Psychosocial risk factors for coronary heart disease, their importance compared with other risk factors and gender differences in sensitivity

BACKGROUND: Few studies have focused on risk factors in women's lives concerning psychosocial factors and coronary heart disease (CHD). The present study is one of a series in which a wide range of psychosocial factors will be analysed with a focus on women. Women and men have been compared with respect to sensitivity to psychosocial risk factors regarding CHD. The importance of psychosocial risk factors for women, compared with biomedical risk factors has also been studied. METHODS: A questionnaire (The Stress Profile) was answered by 538 rehabilitation participants (97 women, 441 men) and a reference group (5308 women, 5177 men), aged 40-65 years. Psychosocial factors were investigated using means and b-coefficients. Comparisons between psychosocial and biomedical risk factors were made, with respect to the product of the beta-coefficient and the standard deviation for each compared risk factor. RESULTS: Significant differences appeared concerning five areas: work content, workload and control, physical stress reactions, emotional stress reactions and burnout. All showed that the relative sensitivity was larger for women than for men. Predictive psychosocial risk factors for women with respect to CHD were physical stress reactions, emotional stress reactions, burnout, family relationships and daily hassles/satisfactions, and they were on approximately the same level as biomedical risk factors. CONCLUSIONS: Women appear to be more sensitive than men with respect to psychosocial risk factors for CHD, and the predictive ability of psychosocial risk factors shows great importance. Actions against unhealthy psychosocial conditions are recommended. Both presumptive CHD patients and others might benefit from preventive actions, and since women are more sensitive they will probably gain more than men.     

Footprints of atherosclerotic coronary heart disease in children.

Formerly viewed as a bland lipid storage disease mainly affecting adults, atherosclerosis is nowadays recognized to be a chronic inflammatory disease that begins much earlier, probably already during fetal life. There has inevitably been reorientation from the traditional risk factor cholesterol to a broad category of factors, including those triggering chronic inflammation, such as infections. In addition, major advances in the field of vascular biology have led to a reassessment of our perception and understanding of the pathogenesis of atherosclerosis. A key role in this process is now attributed to vascular endothelium.     

Women and coronary heart disease risk factors

The prevalence of cardiovascular risk factors among women is high and cardiovascular risk factors often occur in clusters. Strong relationships between exposure to cigarette smoke, physical inactivity, hypertension, and abnormal levels of lipoproteins and homocysteine and subsequent coronary heart disease (CHD) in women are evident from many studies, while the impact of menopause, psychosocial factors, and inflammatory markers is less clear and requires further study. Observational studies document that smoking cessation reduces CHD risk among persons with and without existing CHD, and that moderate levels of physical activity are associated with lower CHD risk. Clinical trials over the last decade have convincingly shown that treatment of hypertension and dyslipidemia reduces CHD risk in both genders, but many women (and men) with hypertension and dyslipidemia remain either untreated or under-treated.     

Cholesterol and coronary heart disease. The importance of patient-specific attributable risk

The value of treating hypercholesterolemia remains controversial despite extensive investigation, in part because of the research orientation of much of the relevant literature. Most published studies report relative measures of risks such as the risk ratio. However, clinicians are concerned with the magnitude of risk, or attributable risk, the difference in risk in those with highest and lowest serum cholesterol levels. Since maximum risk modification is rarely achieved, the attributable risk often overstates the potential benefit of risk factor reduction. A variant of the attributable risk, the practical attributable risk, gives a more realistic estimate of potential benefit. Since clinicians treat individuals and not populations, these measures of risk are most useful if reported for subgroups of patients (eg, men and women, as well as those of varying age). To illustrate these concepts, we review the literature on hypercholesterolemia, report the risk ratio, attributable risk, and practical attributable risk for important patient populations, and discuss the implications for clinical practice.     

冠心病新危险因素研究的进展

冠心病的已知传统危险因素已经不能完全解释其发病原因,而一些新的危险因素如载脂蛋白B、新喋呤等血液相关危险因素,雌激素、睾酮等性激素相关危险因素,抑郁症、D-型人格等身心疾病相关危险因素,对冠心病发病的影响,已经引起人们广泛的关注.本文对这些新危险因素逐一进行综述.     

冠心病新的危险因素

冠心病是目前全球范围最常见的心血管疾病 ,它的发生是由外界环境因素和内在的多基因调控异常共同作用的结果。已报道的冠心病危险因素有 2 0 0多种 ,包括我们已经熟悉的危险因素和一些新的危险因素。本文就冠心病的一些新的危险因素做一简述     

冠状动脉狭窄程度与冠心病危险因素的相关性分析

目的探讨冠状动脉狭窄程度与冠心病危险因素的相关性。方法连续性收集我科行冠状动脉造影的患者121例,根据造影结果,将患者分为冠心病组89例与对照组32例。收集2组患者临床、实验室和影像学资料,采用单因素和多因素logistic回归模型进行分析。结果冠心病组男性、糖尿病、吸烟比例和LDL-C水平均高于对照组,HDL-C水平低于对照组(P<0.05);多因素logistic回归分析示,糖尿病(OR=3.769,P=0.042)、LDL-C水平(OR=1.873,P=0.021)是冠心病的独立危险因素。中、重度冠状动脉狭窄患者吸烟比例均高于轻度狭窄者,中度狭窄患者男性比例、年龄与尿酸水平和重度狭窄患者高血压、糖尿病比例均高于轻度狭窄者,差异均有统计学意义(P<0.05);logistic回归分析示,年龄(OR=1.094,P=0.001)、高血压(OR=3.340,P=0.003)、糖尿病(OR=3.877,P=0.003)和吸烟(OR=4.536,P=0.003)与冠状动脉狭窄程度相关。结论冠心病的危险因素与冠状动脉狭窄程度存在显著相关性,其中糖尿病是两者共同的重要危险因素。     

Cannabinoids and atherosclerotic coronary heart disease

Marijuana is the most abused recreational drug in the United States. Cannabinoids, the active ingredients of marijuana, affect multiple organ systems in the human body. The pharmacologic effects of marijuana, based on stimulation of cannabinoid receptors CB1 and CB2, which are widely distributed in the cardiovascular system, have been well described. Activation of these receptors modulates the function of various cellular elements of the vessel wall, and may contribute to the pathogenesis of atherosclerosis. Clinically, there are reports linking marijuana smoking to the precipitation of angina and acute coronary syndromes. Recently, large published clinical trials with CB1 antagonist rimonabant did not show any significant benefit of this agent in preventing progression of atherosclerosis. In light of these findings and emerging data on multiple pathways linking cannabinoids to atherosclerosis, we discuss the literature on the role of cannabinoids in the pathophysiology of atherosclerosis. We also propose a marijuana paradox, which implies that inhalation of marijuana may be linked to precipitation of acute coronary syndromes, but modulation of the endocannabinoid system by a noninhalation route may have a salutary effect on the development of atherosclerosis.     

Toll样受体与冠心病

冠心病是一种慢性炎症性免疫性疾病,冠心病的各种危险因素通过对Toll样受体家族基因和其下游炎症网络的调控,参与冠心病的炎症和免疫反应。炎症和免疫反应损伤血管,引起脂质浸润,平滑肌细胞增殖,导致斑块形成,炎症免疫反应又可以促进斑块的发展。Toll样受体介导冠状动脉粥样斑块的发生、进展、斑块不稳定乃至破裂等。干预Toll样受体家族,可能是冠状动脉粥样硬化性心脏病防治的新靶点。