美国心血管病近年发病趋势

美国心血管病从上世纪60年代和70年代经历了惊人的增长后,胆固醇阻塞冠状动脉的死亡率从80年代开始逐年呈下降的趋势(如图一)。这个数字的下降归功于积极控制诱发心血管病的危险因素如:血压、胆固醇、吸烟、及其他危险的因素,以及推出新的治疗方案。研究人员使用复杂的电脑模式对全国诱发心血管病的危险因素改善,新技术,治疗方案等作出它们应有的贡献给予评价,     

高血压与心血管病发病的风险综述

高血压作为心血管疾病的常见病,其危害性也取决于其他心血管病等因素的影响,高血压除了对患者器官损害及其它合并症相关外,现在研究已经确认与糖尿病、高血脂等疾病有一定的危险因素,而且也有专家研究发现,患者的年龄性别及体重、胆固醇高低及体重高低,是否吸烟、是否有糖尿病等危险因素对心血管病发病因素有很大的关联,下面笔者就高血压与心血管病的发病风险综述进行整体与分析。     

高校无症状成年人心血管病发病危险调查

目的:调查武汉大学无症状成年人心血管病危险因素的患病情况,评估该人群未来10年缺血性心血管病发病的风险。方法:选取该校近1年无缺血性心血管病症状成年人的体检资料,了解其性别、年龄、吸烟史、体质指数、胆固醇水平及患糖尿病、高血压病情况,通过简易查表法,对个体的危险因素进行评分,根据总分查到相应10年缺血性心血管病发病绝对危险。结果:总体人群吸烟率、超重、肥胖、高血压、糖尿病、血脂异常的比例分别为13.3%、35.2%、7.4%、33.4%、14.9%、41.6%。男性吸烟率及超重、肥胖的比例明显高于女性,女性血脂异常的患病率明显高于男性。50岁以上男女性高血压、糖尿病患病率无显著性差异。10年心血管病发病绝对危险随年龄增长不断增高,女性各年龄组发病风险均低于男性。结论:60岁以上男性及70岁以上女性心血管病总体危险较高,男性应加强体重的干预,女性应加强控制血脂的干预措施。     

中国正常高值血压人群的心血管病发病危险

目的研究在多省市35～64岁人群中正常高值血压的分布情况,分析正常高值血压[SBP130～139mmHg及(或)DBP85～89mmHg]与心血管病(CVD)发病危险的关系。方法在中国多省市前瞻性队列研究数据基础上,对1992年建立的11省市35～64岁队列人群共30378人的基线血压水平和1992-2003年期间发生的CVD[包括冠心病(CHD)和脑卒中]事件的关系进行分析。结果1)我国35～64岁人群中正常高值血压者占32.1%,与高血压的比例为1.2:1.0。2)多因素分析显示:以正常血压为对照,正常高值血压增加脑卒中发病危险56%(RR=1.559;95%CI1.163,2.089);增加CHD发病危险44%(RR=1.441;95%CI0.996,2.086);增加总的CVD发病危险52%(RR=1.522,95%CI1.206,1.919)。正常高值血压对出血性卒中的作用(RR=2.082,95%CI1.116,3.885)大于对缺血性卒中的作用(RR=1.474;95%CI1.050,2.069)。3)在总的CVD事件中,14.4%归因于正常高值血压;其中12.4%的CHD事件和15.2%的脑卒中事件归因于正常高值血压。结论我国35～64岁人群中正常高值血压比例很高。正常高值血压增加人群脑卒中和CVD发病危险。对正常高值血压人群采用生活方式干预具有重要的公共健康意义。     

高同型半胱氨酸血症与心血管病发病机制研究进展

随着检测水平的提高和分子生物学技术的发展 ,越来越多的研究证实 :高同型半胱氨酸( Hyperhomocysteiemia,HCY)血症与动脉粥样硬化 ( AS)及血栓形成密切相关。因此 ,对于 HCY血症与冠心病 ( CHD)发病机制的研究 ,已引起基础和临床界的关注。本文着重就近年有关 HCY血症与CHD之间的关系、引发机制、HCY的形成及治疗研究综述如下。1　HCY血症与心血管疾病 ( CVD)的关系1 .1　HCY血症与 AS的关系早在 1 969年曾有人从尸检发现 2例血浆HCY浓度超过正常人的几十倍的患儿 ,存在广泛的 AS和动脉血栓。Welch等〔1〕给狒狒注射 HCY…     

中国正常高值血压人群的心血管病发病危险

目的 研究在多省市35～64岁人群中正常高值血压的分布情况,分析正常高值血压[SBP 130～139 mm Hg及(或)DBP 85～89 mm Hg]与心血管病(CVD)发病危险的关系.方法 在中国多省市前瞻性队列研究数据基础上,对1992年建立的11省市35～64岁队列人群共30378人的基线血压水平和1992-2003年期间发生的CVD[包括冠心病(CHD)和脑卒中]事件的关系进行分析.结果 1)我国35～64岁人群中正常高值血压者占32.1%,与高血压的比例为1.2:1.0.2)多因素分析显示:以正常血压为对照,正常高值血压增加脑卒中发病危险56%(RR=1.559;95%CI 1.163,2.089);增加CHD发病危险44%(RR=1.441;95%CI 0.996,2.086);增加总的CVD发病危险52%(RR=1.522,95%CI 1.206,1.919).正常高值血压对出血性卒中的作用(RR=2.082,95%CI 1.116,3.885)大于对缺血性卒中的作用(RR=1.474;95%CI 1.050,2.069).3)在总的CVD事件中,14.4%归因于正常高值血压;其中12.4%的CHD事件和15.2%的脑卒中事件归因于正常高值血压.结论 我国35～64岁人群中正常高值血压比例很高.正常高值血压增加人群脑卒中和CVD发病危险.对正常高值血压人群采用生活方式干预具有重要的公共健康意义.     

低密度脂蛋白胆固醇与心血管病发病关系的前瞻性研究

目的研究我国人群低密度脂蛋白胆固醇(LDL-C)的分布特征及其与心血管病发病的关系.方法采用前瞻性队列研究方法,对11省市队列人群(35～64岁)共29564人于1992年进行基线调查.对1992～1999年共129350观察人年中发生的心血管病事件进行登记.分析人群基线调查的LDL-C分布特征及其与心血管病发病的关系.结果(1)男女两性LDL-C均值分别为2.65mmol/L和2.70mmol/L(P＜0.01).LDL-C随年龄的增加而升高,女性50～54岁组升高最多;(2)LDL-C超过中位数(2.60mmol/L)时男性缺血性心血管病发病率明显升高;(3)甘油三酯升高(男性≥1.24mmol/L;女性≥1.13mmol/L)合并LDL-C升高者,男女冠心病发病率分别是单纯LDL-C升高者的3倍和2倍;(4)C0x回归显示本研究人群LDL-C每升高1mmol/L可使男性冠心病增加36%,缺血性卒中增加31%.结论我国人群的LDL-C处于较低水平,但LDL-C仍是男性缺血性心血管病(冠心病、缺血性脑卒中)的"独立”危险因素.心血管病防治中不应"独立”地看待某一因素,更应注重多因素的协同作用.     

抗氧化维生素是否能降低心血管病发病的危险性

美国心脏病学会科学顾问组于 2 0 0 4年 8月 3日发表论著 ,其结论是 :(1)目前尚不能证明应用抗氧化维生素能降低心血管发病的危险性。相同的结论见于美国心脏病学会2 0 0 4年关于女性心血管病预防的建议 ,美国心脏病学院和美国心脏病学会 2 0 0 2年关于慢性稳定型心绞痛的建议。(2 )欲降低心血管病发病的危险性 ,应该做到 :长期摄取符合美国心脏病学会饮食指南的膳食 ;依靠能量摄取和有规律的体力活动相平衡来达到长期维持健康体重 ;以及维持满意的血胆固醇和脂蛋白水平和血压水平。 (3)摄取微量营养素超过美国心脏病学会饮食指南规定的合理…     

HIV type 1 incidence estimates by detection of recent infection from a cross-sectional sampling of injection drug users in Bangkok: use of the IgG capture BED enzyme immunoassay

Development of serologic tests to detect recent HIV-1 infection has generated worldwide interest in applying this approach to estimate incidence. We previously devised an IgG-capture BED-EIA (or BED-CEIA) that detects increasing levels of anti-HIV IgG following seroconversion to identify recent infection and to estimate incidence among persons infected with diverse HIV-1 subtypes worldwide. Injection drug users (IDUs; n = 1969) were screened in 1996 for participation in a prospective cohort study. Serum specimens from 594 IDUs were HIV-1 seropositive (30.2%) and were tested with the BED-CEIA. The proportion of recent infections and estimated incidence by different epidemiological risk factors were compared with incidence data measured from the prospective cohort. Of 594 HIV-1-seropositive specimens, 113 (19%) were identified as recent infections. Overall, the estimated annual incidence among persons screened was 17.3%/year (95% CI, 12.8-24.2%/year) compared with 9.0%/year (95% CI, 6.7-11.9%/year) measured from the prospective cohort during the same time period. Estimated incidence was higher among younger aged and unemployed IDUs as well as among those who injected more frequently, confirming previously reported risk factors from this prospective cohort. As persons screened from a cross-sectional sampling probably have higher risk for HIV than selected uninfected individuals who choose to participate and receive risk reduction counseling in a longitudinal cohort study, use of this or other serologic testing strategies to identify populations with high incidence (such as for HIV vaccine trials) may overestimate incidence measured from prospective cohorts.     

Associations of factor VIIIc,D‐dimer,and plasmin–antiplasmin with incident cardiovascular disease and all‐cause mortality

To examine the associations of three understudied hemostatic factors—D‐dimer, factor VIII_c, and plasmin‐antiplasmin (PAP) complex—with incident cardiovascular disease (CVD) and all cause mortality in the Multiethnic Study of Atherosclerosis cohort. Hemostatic factors were measured at baseline in 45–84‐year‐old patients (n = 6,391) who were free of clinically recognized CVD. Over 4.6 years of follow‐up, we identified 307 CVD events, 207 hard coronary heart disease events, and 210 deaths. D‐dimer, factor VIII_c, and PAP were not associated with CVD incidence after adjustment for other risk factors. In contrast, each factor was associated positively with total mortality, and D‐dimer and factor VIII_c were associated positively with cancer mortality. When modeled as ordinal variables and adjusted for risk factors, total mortality was greater by 33% (95% CI 15–54) for each quartile increment of D‐dimer, 26% (11–44) for factor VIIIc, and 20% (4–38) for PAP. This prospective cohort study did not find D‐dimer, factor VIII_c, or PAP to be risk factors for CVD. Instead, elevated levels of these three hemostatic factors were associated independently with increased risk of death. Elevated D‐dimer and factor VIII_c were associated with increased cancer death. Am. J. Hematol., 2009. © 2009 Wiley‐Liss, Inc.     

Screen-detected diabetes, hypertension and hypercholesterolemia as predictors of cardiovascular mortality in five populations of Asian origin: the DECODA study.

BACKGROUND: The World Health Organization (WHO) predicts that the Asia Pacific region will experience an increase in cardiovascular disease (CVD) as a result of demographic changes and an increasing prevalence of diabetes. The aims of this study were to assess the predictive value of glucose tolerance status as a risk factor for CVD and identify a high-risk group for fatal CVD in population-based studies of Asians. DESIGN: A meta-analysis of five prospective cohort studies of Japanese and Asian Indian origin from five countries. METHODS: A total of 6573 subjects without a history of CVD from five prospective studies were followed for 5-10 years. Diabetes at baseline was diagnosed according to 1999 WHO criteria. Hazard ratios for death from CVD were estimated using a Cox proportional hazard model, adjusting for glucose tolerance status together with established risk factors for CVD. RESULTS: The meta-analysis showed that the overall hazard ratios (95% confidence interval) for CVD mortality corresponding to the presence of screen-detected diabetes, hypertension and hypercholesteremia were 3.42 (2.23-5.23), 1.57 (1.10-2.24) and 1.49 (1.05-2.10), respectively. Stratified multivariate analysis of the pooled data showed that subjects with screen-detected diabetes in the presence of hypertension or hypercholesteremia had the highest risk of CVD in individuals without previous CVD or diabetes. Subjects with screen-detected diabetes in the presence of hypertension or hypercholesteremia comprised 78% of CVD deaths that occurred in all subjects with screen-detected diabetes. CONCLUSIONS: The early detection of undiagnosed diabetes in hypertension or hypercholesteremia may have clinical and public health implications for the primary prevention of rapidly increasing diabetes-related atherosclerotic CVD in Asian populations.     

Cardiovascular morbidity and associated risk factors in Spanish patients with chronic inflammatory rheumatic diseases attending rheumatology clinics: Baseline data of the CARMA Project

ObjectiveTo establish the cardiovascular (CV) morbidity and associated risk factors for CV disease (CVD) in Spanish patients with chronic inflammatory rheumatic diseases (CIRD) and unexposed individuals attending rheumatology clinics.MethodsAnalysis of data from the baseline visit of a 10-year prospective study [CARdiovascular in rheuMAtology (CARMA) project] that includes a cohort of patients with CIRD [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)] and another cohort of matched individuals without CIRD attending outpatient rheumatology clinics from 67 hospitals in Spain. Prevalence of CV morbidity, CV risk factors, and systematic coronary risk evaluation (SCORE) assessment were analyzed.ResultsA total of 2234 patients (775 RA, 738 AS, and 721 PsA) and 677 unexposed subjects were included. Patients had low disease activity at the time of recruitment. PsA patients had more commonly classic CV risk factors and metabolic syndrome features than did the remaining individuals. The prevalence of CVD was higher in RA (10.5%) than in AS (7.6%), PsA (7.2%), and unexposed individuals (6.4%). A multivariate analysis adjusted for the presence of classic CV risk factors and disease duration revealed a positive trend for CVD in RA (OR = 1.58; 95% CI: 0.90–2.76; p = 0.10) and AS (OR = 1.77; 95% CI: 0.96–3.27; p = 0.07). Disease duration in all CIRD groups and functional capacity (HAQ) in RA were associated with an increased risk of CVD (OR = 2.15; 95% CI: 1.29–3.56; p = 0.003). Most patients had a moderate CV risk according to the SCORE charts.ConclusionsDespite recent advances in the management of CIRD, incidence of CVD remains increased in Spanish subjects with CIRD attending outpatient rheumatology clinics.     

北京地区青年人群心血管病危险因素10年变化趋势

目的 :探讨北京地区青年人群心血管病危险因素 10年 (1992年至 2 0 0 2年 )变化趋势。方法 :1992年在北京大学和首钢地区建立了年龄为 35～ 6 4岁人群的心血管病危险因素研究队列 ,取得了基线调查数据 ,在 2 0 0 2年对该人群再次进行了心血管病危险因素调查。该研究对 1992年参加调查的 35～ 4 4岁人群 ,同时参加了 2 0 0 2年调查且资料完整的 12 0 3人的 10年心血管病危险因素变化情况进行流行病学分析。结果 :1 1992年至 2 0 0 2年北京地区 35～ 4 4岁青年人的主要心血管病危险因素均呈上升趋势。其中甘油三酯 (TG)变化幅度最大 ,10年间上升了 5 0 . 3%。其次为总胆固醇 (TC) ,增加了 16 . 6 %。2 10年间男女两性危险因素水平均呈增加变化 ,但女性多个危险因素增加的幅度大于男性。 3 心血管疾病的危险因素普遍存在 ,具有一个或一个以上危险因素的比例由 1992年的 4 1 9%上升到 2 0 0 2年的6 9. 8%。青年人群超重肥胖率由 4 7. 4 %上升到 6 8. 3%。结论 :北京地区 35～ 4 4岁青年人随着年龄的增加 ,10年间心血管病危险因素水平均呈上升变化 ,其中血脂水平增加的幅度最大。女性心血管病危险因素平均水平上升的幅度大于男性。心血管病危险因素在北京地区的青年人群中普遍存在。应该更加重视控制青年人?     

Impact of high-normal blood pressure on the risk of cardiovascular disease in a Japanese urban cohort: the Suita study

Few prospective studies have examined the association between high-normal blood pressure and cardiovascular disease (CVD) in Asia. We examined the impact of high-normal blood pressure on the incidence of CVD in a general urban population cohort in Japan. We studied 5494 Japanese individuals (ages 30 to 79 years without CVD at baseline) after completing a baseline survey who received follow-up through December 2005. Blood pressure categories were defined on the basis of the ESH-ESC 2007 criteria. In 64 391 person-years of follow-up, we documented the incidence of 346 CVD events. The frequencies of high-normal blood pressure and hypertension Stage 1 and Stage >or=2 were 18.0%, 20.1%, and 10.1% for men and 15.9%, 15.6%, and 8.8% for women, respectively. Antihypertensive drug users were also classified into the baseline blood pressure categories. Compared with the optimal blood pressure group, the multivariable hazard ratios (95% confidence intervals) of CVD for normal and high-normal blood pressure and hypertension Stage 1 and Stage >or=2 were 2.04 (1.19 to 3.48), 2.46 (1.46 to 4.14), 2.62 (1.59 to 4.32), and 3.95 (2.37 to 6.58) in men and 1.12 (0.59 to 2.13), 1.54 (0.85 to 2.78), 1.35 (0.75 to 2.43), and 2.86 (1.60 to 5.12) in women, respectively. The risks of myocardial infarction and stroke for each blood pressure category were similar to those of CVD. Population-attributable fractions of high-normal blood pressure and hypertension for CVD were 12.2% and 35.3% in men and 7.1% and 23.4% in women, respectively. In conclusion, high-normal blood pressure is a risk factor for the incidence of stroke and myocardial infarction in a general urban population of Japanese men.     

The association between hepatitis C infection and prevalent cardiovascular disease among HIV-infected individuals

OBJECTIVE: To examine the association between hepatitis C and prevalent cardiovascular disease (CVD) among HIV-infected individuals. DESIGN: A cross-sectional analysis of data from the HIV-Longitudinal Interrelationships of Viruses and Ethanol (HIV-LIVE) cohort, a prospective cohort of HIV-infected individuals with current or past alcohol problems. METHODS: We analysed health questionnaire and laboratory data from 395 HIV-infected individuals (50.1% co-infected with hepatitis C) using logistic regression to estimate the odds ratio (OR) for the prevalence of CVD among those co-infected with hepatitis C and HIV compared with those infected with HIV alone. RESULTS: The prevalence of CVD was higher among those co-infected with hepatitis C compared with those with HIV alone (11.1 versus 2.5%, respectively). After adjusting for age, the OR for the prevalence of CVD was significantly higher among those with hepatitis C co-infection (adjusted OR 4.65, 95% confidence interval 1.70-12.71). The relationship between hepatitis C and CVD persisted when adjusting for age and other sociodemographic characteristics, substance use, and cardiovascular risk factors in separate regression models. CONCLUSION: Co-infection with hepatitis C among a cohort of HIV-infected individuals was associated with a higher age-adjusted odds for the prevalence of CVD. These data suggest that hepatitis C infection may be associated with an increased risk of CVD among those co-infected with HIV.     

Transition from metabolically healthy to unhealthy overweight/obesity and risk of cardiovascular disease incidence: A systematic review and meta-analysis

AimsDiscrepant results have been demonstrated regarding the cardiovascular (CV) risk of populations with metabolically healthy overweight/obesity (MHO) who were transitioned into metabolically unhealthy states. So, the objective of this systematic review and meta-analysis was to estimate the risk of cardiovascular diseases (CVD) incidence in individuals with transitional MHO phenotype.Data synthesisA literature review was done in PubMed, Scopus, EMBASE, and google scholar databases. Pooled HRs for all fatal and nonfatal CV events were computed using random-effect models for transitional MHOs in general as well as for each sex subgroup separately.This systematic review and meta-analysis included a total of 7 prospective observational studies with a total of 7,720,165 participants, published between 2018 and 2020. The mean follow-up duration of participants was 11.7 (5.5) years. Overall, the transitional MHO individuals had a significant risk of CVD incidence [HR = 1.42, 95% CI (1.24–1.60)]. In addition, in both male and female subgroups, unstable MHO phenotype demonstrated a significant CVD risk and HRs for incident CVD in males and females were 1.51 (1.07–1.96) and 1.71 (1.08–2.34), respectively.ConclusionTransition from MHO to unhealthy state throughout follow-up elevated the risk of CVD in both male and female groups. This can explain the association between MHO and incidence of CV events especially with longer follow up period.Registration code in prosperoCRD42021270225.     

Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies

Background

The association between obstructive sleep apnea (OSA) and the incidence of cardiovascular disease (CVD) has been examined in many studies. However, the findings are not entirely consistent across studies. Our goal was to evaluate the association between OSA and risk of CVD and all-cause mortality by performing a meta-analysis of prospective cohort studies.

Methods

We used generalized least squares regression models to estimate the dose–response relationship. Heterogeneity, subgroup, and sensitivity analyses and publication bias were performed.

Results

Twelve prospective cohort studies involving 25,760 participants were included in the meta-analysis. The overall combined relative risks for individuals with severe OSA compared with individuals with an AHI of < 5 were 1.79 (95% confidence interval [CI]: 1.47 to 2.18) for CVD, 1.21 (95% CI: 0.75 to 1.96) for incident fatal and non-fatal coronary heart disease, 2.15 (95% CI: 1.42 to 3.24) for incident fatal and non-fatal stroke, and 1.92 (95% CI: 1.38 to 2.69) for deaths from all-causes. A positive association with CVD was observed for moderate OSA but not for mild OSA. The results of the dose–response relationship indicated that per 10-unit increase in the apnea–hypopnea index was associated with a 17% greater risk of CVD in the general population.

Conclusions

This meta-analysis of prospective cohort studies suggests that severe OSA significantly increases CVD risk, stroke, and all-cause mortality. A positive association with CVD was observed for moderate OSA but not for mild OSA.     

Diabetes and cardiovascular disease

Cardiovascular disease (CVD) is the most frequent and costly complication of type 2 diabetes. In this review, we examine the impact of diabetes on CVD. Shedding some light on the diabetes/CVD relationship are epidemiologic studies, which focused on Native Americans, who collectively experienced little or no diabetes or CVD in the past, but experience both conditions in epidemic proportions today. Almost half of the Native Americans studied had diabetes at baseline. When CVD events were stratified by diabetic status, the relative CVD risk among diabetic men was twice that of nondiabetic men, and the risk among diabetic women was threefold that of nondiabetic women. Among all CVD events, diabetes accounted for 56% in men and 78% in women; most CVD deaths occurred in those with diabetes. Recent attention has focused on defining the relative strength of CVD risk factors in diabetic populations. In many populations, low-density lipoprotein (LDL) cholesterol is lower in diabetic individuals. However, in American Indians, every 10-mg/dL increase in LDL cholesterol has been associated with a 12% increase in CVD risk and every 10-mg/dL decrease in high-density lipoprotein (HDL) cholesterol was associated with an 8% increase in CVD risk. Albuminuria is an important predictor of CVD in diabetic populations. Those with macroalbuminuria had a CVD risk that was four to five times that of diabetic individuals without albuminuria. Other CVD risk factors in diabetes that have come under recent scrutiny in other populations are increased levels of fibrinogin, and C-reactive protein, and leukocytosis. Angiogenic response may be lower in diabetic individuals, and the possible role of infection is being examined in diabetic patients. LDL cholesterol and albuminuria should be the targets of preventive strategies, and promising new areas such as cytokines, growth factor, and the role of infection should be further explored.