冠心病与高血压

高血压和冠心病是两种不同的疾患,但可同时存在于一个患者,两者相互影响,互相促进。高血压是最常见的心血管病,是全球范围内重大的公共卫生问题。据WHO预测,至2 0 2 0年非传染性疾病将占我国死亡原因79% ,其中心血管病将占首位。高血压是冠心病的主要危险因素之一,动脉粥样硬化的过程可由于合并存在的高血压而明显加速。本章讨论高血压合并冠心病的临床表现、诊断和治疗。1　高血压合并冠心病的临床表现和诊断高血压合并冠心病的临床表现可表现为冠心病的五种临床类型。正常情况下冠状循环具有较大的储备能力,在剧烈活动时,冠状动脉适当地…     

Coronary heart disease in women

Summary The results presented above indicate that the risk factors associated with the development of coronary heart disease in women are not that different than those identified for men. It is encouraging to note that while the prevalence of hypertension in women has not changed over that past twenty years, the proportion of treated hypertensive women has increased dramatically and the proportion with controlled blood pressure has doubled since 1960. It is also encouraging to note that the number of adult women who smoke cigarettes has decreased since 1960, but the number of young girls who smoke has increased at an alarming rate. It has been noted by researchers that among women who smoke, the number of cigarettes smoked per day has increased from the 1950s to the present. From the Framingham data it can be seen that womens' serum cholesterol level increases substantially with age and women should take steps to eat a healthy low-saturated fat, low cholesterol diet in order to maintain a low blood cholesterol level.It has been shown from the Framingham Study data that although the same risk factors operate in men and women, the standard risk factors do not explain the marked differences in morbidity and mortality from heart disease between the two sexes. We must continue to study the epidimiology and biology of coronary heart disease in women both to better understand the disease process in women and to understand the large sex differential for CHD in most westernized countries.

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Koronare Herzkrankheiten bei Frauen

Zusammenfassung Die Risikofaktoren der koronaren Herzkrankheit bei Frauen sind nicht wesentlich verschieden von denen bei Männern.Während sich die Hypertonieprävalenz bei Frauen in den letzten 20 Jahren nicht verändert hat, hat der Anteil der behandelten Hypertonikerinnen dramatisch zugenommen und der Anteil mit kontrollierten Blutdruckwerten hat sich seit 1960 verdoppelt. Die Zahl der erwachsenen Frauen, die Zigaretten rauchen, hat seit 1960 abgenommen, aber die Zahl der jungen Mädchen, die rauchen, hat sehr stark zugenommen. Unter den Raucherinnen hat die Zahl der pro Tag gerauchten Zigaretten von 1950 bis heute zugenommen. Aus der Framingham-Studie wird ersichtlich, dass die Serumcholesterinspiegel bei Frauen mit dem Alter stark zunehmen. Frauen sollten Nahrungsmittel mit einem niedrigen Gehalt an gesättigten Fetten und Cholesterin zu sich nehmen, um einen niedrigen Blutcholesterinspiegel zu erreichen.Die Daten der Framingham-Studie haben gezeigt, dass bei Männern und Frauen dieselben klassischen Risikofaktoren wirksam sind. Allerdings können die klassischen Risikofaktoren nicht die ausgeprägten Unterschiede in der Morbidität und Mortalität an koronarer Herzkrankheit zwischen beiden Geschlechtern erklären. Wir müssen weiterhin die Epidemiologie und Biologie der koronaren Herzkrankheit bei Frauen studieren, um den Krankheitsprozess bei Frauen besser zu verstehen und den grossen Unterschied in der Häufigkeit der Erkankung zwischen Männern und Frauen in den meisten westlichen Ländern besser erklären zu können.

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Maladies coronariennes chez les femmes

Résumé Alors que la prévalence de l'hypertension chez les femmes n'a guère changé durant les 20 dernières années, la proportion d'hypertensives traitées a augmenté considérablement, de même que celle des patients dont l'hypertension est contrÔlée (la proportion a doublé depuis 1960). Le nombre de femmes adultes fumant la cigarette a diminué, mais le nombre de jeunes fumeuses a fortement augmenté. Parmi les fumeuses, le nombre moyen de cigarettes par jour a augmenté depuis 1950. L'étude de Framingham a montré que le taux sanguin de cholestérol augmente avec l'âge des femmes. Elles devraient consommer des aliments contenant moins de graisses animales saturées, de faÇon à diminuer les taux sanguins de cholestérol. Les données de Framingham ont montré que les mêmes facteurs de risques agissent chez les femmes et les hommes. Ce sont les différences de prévalence de ces facteurs entre les sexes qui expliquent les différences de mortalité et de morbidité liées aux maladies coronaires. Il faut étudier plus à fond l'épidémiologie et la biologie de ces maladies chez les femmes, de faÇon à mieux comprendre les processus à l'uvre dans l'apparition de la maladie.

     

冠心病的抗凝治疗

冠心病的发生发展与脂质代谢紊乱、血管内皮损伤、炎症反应、冠状动脉粥样斑块形成、斑块破裂及血栓形成密切相关 ,而粥样斑块突然破裂及血栓形成则是导致急性冠脉综合征 (ACS)的主要原因。ACS是近年来提出的有关冠心病诊断的新概念 ,其包括了不稳定型心绞痛、Q波心肌梗死、非Q波心肌梗死及心脏缺血性猝死 ;ACS的病理基础是冠状动脉内不稳定斑块的存在 ,继而发生了痉挛、破裂、出血和血栓形成。由于血栓形成与血小板黏附及聚集性增高、血液凝固性增强及纤溶活性减弱等有关 ,故抗血小板治疗及抗凝治疗在冠心病治疗中占有重要地位 ,而本…     

冠心病与糖尿病

冠心病是冠状动脉粥样硬化引起的心脏病,为多因素疾病,其主要危险因素包括高龄、高脂血症、高血压、吸烟和糖尿病。糖尿病是一种全身代谢性疾病,其血管病变是引发其他复杂病变的基础,其中大血管病变常引起冠心病、脑血管病和周围血管病。糖尿病大血管病变的主要危险因素除了高血压、高血脂和高血糖外,还包括高胰岛素血症和(或)胰岛素抵抗、血小板凝集及黏附功能异常,因而动脉粥样硬化进展更快,冠心病的发生率和病死率急剧增加。最近美国心脏学会(AHA)提出“糖尿病是心血管疾病”,并与美国糖尿病学会组成心血管疾病的防治联盟。美国胆固醇…     

Coronary heart disease risk assessment

A coronary heart disease (CHD) risk assessment was conducted on 883 patients enrolled in two primary-care rural practices in western Maryland to evaluate the relationship among presence of cardiovascular disease, major risk factors, and self-perception for CHD among the clients. Patients with preexisting cardiovascular disease other than peripheral vascular disease were more likely to perceive themselves at increased risk. However, 16% (39/246) regarded themselves to be at below average risk. These patients tended to have lower income, education, and anxiety levels. Nineteen percent of patients without preexisting cardiovascular diseases regarded themselves to be at above average risk. These patients tended to be disabled, unemployed, and have increased anxiety levels. Regardless of the presence or absence of preexisting cardiovascular disease, a patient's self-perceived risk was not altered significantly by the presence of one or more risk factors other than a positive family history of CHD. Based on Framingham risk profiles, 7.3% (29/395) of the white patients 35-74 years of age without preexisting cardiovascular disease had scores of 0.301 and above. Women had 1.4 times lower estimates of risk compared to men. The discrepancy that can occur between perceived and actual risk for CHD among a significant percentage of patients attending a primary-care rural practice underscores the importance of ascertaining both prior to prescribing risk reduction interventions.     

Coronary heart disease: Women's assessment of risk--a qualitative study

Coronary heart disease (CHD) kills over 135,000 people each year. The underlying premise of this study was that women might not assess themselves as at risk because CHD has generally been perceived within popular culture, medicine and research as a man's disease. Hayes ( Social Science and Medicine, 35, pp. 55-61, 1991) suggests that critical to the success of any risk assessment strategy is: the identification of risk markers that can accurately predict specific adverse health outcomes and the ability of the strategy users to measure risk factors and calibrate them appropriately. In-depth interviews were conducted with 83 women, 50 who had been admitted to hospital with a CHD-related cardiac event and 33 without manifest CHD. They were found to adopt risk assessment strategies that enabled them to conceptually distance themselves from risk of CHD by: attributing risky lifestyle behaviour to men; subjectively manipulating the potential threat posed by their own risk factors and by over-emphasising the importance of social position to risk. The outcome of these strategies can be summed up as--'women are only at high risk of developing CHD if they adopt a man's way of life'. This has important implications for the prevention of CHD in women.     

Benign monoclonal gammopathy in the elderly--a prevalence study and review

Monoclonal gammopathy of uncertain significance (MGUS) may present the clinician with diagnostic difficulties. This paper reviews the literature relating to MGUS, presents findings of a local prevalence study, and provides advice on monitoring.     

冠心病危险因子在女性冠心病心力衰竭中的研究

目的 探讨冠心病危险因子在女性冠心病患者发生心力衰竭中的影响。方法 选取328例冠心病患者,其中男196例（男性冠心病组）,女132例（女性冠心病组）,对两组患者各种冠心病危险因子包括年龄、高血压、糖尿病、血脂、血浆纤维蛋白原及血尿酸水平等进行比较;对所有患者随访1～3年,观察两组患者心力衰竭发生率,并对女性冠心病组发生心力衰竭者与未发生心力衰竭者的血尿酸水平进行比较。结果 女性冠心病组三酰甘油、血浆纤维蛋白原及血尿酸水平显著高于男性冠心病组(P＜0.05)。随访l～3年,女性冠心病组心力衰竭发生率显著高于男性冠心病组[27.27％(36/132)比16.84％( 33/196)],女性冠心病组发生心力衰竭者血尿酸水平为(368.85±78.60)μmol/L,未发生心力衰竭者血尿酸水平为(336.63±69.65)μmol/L,两者比较差异有统计学意义(P＜0.05)。结论 冠心病危险因子是女性冠心病患者心力衰竭的重要推动因素,而血尿酸是其发生心力衰竭的独立危险因素,可通过对血尿酸等进行早期监测并采取干预措施,减缓疾病的发展。     

Coronary heart disease risk prediction in the Atherosclerosis Risk in Communities (ARIC) study

Risk prediction functions for incident coronary heart disease (CHD) were estimated using data from the Atherosclerosis Risk in Communities (ARIC) Study, a prospective study of CHD in 15,792 persons recruited in 1987-1989 from four U.S. communities, with follow-up through 1998. Predictivity of which individuals had incident CHD was assessed by increase in area under ROC curves resulting from adding nontraditional risk factors and markers of subclinical disease to a basic model containing only traditional risk factors. We also assessed the increase in population attributable risk. The additional factors were body mass index; waist-hip ratio; sport activity index; forced expiratory volume; plasma fibrinogen, factor VIII, von Willebrand factor, and Lp(a); heart rate; Keys score; pack-years smoking; and subclinical disease marker carotid intima-media thickness. These factors substantially improved prediction of future CHD for men, less for women, and also increased attributable risks.