北京市怀柔区农村脑卒中高危人群筛查分析

目的了解北京市怀柔区50岁以上农村居民脑卒中高危人群危险因素分布情况,为社区建立脑卒中高危人群干预体系提供科学依据。方法采取整群抽样的方法,选取怀柔区户籍≥50岁农村居民1965人进行问卷调查、体格检查及颈动脉超声检查,然后将调查数据进行分析。结果≥50岁农村居民脑卒中高危人群为77.4%,除家族史、年龄为不可干预的危险因素外,主要的危险因素为高血压(56.0%),其次为吸烟(33.5%)和肥胖(22.6%)。男性主要危险因素为吸烟、高血压;女性的主要危险因素为高血压、肥胖。结论脑卒中高危人群中,高血压、肥胖患病人群和吸烟(男性为重点人群)所占比例较高,应作为脑卒中干预重点人群。     

浙江省成人高血压合并糖尿病患病率及心血管病风险分析

目的探讨浙江省成人高血压合并糖尿病流行现状及心血管病发生风险。方法采用多阶段分层整群随机抽样方法,抽取19 113名浙江省≥18岁常住居民进行代谢综合征患病情况问卷调查和相关指标检测,采用描述性流行病学方法分析高血压合并糖尿病患病情况及该人群心血管病危险因素聚集暴露情况。结果有效调查17 437人,检出高血压合并糖尿病934例,患病率为5.36%;女性患病率为5.71%,高于男性的4.96%(P0.05);城市居民患病率高于农村(P0.01);患病率随年龄增加呈上升趋势(P0.01)。心血管病危险因素聚集(具有≥3项心血管病危险因素)暴露率为98.29%,随年龄增加呈升高趋势(P0.01);男性患者心血管病危险因素聚集暴露率为99.26%,高于女性患者的97.54%(P0.05)。结论浙江省高血压合并糖尿病患者的心血管病发生风险较高,尤其是老年和男性患者,应针对其心血管病危险因素实施综合干预。     

美国男性医师中糖尿病发生率与吸烟的关系

目的　确定吸烟与Ⅱ型糖尿病发生率之间的关系。方法　对2 1 0 6 8名年龄在4 0～84岁间的美国男性医师进行研究,在研究前这些医师均未患过糖尿病、心血管疾病和癌症。结果　在追踪的2 55830人1年期间,新增770例Ⅱ型糖尿病患者。吸烟者发展成Ⅱ型糖尿病的剂量 依赖性危险增加:与不吸烟者相比,目前每天吸烟≥2 0支者年龄调整后的相对危险是2 1 ( 95%CI 1 7～2 6 ) ,每日吸烟<2 0支者为1 4 ( 95%CI1 0～2 0 ) ,已往吸烟者为1 2 ( 95%CI 1 0～1 4 )。对体重指数、体力及其他危险因素等多变量调整后,相对危险分别是每日吸烟≥2 0支者…     

浅谈高血压病患者的优化降压治疗

<正>2005年第20届美国高血压学会(ASH)年会对高血压提出了新定义,即高血压不是单纯的血压数值升高,而是一种不断进展,最终导致心血管系统结构及功能改变的综合征,有多种心血管危险因素参与其中,并伴随多种心血管疾病。高血压是我国脑卒中最主要的危险因素,是冠心病、心力衰竭及肾病的重要危险因素,已成为我国40岁以上人群总死亡的第一危险因素。因此,针对不同心血管危险因素的人群,优化选择不同的抗高血压药物治疗,对于降低心血管病发病率和死亡率尤为重要。     

舟山市高血压流行病学调查及危险因素分析

目的探讨海岛地区高血压的流行特点及危险因素.方法对舟山市定海(城市)、普陀(农村)二地区15岁以上的自然人群1174人进行高血压患病和危险因素调查.结果高血压总患病率31.69%,标化率14.96%.高血压患病率随年龄递增,40岁始患病率明显增高;高血压危险因素为年龄、超重、高血糖、高血脂、高血压家族史、心脑血管病史及饮酒;血压与性别、吸烟、食盐摄人量无相关性.高血压患者服药率为34.95%,血压控制率为11.02%.结论舟山市高血压患病率呈快速上升趋势,患病年龄有提前趋势.超重、高血糖,高血脂是目前海岛高血压的最主要危险因素.     

中国高血压防治指南2010

  目的  了解金昌队列高血压患者合并症发病情况及其影响因素,为高血压患者的预后控制提供参考依据。  方法  收集金昌队列2011年6月 — 2015年12月完成基线调查和随访调查的4551例原发性高血压患者的相关数据,进行高血压患者合并症发病情况及其影响因素分析。  结果  金昌队列4551例基线高血压患者中,随访期间共325例患者发生不同程度的高血压合并症,总观察人年数为10174.90人年,发病密度为31.94/千人年;其中,299例（92.00 %）高血压患者仅出现1种合并症,26例（8.00 %）高血压患者出现 ≥ 2种合并症,3种高发合并症依次为脑卒中（12.87/千人年）、冠心病（10.91/千人年）和糖尿病（10.61/千人年）。多因素非条件logistic回归分析结果显示,年龄 ≥ 45岁是金昌队列高血压患者合并脑卒中的危险因素,文化程度大专及以上是金昌队列高血压患者合并脑卒中的保护因素;年龄 ≥ 45岁是金昌队列高血压患者合并冠心病的危险因素;年龄 ≥ 65岁、肥胖、总胆固醇（TC）异常和甘油三酯（TG）异常是金昌队列高血压患者合并糖尿病的危险因素。  结论  脑卒中、冠心病和糖尿病是金昌队列高血压患者的高发合并症且具有不同的发病风险,年龄较大是高血压患者合并脑卒中、冠心病和糖尿病的共同危险因素。     

上海市≥50岁城镇社区居民脑卒中危险因素调查

目的探讨上海市≥50岁城镇社区居民脑卒中危险因素及脑血流动力学指标(CVHI)异常与脑卒中发生的关系,为采取相应的干预措施提供参考依据。方法采用整群随机抽样方法对在上海市长白和五角场镇社区抽取的2 031名≥50岁社区居民进行脑卒中危险因素问卷调查、体格检查和CVHI检测。结果上海市≥50岁城镇社区居民高血压、心血管病、糖尿病、高脂血症、脑卒中家族史、超重或肥胖、吸烟和饮酒等危险因素暴露率分别为51.1%、30.3%、18.2%、21.6%、26.9%、46.3%、11.6%和8.0%;CVHI积分值<75分的脑卒中高危个体比例为42.0%,且随着年龄增长呈显著的上升趋势(χ2=100.620,P<0.01);CVHI积分值0~24.9、25.0~49.9、50.0~74.9、75.0~100分者分别占7.9%、12.6%、21.5%、58.0%,不同年龄居民CVHI积分值分布差异有统计学意义(χ2=123.87,P<0.01)。结论上海市≥50岁城镇社区居民脑卒中危险因素的暴露率处于较高水平,脑卒中高危个体较多,且高危个体比例随年龄增长而升高。     

不同危险分层对糖尿病患者临床终点事件的影响

目的 探讨不同危险分层对糖尿病患者临床终点事件的影响.方法 采用前瞻性队列研究方法,以参加2006年7月至2007年10月健康查体的101510名开滦煤矿集团职工中空腹血糖≥7.0 mmol/L或＜7.0 mmol/L已确诊为糖尿病正在使用降糖药物的8302例患者作为观察队列,采用中国医学科学院心血管病研究所开发的“国人缺血性心血管病10年发病危险的评估方法”,将研究队列依据发病风险分为极低危、低危、中危和高危组,随访38～53(48.01±3.14)个月,随访期间每半年收集一次新发心脑血管事件情况.分析不同危险分层对糖尿病人群新发心脑血管事件的影响.结果 (1)随着发病风险的增加,发生总心脑血管事件、心肌梗死、脑卒中、心血管死亡以及全因死亡事件率均逐渐增高,差异有统计学意义(P＜0.01);而发生猝死事件率的差异无统计学意义(P＞0.05).(2)校正年龄及性别因素,Cox比例风险回归分析表明,随着发病风险的增加,相对于极低危组,中危和高危组发生总心脑血管事件的相对危险(RR)分别增加1.42倍(95％CI:1.02～ 1.96,P＜0.05)、2.26倍(95％CI:1.67～3.04,P＜0.01).结论 在作为高危人群的糖尿病患者中,缺血性心血管病主要危险因素年龄增加、高血压、BMI、总胆固醇水平、吸烟可预测该人群发生心脑血管事件,随着发病因素增加,临床发生心脑血管事件的危险亦增加.     

缺血性脑卒中患者二级预防现状及病情再发的影响因素

目的 了解缺血性脑卒中患者二级预防现状,探讨脑卒中再发的危险因素。方法 纳入2016年6月至2017年6月在本院门诊就诊的缺血性脑卒中患者251例,通过当面询问和查询门诊病历收集患者的年龄、性别、体重,是否吸烟、饮酒、中风家族史,是否诊断为高血压、糖尿病、房颤,总胆固醇是否异常,是否接受抗栓治疗等信息;根据6个月内脑卒中再发次数,分为观察组(再发性脑卒中≥1次)和对照组(未再发性脑卒中),分别探讨各因素对脑卒中复发的影响。结果 251例缺血性脑卒中患者中糖尿病207例(82.47%),控制率51.21%(106/207);高血压207例(82.47%),控制率49.76%(103/207);总胆固醇正常率51.79%(130/251);房颤患病率40.64%(102/251);吸烟率23.11%(58/251);抗栓治疗率58.17%(146/251)。6个月内再发脑卒中47例(18.72%)归为观察组,未再发脑卒中204例(81.28%)归为对照组。观察组患者吸烟、房颤、抗栓治疗的比例明显高于对照组,糖尿病控制率、高血压控制率、总胆固醇正常率明显低于对照组,差异均有统计学意义(均P0.05)。进行多因素Logistic回归分析,高血压未控制、糖尿病未控制、总胆固醇异常、房颤是再发缺血性脑卒中的独立危险因素(均P0.05)。结论 本地区缺血性脑卒中患者二级预防中高血压、糖尿病控制率较低,吸烟、房颤、胆固醇异常率较高,应针对独立危险因素做好防控工作。     

小心脏,大能量——心血管病人的运动指导

对于心血管疾病患者,运动可提高肌肉摄氧能力,促进酶、激素、免疫物的运送,调节机体免疫力,增加心脏搏出量,改善心肺功能.大量研究表明,适当的体育运动可以提高高血压、超重、高胆固醇血症和糖尿病患者的生存率. 2014年8月8日,《中国心血管病报告2013》发布.报告显示,心血管病死亡占城乡居民总死亡原因的首位,农村为38.7％,城市为41.1％;中国心血管病危险因素流行趋势明显,导致心血管病的发病人数持续增加,估计目前心血管病患者2.9亿,脑卒中至少700万,心肌梗死250万,心力衰竭450万,肺心病500万,而今后10年心血管病患病人数仍将快速增长.2012年心血管病死亡率为255/10万,每5例死亡中有2例死于心血管病.     

海南省成年人吸烟与心血管疾病发病风险的前瞻性研究

目的 探讨海南省成年人吸烟与各类心血管疾病发病风险的关联。方法 利用中英合作项目“中国慢性病前瞻性研究”项目海南省人群数据,剔除基线调查时自报患有冠心病、脑卒中和恶性肿瘤的个体后,纳入基线年龄为30～79岁的研究对象共28 940人,利用Cox回归分析计算非吸烟者、戒烟者和当前吸烟者的心血管疾病发病风险HR值和95%CI。结果 研究人群平均随访6.2年,累积随访177 279人年。随访期间男性1 310人,女性2 200人发病。男性吸烟率（47.0%）远高于女性吸烟率（0.3%）。多因素调整后,与非吸烟者相比,吸烟人群心血管疾病的发病风险有所增加,HR值(95%CI)分别为急性冠心病1.63(1.12～2.38)和缺血性心脏病1.53(1.22～1.91)。在当前吸烟者中,每天吸烟量多于30支的人群急性冠心病、缺血性脑卒中和出血性脑卒中的发病风险最高。结论 吸烟能够增加心血管疾病的发病风险,应基于不同心血管疾病风险制定吸烟者戒烟目标和全人群控烟措施。     

Smoking habits and risk of fatal stroke: 18 years follow up of the Oslo Study.

STUDY OBJECTIVE: To examine the risk of fatal stroke in relation to smoking habits in men screened for the Oslo study. DESIGN: The Oslo study is a prospective, cohort study of the epidemiology and preventive aspects of cardiovascular diseases in middle aged men. Screening started in May 1972 and results after 18 years of follow up are reported. PARTICIPANTS: There were 16209 men aged 40-49 years, of whom 16173 had no stroke history. Eighty five men died from stroke, of whom 48 were daily cigarettes smokers, 7 were pipe and cigar smokers, 15 smoked cigarettes and pipe or cigars daily, 11 were previous cigarette smokers, and 4 had never smoked cigarettes. MAIN RESULTS: Results of proportional hazards regression analysis adjusted for age, diastolic blood pressure, and glucose concentration showed the following rate ratios (RR) (95% confidence interval) of smoking groups compared with those who had never smoked or had previously smoked: combined cigarette and cigar or pipe smokers, RR = 6.1 (3.0, 12.5); cigarettes only, RR = 4.1 (2.3,7.4); and pipe and/or cigars only RR = 2.2 (0.9,5.5). The overall, age adjusted risk of smoking cigarettes daily was 3.5 and was found to increase with increasing cigarette consumption. Regardless of their smoking group, stroke cases had increased diastolic (DBP) and systolic blood pressure (SBP) when compared with men who had not had a stroke. The absolute differences in DBP and SBP between stroke cases and others for never and previous cigarette smokers versus daily smokers were twice as large: DBP, 12.1 mmHg versus 6.5 mmHg respectively and SBP, 16.0 mmHg versus 7.1 mmHg respectively. A high BMI increased the risk of fatal stroke of never and previous cigarette smokers. Men being treated for hypertension at the time of screening had three times the crude risk of fatal stroke of men who were not taking hypertensive treatment. CONCLUSIONS: Daily cigarette smoking increased the risk of fatal stroke three and a half times. Combined cigarette and pipe or cigar smoking had a higher risk than smoking cigarettes only. An increased risk was found in relation to increased daily cigarette consumption.     

Cigarette smoking and coronary heart disease in Puerto Rico

Cigarette smoking habits were assessed in over 9000 men, aged 45–64 years, who participated in a prospective study of coronary heart disease (CHD) in Puerto Rico beginning in 1965. Fewer Puerto Rican men smoked cigarettes, and they smoked fewer cigarettes per day than in comparable studies in the mainland United States. Even in this lower-smoking, low-CHD population, cigarette smoking showed a significant independent association with the incidence of myocardial infarction (MI) over an 8-year period both in the rural and urban areas; however, this association was not statistically significant for other manifestations of CHD. Pipe and cigar smokers had a risk of MI similar to nonsmokers. Those men who used filter cigarettes or who stated that they did not inhale showed the same risk of MI as other cigarette smokers. Ex-smokers had a risk of MI intermediate to that of nonsmokers and current smokers. The risk of MI did not increase with an increase in the number of cigarettes smoked, but the risk of MI in smokers as a group relative to those who had never smoked was 3.4 in the rural area and 2.0 in the urban area. These results emphasize that there is an excess risk of MI in those cigarette smokers who report that they used filter cigarettes, did not inhale, or smoked a small number of cigarettes a day.     

Cigarette smoking and the risk of diabetes in women.

OBJECTIVES. Noninsulin-dependent diabetes mellitus, a major risk factor for cardiovascular disease, is prevalent in more than 12 million Americans. A voluminous amount of data demonstrates that cigarette smoking is an important cause of cancer and coronary heart disease. However, the association between cigarette smoking and the risk of diabetes is virtually unexplored, especially in women. METHODS. We examined the association between smoking and the incidence of noninsulin-dependent diabetes mellitus among 114,247 female nurses who were free of diabetes, cardiovascular disease, and cancer in 1976. We collected exposure information and disease status prospectively for 12 years from biennially self-administered questionnaires. RESULTS. Current smokers had an increased risk of diabetes, and we observed a significant dose-response trend for higher risk among heavier smokers. During 1,277,589 person-years of follow-up, 2333 women were clinically diagnosed with diabetes. The relative risk of diabetes, adjusted for obesity and other risk factors, was 1.42 among women who smoked 25 or more cigarettes per day compared with nonsmokers. CONCLUSIONS. These data suggest that cigarette smoking may be an independent, modifiable risk factor for noninsulin-dependent diabetes mellitus.     

Risks of lung cancer, chronic bronchitis, ischaemic heart disease, and stroke in relation to type of cigarette smoked.

In a case control study of over 12 000 inpatients aged 35-74, risk of lung cancer, chronic bronchitis, and, particularly in those aged 35-54, ischaemic heart disease was positively associated with the number of manufactured cigarettes smoked daily and was negatively associated with long term giving up. Risk of stroke was not clearly related to smoking. Among manufactured cigarette smokers, lung cancer risk tended to be lowest in those who had always smoked filter cigarettes. This pattern was, however, evident only in men who additionally smoked pipes, cigars or handrolled cigarettes and in women, not being seen in men who smoked only manufactured cigarettes. Risk of lung cancer was not clearly related to time of switch to filter cigarettes. A markedly lower risk of chronic bronchitis was seen in men, but not women, who smoked filter rather than plain cigarettes. Heart disease risk did not vary by type of cigarette smoked 10 years before admission, but, compared with those who had never smoked filter cigarettes, those who had ever smoked filter cigarettes had a higher risk in men and a lower risk in younger women. Compared with the general population, markedly more controls were ex-smokers, suggesting incipient disease, whether or not smoking related, may alter smoking habits, thus affecting the interpretability of the findings. Control smokers were also relatively much more likely to report smoking plain cigarettes than expected. This comparison, not made in other studies relating risk to type of cigarette smoked, indicates that great care must be taken in verifying validity of reported smoking habits. While our findings are compatible with other evidence that risk of lung cancer and chronic bronchitis is probably reduced by switching from plain to filter cigarettes, they underline the difficulties in obtaining valid evidence from epidemiological studies.     

Association of passive smoking by husbands with prevalence of stroke among Chinese women nonsmokers

Growing evidence suggests that exposure to environmental tobacco smoke may have deleterious cardiovascular effects. Few studies have investigated environmental tobacco smoke exposure in relation to stroke. The authors examined the association between smoking by husbands and stroke prevalence among women nonsmokers in Shanghai, China, where two thirds of men but few women smoke. They analyzed baseline survey data (1997-2000) from a population-based cohort study, the Shanghai Women's Health Study. A total of 60,377 eligible women (aged 40-70 years) were included in the analysis. Information on husbands' smoking status and history of physician-diagnosed stroke was obtained through in-person interviews. Logistic regression was used to compute odds ratios for the associations. There were 526 prevalent cases of stroke reported. The adjusted odds ratios of stroke in women associated with husbands' current smoking of 1-9, 10-19, and > or =20 cigarettes per day were 1.28 (95% confidence interval: 0.92, 1.77), 1.32 (95% confidence interval: 1.01, 1.72), and 1.62 (95% confidence interval: 1.28, 2.05), respectively (p for trend = 0.0002). Prevalence of stroke also increased with increasing duration of husbands' smoking. The authors found that women nonsmokers who lived with husbands who smoked had an elevated prevalence of stroke, and prevalence increased with increasing intensity and duration of husbands' smoking.     

Smoking and health: the association between smoking behaviour, total mortality, and cardiorespiratory disease in west central Scotland.

The relationship of smoking to total mortality and to the prevalence of cardiorespiratory symptoms has been studied in three prospective surveys in west central Scotland in which 18 786 people attended a multiphasic screening examination. The prevalence of respiratory symptoms, and to a lesser extent cardiovascular symptoms, increased with the number of cigarettes smoked, with inhalation, and with a younger age of starting to smoke. A lower prevalence of respiratory symptoms in both sexes was observed in smokers of filter cigarettes than in smokers of plain cigarettes, and in those who smoked cigarettes with lower tar levels, irrespective of whether these were filtered or plain. In general, the relationships found between smoking and mortality were similar to those reported by other workers. Current cigarette smokers had a death rate from all causes which was twice that of those who had never smoked. No difference was found between the mortality rates of smokers of plain and filter cigarettes.     

Age at starting smoking and number of cigarettes smoked in Catalonia, Spain

BACKGROUND: Few studies have investigated the association between age at starting smoking and the average number of cigarettes smoked per day in adulthood. To provide further evidence on this issue, we analyzed data from the Catalan Health Interview Survey (CHIS). METHODS: The CHIS was conducted in 1994 on a randomly selected sample (N = 15,000) of the population of Catalonia, Spain. A total of 4,897 current or exsmokers (3,276 males and 1,621 females) were included for analysis. Age-standardized proportions of subjects smoking <15, 15-24, and >/=25 cigarettes/day, age-standardized mean number of cigarettes smoked per day, and multivariate odds ratios (OR) of being a heavy smoker (>/=25 cigarettes/day) according to age at starting smoking (<15, 15-17, 18-19, >/=20 years) were computed. RESULTS: Men who started smoking before the age of 15 smoked on average 5.5 cigarettes more than those who started at age 19 or over. Women who started smoking early in life smoked, on average, 6.8 cigarettes/day more than women who started later. The proportion of smokers of <15 cigarettes/day was higher among subjects who started smoking later. Both for males and for females, the OR of being a heavy smoker significantly increased with decreasing age at starting smoking (OR = 2.4 for males and 4.5 for females who started at age <15 versus >/=20 years). The level of education did not modify the relationship in males, whereas the association with age at starting was only apparent for more educated women. CONCLUSIONS: This study confirms that age at starting smoking is inversely and strongly associated to the number of cigarettes smoked per day. Thus, actions aimed at the prevention or delay of smoking onset among adolescents would have an important beneficial effect.     

Demographics and cigarette smoking among women

BACKGROUND. A population-based sample of 893 white women ages 25 to 59 years from five San Francisco, California, Bay Area counties were queried about their demographic characteristics, height, reported weight at age 25, cigarette smoking history, and oral contraceptive and sunscreen use. METHODS. Multiple logistic regression techniques were used to analyze the data. Forty-three percent of the women in the sample had never smoked more than 100 cigarettes, while 27% were current and 30% were former smokers. Separated or divorced women were more likely to have ever smoked. RESULTS. Women who were less educated, single, separated, or divorced or had smoked between 10 and 30 cigarettes per day were less likely to quit smoking. Women with less education and a longer history of smoking smoked more cigarettes per day. Women who had never smoked were more likely to use sunscreen and to report their weight as slightly less at age 25 than were smokers.     

"Tar" and nicotine content of cigarette smoke in relation to death rates.

Over 1,000,000 men and women who enrolled in an epidemiological study in 1959–1960 were (with few exceptions) traced for 12 years. They all answered questionnaires on cigarette smoking and various other factors at time of enrollment; and survivors answered repeat questionnaires on three later occasions. In this analysis, cigarette smokers were classified by the amount of tar and nicotine delivered by the brand they usually smoked at the start of each of two 6-year periods. Among subjects who smoked the same number of cigarettes a day, total death rates, death rates from coronary heart disease, and death rates from lung cancer were somewhat lower for those who smoked “low” tar-nicotine cigarettes than for those who smoked “high” tar-nicotine cigarettes. The death rates of subjects who smoked “low” tar-nicotine cigarettes were far higher than the death rates of subjects who never smoked regularly.