Reduced 10-year risk of developing cardiovascular disease after participating in a lifestyle programme in primary care

Background: Despite well-known preventive effects for future cardiovascular disease (CVD) risk through lifestyle changes, scientific evaluations of lifestyle programmes in primary care are scarce. Moreover, structured lifestyle counselling is still not integrated in everyday clinical practice. We aimed to evaluate change in cardiovascular risk factors and Framingham 10-year risk score of developing CVD in men and women at high cardiovascular risk after participation in a structured lifestyle programme over 1 year. A single-group study was carried out with a 1-year follow-up including before and after measurements.Methods: The lifestyle programme comprised five appointments to a district nurse over 1 year, focussing on lifestyle habits based on motivational interviewing. Fasting blood samples and anthropometric measurements were obtained at baseline and 1-year follow-up. The 10-year risk of CVD was calculated according to Framingham general CVD risk score.Results: A total of 404 patients were included in the study. There was a positive change over 1 year in the total study population for all risk factors evaluated. This included improvements in weight, waist circumference, blood pressure, blood lipids, and fasting glucose. The 10-year risk of developing CVD decreased for the total population from 24.8% to 21.4% at 1 year, equivalent to a 14% decrease.Conclusions: A structured lifestyle programme in primary care contributes to significant improvements of cardiovascular risk factors and the reduction of 10-year risk for CVD for both men and women at high cardiovascular risk.     

正常偏高血压对心脑血管病发病危险的影响

目的　探讨不同性别正常偏高血压对心血管病发病的危险。方法　采用 1 1省市队列人群 (35～ 64岁 )共 2 7739人 ,于 1 992年进行基线危险因素调查的资料。计算队列人群不同血压范围构成比、危险因素分布 ,以及在观察终点心脑血管病事件的人年标化发生率 ,用Cox回归模型对不同血压范围心脑血管病发病率的危险进行预测。结果　 (1 )队列人群具有正常偏高血压者为 1 3 4%(男性 1 4 8% ,女性 1 1 8% ) ;(2 )具有正常偏高血压者多种危险因素显著高于具有理想血压者 ;(3)具有正常偏高血压者心脑血管病人年标化发病率显著高于具有理想血压者 ;(4)正常偏高血压者的心脑血管病发病危险为 2 876 5(95 %可信区间 2 0 50 6～ 4 0 35 1 ,P <0 0 1 ) ,男性为 3 2 34 6(95 %可信区间 ,2 1 1 3 1～ 4 951 2 ,P <0 0 1 ) ,女性为 2 335 0 (95 %可信区间 1 31 83～ 4 1 35 9,P <0 0 1 )。结论　具有正常偏高血压者的心血管病危险比具有理想血压者显著高 ,降低正常偏高血压以减少心血管病危险的必要性有待研究     

社区老年人群性激素结合球蛋白与心血管发病风险的关联性

 目的  探讨社区老年人群中性激素结合球蛋白(sex hormone binding globulin,SHBG)与心血管疾病(cardiovascular disease,CVD)之间的相关性。方法  于2014年选取上海市宝山区友谊社区1 916例老年人群(男796例、女1 120例),收集基础的流行病学资料并采集空腹静脉血进行检测,计算得到10年Framingham风险积分。将肥胖、收缩压、空腹血糖、脂类浓度及超敏C反应蛋白作为心血管疾病风险因子,Framingham风险积分作为心血管疾病事件预测危险积分,分析SHBG与它们之间的相关性。结果  存在心血管病史人群的SHBG均值低于不存在心血管病史人群(P<0.001);男性SHBG与腰围、臀围、BMI指数、收缩压、胆固醇、三酰甘油、高密度脂蛋白胆固醇、载脂蛋白A、超敏C反应蛋白的相关系数分别为-0.312、-0.307、-0.266、-0.113、0.155、-0.277、0.510、0.394、-0.130(P<0.01);女性SHBG与腰围、臀围、BMI指数、空腹血糖、胆固醇、三酰甘油、高密度脂蛋白胆固醇、载脂蛋白A和超敏C反应蛋白的相关系数分别为-0.236、-0.248、-0.168、-0.183、0.135、-0.264、0.445、0.358、-0.295 (P<0.001);SHBG水平的降低与Framingham积分的升高存在一致性(κ=0.062,P<0.001),且SHBG水平的升高会降低10年内CVD的发病风险(P<0.01)。结论  该社区老年人群基线SHBG水平与CVD风险因子之间存在负相关性,与CVD保护因子之间存在正相关性,并且低水平SHBG预示着更高的CVD发病风险。     

Predicted 10-year Cardiovascular Disease Risk and Its Association with Sleep Duration among Adults in Beijing-Tianjin-Hebei Region,China

Objective The study aims to predict 10-year cardiovascular disease (CVD) risk and explore its association with sleep duration among Chinese urban adults. Methods We analyzed part of the baseline data of a cohort that recruited adults for health screening by cluster sampling. The simplified Pittsburgh Sleep Quality Index (PSQI) and Framingham 10-year risk score (FRS) were used to measure sleep duration and CVD risk. Demographic characteristics, personal history of chronic diseases, lifestyle factors were collected using a questionnaire. Height, weight, total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) were also measured. Multiple logistic regression models were performed to explore the association of sleep duration with the predicted CVD risk. Results We included 31, 135 participants (median age 44 years, 53.02％ males) free of CVD, cerebral stroke, and not taking lipid-lowering agents. Overall, 14.05％, and 25.55％ of participants were at medium and high predicted CVD risk, respectively. Short sleep was independently associated with increased odds of medium to high risk of predicted 10-year CVD among males (OR = 1.10; 95％ CI:1.01–1.19) and increased odds of medium to high and high risk of predicted 10-year CVD among females (OR = 1.23; 95％ CI: 1.08–1.40; OR = 1.27; 95％ CI: 1.11–1.44). In contrast, long sleep had no association with cardiovascular risk. Conclusion A substantial number of adults free of CVD were at high 10-year CVD risk. Short sleep was associated with increased odds of predicted CVD risk.     

家庭医生签约高脂血症患者的血脂管理现状及影响因素分析

目的了解签约家庭医生服务的高脂血症患者血脂管理现状及其影响因素,为进一步制定血脂管理方案提供理论依据。方法本研究采用横断面调查,纳入2019年11月至2020年5月就诊于北京市月坛社区卫生服务中心及下属站并行生化检查的高脂血症患者,均已签约家庭医生服务,收集其基线资料及血脂指标,比较不同特征患者的动脉粥样硬化性心血管疾病(ASCVD)危险分层分布、低密度脂蛋白胆固醇(LDL-C)达标率,采用logistic回归分析LDL-C不达标的影响因素。结果共收集病例752例,其中男性334例,女性418例。ASCVD风险评估结果显示低危、中危、高危、极高危比例分别为22.87%(172/765)、22.21%(167/752)、46.81%(352/752)、8.11%(61/752)。ASCVD危险分层在性别、是否吸烟、是否超重或肥胖中的分布差异有统计学意义(P<0.05)。LDL-C总体达标率为48.80%(367/752),其中低危、中危、高危、极高危达标率分别为83.73%(144/172)、53.89%(90/167)、34.38%(121/352)、19.67%(12/61)。女性(52.87%,221/418)、年龄≥80岁(58.82%,110/187)、不吸烟(52.40%,327/624)、规律用药(52.87%,221/418)的患者达标率更高(χ2值分别为6.323、11.816、19.022、25.274,P<0.05)。多因素logistic回归分析显示,男性(OR=1.800,95%CI:1.325~2.419)、吸烟(OR=2.630,95%CI:1.726~4.007)、不规律/自行停药(OR=2.179,95%CI:1.581~3.003)是影响患者LDL-C达标的独立危险因素。结论家庭医生签约的高脂血症患者心血管病风险较高,血脂控制尚不满意,应加强患者尤其是男性、吸烟、不规律用药患者的血脂管理。     

基于弗明翰风险评分与血管内皮功能分类的心血管疾病危险因素研究

目的　探讨基于弗明翰风险评分（FRS）与血管内皮功能分类的心血管疾病危险因素。方法　于2015年8—9月在广西融安县泗顶镇和融水县安陲乡现场招募752例成年人为研究对象。使用FRS评估研究对象10年内心血管疾病发生风险,将其分为FRS正常（FRS≤20%）和FRS高（FRS>20%）两类;采用肱动脉血流介导的血管舒张功能（FMD）测定血管内皮功能,将其分为血管内皮功能正常（FMD≥6%）和血管内皮功能受损（FMD<6%）两类。采用Logistic回归分析不同FRS与血管内皮功能分组的心血管疾病的危险因素。结果　多因素Logistic逐步回归分析结果显示,男性、年龄大、吸烟、收缩压高、低密度脂蛋白胆固醇（LDL-C）高、三酰甘油（TG）高为FRS高但血管内皮功能正常的危险因素;男性、年龄大是FRS正常但血管内皮功能受损的危险因素;男性、年龄大、吸烟、体力活动水平中低、收缩压高、总胆固醇（TC）高、高密度脂蛋白胆固醇（HDL-C）低、C反应蛋白（CRP）高、空腹血糖高是FRS高和血管内皮功能受损的危险因素。结论　不同心血管疾病群体的危险因素存在差异,应采取针对性的个体化措施防治不同特征群体的心血管疾病。     

胰岛素抵抗与心血管危险因素聚集的流行病学研究

目的 研究人群中胰岛素抵抗与心血管危险因素聚集的关系。方法 按照随机抽样的原则,在江苏省邳州市的农村共调查35－59岁的常住居民1196人,其中男性533人,女性663人,平均年龄为46．7岁。应用单克隆抗体为基础的酶联免疫吸附试验方法检测空腹真胰岛素,采用HOMA指数作为胰岛素抵抗的指标。应用Spearman相关、偏相关分析以及多因素非条件Logistic回归等统计分析方法研究胰岛素抵抗与高血压、超重、中心性肥胖、血脂紊乱及心血管危险因素聚集的关系。结果 真胰岛素与HOMA指数的中位数（四分位间距）分别为4．89（3．02－7．09）mIU/L及0．98（0．57－1．44）,在性别间分布均为女性高于男性（P＜0．01）。HOMA指数与心血管危险因素数目的相关系数为0．290（P＜0．01）。在调整了年龄、性别、体重指数与腰围变量后,HOMA指数与危险因素数目的偏相关系数为0．1776（P＜0．01）。非条件多元逐步Logistic回归分析显示,胰岛素抵抗独立于年龄、性别、体重指数、腰围与心血管危险因素聚集相关,其OR值（95％可信限）为1．250（1．089－1．434）。结论 胰岛素抵抗为心血管危险因素聚集的中心环节,非酯化脂肪酸的代谢异常引起碳水化合物与血脂代谢紊乱可能是胰岛素抵抗导致心血管危险因素聚集的机制。     

Metabolic syndrome and C-reactive protein among cardiology patients

BACKGROUND: Associations between inflammation, metabolic syndrome (MetS), and cardiovascular disease have been reported. Limited information, however, is available on the prevalence of MetS and its relation to inflammation among Georgian cardiology patients. We investigated MetS components (elevated blood pressure, abdominal obesity, elevated triglyceride concentrations, decreased HDL-cholesterol concentrations, and elevated fasting glucose) and their relationships with C-reactive protein (CRP) concentrations in this population. METHODS: A total of 167 patients (mean age 53.1 years, 54% male) who attended an Emergency Cardiology Center in Tbilisi, Republic of Georgia were enrolled in this cross-sectional study. In-person interviews and clinical exams, as well as laboratory studies, were conducted to characterize MetS (using the ATP III criteria) and cardiac conditions in the study population. CRP concentrations were determined using standardized immunoassays. RESULTS: Overall prevalence of MetS was 40.7%. Patients with coronary heart disease (CHD) had higher CRP concentrations compared with non-CHD patients. A linear relationship between increase in number of MetS components and CRP concentrations was observed among females (p value for linear trend <0.05), but not males. Further, among females, all components of MetS except HDL-C concentrations were correlated with CRP concentrations after adjustment for age and body mass index (all p values <0.05). However, among males, only abdominal obesity was significantly correlated with CRP. CONCLUSIONS: MetS is prevalent among Georgian cardiology patients. CRP concentrations are positively associated with MetS. Further prospective studies are required to determine whether combining MetS and CRP data may have utility in the assessment of risk for developing future cardiovascular events in both males and females.     

老年人群睡眠时长及睡眠质量与心血管疾病危险因素的关系研究

目的 本研究拟调查老年人睡眠情况与心血管疾病危险因素之间的相关性,为心血管疾病防治提供参考。 方法 选取2018年2月—2019年6月在浙江医院健康管理科参加体检老年人1 061名,其中男性473名,女性588名,年龄≥60岁,对研究对象进行问卷调查、体格检查和生化检查。采用自述方式对研究对象睡眠时长、睡眠质量进行评估。 结果 睡眠时长<7 h组和>9 h组糖尿病、高血压、血脂异常至少1种疾病的患病率分别为57.2%和63.4%,显著高于睡眠时长7~8 h组42.3%(P<0.05)。多因素logistic回归分析的结果,与7~8 h组相比,睡眠时长<7 h组、8~9 h组和>9 h组的老年人,糖尿病、高血压、血脂异常中至少1种疾病的OR值分别为2.493(95%CI:1.207~4.934,P<0.05)、1.093(95%CI:0.762~1.874,P>0.05)和1.258(95%CI:1.074~2.706,P<0.05);与睡眠质量好者相比,睡眠差者糖尿病、高血压、血脂异常中至少1种疾病的OR值为1.817(95%CI:1.024~3.272,P<0.05)。 结论 老年人群睡眠时长与心血管疾病危险因素之间存在一种“U”形关系,睡眠时间减少和延长都会增加心血管疾病危险因素的发病风险,睡眠质量也与心血管疾病危险因素密切相关。      

Gender specific association of neonatal characteristics and cardiovascular risk factors on carotid intima-media thickness in a Chinese cohort

Background Multiple neonatal characteristics and adult cardiovascular risk factors are associated with the development of atherosclerosis, however little conclusive evidence exists characterizing the relative strength of these factors. In a large retrospective study, we investigated the association between both objective neonatal measurements and comprehensive adult cardiovascular risk factors with the development of atherosclerosis, quantified by carotid intima-media thickness （CIMT）. Further, we assessed the impact of gender on the relative impact of these risk factors.Methods CIMT, a measure of atherosclerosis, was determined by carotid ultrasound on 1568 participants （age 50-85）whose birth records were obtained from Peking Union Medical College Hospital. In addition, each participant was given a physical examination, and completed a medical questionnaire to identify a panel of cardiovascular risk factors. Multiple regression analysis was performed on the population and on the male and female cohorts individually, to identify the relative contribution of these risk factors to increased CIMT.Results For the total population the Framingham score, renal function, adult abdominal circumference and mother＇s gestational age were associated with CIMT, accounting for 14.7%, 1.4%, 0.9%, and 0.2% of total variance, respectively.In the male population the Framingham score, renal function, abdominal circumference and hemoglobin were the most significant risk factors for CIMT. Risk in the female population was associated with Framingham score, renal function,insulin resistance and gestational age. No relationship between birth weight or head circumference and CIMT were observed.Conclusions Adult cardiovascular risk factors were the most significantly associated with the development of atherosclerosis; however mother＇s age at birth was associated with CIMT, particularly in the female cohort. The relative contribution of the risk factors analyzed varied between the male and female populations.     

Association between myeloperoxidase levels and risk of coronary artery disease.

CONTEXT: Myeloperoxidase (MPO), a leukocyte enzyme that promotes oxidation of lipoproteins in atheroma, has been proposed as a possible mediator of atherosclerosis. OBJECTIVE: To determine the association between MPO levels and prevalence of coronary artery disease (CAD). DESIGN, SETTING, AND PATIENTS: Case-control study conducted from July to September 2000 in a US tertiary care referral center, including 158 patients with established CAD (cases) and 175 patients without angiographically significant CAD (controls). MAIN OUTCOME MEASURES: Association of MPO levels per milligram of neutrophil protein (leukocyte-MPO) and MPO levels per milliliter of blood (blood-MPO) with CAD risk. RESULTS: Leukocyte- and blood-MPO levels were both significantly greater in patients with CAD than in controls (P<.001). In multivariable models adjusting for traditional cardiovascular risk factors, Framingham risk score, and white blood cell counts, MPO levels were significantly associated with presence of CAD, with an OR of 11.9 (95% CI, 5.5-25.5) for the highest vs lowest quartiles of leukocyte-MPO and an OR of 20.4 (95% CI, 8.9-47.2) for the highest vs lowest quartiles of blood-MPO. CONCLUSIONS: Elevated levels of leukocyte- and blood-MPO are associated with the presence of CAD. These findings support a potential role for MPO as an inflammatory marker in CAD and may have implications for atherosclerosis diagnosis and risk assessment.     

Hypertension and associated cardiovascular risk factors in Kelantan

Two thousand five hundred and eight subjects from the state of Kelantan in North-East Peninsular Malaysia were included in this study to determine the prevalence of hypertension and their association with cardiovascular risk factors. The overall prevalence of hypertension was 13.9%. There was no difference in the prevalence of hypertension between the males and females. The prevalence increased with age--the highest being in those above 70-years old. Subjects with hypertension also had a higher prevalence of diabetes mellitus (19.0%), obesity (39.4%) and hypercholesterolaemia (70.7%) than non-hypertensive subjects. Of the hypertensive subjects, 83.3% had 1 other risk factor for cardiovascular disease, 66.7% had 2 other risk factors and 16.7% had more than 2 risk factors. Other than age, body mass index, plasma glucose, total cholesterol and LDL-cholesterol, hypertensive subjects also had a higher mean serum urea, creatinine, uric acid and triglyceride than non-hypertensive subjects. In conclusion, hypertension is a common disease in this area and is associated with multiple risk factors for cardiovascular disease. The prevalence is likely to increase in the near future with increasing affluence and becoming a major health problem.     

腰围身高比对MS的筛选切点研究

目的:评估中国成年人腰围身高比值与代谢综合征(MS)的相关性并探讨其对MS以及各项亚指标的筛选切点。方法:选择河北医科大学第二医院的体检中心2006年体检者共4457名,男性2733名,女性1724名。通过计算ROC曲线下面积评估腰围身高比值预测MS以及各项亚指标的敏感性和特异性及其筛选切点,并通过Logistic回归分析矫正年龄因素影响后分析腰围身高比值预测MS发病的风险值。结果:腰围身高比值与MS以及各亚指标关系密切,以腰围身高比值筛查MS以及各项亚指标均有一个有意义的ROC曲线下面积>0.5,预测MS发生危险增加的筛选切点界值男女分别为0.5223,0.5032。高于此切点年龄矫正MS的发病风险男女分别增加32.76和20.75倍。结论:在中国成年人腰围身高比值是预测MS的重要指标,男女腰围身高比值0.5223,0.5032的各自切点是MS的警戒线,高于此切点预示着MS的风险明显增加。     

Serum Uric Acid is Associated with the Predicted Risk of Prevalent Cardiovascular Disease in a Community-dwelling Population without Diabetes

Objective To examine the association between serum uric acid levels and cardiovascular disease risk among individuals without diabetes. Methods We investigated the association between serum uric acid levels and the risk of prevalent cardiometabolic diseases, 10-year Framingham risk for coronary heart disease, and 10-year risk for atherosclerotic cardiovascular diseases(ASCVD) among 8,252 participants aged ≥ 40 years without diabetes from Jiading district, Shanghai, China. Results Body mass index, waist circumference, blood glucose, glycated hemoglobin, blood pressure, and serum lipids increased progressively across the sex-specific quartiles of uric acid(all P trend 0.05). Compared with individuals in the lowest quartile, those in the higher quartiles had a significantly higher prevalence of obesity, hypertension, and dyslipidemia(all P trend 0.05). A fully adjusted logistic regression analysis revealed that individuals in the highest quartile had an increased risk of predicted cardiovascular disease compared with those in the lowest quartile of uric acid. The multivariate adjusted odds ratios(ORs) [95% confidence intervals(CIs)] for the highest quartiles for high Framingham risk were 3.00(2.00-4.50) in men and 2.95(1.08-8.43) in women. The multivariate adjusted ORs(95% CIs) for the highest quartile for high ASCVD risk were 1.93(1.17-3.17) in men and 4.53(2.57-7.98) in women. Conclusion Serum uric acid level is associated with an increased risk of prevalent obesity, hypertension, dyslipidemia, 10-year Framingham risk for coronary heart disease, and 10-year risk for ASCVD among Chinese adults without diabetes.     

Assessment of Snoring and obstructive sleep apnoea in a Nigerian university: Association with cardiovascular risk factors

Background:

Snoring remains under diagnosed in general population. It however has significant morbidity and mortality risk factors with multiple effects on the cardiovascular system. The Berlin questionnaire is a worldwide validated instrument to identify those at increased risk for obstructive sleep apnoea (OSA).

Materials and Methods:

In all, 206 workers of LAUTECH were invited to participate in the study. The Berlin questionnaire was used for this study. It was a cross-sectional study. Socio-demographic and clinical data were taken with a data form. Statistical Package for the Social Sciences software (SPSS 17.0) was used for statistical analysis. P < 0.05 was taken as statistically significant value.

Results:

The study participants consisted of 96 males (46.6%) and 110 (53.4%) females. The mean age was 45.3 ± 7.9 years. The mean body mass index was 28.5 ± 6.0 kg/m². The frequency of occurrence of snoring was 91 (44.2%) including 50 males (54.9% and 41 females (37.3 %, P <0.05). Using the Berlin score, 63 (30.6%) including 34 females (30.9%) were assessed to be at high risk for OSA. Snorers were more likely to be at higher risk of OSA compared to non snorers: odd risk was 113.8, relative risk was 3.3. Snoring was most likely to be associated with obesity, elevated blood pressure and male gender in this study.

Conclusion:

We concluded that snoring and high risk for sleep apnoea is common among this unselected University population and they are closely related to many conventional cardiovascular risk factors. Appropriate interventional strategies are indicated to reduce the burden of the increased morbidity and mortality associated with sleep apnoea in our population.     

Knowledge of heart disease risk factors among workers in a Nigerian University: A call for concern

Introduction:

Cardiovascular disease is the commonest cause of mortality worldwide. Many risk factors predate the development of cardiovascular diseases. Adequate knowledge of risk factors for cardiovascular diseases is the first step towards effective preventive strategies to combat the cardiovascular diseases burden in any population. This study aims to determine the knowledge of workers in a Nigerian University on risk factors for cardiovascular diseases.

Materials and Methods:

A cross-sectional survey of 206 academic and non-academic staff of Ladoke Akintola University of Technology, Ogbomoso, Nigeria using the Heart Disease Fact Questionnaire (HDFQ). Demographic data were taken. The lipid profile and random blood sugar were taken. Statistical analysis was done using SPSS 17.0.

Results:

The mean age of the study participants was 45.3 ± 7.9 years. There were 96 males (46.6%). The mean HDFQ score was 48.6%. Only 41 (19.9%) of participants were assessed to have good knowledge of heart disease risk factors. Majority, 101 (49.0%) had poor knowledge while 64 (31.2%) had fair knowledge of heart disease risk factors. There was no significant difference between prevalence of CV risk factors between those with good or fair or low level of knowledge. Most participants did not have a good level of knowledge about risk factors, prevention, treatment and association with diabetes as it relates to heart diseases.

Conclusion:

Knowledge of heart disease risk factors is low among University workers in Nigeria. Effective education on heart disease risk factors and appropriate preventive strategies are indeed important to reduce cardiovascular disease burden in Nigerian University communities.     

无血管病变的2型糖尿病患者循环晚期氧化蛋白产物水平与Framingham风险评分的关系

目的研究无血管病变的2 型糖尿病患者循环晚期氧化蛋白产物（AOPPs）水平与Framingham 风险评分关系。方法采 用横断面调查研究,于2010 年3 月~2011 年5 月在南方医科大学三所附属医院招募无血管病变的2 型糖尿病患者为研究对 象,以年龄、性别相匹配的正常健康人群为对照组,统计一般人口学指标,检测生化指标以及循环AOPPs 水平,采用 Framingham 风险评分评估10 年内发生心血管事件的风险。结果入组112 例2 型糖尿病患者,49 例健康人群。2 型糖尿病 患者的体质量指数（BMI）、血糖、甘油三脂、低密度脂蛋白、循环AOPPs、Framingham 风险评分显著高于正常人群,而高密度 脂蛋白较正常人群显著降低;通过Spearman 相关分析发现,AOPPs 与Framingham 风险评分呈显著正相关（r=0.44, P< 0.001）,进一步通过多元线性回归分析发现,AOPPs仍与Framingham 风险评分呈显著正相关（β=0.305, P<0.001）。结论无 血管病变的2 型糖尿病患者循环AOPPs较正常人显著升高,且其发生心血管事件的风险评分显著高于正常人,而AOPPs与 患者心血管事件发生风险评分呈独立的正相关关系,提示AOPPs的升高可能预示着2 型糖尿病患者发生心血管事件的风险 升高。     

急性心力衰竭患者住院期间发生心血管不良事件风险预测模型的构建与验证

目的 分析急性心力衰竭（AHF）患者住院期间心血管不良事件发生的主要影响因素,构建心血管不良事件风险预测模型并进行验证。方法 回顾性选取2021年2月—2022年2月宁夏医科大学总医院心脑血管病医院收治的515例AHF患者,根据患者住院期间是否发生心血管不良事件将其分为发生组与未发生组。采用R 4.2.1统计软件对两组各项指标进行单因素Logistic分析并进行Lasso回归初步筛选,再经多因素一般Logistic回归分析确定预测变量,构建AHF患者住院期间心血管不良事件预测模型,并通过绘制列线图、受试者工作特征（ROC）曲线及校准曲线对模型的性能进行评价,最后采用Bootstrap法对模型进行内部验证。结果 515例AHF患者中有62例发生心血管不良事件。心血管不良事件发生组与未发生组的冠心病、扩心病、脑卒中、睡眠差、呼吸频率、合并心房颤动（以下简称房颤）比较,差异均有统计学意义（P <0.05）;先后经单因素Logistic分析及Lasso回归初步筛选变量后,最终通过多因素一般Logistic回归分析确定AHF患者住院期间发生心血管不良事件的主要影响因素为脑卒中［O^R=7.99（95% CI：3.29,19.59）］、白细胞计数［O^R=1.25（95% CI：1.00,1.52）］、血尿素氮［O^R=1.13（95% CI：1.04,1.23）］、D-二聚体［O^R=1.13（95% CI：1.03,1.24）］、左心室短轴缩短率［O^R=0.89（95% CI：0.81,0.96）］、合并房颤［O^R=2.40（95% CI：1.07,5.31）］。基于以上6个影响因素构建风险预测列线图模型,结果显示,模型的ROC曲线下面积（AUC）为0.82（95% CI：0.76,0.88）,校准曲线贴近理想曲线。经Bootstrap法内部验证所得AUC值为0.81（95% CI：0.75,0.87）。结论 AHF患者住院期间发生心血管不良事件的主要影响因素是脑卒中、白细胞计数、血尿素氮、D-二聚体、左心室短轴缩短率、合并房颤,以此构建的心血管不良事件风险预测模型具有良好的效能。     

上海市某社区人群高血压流行特征及影响因素分析

目的：通过杜区调查分析人群高血压的流行特征及主要危险因素。方法：以整群随机抽样方法抽取2个居委，对年满20岁以上的城市常住居民调查一般情况、高血压危险因素和体格检查。结果：人群高血压患病率为34．30％，男性与女性高血压的患病率有显著差别(P＜0．01)；随着血压分类级别的升高患病率逐渐降低，Ⅰ级和Ⅱ级高血压占高血压总人数的90．22％；人群高血压的患病率与年龄呈显著正相关，而与文化程度呈负相关(P＜0．01)；超重者和肥胖者患高血压的相对危险性增高。结论：在社区采取全人群和高危人群相结合的策略，加强对中老年、文化程度低、超重、肥胖以及轻、中度高血压人群的健康教育，对防治高血压和控制心脑血管疾病具有重要意义。     

Prevalence of cardiovascular disease risk factors among attendees of the Batu 9, Cheras Health Centre, Selangor, Malaysia

This study describes the prevalence of selected cardiovascular disease (CVD) risk factors screened in patients 30 years and above attending a health centre in Cheras, Selangor. The study involved 3772 patients screened from March 2002 to June 2008. Risk factors screened included blood pressure, height, weight, serum total cholesterol, random blood sugar levels and smoking status. Majority of respondents were between 40 and 49 years of age (58.1%), males (64.7%) and ethnic Malays (74.4%). About two thirds (62.6%) were found to be overweight or obese, two fifths (40.2%) had hypercholesterolemia, a third (34.2%) had hypertension and 31.6% were smokers at some time. Overall 87% and 60% had at least one and two CVD risk factors respectively. Prevalence of four of the five risk factors screened was highest among the Malay middle aged men and lowest among the Chinese. Thus a substantial proportion of middle aged men were at high risk of CVD. Our findings show the need for ongoing monitoring of CVD risk factors and implementation of effective preventive strategies.