郑州心血管病危险因素比较

郑州心血管病监测区于1984、1985、1988三年中的9～10月间,对206,502人城市居民25～64岁人群115,728人,进行随机抽样调查。1988年与1984、1985年比,高年龄组男、女两性收缩压均值,和男、女两性各年龄组舒张压均值明显升高,高血压患病率仍在上升。血清总胆固醇均值逐年上升,而高密度脂蛋白变化较小。吸烟率尤其是低年龄组下降显著。     

大庆市心血管病发病危险因素调查——前瞻性研究对比分析

大庆心血管病人群监测1984年与1988年发病危险因素调查情况,结果示血压、胆固醇(TC)、甘油三酯(Tg)。体重指数(BMI)、高血压患病率及诊断冠心病的心电图主要明尼苏达编码,1988年均高于1984年。上述指标除BMI外,其余各项差异均有统计学意义。同步膳食调查结果,大多数营养素的摄入亦是1988年高于1984年,且胆固醇及钠的差异有显著性。提示膳食水平的改变可能与发病危险因素变化趋势有关。     

广州市健康体检人群腰身指数与心血管病危险因素相关研究

目的探讨广州健康体检人群中作为腹型肥胖指标的腰身指数（腰围/身高比值WHtR）与心血管病危险因素的相关性。方法对2003年3月2006年12月入广州疗养院体检的广州市各类人员共1 536人测量和检测身高、体质量、腰围、血压、心率、生化等指标,并进行统计学分析。结果WHtR随年龄增大而增高;WHtR异常组的年龄、体质量、SBP、DBP、FBS、TC、TG以及尿酸均显著高于WHtR正常组,HDL-C的结果则相反（P<0.01）;同时WHtR与年龄、体质量、SBP、DBP、FBS、TC、TG呈显著正相关、与HDL-C呈显著负相关（P<0.05,P<0.01）。结论WHtR可作为有效的腹型肥胖参考指标,WHtR异常者其心血管病危险因素水平比正常者高。     

血脂异常与心血管病危险因素控制

众所周知 ,血脂异常是引起糖尿病、心脑血管病死亡的首要危险因素。纠正血脂异常对心血管病危险因素控制有极为重要的意义。一、血脂异常的概念与类型(一 )血脂异常的概念血脂异常是血液脂质代谢异常的简称 ,它主要指血中总胆固醇 (ＴＣ)和甘油三酯 (ＴＧ)水平过高 ,以及血中高密度脂蛋白胆固醇 (ＨＤＬ Ｃ)水平过低。血脂异常是一个非常复杂的问题。血脂的主要成份为ＴＣ、ＴＧ、磷脂及游离脂肪酸。这些成份在血液中都与蛋白质结合成各种颗粒大小及密度不同的脂蛋白。在生理与病理条件下各种脂蛋白又有各自不同的代谢途径 ,起着各种生理或…     

心血管病的危险因素——血尿酸增高

1　高尿酸血症与心血管疾病的关系高尿酸血症常合并有肥胖、肾疾患、动脉粥样硬化高血压和早发冠心病。但高尿酸血症与心血管疾病的关系 ,多年以来一直存在争议。Fessel等 [1 ]经 1 0年随访研究 ,发现高尿酸血症患者发生冠心病或高血压者 ,其危险性增加 1 0倍。原发性高血压患者较正常血压者发生痛风的危险性增加 3倍。 Framingham研究 [2 ] 每两年作一次体检及血脂、血尿酸等测定的患者 ,在第 4次时男性平均血尿酸水平为 5 mg/dl (2 97μmol/l) ,第 1 3次时为 5 .7mg/dl(3 3 9μmol/l) ;女性分别为 3 .9mg/dl (2 3 2 μmol/l)和4.7mg/dl(2…     

女性健康研究——阿斯匹林用于心血管病的一级预防

阿斯匹林已成为上一世纪二级预防的标准药物。它价廉而具有保护作用。但它在一级预防中的作用仍未有共识。     

糖尿病与其他心血管病危险因素关系的流行病学研究

辉瑞全国糖尿病专家血脂研讨会于2003年10月22日在四川省成都市举行。来自全国各地的糖尿病、心血管病专家共60人与会。傅祖植教授、潘长玉教授、高妍教授任大会主席。王薇副教授、杨文英教授、陆国平教授、邹大进教授以及蔡德鸿教授进行了精彩的发言。主要内容有：糖尿病与其他心血管病危险因素关系的流行病学研究、2型糖尿病伴血脂异常的可能机制、糖尿病血脂异常的首要治疗目标是降低低密度脂蛋白一胆固醇(LDL-C)、从循证医学看糖尿病降脂治疗的意义、2型糖尿病血脂紊乱治疗指南。参会人员还对以上专题进行了热烈的讨论。本专栏刊出专题发言的主要内容。     

高脂血症家族遗传因素与心血管病危险因素的聚集性研究

目的 探讨高脂血症家族遗传因素与心血管病危险因素个体聚集性的关系。方法 采用遗传流行病学研究方法,分析高脂血症先证者一级亲属与二级亲属心血管病危险因素的个体聚集性。其中,家族性混合型高脂血症家系15个（共93人）,家族性高胆固醇血症家系11个（共94人）。结果 超重、高收缩压、高舒张压、高apoB血症、高血糖、低水平高密度脂蛋白胆固醇,这6种高危因素中,心血管病危险因素的个体聚集性随着先证者亲属亲缘系数的下降而下降（P＜0．01）。结论 高脂血症家族遗传因素对心血管病危险因素的聚集起着重要作用。     

甘肃榆中农村居民体力活动与其他心血管病危险因素的关系研究

目的探讨农村体力活动与其他心血管病危险因素的关系。方法利用甘肃榆中农村心血管病及危险因素的流行病学调查资料进行统计分析。体力活动量采用梅脱-小时（MET-hr）为定量单位。结果本次研究有效问卷1087份。男女间文化程度和年收入差异有统计学意义（P〈0.01）,肥胖率和吸烟率有显著差异（P〈0.01）。劳作、家务、运动和交通体力活动中,农民的劳作日均活动量最高。高血压人群及中心性肥胖人群的劳作和日均活动总量分别低于非患病人群,差异有统计学意义（P〈0.01）,交通和休闲运动量与各类心血管病危险因素之间的差异均无统计学意义（P〉0.01）。调整人口学特征后,劳作活动量和日均体力活动总量的增加对中心性肥胖有保护作用,运动量越大保护作用越强（P〈0.05）;同时高强度的劳作或增加日均活动总量对超重/肥胖有保护作用（P〈0.05）。结论我国不同社会人口学特征的居民运动情况不同,国内应针对不同人群的体力活动特点制定指南,引导我国居民积极参加体力活动。     

The effect of fruit and vegetable intake on risk for coronary heart disease.

BACKGROUND: Many constituents of fruits and vegetables may reduce the risk for coronary heart disease, but data on the relationship between fruit and vegetable consumption and risk for coronary heart disease are sparse. OBJECTIVE: To evaluate the association of fruit and vegetable consumption with risk for coronary heart disease. DESIGN: Prospective cohort study. SETTING: The Nurses' Health Study and the Health Professionals' Follow-Up Study. PARTICIPANTS: 84 251 women 34 to 59 years of age who were followed for 14 years and 42 148 men 40 to 75 years who were followed for 8 years. All were free of diagnosed cardiovascular disease, cancer, and diabetes at baseline. MEASUREMENTS: The main outcome measure was incidence of nonfatal myocardial infarction or fatal coronary heart disease (1127 cases in women and 1063 cases in men). Diet was assessed by using food-frequency questionnaires. RESULTS: After adjustment for standard cardiovascular risk factors, persons in the highest quintile of fruit and vegetable intake had a relative risk for coronary heart disease of 0.80 (95% CI, 0.69 to 0.93) compared with those in the lowest quintile of intake. Each 1-serving/d increase in intake of fruits or vegetables was associated with a 4% lower risk for coronary heart disease (relative risk, 0.96 [CI, 0.94 to 0.99]; P = 0.01, test for trend). Green leafy vegetables (relative risk with 1-serving/d increase, 0.77 [CI, 0.64 to 0.93]), and vitamin C-rich fruits and vegetables (relative risk with 1-serving/d increase, 0.94 [CI, 0.88 to 0.99]) contributed most to the apparent protective effect of total fruit and vegetable intake. CONCLUSIONS: Consumption of fruits and vegetables, particularly green leafy vegetables and vitamin C-rich fruits and vegetables, appears to have a protective effect against coronary heart disease.     

The dose-response relationship of fruit and vegetable intake and risk of type 2 diabetes among rural China: The Henan Rural Cohort study

AimsTo explore the dose-response relationship of fruit and vegetable (F&V) intake and type 2 diabetes (T2D) risk in rural China.MethodsA total of 38798 adults were recruited from the Henan Rural Cohort Study. F&V intake was assessed by a validated food-frequency questionnaire. Logistic regression and restricted cubic splines analysis were conducted to calculate the odds ratio (OR) for T2D relative to F&V intake and investigate the dose-response relationship.ResultsHigher intake of fruit or combined F&V was in connection with a lower risk of T2D, after adjusting for multiple confounders. After analyzing the dose-response relationship, we found that the odds of T2D decreased significantly with fruit consumption ≥ 260 g/day or F&V intake between 600 and 1000 g/day. And in subgroup analysis, we found that the negative correlation between fruit consumption and T2D was more pronounced in non-current smokers and non-current drinkers.ConclusionsHigh intake of fruit alone or combined F&V is related to a reduced risk of T2D in rural China. Fruit intake ≥ 260 g/day and total F&V consumption of 600–1000 g/day should be encouraged to promote good health.     

Relationship of fruit and vegetable intake with adiposity: a systematic review

Fruit and vegetable (FV) intake has been proposed to protect against obesity. The purpose of this paper was to assess the FV consumption to adiposity relationship. Twenty‐three publications were included. Inclusion criteria: longitudinal or experimental designs; FV intake tested in relation to adiposity; child, adolescent or adult participants; published in English‐language peer‐reviewed journals. Exclusion criteria: dietary pattern and cross‐sectional designs; participants with health concerns. Experimental studies found increased FV consumption (in conjunction with other behaviours) contributed to reduced adiposity among overweight or obese adults, but no association was shown among children. Longitudinal studies among overweight adults found greater F and/or V consumption was associated with slower weight gain, but only half of child longitudinal studies found a significant inverse association. Limitations in methods prevented a thorough examination of the role of increased FV intake alone or mechanisms of effect. An inverse relationship between FV intake and adiposity among overweight adults appears weak; this relationship among children is unclear. Research needs to clarify the nature of, and mechanisms for, the effects of FV consumption on adiposity. Whether increases in FV intake in isolation from lower caloric intake or increased physical activity will result in declines or slower growth in adiposity remains unclear.     

The effect of intensive glycaemic control on cardiovascular outcomes

The relationship between glycaemia and cardiovascular disease remains controversial. For patients with type 1 diabetes in the Diabetes Control and Complications Trial, intensive glycaemic control reduced microvascular outcomes and, on longer term follow‐up, a significant reduction in macrovascular events was observed. For patients with recently diagnosed type 2 diabetes, the findings in the United Kingdom Prospective Diabetes Study were similar; intensive glycaemic control reduced microvascular events during the intervention phase of the study, and a reduction in macrovascular events was observed on longer follow‐up. More recently, the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation study showed a microvascular benefit of more intensive blood glucose control in patients with longstanding diabetes, whereas the Action to Control Cardiovascular Risk in Diabetes study showed harm if this was performed rapidly, with increase in weight, hypoglycaemia and mortality. Collectively, these studies suggest that slow and steady intensive control of glycaemia improves outcomes in people with diabetes, and that to reduce mortality this should be commenced early in the management of patients with type 2 diabetes.     

钙摄入与心血管疾病风险的研究进展

钙摄入对于心血管系统的健康效应正日益受到争议。尽管早期研究提示钙质可能具有心血管系统保护作用,日益增多的证据支持过量摄入膳食钙及补充钙剂可能对心血管系统产生不利影响。钙可通过上调肾素-血管紧张素-醛固酮系统、促进血管钙化、导致短期内血钙波动、引发高凝状态等多种机制影响心血管系统。钙对于心血管系统的潜在获益与风险亟需大规模试验进一步深入评估。     

The ADVA NCE cardiovascular risk model and current strategies for cardiovascular disease risk evaluation in people with diabetes

Cardiovascular disease (CVD), the leading global killer, is multifactorial by nature. No single risk factor taken alone is able to distinguish people who will go on to develop a cardiovascular event from those who will not. This consideration forms the basis of the contemporary multifactorial approaches to CVD risk evaluation and reduction.A key aim of CVD risk evaluation is to identify those in the population who’s health outcomes can be modified by performing more medical tests, starting treatments to reduce the level of risk factors or increasing the doses of prescribed risk-reducing therapies.1,2 Estimated risks are also used to educate patients about their chances of experiencing a cardiovascular event within a given time period (for example, five or 10 years).Equipped with this knowledge, patients are more likely to be motivated to adopt healthy lifestyle measures and/or to observe prescribed risk-modifying treatments. These patients are also more likely to regularly report back to their healthcare provider for monitoring and adaptation of treatments, to lower and maintain their risk factors at optimal levels.Concerning CVD in people with diabetes, healthcare providers who see these patients on a routine basis are interested in gauging the chances of their patients developing any major CVD event over a reasonable period of time (often five to 10 years), and not just specific components such as stroke or myocardial infarction. These busy healthcare providers are also interested in assessing the CVD risk of their patients using accurate and validated global CVD risk-evaluation tools.3-5In the general population, efforts to develop reliable tools for evaluating CVD risk based on a combination of several risk factors have paralleled efforts to improve our understanding of the determinants of CVD and more efficient ways to control them.6 These efforts were initially led by the Framingham investigators, and more recently by investigators from other parts of the world.6,7 The first attempts to develop such tools from the Framingham study date back to the year 1967.8 These first tools, however, did not account for diabetes status or for any other indicator of chronic hyperglycaemia.Although many subsequent Framingham tools took diabetes status into consideration, the uptake of the Framingham tools in people with diabetes around the world has remained very limited, resulting in the adoption of multivariable CVD tools in people with diabetes to lag behind the general population. One reason was the lack of trust among researchers on the validity of the Framingham tools in people with diabetes, due to the relatively small number of people with diabetes in the Framingham cohort, and the non-inclusion of other indicators of exposure to chronic hyperglycaemia in the Framingham tools.9Another major reason was the publication in the late 1990s of a study from Finland suggesting that people with diabetes but no history of cardiovascular disease had a future risk of CVD similar to the risk of non-diabetic people who have survived a CVD event in the past.10 This study inspired the concept of diabetes as a ‘CVD risk equivalent’, based on which people with diabetes should be treated with cardiovascular risk-reducing therapies such as statins or aspirin, without taking into consideration their absolute CVD risk levels.However, the concept of diabetes as a CVD risk equivalent has been losing ground in recent years, with the accumulating evidence challenging its validity in all circumstances,11 and supporting the importance of absolute risk estimation in people with diabetes as the appropriate basis for CVD risk-factor modification. Such an approach is further supported by the gradual shift in the management of diabetes mellitus from a glucocentric focus to an intensive multifactorial strategy targeting reduction in the risk of both macro- and microvascular complications of diabetes.12,13The growing recognition of the importance of global CVD risk in people with diabetes has generated interest among researchers to develop tools with improved performance to estimate absolute risk in people with diabetes, or to establish the validity of the existing ones and refine their performance.7 The following development is a discussion on the rationale and strategies for global CVD risk estimation in people with diabetes, with emphasis on the specificities and limitations of these strategies. The discussion is largely inspired by new knowledge gained from CVD risk modelling in the ADVANCE study.3,14     

Identifying novel biomarkers for cardiovascular disease risk prediction

The primary prevention of cardiovascular disease relies on the ability to identify at‐risk individuals long before the development of overt events. In the past decade, research into circulating, genetic and imaging biomarkers to augment traditional methods of risk prediction has only achieved modest success. Emerging technologies in the fields of genomics, metabolomics and proteomics are providing new platforms for biomarker discovery. Here, we review current concepts in the evaluation and discovery of cardiovascular biomarkers. Further research is needed to identify new biomarkers to successfully stratify risk of cardiovascular disease in low‐risk populations, as well as to test whether management strategies informed by biomarker testing are better than standard of care.     

Calcium supplementation and cardiovascular risk: A rising concern

Over the past decade, the number of individuals taking calcium supplementation worldwide has been on the rise, especially with the emergence of new pharmaceutical companies specialized in the marketing of dietary supplements; with calcium supplementation being their main business axis. This is mostly because of the established role of calcium in the prevention and treatment of osteoporosis and, to a lesser extent, its role in the prevention of fractures. Recently, a rising body of evidence on the adverse effect of calcium supplementation on nonskeletal, especially cardiovascular, health has been a cause for concern. In fact, a significant number of studies have reported an association between calcium supplementation and adverse cardiovascular events, even though high dietary calcium intake was shown to have a protective effect. The mechanism by which calcium supplementation could cause a cardiovascular event was still unclear until a recent study published in the Journal of the American Heart Association. Combining this recent finding with available data associating calcium supplementation with cardiovascular mortality and all‐cause mortality, we call on the need for an evidence‐based approach to calcium supplementation, while stressing on the safety of dietary calcium intake over the former on cardiovascular health.     

Associations of blood rheology and interleukin-6 with cardiovascular risk factors and prevalent cardiovascular disease

Haemorheological variables (whole-blood, plasma and relative blood viscosity, haematocrit, red cell aggregation, white cell count and fibrinogen) were measured in 753 men and 821 women aged 25-74 years, and related to cardiovascular risk factors and prevalent cardiovascular disease (CVD). Men had higher levels than women of blood viscosity, haematocrit, corrected viscosity and relative viscosity. Post-menopausal women had higher levels than pre-menopausal women of blood viscosity, haematocrit, corrected blood viscosity, plasma viscosity and fibrinogen: each of these differences was completely or partly abolished by use of hormone replacement therapy. Serum total cholesterol, triglycerides, diastolic blood pressure, body mass index and smoking markers showed positive associations with most rheological variables, whereas HDL-cholesterol, plasma vitamin C and social class showed inverse associations. Rheological variables were associated with prevalent CVD after age-adjustment. However, after multiple risk factor adjustment only plasma viscosity and red cell aggregation showed significant (P<0.04) associations in both men and women (comparing top to bottom quarters). Plasma interleukin-6 (measured in a 25% subsample of 196 men and 221 women) correlated significantly with age, fibrinogen, white cell count, plasma and blood viscosity, current smoking, and (in men) with low serum vitamin C levels; but not with other major risk factors or with prevalent cardiovascular disease.