Tobacco smoking and hypertension

Coronary artery diseases is rapidly increasing in our part of the world. The South Asian ethnic groups are especially vulnerable to coronary artery disease. The two most striking features of coronary artery disease in the South Asian population are extreme prematurity and severity of the disease, both resulting from the malignant atherosclerosis that begins at an earlier age than in other population. Triple vessel disease and complicated lesions are not common even in young people and follow a malignant course. The most important aspect of prevention is to identify individuals with high risk of coronary artery disease at an early age and aggressive modification of risk factors. Tobacco smoking and hypertension are the two most important risk factors for coronary heart disease and stroke. Both of these risk factors have very high prevalence in India, Nepal and other countries of this region. There is a synergistic interaction of tobacco smoking with hypertension and high blood cholesterol which greatly increase coronary heart disease risk as well as sudden death and stroke.     

A 5 years prospective study of incidence, morbidity and mortality profile of stroke in a rural community of eastern India

Community-based longitudinal study on stroke is rare in India. It has been predicted that the stroke incidence will be higher in developing countries than developed countries. Hence a five years prospective study was planned to carry out in the rural Bengal, India based on WHO protocol to determine the incidence rate, risk factors, morbidity and mortality profile of stroke. In a two-stage procedure, 20717 subjects out of 20842 people from a cluster of 12 villages was surveyed by house-to-house method and the screened cases were examined by a team of neurologists including post stroke surveillance for one year. Altogether 128 first ever stroke cases were detected over 5 years showing an average annual incidence rate of 123.57 per 100,000 persons [age adjusted incidence rate (AAIR)--262/100,000; based on USA population, 1990] and sex-specific AAIR (274/100,000) among women is slightly higher than men (253/100,000). Age-specific stroke incidence rate showed increasing rate from fourth decade up to seventh decade in both sexes when the rate was maximum. First 30 days mortality recorded was 18% with men suffering twice than women. Follow-up after one year revealed speech improvement in 47%, residual spasticity in 46% and independency in activities daily living in 62% of cases. Age and sex matched case control study has shown that hypertension (OR - 2.79), heart disease (OR - 6.20) and smoking (OR - 3.92) are significant risk factors.This study had indicated a higher age adjusted incidence rate of stroke in India as compared to that of developed country and hypertension, heart disease and smoking are important risk factors.     

颈动脉狭窄患者发生缺血性脑卒中的危险因素及预防

目的：分析探讨本地区颈动脉狭窄患者发生缺血性脑卒中的危险因素及相关有效预防措施。方法：回顾分析本院收治的颈动脉狭窄所致的缺血性脑卒中患者60例及门诊对照组正常患者60例,对比两组患者的相关资料,分析发生缺血性脑卒中的危险因素。结果：颈动脉狭窄患者发生缺血性脑卒中危险因素包括年龄、冠心病、高血压、糖尿病、高脂血症、房颤、吸烟等。分层分析中60岁以上,同时伴有高血压、冠心病及吸烟的患者发生缺血性脑卒中几率增加。结论：对于60岁以上伴高血压高血脂的吸烟患者应早期进行颈动脉彩超检查,加强药物预防,加强宣传教育,鼓励戒烟,降低缺血性脑卒中发生。     

进展性卒中采用CISS分型法分析其病因及危险因素

目的探讨基于CISS分型的进展性卒中与不同危险因素的相关性。方法回顾性分析2011—2014年来该院接受治疗的40例急性缺血性进展性卒中患者的临床资料,按照CISS分型法对其进行分型,观察其不同分型与不同危险因素的相关性。结果按照CISS分型法这40例病人分为3型,其中与心源性脑卒中型呈正相关的危险因素为房颤（B=1.39以及冠心病（B=2.13）,吸烟（B=1.41）;与穿支动脉疾病性脑卒中型呈正相关的危险因素为高血压（B=1.13）,血脂异常（B=1.31）,吸烟（B=1.45）;与大动脉粥样硬化型脑卒中呈正相关的危险因素为：血脂异常（B=1.29）,吸烟（B=1.43）。结论与脑卒中发生发展相关的主要危险因素为房颤、冠心病、高血压、血脂异常以及吸烟。     

脑卒中危险因素与生活质量相关性分析

目的:探讨脑卒中危险因素与生活质量之间的相关性。方法:采用脑卒中专用生活质量量表(SS-QOL)对患者进行生活质量评定,结合患者的危险因素进行相关性分析。结果:高血压病、冠心病、糖尿病、颈动脉狭窄、吸烟以及饮酒这些危险因素对脑卒中患者生活质量的影响具有统计学意义;性别、年龄、血脂异常、家族史对脑卒中患者生活质量的影响没有统计学意义;体重指数与脑卒中患者的生活质量呈正相关的关系,且具有统计学意义。结论:不同危险因素对脑卒中患者的影响不同,影响脑卒中患者生活质量的各种因素需要进一步的研究证实。     

Prevention of coronary heart disease among Indians: focus on primary prevention

Epidemiological transition with increasing life expectancy and demographic shifts in population age-profile combined with lifestyle related increases in the levels of cardiovascular risk factors is accelerating coronary heart disease (CHD) epidemic in India. As prospective cohort studies for evaluation of coronary risk factors do not exist, urban-rural differences in prevalence of coronary risk factors and case-control studies provide important information regarding coronary risk factors that need prevention to control the CHD epidemic. The risk factors more in urban Indians or associated with increased risk in case-control studies are: Sedentary lifestyle, smoking, truncal obesity, hypertension, hypercholesterolaemia, impaired glucose tolerance, insulin resistance and diabetes. Primordial prevention ie, prevention of risk factors can be achieved by encouragement of positive health behaviour and promotion of the concept of health as a social value. Special target groups are children, adolescents, family unit, under-privileged and high-risk groups. Behavioural and environmental changes relevant to primordial prevention are changes in eating patterns, drinking, smoking, physical activity and stress management. Primary prevention focuses on population and on high-risk groups. Specific high-risk subjects are those with family history of CHD, hypertension or diabetes or those having sedentary lifestyle, obesity, truncal obesity and biochemical coronary risk factors. The interventions are smoking cessation, increased physical activity, weight regulation, blood pressure control, lipid regulation and diabetes management.     

105例脑梗死患者的危险因素分析

目的探讨脑梗死患者的主要危险因素并提出预防措施。方法对105例脑梗死患者的危险因素进行调查及相关分析。结果脑梗死患者主要的危险因素有高血压、高脂血症、糖尿病、心脏病、吸烟史、卒中史,发病率随年龄增长呈上升趋势,男性多于女性,且发病部位多在基底节区。结论高血压、高脂血症、糖尿病、心脏病、吸烟史、卒中史为脑梗死患者的主要危险因素,控制好这些危险因素,对预防脑梗死发生有重要的临床价值。     

多种危险因素在脑卒中和冠心病之间的分布差异

脑卒中和冠状动脉粥样硬化性心脏病具有相似的危险因素,其发病在国际和国内的分布却有很大差异,阐明危险因素对不同类型的心脑血管疾病的预防和治疗具有重要意义,现在研究的危险因素众多,文章就血压、血脂异常、吸烟、饮酒、糖尿病、肥胖6个危险因素在脑卒中和冠状动脉粥样硬化性心脏病之间的分布差异做一综述。     

缺血性卒中患者的危险因素分析

目的研究缺血性卒中患者危险因素的分布情况以反映卒中二级预防的负担。方法前瞻性调查478例连续的脑卒中门诊的缺血性卒中患者的人口学、个人疾病史和不良生活方式,计算单个危险因素的百分比、危险因素的累积数目和组合情况。结果在所调查的危险因素中,高血压(77.2%)、血脂异常(66.7%)和吸烟(42.9%)列前3位。有0~7个危险因素的患者百分比依次为1.5%、8.6%、30.1%、29.7%、19.9%、6.7%、3.3%和0.2%。在具有2种危险因素的患者中,主要的危险因素组合为高血压和血脂异常(28.5%)、吸烟和血脂异常(13.2%)、高血压和吸烟(10.4%)、高血压和糖尿病(10.4%)。结论高血压是卒中预防的重中之重。改变不良生活方式是卒中预防的重要环节。90%的患者有2种或2种以上的危险因素,是缺血性卒中的高危人群,应对之综合干预,多数患者需要更严格的治疗靶目标。     

高血压病患者血压各参数与其发生冠心病脑卒中的相关性研究

目的　探讨高血压病患者血压各参数与其发生冠心病脑卒中的关系。方法　回顾性分析 1190例高血压病患者 ,年龄 4 5～ 6 5岁 ,其中单纯高血压病患者 4 0 0例 ,高血压并发冠心病者 392例 ,高血压并发脑卒中者 398例 ,分析三组患者的血压各参数关系 ,探讨收缩压、舒张压、平均血压、脉压与高血压并发冠心病、脑卒中的相关性。结果　脑卒中组的收缩压显著高于单纯高血压组或冠心病组 (P <0 . 0 5 ) ;冠心病组的舒张压显著低于单纯高血压组或脑卒中组 (P <0 . 0 1) ;脑卒中组的平均血压显著高于单纯高血压组或冠心病组 (P <0 .0 5 ) ;冠心病组或脑卒中组的脉压显著高于单纯高血压组 (P <0 . 0 1)。Logistic回归分析显示 :校正年龄、性别、高血压病程和其他危险因素 (吸烟、糖尿病、高脂血症 ) ,脉压仍与冠心病、脑卒中的发生有显著相关性 (P<0 . 0 5 ,P<0 . 0 1)。结论　中老年高血压病患者 ,收缩压、平均血压与脑卒中的发生有显著相关性 ,舒张压与冠心病的发生有显著相关性 ,脉压与冠心病、脑卒中的发生均有显著相关性。校正年龄、性别、高血压病程和其他危险因素 (吸烟、糖尿病、高脂血症 ) ,脉压是高血压并发冠心病、脑卒中的独立危险因素。     

马鞍山市金家庄社区居民慢性病危险因素认知与行为现状研究

目的: 了解安徽省马鞍山市金家庄社区居民的慢性病危险因素认知与行为的现状,为针对性地开展社区居民的慢性病健康教育提供科学的依据.方法: 采用分层整群抽样的方法,对4 676名马鞍山市金家庄社区18岁以上居民进行问卷调查,内容主要包括居民慢性病危险因素认知与行为现状.结果: 居民高血压危险因素知晓率为38.37%,高血压患者危险因素知晓率明显高于非高血压人群(P<0.01);居民糖尿病危险因素知晓率为33.00%,糖尿病患者危险因素知晓率高于非糖尿病人群(P<0.05);居民脑卒中危险因素知晓率为38.54%,脑卒中患者与非脑卒中人群危险因素知晓率差异无统计学意义(P>0.05).3种慢性病患者的吸烟率普遍较高,分别为72.34%、73.21%和73.24%;高血压患者饮酒率和主动锻炼率分别为12.40%和20.57%;肥胖率和健康教育率在高血压和糖尿病患者中较高,肥胖率分别为43.19%与41.52%,健康教育率分别为59.26%和58.04%.结论: 慢性病患者中普遍存在吸烟、过量饮酒、肥胖、缺乏主动锻炼等危险因素.社区居民对慢性病危险因素的认知不足,需通过有针对性的慢性病防治知识健康教育,提高居民的认知水平,建立健康的生活方式.     

微量蛋白尿与缺血性脑卒中的相关危险因素分析

目的 探讨微量蛋白尿与急性初发缺血性脑卒中的相关危险因素.方法 将所有患者分为病例组（急性初发缺血性脑卒中患者84例）与对照组（非缺血性脑卒中患者62例）,比较两组微量蛋白尿阳性率及绝对值,用Logistic回归分析其是否为具有与高血压病,糖代谢紊乱,吸烟等传统缺血性卒中危险因素同等地位的独立危险因素.结果 急性初发缺血性脑卒中组微量蛋白尿阳性率明显高于非卒中组,差异有统计学意义,微量蛋白尿与吸烟,高血压病,性别等同为脑梗塞发生的危险因素,OR值分别为8.163,4.979,9.196,2.720.结论 微量蛋白尿是急性初发缺血性脑卒中的独立危险因素,可作为潜在的治疗靶点.     

伴同型半胱氨酸增高的缺血性卒中患者相关危险因素Logistic回归分析

目的:分析伴同型半胱氨酸(Hcy)增高的缺血性卒中患者(IS)的相关危险因素。方法:共纳入80例经头颅MRI/CT证实的且Hcy水平>20μmol/L的IS患者,同时随机抽取138例不伴Hcy增高的IS患者作为对照组。所有受试者均记录IS的传统危险因素。先以单因素分析筛选出有统计学意义的危险因素,再应用多因素非条件Logistic回归分析伴Hcy增高的IS患者的独立危险因素。结果:单因素分析表明:生活规律及高密度脂蛋白(HDL)与伴Hcy增高的IS患者呈负相关(P<0.05);男性、高血压病史、糖尿病史、家族卒中病史、冠心病病史、吸烟史、饮酒史、入院首次收缩压、C反应蛋白(CRP)及LDL与之呈正相关(P<0.05)。多因素分析表明:高血压病史、糖尿病史、吸烟史、CRP及LDL是伴Hcy增高的IS患者的独立危险因素;而生活规律是伴Hcy增高的IS患者的保护因素。结论:伴Hcy增高的IS患者的保护因素是生活规律,其独立危险因素是高血压病史、糖尿病史、吸烟史、CRP及LDL,对该类人群的高血压、糖尿病等危险因素进行必要的干预具有重要的意义。     

北京市40岁以上女医师脑卒中危险因素研究

目的 探讨北京市40岁以上女医师脑卒中的危险因素.方法 选样北京市40家医院40岁以上女医师1406例,进行脑卒中危险因素调查和特征分析.结果 本组平均年龄(46.5±5.4)岁,脑卒中危险因素依次为高脂血症(27.7%)、高血压(20.8%)、睡眠障碍(14.3%)、焦虑抑郁(14.1%)、糖尿病(8.6%)、吸煳(...     

椎基底动脉扩张延长症发病的危险因素分析

目的分析椎基底动脉扩张延长症发病的危险因素。方法本研究收集2016年9月~2017年9月牡丹江医学院红旗医院神经内科入院脑梗死患者200例为研究对象,根据MRA或CTA检查诊断分为椎基底动脉扩张延长症(VBD)患者100例(VBD组)及非VBD患者100例(非VBD组),观察、分析椎基底动脉扩张延长症发病的危险因素。结果 VBD组的年龄、吸烟史、饮酒史、合并基础疾病包括高血压、高脂血症、高同型半胱氨酸血症、冠心病、脑卒中、高尿酸血症、合并两种或三种及以上基础疾病、TC、TG、LDL-C、HDL-C方面与非VBD组比较,差异有统计学意义(P0.05),但两组在性别、糖尿病、BMI方面比较,差异不显著。采用非条件Logistic回归分析法,对椎基底动脉扩张延长症发病的危险因素进行分析,吸烟史、饮酒史、合并脑卒中、高血压、冠心病及两种或三种及以上基础疾病均为导致椎基底动脉扩张延长症发病的危险因素(P0.05)。结论椎基底动脉扩张延长症临床表现复杂,危险因素较多,临床应对VBD发病的危险因素予以广泛重视,对合并高血压、吸烟、高脂血症的患者应及时干预,从而为脑梗死的预防及治疗提供新思路。     

脑卒中相关危险因素及干预措施的建议

为探讨脑卒中患者的相关危险因素,对北京市和平里地区269例在社区卫生站就诊的脑卒中患者进行问卷调查和访谈,结果显示高血压、吸烟、饮酒、高血脂和糖尿病是重要危险因素,并且发病年龄呈现年轻化趋势。为了降低脑卒中发生率,我们针对这些危险因素,对社区卫生站和社区医护人员在预防与救治脑卒中方面提出了相应建议。     

缺血性脑卒中后血管性痴呆的相关因素研究

目的 分析缺血性脑卒中后血管性痴呆相关因素。方法 将2018年2月至2018年11月延长县人民医院接收的45例缺血性脑卒中后血管性痴呆患者纳入至研究组中,将同期非缺血性脑卒中后血管性痴呆患者45例纳入至对照组中,对缺血性脑卒中后血管性痴呆危象因素进行分析。结果 在白质疏松、吸烟、高脂血症、糖尿病、心脏病及高血压发生率方面,研究组均较对照组更高,差异有统计学意义(P＜0.05);经Logistic回归分析可知,缺血性脑卒中后血管性痴呆独立危险因素包括高血压、年龄、糖尿病、白质疏松、高脂血症及心脏病。结论 根据缺血性脑卒中后血管性痴呆诱发危险因素,及早实施预防及治疗对策,有助于缺血性脑卒中后血管性痴呆发生率降低。     

急性脑梗塞与脑出血危险因素的对比研究

目的通过对脑卒中资料的分析,观察患者临床资料、生化指标与脑卒中患者的关系,并对脑梗塞与脑出血的危险因素进行比较。方法对本院收治的卒中患者408例,其中脑梗塞281例,脑出血127例,均预先对各项资料进行编码,输入计算机数据库。所有患者均进行系统的临床和辅助检查,脑卒中诊断经过磁共振或CT确诊。结果(1)高血压、吸烟是脑卒中最重要的危险因素。(2)与脑梗塞相比,吸烟(OR=0.226,95%CI=0.107-1.623)、糖尿病病史(OR=0.094,95%CI=0.023-2.401)、心脏病病史(OR=0.046,95%CI=0.236-0.905)对脑出血的危险较小;高血压病史(OR=1.096,95%CI=0.542-0.895)是脑出血唯一危险因素。结论高血压、吸烟是脑卒中最重要的危险因素,脑梗塞与脑出血的危险因素并不完全一致。     

The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit

OBJECTIVES: To determine the prevalence of stroke risk factors in a general practice population and to identify pharmacotherapies currently used in management of stroke risk factors. DESIGN: Multicentre, observational study by 321 randomly selected general practitioners who each collected data on 50 consecutive patients attending their surgery. PATIENTS AND SETTING: 16 148 patients aged 30 years or older attending general practices across Australia during 2000. OUTCOME MEASURES: Prevalence of hypertension, current smoking, diabetes, hypercholesterolaemia, atrial fibrillation, recent history of stroke or TIA; extent of pharmacotherapy use in risk-factor management. RESULTS: 70% of patients had one or more risk factors and 34% had two or more. Hypertension was the risk factor with greatest prevalence (44%), followed by hypercholesterolaemia (43%) and current smoking (17%). The prevalence of risk factors generally increased with age, except for current smoking, where a decrease with age was seen. The most common pharmacotherapies were cardiovascular agents, followed by antiplatelet agents. Two-thirds of patients with hypertension were taking cardiovascular drugs, most commonly angiotensin-converting enzyme inhibitors. CONCLUSIONS: Stroke risk factors are highly prevalent in general practice patients and GPs are ideally placed for opportunistic case-finding. There is considerable scope for improving management of stroke risk factors. The Avoid Stroke as Soon as Possible (ASAP) general practice stroke audit provides a baseline against which progress in risk-factor management can be measured.     

Cigarette smoking and risk of premature stroke in men and women

A case-control study was carried out of the relation between cigarette smoking and hypertension and stroke. A total of 132 cases of stroke (79 in men, 53 in women) identified as a part of a population based register were compared with 1586 controls (1017 men, 569 women) from a survey of cardiovascular risk factors conducted in the same population. Cigarette smokers had a threefold increase in the risk of stroke compared with current non-smokers. This association remained significant after adjusting for hypertension. Those who both smoked and had hypertension had an increased risk of stroke of almost 20-fold compared with those who neither smoked nor had hypertension. Overall, in this population roughly 37% of stroke events may be attributed to cigarette smoking and 36% to hypertension.