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Sina?Kianoush Mahmoud?Al?Rifai Miguel?Cainzos-Achirica Priya?Umapathi Garth?Graham Roger?S.?Blumenthal Khurram?Nasir
Estimating cardiovascular disease (CVD) risk is necessary for determining the potential net benefit of primary prevention pharmacotherapy. Risk estimation relying exclusively on traditional CVD risk factors may misclassify risk, resulting in both undertreatment and overtreatment. Coronary artery calcium (CAC) scoring personalizes risk prediction through direct visualization of calcified coronary atherosclerotic plaques and provides improved accuracy for coronary heart disease (CHD) or CVD risk estimation. In this review, we discuss the most recent studies on CAC, which unlike historical studies, focus sharply on clinical application. We describe the MESA CHD risk calculator, a recently developed CAC-based 10-year CHD risk estimator, which can help guide preventive therapy allocation by better identifying both high- and low-risk individuals. In closing, we discuss calcium density, regional distribution of CAC, and extra-coronary calcification, which represent the future of CAC and CVD risk assessment research and may lead to further improvements in risk prediction. 相似文献
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Tailoring therapeutic targets to patients’ risk is a fundamental principle of many coronary heart disease (CHD) treatment
guidelines. Although the National Cholesterol Education Program’s guidelines do not include chronic kidney disease (CKD) as
a CHD risk equivalent, the National Kidney Foundation and American Heart Association have recommended its inclusion in the
highest-risk grouping for the prevention and treatment of cardiovascular disease. In three population-based studies, the risk
of cardiovascular disease was higher among participants with established CHD when compared to their counterparts with CKD.
Although there are other reasons for including CKD as a CHD risk equivalent in treatment guidelines (eg, higher case fatality
rates from CHD and stroke), the inclusion of CKD as a CHD risk equivalent has treatment implications for a large number of
US adults. Randomized trials assessing the benefits and drawbacks of aggressive CHD risk reduction among patients with CKD
are needed. 相似文献
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目的探讨中、老年病人中各血压参数与冠心病(CHD)的关系.方法对行冠状动脉造影的病人记录血压、性别、糖尿病等危险因素分组进行Logistic回归、逐步回归分析,比较各OR值.结果<60岁病人组,舒张压(DBP)的OR值最大(1.20;95%CI1.14~1.28),DBP每增加5 mmHg,CHD发病率增加率增加20%.>60岁病人组,脉压(PP)的OR值最大(1.11;95%CI1.07~1.14),PP每增加5 mmHg,冠心病发病率增加率增加11%.逐步回归分析表明,DBP和PP分别是<60岁病人组和>60岁病人组CHD发病的重要影响因子.结论中青年病人中,DBP高者CHD发病率较高,老年病人中,PP高者CHD发病率较高. 相似文献
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中老年病人血压参数与冠心病的关系 总被引:1,自引:0,他引:1
目的 探讨中、老年病人中各血压参数与冠心病 (CHD)的关系。方法 对行冠状动脉造影的病人记录血压、性别、糖尿病等危险因素分组进行Logistic回归、逐步回归分析 ,比较各OR值。结果 <60岁病人组 ,舒张压 (DBP)的OR值最大 ( 1 2 0 ;95 %CI:1 14~ 1 2 8) ,DBP每增加 5mmHg ,CHD发病率增加率增加 2 0 %。 >60岁病人组 ,脉压 (PP)的OR值最大 ( 1 11;95 %CI :1 0 7~ 1 14 ) ,PP每增加 5mmHg ,冠心病发病率增加率增加 11%。逐步回归分析表明 ,DBP和PP分别是 <60岁病人组和 >60岁病人组CHD发病的重要影响因子。结论 中青年病人中 ,DBP高者CHD发病率较高 ,老年病人中 ,PP高者CHD发病率较高 相似文献
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Mercedes R. Carnethon Mary L. Biggs Joshua Barzilay Lewis H. Kuller Dariush Mozaffarian Kenneth Mukamal Nicholas L. Smith David Siscovick 《The American journal of medicine》2010,123(6):378
Background
Type 2 diabetes has been described as a coronary heart disease (CHD) “risk equivalent.” We tested whether cardiovascular and all-cause mortality rates were similar between participants with prevalent CHD vs diabetes in an older adult population in whom both glucose disorders and preexisting atherosclerosis are common.Methods
The Cardiovascular Health Study is a longitudinal study of men and women (n = 5784) aged ≥65 years at baseline who were followed from baseline (1989/1992-1993) through 2005 for mortality. Diabetes was defined by fasting plasma glucose ≥7.0 mmol/L or use of diabetes control medications. Prevalent CHD was determined by confirmed history of myocardial infarction, angina, or coronary revascularization.Results
Following multivariable adjustment for other cardiovascular disease risk factors and subclinical atherosclerosis, CHD mortality risk was similar between participants with CHD alone vs diabetes alone (hazard ratio [HR] 1.04, 95% confidence interval [CI], 0.83-1.30). The proportion of mortality attributable to prevalent diabetes (population-attributable risk percent = 8.4%) and prevalent CHD (6.7%) was similar in women, but the proportion of mortality attributable to CHD (16.5%) as compared with diabetes (6.4%) was markedly higher in men. Patterns were similar for cardiovascular disease mortality. By contrast, the adjusted relative hazard of total mortality was lower among participants with CHD alone (HR 0.85, 95% CI, 0.75-0.96) as compared with those who had diabetes alone.Conclusions
Among older adults, diabetes alone confers a risk for cardiovascular mortality similar to that from established clinical CHD. The public health burden of both diabetes and CHD is substantial, particularly among women. 相似文献10.
Jamal S. Rana Howard H. Moffet Marc Jaffe Andrew J. Karter 《Journal of general internal medicine》2016,31(4):387-393
Background
For more than a decade, the presence of diabetes has been considered a coronary heart disease (CHD) “risk equivalent”.Objective
The objective of this study was to revisit the concept of risk equivalence by comparing the risk of subsequent CHD events among individuals with or without history of diabetes or CHD in a large contemporary real-world cohort over a period of 10 years (2002 to 2011).Design
Population-based prospective cohort analysis.Participants
We studied a cohort of 1,586,061 adult members (ages 30–90 years) of Kaiser Permanente Northern California, an integrated health care delivery system.Main Measurements
We calculated hazard ratios (HRs) from Cox proportional hazard models for CHD among four fixed cohorts, defined by prevalent (baseline) risk group: no history of diabetes or CHD (None), prior CHD alone (CHD), diabetes alone (DM), and diabetes and prior CHD (DM + CHD).Key Results
We observed 80,012 new CHD events over the follow-up period (~10,980,800 person-years). After multivariable adjustment, the HRs (reference: None) for new CHD events were as follows: CHD alone, 2.8 (95 % CI, 2.7–2.85); DM alone 1.7 (95 % CI, 1.66–1.74); DM + CHD, 3.9 (95 % CI, 3.8–4.0). Individuals with diabetes alone had significantly lower risk of CHD across all age and sex strata compared to those with CHD alone (12.2 versus 22.5 per 1000 person-years). The risk of future CHD for patients with a history of either DM or CHD was similar only among those with diabetes of long duration (≥10 years).Conclusions
Not all individuals with diabetes should be unconditionally assumed to be a risk equivalent of those with prior CHD.KEY WORDS: coronary heart disease, diabetes, epidemiology 相似文献11.
《The American journal of the medical sciences》2014,347(2):151-158
Coronary heart disease (CHD) is one of the leading causes of death in the United States. Traditional risk factors such as family history, hypertension, hypercholesterolemia, diabetes mellitus and smoking cannot account for the entire risk for incident coronary events. Several other potential risk factors have been identified in an effort to improve risk assessment for CHD. This article reviews the current evidence on new and emerging risk factors for CHD and their current utility in screening, specifically focusing on coronary artery calcium score, C-reactive protein, lipoprotein (a), carotid intima-media thickness, homocysteine, lipoprotein-associated phospholipase A2, as well as high-density lipoprotein functionality. 相似文献
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Coronary heart disease (CHD) is the leading cause of death in the United States. The high content of polyphenols and flavonoids
present in cocoa has been reported to play an important protective role in the development of CHD. Although studies have demonstrated
beneficial effects of chocolate on endothelial function, blood pressure, serum lipids, insulin resistance, and platelet function,
it is unclear whether chocolate consumption influences the risk of CHD. This article reviews current evidence on the effects
of cocoa/chocolate on clinical and subclinical CHD, CHD risk factors, and potential biologic mechanisms. It also discusses
major limitations of currently available data and future directions in the field. 相似文献
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单核细胞源性微囊泡是单核细胞应激后脱落的微小囊泡状颗粒,能够引起内皮细胞功能异常,具有促炎活性和促凝血活性,在冠心病的病理过程中发挥着重要作用。同时,冠心病的一些危险因素能够促进单核细胞源性微囊泡的产生。因此,单核细胞源性微囊泡有潜力成为新的冠心病诊断依据和治疗靶点。文章就单核细胞源性微囊泡与冠心病及其危险因素关系的最新研究进展进行综述。 相似文献
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Heart disease remains the leading cause of death in the USA. Overall, heart disease accounts for about 1 in 4 deaths with coronary heart disease (CHD) being responsible for over 370,000 deaths per year. It has frequently and repeatedly been shown that some minority groups in the USA have higher rates of traditional CHD risk factors, different rates of treatment with revascularization procedures, and excess morbidity and mortality from CHD when compared to the non-Hispanic white population. Numerous investigations have been made into the causes of these disparities. This review aims to highlight the recent literature which examines CHD in ethnic minorities and future directions in research and care. 相似文献
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Jiaqi Li Hironori Imano Kazumasa Yamagishi Mari Tanaka Renzhe Cui Isao Muraki Mitsumasa Umesawa Mina Hayama-Terada Tetsuya Ohira Masahiko Kiyama Takeo Okada Tomoko Sankai Takeshi Tanigawa Akihiko Kitamura Hiroyasu Iso 《Journal of atherosclerosis and thrombosis》2022,29(4):527
Aim: This study aimed to investigate the associations of leukocyte count with the risks of stroke and coronary heart disease among the general Japanese population. Methods: A total of 5,242 residents aged 40–69 years living in two Japanese communities underwent leukocyte count measurements between 1991 and 2000, and the data were updated using 5- or 10-year follow-ups or both. Participants who had histories of stroke, coronary heart disease, or high values of leukocyte count (>130×10 2 cells/mm 3 ) were excluded. Hazard ratios with 95% confidence intervals (CIs) were calculated according to quartiles of cumulative average leukocyte count. Results: During follow-up of 21 years, 327 stroke and 130 coronary heart disease cases were determined. After adjustments for age, sex, community, and updated cardiovascular risk factors, the multivariable hazard ratio (95% CI) for the highest versus lowest quartile of leukocyte count was 1.50 (1.08–2.08) for ischemic stroke, 1.59 (1.00–2.51) for lacunar infarction, 1.42 (0.90–2.26) for non-lacunar infarction, 2.17 (1.33–3.55) for coronary heart disease, and 1.40 (1.11–1.76) for total cardiovascular disease. In smoking status-stratified analyses, the corresponding multivariable hazard ratio (95% CI) was 2.45 (1.11–5.38) for ischemic stroke, 2.73 (1.37–5.44) for coronary heart disease in current smokers, 2.42 (1.07–5.46), 1.55 (0.58–4.15) in former smokers, and 1.17 (0.75–1.82), 1.78 (0.83–3.82) in never smokers. Conclusion: Leukocyte count was positively associated with the risks of ischemic stroke and coronary heart disease among the general Japanese population, especially in current smokers. 相似文献
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Humphrey LL Fu R Buckley DI Freeman M Helfand M 《Journal of general internal medicine》2008,23(12):2079-2086
BACKGROUND Periodontal disease is common among adults in the US and is a potential source of chronic inflammation. Recent data have suggested
an important role for chronic inflammation in the development of coronary heart disease (CHD).
OBJECTIVE To aid the United States Preventive Services Task Force (USPSTF) in evaluating whether periodontal disease is an independent
novel risk factor for incident CHD.
METHODS Studies were identified by searching Medline (1966 through March 2008) and reviewing prior systematic reviews, reference lists,
and consulting experts. Prospective cohort studies that assessed periodontal disease, Framingham risk factors, and coronary
heart disease incidence in the general adult population without known CHD were reviewed and quality rated using criteria developed
by the USPSTF. Meta-analysis of good and fair quality studies was conducted to determine summary estimates of the risk of
CHD events associated with various categories of periodontal disease.
RESULTS We identified seven articles of good or fair quality from seven cohorts. Several studies found periodontal disease to be independently
associated with increased risk of CHD. Summary relative risk estimates for different categories of periodontal disease (including
periodontitis, tooth loss, gingivitis, and bone loss) ranged from 1.24 (95% CI 1.01–1.51) to 1.34 (95% CI 1.10–1.63). Risk
estimates were similar in subgroup analyses by gender, outcome, study quality, and method of periodontal disease assessment.
CONCLUSION Periodontal disease is a risk factor or marker for CHD that is independent of traditional CHD risk factors, including socioeconomic
status. Further research in this important area of public health is warranted. 相似文献
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《Trends in Endocrinology and Metabolism》1999,10(8):320-325
Selective estrogen receptor modulators (SERMs) represent a growing class of compounds that act as either estrogen receptor agonists or antagonists in a tissue-selective manner. Preclinical and clinical studies have shown that estrogen has favorable effects on serum lipids and might affect processes at the blood vessel wall to inhibit atherosclerosis. SERMs with the appropriate selectivity profile offer the opportunity to dissociate these favorable cardiovascular effects of estrogen from its unfavorable stimulatory effects on the breast and uterus. This article reviews the data from both animal and human studies that document the cardiovascular effects of SERMs and discusses the clinical implications of these results. 相似文献