健脾化痰通脉方治疗冠心病血脂异常30例临床观察

目的 观察健脾化痰通脉方对冠心病血脂异常患者临床症状及血脂水平的影响.方法 将60例冠心病血脂异常患者随机分为治疗组和对照组各30例,在常规治疗的基础上,治疗组给予健脾化痰通脉方,每日一剂,分早晚两次温服;对照组给予辛伐他汀20 mg,于每晚睡前口服.疗程均为8周.疗程结束时比较两组中医症状积分变化及血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等指标.结果 健脾化痰通脉方能明显改善冠心病血脂异常患者胸闷、胸痛、气短、体胖多痰、身体困重等临床症状,与对照组比较差异有统计学意义(P<0.05或P<0.01);且能明显改善患者各项血脂指标(P<0.01),实验室指标总有效率为73.33%,与对照组比较疗效接近,差异无统计学意义(P>0.05).结论 健脾化痰通脉方能明显改善冠心病血脂异常患者临床症状及各项血脂指标,并具有较高的安全性.     

冠心病患者合理调脂的几个最新要点(续5)

1 血脂异常的现状 血脂异常是血液脂质代谢异常的简称,主要包括:血清低密度脂蛋白胆固醇(LDL-C)水平过高和(或)总胆固醇(TC)水平过高;血清甘油三酯(TG)水平过高;血清高密度脂蛋白胆固醇(HDL-C)水平过低.     

银丹心脑通软胶囊对冠心病伴血脂异常病人血脂及Hcy水平的影响

目的分析银丹心脑通软胶囊对冠心病伴血脂异常病人血脂及同型半胱氨酸(Hcy)水平的影响。方法选取我院收治的冠心病伴血脂异常病人82例,采取随机数字法分成两组。对照组(n=41)采取常规治疗,观察组(n=41)在此基础上加用银丹心脑通软胶囊治疗,比较两组血脂及Hcy水平。结果两组治疗后低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、三酰甘油(TG)水平均优于治疗前,差异有统计学意义(P0.05)。观察组治疗后LDL-C、HDL-C、TC、TG水平均优于对照组,差异有统计学意义(P0.05)。两组治疗后Hcy水平均低于治疗前,差异均有统计学意义(P0.05)。观察组治疗后Hcy水平均优于对照组,差异有统计学意义(P0.05)。结论银丹心脑通软胶囊可确切改善冠心病伴血脂异常的血脂水平,并且可改善同型半胱氨酸水平,是一种有效的治疗药物。     

浅谈血脂异常的防治

所谓血脂异常是指血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)水平的升高，高密度脂蛋白-胆固醇(HDL-C)水平的降低而言。长期的血脂异常，可使脂质沉积在血管壁上，使管壁增厚、变硬，导致管腔狭窄，容易诱发动脉粥样硬化和冠心病。引起血脂异常的发病原因有多种，其中环境因素、个人膳食结构和生活习惯是造成血脂异常的重要危险因素。因此，预防和治疗血脂异常，对预防或减轻动脉粥样硬化的发生和发展，减少冠心病的发病率和病死率有其重要意义。     

中老年人TC、LDL-C、HDL-C与复发性脑梗死的关系

胆固醇(TC)水平与动脉粥样硬化密切相关,也是冠心病的重要危险因素,血脂异常与缺血性卒中之间关系的研究仍然没有确切的结论,研究表明动脉粥样硬化为脑梗死的病理基础[1~3].本文就TC、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-L)与复发性脑梗死关系进行探讨,拟为其预防和治疗提供临床依据.     

警惕无声杀手血脂异常

随着社会经济的发展,人民生活水平的提高和生活方式的变化,血脂异常的患病人数越来越多,是潜伏在我们身边的"无声杀手",严重威胁着我们的健康.专家提醒,只要改变一下生活方式,就可有效控制血脂,有助于预防心脏病和降低中风风险. 近三成居民健康受到高血脂威胁 血脂异常是指血脂水平超出了正常范围,主要有以下几种情况:血清中总胆固醇(TC)水平过高;低密度脂蛋白-胆固醇(LDL-C)水平过高;高密度脂蛋白-胆固醇(HDL-C)水平过低;甘油三酯(TG)水平过高.     

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…     

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。     

《中国成人血脂异常防治指南》解读

随着我国人民生活水平的提高、生活方式的改变,心脑血管疾病(冠心病和卒中)成为我国城乡居民的第一位死亡原因,目前已占总死亡人数的40%,且呈逐年上升和年轻化趋势.大量研究表明,血脂异常是心血管疾病的独立而重要的危险因素.1984-1999年北京市血脂异常调查表明,与冠心病病死率增加的相关因素中,77%归因于胆固醇水平的升高.目前我国成人血脂异常现患率为18.6%,估计全国血脂异常现患人数达1.6亿人,血脂异常已经成为我国居民的一个重要公共卫生问题.     

胆固醇吸收合成标志物与冠心病

冠心病是由多种危险因素引发的重大疾病,血脂异常是其重要的危险因素之一.目前,我国面临着严峻的血脂异常防治形势和严重的疾病防控挑战.2007年中国成人血脂异常防治指南的发表[1],标志着我国血脂异常防治工作进入一个新的历史阶段.胡大一教授最近指出,丰富的循证医学依据一再证实胆固醇的升高是引发冠心病的罪魁祸首,在当前繁重的血脂异常防治工作中,胆固醇是血脂干预的首要目标[2].20世纪90年代,北欧辛伐他汀生存研究(scandinavian simvastatin survival study,4S)等一系列采用他汀类药物调脂治疗的大规模临床试验已充分表明,通过大幅降低血清总胆固醇(TC)、特别是低密度脂蛋白胆固醇(LDL-C),可显著降低冠心病事件发生.     

冠心病糖尿病患者行血脂检验的临床探析

目的探讨血脂检验在诊断冠心病糖尿病中的效果。方法将2019年3月—2020年8月该院40例冠心病糖尿病患者作为实验组,选择同期健康体检40名作为对照组。两组均给予血脂检验,比较两组高密度脂蛋白胆固醇和总胆固醇、低密度脂蛋白胆固醇、甘油三酯和空腹血糖。结果实验组高密度脂蛋白胆固醇显著低于对照组,总胆固醇、低密度脂蛋白胆固醇、甘油三酯、空腹血糖显著高于对照组,差异有统计学意义(P<0.05)。结论血脂检验在诊断冠心病糖尿病中的效果确切,可准确有效反映患者血脂水平和健康人之间的差异,患者的总胆固醇、低密度脂蛋白胆固醇、甘油三酯明显升高,而高密度脂蛋白胆固醇明显降低,对于冠心病糖尿病的早期诊断,疾病预后的评估有重要的作用。     

微量元素与冠心病及其血脂的关系探讨

目的探讨微量元素与冠心病及其高血脂的关系.方法 用电感耦合等离子体原子发射光谱法测定了82例冠心病患者的6种微量元素变化,并与血脂做相关分析.结果示血清铁、锌、锌、铜比和铅在冠心病组较正常组明显增高,铬明显降低(P<0.01或0.001),铜和镉两组间无统计学差异.总胆固醇和低密度脂蛋白胆固醇分别与铁、锌、铅呈显著正相关,与铬呈显著负相关,高密度脂蛋白胆固醇与锌呈显著负相关(P<0.05或0.01).结论 提示部分微量元素的不平衡可能影响脂质代谢,并在冠心病中有重要发病学意义.     

清脂化瘀方联合阿托伐他汀治疗痰瘀互结证冠心病的临床研究

目的观察清脂化瘀方对常规他汀类药物治疗后血脂仍未达标的冠心病痰瘀互结证病人血脂、血液流变学及炎性因子的影响。方法选取2018年5月—2019年12月上海某三级甲等医院心血管内科门诊及住院治疗的冠心病痰瘀互结证病人72例,均经常规他汀类药物治疗后血脂仍未达标。按照随机数字表法分为对照组和治疗组,各36例,对照组给予西药常规治疗(阿托伐他汀及其他冠心病二级预防药物)加用安慰剂,治疗组给予西药常规治疗(阿托伐他汀及其他冠心病二级预防药物)及清脂化瘀方治疗。观察两组治疗前后血脂[小而密低密度脂蛋白胆固醇(sdLDL-C)、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)]、血液流变学[全血黏度(高切、低切)、纤维蛋白原(FIB)及红细胞比容]、炎性因子[白介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)]的变化,比较两组中医证候疗效。结果治疗组中医证候疗效总有效率高于对照组(88.9%与63.9%,P<0.05)。治疗后,治疗组sdLDL-C、TC、LDL-C、FIB、红细胞比容、TNF-α、IL-6均低于对照组(P<0...     

高血压冠心病与骨质疏松骨量的相关性研究

目的探讨高血压冠心病与骨质疏松骨量的关系。方法93例骨质疏松及骨量减少的绝经后女性，其中无高血压和冠心病组（A组）53例，有高血压或冠心病组（B组）40例，经双能X线骨密度仪测定腰椎、髋部骨密度．生化检测各项血脂指标即总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）。比较2组血脂及各部位骨密度的相关性变化。结果2组患者TC、LDL-C及腰椎骨密度有显著性差异（P〈0．05），A组TC、LDL．C均高于B组，腰椎骨密度低于B组；Ward三角、左侧股骨近端总骨密度、TG、HDL．C2组间无显著性差异。结论心血管疾病与骨质疏松之间存在一定的相关性。     

Body fat: Its relationship to coronary heart disease,blood pressure,lipids and other risk factors measured in a large male population

Obesity is variably considered to be a major contributor to hypertension and hyperlipidemia, and its treatment is recommended in the management of coronary heart disease. Total body fat was measured by tritium dilution in a large male population and its relationship to age, blood pressure, serum lipids, uric acid and the diagnoses of coronary heart disease, hypertension and glucose intolerance was examined. In addition, three commonly used weight: height indices of obesity were correlated with each of these parameters.The correlation of body fat with blood pressure, serum cholesterol and triglycerides, although statistically significant, was of only small magnitude. Mean levels of body fat were not significantly different between patients with coronary disease and control subjects, whereas serum cholesterol and, to a lesser extent, systolic blood pressure were potent risk factors for the disease. It is concluded that obesity is only a minor determinant of blood pressure and lipid level, and that its contribution to coronary heart disease is small or nonexistent.     

A comparative study of doxazosin versus atenolol in mild-to-moderate hypertension

Doxazosin, a quinazoline derivative, is a selective α₁-inhibitor that reduces calculated coronary heart disease risk by lowering blood pressure while favorably affecting blood lipid levels. The aim of this study was to compare the efficacy and toleration of doxazosin with atenolol, one of the most frequently used cardioselective β-blockers in Italy. Forty patients with mild-to-moderate hypertension were treated with either atenolol (100 mg) or doxazosin (mean dose, 3.3 mg) once daily for 8 weeks. Both drugs significantly reduced supine and standing systolic and diastolic blood pressures. Atenolol induced marked bradycardia, whereas doxazosin had very little effect on heart rate. Doxazosin produced a favorable effect on blood lipid levels by decreasing triglyceride and total cholesterol levels and increasing high-density lipoprotein cholesterol and high-density lipoprotein total cholesterol ratio. Atenolol had exactly the opposite effect on blood lipid levels. Both drugs had equivalent toleration profiles. It was concluded that doxazosin was as effective as atenolol in reducing elevated supine and standing blood pressures. In addition, doxazosin had a beneficial effect on lipid profiles and minimal effect on heart rate. Therefore doxazosin may reduce calculated coronary heart disease risk in hypertensive patients.     

Importance of HDL cholesterol levels and the total/ HDL cholesterol ratio as a risk factor for coronary heart disease in molecularly defined heterozygous familial hypercholesterolaemia.

AIMS: To assess the relationship of the lipid profile to coronary heart disease in a group of heterozygous familial hypercholesterolaemic subjects with similar age, sex, body mass index, prevalence of angiotensin converting enzyme DD genotype and type of low density lipoprotein receptor mutation. METHODS AND RESULTS: A total of 66 molecularly defined heterozygous familial hypercholesterolaemic subjects, 33 of whom had coronary heart disease, were studied. Clinical features, cardiovascular risk factors and lipid parameters were compared in both groups. Familial hypercholesterolaemic patients with coronary heart disease showed significantly lower values of mean plasma HDL cholesterol and a higher total/HDL cholesterol ratio as compared with familial hypercholesterolaemic subjects free of coronary heart disease. Total and LDL cholesterol concentrations were higher in patients with coronary heart disease, without reaching statistical significance. No differences in plasma lipoprotein(a) levels on absolute and log-transformed values were observed between the two groups. In the whole familial hypercholesterolaemia group, plasma HDL cholesterol levels were related to plasma triglyceride values and to LDL receptor gene 'null mutations'. CONCLUSIONS: In familial hypercholesterolaemic subjects of similar age, gender, body mass index, systolic and diastolic blood pressure, and genetic factors that could influence coronary heart disease risk, plasma HDL cholesterol values and total/HDL cholesterol ratios are two important coronary risk factors. Hence, treatment of familial hypercholesterolaemia should focus not only on lowering total and LDL cholesterol levels, but also on increasing HDL cholesterol values for coronary heart disease prevention. More prospective and intervention trials should be conducted to establish the relationship of HDL cholesterol levels and coronary heart disease in familial hypercholesterolaemia.     

Family history of myocardial infarction as an independent risk factor for coronary heart disease

The hypothesis that a family history of heart attack before the age of 60 years is an independent risk factor for coronary heart disease was examined in a random sample of 1044 men aged 40-70. Data on personal and family history, smoking, weight, height, plasma lipid and lipoprotein concentrations, blood pressure, and resting and exercise electrocardiograms were collected according to the standard Lipid Research Clinics protocol. A history of heart attack in first degree relatives was ascertained by interviewing the participants. Evidence of coronary heart disease was found in 123 men (reported heart attack in 20, electrocardiographic findings of ischaemic heart disease at rest in 40, and electrocardiographic findings during heart rate limited exercise in 63). Subjects with coronary heart disease had considerably higher concentrations of total cholesterol, higher blood pressures, and lower concentrations of high density lipoprotein cholesterol than those without. Twenty nine per cent of the subjects with coronary heart disease reported a history of heart attack in a first degree relative before 60 years of age compared with 19% of those without. In a multivariate logistic model, the coefficients for age, cholesterol concentrations, and hypertension were all positive and statistically significant. The coefficient for HDL cholesterol concentration was negative and significant. A family history of heart attack showed a significant positive association, indicating a relation with coronary heart disease that is independent of the other variables in the model. The relation persisted in apparently asymptomatic patients with coronary heart disease.     

Family history of myocardial infarction as an independent risk factor for coronary heart disease.

The hypothesis that a family history of heart attack before the age of 60 years is an independent risk factor for coronary heart disease was examined in a random sample of 1044 men aged 40-70. Data on personal and family history, smoking, weight, height, plasma lipid and lipoprotein concentrations, blood pressure, and resting and exercise electrocardiograms were collected according to the standard Lipid Research Clinics protocol. A history of heart attack in first degree relatives was ascertained by interviewing the participants. Evidence of coronary heart disease was found in 123 men (reported heart attack in 20, electrocardiographic findings of ischaemic heart disease at rest in 40, and electrocardiographic findings during heart rate limited exercise in 63). Subjects with coronary heart disease had considerably higher concentrations of total cholesterol, higher blood pressures, and lower concentrations of high density lipoprotein cholesterol than those without. Twenty nine per cent of the subjects with coronary heart disease reported a history of heart attack in a first degree relative before 60 years of age compared with 19% of those without. In a multivariate logistic model, the coefficients for age, cholesterol concentrations, and hypertension were all positive and statistically significant. The coefficient for HDL cholesterol concentration was negative and significant. A family history of heart attack showed a significant positive association, indicating a relation with coronary heart disease that is independent of the other variables in the model. The relation persisted in apparently asymptomatic patients with coronary heart disease.     

High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study.

Lipid and lipoprotein values, including fasting triglycerides and high density lipoproteins (HDL), low density lipoproteins (LDL) and total cholesterol levels, were obtained on 2,815 men and women aged 49 to 82 years chiefly between 1969 and 1971 at Framingham. In the approximately four years following the characterization of lipids, coronary heart disease developed in 79 of the 1,025 men and 63 of the 1,445 women free of coronary heart diseases. At these older ages the major potent lipid risk factor was HDL cholesterol, which had an inverse association with the incidence of coronary heart disease (p less than 0.001) in either men or women. This lipid was associated with each major manifestation of coronary heart disease. These associations were equally significant even when other lipids and other standard risk factors for coronary heart disease were taken into consideration. A weaker association with the incidence of coronary heart disease (p less than 0.05) was observed for LDL cholesterol. Triglycerides were associated with the incidence of coronary heart disease only in women and then only when the level of other lipids was not taken into account. At these ages total cholesterol was not associated with the risk of coronary heart disease.