急性冠脉综合征患者血尿酸变化的临床意义

随着生活方式及饮食结构的改变，冠心病的发病率明显增高，高血压、糖尿病、高血脂是冠心病的易患因素被临床广泛重视。近年来的研究发现，高尿酸血症与冠心病的发生密切相关，是独立的危险因素。但临床上对尿酸（uA）的重视程度不及高血压、高血糖和高血脂。我们对50例急性冠脉综合征（ACS）患者进性了血UA检测，探讨其临床意义。     

ApoE基因多态性与多因素作用致冠心病研究

目的 探讨冠心病的主要危险因素及载脂蛋白E(ApoE)基因多态性与其它各危险因素之间的交互效应。方法 选择90例冠心病患者(CHD组)及90例非冠心病患者(对照组)，在Logistic回归分析的基础上，分析各因素的比值比以及ApoE基因多态性与其它危险因素之间的交互作用。结果 多因素Logistic回归结果显示，高血压史、高血脂史、肺炎衣原体(Cpn)感染、巨细胞病毒(CMV)感染和ApoE基因多态性为冠心病的危险因素，比值比OR分别为5.04，3.64，2.37，3.51，3.33。ApoE基因多态性与高血压史、高血脂史、Cpn感染、CMV感染间交互作用指数分别为1、73，1.55，1.28，1.20，归因交互百分比分别为40.64％，33.25％，19.01％和15.15％。结论 高血压史、高血脂史、Cpn感染、CMV感染和ApoE基因多态性可能是冠心病的主要危险因素，且ApoE基因多态性与其它危险因素在致冠心病的关系中存在正交互作用。     

高血压、吸烟、脂代谢紊乱在冠心病中协同作用的研究

在100例冠脉造影确诊的冠心病患者和141例非冠心病对照中进行了高血压、吸烟、脂蛋白及载脂蛋白水平与冠状动脉粥样硬化的关系及其三者在冠心病发病中相互作用关系的研究。结果示:(1)高血压水平、累积吸烟量、高密度脂蛋白及其分型和载脂蛋白Al及B的水平与冠状动脉粥样硬化病变程度呈剂量-反应关系;(2)同时具有高血压和吸烟两项危险因素者的冠脉病变程度及脂代谢紊乱较单一因素者更为严重。提示高血压和吸烟之间在冠心病的发生中有某种相互协同作用,推测其机制可能与脂代谢有关。     

高血压与冠心病

对103例经冠脉造影确诊的冠心病患者1:1配对进行病例对照调查,结果为:有高血压病史者患冠心病的OR为4.636;高血压水平及年限与冠心病的OR值及冠状动脉病变程度间有剂量反应关系;经常服降压药则可使其患冠心病的相对危险性下降70~80%;高血压致冠心病的平均潜隐期为10年;分层及Logistic回归分析均表明:高血压是冠心病的一个独立危险因素。     

内皮脂酶阳性循环内皮细胞比例与冠心病危险因素的关系

目的检测冠心病患者内皮脂酶（EL）阳性循环内皮细胞比例（EL＋／CECs），分析其与冠心病常见危险因素间的关系。方法107例急性冠脉综合征（ACS）患者和69例稳定性心绞痛（SAP）患者经冠脉造影证实有明显冠脉狭窄；经临床检查有危险因素，而冠脉造影无明显狭窄的82例患者为对照。采集肘静脉血液标本，检测血脂、血糖、高敏C反应蛋白（hsCRP）等。分离循环内皮细胞（CEC），以免疫组化法检测循环内皮细胞中EL的表达，并计算EL＋／CECs。所有研究对象收集常见冠心病危险因素（如冠心病家族史、吸烟史、高血压病史、体重指数等），分析EL＋／CECs与危险因素间的关系。结果对照组患者的一般情况与冠心病患者差异无统计学意义，但EL＋／CECs在各组间差异有显著统计学意义（P〈0．05），以ACS组值最大，对照组值最小。以EL＋／CECs比例均数为基准，发现高于EL＋／CECs均数的患者较低于均数组患者其冠心病家族史、吸烟史、糖尿病、低HDL血症等危险因素显著增强（P〈0．05），多元线性Logistic回归分析提示冠心病家族史、吸烟史、糖尿病、低HDL血症、LDIJHDL比值和hsCRP对EL＋／CECs有重要作用（P〈0．05）。结论EL＋／CECs与冠心病临床危险性呈正相关，受冠心病多种危险因素的综合影响。     

内皮脂酶阳性循环内皮细胞比例与冠心病危险因素的关系

目的 检测冠心病患者内皮脂酶(EL)阳性循环内皮细胞比例(EL+/CECs),分析其与冠心病常见危险因素间的关系.方法 107例急性冠脉综合征(ACS)患者和69例稳定性心绞痛(SAP)患者经冠脉造影证实有明显冠脉狭窄;经临床检查有危险因素,而冠脉造影无明显狭窄的82例患者为对照.采集肘静脉血液标本,检测血脂、血糖、高敏C反应蛋白(hsCRP)等,分离循环内皮细胞(CEC),以免疫组化法检测循环内皮细胞中EL的表达,并计算EL+/CECs.所有研究对象收集常见冠心病危险因素(如冠心病家族史、吸烟史、高血压病史、体重指数等),分析EL+/CECs与危险因素间的关系.结果 对照组患者的一般情况与冠心病患者差异无统计学意义,但EL+/CECs在各组间差异有显著统计学意义(P＜0.05),以ACS组值最大,对照组值最小.以EL+/CECs比例均数为基准,发现高于EL+/CECs均数的患者较低于均数组患者其冠心病家族史、吸烟史、糖尿病、低HDL血症等危险因素显著增强(P＜0.05),多元线性Ligistic回归分析提示冠心病家族史、吸烟史、糖尿病、低HDL血症、LDL/HDL比值和hsCRP对EL+/CECs有重要作用(P＜0.05).结论 EL+/CECs与冠心病临床危险性呈正相关,受冠心病多种危险因素的综合影响.     

寒冷＋高血脂=〉心脏高危

杀手一：高血脂 动脉粥样硬化是冠心病和脑动脉血栓形成的病理基础，而动脉粥样硬化的发生与很多危险因素有关，如高血压、高血脂、糖尿病、吸烟和肥胖等。其中高血脂与动脉粥样硬化的形成关系较为密切。     

冠心病患者冠状动脉病变严重程度与冠心病危险因素的相关分析

目的:对冠心病危险因素与冠心病患者冠状动脉病变程度的相关性进行分析,探讨它们之间的联系.方法:60例冠心病患者选自2014年10月至2016年2月期间,对其进行回顾性分析,对临床资料中的危险因素:吸烟、高龄、高血压、糖尿病、血脂、体重指数(BMI),与冠状动脉的严重程度进行先关性分析.结果:冠脉分支病变越多,Gensini评分越高,是否吸烟、高龄、高血压、糖尿病、高血脂、体重指数异常与Gensini评分结果差异明显(P<0.05),单因素分析与多因素分析结果相一致.结论:高龄、吸烟、糖尿病、血脂、体重指数(BMI)与冠脉的病变程度呈正相关,冠心病的防治要积极控制危险因素.     

血尿酸、血脂的改变与冠心病的相关分析

冠心病的危险因素中,高血压、糖尿病、高血脂已被临床广泛重视。近年来,有研究表明高尿酸血症亦与高血压、冠心病的发生密切相关,是独立的危险因素〔1,2〕。但目前临床上对尿酸的重视程度还不及高血压、高血糖、高血脂。笔者进一步探讨高尿酸     

泰安市高校中老年人群高血压患病调查

目的 调查泰安市高校中老年人群高血压患病率,探讨患病危险因素。方法 现况调查和危险因素的病例对照研究。结果 该市高校中老年男女患病率分别为30．89％和29．15％,合并高血脂、冠心病和高血糖分别为32．60％、17．21％和6．22％。患病率随着年龄增加而升高,女性绝经期后患病率迅速升高。结论 泰安地区中老年人群高血压患病率较高,高血脂、肥胖、高盐饮食、缺乏体力活动、高血压家族史、吸烟及睡眠差可能是重要的危险因素。     

Risk perception, knowledge, and lifestyles in siblings of people with premature coronary disease

This study examines perceptions of coronary heart disease (CHD) risk, associated risk factors, and CHD contributory lifestyles in 80 unaffected siblings of people under 60 years of age with recently documented CHD hospitalizations. Brothers and sisters in the aggregate did not perceive their own high relative risk for CHD nor significantly change their smoking habits, body weight, dietary salt or fat intake, self-reported stress levels, or exercise patterns in the four months following a CHD event in a young index case. They did demonstrate moderate general knowledge; however, specific knowledge about the presence or absence of hypercholesterolemia and hypertension in the index sibling was poor, as documented by comparisons of sibling reports to medical records. This study has implications for risk reduction in this easily identifiable high-risk group, which appears, in the aggregate, to resist lifestyle changes following a CHD event in young brothers or sisters.     

冠心病家族史在冠心病发病中作用地位的研究

108例经冠状动脉造影检查(CAG)确诊为冠心病和45例CAG检查结果正常的病人进行了冠心病危险因素的病例对照研究.发现冠心病家族史、高血压病家族史、吸烟、高脂饮食习惯和年龄是冠心病的主要危险因素,其中冠心病家族史的优势比(OR)为5.82,占诸危险因素的首位.冠心病、高血压和脑卒中家族史合并出现时,冠心病的OR值显著提高.多因素分析和分层分析均提示,冠心病家族史是一个独立的危险因素.     

Short- and long-term prediction of clinical and subclinical atherosclerosis by traditional risk factors.

This study compares the cross-sectional and longitudinal associations of cardiovascular risk factors with clinical coronary heart disease (CHD) and with subclinical carotid atherosclerosis measured by ultrasound. The study population were 1410 participants in the Atherosclerotic Risk in Community (ARIC) Study (1987-1989) who also participated in a 1974 community health survey. Smoking in 1974 was associated with increased CHD prevalence in 1987-1989 (adjusted prevalence ratio = 2.2), whereas the corresponding cross-sectional association was practically absent. For hypercholesterolemia and hypertension, the longitudinal associations with CHD were also stronger than the cross-sectional associations. In contrast, the strength of the longitudinal and cross-sectional associations with carotid atherosclerosis was generally similar. These results underscore the advantages of using subclinical measures of atherosclerosis in cross-sectional studies. In addition, they suggest that the presence of smoking, hypertension, or hypercholesterolemia in mid-adulthood may have some persisting effects on the development of atherosclerotic disease in later life.     

Low Fat Intake and Coronary Artery Disease in a Population with Higher Prevalence of Coronary Artery Disease: The Indian Paradox

Objective: To determine the association between saturated fat intake and prevalence of coronary artery disease (CAD) and coronary risk factors.

Design and Setting: Total community cross sectional survey of 20 urban streets out of 196 streets, in the city of Moradabad in north India.

Subjects and Methods: Adult population between 25 to 64 years inclusive comprised of 1806 subjects (904 men, 902 women) were divided into three groups according to level of saturated fat intake as assessed by 7-day dietary intake records (very low <7%, low 7 to 10%, high >10% energy (en) per day).

Results: We examined the relationship between CAD risk and levels of % en from fat intake. Low (7 to 10% en/day) and high (>10% en/day) saturated fat were positively and significantly associated with higher prevalence of CAD. The prevalence of coronary risk factors (hypertension, hypercholesterolemia, obesity and sedentary lifestyle) were significantly higher among subjects with low and high saturated fat intake compared to subjects with very low (<7%) saturated fat intake. Logistic regression analysis with adjustment for age showed that hypercholesterolemia (OR: men 0.89, women 0.68), hypertension (men 0.92, women 0.56), physical activity (men 0.80, women 0.36), obesity (men 0.82, women 0.88) and smoking (0.70 men) were significant risk factors of CAD. Low and high saturated fat intake were associated with more prestigious occupations, higher and middle income status and better educational levels compared to very low saturated fat intake.

Conclusions: The prevalence of CAD and coronary risk factors was higher in urban Indians with low and high saturated fat intake than those with lower saturated fat intake. These findings suggest that the saturated fat intake should be <7% en/day for prevention of CAD in Indians.     

Risk stratification of coronary heart disease in Greece: final results from the CARDIO2000 Epidemiological Study

BACKGROUND: In past years several risk factors have been associated with the incidence of coronary heart disease. The aim of this study was to investigate the associations between the risk of developing acute coronary syndromes and several risk factors in Greece. METHODS: During 2000-2002, 700 male (59 +/- 10 years old) and 148 female (65 +/- 9 years old) patients with the first event of an acute coronary syndrome were randomly selected from cardiological clinics of all Greek regions. Afterward, 1,078 population-based controls were randomly selected from the same hospitals and matched to the patients by sex and age. Detailed information regarding their medical and psychosocial status and various lifestyle habits related to coronary risk was recorded. RESULTS: The frequency ratio between males and females in the case series of patients was 4:1. The statistical analysis showed that smoking (odds ratio = 1.61, P < 0.001), hypertension (odds ratio = 1.99, P < 0.001), hypercholesterolemia (odds ratio = 3.53, P < 0.001), diabetes mellitus (odds ratio = 2.44, P < 0.01), family history of CHD (odds ratio = 3.19, P < 0.001), exposure to passive cigarette smoking (odds ratio = 1.54, P < 0.01), and depressive episodes (odds ratio = 1.35, P < 0.01) were associated with an increased coronary risk, while physical activity (odds ratio = 0.81, P = 0.01), adoption of Mediterranean diet (odds ratio = 0.80, P < 0.05), and high education (odds ratio = 0.81, P < 0.001) were associated with a significant reduction of the coronary risk. Also, a J-shape association was found between alcohol intake and coronary risk. CONCLUSION: Several emerging lifestyle risk factors (education, depression, diet, passive smoking), in addition to the conventional ones, may contribute to the risk of coronary events in this population.     

Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches

STUDY OBJECTIVES: There are contradictory perspectives on the importance of conventional coronary heart disease (CHD) risk factors in explaining population levels and social gradients in CHD. This study examined the contribution of conventional CHD risk factors (smoking, hypertension, dyslipidaemia, and diabetes) to explaining population levels and to absolute and relative social inequalities in CHD. This was investigated in an entire population and by creating a low risk sub-population with no smoking, dyslipidaemia, diabetes, and hypertension to simulate what would happen to relative and social inequalities in CHD if conventional risk factors were removed. DESIGN, SETTING, AND PARTICIPANTS: Population based study of 2682 eastern Finnish men aged 42, 48, 54, 60 at baseline with 10.5 years average follow up of fatal (ICD9 codes 410-414) and non-fatal (MONICA criteria) CHD events. MAIN RESULTS: In the whole population, 94.6% of events occurred among men exposed to at least one conventional risk factor, with a PAR of 68%. Adjustment for conventional risk factors reduced relative social inequality by 24%. However, in a low risk population free from conventional risk factors, absolute social inequality reduced by 72%. CONCLUSIONS: Conventional risk factors explain the majority of absolute social inequality in CHD because conventional risk factors explain the vast majority of CHD cases in the population. However, the role of conventional risk factors in explaining relative social inequality was modest. This apparent paradox may arise in populations where inequalities in conventional risk factors between social groups are low, relative to the high levels of conventional risk factors within every social group. If the concern is to reduce the overall population health burden of CHD and the disproportionate population health burden associated with the social inequalities in CHD, then reducing conventional risk factors will do the job.     

Coronary heart disease and cardiovascular risk factors among people aged 25–65 years,as seen in Romanian primary healthcare

Background: In Romania data on cardiovascular risk factors are sparse. Objective: To describe the prevalence and distribution of cardiovascular risk factors in a primary care setting in Romania. Methods: In a cross-sectional study, patients aged 25–65 years on the lists of four general practitioners in Iasi (Romania), selected by 1/5 systematic sampling, were invited for a cardiovascular risk evaluation (interview, physical examination, blood tests for cholesterol and glucose). Prevalence rates for coronary heart disease (CHD), diabetes (DM) and other risk factors were estimated, SCORE risk was determined, and treatment targets were evaluated. Results: The response rate was 79% (325 men, 476 women). Prevalence rates were: CHD 7.4%, DM 3.2%, hypercholesterolemia (>190 mg%) 47.2%, hypertension 23.7%, obesity 21.2%, and smoking 33.8%. In women, obesity and lack of physical exercise were more prevalent, whereas in men, higher rates were found for smoking and an unhealthy diet. The proportion of patients considered to be at high risk (CHD, DM or SCORE ≥ 5%) was 39.2%. Female patients failed to meet targets for systolic blood pressure, total cholesterol and glucose, whereas smoking cessation will be the greatest challenge for men. Conclusion: There were relevant gender differences in modifiable cardiovascular risk factors. Many patients failed to meet treatment targets.     

Cereal fiber and coronary heart disease: a comparison of modeling approaches for repeated dietary measurements,intermediate outcomes,and long follow-up

The appropriate manner of incorporating incident angina, coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), diabetes, hypertension, and hypercholesterolemia, which may be both intermediate events and time-dependent confounders, into analyses of diet and coronary heart disease (CHD) is not clear. Using data from 72,266 women in the Nurses’ Health Study between 1984 and 2006, the authors examined the relation between report of intermediate events and change in cereal fiber intake and used different proportional hazards models to evaluate the association between cereal fiber and CHD. Cereal fiber intake increased significantly among participants who reported hypercholesterolemia (0.42 g/day; 95% CI: 0.34, 0.51 g/day) and diabetes (0.07 g/day with each additional 2-year increment; 95% CI: 0.01, 0.13 g/day). However, angina, CABG/PCI, and hypertension were not associated with a change in cereal fiber intake and thus were not important time-dependent confounders. Cereal fiber intake was inversely associated with risk of CHD in all proportional hazards models, but results varied modestly depending on the approach used to incorporate multiple measures of diet. Because stopping the updating of dietary variables when an intermediate event is diagnosed may lead to misclassification, future analyses should consider updating diet even after these diagnoses to best represent long-term intake. To best evaluate associations with incidence of disease, considerations should include the temporal trends in diet, changes in intake following intermediate events, and latency patterns. Sensitivity analyses can also be useful.     

The relationship between education and risk factors for coronary heart disease

In nine samples of adult populations (2707 males and 2871 females, aged 20–59 years) we studied the relationship between educational level and several lifestyle factors at risk for coronary heart disease (CHD), (i.e., smoking, alcohol consumption, dietary fat intake, sedentary behaviour at work and leisure) and the association between education and certain CHD risk factors (i.e., total cholesterol, HDL-cholesterol, triglycerides, systolic and diastolic blood pressure, body mass index). The data were analyzed separately in samples from North, Central and Southern Italy. The results show that educational level is often associated to the lifestyle factors considered here. This association was positive for both men and women for physical activity at leisure and work stress and only for women with respect to smoking. It was negative for both men and women for alcohol consumption and physical activity at work and for men only for cigarette smoking. The age-adjusted mean levels of the CHD risk factors show some significant differences among subjects with different educational levels, which were not always the same for the three geographical areas. This was with the exception of BMI in females, which appears negatively associated to education in all areas. These differences decreased after adjustments were made for daily cigarette smoking, wine consumption and dietary fat intake. Education seems to play a determining role in lifestyle, however its direct and indirect effects on some major CHD risk factors are somewhat different in areas at different socio-economic conditions.     

A case-control study of coronary heart disease in Athens, Greece.

A case-control study of coronary heart disease (CHD) was conducted in Athens, Greece. The case series consisted of 329 patients with electrocardiographically confirmed coronary infarct or a diagnostic coronary arteriogram, or both, who were admitted during a 16-month period to a major teaching hospital. Controls were 570 patients admitted to the same hospital just before or after the CHD cases for minor surgery; eye, ear, nose or minor urological problems; or chest problems definitely shown to be unrelated to CHD. All cases and controls were interviewed in the hospital wards and selected laboratory data were abstracted. The main analysis was done by modelling through multiple logistic regression, controlling for demographic variables as well as for the mutual confounding effects of the investigated risk factors. Obesity, hypertension, diabetes mellitus, elevated blood cholesterol and excessive coffee intake were significant (P < 0.02) independent risk factors with relative risk estimates in the 2- to 3-fold range. Non-significant positive associations were found with respect to tobacco smoking and modest coffee consumption, whereas non-significant negative associations were noted with respect to alcohol intake and regular exercise. A negative association with duration of afternoon siesta was of borderline statistical significance.