New cardiovascular risk determinants do exist and are clinically useful.

Can we improve our understanding of cardiovascular disease (CVD) causality and prediction? Intuitively, we can. Recent publications, however, could be misinterpreted as suggesting the opposite. First, the Interheart study, which concluded that nine conventional risk factors explain >90% of premature myocardial infarction, is at risk for being interpreted as saying that other, 'new' cardiovascular risk factors can only cause a small remaining fraction of disease of at most 10%. Secondly, papers addressing the predictive value of new risk factors or markers of early CVD risk have concluded that risk prediction does not improve by adding these variables to risk models. In this paper, we will explain that searching for 'new causes' of CVD is still highly relevant, and that improvement of risk prediction is often assessed using inappropriate statistical methodology.     

学龄期儿童心血管疾病危险因素现状调查

目的：为了解城市学龄期儿童心血管疾病危险因素的现状。方法：对长沙市 ４９５ 名９～１４ 岁儿童的血压、血脂、血糖、肥胖、膳食与运动习惯以及心血管病家族史等心血管疾病危险因素进行调查。结果：血压偏高检出率为４．８４％ ,血脂单项指标异常检出率为０．４０％ ～１７．３７％ ,总异常检出率为２１．８２％ 。３７．７５％ 儿童血脂水平超过膳食干预的推荐值。１．０１％ 儿童的空腹血糖≥６．７２ｍ ｍ ｏｌ／ Ｌ。４．６５％ 儿童超重度≥２０％ ,体重指数≥２４ 者占３．６３％ 。大部分儿童摄入脂肪及胆固醇较多,２２．６２％ 的儿童缺乏体育锻炼,５７．７８％ 家庭中有吸烟者,２６．８６％ 有心血管疾病家族史。结论：加强儿童时期心血管病危险因素的监测与干预势在必行。     

胰岛素抵抗与心血管病危险因素个体聚集性的剂量-反应关系

目的 探讨中国人群胰岛素抵抗与心血管病危险因素个体聚集性之间的关系。方法 对北京石景山地区农民、首都钢铁公司工人共3899人（年龄35－64岁）的空腹胰岛素与空腹血糖、血压、血脂、血尿酸之间的关系进行调查。结果 由低至高胰岛素四等分组的心血管病危险因素个体聚集率分别为18.89%、28.03%、40.2%、49.49%（x^2MH=227.34,P=0.001），经多元logistic回归调整年龄、性别、工农、体重指数、吸烟、饮酒等因素后，显示第2、3、4等分组与第1组比较的优势（OR）及其95％可信区间分别为1.7(1.4-2.2),3.1(2.5-3.9),4.6(3.7-5.7）。结论 在中国人群中胰岛素抵抗与心血管病危险因素个体聚集呈剂量－反应关系，随着胰岛素水平的升高，个体发生危险因素聚集的风险性逐渐增高。     

大连市獐子岛地区心血管疾病危险因素的流行病学调查

目的了解獐子岛地区居民心血管疾病的危险因素发生情况,为实施心血管疾病干预措施提供依据。方法按年龄性别随机分层抽取獐子岛镇18岁以上常驻居民(≥5年)1024例,进行心血管疾病危险因素流行病学调查,并对35~59岁人群用"国人缺血性心血管病十年发病危险度评估表"进行评估,对结果进行统计学分析。结果(1)高血压、高总胆固醇、高低密度脂蛋白胆固醇、低高密度脂蛋白胆固醇、高三酰甘油、糖尿病、高尿酸血症患病率依次为43.8%、28.4%、12.4%、9.4%、21.7%、7.2%、9.8%。吸烟率27.1%,超重率56.3%,高摄盐率56.2%。(2)具有1个以上危险因素的个体占89.8%,无同时≥8个以上危险因素的个体。男性具有1个以上危险因素者比例大于女性,差异具有统计学意义(P<0.01)。(3)10年缺血性心血管病发病危险度<10%(低危):男性为96.3%,女性为94.4%;≥20%(高危):男性为1.5%,女性为0.4%。不同性别10年缺血性心血管病发病危险度在中高危以上(≥10%)检出率差异无统计学意义(P>0.05)。结论獐子岛地区心血管疾病危险因素的人群比例高,应积极加强对心血管疾病危险因素干预。     

Constipation and risk of cardiovascular disease among postmenopausal women

Background

Constipation is common in Western societies, accounting for 2.5 million physician visits/year in the US. Because many factors predisposing to constipation also are risk factors for cardiovascular disease, we hypothesized that constipation may be associated with increased risk of cardiovascular events.

Methods

We conducted a secondary analysis in 93,676 women enrolled in the observational arm of the Women's Health Initiative. Constipation was evaluated at baseline by a self-administered questionnaire. Estimates of the risk of cardiovascular events (cumulative end point including mortality from coronary heart disease, myocardial infarction, angina, coronary revascularization, stroke, and transient ischemic attack) were derived from Cox proportional hazards models adjusted for demographics, risk factors, and other clinical variables (median follow-up 6.9 years).

Results

The analysis included 73,047 women. Constipation was associated with increased age, African American and Hispanic descent, smoking, diabetes, high cholesterol, family history of myocardial infarction, hypertension, obesity, lower physical activity levels, lower fiber intake, and depression. Women with moderate and severe constipation experienced more cardiovascular events (14.2 and 19.1 events/1000 person-years, respectively) compared with women with no constipation (9.6/1000 person-years). After adjustment for demographics, risk factors, dietary factors, medications, frailty, and other psychological variables, constipation was no longer associated with an increased risk of cardiovascular events except for the severe constipation group, which had a 23% higher risk of cardiovascular events.

Conclusion

In postmenopausal women, constipation is a marker for cardiovascular risk factors and increased cardiovascular risk. Because constipation is easily assessed, it may be a helpful tool to identify women with increased cardiovascular risk.     

1992-2002年北京一组队列人群心血管病危险因素变化趋势研究

目的评价北京地区队列人群1992--2002年10年心血管病危险因素变化趋势。方法于1992年和2002年分别对同一组个体,按照世界卫生组织MONICA方案心血管病危险因素调查方法进行调查。对血压、体重指数、腰围、臀围、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和甘油三酯、血糖、高血压患病率、治疗率和控制率的变化进行比较。结果（1）1992-2002年相同年龄组（45～54岁和55～64岁）比较心血管病危险因素水平呈显著升高的趋势。（2）1992年理想血压者,2002年有19．0％的人成为高血压患者;正常血压者,45．3％的人成为高血压患者。（3）1992年血脂正常者,2002年有43．8％的人成为血脂异常者。（4）1992年体重指数正常者,2002年有37．0％的人成为超重者;腰围正常者,有43．7％的人成为高腰围者。（5）1992年无代谢综合征者,2002年有14．6％的人成为有代谢综合征者。结论本队列人群10年心血管病危险因素水平明显上升,其主要危险因素均与生活方式密切相关。改变不良生活方式是控制和减慢主要危险因素上升的速度和减少心血管病发病的关键。     

上海市心血管病主要危险因素变化趋势分析

目的：评价上海地区人群心血管病主要危险因素的变化趋势。方法：采用重复横断面调查的方法,1992、1995、1996和1999年共4次对上海市某工厂人群进行心血管病主要危险因素调查,共1118人,对收缩压、舒张压、体重指数、高血压的患病率和吸烟情况的变化趋势进行了分析。结果：（1）1992年人群基线心血管病危险因素如血压、吸烟率、血清总胆固醇、甘油三酯、HDL－胆固醇、腰臀比、体重指数结果与MONICA北京的地区监测结果相近。（2）无论男性或女性,收缩压和舒张压水平均呈上升趋势。男性收缩压平均升高12.3mmHg, 舒张压平衡升高6.4mmHg;女性依次为11.5mmHg和4.9mmHg;（3）男性高血压患病率呈上升趋势;女性变化趋势不明显。（4）男性与女性体重指数各年度比较均无显著性差异,无逐渐肥胖的倾向。（5）男性吸烟率一直维持在较高水平,1996年较1992年有明显下降,1996至1999年下降趋势不明显;女性吸烟率维持在较低水平,趋势平稳。结论：上海地区应重视吸烟和高血压的预防控制。     

HIV感染与心血管疾病危险因子的研究进展

高效抗反转录病毒治疗（Highly active antiretroviral therapy,HAART）使艾滋病（HIV/AIDS）病人的预期寿命延长,但是其引起代谢综合征的不良反应,使病人增加了罹患心血管疾病（CVD）的危险。然而近年来的研究发现,中断HAART治疗并没有降低此风险,未进行HAART治疗的艾滋病病毒（HIV）感染者也存在心血管病高发因素。文章通过对近年来HIV感染引起的病人血脂异常、免疫功能缺陷、炎症反应及血栓相关因子激活、血管损伤几个方面的文献的综述,分析单纯HIV感染对病人易患CVD的作用机制。     

脉搏波速度在心血管病中的临床应用

目的：观察心血管病患者臂踝脉搏波速度（baPWV）与心血管事件和心血管危险因素的相关性。方法：连续收集296例心血管病高危患者,进行病史采集,baPWV、身高、体重、腰围、血压、心率测量及血生化检查。比较高baPWV组（≥1700cm／s,138例）与低baPWV组（〈1700cm／s,158例）患者具有危险因素的个数和临床心血管事件发生情况。结果：与低baPWV组相比,高baPWV组心血管事件发生率较高（46．8％：73．9％,P〈0．01）,心血管危险因素数目较多[（3．8±1．0）;（4．7±1．1）,P〈0．001]。影响baPWV的因素主要为年龄（OR=4．985,P〈0．001）、收缩压（OR=4．012,P〈0．01）和脉压（OR=2．691,P〈0．05）。结论：在心血管病患者中,baPWV较高的患者心血管事件发生率高,心血管危险因素多。年龄、收缩压和脉压是影响baPWV的独立危险因素。     

Lifestyle and cardiovascular disease in middle-aged British men: the effect of adjusting for within-person variation.

AIMS: To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index (BMI) and the development of cardiovascular disease (CVD) in middle-aged British men. METHODS AND RESULTS: In total, 6452 men aged 40-59 with no prior evidence of CVD were followed for major CVD events (fatal/non-fatal myocardial infarction or stroke) and all-cause mortality over 20 years; lifestyle characteristics were ascertained at regular points throughout the study. A major CVD event within the first 20 years was observed in 1194 men (18.5%). Use of baseline assessments of cigarette smoking and physical activity in analyses resulted in underestimation of the associations between average cumulative exposure to these factors and major CVD risk. After correction for within-person variation, major CVD rates were over four times higher for heavy smokers (> or =40 cigarettes/day) compared with never smokers and three times higher for physically inactive men compared with moderately active men. Major CVD risk increased by 6% for each 1 kg/m(2) increase in usual BMI. If all men had experienced the risk levels of the men who had never regularly smoked cigarettes, were moderately active, and had a BMI of < or =25 kg/m(2) (6% of the population), 66% of the observed major CVD events would have been prevented or postponed (63% before adjustment for within-person variation). Adjustment for a range of other risk factors had little effect on the results. Similar results were obtained for all-cause mortality. CONCLUSION: Failure to take account of within-person variation can lead to underestimation of the importance of lifestyle characteristics in determining CVD risk. Primary prevention through lifestyle modification has a great preventive potential.     

Comparison of the Framingham Risk Score,SCORE and WHO/ISH cardiovascular risk prediction models in an Asian population

Background

Cardiovascular risk-prediction models are used in clinical practice to identify and treat high-risk populations, and to communicate risk effectively. We assessed the validity and utility of four cardiovascular risk-prediction models in an Asian population of a middle-income country.

Methods

Data from a national population-based survey of 14,863 participants aged 40 to 65 years, with a follow-up duration of 73,277 person-years was used. The Framingham Risk Score (FRS), SCORE (Systematic COronary Risk Evaluation)-high and -low cardiovascular-risk regions and the World Health Organization/International Society of Hypertension (WHO/ISH) models were assessed. The outcome of interest was 5-year cardiovascular mortality. Discrimination was assessed for all models and calibration for the SCORE models.

Results

Cardiovascular risk factors were highly prevalent; smoking 20%, obesity 32%, hypertension 55%, diabetes mellitus 18% and hypercholesterolemia 34%. The FRS and SCORE models showed good agreement in risk stratification. The FRS, SCORE-high and -low models showed good discrimination for cardiovascular mortality, areas under the ROC curve (AUC) were 0.768, 0.774 and 0.775 respectively. The WHO/ISH model showed poor discrimination, AUC = 0.613. Calibration of the SCORE-high model was graphically and statistically acceptable for men (χ² goodness-of-fit, p = 0.097). The SCORE-low model was statistically acceptable for men (χ² goodness-of-fit, p = 0.067). Both SCORE-models underestimated risk in women (p < 0.001).

Conclusions

The FRS and SCORE-high models, but not the WHO/ISH model can be used to identify high cardiovascular risk in the Malaysian population. The SCORE-high model predicts risk accurately in men but underestimated it in women.     

106例血液透析患者心血管疾病的危险因素分析

目的探讨血液透析患者心血管疾病的危险因素。方法常规检测106例维持性血液透析患者的血脂、血清白蛋白(ALB)、尿素清除指数(KT/V)、尿酸、血磷及血压水平,并分析上述因素与血液透析患者心血管疾病之间的关系。结果血液透析患者心血管疾病为25%,其中缺血性心脏病6例,心功能不全5例,心脏增大21例,脑血管意外3例。伴心血管疾病的血液透析患者血清甘油三酯(TG)水平、年龄、透析前血清肌酐、尿酸、白蛋白、伴有高血压和心血管病变家族史的比例显著高于无心血管疾病患者,KT/V、透析时体外循环血量和超滤量显著低于后者。逐步条件logistic回归分析结果显示,年龄、高血压、TG、血磷、ALB是心血管疾病的重要危险因素,回归方程为P/(1-P)=exp(-12.81 0.239年龄 0.288高血压 1.586TG 4.270血磷-0.439ALB)。结论高血压、高龄、血清甘油三酯水平和血磷水平增高、血清白蛋白水平降低是血液透析患者心血管疾病的危险因素,血液透析不充分、透析时的体外血循环量及心血管家族史也与心血管疾病的发生有关。     

Homocysteine lowering and cardiovascular disease risk: lost in translation

Studies of the general population have suggested that high homocysteine levels are associated with cardiovascular morbidity and mortality. In chronic kidney disease, homocysteine levels rise, and cardiovascular risk increases with declining kidney function. While some studies in this population have found an association between elevated homocysteine and cardiovascular risk, others have noted that this association is largely attenuated by adjustment for kidney function, and several studies of patients with kidney failure have found that lower homocysteine levels predict mortality. Homocysteine levels can be lowered with folate, vitamin B6 and vitamin B12. Three large, randomized, controlled trials of patients with pre-existing cardiovascular disease and two smaller, randomized, controlled trials of patients with kidney failure failed to detect any cardiovascular benefit from homocysteine-lowering vitamins. Several more interventional trials are ongoing, but the available data thus far do not support screening for or treatment of hyperhomocysteinemia.     

1994年和2004年华中师范大学副高职以上人群心血管危险因素的分析

目的:研究华中师范大学副高职称以上群体1994年、2004年心血管病危险因素的变化情况,指导这一群体心血管病的防治工作。方法:分别于1994年和2004年体检对象中选择年龄为30~89岁、副高职称以上的教职工,测量血压、血脂和血糖3种心血管病危险因素,询问病史;整理数据,采用SPSS10·0统计软件处理数据。结果:随着年龄的增长,心血管病危险因素的检出率在逐步增加;女性在50岁之前的检出率较低,50岁之后,各种心血管病危险因素的检出率明显升高;与10年前相比,2004年各种心血管病危险因素检出率均明显增高(P<0·01)。结论:高血压、高脂血症和糖尿病是高校教职工的高发病,应加强这一人群的健康教育,做好心血管病的防治工作。     

Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components

Background

In the canine wedge preparation, the interval from the peak to the end of the T wave (TpTe) reflects transwedge heterogeneities. Increase of ventricular dispersion of action potential durations has been repeatedly shown to be arrhythmogenic; thus, prolonged TpTe intervals were assumed to reflect increased risk. However, despite attempted extrapolation to clinical electrocardiograms, the appropriateness of this assumption has not been investigated in a large population. In another animal model, nondipolar components of the descending T-wave limb (TWRd) have been shown to correlate with TpTe interval. Although total T-wave nondipolar components (TWRt), believed to reflect heterogeneities during total repolarization, were shown associated with worse outcome of cardiac patients, this has not been investigated for TWRd.

Methods and Results

Male cardiovascular patients (n = 813) had digital 12-lead electrocardiograms recorded between 1984 and 1991 and were followed until 2000. Using commercial and previously validated technology, QT intervals, TpTe intervals, TWRd, and TWRt were calculated, heart rate corrected, and compared between survivors and nonsurvivors. Their predictive power was also compared with established markers of mortality risk. In contrast to former reports, TpTe_c intervals were significantly shorter in nonsurvivors (98.76 ± 20.63 milliseconds vs 103.14 ± 20.87 milliseconds, P = .016) and not predictive of outcome. Although TWRd_c was significantly higher in nonsurvivors (0.007% ± 0.02% vs 0.005% ± 0.08%, P = .03), it was also not predictive of outcome. Only increased TWRt_c, increased heart rate, and increased age were predictive of death.

Conclusions

The findings challenge the concept that prolongation of TpTe corresponds to higher risk of death from any cause in every population. Further investigations are needed to confirm that clinically measured TpTe reflects transmural repolarization heterogeneity in all clinical populations and indeed is a useful risk marker.     

血清超敏C反应蛋白与心血管危险因素的关系

目的：探讨血清超敏C反应蛋白（hs—CRP）与心血管危险因素的关系。方法：对,388例健康成人（男223例,女165例,年龄47～53岁）的身高、体重、血压、心电图、血糖、血脂及血清hs～CRP等进行测定。结果：由低至高的血清hs—CRP四等分组（〈2．1mg／L,2．1～5．0mg／L,5．1～8．0mg／L,〉8．0mg／L）的心血管危险因素体重指数、血压、空腹血糖、高密度脂蛋白-胆固醇（HDL—C）组间差异非常显著（F=7．63～22．46,P均〈0．001）,总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白-胆固醇（LDL—c）的组间差异有显著性（F=2．89～8．88,P分别为0．031,0．022,0．015）,四组心血管危险因素聚集检出率分别为32．3％,48．9％,58．0％,79．4％．差异有显著性（x^2=28．12,P〈0．001）。结论：血清hs—CRP与心血管危险因素（体重指数、血压、血糖和血脂）有关。     

高校社区中老年人群心血管病危险因素持探讨

目的：探讨高校社区中老年人群心血管病发病的危险因素。方法：对武汉大学社区1999年底中老年人群体检资料进行统计、分析,并分析体重指数（BMI,kg/m^2)及某些不良生活习惯对心脑血管病及其危险因素发生率的影响。结果：BMI≥25心血管病及其危险因素发生率呈上升趋势（P＜0．01或P＜0．05）,某些不良生活习惯也明显增加心血管病及其危险因素的发生率。结论：为中老年人群减肥,或控制其钠盐摄入及饮酒量,就可降低心血管病的发病率。     

Prediction of the risk of cardiovascular mortality using a score that includes glucose as a risk factor. The DECODE Study

Aims/hypothesis Risk scores have been developed to predict cardiovascular or coronary risk, and while most have included diabetes as a risk factor, none have included lower glucose concentrations, either at fasting or following a 2-h oral glucose tolerance test. This article develops 5- and 10-year risk scores for cardiovascular mortality that include glucose concentrations as well as known diabetes status.Methods Data is from the DECODE cohort: 16,506 men and 8,907 women from 14 European studies. The risk factors studied were as follows: age, fasting and 2-h glucose (including cases of known diabetes), fasting glucose alone (including cases of known diabetes), cholesterol, smoking status, systolic blood pressure and BMI. For an absolute risk score the 1995 country- and sex-specific cardiovascular death rates were used.Results In men, for both 5- and 10-year cardiovascular mortality, after adjusting for age and study centre, all studied risk factors, except BMI, were significantly associated with cardiovascular mortality (p<0.05). These results were unchanged in multivariate models with all factors included. In women, after adjusting for age and centre, glucose categories, systolic blood pressure and BMI were predictive of 5-year cardiovascular mortality. With all factors in the model, only age and glucose categories were predictive. In terms of 10-year cardiovascular mortality, smoking status and blood pressures were also predictive in the women. For men and women, the same scores were used for the risk factors, except for age and glucose categories where the hazard ratios differed significantly.Conclusions/interpretation Including glucose concentrations as well as diabetic status provides quantitative information on cardiovascular risk prediction.Corresponding author of the DECODE Insulin Study Group: B. Balkau, IINSERM U258-IFR69, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif cedex, France, Phone: +33-1-4559516, Fax: +33-1-47269454, e-mail: balkau@vjf.inserm.fr