Job strain and risk of acute recurrent coronary heart disease events

Context  There is evidence that job strain increases the risk of a first coronary heart disease (CHD) event. However, little is known about its association with the risk of recurrent CHD events after a first myocardial infarction (MI). Objective  To determine whether job strain increases the risk of recurrent CHD events. Design, Setting, and Patients  Prospective cohort study of 972 men and women aged 35 to 59 years who returned to work after a first MI and were then followed up between February 10, 1996, and June 22, 2005. Patients were interviewed at baseline (on average, 6 weeks after their return to work), then after 2 and 6 years subsequently. Job strain, a combination of high psychological demands and low decision latitude, was evaluated in 4 quadrants: high strain (high demands and low latitude), active (high demands and high latitude), passive (low demands and low latitude), and low strain. A chronic job strain variable was constructed based on the first 2 interviews, and patients were divided into those exposed to high strain at both interviews and those unexposed to high strain at 1 or both interviews. The survival analyses were presented separately for 2 periods: before 2.2 years and at 2.2 years and beyond. Main Outcome Measure  The outcome was a composite of fatal CHD, nonfatal MI, and unstable angina. Results  The outcome was documented in 206 patients. In the unadjusted analysis, chronic job strain was associated with recurrent CHD in the second period after 2.2 years of follow-up (hazard ratio [HR], 2.20; 95% CI, 1.32-3.66; respective event rates for patients exposed and unexposed to chronic job strain, 6.18 and 2.81 per 100 person-years). Chronic job strain remained an independent predictor of recurrent CHD in a multivariate model adjusted for 26 potentially confounding factors (HR, 2.00; 95% CI, 1.08-3.72). Conclusion  Chronic job strain after a first MI was associated with an increased risk of recurrent CHD.      

血浆内毒素与冠心病及其危险因素的相关性分析

目的:探讨血浆内毒素与冠状动脉粥样硬化性心脏病(CHD)及其危险因素之间的关系.方法:抽取查体人群体检资料240例,根据体检结果分为CHD组和正常对照组.记录入选对象的一般资料及血糖、血脂等检查结果,并通过鲎试剂动态比浊法测定血浆内毒素水平.分析血浆内毒素与冠心病及其危险因素的相关关系.结果:CHD组患者的血浆内毒素、纤维蛋白原、血尿酸、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、收缩压、舒张压均高于正常对照组,而高密度脂蛋白胆固醇低于正常对照组(P＜0.01).冠心病患者所占比例随血浆内毒素水平升高而增高(P＜0.01).CHD组患者的血浆内毒素与甘油三酯、低密度脂蛋白胆固醇、纤维蛋白原呈正相关(P＜0.05);而与高密度脂蛋白胆固醇则呈负相关(P＜0.05).二分类Logistic回归分析显示:血浆内毒素及低密度脂蛋白胆固醇是CHD危险因素,高密度脂蛋白胆固醇是CHD保护性因素.结论:血浆内毒素与冠心病及其危险因素密切相关,其可能是通过与CHD相关危险因素协同作用从而促进CHD发生与发展.     

冠状动脉钙化与冠心病危险因素的相关性

探讨太动脉钙化（ＣＡＣ）与ＣＨＤ危险因素之间的关系,以增加ＣＴ诊断ＣＨＤ的敏感性和可靠性。方法１８８例住院患均行冠脉造影及冠脉ＣＴ检查,并详细记录病史及冠心病的危险因素。结果年龄〈４５岁ＣＡＣ对ＣＨＤ诊断的特异性较高,冠脉狭窄≥７５％组ＣＡＣ诊断ＣＨＤ的阳性预告值明显高于狭窄〈７５％组。     

冠心病介入术后再狭窄危险因素的多因素 Logistic 分析

目的：分析冠心病介入术后再狭窄的危险因素。方法：选取108例2012年1月～2014年1月在我院接受冠心病介入手术患者的临床资料,对选取病人进行术后6个月随访并行冠状动脉造影术,依据患者是否出现冠状动脉再狭窄分为观察组和对照组。结果：本研究共纳入受试者108例,其中观察组78例,对照组40例。对两组受试对象的支架直径进行比较发现,差异具有统计学意义。观察组受试对象血清 TC、TG、HDL-C、HDL-C、LP （α）、CRP 水平显著高于对照组,差异均具有统计学意义。Logistic 多因素回归分析方法分析,支架直径、TC、TG、HDL-C、CRP 水平升高是冠心病再狭窄的独立危险因素。观察组患者 CRP 与 TG 呈现正相关,与 HDL-C 呈现负相关。结论：支架直径、TC、TG、HDL-C、CRP 水平升高是引起冠心病再狭窄的危险因素。     

高血压病患者的冠心病危险因素分析

目的　探讨高血压患者发生冠心病的危险因素。方法　 15 9例中男 89例 ,女 70例 ,平均年龄 (5 9.6± 9.2 3)岁 ,有典型心绞痛或不典型胸痛的高血压病患者以性别、年龄、体重指数 (BMI)、坐位舒张压、空腹血糖、总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白 (HDL C)、低密度脂蛋白 (LDL C)、纤维蛋白原、吸烟量、冠心病家族史等多种危险因素及冠状动脉狭窄程度评分 (冠脉评分 )进行多变量分析 ,患者均行冠脉造影 ,84例冠状动脉造影狭窄≥ 5 0 % ,诊断为冠心病。结果　多元逐步回归及多元lo gistic回归分析显示 :纤维蛋白原、空腹血糖、舒张压、吸烟等级与冠心病独立相关 ,冠心病的相对危险率(OR)分别为 :纤维蛋白原 >5g L为≤ 5g L的 4 .36 2倍 ;空腹血糖 >6 .1mmol L为≤ 6 .1mmol L 7.6 5 4倍 ;舒张压≥ 90mmHg为 <90mmHg的 2 .6 77倍 ;吸烟级别 =3级为 <3级的 6 .5 0 2倍。回归分析结果显示纤维蛋白原、空腹血糖、舒张压、吸烟等级与冠心病独立相关 ,纤维蛋白原、总胆固醇与冠脉狭窄评分独立相关。结论　高血压病患者的纤维蛋白原、空腹血糖、吸烟等级、舒张压与冠心病独立相关 ,纤维蛋白原、总胆固醇与冠脉病变程度有关     

高密度脂蛋白胆固醇与冠心病及其危险因素的回顾性分析

目的：探讨高密度脂蛋白胆固醇（HOE-C）与冠心病、冠心病危险因素的关系。方拔：将931份心脏科住院病例按HDL—C水平分为3组,小于1.04mmol／L为低水平组,1．04—1．54mmol／L为适当水平组,大于等于1．55mmol／L为高水平组,对3组资料进行回顾性分析。结果：甘油三酯（TG）、动脉粥样硬化指数、尿酸（UA）、血糖、急性心肌梗死和2型糖尿病患病率高水平组和（或）适当水平组明显低于低水平组（P〈0．05）,高水平组较适当水平组2型糖尿病和急性心肌梗死患病率、随机血糖、低密度脂蛋白（LDL）无显著差异（P〉0．05）。3组病人的住院天数、高血压、心律失常、冠心病患病率无明显差别（P〉0．05）。高水平组总胆固醇（TC）,收缩压最高（P〈0．05）。结论：虽然高水平、适当水平组较低水平组心血管保护作用明显。但高水平组较适当水平组心血管保护作用不显著。高密度脂蛋白胆固醇的质量比数量重要。     

"Stress" and coronary heart disease: psychosocial risk factors

An Expert Working Group of the National Heart Foundation of Australia undertook a review of systematic reviews of the evidence relating to major psychosocial risk factors to assess whether there are independent associations between any of the factors and the development and progression of coronary heart disease (CHD), or the occurrence of acute cardiac events. The expert group concluded that (i) there is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of CHD; and (ii) there is no strong or consistent evidence for a causal association between chronic life events, work-related stressors (job control, demands and strain), Type A behaviour patterns, hostility, anxiety disorders or panic disorders and CHD. The increased risk contributed by these psychosocial factors is of similar order to the more conventional CHD risk factors such as smoking, dyslipidaemia and hypertension. The identified psychosocial risk factors should be taken into account during individual CHD risk assessment and management, and have implications for public health policy and research.     

Periodontal disease and coronary heart disease risk

CONTEXT: Research has suggested a relationship between periodontal disease and coronary heart disease (CHD), but data on the association between these 2 common conditions are inconclusive due to the possibility of confounding. OBJECTIVE: To evaluate the risk of CHD in persons with periodontitis, gingivitis, or no periodontal disease. DESIGN: Prospective cohort study. SETTING: The First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992. PARTICIPANTS: A total of 8032 dentate adults aged 25 to 74 years with no reported history of cardiovascular disease, including 1859 individuals with periodontitis, 2421 with gingivitis, and 3752 with healthy periodontal tissues. MAIN OUTCOME MEASURE: First occurrence of death from CHD or hospitalization due to CHD, or revascularization procedures, obtained from death certificates and medical records, by baseline periodontal status. RESULTS: During follow-up, 1265 individuals had at least 1 CHD event, including CHD fatality (n = 468) or at least 1 hospitalization with a diagnosis of CHD (n = 1022), including coronary revascularization procedures (n = 155). After adjustment for known cardiovascular risk factors, gingivitis was not associated with CHD (hazard ratio, 1.05; 95% confidence interval, 0.88-1.26), while periodontitis was associated with a nonsignificant increased risk for CHD event (hazard ratio, 1. 14; 95% confidence interval, 0.96-1.36). CONCLUSION: This study did not find convincing evidence of a causal association between periodontal disease and CHD risk. JAMA. 2000;284:1406-1410.     

Assessing risk factors of perioperative major cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery

To the editor： In a retrospective observational clinical study including 482 elderly patients with coronary heart diseaseundergoing elective major noncardiac surgery, Liu et al＇ showed that the incidence ofperioperative major adverse cardiac events （MACEs） was 12.7%, and five risk factors were independently associated with perioperative MACEs. This study makes an important contribution to the effort to define risk factors for perioperative MACEs in elderly patients with coronary heart disease undergoing noncardiac surgery. Strengths of this study include a large sample of patients and most of the known risk factors that can affect perioperative MACEs. Furthermore, the authors have used appropriate methods to identify independent risk factors for perioperative MACEs. However, in our view, there are several aspects of this study that should be considered.     

冠心病心血管危险因素同年龄的相关性研究

目的探讨年龄与冠心病心血管危险因素的相关性。方法收集256例冠心病患者作为观察组,并以非冠心病患者132例为对照,比较两组各危险因素,并对患者按年龄分组,进行心血管危险因素的逐步Logistic回归分析。结果冠心病患者与对照组间多项心血管危险因素差异具有统计学意义(P0.05),逐步Logistic回归分析显示,年龄与冠心病发病相关(OR=0.415,95CI(0.214,0.698));青年人群中,家族史、hs-CRP、poA-I/apoB是冠心病的独立危险因素;中年组中,家族史、血脂异常、吸烟是冠心病的独立危险因素;老年组中,吸烟、家族史、高血压、血脂异常、TG、apoB、RDW、hs-CRP是冠心病的独立危险因素。结论年龄是冠心病的影响因素之一,排除年龄影响后,载脂蛋白水平可能是冠心病的独立危险因素。     

组织蛋白酶L与冠心病及其危险因素的相关性

目的:探讨组织蛋白酶L(CatL)与冠心病发病、冠脉狭窄程度以及冠心病危险因素之间的关系.方法:采用酶联免疫吸附剂实验(enzyme linked immunosorbent assay,ELISA)测定137例冠心病患者和48名对照者的血清CatL水平.同时测定空腹血糖(FBS)、血脂及高敏C反应蛋白(hs-CRP)水平.所有受试者均行冠脉造影,以Gensini积分评估冠脉狭窄程度.结果:冠心病组血清CatL水平(5.63±0.12 μg/L)与对照组(3.93±0.22 μg/L)比较显著升高(P<0.01).Logistic回归分析显示CatL血清浓度与冠心病发病独立相关,相对危险度为2.341(P<0.01,95%CI为1.567～3.496).冠心病患者的血清CatL水平与冠脉狭窄的Gensini积分呈显著正相关(r=0.228, P<0.01),且CatL是Gensini积分的独立相关因子(P<0.05).血清CatL水平与高密度脂蛋白胆固醇(r=-0.228, P<0.01)、载脂蛋白A1 (r=-0.187, P<0.05)呈显著负相关,与FBS呈显著正相关(r=0.161, P<0.05).结论:CatL可能与冠心病的发病独立相关,其血清水平可反映冠心病患者冠状动脉狭窄病变程度,CatL 可能对糖代谢及脂代谢有一定影响.     

颈动脉粥样硬化与冠心病的相关性研究及危险因素分析

目的:探讨颈动脉粥样硬化与冠心病的相关性,分析与其相关的危险因素,为冠心病的早期诊断和治疗提供依据。方法:选取我院拟诊冠心病患者进行冠状动脉造影检查(CAG),依据冠脉造影检查结果将拟诊冠心病患者分为冠心病组及对照组,对其进行颈动脉超声检查患者颈动脉内-中膜厚度(IMT)及斑块积分(Crouse),同时检测患者血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)以及血清同型半胱氨酸(HCY)水平,所有结果均采用SPSS 16.0软件包进行统计学分析。结果:本次研究共收集了183例拟诊冠心病患者,其中冠心病组82例,对照组101例,经统计分析:冠心病组患者的IMT、Crouse积分均高于对照组(P<0.05);两组患者总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白固醇(LDL-C)水平相比无统计学意义(P>0.05);冠心病组患者的高密度脂蛋白胆固醇(HDL-C)水平低于对照组,有统计学意义(P<0.05);冠心病组的HCY水平高于对照组,差异有统计学意义(P<0.01)。结论:颈动脉内-中膜厚度(IMT)及斑块形成与冠心病有着明显的相关性,HDL-C的降低和HCY的升高是动脉粥样硬化性疾病的危险因素。     

Hindu-Muslim differences in the prevalence of coronary heart disease and risk factors

Differences in coronary risk factors and coronary heart disease (CHD) prevalence between the Hindus and the Muslims have not been adequately studied. This study aims to determine the prevalence of certain socio-economic and biological coronary risk factors in urban communities and to compare the findings found in the Hindus and the Muslims. The study employed a cross-sectional survey design and stratified random sampling technique consisting of 1,415 males and 797 females. Among males there were 1,092 Hindus (77.2%) and 272 Muslims (19.2%) while in females there were 685 Hindus (85.9%) and 91 Muslims (11.4%). Prevalence of illiteracy and sedentary lifestyle were significantly more in Muslims (p<0.05). Smoking or tobacco use in males was similar but in females it was more in the Hindus. Self-reported diabetes was found in 1.4% Hindu males and in 1.2% Hindu females. No Muslim reported diabetes. Hindu males were significantly taller than Muslims (163.9 +/- 8.3 versus 160.9 +/- 8.9 cm; p < 0.001). In both males and females there was no significant difference in body mass index and obesity. In Hindu males the diastolic BP was significantly greater than in Muslims (81.2 +/- 9.2 versus 79.0 +/- 8.6 mm Hg; p < 0.001); prevalence of hypertension (30.5% versus 25.7%) was also significantly more (p = 0.048). In Hindu females the mean systolic BP was significantly more and there was also difference in hypertension prevalence (35.2% versus 25.3%). CHD prevalence was significantly greater in Hindu males as compared to the Muslims when determined by the presence of either ECG changes alone (4.3% versus 0.7%; p = 0.008) or ECG changes combined with clinical history (7.1% versus 1.8%; p = 0.002). A similar, though not significant, trend was seen in females (ECG changes: 8.9% versus 6.6%, clinical and ECG changes: 10.4% versus 6.6%). The prevalence of CHD is significantly more in Hindu males as compared to the Muslims and is associated with a greater prevalence of diabetes and hypertension.     

胆囊疾病与冠状动脉粥样硬化性心脏病的相关性及危险因素分析

目的 分析胆囊疾病(GBD)与冠状动脉粥样硬化性心脏病(CAD)的关系及相关危险因素.方法 回顾性分析经冠状动脉造影明确的CAD患者(CAD组,n=712)和冠状动脉无狭窄的疑似CAD者(对照组,n=571)的临床资料,比较两组GBD的患病率,采用Logistic回归分析体质量指数(BMI)、腰围、高血脂及糖尿病与GBD的相关性.结果 CAD组中GBD的患病率显著高于对照组(37.5％和25.6％,P＜0.01).单因素和多因素Logistic回归分析均显示,男性GBD与CAD具有显著相关性(OR=1.32,95％ CI:1.17 ～1.49,P＜0.01),女性CAD与GBD无显著相关性.BMI、高血压史、高血脂史和糖尿病史是与GBD相关的危险因素.结论 男性GBD与CAD具有显著相关性.     

不同年龄段冠心病患者危险因素的调查

目的探讨中青年和中老年冠心病患者罹患心血管疾病的相关危险因素,为临床防治工作提供指导。方法回顾性分析我院2005年12月～2010年12月收治的冠心病患者的相关资料,对比分析不同的危险因素在不同的年龄段患者中所占的比例。结果中青年组患者高舒张压、吸烟、酗酒等危险因素的出现率明显高于老年组,具有统计学意义（P〈0．05）。老年组患者高收缩压、糖尿病发生率明显高于中青年组,具有统计学意义（P〈0．05）。两组患者在糖化血红蛋白、高空腹血糖、肥胖等影响因素方面差异无统计学意义（P〉0．05）。中青年组患者冠心病、糖尿病、高血压家族史出现率明显高于老年组（P〈0．05）,高脂血症发生率差异无统计学意义（P〉0．05）。结论不同年龄段的冠心病患者在各常见危险因素、患者家族史和病变类型等方面均有差别,可根据统计结果对不同年龄段患者做出不同的干预。