运动训练对血脂谱的影响

临床常见的血脂异常主要包括血清总胆固醇、低密度脂蛋白胆固醇及甘油三酯升高，和高密度脂蛋白胆固醇（HDL-C）降低。血脂异常是冠心病的重要危险因素，发现并干预血脂异常是降低冠心病发病率和死亡率的有效手段。许多研究证实，有氧运动和抗阻训练有助于调节血脂水平，改善血脂谱，从而降低冠心病发病率和死亡率。运动训练还可以提高HDL-C，促进胆固醇逆向转运。有关运动训练在血脂调节中作用的研究逐渐增多。本文对不同类型运动训练对血脂谱影响的研究进行回顾总结。     

我国人群血脂的流行病学

血脂水平与动脉粥样硬化的形成密切相关。血清总胆固醇增高,特别是低密度脂蛋白胆固醇增高,是冠心病的重要危险因素。而甘油三酯增高、高密度脂蛋白降低也可增加冠心病的危险性。近2 0年来,我国人群血脂水平和变化趋势得到国内外学者的关注。2 0世纪80年代以后国内开展的大规模心血管病流行病学研究,包括长达2 0年的中美心血管病及心肺疾病流行病学合作研究(中美合作研究,1981～2 0 0 1) ,中国多省市心血管病人群监测研究(中国-MONICA研究,1984～1993) ,以及得到“六五”至“十五”心血管病流行病学专题的国家科技攻关项目,均将血脂水平…     

柳州市7660例成人血脂状况调查

评价柳州市人群中血脂状况,为人群干预作基线调查。整群抽取柳州市常住居民7660例,男性389b4例,女性3766例,年龄39.5±11.0岁,进行血脂、身高、体重、腰围及臀围等指标检测和统计分析。结果发现,男性和女性总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平均有随年龄增大而增高的趋势。全组高总胆固醇、高甘油三酯、高低密度脂蛋白胆固醇和低高密度脂蛋白胆固醇检出率分别为20.76%、26.37%、17.75%及15.59%。男性高总胆固醇、高甘油三酯及高低密度脂蛋白胆固醇的检出率分别是女性的1.64、2.86及1.52倍。血脂异常率有随年龄增大而增高的趋势。超重和肥胖显著增高血脂异常率。其中以反映腹部脂肪积聚的腰围对血脂的影响更为显著。结果表明,本组人群中血脂异常率较高,高甘油三酯是最常见的血脂异常类型,腰围增大是影响血脂代谢异常的重要因素。     

柳州市7660例成人血脂状况调查

评价柳州市人群中血脂状况,为人群干预作基线调查.整群抽取柳州市常住居民7 660例,男性3 894例,女性3 766例,年龄39.5±11.0岁,进行血脂、身高、体重、腰围及臀围等指标检测和统计分析.结果发现,男性和女性总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平均有随年龄增大而增高的趋势.全组高总胆固醇、高甘油三酯、高低密度脂蛋白胆固醇和低高密度脂蛋白胆固醇检出率分别为20.76%、26.37%、17.75%及15.59%.男性高总胆固醇、高甘油三酯及高低密度脂蛋白胆固醇的检出率分别是女性的1.64、2.86及1.52倍.血脂异常率有随年龄增大而增高的趋势.超重和肥胖显著增高血脂异常率.其中以反映腹部脂肪积聚的腰围对血脂的影响更为显著.结果表明,本组人群中血脂异常率较高,高甘油三酯是最常见的血脂异常类型,腰围增大是影响血脂代谢异常的重要因素.     

老年人血脂代谢异常

大量流行病学调查资料观察到血脂随年龄变化 ,血脂异常多见于老年人群 ,即使高龄老年人血脂异常仍然是冠心病 (CHD)的重要危险因素。　　一、主要血脂指标及其危险水平分类　　临床所重视的血脂异常主要是总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C)及甘油三酯 (TG)升高 ,高密度脂蛋白胆固醇 (HDL C)降低。由于起到动脉粥样硬化致病作用的是LDL C ,现在划分心血管病危险水平及制定降脂治疗目标时都主张用LDL C。　　美国国家胆固醇教育计划的防治指南于 1988年提出 ,2 0 0 1年公布了经过大量修改的第 3版 (ATPⅢ ) ,它是根据大量…     

防治缺血性心血管病，必须积极进行“调脂”治疗（上）

一、为什么必须重视防治血脂异常?近年来,以冠心病和脑梗塞为主的缺血性心血管病已成为我国居民的第一死因。研究表明这跟人群血脂水平上升速度密切相关,血脂异常是缺血性心脑血管病(冠心病和脑梗塞)的独立的主要危险因素。     

北京市社区居民血脂及冠心病主要危险因素异常及边缘异常的流行特征

目的 调查北京市社区居民血脂及冠心病危险因素异常及边缘异常的流行病学特征,探讨北京市防治冠心病的方向.方法 2007年6月至8月,分层整群随机抽样调查北京市社区居民10 054名,采取问卷调查、体格检查和生化检测的方法,进行主要冠心病危险因素及血脂异常的调查.结果 经年龄、性别标化后,北京社区居民高胆固醇血症、高低密度脂蛋白胆固醇血症、低高密度脂蛋白胆固醇血症和高甘油三酯血症的患病率分别是9.3%、2.56%、18.79%和16.84%,而处于胆固醇边缘升高的比例为23.96%.北京社区居民中血脂异常的患病率为31.23%,而处于血脂边缘异常的居民占23.30%.经年龄、性别标化后,71.17%的居民伴有冠心病主要危险因素,20.23%的居民伴有边缘异常的危险因素.高血压、糖尿病发病率分别为41.57%、11.08%,吸烟和肥胖的发生率分别是35.81%和22.89%.相对于理想状态,具有1项冠心病危险因素边缘异常人群患血脂异常的相对风险(OR)为1.668(95%CI:1.319～2.110);具有2项冠心病危险因素边缘异常人群患血脂异常的OR为2.537,(95%CI:1.989～3.235);具有≥3项冠心病危险因素边缘异常人群患血脂异常的OR为3.203,(95%CI:2.007～5.114).结论 北京社区居民血脂异常及冠心病主要危险因素的发生率较高,超过1/5的居民处于冠心病主要危险因素的边缘异常状态.具有边缘危险及冠心病主要危险的人群是今后北京市人群防治的重点.     

石龙机关工作人员血脂水平分类及分型的统计分析

目的 研究石龙职业人群血脂水平分类及分型特征。方法 根据近年1200例血脂调查资料(男女各600例，年龄20—98岁)，按我国“血脂异常防治建议”作血脂分类及分型研究。结果 本组人群中40岁以上者只有1／3总胆固醇(1℃)及甘油三酯(TG)都在合适水平，高1℃者超过50％。高1℃明显多于高TG，Ⅱa型高脂蛋白血症比Ⅳ型多2倍。男／女性中约有6％高密度脂蛋白胆固醇（HDL-C)降低；女性组达60％，男性中仅有45％HDL-C明显增高；高HDL-C多见于高TC者，而抵HDL-C多见于高TC者。结论 本调查结果示中老年人血脂异常者已达2／3，表明动脉粥样硬化性心血管病的风险明显增高，防治血脂异常应有利于冠心病预防。     

家族性高胆固醇血症

正家族性高胆固醇血症是早期冠心病发作的主要原因,需要更好地识别和治疗。近30年来,中国人群的血脂水平逐步升高,血脂异常患病率明显增加。中国成人血脂异常总体患病率高达40.4%。人群血清胆固醇水平的升高将导致2010年～2030年期间我国心血管病事件约增加920万。2012年全国调查结果显示,高胆固醇血症的患病率4.9%;     

血脂异常与冠心病的防治

血脂异常是指血液脂质代谢异常,包括血胆固醇、三酰甘油水平的增高与高密度脂蛋白胆固醇水平的降低。血液中的脂质参与体内的能量代谢,包括能量的产生和储存。胆固醇是细胞膜的主要成分,能稳定细胞膜的流动性,并且也是合成类固醇激素和胆酸的重要原料。血脂代谢异常却是心血管疾病的危险因素,容易引发动脉粥样硬化及冠心病。1血脂异常与冠心病的关系血浆总胆固醇是指各类脂蛋白所含胆固醇的总和,其中约65%是低密度脂蛋白胆固醇(LDL-C)。冠心病的病理基础是动脉粥样硬化斑块,而LDL-C对斑块的形成与进展起着关键的作用。当血管壁因各种原…     

几种用于评价高脂血症疗效的新型指标

高脂血症是冠心病、脑梗死等慢性心脑血管疾病的重要危险因素。预防和治疗血脂异常已经成为目前冠心病预防的重要方法之一。目前用于评价高脂血症疗效的指标多是总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白,以及体质量等。致动脉粥样硬化指数、瘦素、脂联素和粪便总胆汁酸是用于评价高脂血症疗效的新型指标,本文对这四个指标在评价高脂血症治疗疗效方面进行综述。     

Tooth loss is associated with an increased risk of hypertension in postmenopausal women

Tooth loss has been associated with an increased risk of vascular diseases such as coronary heart disease and cerebrovascular disease. Little is known whether hypertension is an important factor linking 2 phenomena in postmenopausal women. We compared an incidence of hypertension and traditional risk factors for vascular diseases between 2 age-matched groups: 67 postmenopausal women with missing teeth and 31 without missing teeth. In addition to blood pressure, serum concentration of total cholesterol, high- and low-density lipoprotein cholesterol and triglycerides, plasma angiotensin-converting enzyme activity, plasma angiotensin II concentration, plasma renin activity, and resting heart rate were measured as traditional risk factors for vascular diseases. Subjects without missing teeth had significantly lower diastolic blood pressure than did subjects with missing teeth (P=0.021). The former tended to have lower systolic blood pressure than did the latter (P=0.058). There were no significant differences in other variables between subjects with and without missing teeth. The odds ratio of having hypertension in subjects with missing teeth was 3.59 (95% confidence interval, 1.10 to 11.7) after adjustment of obesity, hypercholesterolemia, and hypertriglyceridemia. Our results suggest that hypertension may be an important factor linking tooth loss and an increased risk of vascular diseases in postmenopausal women.     

Plasma lipoprotein abnormalities in type 1 (insulin-dependent) diabetes mellitus

Lipoprotein abnormalities may well contribute to the increased risk of coronary heart disease, cerebrovascular disease and peripheral vascular disease observed in type 1 (insulin-dependent) diabetes mellitus. The spectrum of diabetes-associated changes in lipoprotein metabolism is discussed. The plasma levels of lipoprotein cholesterol and triglycerides are largely influenced by the degree of glycaemic control. With poor metabolic control, plasma cholesterol and triglycerides are frequently elevated. In contrast, in well-regulated patients without micro- and macrovascular complications lipid levels are generally normal or even favourable, although lipoprotein composition abnormalities can persist despite intensified insulin treatment. With the development of diabetic nephropathy the cardiovascular risk increases markedly and this complication is associated with increased concentrations of cholesterol and of the atherogenic lipoprotein species, lipoprotein(a), and low levels of high-density lipoprotein cholesterol. The rationale for treatment of lipid disorders in diabetes mellitus is based upon results of trials conducted primarily in non-diabetic populations. It is hoped that with increased recognition of dyslipidaemia and aggressive therapeutic measures the overkill in diabetes mellitus from macrovascular diseases will be reduced.     

Homocysteinemia as an independent risk factor in the Chinese population at a high risk of coronary artery disease

In this study, we examined whether homocystinemia acted as an independent and important risk factor in the Chinese population at a high risk of coronary artery disease (CAD). The study population included 237 consecutive patients undergoing coronary angiography and was divided into 2 groups. Group A consisted of 138 patients with CAD and group B of 99 patients with normal coronary angiogram. Prevalence of conventional risk factors of CAD including aging, male gender, family history of CAD, smoking, hypertension, dyslipidemia, diabetes, obesity, and increased high-sensitivity C-reactive protein (hs-CRP) was derived and fasting plasma homocysteine was measured. Results showed that level of plasma fasting homocysteine in group A was significantly higher compared with that in group B and homocystinemia was more prevalent in group A than in group B (p <0.001 for the 2 comparisons). Levels of systolic and diastolic blood pressures, fasting serum glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and hs-CRP were higher, whereas level of high-density lipoprotein cholesterol was lower (all p value <0.05) in group A than in group B. Using a multivariate logistic regression model, we identified smoking, hs-CRP, total cholesterol, plasma homocysteine, systolic blood pressure, and high-density lipoprotein cholesterol as independent risk or protective factors of CAD with odds ratios of 3.83, 3.15, 2.51, 2.14, 1.08, and 0.02, respectively. In conclusion, a high homocysteine level is an independent and important risk factor of CAD and the relative risk of CAD conferred by homocystinemia is similar to that of dyslipidemia in the Chinese population at high risk of CAD.     

Usefulness of atherogenic dyslipidemia for predicting cardiovascular risk in patients with angiographically defined coronary artery disease

The identification of factors contributing to residual cardiovascular risk is important to improve the management of patients with established coronary artery disease (CAD). This study was conducted to assess the predictive value of atherogenic dyslipidemia (defined as high triglycerides and low high-density lipoprotein [HDL] cholesterol) for long-term outcomes in patients with CAD. In 284 patients (238 men, 46 women; mean age at baseline 59.2 +/- 8.9 years) with coronary stenosis (>50% in > or =1 vessel), the presence of atherogenic dyslipidemia was prospectively associated with the incidence of major adverse cardiovascular events (MACEs) during a median follow-up of 7.8 years. MACEs were defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, the recurrence of angina, and revascularization procedures. MACEs were observed in 111 (39.1%) patients with CAD. MACEs occurred more frequently in patients with atherogenic dyslipidemia (50.9%) than in those with isolated low HDL cholesterol or high triglycerides (33.0%) or with normal HDL cholesterol and triglyceride concentrations (29.2%) (p <0.01 for trend). Kaplan-Meier survival analysis showed a decrease in event-free survival in patients with compared with those without atherogenic dyslipidemia (log-rank p = 0.006). Patients with atherogenic dyslipidemia presented with increased plasma concentrations of remnants, denser low-density lipoprotein, more atherogenic HDL particles, and insulin-resistant status. After adjustment for potential confounding variables, the magnitude of increased risk associated with atherogenic dyslipidemia was 1.58 (95% confidence interval 1.12 to 2.21, p = 0.008). In conclusion, these data provide evidence that atherogenic dyslipidemia is an independent predictor of cardiovascular risk in patients with CAD, even stronger than isolated high triglycerides or low HDL cholesterol.     

Nonalcoholic Fatty Liver Disease: Dyslipidemia,Risk for Cardiovascular Complications,and Treatment Strategy

Studies have shown that nonalcoholic fatty liver disease (NAFLD) is strongly associated with several metabolic disorders and diseases, such as obesity, type 2 diabetes mellitus, and dyslipidemia. In NAFLD, dyslipidemia is manifested as increased serum triglyceride and low-density lipoprotein cholesterol levels and decreased high-density lipoprotein cholesterol levels, all of which are key risk factors for cardiovascular disease (CVD). CVD is a leading cause of mortality in NAFLD patients. Thus, implementation of an aggressive therapeutic strategy for dyslipidemia with hypolipidemic agents may mitigate the risk for CVD among NAFLD patients. Here, we provide a current review of literature regarding NAFLD, with particular emphasis on dyslipidemia and available treatment options.     

Management of type IIb dyslipidemia

Although the Japan Atherosclerosis Society guideline for the diagnosis and prevention of atherosclerosis cardiovascular diseases for the Japanese population provides targets for low-density lipoprotein (LDL) cholesterol, triglycerides, and high-density lipoprotein (HDL) cholesterol to prevent cardiovascular disease in patients with dyslipidemia, there is no guideline specifically targeting the treatment of type IIb dyslipidemia, which is one of the most common types of dyslipidemia, along with type IIa and type IV dyslipidemia. Type IIb dyslipidemia is important because it sometimes accompanies atherogenic lipid profiles, such as small, dense LDL, remnants, low HDL cholesterolemia. It is also associated with type 2 diabetes mellitus, metabolic syndrome, and chronic kidney disease (CKD), and most patients with familial combined hyperlipidemia (FCHL) show this phenotype; therefore, it is assumed that patients with type IIb dyslipidemia have a high risk for cardiovascular disease. Thus, the management of type IIb dyslipidemia is very important for the prevention of cardiovascular disease, so we have attempted to provide a guideline for the management of type IIb dyslipidemia.     

Beneficial effects of indapamide on lipoproteins and apoproteins in ambulatory hypertensive patients

Among the numerous risk factors for atherosclerosis, 2 are particularly important: hypertension and primary or secondary abnormalities of plasma lipids and lipoproteins. Antihypertensive treatments significantly decrease the risk of cerebrovascular accidents, renal failure or hypertensive cardiomyopathy, but they have little influence on coronary artery disease. It has been suggested that some antihypertensive agents may have deleterious effects by altering serum lipoproteins and this may override the benefit of blood pressure reduction. Diuretics increase the blood concentration of total cholesterol, low-density lipoproteins and triglycerides. Indapamide, a methylindoline agent with vasodilator activity, has no adverse lipid effects. Twenty-six studies have clearly demonstrated that indapamide appears to be unique among diuretics because of an absence of adverse lipid effects. In some studies indapamide significantly increased high-density lipoprotein cholesterol, apoproteins A1, A2 and apoprotein E. When a thiazide diuretic had been given previously, indapamide treatment normalized the lipid and lipoprotein profiles. The reason for the lack of adverse lipid effects of indapamide is discussed. Thus indapamide, 2.5 mg once daily, is effective and safe for the control of mild to moderate hypertension, both in young and older patients. It may be an optimal diuretic for use in normolipidemic or hyperlipidemic patients, as it increases high-density lipoprotein but not low-density lipoprotein cholesterol.     

Relative atherogenicity and predictive value of non-high-density lipoprotein cholesterol for coronary heart disease

Although low-density lipoprotein cholesterol (LDL-C) is a well-established atherogenic factor for coronary heart disease, it does not completely represent the risk associated with atherogenic lipoproteins in the presence of high triglyceride (TG) levels. Constituent lipoproteins constituting non-high-density lipoprotein cholesterol (non-HDL-C) include atherogenic TG-rich lipoproteins, cholesteryl ester-enriched remnants of TG-rich lipoproteins, and lipoprotein(a). Recent observational and intervention studies suggest that the predictive value of non-HDL-C for cardiovascular risk and mortality is better than low-density lipoprotein cholesterol and that non-HDL-C correlates highly with plasma apolipoprotein B levels. Currently, the National Cholesterol Education Program Adult Treatment Panel III guidelines identify non-HDL-C as a secondary target of therapy in patients with TG elevation (> or =200 mg/dl) after the attainment of LDL-C target goals. In patients with coronary heart disease or coronary heart disease risk equivalents, an optional non-HDL-C goal is <100 mg/dl. To achieve the non-HDL-C goal, statin therapy may be intensified or combined with ezetimibe, niacin, a fibrate, or omega-3 fatty acids. In conclusion, non-HDL-C remains an important target of therapy for patients with elevated TGs, although its widespread adoption has yet to gain a foothold among health care professionals treating patients with dyslipidemia.     

Obesity and atherogenic dyslipidemia

Obesity is associated with an increased risk of coronary heart disease, in part due to its strong association with atherogenic dyslipidemia, characterized by high triglycerides and low high-density lipoprotein (HDL) cholesterol. There has been substantial research effort focused on the mechanisms of the link between obesity and atherogenic dyslipidemia, both in the absence and presence of insulin resistance. After a brief overview of the epidemiology of atherogenic dyslipidemia, this article details the known molecular mechanisms of adipocyte function and its relationship to apoB-containing lipoprotein assembly and metabolism, both in the healthy as well as in the obese states. We also discuss the pathophysiology of low HDL cholesterol in obesity and the implications for cardiovascular disease risk.