碳水化合物和心血管疾病危险因素的研究进展

不合理饮食和心血管疾病风险因素息息相关。碳水化合物作为三大营养素之一,其摄入的量和质对健康的影响近年来备受关注。随着膳食评估方式的不断优化,碳水化合物质量对血压、血脂和血糖的影响逐渐明了,低血糖负荷饮食、增加全谷物和膳食纤维的摄入、控制碳水化合物的摄入总量可以改善血压、血脂、血糖等心血管疾病危险因素。     

某些非传统危险因素对慢性肾脏疾病患者的心血管并发症的影响

慢性肾脏疾病(chronic kidney disease,CKD)流行病学的最新资料表明,心血管疾病(carcliovascular disease,CVD)是CKD患者最主要的并发症,而且其患病率大大高于普通人群;CVD也是导致CKD患者死亡的头号杀手,至今病死率仍居高不下.     

心血管危险因素对动脉弹性的影响

心血管危险因素对动脉血管的结构及功能造成损害，导致心血管疾病，甚至发生严重事件。动脉受损的早期改变是动脉弹性功能降低。本研究对504例自然人群进行心血管危险因素调查的同时测定大、小动脉弹性功能，探讨两之间的关系。     

慢性肾脏病患者发生心血管事件危险因素的研究

目的 探讨慢性肾脏病(CKD)患者发生院内心血管事件的相关危险因素及对CKD患者院内死亡的影响.方法 选取2006年我院557例患有3期或3期以上CKD的住院患者,分析影响CKD患者发生心血管事件的相关危险因素以及心血管事件对CKD患者院内死亡的影响.结果 557例CKD患者中,男性332例,女性225例;住院期间心血管事件的发生率为29.3%(163/557).发生心血管事件的独立危险因素包括:年龄、既往冠心病史、空腹血糖水平和血红蛋白水平.发生心血管事件患者的住院死亡率显著高于未发生心血管事件患者的住院死亡率(9.82%比2.28%,X2=15.3,P＜0.001).结论 对于CKD患者,除年龄、既往冠心病史和空腹血糖这些传统的心血管事件危险因素外,贫血是其较为独特的独立危险因素.     

1677例老干部向心性肥胖和心血管病危险因素的关系

目的　调查分析军队退休老干部群体向心性肥胖及其与心血管病危险因素的关系。方法　根据计划方案对成都地区 6 0岁以上军队退休老干部进行病史询问和体格检查 ,获得完整资料 16 77份。对腰围和体重指数 (BMI)、高血压、糖尿病、高胆固醇血症、高甘油三酯血症等心血管病危险因素进行分析。结果　BMI在男性和女性分别为2 4 .4 2± 3.0 4和 2 3.97± 3.12 (P >0 .0 5 )。腰围在男性和女性分别为 (83.79± 8.34)cm和 (78.4 3± 7.89)cm(P <0 .0 0 1) ,并呈现随年龄增长而增大的趋势。腰围过大者占总体的 4 7.88% ;腰围与BMI正相关 ,但 2 9.5 2 %的腰围过大者其BMI<2 5 ;对腰围进行分层处理后 ,可见除高胆固醇以外 ,各危险因素及危险因素聚集 (具有 2个及以上危险因素 )的检出率随腰围的增大而逐渐上升 ,呈密切的正相关。结论　军队退休老干部反映向心性肥胖的指标———腰围与心血管病危险因素及其分布情况密切相关     

原发性高血压患者饮食结构与心血管病危险因素

研究背景 饮食治疗和生活方式的改善始终是临床预防和干预的基础.目的 通过对北京地区原发性高血压患者饮食结构的调查研究,探讨不同膳食结构对原发性高血压患者心血管病危险因素的影响.方法 应用膳食调查问卷形式连续收集了424例北京地区原发性高血压患者的饮食结构,测量患者的身高、体质量、腰围,并清晨空腹取静脉血检测各项生化指标.根据调查结果采用病例对照研究的方法对患者进行分组:素食为主组(素食组,n＝95)、肉食为主组(肉食组,n＝133)和荤素平衡组(平衡组,n＝196),分别比较组问临床和生化指标.以膳食结构和传统心血管危险因素为自变量做logistic回归分析.结果 1)肉食组患者发生肥胖的比例(46.6%)明显高于素食组(21.7%)和平衡组(30.0%),P均＜0.01;肉食组超重加肥胖患者所占的总比例(90.5%)也显著高于素食组(61.4%)和平衡组(72.9%),P均＜0.01.2)与素食组比较,肉食组和平衡组患者的体质量指数(BMI)、腰围、血清肌酐和尿酸水平均呈显著增高(P＜0.01和P＜0.05);而平衡组患者的BMI,腰围、血清肌酐和尿酸水平均显著低于肉食组(P＜0.01).3)与素食组和平衡组比较,肉食组患者的肱动脉脉压、血清丙氨酸氨基转移酶和三酰甘油水平均显著增高(P＜0.01),高密度脂蛋白胆固醇(HDL-C)水平显著降低(P＜0.01);而这些指标在素食组和平衡组之间未见显著差异.4)肉食组患者代谢综合征(MS)的患病率(74.3%)明显高于素食组(53.7%,P＜0.01)和平衡组(62.4%,P＜0.05),而素食组和平衡组患者之间MS的患病率未呈现显著差异.5)Logistic回归分析显示,膳食结构是原发性高血压患者HDL-C(OR＝2.118,P＝0.008)和腰围(OR＝5.376,P＝0.017)的独立相关因素.结论 1)不同膳食结构与北京地区原发性高血压患者超重和肥胖的患病率显著相关;2)富于蔬菜、水果和碳水化合物的膳食可能改善原发性高血压患者HDL-C和腰围的水平,降低代谢综合征的患病率.     

三明市三元区公务员心血管危险因素的分析

目的:研究三明市三元区公务员心血管病危险因素的情况,以便指导其防治工作.方法:分别从2005年和2010年体检对象中随机选择年龄为30～89岁的公务员,测量血压、血脂、血糖3种心血管病危险因素,询问病史,进行统计分析.结果:(1)随着年龄的增长,心血管病危险因素的检出率在逐渐升高;女性在50岁之前的检出率较低,50岁之...     

控制糖尿病心血管危险因素研究进展

在我国．2型糖尿病的发病率已经上升到接近4％．预计总患病人数4千余万。华人可能是糖尿病的好发人群之一，根据IDF(国际糖尿病联盟)的文献，香港地区的发病率为12％．在全球国家／区域性统计中排名首位．新加坡11％排第四，这可能是现代西方化的生活方式和华人遗传素质相结合的结果。在美国少数人种也是糖尿病的好发人群。随着发展中国家现代化的进展，专家估计发展中国家的发病率将以较快的速度增长．其危害将逐步全球化。     

原发性高血压患者饮食结构与心血管病危险因素

研究背景饮食治疗和生活方式的改善始终是临床预防和干预的基础。目的通过对北京地区原发性高血压患者饮食结构的调查研究,探讨不同膳食结构对原发性高血压患者心血管病危险因素的影响。方法应用膳食调查问卷形式连续收集了424例北京地区原发性高血压患者的饮食结构,测量患者的身高、体质量、腰围,并清晨空腹取静脉血检测各项生化指标。根据调查结果采用病例对照研究的方法对患者进行分组:素食为主组(素食组,n=95)、肉食为主组(肉食组,n=133)和荤素平衡组(平衡组,n=196),分别比较组间临床和生化指标。以膳食结构和传统心血管危险因素为自变量做 logistic 回归分析。结果 1)肉食组患者发生肥胖的比例(46.6%)明显高于素食组(21.7%)和平衡组(30.0%),P 均<0.01;肉食组超重加肥胖患者所占的总比例(90.5%)也显著高于素食组(61.4%)和平衡组(72.9%),P 均<0.01。2)与素食组比较,肉食组和平衡组患者的体质量指数(BMI)、腰围、血清肌酐和尿酸水平均呈显著增高(P<0.01和 P<0.05);而平衡组患者的 BMI、腰围、血清肌酐和尿酸水平均显著低于肉食组(P<0.01)。3)与素食组...     

The low-carbohydrate diet and cardiovascular risk factors: Evidence from epidemiologic studies

AimsObesity is an important public health issue because of its high prevalence and concomitant increase in risk of cardiovascular diseases. Low carbohydrate diets are popular for weight loss and weight management but are not recommended in leading guidelines due to the perception that increases in dietary fat intake may lead to an adverse cardiovascular risk profile. To clarify the effects of a low-carbohydrate diet for weight loss on cardiovascular disease risk factors as compared to a low fat diet for weight loss, we systematically reviewed data from randomized controlled clinical trials and large observational studies.Data synthesisWe searched the MEDLINE database (Jan 1966–Nov 2013) to identify studies that examined a low-carbohydrate diet as compared to a low-fat diet for weight loss or the improvement of cardiovascular disease risk factors.ConclusionsRecent randomized controlled trials document that low-carbohydrate diets not only decrease body weight but also improve cardiovascular risk factors. In light of this evidence from randomized controlled trials, dietary guidelines should be re-visited advocating a healthy low carbohydrate dietary pattern as an alternative dietary strategy for the prevention of obesity and cardiovascular disease risk factors.     

上海市心血管病主要危险因素变化趋势分析

目的：评价上海地区人群心血管病主要危险因素的变化趋势。方法：采用重复横断面调查的方法,1992、1995、1996和1999年共4次对上海市某工厂人群进行心血管病主要危险因素调查,共1118人,对收缩压、舒张压、体重指数、高血压的患病率和吸烟情况的变化趋势进行了分析。结果：（1）1992年人群基线心血管病危险因素如血压、吸烟率、血清总胆固醇、甘油三酯、HDL－胆固醇、腰臀比、体重指数结果与MONICA北京的地区监测结果相近。（2）无论男性或女性,收缩压和舒张压水平均呈上升趋势。男性收缩压平均升高12.3mmHg, 舒张压平衡升高6.4mmHg;女性依次为11.5mmHg和4.9mmHg;（3）男性高血压患病率呈上升趋势;女性变化趋势不明显。（4）男性与女性体重指数各年度比较均无显著性差异,无逐渐肥胖的倾向。（5）男性吸烟率一直维持在较高水平,1996年较1992年有明显下降,1996至1999年下降趋势不明显;女性吸烟率维持在较低水平,趋势平稳。结论：上海地区应重视吸烟和高血压的预防控制。     

大学生心脑血管疾病危险因素现状调查

目的 了解探讨大学生心脑血管疾病危险因素的现状。方法 对河北医科大学150名18岁-22岁的大学生的血压、血脂、血糖、体重指数(BMI)、膳食、运动习惯、心血管疾病家族史等因素进行的一个小样本调查。结果 以收缩压(SBP)≥140mmHg和／或舒张压(DBP)≥90mmHg为诊断标准，血压偏高校出率为9．02％。超重检出率为9．02％(体重指数≥24)。空腹血糖(GLU)≥6．10mmol/L者有1．50％。血脂各项指标单项偏高检出率为19．55％。进一步做各指标的相关性研究提示，SBP与BMI、血脂(TG)间两两相关；GLU与血脂各指标之间均有相关关系。65．41％有心脑血管疾病家族史。结论 加强青年时期心脑血管疾病危险因素的监侧与干预势在必行。     

Long-term effects of a ketogenic diet in obese patients

BACKGROUND:

Although various studies have examined the short-term effects of a ketogenic diet in reducing weight in obese patients, its long-term effects on various physical and biochemical parameters are not known.

OBJECTIVE:

To determine the effects of a 24-week ketogenic diet (consisting of 30 g carbohydrate, 1 g/kg body weight protein, 20% saturated fat, and 80% polyunsaturated and monounsaturated fat) in obese patients.

PATIENTS AND METHODS:

In the present study, 83 obese patients (39 men and 44 women) with a body mass index greater than 35 kg/m², and high glucose and cholesterol levels were selected. The body weight, body mass index, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, fasting blood sugar, urea and creatinine levels were determined before and after the administration of the ketogenic diet. Changes in these parameters were monitored after eight, 16 and 24 weeks of treatment.

RESULTS:

The weight and body mass index of the patients decreased significantly (P<0.0001). The level of total cholesterol decreased from week 1 to week 24. HDL cholesterol levels significantly increased, whereas LDL cholesterol levels significantly decreased after treatment. The level of triglycerides decreased significantly following 24 weeks of treatment. The level of blood glucose significantly decreased. The changes in the level of urea and creatinine were not statistically significant.

CONCLUSIONS:

The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients. Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol. Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.     

心血管疾病护理中不安全因素分析

本文将2010年6月-2012年6月来我院进行治疗的心血管患者198例作为研究对象,分析护理过程中存在的不安全因素,进而提出相关的改进措施。采取问卷调查的方式,本文对其中的不安全因素进行了归纳总结,得出心血管科的护理人员应该对护理过程中所存在的这些不安全因素给予足够的重视,通过自身护理水平的不断提高来减少医惠之间的纠纷,进而提高医院的整体服务质量。     

106例血液透析患者心血管疾病的危险因素分析

目的探讨血液透析患者心血管疾病的危险因素。方法常规检测106例维持性血液透析患者的血脂、血清白蛋白(ALB)、尿素清除指数(KT/V)、尿酸、血磷及血压水平,并分析上述因素与血液透析患者心血管疾病之间的关系。结果血液透析患者心血管疾病为25%,其中缺血性心脏病6例,心功能不全5例,心脏增大21例,脑血管意外3例。伴心血管疾病的血液透析患者血清甘油三酯(TG)水平、年龄、透析前血清肌酐、尿酸、白蛋白、伴有高血压和心血管病变家族史的比例显著高于无心血管疾病患者,KT/V、透析时体外循环血量和超滤量显著低于后者。逐步条件logistic回归分析结果显示,年龄、高血压、TG、血磷、ALB是心血管疾病的重要危险因素,回归方程为P/(1-P)=exp(-12.81 0.239年龄 0.288高血压 1.586TG 4.270血磷-0.439ALB)。结论高血压、高龄、血清甘油三酯水平和血磷水平增高、血清白蛋白水平降低是血液透析患者心血管疾病的危险因素,血液透析不充分、透析时的体外血循环量及心血管家族史也与心血管疾病的发生有关。     

Serum copper and the risk of cardiovascular disease death in Finnish men

Background and aimsCopper (Cu) is a component of enzymes catalyzing oxidation-reduction reactions. With the persisting burden of cardiovascular disease (CVD), there is evident need to identify biomarkers and potential risk factors for CVD. We therefore examined the association between serum Cu levels and the risk of CVD death in Finnish men and across different body mass index (BMI) categories.Methods and resultsThis Finnish prospective study is based on 1911 men aged 42–60 years who were free of coronary heart disease at baseline. Cu concentrations (mg/l) were determined using atomic absorption spectrometer and categorized into quartiles (<1.0; 1 to <1.1; 1.1 to <1.21; ≥1.21). Participants were categorized into normal weight <25 kg/m², pre-obesity 25–29.9 kg/m², and obesity >30 kg/m². The association between Cu and CVD death was analyzed using multivariable Cox regression models. During a median follow-up of 25.8 years, 358 CVD deaths occurred. The risk of CVD death increased continuously with increasing Cu levels (for non-linearity, p = 0.64). Using the first quartile as reference after adjustment for covariates, the hazard ratios (HR) (95% confidence interval (CI)) for CVD death for Cu concentrations in second, third and fourth quartiles were 1.45(1.05–2.01), 1.69(1.25–2.27), and 1.68(1.23–2.29), respectively. Obese men in the third quartile of serum Cu concentrations had highest risk of CVD death (HR (95%CI) 2.71(1.27–5.78)).ConclusionElevated serum Cu level was associated with increased risk of CVD death across all BMI categories in middle-aged and older Finnish men. Serum Cu may have prognostic implication for CVD mortality risk; however, further studies are needed.     

The epidemiology of Lp-PLA(2): distribution and correlation with cardiovascular risk factors in a population-based cohort

Lipoprotein-associated phospholipase A₂ (Lp-PLA₂) is an enzyme that is produced by inflammatory cells (macrophages, T-lymphocytes and mast cells) and hydrolyzes oxidized phospholipids in LDL. Several epidemiology studies indicate that Lp-PLA₂ appears to be an independent marker of cardiovascular risk. This study was conducted to define the distribution of Lp-PLA₂ in a large population-based cohort and to determine associations between Lp-PLA₂ and other risk factors for CVD. The study group consisted of participants from the Malmö Diet and Cancer study (1992–1994). Lp-PLA₂ (activity and mass) was measured from samples obtained at baseline for 5402 participants (3167 women). A strong correlation was observed between Lp-PLA₂ activity and mass in this study (r = 0.57). Highest correlations were observed between Lp-PLA₂ activity and LDL (r = 0.45) and LDL/HDL ratio (r = 0.54) and a strong inverse correlation to HDL (r = −0.31). The correlations between Lp-PLA₂ mass and lipids were not as strong as the correlation between activity and lipids. Lp-PLA₂ activity and mass were correlated with increased ultrasound determined carotid intima-media thickness. We conclude that Lp-PLA₂ is strongly correlated with several cardiovascular risk factors, especially lipid fractions, and with the degree of carotid artery atherosclerosis. However, the measured variables accounted for only 19% and 35% of the variation in Lp-PLA₂ mass and activity respectively.     

心血管危险因素与小动脉弹性的关系

目的　探讨小动脉弹性下降的主要心血管危险因素及多种危险因素并存时对小动脉弹性的影响。方法　采用CVProfilorDO 2 0 2 0动脉脉搏分析仪测量大动脉和小动脉弹性指数 (C1和C2 ) ;用稳态模式评估法 (HOMA)评价胰岛素抵抗。依据中国健康人群动脉弹性功能参考标准把受试者分为小动脉弹性 (C2 )异常组和对照组 ;根据危险因素个数多少将C2 异常组分为 4个亚组 (0～ 3亚组 )。结果　 (1)C2 异常组的年龄、总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C)、空腹血糖 (FBG)、收缩压 (SBP)和舒张压 (DBP)明显高于对照组 ,而C2 明显低于对照组 (P均 <0 0 5 ) ;单因素相关分析 ,年龄、TC、LDL C、FBG、SBP和DBP分别与C2 呈负相关。 (2 )随着危险因素聚集程度的增加 ,0到3亚组C2 呈依次下降趋势 (6 5± 2 6比 5 4± 2 3比 4 7± 2 7比 3 1± 1 6 ,P <0 0 0 1) ,多个危险因素并存亚组 (3亚组 )C2 下降最显著。 (3) 3亚组血浆胰岛素浓度和胰岛素抵抗指数显著高于其他亚组 (P <0 0 5 ,P <0 0 0 1)。结论　年龄、总TC、HDL C、FBG、SBP和DBP水平增加是小动脉弹性下降的主要心血管危险因素 ,它们对小动脉弹性的影响是连续的 ;多种危险因素并存时 ,可通过协同作用使小动脉弹性降低更显著 ;胰岛素抵抗可能是危险因     

体脂分布类型和胰岛素抵抗对心血管病危险因素聚集性的 …

目的：探讨体脂分布类型和胰岛素抵抗对心血管病危险因素聚集性的影响。方法在自然人群中调查体重指数（ＢＭＩ）、腰围／臂围比值（ＷＨＲ）、血压、血胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白－胆固醇（ＨＬＤ－Ｃ）、血糖（ＦＢＳ）、胰岛素（ＩＮＳ）及胰岛素敏感性指数（ＩＳＩ）。结果外周型超重组血压、ＴＧ、ＩＮＳ高于非超重组,ＨＤＬ－Ｃ、ＩＳＩ低于非超重组;而中心型超重组血压、ＩＮＳ及危险因素聚集程度高于