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目前,慢性肾脏病(CKD)已经成为威胁全球人类健康的重大疾病之一,中国CKD的患病率约10.8%.既往研究显示,CKD患者心血管疾病的发病率和死亡率很高,而血脂异常作为CKD患者心血管疾病的一个独立危险因素,与肾脏疾病密切相关.脂代谢紊乱既是CKD的一种伴随的生化改变,也是CKD发生发展的始动因素. 相似文献
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赵水平 《中华心血管病杂志》2011,39(3)
他汀是一类目前最强效的调脂药物,可用于患有肾脏疾病合并高脂血症的患者.有临床观察提示,他汀类药物通过纠正血脂代谢紊乱,可降低肾脏疾病患者发生缺血性心血管疾病如冠心病和缺血性脑卒中等危险;此外还有可能通过改变肾脏血液动力学或抑制炎症反应等作用,改善肾功能或延缓肾功能的恶化. 相似文献
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2型糖尿病血脂异常的处理 总被引:3,自引:0,他引:3
李蓉 《中国实用内科杂志》2009,29(3)
2型糖尿病患者心血管疾病风险显著增加,治疗血脂异常可以降低心血管事件发生危险.本文介绍了糖尿病调脂治疗的临床证据、调脂治疗目标,并对临床如何选择调脂治疗药物进行综述. 相似文献
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王禹 《中华老年心脑血管病杂志》2011,13(5)
<正>血脂异常的防治,重要在于降低心血管疾病的发病率和病死率。以他汀类为主的调脂药物,正广泛地应用于临床。然而,调脂治疗,远未达到理想预期,例如高危冠心病患者的药物应用并未普及、血脂达标率仍较低;虽LDL-C达标,但对其余心血管危 相似文献
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他汀类药物的评价与合理应用 总被引:10,自引:0,他引:10
血脂异常是心脑血管疾病的危险因素。在他汀类药物问世之前 ,使用其他调脂药物进行的临床研究已显示 ,调脂治疗在改善血脂异常的同时能有效降低冠心病的发病率及病死率 ,但尚未肯定其对总病死率的降低作用 ,甚至有增加的报道。因此 ,人们曾怀疑调脂治疗是否会增加心血管疾病以外的其他死亡。近 10多年来 ,应用他汀类药物进行的一系列大型的对冠心病一级、二级预防试验取得了举世瞩目的成就 ,一致证实了应用他汀类药物调整血脂的同时 ,还能有效降低冠心病事件及病死率 ,降低对经皮冠状动脉 (冠脉 )腔内成形术及主动脉冠脉旁路移植术的需求 ,… 相似文献
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江东向 《糖尿病天地(学术刊)》2009,(7):25-25
近20年来大量临床研究显示,应用调脂药物可以调整血脂异常——降低血浆总胆固醇(TC)、低密度脂蛋白胆固醇(LDL—C)和升高高密度脂蛋白胆固醇(HDL—C).从而有效降低冠心病患者的心血管事件与死亡率.降低脑卒中发生率、死亡率及致残率,并且还能大大减少冠心病人需做介入治疗和搭桥术的概率,因此调脂药物.特别是他汀类药物已成为防治心脑血管疾病的非常重要的药物。 相似文献
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刘梅林 《中国实用内科杂志》2017,37(4):293-296
他汀类药物治疗可以降低动脉粥样硬化性心血管疾病(ASCVD)的病死率,减少心血管事件。由于老年人心血管疾病患病率高,发生心血管事件的危险更大,他汀治疗带来的绝对获益更大。目前,缺乏专为高龄老年人设计的前瞻、随机、对照、大规模临床试验,缺乏大剂量他汀类药物治疗使老年人获益的临床证据。低密度脂蛋白水平是老年人血脂异常管理的首要目标,非高密度脂蛋白水平是次要目标。健康的饮食结构和生活方式是治疗老年人血脂异常的基本措施,他汀类药物是首选的调脂药物。建议根据患者心血管疾病的危险分层及个体特点,充分评估调脂治疗的利弊,合理地选择调脂药物,以达到改善生活质量、减少心血管事件和降低病死率的目的。 相似文献
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Managing dyslipidemia in chronic kidney disease 总被引:1,自引:0,他引:1
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ADMA在慢性肾脏疾病患者并发心血管疾病中的作用 总被引:1,自引:1,他引:1
目前发现在肾功能正常或轻-中度异常的慢性肾脏疾病(CKD)直至终末期肾功衰竭(ESRD)患者中心血管并发症(CVD)的发生及死亡率较普通人群明显升高,其原因可能与不对称二甲基精氨酸(ADMA)升高所致的内皮功能异常有关。新近开展的各项研究集中于在慢性肾脏疾病中ADMA的病理作用,探讨在高ADMA的患者中如何采取有效的干预措施来改善预后,以及评价使用血浆ADMA水平预测慢性肾脏疾病进展及其心血管并发症风险的价值。 相似文献
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慢性肾脏病(CKD)的患病率逐年上升,而心血管疾病(CVD)是导致其死亡的主要原因。CKD患者往往同时合并脂质代谢异常,这是促进CVD发生发展的重要因素,但CKD患者的脂质代谢异常与CVD发病率和死亡率之间的关系有其特殊性,各类降脂治疗能否有效改善CKD患者的CVD也存在争议。因此,文章就脂质代谢异常与CKD患者合并CVD发生的病理生理机制及相关性作一综述,这对降低CKD患者CVD发生率及改善患者预后具有十分重要的意义。 相似文献
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Harsh Agrawal Kul Aggarwal Rachel Littrell Poonam Velagapudi Mohit K. Turagam Mayank Mittal Martin A. Alpert 《Current Cardiology Reviews》2015,11(3):261-269
Patients with advanced chronic kidney disease (CKD), including those treated with dialysis, are at high risk for the development of cardiovascular disease (CVD). CVD accounts for 45-50% of deaths among dialysis patients. Therapy of acute and chronic coronary heart disease (CHD) that is effective in the general population is frequently less effective in patients with advanced CKD. Drug therapy in such patients may require dose modification in some cases. Oral anti-platelet drugs are less effective in those with advanced CKD than in persons with normal or near normal renal function. The intravenous antiplatelet drugs eptifibatide and tirofiban both require dose reductions in patients with advanced CKD. Enoxaparin requires dose reduction in early stage CKD and is contraindicated in hemodialysis patients. Unfractionated heparin and warfarin maybe used without dose adjustment in CKD patients. Atenolol, acetbutolol and nadolol may require dose adjustments in CKD. Metoprolol and carvedilol do not. Calcium channel blockers and nitrates do not require dose adjustment, whereas ranolazine does. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers may safely be used in CKD patients with close observation for hyperkalemia. The safety of spironolactone in such patients is questionable. Statins are less effective in reducing cardiovascular complication in CKD patients and their initiation is not recommended in dialysis patients. Coronary artery bypass grafting is associated with higher short-term mortality, but better long-term morbidity and mortality than percutaneous coronary interventions in patients with advanced CKD with non-ST segment ACS and chronic CHD. 相似文献
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Moody WE Chue CD Inston NG Edwards NC Steeds RP Ferro CJ Townend JN 《Journal of human hypertension》2012,26(3):141-148
Chronic kidney disease (CKD) is now a recognized global public health problem. It is highly prevalent and strongly associated with hypertension and cardiovascular disease (CVD); far more patients with a glomerular filtration rate below 60?ml?min(-1) per 1.73?m(2) will die from cardiovascular causes than progress to end-stage renal disease. A better understanding of the complex mechanisms underlying the development of CVD among CKD patients is required if we are to begin devising therapy to prevent or reverse this process. Observational studies of CVD in CKD are difficult to interpret because renal impairment is almost always accompanied by confounding factors. These include the underlying disease process itself (for example, diabetes mellitus and systemic vasculitis) and the complications of CKD, such as hypertension, anaemia and inflammation. Kidney donors provide an ideal opportunity to study healthy subjects without manifest vascular disease who experience an acute change from having normal to modestly impaired renal function at the time of uninephrectomy. Prospectively examining the cardiovascular consequences of uninephrectomy using donors as a model of CKD may provide useful insight into the pathophysiology of CVD in CKD and, therefore, into how the CVD risk associated with renal impairment might eventually be reduced. 相似文献
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Chronic kidney disease (CKD) is a pathology with a high worldwide incidence and an upward trend affecting the elderly. When CKD is very advanced, the use of renal replacement therapies is required to prolong its life (dialysis or kidney transplantation). Although dialysis improves many complications of CKD, the disease does not reverse completely. These patients present an increase in oxidative stress, chronic inflammation and the release of extracellular vesicles (EVs), which cause endothelial damage and the development of different cardiovascular diseases (CVD). CKD patients develop premature diseases associated with advanced age, such as CVD. EVs play an essential role in developing CVD in patients with CKD since their number increases in plasma and their content is modified. The EVs of patients with CKD cause endothelial dysfunction, senescence and vascular calcification. In addition, miRNAs free or transported in EVs together with other components carried in these EVs promote endothelial dysfunction, thrombotic and vascular calcification in CKD, among other effects. This review describes the classic factors and focuses on the role of new mechanisms involved in the development of CVD associated with CKD, emphasizing the role of EVs in the development of cardiovascular pathologies in the context of CKD. Moreover, the review summarized the EVs’ role as diagnostic and therapeutic tools, acting on EV release or content to avoid the development of CVD in CKD patients. 相似文献
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OPINION STATEMENT: Chronic kidney disease (CKD) is associated with a large burden of cardiovascular risk factors ultimately leading to increased cardiovascular events and mortality. Prevention of cardiovascular disease (CVD) in CKD involves early identification of individuals at high-risk of renal disease. In fact, substantial evidence points to a complex bidirectional relationship between CKD and CVD. Therefore, most interventions directed at CKD prevention should include multiple risk factor interventions with the goal of preventing CVD events while slowing progression of CKD. Clearly, prevention of CVD in CKD is a complex task and requires a multidisciplinary team approach, with a well-defined program, rational targets for each risk factor, and implementation of the most effective intervention strategies. Although several interventions to prevent CVD have proven effective in the general population and in individuals at high risk for CVD, a true benefit in patients with CKD remains to be demonstrated for several of them. A few rational targets of intervention should be optimal blood pressure control, reduction of proteinuria, treatment of dyslipidemia, good control of diabetes, smoking cessation, dietary salt restriction, achievement of normal body mass index, partial correction of anemia, and management of mineral metabolism abnormalities. Lifestyle modification and pharmacological therapy with renin-angiotensin blockers, β-blockers, diuretics, statins, and aspirin should be encouraged in the early stages of CKD. 相似文献
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Prof. Dr. M.D. Alscher 《Der Kardiologe》2009,3(6):489-498
The cardiorenal syndrome (CRS) is seen in increasing numbers in emergency rooms, intensive care units, hospitals as a whole and outpatient departments. This is caused by the demographic shifts that lead to increasing numbers of elderly patients with multimorbidities. Often a heart disease is causing kidney failure and vice versa. The management of these patients is difficult due to the fact that often the goals of therapy are opposite. Patients with chronic kidney disease (CKD) have a 100-fold increased risk for the development of cardiovascular diseases (CVD). CKD alone is an important cardiovascular risk factor and has surpassed diabetes mellitus as a risk factor by far. However, awareness of this is low among doctors and patients. The treatment of patients with CRS is different from patients with CVD alone. The goals of therapy are different and the findings of studies in patients with CVD without CKD cannot simply be extended to these patients. 相似文献
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Shoji T Abe T Matsuo H Egusa G Yamasaki Y Kashihara N Shirai K Kashiwagi A;Committee of Renal Peripheral Arteries Japan Atherosclerosis Society 《Journal of atherosclerosis and thrombosis》2012,19(4):299-315
Patients with chronic kidney disease (CKD) are at an increased risk not only for end-stage kidney disease (ESKD) but also for cardiovascular disease (CVD). In this review article, we summarize the current evidence of CKD as a high-risk condition for CVD based on reports from Japan and other countries to draw attention to the close clinical association between CKD and CVD. Several epidemiologic studies have shown that the presence of CKD and reduced renal function are independent predictors of CVD also in Japan. According to a post-hoc analysis of CASE-J, the power of CKD as a predictor of CVD is as strong as diabetes mellitus and a previous history of ischemic heart disease. CKD worsens classical risk factors including hypertension and dyslipidemia, and dyslipidemia is associated with increased thickness and stiffness of large arteries independent of major confounders. A post-hoc analysis of MEGA indicates that lipid-lowering therapy with statins reduces the risk of CVD, and that it appears to be more efficacious in patients with than without CKD. These reports from Japan and other countries suggest that CKD should be regarded as a high-risk condition comparable to diabetes mellitus, and that strict control of dyslipidemia would be beneficial in preventing CVD, at least early stages of CKD. 相似文献
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谌贻璞 《中国实用内科杂志》2010,30(2):108
慢性肾脏病(CKD)是心血管疾病(CVD)的高危因素,CKD患者的CVD患病率很高,非常值得重视。本文将对CKD时的冠状动脉粥样硬化性心脏病、尿毒症心肌病、尿毒症心包炎、脑卒中及外周动脉病做一简介。 相似文献