影响他汀类药物治疗心血管疾病依从性的相关因素分析

目的对影响他汀类药物治疗心血管疾病依从性的有关因素进行研究分析。方法随机选择我院2010年5月至2012年5月心血管疾病患者88名,分成A、B两组,A组55名依从性较好的患者为治疗组,B组33名依从性较差的患者为对照组,分别对A、B组患者治疗和住院资料进行回顾性总结。结果经分析,A组患者年龄相比于B组较小,对药物使用知识掌握较多,与医生护士关系较佳,自费支付医药费比例较低,对依从性影响较大。结论对影响他汀类药物治疗心血管疾病依从性较大的因素加以改善,能够较好增强依从性。     

Family history influence on drug abuse severity and treatment outcome

Influence of parental alcohol/substance abuse on methadone maintenance therapy (MMT) outcome was examined in 164 DSM-III-R opioid dependent adults with no other current DSM Axis I disorder. Family history positive patients had more DSM-III-R opioid dependence symptoms and were more likely to be classified as severely dependent. However, when placed on identical daily doses of methadone (50 mg), they had lower rates of illicit opioid use but higher rates of cocaine use than family history negative patients. Both effects remained significant after adjusting for gender and race. These results suggest that common genetic factors may underlie both susceptibility to heroin dependence and response to therapeutic methadone treatment.     

西地那非的应用与对心血管疾病的影响

勃起功能障碍的病人有相当部分伴有冠状动脉粥样硬化性心脏病 (冠心病 ) ,其中又有许多病人需持续服用硝酸酯类等血管活性药物。本文回顾了以往的研究 ,提出 :西地那非禁用于需持续服硝酸酯类药物的冠心病病人 ,用于心肌病、肺动脉高压、高血压病及心力衰竭等病人应待更多研究的总结     

Novel concepts of statin therapy for cardiovascular risk reduction in hypertension

Hypertension is associated with an increase in cardiovascular events. Pathophysiological mechanisms of this include endothelial damage/dysfunction, inflammatory activation, insulin resistance, platelet activation and alterations in the coagulation cascade leading to a prothrombotic state. Dyslipidaemia acts synergistically with hypertension in increasing cardiovascular risk. HMG CoA reductase inhibitors (statins) are lipid-lowering drugs and more recently have been shown to have a significant pleiotropic effect on endothelial function, inflammation, platelet activation and coagulation. Statins affect the whole pathophysiology of atherogenesis from deposition to plaque rupture and thrombogenesis because of its pleiotropic effects. Therefore it is intuitive that statins may be of benefit in hypertensive patients with conventionally normal lipid levels by preventing the pathological effects of hypertension. There is an increasing clinical evidence base for statins use in patients with hypertension. In this article, the novel pleiotropic and conventional mechanisms of statins, and clinical data of statin therapy in patients with hypertension are reviewed.     

腹膜透析和血液透析对心血管疾病的影响

目的比较腹膜透析和血液透析对尿毒症患者心血管疾病的影响。方法收集2015年6月~2017年6月在本院行透析治疗的尿毒症患者86例,分为腹膜透析组和血液透析组,两组患者在透析前后均进行心脏彩超检査,收集患者透析2年后心脏结构和功能的各项指标变化,包括心脏室间隔舒张末期厚度(IVSd)、左心室舒张末期厚度(LVPWd)、左心室舒张末内径(LVEDd)、左心房内径(LA),并计算左心室重量指数(LVMI)。比较两组患者生化指标、心脏结构、功能指标在透析前后组间及组内的差异。结果透析前,两组患者心脏结构指标组间比较无统计学差异。透析后,腹膜透析组患者的白蛋白(ALB)和C反应蛋白(CRP)水平显著低于于血液透析组患者,而低密度脂蛋白(LDL)、甘油三酯(TG)和总胆固醇(CHOL)水平明显高于血液透析组患者;透析后,两组患者的LVMI、IVSd、LVPWd均显著升髙,而腹膜透析组与血液透析组比较,血液透析组患者的LVMI、IVSd、LVPWd升髙较腹膜透析组明显,以上差异均有统计学意义(P<0.05)。结论不同的透析方式均会不同程度地影响尿毒症患者的心脏结构和功能,且血液透析的影响可能更大,本文结果提示相对于血液透析,腹膜透析对心脏结构的影响小,能更好的保护心功能,而对血液透析治疗的患者的心功能进行早期干预,减少透析对心脏功能和结构的影响能减少心血管事件的发生,延长患者的寿命。     

Circadian influence on inflammatory response during cardiovascular disease

Circadian rhythms follow a 24 h day and night cycle, regulate vital physiological processes, and are especially relevant to cardiovascular growth, renewal, repair, and remodeling. A recent flurry of clinical and experimental studies reveals a profound circadian influence on immune responses in cardiovascular disease. The first section of this review summarizes the importance of circadian rhythms for cardiovascular health and disease. The second section introduces the circadian nature of inflammatory responses. The third section combines these to elucidate a new role for the circadian system, influencing inflammation in heart disease, especially myocardial infarction. Particular focus is on circadian regulation of the NACHT, LRR, and PYD domains–containing protein 3 inflammasome, neutrophils, monocytes/macrophages, and T cells involved in cardiac repair. A role for biological sex is noted. The final section explores circadian influences on inflammation in other major cardiovascular conditions. Circadian regulation of inflammation has profound implications for benefitting the diagnosis, treatment, and prognosis of patients with cardiovascular disease.     

Costs and health effects of adding functional foods containing phytosterols/-stanols to statin therapy in the prevention of cardiovascular disease

The present modelling study aimed to evaluate if and by how much functional foods containing phytosterols/-stanols add to the benefits of statins in the prevention of cardiovascular disease in terms of cost-effectiveness. Long-term health effects, measured as quality-adjusted life-years gained, and costs for scenarios with additional phytosterol/-stanol use were compared to scenarios without extra use. Phytosterols/-stanols were given only to persons who were eligible for use according to their 10-year absolute risk of fatal cardiovascular disease (SCORE-risk). Intake levels and discontinuation rates as observed in daily practice were included in the model. Two situations were compared: 1) A real-life situation in which persons at high SCORE-risk were identified through clinical case-finding and, 2) A theoretical maximum situation where universal screening was implemented resulting in known SCORE-risks for the whole Dutch population aged 35-75 years (8.4 million people). Sensitivity analyses were performed for variations in the cholesterol-lowering effect and intake level of phytosterols/-stanols, indirect health care costs, time horizon and discount rates. At the model's start year, a total of 1.0 (real-life situation) to 3.3 (maximum situation) million persons qualified for phytosterol/-stanol use based on their SCORE-risk (both statin users and statin non-users). Over the model's time horizon, this resulted in a gain of 2700 to 16,300 quality-adjusted life-years, and yielded cost-effectiveness ratios that ranged between ?2,000 and ?03,000 per quality-adjusted life-year. This simulation study showed that the cost-effectiveness of phytosterols/-stanols as monotherapy and as add-on to statins is above thresholds for cost-effectiveness, generally ranging between ?0,000 and ?0,000, and is thus a non-cost-effective strategy to reduce cardiovascular disease.     

Safety of statin therapy in patients with preexisting liver disease

Cardiovascular disease is the leading cause of mortality in the United States. In high-risk patients, statin therapy has become the standard of care. In fact, statins are the most efficacious drugs for decreasing low-density lipoprotein cholesterol levels; they reduce both primary and secondary cardiovascular risk in the general population. However, less is known about the safety of statin use in patients with liver disease. Results from studies of statin therapy in patients with elevated liver enzyme levels, nonalcoholic fatty liver disease, hepatitis C, cirrhosis, liver transplants, and hepatocellular carcinoma show benefit without increased risk of adverse effects. Thus, based on available evidence, statin therapy should not be withheld in this patient population; however, more robust, prospective clinical trials are needed to confirm the safety and efficacy.     

Nitric oxide and the endothelium: history and impact on cardiovascular disease

There are few discoveries with the magnitude of the impact that NO has had on biology during the 25 years since its discovery. There is hardly a disease today not associated with altered NO homeostasis. In fact, despite numerous other endothelial functions, endothelial dysfunction has become synonymous with reduced biological activity of NO. Translating the preclinical discoveries in NO biology to new modalities for disease management has not been as impressive. Beyond the success of drugs for erectile dysfunction, clinical trials of nitric oxide synthase inhibitor have been proven either ineffective or wrought with side effects. NO donors (e.g., nitroglycerine) remain frequently used cardiovascular agents, but were discovered before 1980. Gene therapy studies have yet to become clinically useful. There is no doubt that endothelial- and NO-dysfunction is a hallmark of cardiovascular disease, including diseases which are considered as major current public health concerns: hypertension, obesity, diabetes, malnutrition. In many cases, cardiovascular disease (CVD) can be prevented by identifying and controlling modifiable risk factors. One conceivable approach to the management of multiple risk factors in CVD could be to treat endothelial dysfunction (e.g., by enhancing eNOS expression), since many CVD risk factors are related to endothelial dysfunction. In this regard one goal may include optimizing eNOS function. This can be realized by supplementing co-factors, e.g., BH4, or substrate, L-arginine, by increasing cGMP availability via phosphodiesterase inhibitors or sGC activators or by increasing NO bioavailability via antioxidants. The association of other proteins with the nitric oxide synthase (NOS) isoforms and sGC could also serve as experimental and potentially therapeutic targets to modulate NO bioactivity. There is tremendous promise behind NO itself as well as the numerous other molecules and processes associated with the L-arginine-NO-cGMP pathway. Collaborative efforts among bench scientists, clinical investigators and epidemiologists are the key in realizing this promise.     

Hormone replacement therapy and cardiovascular disease.

Oestrogen alone probably confers a degree of protection against ischaemic heart disease and stroke and is appropriate for women requiring hormone replacement therapy (HRT) who have undergone hysterectomy. However, the cardiovascular effects of the progestogens used with oestrogen in the much larger number of women who have not undergone hysterectomy are unknown. Some widely used progestogens have adverse effects on lipoprotein levels and may raise blood pressure. The antithrombin III level may be involved in determining the response to oestrogen in different settings. The indications for HRT and the effects of different formulations on cardiovascular disease constitute one of the most pressing but complex issues in present-day medical practice. These questions can only be satisfactorily answered by the randomised controlled trials that should have been initiated several years ago and the feasibility of which is only now being investigated.     

Combating cardiovascular disease with angiogenic therapy

For over a decade we have lived with the promise that therapeutic angiogenesis, defined as the growth of new blood vessels in tissues damaged by poor blood perfusion, would provide a lasting clinical benefit to patients suffering from cardiovascular disease, the leading cause of death in the Western world. Numerous successful protein, gene and cell-based angiogenesis studies in animals with experimentally induced ischemia have not been followed by positive efficacy data in human trials. Armed with knowledge of the shortcomings of earlier clinical studies, emerging results from more recent trials indicate that protein-based angiogenesis therapy may provide a viable treatment option for patients suffering from advanced atherosclerotic disease.     

Nitric oxide therapy For cardiovascular disease

Endothelium-derived NO is acknowledged as a key mediator of cardiovascular homeostasis. Indeed, an impairment in endothelial function resulting in limited NO bioavailability may contribute to a raft of vascular pathologies while a failure of peripheral 'nitrergic' neurovasodilator tone is implicated in erectile dysfunction. In addition to the established NO therapy exemplified by the use of nitrovasodilators, the endogenous NO pathway can now be therapeutically modulated to optimise endothelial or peripheral neuronal vasodilator function by inhibiting PDEV. A similar modulation of the NO pathway may also be clinically viable through the supplementation of precursors and cofactors of NO synthesis, the upregulation of endothelial NO synthase (eNOS) and the transfection of NOS genes to the vasculature.     

Gene therapy for cardiovascular disease.

Cardiovascular gene therapy has progressed to the point where clinical trials are now underway, in particular, for peripheral and myocardial ischemia and for restenosis. The delivery vectors are now more sophisticated--targeted to deliver genes only to specific tissues, and with gene expression regulated by disease-inducible promoters--which contributes to improved safety.     

Dynamics of long-term statin therapy

Purpose  

Knowledge of the different usage patterns that emerge during a long-term statin therapy is limited. The aim of this study was to characterize statin use, including the rates of reinitiation after extended periods of non-use, transitions between good and poor adherence, and the effect of the length of a drug-free period on the identification of new users.     

Postmenopausal hormone therapy and the risk of cardiovascular disease

Background: Risks and benefits of postmenopausal hormone therapy remain highly controversial. After publication of the Women's Health Initiative hormone trials and several other major trials, the American Heart Association designated postmenopausal hormone therapy as ‘Class III’, if initiated for the purpose of cardiovascular disease prevention. Subsequent post hoc analyses of the Women's Health Initiative data have renewed enthusiasm for hormone therapy among younger postmenopausal women. Objective: To review data from randomized clinical trials that have assessed cardiovascular outcomes of hormone therapy including coronary heart disease, stroke, peripheral arterial disease, and venous thromboembolism. Methods: The review focuses on cardiovascular effects of hormone therapy only and does not attempt to integrate potential risks and benefits related to symptoms, cancer, osteoporosis or other noncardiovascular effects of postmenopausal hormone therapy. The literature search included original trial publications, post hoc analyses, and aggregate data from meta-analyses published in English and accessible to the author in full-text format for detailed analysis. Results/conclusion: Risks of hormone therapy seem to predominate among older postmenopausal women. Data among younger women close to menopause are insufficient to recommend such therapy for cardiovascular disease prevention.     

Early vascular benefits of statin therapy

Large-scale trials established that statin administration in hypercholesterolaemic individuals and patients with coronary heart disease (CHD) significantly reduces the risk of vascular events and death. This benefit was primarily attributed to their actions on lipids. This review focuses on the benefits (clinical and experimental) of statins observed soon (approximately 12 weeks) after their administration. Statins rapidly increase nitric oxide production and improve endothelial function (e.g. increased flow-mediated dilatation). Similarly, antioxidant properties decrease the susceptibility of low density lipoprotein cholesterol to oxidation. Statins inhibit the migration of macrophages and smooth muscle cell proliferation leading to an antiproliferative effect and the stabilisation of atherosclerotic plaques. Anti-inflammatory effects include a reduction in serum C-reactive protein levels, inflammatory and proinflammatory cytokines (e.g. IL-6, IL-8), adhesion molecules (e.g. ICAM-1, VCAM-1) and other acute phase proteins. Statins influence the haemostatic system. They reduce tissue factor expression and platelet activity, whereas fibrinolysis can be enhanced. Statins improve microalbuminuria, renal function, hypertension and arterial wall stiffness. A significant reduction of the carotid intima media thickness (IMT) was also reported early after statin treatment. These early effects of statins probably contribute to the significant reduction in vascular events seen in some 'short-term' studies. There is a need to further elucidate the rapid and non-lipid lowering properties of statins.