女性心血管疾病的临床证据和预防指南

随着女性老龄化、肥胖人群的增加,代谢综合征以及糖尿病发病率的增加,女性心血管疾病越来越引起人们的关注。大量的临床证据表明,与男性相比,女性心血管疾病患者更容易表现为症状的多样性和不典型性,经确诊的女性心血管疾病患者预后较差.因此,美国心脏病学会在充实的临床试验证据基础上,制订了第一个针对女性群体的心血管病预防指南。该指南对女性心血管病预防提出专门的指导建议,在心血管病危险分层的标准、心血管病预防和治疗的标准上均针对女性。     

Patient-centered prevention strategies for cardiovascular disease, cancer and diabetes

Collectively, cardiovascular disease, cancer and diabetes are responsible for more than 25 million deaths in the world each year, and millions more live with one or more of these diseases. Much of this disease burden could be prevented, however, by controlling the modifiable risk factors. Although this Review focuses primarily on health-care providers caring for patients with cardiovascular disease, we stress the importance of considering the totality of patients' health. We discuss the common features and risks of cardiovascular disease, cancer and diabetes, and how best to implement practices aimed at prevention. The shared risk factors of tobacco use, physical inactivity, overweight and obesity, and poor nutrition, and their management are discussed. General risk-factor screening recommendations are also outlined and specific screening strategies for the disease states are given. Finally, we discuss the appropriate role of cardiology health-care providers with respect to risks for other chronic conditions and occult disease.     

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??Abstract??The global population is progressively aging??to the extent that over 1.5 billion people worldwide will be aged 65 years or more by 2050.Chronic kidney disease (CKD) in the elderly has become a major public health problem in China with approximately one third to one half of the individuals older than 70 years have CKD.Rates of treated end-stage renal disease (ESRD) among the elderly have been rising dramatically over the last decade.Most of older individuals with CKD die from cardiovascular diseases??infections and cerebrovascular diseases before reaching ESRD.Proteinuria??hypertension??diabetes??hyperlipidemia??and diet are strong risk factors for progression from CKD to ESRD.In this review??we will discuss comprehensive treatment strategy in preventing and slowing progression of CKD in elderly patients concerning the above risk factors.     

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??In last century??aspirin became a standard drug for the secondary prevention of cardiovascular disease.In recent years??a number of clinical trial evidence has confirmed that aspirin had been used as the primary prevention of cardiovascular disease.The mechanism is to block the thromboxane A??2 formation by inhibiting cycloosygenase.Studies have shown that low-dose aspirin could effectively reduce coronary heart disease and ischemic stroke risk in males.However??for women??aspirin for primary prevention of coronary heart disease is unobvious.In this paper??we discuss the relationship between aspirin and heart health in females by retrospectively reviewing the mechanism of aspirin??its efficacy and primary prevention effect on cardiovascular disease.     

Benefits and risks of antihypertensive medications in the elderly

Hypertension is highly prevalent in older age and accounts for a large proportion of cardiovascular (CV) morbidity and mortality worldwide. Isolated systolic hypertension is more common in the elderly than younger adults and associated with poor outcomes such as cerebrovascular disease and acute coronary events. International guidelines are inconsistent in providing recommendations on optimal blood pressure targets in hypertensive elderly patients as a result of the limited evidence in this population. Evidence from clinical trials supports the use of antihypertensive drugs in hypertensive elderly patients due to benefits in reducing CV disease and mortality. However, elderly participants in these trials may not be typical of elderly patients seen in routine clinical practice, and the potential risks associated with use of antihypertensive drugs in the elderly are not as well studied as younger participants. Therefore, the purpose of this review was to provide a comprehensive summary of the benefits and risks of the use of antihypertensive drugs in elderly patients (aged ≥65 years), highlighting landmark clinical trials and observational studies. We will focus on specific outcomes relating to the benefits and risks of these medications in hypertensive elderly patients, such as CV disease, cognitive decline, dementia, orthostatic hypotension, falls, fractures, cancer and diabetes, in order to provide an update of the most relevant and current evidence to help inform clinical decision‐making.     

The Dementia of Cardiac Disease

Cardiovascular disease and dementia are common in the elderly and are major causes of disability in the general population. The public health burden of dementia is projected to increase as life expectancy increases in the United States and elsewhere. Epidemiological studies suggest that these once believed unrelated conditions, heart disease and dementia, may be linked by shared common risks and pathogenic elements. These observations have sparked the notion that prevention or modification of certain vascular risk factors and proper management of cardiovascular disease may prevent the development or progression of dementia including Alzheimer??s disease. In this article, the authors discuss the association between cognitive impairment and atrial fibrillation, coronary artery disease, congestive heart failure, and cardiovascular procedures.     

加强老年人慢病防控，提升健康水平

“慢病”是慢性非传染然性疾病的简称。近10年来,我国慢病死亡人数占总死亡人数的比例呈现持续上升趋势。心血管病死亡人数占总死亡人数的41％,居各种疾病之首。我国心血管病患病率处于持续上升态势,老年人是心血管疾病的高发人群,尤以高血压病、冠心病、退行性心脏瓣膜病、糖尿病多见,多种慢病常并存于一身。不健康的生活方式是慢病高发的主要原因。早防早治、综合干预是慢病防控的重要措施。     

Chronic non-communicable diseases

Chronic non-communicable diseases (NCD) account for almost 60% of global mortality, and 80% of deaths from NCD occur in low- and middle-income countries. One quarter of these deaths--almost 9 million in 2005--are in men and women aged <60 years. Taken together, NCD represent globally the single largest cause of mortality in people of working age, and their incidences in younger adults are substantially higher in the poor countries of the world than in the rich. The major causes of NCD-attributable mortality are cardiovascular disease (30% of total global mortality), cancers (13%), chronic respiratory disease (7%) and diabetes (2%). These conditions share a small number of behavioural risk factors, which include a diet high in saturated fat and low in fresh fruit and vegetables, physical inactivity, tobacco smoking, and alcohol excess. In low- and middle-income countries such risk factors tend to be concentrated in urban areas and their prevalences are increasing as a result of rapid urbanization and the increasing globalisation of the food, tobacco and alcohol industries. Because NCD have a major impact on men and women of working age and their elderly dependents, they result in lost income, lost opportunities for investment, and overall lower levels of economic development. Reductions in the incidences of many NCD and their complications are, however, already possible. Up to 80% of all cases of cardiovascular disease or type-2 diabetes and 40% of all cases of cancer, for example, are probably preventable based on current knowledge. In addition, highly cost-effective measures exist for the prevention of some of the complications of established cardiovascular disease and diabetes. Achieving these gains will require a broad range of integrated, population-based interventions as well as measures focused on the individuals at high risk. At present, the international-assistance community provides scant resources for the control of NCD in poor countries, partly, at least, because NCD continue to be wrongly perceived as predominantly diseases of the better off. As urbanization continues apace and populations age, investment in the prevention and control of NCD in low-and middle-income countries can no longer be ignored.     

The importance of diagnosing the polycystic ovary syndrome

The polycystic ovary syndrome (PCOS) is an extremely common disorder that occurs in 4% to 7% of women of reproductive age. Although PCOS is known to be associated with reproductive morbidity and increased risk for endometrial cancer, diagnosis is especially important because PCOS is now thought to increase metabolic and cardiovascular risks. These risks are strongly linked to insulin resistance and are compounded by the common occurrence of obesity, although insulin resistance and its associated risks are also present in nonobese women with PCOS. Women with PCOS are at increased risk for impaired glucose tolerance, type 2 diabetes mellitus, and hypertension. Cardiovascular disease is believed to be more prevalent in women with PCOS, and it has been estimated that such women also have a significantly increased risk for myocardial infarction. Many lipid abnormalities (most notably low high-density lipoprotein cholesterol levels and elevated triglyceride levels) and impaired fibrinolysis are seen in women with PCOS. Early diagnosis of the syndrome and close long-term follow-up and screening for diabetes and cardiovascular disease are warranted. An opportunity exists for preventive therapy, which should improve the reproductive, metabolic, and cardiovascular risks.