住院老年动脉粥样硬化性心血管疾病患者血脂达标情况分析

目的调查住院老年动脉粥样硬化性心血管疾病(ASCVD)患者血脂的达标情况。方法采用分层随机抽样的方法对我院年龄≥60岁ASCVD的住院患者1019例进行血脂现状调查。男性571例、女性448例;心内科459例、神经内科194例、老年科99例、姑息科115例、精神心理科152例。根据2011年欧洲血脂异常管理指南对患者进行危险分层,极高危841例,高危114例,中危64例。判断血脂达标情况。结果所有患者血脂达标率26.9%,其中极高危血脂达标率20.3%,高危46.5%,中危78.1%(P0.05)。极高危患者中,老年科血脂达标率最高(30.5%),各专科高危血脂达标率比较有统计学差异(P=0.013)。女性、危险因素≥3个、共病3种和极高危患者为血脂达标率低的影响因素。结论 ASCVD患者血脂达标率低,各专科都要加强血脂管理,提高血脂达标率。     

中国糖尿病合并动脉粥样硬化性心血管疾病患者他汀类药物的应用现状调查

目的了解中国糖尿病合并动脉粥样硬化性心血管疾病(CVD)患者他汀类药物的应用现状。方法借助1项国际多中心大规模临床试验在中国实施之际,于2007年6～12月在10个城市的39家三级医院对符合标准的高危动脉粥样硬化性CVD患者进行调查,利用电子问卷采集临床资料,对他汀类药物的使用情况进行统计描述和分析。结果调查4429例糖尿病合并动脉粥样硬化性CVD患者,年龄50～80岁,平均(64±8)岁,66.2%为男性,3345例(75.5%)合并冠心病,2053例(46.4%)合并心肌梗死,1976例(44.6%)合并缺血性脑卒中,3181例(71.8%)合并高血压。仅1952例(44.1%)患者在服用他汀类药物,其中1411例(72.3%)患者末在确诊糖尿病后立即开始服用他汀,而451例(23.1%)患者未在确诊CVD后即开始服用他汀。辛伐他汀(20mg≤且40mg)和阿托伐他汀(10mg≤且20mg)为最常用剂量,分别占63.5%(489/770)和61.0%(428/702)。结论目前中国糖尿病合并动脉粥样硬化性CVD患者他汀类药物的使用明显不足,应加强对医师的培训和对患者的健康宣教,努力缩小临床实践与循证医学证据和指南推荐之间的差距。     

老年患者的他汀类药物降胆固醇治疗

过去10余年中,国内外先后完成了从4S研究到活化降脂进一步减少临床终点试验等一系列里程碑意义的他汀类降脂试验。这些研究结果有力论证了他汀类药物降TC在冠心病及相关心血管疾病一、二级预防中的重要意义。无论是冠心病及其等危症（如糖尿病、动脉粥样硬化性外周血管疾病）,还是具有多重危险因素的高危患者,积极有效的降脂治疗均可显著降低心血管疾病的发病率与病死率。[第一段]     

高龄男性动脉粥样硬化性心血管疾病患者他汀类药物疗效分析及不良反应探究

目的探究在高龄男性动脉粥样硬化性心血管疾病(ASCVD)患者中他汀类药物的治疗效果及不良反应。方法选择我院心血管内科住院的高龄男性ASCVD患者310例,根据数次入院随访服用他汀类药物情况分为他汀组195例和非他汀组115例,分析2组全因死亡及主要终点事件。结果他汀组和非他汀组平均生存时间分别为104.10个月(95%CI:97.46～110.75)和97.14个月(95%CI:89.61～104.67)。他汀组不稳定性心绞痛发生率明显低于非他汀组(P0.05)。校正他汀类药物、高血压等混杂因素后,肾功能不全是全因死亡、主要心血管事件、不稳定性心绞痛及非致死性心肌梗死的危险因素(HR=1.944,P=0.004;HR=2.095,P=0.004;HR=2.179,P=0.014;HR=3.172,P=0.019);而在校正混杂因素后,他汀类药物治疗与不稳定性心绞痛有关(P=0.015)。他汀组LDL-C水平明显低于非他汀组,HDL-C、LDL-C达标率、丙氨酸转氨酶轻度升高率明显高于非他汀组(P0.05,P0.01)。结论他汀类药物能显著降低高龄男性ASCVD患者LDL-C水平,减缓HDL-C下降趋势,具有良好的安全性。     

动脉粥样硬化性心血管疾病患者逆转斑块他汀类药物治疗专家共识

动脉粥样硬化性心血管疾病(ASCVD)包括冠心病、动脉粥样硬化性卒中和外周血管疾病,其病理基础是动脉粥样硬化(AS)。AS是脂代谢紊乱和炎症性血管疾病,他汀类药物具有调脂和抑制炎症作用。临床试验证明他汀类药物可逆转AS斑块,降低心血管事件发生风险。1逆转斑块的必要性逆转斑块是指通过使AS斑块内脂质逆向转运而减小斑块体积。1.1他汀类药物通过调脂降低ASCVD发生风险多个大规模临床试验结果证实,应用他汀类药物进行一级预防或二级预防可明显降低ASCVD     

严格管理好血脂，从源头防治动脉粥样硬化性心血管疾病

致动脉粥样硬化性脂蛋白异常是动脉粥样硬化性心血管疾病（ASCVD）的病因或称之为元凶,为了从根本上防治ASCVD,积极认真管理好血脂甚为重要。应用药物降低胆固醇水平能够显著地减少ASCVD发病率和死亡率。有效地管理好血脂,需要对脂蛋白代谢过程的多个靶点进行共同干预。所以,降脂药物的联合应用已是大势所趋。降脂药物联合应用...     

晚期慢性肾脏病动脉粥样硬化性心血管疾病发生发展的研究现状

心血管疾病(cardiovascular disease,CVD)是慢性肾功能衰竭(CRF)以及透析患者的主要死亡原因,部分慢性肾脏病(chrouic kidney disease,CKD)3期、4期患者尚未开始透析已死于心血管合并症。不少研究已证实,CKD患者患动脉粥样硬化性冠心病的风险明显高于与之年龄、性别相匹配而肾功能正     

反思他汀直面动脉粥样硬化心血管病挑战

正近两年内,欧美医学界连续推出4个调脂指南和建议,即2013ACC/AHA发布的胆固醇治疗指南,2014年美国国家脂质学会(NLA)制定的"以患者为中心的血脂异常管理建议",2013年国际动脉粥样硬化学会颁发的血脂异常管理建议并复习血脂与动脉粥样硬化的关系,2014年英国国家优化卫生与保健研究所发布的血脂管理指南。动脉粥样硬化心血管病(ASCVD)在中国的发病状况越来越严重,让中国医学界期待已久的这些具有国际影响力的全     

高龄男性动脉粥样硬化性心血管疾病患者

目的 探究在高龄男性动脉粥样硬化性心血管疾病(ASCVD)患者中他汀类药物的治疗效果及不良反应.方法 选择我院心血管内科住院的高龄男性ASCVD患者310例,根据数次入院随访服用他汀类药物情况分为他汀组195例和非他汀组115例,分析2组全因死亡及主要终点事件.结果 他汀组和非他汀组平均生存时间分别为104.10个月(...     

徐凤芹教授治疗老年动脉粥样硬化性心血管疾病经验浅析

动脉粥样硬化性心血管疾病严重影响人类健康,中医药治疗本病具有多种优势,临床应用日益普遍。徐凤芹教授认为本病病机为本虚标实,病机演化规律以气、血、阴、阳虚损为开端;随病程进展,出现痰浊、瘀血困阻;久之毒热内生,痰浊、瘀血、毒热交杂脉道,病情恶变。徐凤芹教授重视老年病人;治疗本病多以活血化瘀、祛湿化痰、解毒化浊之法,配合补虚扶正;并关注情志致病,提倡“双心同调”,临床疗效颇佳。在疾病预防方面,徐凤芹教授重视减重降脂,关注老年肌少症人群的综合管理,以期降低本病发病率。     

Risk-factor clustering and cardiovascular disease risk in hypertensive patients

BACKGROUND: Patients with hypertension often have other major risk factors for cardiovascular disease (CVD). Little is known, however, about the extent of risk-factor clustering in these patients and its importance in CVD risk and medical-care costs. METHODS: Study subjects were selected from the electronic medical records system of Kaiser Permanente Northwest, a large health maintenance organization, and included all patients aged > or =35 years with hypertension who were free of CVD in 1998. Subjects were stratified into eight risk-factor clusters based on whether or not they also had diabetes, hyperlipidemia, or a high body mass index (BMI). The risk of cardiovascular events was examined in each cluster over 6 years beginning January 1, 1999, using Kaplan-Meier methods and Cox proportional hazards models. Cumulative total medical-care costs (per patient) over 6 years also were examined. RESULTS: A total of 57,573 patients with hypertension who were free of CVD in 1998 were identified; 56% of subjects also had diabetes, hyperlipidemia, or high BMI. In analyses controlling for age, sex, and smoking status, the relative risk of cardiovascular events over 6 years was highest for patients with comorbid diabetes, ranging from 2.07 (95% confidence interval, 1.86-2.30) for those with diabetes only to 2.80 (95% confidence interval, 2.48-3.17) for those with diabetes, hyperlipidemia, and high BMI. Cumulative medical-care costs generally increased with additional risk factors. Comorbid diabetes had the greatest impact on costs over 6 years. CONCLUSIONS: More than 50% of patients with hypertension also had diabetes, hyperlipidemia, or high BMI. Patients with these additional risk factors (especially diabetes) had a substantially higher CVD risk and medical-care costs.     

老年男性血清抵抗素水平与外周动脉硬化闭塞症的关系

目的探讨老年男性血清抵抗素水平与外周动脉硬化闭塞症(PAOD)的关系。方法选择843例老年男性患者,分为PAOD组165例和非PAOD组678例。检测血清抵抗素及C反应蛋白水平,进行相关分析。结果PAOD组血清抵抗素水平明显高于非PAOD组[(7.26±2.94)ng/L vs(6.49±3.09)ng/L,P<0.05]。血清抵抗素水平与C反应蛋白和HDL-C独立相关(β=0.058,β=-0.810,P<0.05)。抵抗素是PAOD的独立危险因素(P=0.004)。结论老年男性PAOD患者血清抵抗素水平升高,血清抵抗素水平可能是PAOD发病的预测因素。     

Antibodies against endothelial cells and cardiolipin in young patients with peripheral atherosclerotic disease

Abstract. Objectives . To investigate the prevalence of anti-cardiolipin and antiendothelial cell antibodies in patients operated on for atherosclerotic peripheral vascular disease before 50 years of age. The hypothesis to be tested was whether antibodies associated with an immune/inflammatory damage to the vascular wall were associated also with early atherosclerosis. Design . A case-control study. Setting . Departments of surgery and an immunological research laboratory, and routine laboratories of two tertiary referral hospitals. Subjects . All patients operated for atherosclerotic peripheral vascular disease before 50 years of age. Sixty-two patients (33 males, 29 females), and 67 age- and sex-matched controls participated. The diagnosis of atherosclerosis was made on the basis of the clinical presentation and angiographic visualization of the diseased vasculature. Main outcome measures . Subjects were compared for the prevalence of anticardiolipin and antiendothelial cell antibodies, altered serum lipoprotein levels, smoking, diabetes, hypertension, and signs of inflammation. Results . Antibodies against endothelial cells and cardiolipin were found in 12.9 and 14.5% of the patients, respectively, which was higher than observed in the control group (P < 0.05). Sixty per cent of patients with antibodies were females. Conventional risk factors were more often noted in the patient group. However, patients with antibodies against endothelial cell and/or cardiolipin had a lower prevalence of hyperlipidaemia/dyslipidaemia when compared to patients without these antibodies (P < 0.05). Conclusions . Antibodies against endothelial cells and cardiolipin are present in a subset of patients with clinical and angiographic diagnosis of severe premature atherosclerotic peripheral vascular disease. The lower occurrence of hyperlipidaemia/dyslipidaemia in patients with autoantibodies, in comparison to patients without the antibodies, suggests that these antibodies have a role in vascular damage.     

Endovascular interventions of the femoro-popliteal disease in the elderly

In the last few years the treatment of superficial femoral artery (SFA) occlusive disease has undergone greater changes in management including more aggressive endoluminal therapy, especially in the elderly patients who are at high risk for extra-vascular comorbidities from the surgical approach. While acute and chronic arterial limb ischemia is the conditions which the interventional cardiologists frequently encounter, the elderly population represents special problematic clinical and anatomical setting due to heavy calcification and poor distal run-off. Arterial thrombolysis, rheolytic thrombectomy, mechanical thrombectomy, laser angioplasty, cryoplasty, and new flexible long stents are some of the promising techniques to improve the technical and clinical outcomes in these elderly patients.     

SGLT2i在合并糖尿病动脉粥样硬化性心血管疾病中的作用研究进展

糖尿病是一种全球流行病,血糖控制不佳是导致心血管疾病患者死亡的主要原因之一.作为新型降糖药,钠-葡萄糖共转运体2抑制剂(SGLT2i)由于其在临床和基础研究中表现出卓越的心血管系统保护作用而倍受关注.前期针对SGLT2i的大型随机对照试验(EMPA-RED研究、CANVAS研究、DELCARE TIMI-58研究)均证...     

老年心血管疾病患者合并骨骼肌质量下降的临床特点

目的探讨老年心血管疾病合并骨骼肌质量下降患者的临床特点。方法选择心血管疾病患者310例,根据肌少症诊断标准,将患者分为骨骼肌质量下降组209例和无骨骼肌质量下降组101例。其中年龄≥80岁168例,年龄<80岁142例。测定骨骼肌质量,记录患者的基本情况、既往病史、生化指标,建立logistic回归模型筛选独立危险因素。结果年龄≥80岁患者骨骼肌质量下降比例明显高于年龄<80岁患者(82.14%vs 50.00%,P<0.05)。骨骼肌质量下降组年龄[(81.57±8.61)岁vs(73.51±9.50)岁,P<0.01]、男性(74.16%vs 53.47%,P<0.01)、吸烟及慢性阻塞性肺疾病比例、血肌酐、HDL和高敏C反应蛋白水平较无骨骼肌质量下降组明显升高,体质量指数、日常生活活动能力评分、血清白蛋白水平、估算的肾小球滤过率和TG水平较无骨骼肌质量下降组明显降低(P<0.05,P<0.01)。logistic回归分析显示,年龄≥80岁、低白蛋白水平、低体质量指数、男性是骨骼肌质量下降的独立危险因素(P<0.05,P<0.01)。结论老年心血管疾病患者合并骨骼肌质量下降的患病率高,生活能力及营养水平下降。高龄、低白蛋白水平、低体质量指数,男性可能是发生骨骼肌质量下降的危险因素。     

老年高血压合并代谢异常特征及其对靶器官的影响

目的分析老年原发性高血压患者合并不同代谢异常的临床特征及其对靶器官的影响。方法选择老年高血压患者460例,根据合并代谢异常情况分为6组:A组(单纯高血压,21例),高血压合并腹型肥胖、血脂异常、糖尿病、高尿酸血症及代谢综合征分别为B组(32例)、C组(73例)、D组(54例)、E组(27例)和F组(253例),行相关生化指标检测和超声等检查,综合评估其靶器官损害和并发症情况。结果单纯高血压患者仅占4.6%,95.4%的患者合并1项以上代谢异常。与A组比较,F组体重指数、腰围、空腹血糖、餐后2 h血糖、糖化血红蛋白、TG、尿酸及血肌酐明显升高(P<0.05),HDI-C明显下降(P<0.05);各组高血压病程和血压控制水平相当,但F组较其他组需要多种的抗高血压药物(P<0.05);D组与F组颈动脉内膜中层厚度、尿微量白蛋白/肌酐以及合并冠心病和脑血管病差异有统计学意义(P<0.05)。结论老年高血压患者以多重代谢性危险因素聚集为特征,该特征使靶器官损害和心脑血管病的发生明显增加,且需要多种抗高血压药物联用以控制血压。     

Self-rated health status as a risk factor for future vascular events and mortality in patients with symptomatic and asymptomatic atherosclerotic disease: the SMART study

Abstract. Grool AM, van der Graaf Y, Visseren FLJ, de Borst GJ, Algra A, Geerlings MI, on behalf of the SMART Study Group (University Medical Center Utrecht, Utrecht, The Netherlands). Self‐rated health status as a risk factor for future vascular events and mortality in patients with symptomatic and asymptomatic atherosclerotic disease: the SMART study. J Intern Med 2012; 272: 277–286. Objectives. Lower self‐rated health status has been associated with worse prognosis in patients with coronary artery disease (CAD). We investigated the influence of self‐rated physical and mental health status on the risk of future vascular events and mortality for various locations of symptomatic atherosclerotic disease and asymptomatic disease. Design. Patients with CAD (n = 2547), cerebrovascular disease (n = 1061), peripheral arterial disease (PAD; n = 648), abdominal aortic aneurysm (AAA; n = 272) and asymptomatic atherosclerotic disease (n = 1933) were followed for a median of 4 years for the occurrence of a new vascular event or death. Self‐rated health status was assessed with the Short Form‐36 physical and mental component summary scales. Cox regression models were used to estimate associations between health status and vascular events and death, adjusted for age, sex, vascular risk factors and intima–media thickness. Results. In the total population, lower self‐rated physical health status (per 10‐point decrease) increased the risk of vascular events [hazard ratio (HR) = 1.37, 95% confidence interval (CI) 1.24–1.52], and all‐cause (HR = 1.45, 95% CI 1.29–1.63) and vascular mortality (HR = 1.40, 95% CI 1.20–1.64). A 10‐point decrease in mental health status was associated with a modest increase in the risk of vascular events (HR = 1.19, 95% CI 1.08–1.32), and all‐cause (HR = 1.19, 95% CI 1.05–1.34) and vascular mortality (HR = 1.28, 95% CI 1.09–1.49). Risk estimates of physical and mental health status were highest in patients with asymptomatic atherosclerotic disease and lowest in those with PAD. Conclusions. Poorer self‐rated physical and mental health status increases the risk of vascular events and mortality in a broad population of patients with symptomatic and asymptomatic atherosclerotic disease.     

老年人群代谢综合征的患病率及其与心脑血管病的关系

目的调查北京城区老年人群中代谢综合征(MS)的患病率,并探讨其与心血管疾病的关系。方法人群为基础的横断面现况研究。2 334例老年人(年龄60~95岁;男性943例,女性1 391例)为北京市海淀区万寿路地区分层整群抽样样本,占万寿路地区老年人口的11.4%。MS的诊断标准为美国胆固醇教育计划(NCEP ATPⅢ)和国际糖尿病联盟(IDF)2005标准。冠心病和脑卒中的定义为WHO-MONICA标准。结果北京城区老年人群中MS患病率:NCEP标准为30.5%(男性17.6%,女性39.2%);IDF标准为46.3%(男性34.8%,女性54.1%)。无论采用NCEP或IDF诊断标准,具有MS的人群中,冠心病和脑卒中的患病危险均明显增高约50%。在符合IDF标准而不符合NCEP标准的人群中(n=436,18.7%),冠心病和脑卒中的危险度亦有显著增高,其OR(95%CI)分别是1.65(1.31~2.09)和1.53(1.13~2.06)。结论MS在北京城市老年人群中(尤其是女性)患病率较高。IDF标准比NCEP更适合评估和筛选中国MS中的心血管病危险人群。