 to 5.7), with HDL cholesterol < or =0.9 mmol/liter (RR 8.3; 95% CI: 2.0 to 35.5), with hypertension (RR 3.2; 95% CI: 1.4 to 7.2), or within the two highest global risk quintiles (relative risk: 2.7; 95% CI: 1.3 to 5.7). CONCLUSIONS: Lp(a) increases the coronary risk, especially in men with high LDL cholesterol, low HDL cholesterol, hypertension and/or high global cardiovascular risk.     

中国新疆地区维吾尔族人群缺血性卒中的危险因素

目的：探讨中国新疆维吾尔族人群缺血性卒中的危险因素。方法采用病例对照研究模式,按照民族、性别和年龄进行匹配的原则,对504例首发缺血性卒中维吾尔族患者和507例维吾尔族健康对照者进行调查,筛选缺血性卒中的危险因素。结果多变量logistic回归分析显示,肥胖[优势比（odds ratio, OR）4.82,95％可信区间（confidence interval, CI）1.80~12.94;P=0.002]、高血压（ OR 8.20,95％CI 4.93~13.51;P<0.001）和心脏病（ OR 2.40,95％CI 1.07~5.39;P=0.033）是维吾尔族缺血性卒中的独立危险因素,而初中以上文化程度（ OR ）0.38,95％CI 0.18~0.81;P=0.012）、饮茶习惯（ OR 0.22,95％CI 0.06~0.70;P=0.021）和有午睡习惯（ OR 0.38,95％CI 0.24~0.59;P<0.001）、高水平的高密度脂蛋白胆固醇（ OR 0.34,95％CI 0.20~0.59;P<0.001）和载脂蛋白A（ OR 0.23,95％CI 0.07~0.77;P=0.017）均为缺血性卒中的独立保护因素。结论中国新疆维吾尔族人群缺血性卒中的危险因素较多且典型,调整该民族饮食结构,少进食肉类和高盐饮食,多摄取高纤维食物和鱼类等,并适当加强体育锻炼可能将在维吾尔族人群的卒中预防起着重要的作用。     

Fish, n-3 fatty acids, and cardiovascular diseases in women of reproductive age: a prospective study in a large national cohort

Previous studies have indicated a protective effect of long-chain n-3 polyunsaturated fatty acids (LCn3FAs) against cardiovascular disease; however, women are underrepresented in cardiovascular research. The aim of this study was to explore the association between intake of LCn3FAs and the risk of cardiovascular disease in a large prospective cohort of young women (mean age at baseline: 29.9 years [range: 15.7-46.9]). Exposure information on 48 627 women from the Danish National Birth Cohort was linked to the Danish National Patients Registry for information on events of hypertensive, cerebrovascular, and ischemic heart disease used to define a combined measure of cardiovascular diseases. Intake of fish and LCn3FAs was assessed by a food-frequency questionnaire and telephone interviews. During follow-up (1996-2008; median: 8 years), 577 events of cardiovascular disease were identified. Low LCn3FA intake was associated with an increased risk of cardiovascular disease (adjusted hazard ratio for women in lowest versus highest LCn3FA intake group: 1.91 [95% CI: 1.26-2.90]). Restricting the sample to women who had consistently reported similar frequencies of fish intake across 3 different dietary assessment occasions tended to strengthen the relationship (hazard ratio for lowest versus highest intake: 2.91 [95% CI: 1.45-5.85]). Furthermore, the observed associations were consistent in supplementary analyses where LCn3FA intake was averaged across the 3 dietary assessment occasions, and the associations were persistent for all 3 of the individual outcomes. Our findings based on a large prospective cohort of relatively young and initially healthy women indicated that little or no intake of fish and LCn3FAs was associated with an increased risk of cardiovascular disease.     

主动脉根部内径与心血管疾病的关系

目的 分析北京社区中老年人群主动脉根部内径与心血管疾病危险因素及心血管疾病的关系.方法 2004至2005年在北京首钢地区对1061名居民进行流行病学调查,选取超声心动资料齐全者共1041名进行分析.采用超声心动图测量主动脉根部内径、左心室质量、室间隔和左心室后壁厚度以及左心室大小,同时调查相关心血管危险因素及心血管疾病.采用spearman相关计算主动脉根部内径与其他心血管危险因素的关系.采用多因素logistic回归计算主动脉根部内径与心血管疾病的关系.结果 近端升主动脉内径(AAD)和平均根部内径(MRD)与年龄、体重、体质指数(BMI)、收缩压和舒张压相关(P<0.01),还与左心房大小、左心室质量、室间隔及左心室后壁厚度,左心室大小相关(P<0.01).以AAD和MRD下四分之一位数为参考,女性AAD上四分之一位数卒中、心力衰竭、总体心血管疾病OR值分别为2.20(95%CI:1.03~4.72,P=0.04),2.62(95%CI:1.49~4.61,P=0.001),2.52(95%CI:1.51,4.21,P<0.001);MRD上四分之一位数心力衰竭、总体心血管疾病的OR值分别为2.19(95%CI:1.26~3.80,P=0.01),2.20(95%CI:1.32~3.68,P=0.002).调整年龄、BMI、吸烟史、总胆固醇、高血压和糖尿病后,上述结果不再具有统计学意义(P>0.05).结论 主动脉根部内径相关指标与某些心血管疾病危险因素相关,但不与心血管疾病独立相关,可能是心血管疾病的一个中间指标.联合主动脉根部内径及传统的心血管疾病危险因素或许可以更好地评估心血管疾病.

Abstract：

Objective To analyze the relation among aortic root dimension(ARD) measured by echocardiography, cardiovascular disease risk factors and cardiovascular disease in adult Beijing community population.Methods Echocardiography was performed in 1041 individuals in a suburban community of Beijing from 2004 to 2005. ARD and other echocardiographic parameters including left atria dimension, left ventricular mass, septal and posterior wall thickness and dimension were analyzed. Histories of cardiovascular disease as well as risk factors were obtained. Spearman correlation was used to determine the relation between ARD and other cardiovascular risk factors. Multifactorial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of ARD and cardiovascular disease.ResultsAscending aortic dimension (AAD) and mean root dimension(MRD) were positively associated with age, weight, BMI, systolic and diastolic blood pressure, left atria dimension, left ventricular mass, left ventricular septal and posterior wall thickness, and left ventricular dimension. With the lowest quintile of AAD and MRD as the reference, ORs for the highest quintile of AAD for specific cardiovascular diseases in female were as follows: stroke (OR=2.20,95%CI:1.03-4.72,P=0.04),chronic heart failure (OR=2.62, 95%CI:1.49-4.61,P=0.001),total cardiovascular disease (OR=2.52, 95%CI:1.51-4.21,P<0.001).ORs of MRD were as follows: chronic heart failure (OR=2.19, 95%CI:1.26-3.80,P=0.01), total cardiovascular disease (OR=2.20, 95%CI:1.32-3.68,P=0.002). After adjustment for age, BMI, smoking status, TC,hypertension, diabetes mellitus, the ORs were not statistically significant (P>0.05).Conclusion ARD was positively associated with several CHD risk factors, but was not independent risk factor for cardiovascular disease. ARD may act as an intermediate risk factor for cardiovascular disease. Combined ARD and traditional cardiovascular disease risk factors might enhance the predict power for cardiovascular disease.     

Hard drinking water does not protect against cardiovascular disease: new evidence from the British Regional Heart Study.

BACKGROUND: It has been previously suggested that hard drinking water in general, and in particular high calcium and magnesium intake from drinking water, protect against cardiovascular disease. DESIGN: Prospective study of men from 24 British towns, with widely differing levels of hardness in drinking water. METHODS: A total of 7,735 men aged 40-59 years were recruited during 1978-1980. Estimates of town-level water hardness were available and tap water samples, taken from 947 participants who also answered a questionnaire about water consumption, were used to calculate individual calcium and magnesium intakes. Men were followed for incident of major coronary heart disease (CHD) and stroke, and CHD mortality for 25 years. RESULTS: Water hardness varied from 0.27 to 5.28 mmol/l in the 24 towns. A weak inverse association was found between water hardness and incidence of cardiovascular disease (CVD) [hazard ratio (HR), 0.96 per two-fold increase, 95% confidence interval (CI), 0.91-1.01, P=0.08 after adjustment for age and seven established coronary risk factors]. No association was observed with CHD incidence (adjusted HR, 0.99, 95% CI, 0.94-1.04, P=0.62) or mortality (adjusted HR, 0.96, 95% CI, 0.90-1.02, P=0.18). Individual magnesium intake showed a positive, rather than an inverse, association with CHD incidence (adjusted HR, 1.10 per two-fold increase, 95% CI, 1.01-1.20, P=0.045); individual calcium intake was unrelated to CHD or CVD end points. CONCLUSIONS: This study suggests that neither high water hardness, nor high calcium or magnesium intake appreciably protect against CHD or CVD. Initiatives to add calcium and magnesium to desalinated water cannot be justified by these findings.     

Heterogeneity in the prevalence of risk factors for cardiovascular disease and type 2 diabetes mellitus in obese individuals: effect of differences in insulin sensitivity

BACKGROUND: The possibility that substantial heterogeneity in metabolic abnormalities exists in moderately obese individuals has not been emphasized in studies of the effect of obesity on morbidity and mortality. We tested the hypothesis that risk factors for type 2 diabetes mellitus and cardiovascular disease vary dramatically in moderately obese individuals as a function of differences in a specific measure of insulin sensitivity. METHODS: Participants included 211 apparently healthy, obese (body mass index [calculated as weight in kilograms divided by height in meters squared], 30.0-34.9) volunteers for weight loss studies. Main outcome measures included insulin-mediated glucose uptake as quantified by the insulin suppression test and metabolic variables known to increase the risk for type 2 diabetes and cardiovascular disease. RESULTS: Insulin sensitivity varied 6-fold. When compared with the most insulin-sensitive third, the most insulin-resistant third of the population had significantly higher (P<.001) systolic and diastolic blood pressure (139 +/- 20 vs 123 +/- 18 mm Hg, and 83 +/- 3 vs 75 +/- 10 mm Hg, respectively), higher fasting and 2-hour oral glucose load concentrations (103 +/- 11 vs 95 +/- 11 mg/dL [5.7 +/- 0.6 vs 5.3 +/- 0.6 mmol/L], and 139 +/- 30 vs 104 +/- 19 mg/dL [7.7 +/- 1.7 vs 5.8 +/- 1.1 mmol/L], respectively), higher plasma triglyceride concentrations (198 +/- 105 vs 114 +/- 51 mg/dL [2.2 +/- 1.2 vs 1.3 +/- 0.6 mmol/L]), lower plasma high-density lipoprotein cholesterol concentrations (41 +/- 9 vs 50 +/- 13 mg/dL [1.1 +/- 0.2 vs 1.3 +/- 0.3 mmol/L]), and more prevalent impaired glucose tolerance (47% vs 2%). CONCLUSIONS: The magnitude of risk factors for type 2 diabetes and cardiovascular disease varies markedly in moderately obese individuals as a function of differences in degree of insulin sensitivity. Because not all moderately obese individuals are at similar risk for developing type 2 diabetes and cardiovascular disease, intensive therapeutic interventions should be addressed to the insulin-resistant subset of this population.     

秦皇岛市13～15岁人群不同空腹血糖水平心血管危险因素分析

目的探讨秦皇岛市13～15岁人群不同空腹血糖(FPG)水平心血管危险因素聚集情况.方法测量1665名13～15岁青少年的身高、体重、腰嗣、臀同、血压、FPG、血甘油三酯(TG)、总胆固醇(Tc)、高密度脂蛋白一胆固醇(HDL-C)和低密度脂蛋白-胆固醇(LDL-C)水平.具有超重、高血压和血脂异常中2项或以上者为心血管危险因素聚集.结果 (1)人群按FPG分为<4.4(n=176),4.4～4.9(n=740),5.0～5.5(n=650),5.6～6.0(n=91)和≥6.1 mmol/L(n=8)5组.可见心血管危险因素聚集的检出率随FPG升高逐步上升,分别为7.4%,5.9%,8.8%,15.4%和37.5%.Logistic回归分析表明,校正性别、年龄后,5.6～6.0 mmol/L组心血管危险因素聚集的检出率已明显升高,为FPG<4.4 mmol/L组的2.365倍(95%CI:1.005～5.564,P=0.049).(2)以FPG 5.6 mmol/L为切点分为FPG正常组(FPG<5.6 mmol/L,n=1566)及空腹血糖受损(IFG)组(FPG 5.6～7.0 mmol/L,n=99),IFG组体重指数[(21.4±4.2)kg/m2 υs. (20.3 4±3.9)ks/m2]、腰围[(70.4 4-10.7)cm υs.(67.0±9.6)am]、收缩压(109.4±13.8)mm Hg υs.(106.4±12.9)mm Hg,1 mm Hg=0.133 kPa J均高于FPG正常组,两组间比较均有统计学差异(P<0.05).结论FPG超过5.6 mmol/L的13～15岁青少年已存在心血管危险凶素聚集,应该蕈视对青少年心血管危险因素的预防.