中老年人群理想心血管健康评分变化和踝臂指数的关系

目的探讨中老年人群理想心血管健康评分变化(△ICHS)与踝臂指数(ABI)的关系。方法在101510名参加2006-2007年开滦集团职工体检者中,随机分层抽取5852人作为研究对象,其中符合入选标准者5440例。每2年1次体检,并于2010-2011年再次体检时增加ABI。去除数据缺失者,最终纳入统计分析的研究对象为4524例。按照美国心脏协会提出的7项心血管健康指标,将人群进行理想心血管健康评分(ICHS)。根据2006-2007、2010-2011年2次体检的△ICHS,采用线性回归和Logistic回归分析△ICHS与ABI的关系。结果随着△ICHS由低向高转变,△收缩压、△舒张压、△体质指数、△总胆固醇及△空腹血糖均呈逐渐下降趋势(P0.05),理想食盐习惯和体育锻炼人群比例明显改善,分别升高了9.3%和17.2%,理想吸烟人群比例下降约4.6%。总人群的收缩压、舒张压、体质指数、总胆固醇及空腹血糖均较基线时略有升高。ABI随△ICHS升高呈逐渐升高趋势(P0.05)。线性回归结果显示:△ICHS与ABI呈正相关,在校正多种混杂因素之后,△ICHS每增加1分,ABI升高0.004(B值:0.004,P=0.004)。Logistic回归分析也显示:在校正多种混杂因素之后,与ICHS降低组相比较,ICHS不变组和ICHS升高组的ABI异常呈下降趋势,△ICHS每增加1分,ABI异常风险降低约21%(OR:0.79,95%CI:0.68~0.91)。结论△ICHS与ABI呈正相关。△ICHS是中老年人群动脉硬化的独立预测因素。     

冠状动脉钙化评分联合TG/HDLC值对维持性血液透析患者心血管事件的筛查价值

目的 探究冠状动脉钙化评分联合甘油三酯/高密度脂蛋白胆固醇(TG/HDLC)值对维持性血液透析患者心血管事件的筛查价值.方法 选取行维持性血液透析患者110例为研究对象,按是否发生心血管事件分为心血管病变组(n =40)和无心血管病变组(n=70),应用多层螺旋CT对受试者冠状动脉钙化程度进行评分,检测患者血清中TG、...     

理想心血管健康行为与因素变化对健康老龄血管的影响

目的探讨理想心血管健康行为与因素变化对健康老龄血管(HVA)的影响。方法该研究为多中心横断面调查,入选人群为在开滦总医院、开滦林西医院、开滦赵各庄医院等11家医院进行健康体检的开滦集团在职及离退休职工。以2006—2015年至少参加2次健康体检,且心血管健康行为与因素资料完整,并于2010—2016年底接受过臂踝脉搏波传导速度(baPWV)检测者6316人为研究对象。计算入选者的心血管健康评分(CHS),其中基线CHS取自首次体检资料,第2次CHS取自与baPWV检测在同一年度的体检资料,计算2次CHS的差值(ΔCHS)。按ΔCHS将入选者分为5组,即ΔCHS≤-2组(n=2166)、ΔCHS=-1组(n=1284)、ΔCHS=0组(n=1187)、ΔCHS=1组(n=860)和ΔCHS≥2组(n=819)。比较各组人群的一般资料、baPWV及HVA检出率,并采用多因素logistic逐步回归分析ΔCHS与HVA的关系,然后分别移除1个健康行为或因素后重新计算ΔCHS,并再次纳入多因素logistic逐步回归模型,探讨移除因素对HVA的影响。结果ΔCHS≤-2、ΔCHS=-1、ΔCHS=0、ΔCHS=1和ΔCHS≥2组人群的HVA检出率分别为23.3%(505/2166)、27.8%(357/1284)、28.7%(341/1187)、31.9%(274/860)、33.9%(278/819)。校正了年龄、性别、收入、饮酒、教育、基线CHS后,多因素logistic回归分析结果显示ΔCHS与HVA呈正相关(OR=1.50,95%CI 1.44~1.56)。在总的理想心血管健康行为与因素中,分别移除1个行为或因素后,多因素logistic回归分析结果显示,OR值下降幅度从大到小的行为或因素依次为收缩压(OR=1.04,95%CI 1.00~1.09)、空腹血糖(OR=1.14,95%CI 1.09~1.18)、体育锻炼(OR=1.16,95%CI 1.11~1.21)、食盐量(OR=1.17,95%CI 1.12~1.22)、体重指数(OR=1.18,95%CI 1.13~1.23)、吸烟(OR=1.18,95%CI 1.13~1.23)和总胆固醇(OR=1.20,95%CI 1.16~1.24)。结论改善理想心血管健康行为与因素有助于增加HVA人群的比例。     

高龄重症社区获得性肺炎并心血管事件患者预后不良因素分析

目的:分析高龄重症社区获得性肺炎(CAP)合并心血管事件患者预后不良因素,探讨临床诊疗策略。方法:将116例高龄重症CAP并发心血管事件患者按照住院30d内的预后分为治愈出院组(54例)和预后不良组(62例)。分析2组患者性别、年龄、入院时CURB65评分(包括意识障碍、尿素氮、呼吸频率、血压、年龄)、肺炎严重指数(PSI评分)及CRB65评分(包括意识障碍、呼吸频率、血压、年龄)、重症肺炎评判主要标准及次要标准构成情况、住院前心血管事件发生史、住院期间心血管事件类别、辅助治疗措施、初始疗效、并发症情况等,将组间差异有统计学意义的指标纳入多因素Logistic回归分析,分析高龄重症CAP并心血管事件患者预后不良的危险因素。结果:住院期间新发心律失常47例(40. 52%)、急性心肌梗死33例(28. 45%)、心绞痛21例(18. 10%)、急性心力衰竭15例(12. 93%)。2组患者年龄、入院时CURB65评分、PSI评分、CRB65评分、住院前心血管事件发生史、住院期间心血管事件类别、初始疗效比较,差异有统计学意义(均P 0. 05)。多因素Logistic分析显示,年龄(OR=4. 156)、入院时CURB65评分5分(OR=3. 632)、PSIⅤ级(OR=4. 589)、CRB65评分4分(OR=2. 445)、住院前有心血管事件史(OR=4. 625)、住院期间发生急性心肌梗死(OR=4. 514)、初始治疗无效(OR=3. 422)为高龄重症CAP并发心血管事件患者预后不良的危险因素。结论:高龄重症CAP并发心血管事件患者预后不良率高,临床应采取措施加以防范,降低不良事件风险率,改善患者预后。     

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.     

阻塞性睡眠呼吸暂停低通气综合征并原发性高血压患者心血管事件危险因素分析

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)并原发性高血压(EH)发生心血管事件的危险因素。方法:收集213例阻塞性睡眠呼吸暂停低通气综合征并原发性高血压患者的临床资料,根据是否发生不良心血管事件将患者分为病例组(n=57)和对照组(n=156),对两组患者的临床资料进行单因素分析,多因素logistic回归分析OSAHS并EH发生不良心血管事件的危险因素。结果:57例(26.76%)患者发生不良心血管事件,病例组与对照组在性别、年龄、体质量指数(BMI)、家族遗传病史、饮酒史、血压分级、呼吸暂停低通气指数(AHI)、空腹血糖、总胆固醇等方面的差异有统计学意义(P均<0.05),logistic多因素回归分析显示,BMI(OR=1.898,95%CI:1.157~13.142,P=0.015)、年龄(OR=4.633,95%CI:0.563~15.236,P=0.042)、AHI(OR=9.789,95%CI:1.795~40.606,P=0.005)、空腹血糖(OR=5.082,95%CI:0.654~10.632,P=0.043)、总胆固醇(P=0.041,95%CI:1.114~87.431OR=10.892)是OSAHS并EH心血管事件发生的独立高危因素。结论:年龄、BMI、AHI、空腹血糖、总胆固醇是OSAHS并EH患者发生心血管事件的独立危险因素,建议对其进行有针对性的干预,以有效降低不良心血管事件的发生率。     

糖尿病患者效能水平与理想心血管健康行为和健康因素的相关性

目的分析糖尿病患者效能水平与心血管健康行为和健康因素的相关性。方法对河北联合大学附属医院和附属人民医院确诊为糖尿病患者3 240例采用一般自我效能感量表(GSES)进行效能水平评测,随访1年期间心脑血管事件。结果理想心血管健康行为〔吸烟、体质指数(BMI)、饮食、锻炼〕和因素(血压、血糖、血脂)组合项目分布情况在效能水平高、中和低3组中差异均有统计学意义;三组患者1年内累积心脑血管事件发生率分别为1.32%、2.69%和3.86%。结论效能水平与糖尿病人群心血管健康行为和健康因素相关,高效能水平可增加理想心血管健康行为和健康因素,能预防糖尿病病人心脑血管事件的发生。     

血尿酸与心血管健康指数的关联分析临床研究

目的 探讨分析血尿酸水平与查体人群心血管健康指数的相关性。方法 纳入2016年至2019年就诊于解放军总医院健康管理研究院的健康查体人群26273人，其中男性16935人，女性9338人。采集所有研究对象的人口学资料、一般临床资料、体格检查数据和生化检查指标，并基于血尿酸水平将总体人群分为不同亚组，采用倾向评分匹配排除混杂因素干扰，进一步分析不同亚组人群的心血管健康水平。结果 本研究中，正常尿酸人群中具有理想血压、空腹血糖、总胆固醇、体重指数和膳食情况的人数所占百分比高于高尿酸血症人群，其中达到理想血压、空腹血糖、总胆固醇、体重指数和膳食情况水平的正常尿酸人群分别占总体正常尿酸人群的31.6%、57.1%、65.7%、36.4%和25.3%，而在高尿酸血症人群中仅为17.7%、47.4%、58.6%、18.0%和23.1%,但是两组人群在吸烟和运动情况方面的差异无统计学意义。结论 在总体人群中，高尿酸人群的理想心血管健康达标率较正常人群低，提示血尿酸与心血管健康之间存在显著关联。     

高血压合并冠心病患者血压特点及与心血管事件的相关性研究

目的 探讨高血压合并冠心病患者的血压特点及与心血管事件发生的相关性.方法 对60例高血压病合并冠心病患者和30例单纯冠心病患者进行24 h 动态血压监测(ABPM),对所有患者随访6个月～13个月,分析动态血压参数与发生心血管事件的相关性.所有患者都行冠脉造影术,冠脉病变用病变的血管支数及Gensini 积分表示.结果 高血压合并冠心病患者的心血管事件发生率高于单纯冠心病患者(P<0.05).高血压合并冠心病患者中有心血管事件组的年龄、冠脉病变积分、24 h动态收缩压(SBP)、日间动态SBP、夜间动态SBP、24 h动态脉压(PP)、日间动态PP、夜间动态PP都高于无心血管事件组(P<0.05).多因素Logistic回归分析结果显示,年龄、冠脉病变积分、24 h动态SBP、夜间动态PP与心血管事件发生关系密切(P<0.05).结论 年龄、冠脉病变积分、24 h动态SBP、夜间动态PP是高血压合并冠心病患者心血管事件发生的危险因素,应对这些因素进行控制以减少高血压合并冠心病患者的心血管事件的发生.     

开滦研究人群理想心血管健康行为和因素分布调查

目的 调查理想心血管健康行为和因素的分布情况.方法选择2008-2009年度开滦集团公司健康体检职工为研究对象,采用横断面研究的方法,分析研究人群中理想心血管健康行为和因素的分布及影响因素.结果(1)研究人群的一般情况:男性的体质指数、收缩压、舒张压、血总胆固醇、甘油三酯、低密度脂蛋白胆固醇高于女性,高密度脂蛋白胆固醇低于女性,两性间比较差异有统计学意义(P＜0.05);大学及以上学历和家庭人均月收入≥1000元者在女性人群中所占的比例高于男性人群中相应的比例,两性间比较差异亦有统计学意义(P＜0.05).(2)心血管健康行为和因素的分布情况:在可改变的心血管健康行为(吸烟、体质指数、体育锻炼、盐摄入量)中处于理想状态的分别只占55.8％、41.4％、18.9％、14.0％;在可定量评估的心血管健康因素(空腹血糖、总胆固醇、血压)中处于理想状态的分别占80.9％、61.8％和18.5％.其中体育锻炼、低盐饮食、血压处于理想状态的比例较少,均不足20％.(3)理想心血管健康行为和因素组合分布情况:研究人群中,只有0.1％、1.9％、9.1％、20.3％的个体分别具有7项、6项、5项、4项理想心血管健康行为和因素,合计仅占31.4％.(4)影响心血管健康行为和因素的logistic回归分析显示:女性、年龄＜55岁、大学及以上学历、家庭人均月收入＞ 1000元者具备理想心血管健康的RR值(95％可信区间)分别为4.52(4.32～4.72),1.46(1.39～1.53),2.23(2.10～2.37),1.00(0.91～1.09).结论(1)研究人群具有理想心血管的健康行为和因素的人数量较少,多数处于非理想心血管健康状态.(2)女性、年龄＜55岁、大学及以上学历者是理想心血管健康的保护性因素.     

空气污染与心血管疾病专家共识

空气污染是全球性的严重公共卫生问题,也是对我国民众健康的严峻挑战。空气污染可增加心血管疾病发病及死亡风险,已成为一项重要且可干预的心血管疾病危险因素。空气污染导致的死亡主要为心血管疾病死亡。本共识汇总了国内外关于空气污染与心血管疾病的最新流行病学及临床研究证据,推荐室内使用清洁能源烹饪及采暖、在重污染天气佩戴符合国家标准的N95防护口罩等措施以降低个体对空气污染物的暴露水平。该共识为进一步加强医疗卫生人员对空气污染危害心血管健康的认识,帮助其开展健康宣教和确定未来科研方向,并为相关部门制定公共卫生政策提供参考。     

Global cardiovascular health: urgent need for an intersectoral approach

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with more than 80% of CVD deaths occurring in low- and middle-income countries (LMICs). There have been several calls for action to address the global burden of CVD, but there remains insufficient investment in and implementation of CVD prevention and disease management efforts in LMICs. To catalyze the action needed to control global CVD, the Institute of Medicine recently produced a report, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. This paper presents a commentary of the Institute of Medicine's report, focusing specifically on the intersectoral nature of intervention approaches required to promote global cardiovascular health. We describe 3 primary domains of intervention to control global CVD: 1) policy approaches; 2) health communication programs; and 3) healthcare delivery interventions. We argue that the intersectoral nature of global CVD interventions should ideally occur at 2 levels: first, all 3 domains of intervention must be activated and engaged simultaneously, rather than only 1 domain at a time; and second, within each domain, a synergistic combination of interventions must be implemented. A diversity of public and private sector actors, representing multiple sectors such as health, agriculture, urban planning, transportation, finance, broadcasting, education, and the food and pharmaceutical industries, will be required to collaborate for policies, programs, and interventions to be optimally aligned. Improved control of global CVD is eminently possible but requires an intersectoral approach involving a diversity of actors and stakeholders.     

Management of heart conditions in older rural and urban Australian women

Background: Cardiovascular disease death rates are higher among Australians from regional and remote areas than those from major cities. Aims: To investigate the causes of excess mortality from heart disease in rural compared to urban Australian women aged over 75 years. Methods: In 2004, 944 older urban and rural participants in the Australian Longitudinal Study on Women's Health aged 77–83 years with self‐reported ischaemic heart disease (IHD), heart failure or atrial fibrillation took part in a nested cross‐sectional substudy. We used clinical guidelines to determine key management issues for these conditions. Using logistic regression we calculated odds ratios (OR) and 95% confidence intervals (CI) to assess the relationship between management and area of residence. Results: These older Australian women often did not receive recommended management for their heart conditions. Only 30% reported having had an echocardiogram. Reported use of statins and beta‐blockers was low among women with IHD (58% and 41% respectively) and only 32% of women reporting heart failure were taking angiotensin‐converting enzyme inhibitors. Women from regional/remote areas had greater odds of reporting never having seen a cardiologist (OR = 3.88, 95% CI 1.72–8.72) and never having had an echocardiogram than women from major cities (OR = 2.86, 95% CI 1.42–5.75). Medication use was similar for rural and urban women. Conclusions: Our results suggest that best‐practice treatments for heart conditions are suboptimally provided to older women. In addition, they suggest differential use of some health services, which might help explain higher cardiovascular mortality among rural compared with urban women.     

Cardiovascular profile and events of US adults 20–49 years with HIV: Results from the NHANES 1999–2008

The incidence of vascular events in HIV-infected individuals is increasing. We investigated whether there is a higher prevalence of vascular risk factors in the adult US population with HIV compared to uninfected controls that could explain some of the increased vascular events. We obtained prevalence estimates of vascular risk factors, stratified by the HIV status, in sampled adults aged 20–49 years from the 1999 to 2008 National Health and Nutrition Examination Survey. Estimates were weighted to account for oversampling and nonresponse. Logistic regression models with adjustment for demographic and socioeconomic status were created to adjust for confounders. The analysis included 12,339 US adults, 76 with HIV infection. The weighted seroprevalence of HIV was 0.48% (95% CI 0.33–0.65). In univariate analysis, HIV infection was more prevalent in non-Hispanic blacks (odds ratio [OR] 7.4, 95% CI 3.6–15.2), men (OR 2.6, 95% CI 1.42–4.89), the physically inactive (OR 1.8, 95% CI 1.0–3.0), and current smokers (OR 2.4, 95% CI 1.3–4.4). Increased waist circumference (OR 0.5, 95% CI 0.3–1.0) was less common in HIV-infected individuals, although controlling for sex and ethnicity differences, this difference became nonsignificant (OR 0.6, 95% CI 0.3–1.2). Further controlling for differences in income and education rendered the associations with smoking and physical inactivity nonsignificant, but revealed associations of HIV infection with hypertension (OR 2.4, 95% CI 1.0–6.0) and diabetes (OR 4.1, 95% CI 1.1–16.1). These results underscore the need to further investigate the role of cardiovascular risk factors in the growing HIV population.     

National Cross-Sectional Data on Ideal Cardiovascular Health Among Adults in Mongolia in 2019

Background:The study aimed to estimate the prevalence, distribution, and correlates of ideal cardiovascular health (CVH) among individuals (20–69 years) in Mongolia.Method:Cross-sectional data were analyzed from 4,516 individuals (20–69 years, mean age = 42.3 years) who participated in the Mongolia STEPS survey in 2019, who had complete measurement of CVH metrics and no history of cardiovascular disease. Ideal CVH measures included non-smoking, healthy diet, physical activity, fasting blood glucose <100 mg/dL, body mass index (<23 kg/m²), total cholesterol <200 mg/dL, and blood pressure <120/<80 mmHg).Results:The prevalence of five to seven ideal CVH metrics was 27.7% in 2019. Most Mongolians had ideal total cholesterol (77.4%), ideal smoking (67.8%), ideal fasting glucose (73.8%) and ideal physical activity (66.0%), while a lower prevalence was found for ideal blood pressure (42.4%), ideal body mass index (31.4%), and ideal healthy diet (1.8%). The prevalence of poor smoking, poor fruit/vegetable intake, poor fasting glucose, poor blood pressure, and poor total cholesterol was higher in men than in women, while poor physical activity was higher in women than in men, and poor BMI did not differ by sex. In the adjusted logistic regression analysis, older age, male sex, and belonging to the Khalkh ethnic group were negatively associated, and a higher number of adult household members was positively associated with meeting the ideal 5–7 CVH metrics.Conclusions:The proportion of meeting 5–7 ideal CVH metrics was moderate among adults in Mongolia. Primary and secondary prevention programmes should be strengthened to improve CVH in Mongolia, considering identified associated factors.     

Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: a longitudinal study

Objective. The aim of this study was to evaluate the long‐term effects of stress on changes in health behaviour and cardiac risk profile in men and women. Design. A prospective cohort study. Setting. The Copenhagen City Heart Study, Denmark. Subjects. The analyses were based on 7066 women and men from the second (1981–1983) and third (1991–1993) wave of the Copenhagen City Heart Study. All participants were asked questions on stress and health behaviour and they had their weight, height, blood pressure and level of blood lipids measured by trained personnel. Main outcome measures. Changes in health behaviour (smoking, physical activity, alcohol consumption, overweight) and cardiac risk profile (cholesterol, HDL cholesterol, blood pressure, diabetes). Results. Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking (OR = 0.58; 95% CI: 0.41–0.83), more likely to become physically inactive (1.90; 1.41–2.55), less likely to stop drinking above the sensible drinking limits (0.43; 0.24–0.79), and stressed women were more likely to become overweight (1.55; 1.12–2.15) during follow‐up. Men and women with high stress were more likely to use antihypertensive medication (1.94; 1.63–2.30), and stressed men were more than two times as likely to develop diabetes during follow‐up (2.36; 1.22–4.59). Conclusion. This longitudinal study supports a causal relation between stress and cardiovascular diseases mediated through unfavourable changes in health behaviour and cardiac risk profile.     

老年人群心血管疾病的健康管理及预防

我国心血管疾病(CVD)患病人数持续上升,国民CVD危险因素个体暴露显著增加。老年人群作为特殊群体,其CVD患病率及死亡率均高,并带来了沉重的社会及经济负担。通过有效的CVD健康管理及预防能够有效降低老年人CVD患病率及死亡率,不仅可以延长老年人寿命,而且可以改善老年人生活质量。合理的方式包括:生活方式的干预;血压、血脂、血糖的控制及监测;小剂量阿司匹林的应用。老年人群CVD的健康管理模式需个体化,同时要注意评估衰弱、老年共病、多重用药及个人意愿。