强化干预管理在缺血性脑卒中二级预防中的意义

目的探讨强化干预管理缺血性脑卒中患者,对提高缺血性脑卒中二级预防危险因素的控制。方法选择缺血性脑卒中患者441例,随机分为干预组221例,对照组220例。干预组和对照组出院时按缺血性脑卒中二级预防内容进行指导,干预组同时启动强化干预管理;6个月后收集2组生化指标、药物依从性、复发率等数据进行比较。结果 6个月随访时,干预组空腹血糖、糖化血红蛋白、TC、LDL-C及HDL-C水平明显低于对照组[(5.26±1.02)mmol/L vs(5.72±1.32)mmol/L,P=0.037;(5.04±1.01)%vs(6.12±1.04)%,P=0.024;(3.61±0.77)mmol/L vs(4.22±1.10)mmol/L,P=0.002;(2.36±0.65)mmol/L vs(2.78±0.77)mmol/L,P=0.003;(1.12±0.36)mmol/L vs(1.05±0.32)mmol/L,P=0.040]。干预组缺血性脑卒中复发率显著低于对照组(9.5%vs17.3%,P0.05)。干预组阿司匹林、降压药物、他汀类药物依从率,收缩压、舒张压、空腹血糖、糖化血红蛋白、TG、TC、HDL-C、LDL-C达标率明显高于对照组(P0.05,P0.01)。结论强化干预管理可以减少缺血性脑卒中复发率,提高血糖、血压、血脂达标率及对药物依从性。     

老年2型糖尿病血糖水平与缺血性脑卒中的相关研究

测定60例E-T2DM患者和30例非糖尿病老年人的空腹血浆葡萄糖(FPG)水平.据FPG水平分为G1(35例,FPG10.30±2.00mmol/L),G2(25例,FPG8.98±1.49mmol/L),G3(30例,FPG6.34±0.62mmol/L),并对90例测试者做脑CT检查及缺血性脑卒中事件统计.结果随着血糖水平增加,缺血性脑卒中发生率明显增加,差异有统计学意义(P＜0.01).结论E-T2DM患者缺血性脑卒中发生率与其血糖水平呈正相关.     

培哚普利和吲哒帕胺联合降压治疗对脑卒中再发的预防作用-7.5年随访结果

目的探讨患过脑卒中病人采用培哚普利和吲哒帕胺联合用药降压治疗对脑卒中再发的预防作用.方法选择过去5年中确诊为脑卒中(脑出血,脑梗死)病人50例,以随机双盲方法分成培哚普利和吲哒帕胺联合用药组(治疗组)及相匹配的安慰剂组(对照组)各25例,治疗随访5年,解盲后继续门诊随访2.5年.研究终点为脑卒中事件,心血管性死亡和总血管事件及痴呆和残疾的发生率.每次随诊测血压、心率,并定期测血钾、肌酐及MMSE计分、Barthel计分等.结果治疗组病人血压在治疗5年后明显下降,治疗前后血压平均值分别为(155±26/92±11)mm Hg和(125±25/82±13)mm Hg,有非常显著差异(P＜0.01).对照组治疗前后分别为(157±26/92±12)mm Hg和(150±25/90±11)mm Hg,无显著差异(P＞0.05).脑卒中事件治疗组和对照组分别为4例(16%)、11例(44%);心血管性死亡分别为2例(8.0%),8例(32%);总血管事件分别为5例(20%),19例(76%);两组相比均有显著差异(P＜0.01,＜0.05,＜0.001).痴呆和残疾的发生亦有减少(P＞0.05).结论培哚普利和吲哒帕胺联合降压治疗能降低脑卒中病人再发卒中的危险性,同时还能减少心血管性死亡和总血管事件,并可减少痴呆和残疾的发生.因此,这一降压治疗值得在脑卒中病人作为有效的二级预防手段.     

同型半胱氨酸与中老年男性缺血性心脑血管疾病的相关性研究

目的探讨血浆同型半胱氨酸水平与中老年男性缺血性心脑血管疾病的相关性。方法前瞻性连续入选既往无冠心病及脑卒中病史的中老年男性343例,随访7年,记录患者一般资料及7年缺血性不良事件发生率。结果1)缺血性心脏病组的血浆同型半胱氨酸水平略高于未发生缺血性心脏病组,但差异无统计学意义(13.06μmol/L vs 12.38μmol/L,P0.05),而缺血性脑卒中组血浆同型半胱氨酸水平显著高于未发生组(14.25μmol/L vs12.18μmol/L,P0.05)。2)高同型半胱氨酸血症组发生缺血性心脏病例数高于对照组,但是差异无统计学意义(P0.05)。高同型半胱氨酸血症组发生缺血性脑卒中例数明显高于对照组(P0.05)。3)单变量Logistic回归分析,结果提示发生缺血性脑卒中的人群年龄大,体质指数高、肌酐高,有吸烟史、高血压史和高同型半胱氨酸血症。结论同型半胱氨酸与中老年男性缺血性心脏病的发病率无相关性,与中老年男性缺血性脑卒中发病率有显著相关性,但对预测缺血性脑卒中的危险度弱于传统致心脑血管疾病危险因子。     

血脂和脂蛋白水平对我国中年人群缺血性心血管病事件的预测作用

目的 评价不同血脂指标对我国中年人群缺血性心血管病事件的预测作用。方法采用前瞻性队列研究方法,在中美心肺疾病流行病学合作研究4组队列人群(北京和广州两地工人和农民)中选择35～59岁,基线无心肌梗死和脑卒中病史且主要资料完整者10 222人为研究对象(男性4963人,女性5259人),平均随访15.9年。观察终点为缺血性心血管病事件(ICVD),包括冠心病和(或)缺血性脑卒中。结果 随访期间发生ICVD事件378例,其中单纯冠心病96例,缺血性脑卒中270例,冠心病合并缺血性脑卒中12例。多因素Cox回归分析表明,控制年龄、性别以及收缩压(SBP)、糖尿病和吸烟等主要心血管病危险因素后,血清总胆固醇(TC)5.17～5.67 mmol/L组,5.68-6.19 mmol/L组,≥6.20 mmoL/L组ICVD事件发病相对危险性分别为1.34(1.00-1.80),1.61(1.15～2.26)和1.70(1.21～2.37);低密度脂蛋白胆固醇(LDL-C)3.62-4.12 mmol/L组,≥4.13 mmol/L组相对危险性分别为1.62(1.15～2.27)和1.67(1.17～2.40),均显著高于参照组(TC<5.17 mmoL/L,LDL-C<3.10 mmoL/L)。按照我国血脂异常防治建议提出的诊断标准,在TC临界升高以上(≥5.17 mmol/L)和升高(≥5.68 mmol/L)组,ICVD发病的归因危险度百分比(ARP)为33.8％和35.9％,人群归因危险度百分比(PARP)为10.6％和6.2％。而     

糖尿病酮症酸中毒及(或)高渗状态横纹肌溶解症6例回顾分析

目的 了解糖尿病急症酮症酸中毒及(或)高渗状态横纹肌溶解症发生情况.方法 回顾分析52例糖尿病急症病例. 结果 横纹肌溶解症6例 (11.54%).横纹肌溶解症与非横纹肌溶解症血清肌酸磷酸激酶、肌红蛋白、葡萄糖、钠、有效血浆渗透压、钾水平分别是(3886±2817)μ/L vs (99±85)μ/L,( 4131±625)μg/L vs (84±58)μg/L, (59±24)mmol/L vs (28±14)mmol/L, (154±7)mmol/L vs (140±8)mmol/L, (375±31)mmol/L vs (310±21)mmol/L, (3.8±0.5)mmol/L vs (4.4±0.6)mmol/L; 肾功能衰竭100% vs 30.8%; 差异均有统计学意义 (P＜0.01). 结论 糖尿病酮症酸中毒及(或)高渗状态可能诱发横纹肌溶解症,宜重视肌酶检查.     

急性心肌梗死患者血糖波动与冠脉病变程度的相关性研究

【】目的 探讨急性心肌梗死患者血糖波动与冠脉病变程度的关系。方法 选择2012 年2 月至2015 年12 月在我院心内科住院的急性ST段抬高型心肌梗死(STEMI)患者156例为研究对象,采用美敦力动态血糖监测系统(CGMS, Minimed)对入选患者进行连续血糖监测,同时入选患者行冠脉造影检查,对冠脉病变进行SYNTAX评分。根据是否合并糖尿病将所有患者分为糖尿病组(A组)和非糖尿病组(B组),比较两组患者冠脉病变、血糖波动指标间的差异,分析血糖波动与冠脉病变之间的关系。根据平均血糖波动幅度(MAGE)正常与否分为MAGE＞3.9mmol/l组和MAGE≤3.9mmol/l组,比较两组患者之间的冠脉病变程度。结果 A组患者平均血糖(MBG)和血糖标准差(SDBG)明显高于B组(9.7±0.7mmol/L vs 5.5±2.1mmol/L,2.5±1.2mmol/L vs 1.2±0.8mmol/L,P＜ 0.01); A组患者MAGE明显高于B组(3.8±1.2mmol/L vs 2.6±1.3mmol/L,P＜ 0.01);A组患者冠脉SYNTAX评分明显高于B组(17.3±4.7 vs 13.5±3.3,P＜ 0.01)。MAGE＞3.9mmol/l组患者冠脉SYNTAX评分明显高于MAGE≤3.9mmol/l组(18.9±3.1 vs 14.7±4.5,P＜ 0.01)。相关性分析显示,冠脉SYNTAX评分与MAGE、MBG和HBA1c之间呈正相关(r=0.854,0.372,0.468,P＜0.05)。结论 急性心肌梗死患者血糖波动幅度与冠脉病变程度之间有明显相关性,血糖波动幅度越大,冠脉病变程度越重。     

糖尿病人群空腹血糖水平与新发脑梗死事件的相关性研究

目的 探讨糖尿病人群空腹血糖水平与新发脑梗死事件的相关性.方法 采用前瞻性队列研究方法,以空腹血糖≥7.0 mmol/L或＜7.0 mmol/L但已确诊为糖尿病、正在使用降糖药物的8 306例糖尿人群作为观察队列,随访(48.01 ±3.14)个月,随访期间每半年收集一次新发脑梗死事件情况.分析糖尿病人群空腹血糖水平与新发脑梗死事件的相关性.结果 (1)随访结束时,随着基线空腹血糖水平的增高,研究对象的总胆固醇、甘油三酯的水平逐渐增高[总胆固醇:(4.93±1.15,510±1.20,5.15± 1.28,5.33±1.35) mmol/L,甘油三酯:(1.70±1.26,1.83± 1.29,2.18±1.76,2.41±2.08) mmol/L,P＜0.05];低密度脂蛋白胆固醇、收缩压、舒张压、体重指数的水平也增高(P＜0.05).(2) 7.0 mmol/L≤空腹血糖＜9.0mmol/L组累积发生脑梗死事件率最低(2.1％,P＜0.01).校正年龄、性别、收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、体重指数、吸烟、糖尿病病程及降糖治疗因素,Cox比例风险回归分析表明,相对于7.0 mmol/L≤空腹血糖＜9.0 mmoL/L组,6.1 mmol/L≤空腹血糖＜7.0mmol/L组和空腹血糖≥9 mmol/L两组发生脑梗死事件的相对危险(RR)各分别增加1.85倍(95％CI 1.09～3.15,P＜0.05)、1.54倍(95％CI 1.16～2.05,P＜0.01).结论 糖尿病人群空腹血糖控制在7.0 ～9.0 mmol/L水平者似新发生脑梗死事件率最低.     

氯吡格雷在短暂性脑缺血发作后脑卒中二级预防中的应用

目的探讨氯吡格雷在短暂性脑缺血发作(transient ischemic attack,TIA)后预防缺血性脑卒中发作的疗效。方法选择TIA患者279例,随机分为2组:氯吡格雷组158例(氯吡格雷75 mg,1次/d),长效阿司匹林组121例(拜阿司匹林100 mg,1次/d)。患者随访1.5～3.0(2.3±0.3)年,评估2组的安全性。结果氯吡格雷组患者缺血性脑卒中复发率明显低于长效阿司匹林组,差异有统计学意义(5.06% vs 12.40%,P0.05)。全部患者在TIA后缺血性脑卒中复发的危险比为0.4031,氯吡格雷组为0.1284,长效阿司匹林组为0.8129,差异有统计学意义(P0.05)。氯吡格雷组患者发生次要事件概率和胃肠道出血事件明显低于长效阿司匹林组,差异有统计学意义(1.90% vs 8.26%,1.27% vs 6.61%,P0.05)。结论氯吡格雷对TIA患者的缺血性脑卒中的预防,优于长效阿司匹林。     

通心络胶囊联用阿司匹林对非瓣膜性心房颤动患者预防缺血性脑卒中的疗效评价

目的 探讨通心络胶囊与常规剂量阿司匹林联用对非瓣膜性心房颤动患者预防缺血性脑卒中的作用.方法 入选非瓣膜性房颤患者204例,随机分为两组,治疗组采用通心络胶囊与常规剂量阿司匹林联用,对照组给予安慰剂,比较两组缺血性脑卒中的发生率及安全性.结果 治疗组缺血性脑卒中发生率为8.74%,对照组为18.81%,治疗组比对照组低10.07%(P＜0.05).致死性心脑血管事件发生率治疗组比对照组低3.01%,出血性脑卒中治疗组比对照组高, 但两者无统计学意义.结论 通心络胶囊与常规剂量阿司匹林联用能有效地预防非瓣膜性心房颤动患者缺血性脑卒中事件,同时有良好的安全性.     

糖尿病人群中高敏C反应蛋白与新发心脑血管事件关系的前瞻性研究

目的 探讨基线血清高敏C反应蛋白(hsCRP)水平对糖尿病人群新发心脑血管事件的预测价值.方法 本研究采用前瞻性队列研究方法,以参加2006年7月至2007年10月健康查体的101 510名开滦集团职工中空腹血糖≥7.0 mmoL/L或＜7.0 mmol/L但已确诊为糖尿病,正在使用降糖药物的7865例糖尿病者作为观察队列,随访38～53(48.02±3.14)个月,随访期间每半年收集1次新发心脑血管事件情况.分析基线血清hsCRP水平对糖尿病人群新发心脑血管事件的预测价值.结果 (1)随着基线hsCRP水平的增高,发生总心脑血管事件、脑梗死和心肌梗死事件率均逐渐增高,差异有统计学意义(P＜0.01);多变量Cox比例风险回归分析表明校正年龄、性别、收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、体质指数及吸烟因素后,基线hsCRP最高四分位数组(hsCRP≥2.50 mg/L)发生总心脑血管事件、脑梗死和心肌梗死的相对危险(RR)分别为最低四分位数组(hsCRP＜0.41 mg/L)的1.64倍(95% CI:1.20～2.24,P=0.002),1.52倍(95% CI:1.03～2.24,P=0.034)和2.57倍(95% CI:1.34～4.91,P=0.004).(2)随着基线hsCRP水平的增高,研究对象的平均年龄逐渐增高;女性在人群中比例逐渐增多;体质指数、收缩压、舒张压、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平增高,差异均有统计学意义(P＜0.05);高密度脂蛋白胆固醇水平降低,差异有统计学意义(P＜0.05).结论 基线hsCRP可预测糖尿病人群发生心脑血管事件,hsCRP水平较高者发生临床心脑血管事件的危险增加,尤其是脑梗死和心肌梗死的危险.

Abstract：

Objective To evaluate the predictive value of baseline serum high sensitivity C-reactive protein for the first cardio-cerebral vascular event in the population with diabetes. Method In this prospective cohort study, a total of 101 510 employees of Kai Luan Group, who received healthy examination from July 2006 to October 2007, were screened and 7865 subjects with fasting plasma glucose ≥ 7. 0 mmol/L or known diabetes mellitus and under insulin or hypoglycemic drugs therapy were followed up for 38 - 53 (48. 02 ± 3. 14) months. Results ( 1 ) Incidence rates of total cardio-cerebral vascular events, cerebral infarction and myocardial infarction increased in proportion to increased levels of baseline hsCRP ( P ＜ 0. 01 ). After adjusting for age, gender, body mass index ( BMI), systolic blood pressure( SBP), diastolic blood pressure (DBP), total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and cigarette smoking, multivariate Cox's proportional hazards regression analysis indicated that the individuals in the highest quartile of hsCRP levels group (hsCRP≥2. 50 mg/L) had an increased risk of total cardio-cerebral vascular events (RR: 1.64, 95% CI:1.20-2.24), cerebral infarction (RR: 1.52, 95% CI: 1.03-2.24), myocardial infarction (RR: 2.57,95% CI: 1.34 -4. 91 ) compared with those in the lowest quartile group( hsCRP ＜ 0. 41 mg/L). (2) Higher baseline hsCRP levels were associated with aging, female gender, higher BMI, SBP, DBP, fasting blood glucose, TC, TG, LDL-C levels and lower HDL-C levels ( all P ＜ 0. 05 ). Conclusion Baseline hsCRP level is associated with increased first cardio-cerebral vascular event in the population with diabetes.     

中国11省市队列人群危险因素与不同类型心血管病发病危险的比较

目的描述在中国35—64岁人群中,不同类型心血管病（包括急性冠心病事件、急性缺血性脑卒中和出血性脑卒中事件）发病的特点。比较传统心血管病危险因素与冠心病和脑卒中（急性缺血性脑卒中和出血性脑卒中事件）发病危险的关系。方法以中国多省市前瞻性队列研究的数据为基础,该队列由1992年建立的11省市35～64岁27249人和1996年到1999年又加入的3129人所组成,共30378人。本研究基线危险因素水平和1992--2003年期间发生的心血管病（包括冠心病和脑卒中）事件的关系进行分析。结果（1）急性冠心病事件、急性缺血性脑卒中事件和急性出血性脑卒中事件的累积人年发病率分别为114／100000、209／100000和73／100000。（2）随访期间发生心血管病的亚组人群基线时有84％～89％的人伴有1个或1个以上的心血管病危险因素,高于无心血管病的亚组人群（64．7％,P〈0．01）。（3）危险因素对不同类型心血管病发病的影响及作用强度有所差别：对冠心病发病危险的影响因素根据强度依次为高血压、吸烟、高胆固醇血症和低高密度脂蛋白胆固醇血症;对缺血性脑卒中发病危险的影响因素依次为高血压、糖尿病、低高密度脂蛋白胆固醇血症、吸烟和肥胖;对出血性脑卒中发病危险的独立影响因素只有高血压。结论在心血管病的主要危险因素中,不同的危险因素对不同类型的心血管病发病危险的作用存在差别。我国人群不同危险因素的变化趋势将影响不同类型心血管。     

Risk of coronary events in Japanese patients with both hypercholesterolemia and type 2 diabetes mellitus on low-dose simvastatin therapy: implication from Japan Lipid Intervention Trial (J-LIT)

Hypercholesterolemic patients with type 2 diabetes mellitus are at increased risk of coronary heart disease (CHD); however, direct evidence is very limited in Japanese patients. The J-LIT is the first nationwide study conducted to assess the relationship between serum lipid levels and development of coronary events in Japanese hypercholesterolemic patients. We analyzed the coronary events in the J-LIT study subjects by having type 2 diabetes or not. Of the total 41,801 subjects without prior CHD who received open-label simvastatin, 5mg/day, 6554 (male 40.2%, age 57.8+/-7.8) subjects had type 2 diabetes, while 35,247 (male 30.0%, age 57.8+/-7.9) did not. In this analysis, relative coronary event risks based on a 0.26 mmol/l (10mg/dl) increase in low density lipoprotein-cholesterol (LDL-C), were similar between hypercholesterolemic subjects with and without type 2 diabetes (17.3% versus 19.4%). Although all subjects were treated with simvastatin, the subjects with type 2 diabetes have significantly more coronary events compared to the subjects without type 2 diabetes (1.80/1000 and 0.76/1000 patient-years, respectively). Given the results above, to reduce the risk of coronary events in Japanese patients with both hypercholesterolemia and type 2 diabetes, careful and strict cholesterol management is needed in addition to the control of blood glucose.     

老年高血压患者降压治疗后24小时动态血压与心脑血管事件发生率的分析

目的分析老年高血压患者降压治疗后24h动态血压与心脑血管事件发生的情况,为临床降压治疗提供依据。方法将1074例患者分为两组,高血压组748例,非高血压组326例。采用24h动态血压监测技术监测血压,观察老年高血压患者降压治疗后心脑血管事件发生情况及其他相关指标。结果高血压组降压治疗后24h动态血压水平与非高血压组比较有显著差异(P<0.05),大部分患者血压控制良好,动态24h收缩压、舒张压平均值在正常范围,但均高于非高血压组;心脑血管事件发生率、有高血压家族史、吸烟、糖尿病、既往患有心脑血管病史等人数比率以及体重指数、左心室重量指数均显著高于非高血压组。结论高血压组较非高血压组更易发生心脑血管事件;脉压是其发生心脑血管事件的重要因素;应注意适度降压。     

Baseline characteristics in the Collaborative AtoRvastatin Diabetes Study (CARDS) in patients with Type 2 diabetes.

AIM: To describe baseline characteristics of patients in the Collaborative AtoRvastatin Diabetes Study (CARDS), a randomized, placebo-controlled trial of lipid lowering with atorvastatin 10 mg daily for the primary prevention of major cardiovascular events in patients with Type 2 diabetes. METHODS: The main eligibility criteria were Type 2 diabetes, age 40-75 years, no previous history of coronary heart disease, stroke or other major cardiovascular events, a documented history of at least one of retinopathy, micro- or macroalbuminuria, hypertension or current smoking, LDL-cholesterol < or = 4.14 mmol/l and triglycerides < or = 6.78 mmol/l. RESULTS: Randomization of 2838 persons (909 women) into CARDS was completed in June 2001. At entry, mean age was 62 years, 12% were over 70 years old and median duration of diabetes was 6 years. Median fasting lipid levels were total cholesterol 5.4 mmol/l, LDL-cholesterol 3.1 mmol/l, HDL-cholesterol 1.4 mmol/l and triglyceride 1.7 mmol/l. There was a documented history of retinopathy in 30% of patients, micro/macroalbuminuria in 11% (additionally 17% had micro/macroalbuminuria based on two elevated pretreatment measurements of albumin-creatinine ratios), hypertension in 79% and 23% were current smokers. CONCLUSION: CARDS will contribute importantly to the evidence for the macrovascular and microvascular benefits of lipid lowering with atorvastatin in patients with Type 2 diabetes. The results are likely to have important implications for the management of patients.     

Ineffective secondary prevention in survivors of cardiovascular events in the US population: report from the Third National Health and Nutrition Examination Survey.

BACKGROUND: Survivors of myocardial infarction (MI) or stroke are at high risk for subsequent cardiovascular events. There is limited assessment of the effectiveness of risk factor modification through current secondary preventive strategies in the US population. We determined the adequacy of risk factor modification in 1252 survivors of MI, stroke, or both in a nationally representative sample of US adults and identified factors related to inadequate control of risk factors. METHODS: The adequacy of control for hypertension, diabetes mellitus, cigarette smoking, alcohol use, and hypercholesterolemia was assessed by personal interview, blood pressure measurements, and serum glycosylated hemoglobin and cholesterol levels in 17 752 US adults who participated in the Third National Health and Nutrition Examination Survey between 1988 and 1994. We also evaluated the role of potentially related factors, including age, sex, race/ethnicity, educational attainment, socioeconomic status, and medical insurance status using multivariate logistic regression analysis. RESULTS: Of 738 known hypertensive persons, hypertension was uncontrolled in 388 (53%). Previously undiagnosed hypertension was detected in 138 others (11%). Of 289 diabetic persons, serum glucose control was inadequate in 141. Of 1252 survivors, 225 (18%) were currently smoking, and heavy alcohol use was observed in 56 persons. Hypercholesterolemia was poorly controlled in 185 (46%) of 405 persons with known hypercholesterolemia. Undetected hypercholesterolemia was observed in 160 persons (13%). In the multivariate analysis, high-risk profiles were more likely to be observed in persons aged 46 to 65 years, women, and African Americans. CONCLUSIONS: High prevalence of inadequate secondary prevention was found in a subset of the US population at highest risk for stroke and MI. Considerable efforts are required to effectively implement risk factor modification strategies after MI or stroke, particularly in middle-aged persons, African Americans, and women.     

High prevalence of undiagnosed diabetes among Chinese patients with ischaemic stroke.

We reviewed the prevalence of diabetes mellitus, hypertension and cigarette smoking in 176 Chinese patients with acute stroke, classified, on computed tomographic findings, as intracerebral haemorrhage or cerebral infarction. In all patients with no known history of diabetes, a 75 g OGTT was done 3-6 months after ictus and interpreted using WHO criteria. The overall prevalence of diabetes and impaired glucose tolerance (IGT) was 33.5% and 21.0%, respectively, with a higher prevalence being found in patients with cerebral infarction (P less than 0.05). Forty percent of those with diabetes were previously undiagnosed - all but 2 had ischaemic stroke. Compared to reported findings in the general population, an increased prevalence of hypertension, and possibly also cigarette smoking was found in patients with both stroke categories. On the other hand, significant hypercholesterolaemia was not found in patients of either category. In view of the high prevalence of undiagnosed diabetes among these stroke patients and the increased morbidity and mortality associated with diabetes mellitus, screening for diabetes is recommended especially in those with ischaemic stroke. If a fasting plasma glucose of greater than or equal to 6 mmol/l was used for the initial screening of undiagnosed diabetes in this group of patients, the sensitivity and specificity values would have been 78% and 94%, respectively. Whether this cut-off value can be cost-effectively employed for mass screening remains to be confirmed by studies involving larger numbers of stroke patients.     

The risk of cardiovascular events in Japanese hypertensive patients with hypercholesterolemia: sub-analysis of the Japan Lipid Intervention Trial (J-LIT) Study, a large-scale observational cohort study.

Coronary events and stroke are leading causes of death in Japan. However, the effects of hypertension on the risk of coronary events and stroke have not been well established in Japanese hypercholesterolemic patients. This study aimed to determine the relationship between the risk of coronary events or stroke and blood pressure and cholesterol levels during low-dose simvastatin treatment using data from the Japan Lipid Intervention Trial (J-LIT) study (a large scale nationwide cohort study). In the present study, 47,294 hypercholesterolemic patients were treated with open-labeled simvastatin (5 to 10 mg/day) for 6 years by a large number of physicians in a clinical setting. The adjusted incidence rates of coronary events in males and females were 8.9 and 2.3 and those of stroke were 17.6 and 11.3/1000 patients during the 6-year period, respectively. The incidence rate of stroke was higher than that of coronary events in both males and females. An obvious sex difference was observed in terms of the incidence of coronary events. The risk of coronary events, stroke, and total cardiovascular events were increased, with elevations in blood pressure observed in patients treated for hypercholesterolemia. The risk of total cardiovascular events in the groups exhibiting less lipid control increased, with lower blood pressure levels than those of the well-controlled group. For patients with hypercholesterolemia and hypertension, blood pressure should be strictly controlled in order to prevent both coronary events and stroke, and the serum total cholesterol levels should be maintained at low levels as well.     

Cholesterol and other lipids predict coronary heart disease and ischaemic stroke in the elderly, but only in those below 70 years.

The prediction of coronary heart disease (CHD) and stroke by total and low density lipoprotein (LDL) cholesterol in older persons remains problematical. This study tests the hypothesis that cholesterol and other risk factors may be differentially predictive of CHD and ischaemic stroke in older persons when they are segregated into different age groups. CHD and ischaemic stroke outcomes were recorded during 129 months follow-up in a cohort of 2805 men and women of 60 years and older. There were 899 CHD events (32/100) and 326 stroke events (12/100). Using Cox proportional hazards, outcomes were modelled for the total cohort and for age groups 60-69, 70-79, and 80+ years. Total cholesterol, LDL cholesterol, serum apo-B, total cholesterol/high density lipoprotein (HDL) cholesterol and apo-B/apo-A1 were significant predictors of CHD in the total cohort, but significant only in the sub-group of 60-69 years. The respective hazard ratios (CI 95%) were 1.21 (1.09-1.35), 1.21 (1.09-1.35), 1.25 (1.13-1.39), 1.25 (1.14-1.37) and 1.21 (1.10-1.38). Similar findings were applicable with respect to ischaemic stroke in the age group of 60-69 years. Total cholesterol predicted CHD in men above a threshold value of 7.06 mmol/l and in women above 7.8 mmol/l, but with stroke the prediction was incremental. Other risk factors such as HDL cholesterol, triglycerides, lipoprotein(a), diabetes, hypertension and smoking predicted CHD, although only HDL and hypertension similarly predicted ischaemic stroke. The findings support a case for cholesterol testing in older subjects up to 70 years, in whom there is ancillary evidence of CHD and stroke prevention through treatment designed to reduce LDL cholesterol.     

Influence of simvastatin on LDL-subtypes in patients with heterozygous familial hypercholesterolemia and in patients with diabetes mellitus and mixed hyperlipoproteinemia.

This study evaluates the influence of simvastatin on lipid concentrations and on LDL-subtype distribution in patients with heterozygous familial hypercholesterolemia and in patients with type 2 diabetes and mixed hyperlipoproteinemia. Nine patients with familial hypercholesterolemia (LDL-cholesterol: 7.1 +/- 1.1 mmol/L, triglycerides: 1.3 +/- 0.4 mmol/L) and 8 patients with type 2 diabetes mellitus and mixed hyperlipoproteinemia (HbA1c 6.8 +/- 1.1%, LDL-cholesterol: 4.8 +/- 0.7 mmol/L, triglycerides: 2.5 +/- 1.1 mmol/L) were examined. Cholesterol concentration was determined in 7 LDL-subfractions isolated by density gradient ultracentrifugation before and during simvastatin treatment (10-20 mg/d, 4 weeks). Simvastatin decreased LDL-cholesterol (-34%/-30%, all p < 0.05) and triglycerides (-2%, n.s./-25%, p < 0.05), but had little effect on HDL-cholesterol (+7%/+2%, n.s.) in patients with familial hypercholesterolemia and diabetes mellitus, respectively. In both groups a significant reduction of cholesterol in each LDL-subfraction was observed. Large-buoyant (LDL-1, LDL-2) and intermediate-dense (LDL-3, LDL-4) LDL were reduced more than small-dense (LDL-5-LDL-7) LDL-subtypes (-36%/-38%/-23%, respectively) in patients with familial hypercholesterolemia, while in diabetic patients cholesterol reduction was uniform in all LDL-subtypes (-29%/-27%/-31%, respectively). Simvastatin decreases cholesterol concentration in all LDL-subfractions in patients with familial hypercholesterolemia and in patients with diabetes mellitus with mixed hyperlipoproteinemia. However, the relative reduction of individual LDL-subtypes differed between both groups. This suggests that the effect of simvastatin on LDL-subtype distribution depends on the type of underlying hyperlipoproteinemia.