他汀类药物对冠状动脉粥样硬化性心脏病患者脂蛋白a的作用

目的探讨观察不同人群脂蛋白a[1ipoproteina,Lp（a）]的水平及他汀类药物对其的干预效果。方法符合高血脂诊断标准的42例冠状动脉粥样硬化性心脏病（coronary heart disease,CHD）患者（高血脂合并CHD组）,36例CHD合并2型糖尿病（type 2 diabetes mellitus,2TD）患者（高血脂合并CHD＋2TD组）,39例非CHD非2TD患者（对照组）接受他汀类药物治疗8周,于治疗前后测定Lp（a）及低密度脂蛋白浓度,并进行数据统计。结果高血脂合并CHD组及高血脂合并CHD＋2TD组的血清Lp（a）浓度均显著高于对照组,差异有统计学意义［（37．1±11．6）mmol／Lvs．（26．6±4．2）mmol／L,P〈0．05;（39．4±10．7）mmol／Lvs．（26．6±4．2）mmol／L,P〈0．05];而高血脂合并CHD组与高血脂合并CHD＋2TD组比较,差异无统计学意义（p〉0．05）。他汀类药物治疗后3组患者的血清Lp（a）浓度均较治疗前有显著下降,高血脂合并CHD＋2TD组下降最明显,差异均有统计学意义[（28．1±7．3）mmol／Lvs．（37．1±11．6）mmol／L,P〈0．05;（26．1±6．8）mmol／Lvs．（39．4±10．7）mmol／L,P〈0．05;（26．6±4．2）mmol／Lvs（21．2±6．3）mmol／L,P〈O．05]。结论CHD患者的血清Lp（a）浓度高于非CHD患者,他汀类药物可显著降低血清Lp（a）的浓度,在合并2TD的CHD患者中降低更明显。     

吸烟致冠状动脉粥样硬化性心脏病机制研究进展

吸烟是促进心血管疾病发生、发展的重要危险因素。在全球,烟草相关疾病每年约引起500万人死亡,其中超过1／3死于心血管疾病。冠状动脉粥样硬化性心脏病（简称冠心病）是与吸烟关系最为密切的心血管疾病之一,吸烟者冠心病发生率可增加2～3倍[2]。研究吸烟与冠心病的关系及致病机制有助于禁烟、戒烟及对心血管疾病的防治。     

他汀类药物治疗冠状动脉粥样硬化性心脏病的研究进展

随着生活水平的提高和饮食结构的改变,动脉粥样硬化性疾病的发病率迅速上升,病变主要累及主动脉、冠状动脉、脑动脉等大动脉,患者多合并脂质代谢紊乱,主要表现为：总胆固醇升高、低密度脂蛋白胆固醇（LDL-C）升高、高密度脂蛋白胆固醇（HDL-C）降低、甘油三酯升高等。     

OSAHS与冠状动脉粥样硬化性心脏病的研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)由于睡眠时气道塌陷而引起反复缺氧、白天嗜睡等症状,且与高血压、心律失常、冠状动脉粥样硬化性心脏病(CHD)和心力衰竭等心血管疾病关系密切。OSAHS在促进心血管疾病发生、发展过程中起到重要作用,目前OSAHS作为CHD的重要危险因素逐渐受到重视。本文就OSAHS引起CHD的发病机制,OSAHS与冠状动脉狭窄程度之间的联系,OSAHS合并CHD的不良预后及持续气道正压通气对该类患者预后的影响作一综述。     

代谢综合征与冠状动脉粥样硬化性心脏病

代谢综合征(Metabolic syndrome,MS)是一种涉及多种心血管疾病危险因子的聚集状态,据初步研究资料显示我国MS患病率已高达13．25％,随着年龄的增加而增高,55岁以上人群患病率高达20．26％。MS使发生糖尿病和冠心病的危险性明显上升。本文着重对MS与冠状动脉硬化性心脏病(CAD)的相关性作一综述。     

他汀类药物防治阿尔茨海默病的作用机制

阿尔茨海默病(AD)是以进行性认知功能障碍和记忆力损害为特征的神经退行性疾病，主要的神经病理变化有老年斑(SP)，神经原纤维缠结(NFT)，脑萎缩和选择性神经元丢失。由于对其病因及发病机制尚未完全明确，目前缺乏有效的治疗药物。流行病学的研究表明当患者血清胆固醇增高时，AD的发生率随之增高。研究发现他汀类药物在降低血清胆固醇的同时，能降低痴呆发病率，改善认知功能，延缓病程进展。     

他汀类药物强化调脂改善冠状动脉粥样硬化的研究进展

近20年来医学界对他汀类药物的研究进展日益深化,从最初单纯用于降脂到现在越来越多的证据表明他汀类药物具有多效性。随着大量临床试验的研究,越来越多的循证医学证据表明他汀类药物强化调脂策略可以显著减少冠心病事件并降低病死率,而强化调脂带来的安全性问题也备受关注。     

他汀类药物在急性冠状动脉综合征的应用

他汀类药物用于冠心病一级预防 (WOSCOPS)和二级预防 (如 4S ,CARE ,LIPID等 )大规模临床试验显示其可明显降低冠心病事件的发生率 ,即使在平均胆固醇水平的冠心病患者也可收到显著裨益。临床研究结果显示 ,他汀类药物治疗时低密度脂蛋白胆固醇 (LDL C)基线水平及治疗后水平如何 ,对心脑血管事件的发生只产生很少影响。他汀类药物的非降脂作用如稳定斑块 ,改善内皮功能 ,减少炎症反应和抑制血栓形成等作用 ,显然也与心脑血管事件的降低相联系。急性冠状动脉综合征 (ACS)的病理生理基础是冠状动脉粥样硬化斑块破裂和血栓形成 ,各种…     

冠状动脉粥样硬化性心脏病高危患者的强化降脂与瑞舒伐他汀

瑞舒伐他汀具有独特的临床药理特点,其降脂疗效、安全性、成本-效益比均优于其他他汀类药物,具有降脂疗效以外的＂多效性＂,是冠状动脉粥样硬化性心脏病高危患者强化降脂、减少心血管事件的最佳选择,呼吁瑞舒伐他汀能早日在基层医疗单位普及。     

抑郁与冠状动脉粥样硬化性心脏病的研究进展

抑郁与冠状动脉粥样硬化性心脏病是危害人类健康的两大杀手,两者关系密切,两者相互影响,使患者生活质量下降,并增加患者的心血管事件和病死率,然而具体发病机制尚未明了,可能与行为方式、基因、免疫调节紊乱、凝血机制紊乱、内皮功能受损、多不饱和脂肪酸缺乏、自主神经系统紊乱等机制有关。     

Aspirin use for the primary prevention of coronary heart disease in older adults

Purpose

Aspirin for the primary prevention of coronary heart disease (has a more favorable risk/benefit profile among adults with high coronary heart disease risk than among low-risk adults, but there is little information on the current patterns of aspirin use for primary prevention. We determined the prevalence of aspirin use in relation to coronary heart disease risk and changes over time.

Subjects and methods

We measured regular aspirin use in 2163 black and white older adults without cardiovascular disease in a population-based cohort from 1997 to 1998 and 2002 to 2003. We determined the 10-year coronary heart disease risk by using the Framingham risk score.

Results

In 1997-1998, 17% of the cohort were regular aspirin users. Aspirin use increased with coronary heart disease risk from 13% in persons with a 10-year risk less than 6% (low risk) to 23% in those with a 10-year risk greater than 20% (highest risk) (P for trend < .001). Blacks were less likely to use aspirin (13%) than whites (20%). In multivariate analysis, black race was still associated with lower aspirin use (odds ratio 0.66, 95% confidence interval 0.49-0.89). In 1997-1998 and 2002 to 2003, aspirin use increased from 17% to 32% among those still free of coronary heart disease (P < .001), and the association with coronary heart disease risk continued (P for trend < .001). Despite their high coronary heart disease risk, diabetic persons were not more likely to use aspirin than nondiabetic persons, even in 2002 and 2003 (odds ratio 0.89, 95% confidence interval 0.56-1.40).

Conclusion

Regular use of aspirin by older adults with no history of cardiovascular disease has increased in recent years. Individuals at higher coronary heart disease risk are more likely to take aspirin, but there is room for considerable improvement in targeting those at high risk, particularly diabetic persons and blacks.     

Statins for primary cardiovascular prevention in the elderly

The elderly population is increasing worldwide, with subjects > 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older > 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for their primary cardiovascular disease, with the associated risks and benefits of treatment.     

Nonlipid primary and secondary prevention strategies for coronary heart disease

Widespread application of proven primary and secondary preventive strategies for coronary heart disease would result in substantial savings of life and health care dollars. Proven strategies (excluding lipid therapy) include quitting smoking, treating hypertension, physical activity, aspirin therapy, and appropriate use of anticoagulants, beta blockers, and angiotensin-converting enzyme inhibitors in survivors of myocardial infarction. Estrogen replacement therapy is currently under clinical investigation. Avoidance of obesity and tight control of diabetes are prudent interventions as yet unproved by clinical trials. Unfortunately, preventive strategies are frequently underutilized. The greatest challenge for preventive cardiology is to put into practice what we already know to prevent the development and progression of atherosclerosis.     

150例冠心病患者二级预防的效果

目的:调查分析本院冠心病人二级预防的效果。方法:对明确诊断为冠心病,并曾住院治疗的150例患者,进行门诊随访,以问卷的方式,对其冠心病二级预防的情况进行调查。所有患者均进行病史询问,汇总分析了解戒烟、控制血压、血糖,调脂治疗等的效果。结果:150例患者与住院前比较,住院后门诊随访的戒烟率(38%:58%),血压达标率(26.7%:68.7%)、血脂达标率(20.7%:54.0%)、血糖达标率(51.3%:72.7%)、运动达标率(7.3%:22.7%),以及使用阿司匹林、氯吡格雷、他汀类药物、β受体阻滞剂、血管紧张素转换酶抑制剂类有显著增加(P均0.05),说明二级预防的效果及依从性均有显著提高。结论:冠心病二级预防的效果甚好,应推广,普及。     

Revisiting secondary prevention in coronary heart disease

Secondary prevention in coronary heart disease is the prevention of occurrence of recurrent coronary events after clinical diagnosis. High level of adherence to secondary prevention interventions, especially aggressive lifestyle changes and pharmacotherapy can lead to significant decline in recurrent coronary events. Both international and Indian studies have reported low adherence to such therapies. Evidence-based useful interventions include regular physical activity, yoga, intake of healthy diet, smoking and tobacco use cessation and weight management. Pharmacotherapeutic interventions useful are anti-platelet therapy, target oriented lipid lowering therapy with statins, beta blockers and angiotensin converting enzyme inhibitors in patients with impaired left ventricular function. Hypertension and diabetes management with control to targets is important. Novel strategies include use of anticoagulants, anti-inflammatory drugs, and triglyceride lowering for residual risk. Physician and patient level interventions using multifaceted educational, socioeconomic and technological innovations are important to promote life-long adherence to these strategies.     

抑郁症与冠心病

抑郁症可增加冠心病的患病危险及死亡率 ,但迄今为止还没有一种理论可明确阐述这种机制。本文综述抑郁症增加冠心病的发病率及死亡率的可能机制 :下丘脑 -垂体 -肾上腺系统对自主神经功能的改变 ,包括心率 ( HR)增快、心率变异性 ( HRV)降低、压力感受器敏感性 ( BRS)降低 ;中枢神经系统对自主神经功能的改变 ;血小板聚集作用增强 ;炎症反应 ;免疫反应 ;抗抑郁药的心肌毒性及药物间相互作用 ;不良的生活习惯 ;对治疗的依从性差。尽管目前对此机制的研究已有了一些进展 ,但还需要更多和更深入的研究来进一步阐明抑郁症对冠心病的影响。     

瘦素与冠心病

瘦素是肥胖基因编码的一种蛋白质产物,主要由白色脂肪组织分泌,通过与其受体结合发挥抑制食欲、减少能量摄入、增加能量消耗的生物学作用。大量临床研究表明冠心病患者常存在高瘦素血症,表现为瘦素抵抗。本文就瘦素在冠心病发病中的作用机制作一综述。     

冠心病一级预防患者他汀用药依从性及影响因素分析

目的 研究冠心病一级预防患者他汀用药依从性的现状及影响因素.方法 采用回顾性方法,调查和分析冠心病一级预防患者他汀用药依从性情况及其影响因素.结果 150例患者中,他汀治疗患者用药依从性好的仅41例,占27.3％.患者自理能力、用药知识、用药时间、药品费用、对血脂异常的了解、药品不良反应和医患沟通等是影响患者用药依从性的主要因素.结论 他汀治疗患者用药依从性不理想,提高患者用药依从性对改善患者治疗效果有非常重要的意义.     

冠心病患者血浆同型半胱氨酸水平及其意义

目的：观察冠心病(CHD)患者血浆同型半胱氨酸(Hcy)水平的变化。方法：选择 CHD 患者78例,测定其血浆 Hcy,并与冠状动脉造影结果进行对照分析。此外选非冠心病患者29例测定血浆 Hcy 作为对照。结果：CHD 患者的血浆 Hcy 水平较非冠心病者的血浆 Hcy 水平明显升高[(14.56±6.15)μmol/L：(9.89±3.98)μmol/L,P＜ 0.01]。急性心肌梗塞(AMI)、不稳定型心绞痛(UAP)患者的血浆 Hcy 水平皆较稳定型心绞痛(SAP)患者的明显升高[(16.69±7.20)μmol/L、(14.70±5.21)μmol/L vs,(11.59±4.51)μmol/L,P 分别＜0.01、0.05],AMI 患者与 UAP 患者的血浆 Hcy 水平无差异(P＞0.05)。3支血管病变较1支、2支血管病变患者血浆 Hcy 明显升高 [(18.14±7.14)μmol/L vs．(11.14±4.99)μmol/L、(13.43±3.51)μmol/L,P 皆＜0.01]。2支血管病变与1支血管病变患血浆 Hcy 无明显差别(P＞0.05)。血浆 Hcy 水平与冠状功脉病变积分呈轻度正相关(r=0.375,P＜ 0.05)。结论：血浆 Hcy 水平越高,提示其冠状动脉病变越重、病变范围越广。     

2型糖尿病继发冠心病的机制及预防

2型糖尿病（type 2 diabetes mellitus,T2DM）是一种以血糖升高为基本特征的代谢紊乱性疾病,其导致的血管并发症显著增加了糖尿病患者的致残致死率,严重降低了患者的生活质量.国际糖尿病联盟发布最新数据显示,2011年全世界糖尿病患病人数已达3.66亿,较2010年的2.85亿增加近30%[1].中国20岁以上的成年人糖尿病患病率为9.7%,已跃居全球糖尿病第一大国[2].T2DM患者首要致死原因是心血管并发症,调查显示死于冠心病的T2DM患者高达65%～80%.鉴于T2DM继发冠心病的高危害,本文就T2DM继发冠心病的机制及预防进行简单论述.