颈动脉内膜-中层厚度与冠心病危险因素间的关系

目的探讨颈动脉内膜-中层厚度(IMT)与冠心病(CAD)危险因素间的关系。方法可疑或确诊CAD患者104例,入院时均应用超声技术测量双侧颈总动脉远端的IMT,同时检测CAD 危险因子年龄、性别、吸烟情况、收缩压、舒张压、脉压、空腹血糖、甘油三脂、总胆固醇、高密度脂蛋白、低密度脂蛋白(LDL-C)、血尿酸值。数据采用SPSS10．0统计学软件进行多因素回归统计分析。分析颈总动脉IMT(CCIMT)与CAD危险因素之间的关系。结果平均CCIMT与CAD危险因素的关系,在排除混杂因素后,与年龄、吸烟、脉压差、高LDL-C及高尿酸呈显著相关(P<0．001),而与高甘油三脂、高总胆固醇、低高密度脂蛋白及血糖异常无显著相关。结论 CCIMT的增加与冠心病危险因素直接相关。超声测定颈动脉IMT可作为预测CAD的非侵入性检查手段。     

检验血糖、血脂的异常现状及相关危险因素分析

目的分析血糖、血脂异常流行病学以及相关危险因素。方法收集我院体检者共1064例,采用日立7180型全自动生化仪对其血糖以及血脂水平进行检查,并分析其血糖、血脂水平异常危险因素。结果 目前血糖、血脂异常分布率呈上升趋势,年龄、性别、超重、职业、吸烟、研究以及文化程度均是造成血糖及血脂水平异常的主要危险因素。结论近年来,血糖及血脂异常检出率呈上升趋势,其影响因素众多,加强危险因素的防控,针对高危人群非常必要。     

血清脂联素监测对原发性高血压患者的意义

目的评价脂联素在原发性高血压(EH)发生、发展中的作用;分析血清脂联素水平与心血管危险因素之间的关系。方法①选择潍坊医学院附属医院门诊及住院的EH患者60例,以及体质量指数(BMI)、年龄、性别匹配的健康体检者60例。②用酶联免疫吸附测定(ELISA)法检测血清脂联素浓度;进行24h动态血压监测(ABPM)及常规的临床和实验室指标的检测。结果①EH患者血清脂联素水平明显低于BMI、年龄、性别匹配的正常对照者(P<0.01)。②EH患者lg(脂联素浓度)与BMI、腰臀比(WHR)、年龄、24h平均收缩压、24h平均舒张压、24h平均动脉压均呈负相关。回归分析显示,常规心血管危险因素中只有24h平均动脉压、BMI、年龄是血清脂联素水平的独立预测因子。结论①EH患者血清脂联素浓度低于正常对照,低脂联素血症与EH的发生、发展有一定关系。②EH患者的脂联素浓度与年龄、BMI、WHR、24h平均收缩压、24h平均舒张压、24h平均动脉压均呈负相关。24h平均动脉压、BMI、年龄是EH患者血清脂联素水平的独立影响因素。     

高血压患者PWV与早期肾功能损害及左室肥厚的相关性分析

【摘要】目的 探讨原发性高血压患者脉搏波传导速度与早期肾功能损害及左室肥厚之间的关系。方法 选取年龄60~90岁的原发性高血压患者427例,测定其臂踝脉搏波传导速度（baPWV）,根据baPWV四分位数将人群分成4组。测定其各项生化指标,计算肾小球滤过率（eGFR）;心脏多普勒超声检查计算左室心肌质量指数（LVMI）以评价左室肥厚的程度。结果 4组间年龄、踝臂指数(ABI)、收缩压、平均动脉压、脉压、空腹血糖、LVMI及eGFR差异有统计学意义（P＜0.05）;偏相关分析发现,控制年龄及血糖后,baPWV与收缩压、平均动脉压、脉压、LVMI呈正相关（r 分别为0.295、0.187、0.292和0.159,P＜0.01）,baPWV与eGFR呈负相关（r=-0.314,P＜0.01）。多元线性回归显示,调整其他心血管危险因素后,年龄、baPWV和舒张压仍是eGFR的影响因素（t分别为8.251、6.834、2.142,P＜0.05）,收缩压和ABI是LVMI的影响因素（t分别为4.557和3.016,P＜0.05）,尚不能认定baPWV是LVMI的影响因素(t=1.722,P=0.086)。结论 baPWV对预测心血管危险因素及高血压导致肾功能损害的早期筛查和预防有重要作用。     

进展性脑梗死相关因素分析

目的了解进展性脑梗死的相关危险因素。方法进展性脑梗死52例作为观察组,同期非进展性脑梗死104例作为对照组,比较两组患者性别、年龄、颅内外大血管狭窄、入院时平均动脉压、入院时体温、C反应蛋白、空腹血糖等方面的差异。结果观察组的平均动脉压低、体温高、C反应蛋白及空腹血糖水平高,颅内外大血管狭窄率高,两组比较差异有统计学意义。结论引起进展性脑梗死因素复杂,应积极控制相关因素,减少进展性脑梗死的发生。     

高血压早期患者BPV和踝-臂指数的年龄差异

目的 探讨高血压早期患者血压变异率(BPV)与动脉弹性踝-臂指数(ABI)的年龄差异.方法 未经服药治疗的高血压早期患者68例分为两组:A组41例,年龄＜60岁;B组27例,年龄≥60岁.依据24-h动态血压测定不同时间多次血压的脉压(PP)及其均值标准差(SD)来确定BPV;同时采用全自动动脉弹性检测仪检测ABI.结果 B组24-h平均脉压、日间平均脉压、夜间平均脉压和夜间收缩压差值SD均高于A组[(63.4±17.4) mmHg vs.(51.4±6.0) mmHg、(63.6±17.0) mmHg vs.(51.7±6.2)mmHg、(61.4±21.0) mmHg vs.(49.4±8.0)mmHg和(11.2±3.7)mmHg vs.(8.9±3.3) mm Hg](P＜0.05).B组ABI异常发生率也高于A组(51.9％ vs.24.4％)(P＜0.05).结论 ≥60岁高血压早期患者的24-h平均脉压、日间平均脉压、夜间平均脉压、夜间收缩压差值及ABI异常率均高于＜60岁者.     

有心血管危险因素患者的踝臂指数及颈动脉粥样硬化相关性研究

目的探讨有心血管危险因素患者的踝臂指数(ABI)及颈动脉粥样硬化的关系。方法选取2008年10月至2010年10月于我院住院有一个以上心血管危险因素患者。分别测量每位患者的ABI、颈动脉内膜中层厚度(IMT)、体质量、血压、血糖、胆固醇血尿酸、血肌酐。分析心血管危险因素与ABI及颈动脉粥样硬化的关系。结果共入选108例,男66例,女42例,年龄31~92岁。年龄,糖尿病,高胆固醇血症是ABI异常的独立危险因素;年龄,糖尿病,高胆固醇血症,高血压,吸烟是IMT异常的独立危险因素。直线相关分析显示,踝臂指数与颈动脉粥样硬化严重程度呈负相关(r=-0.39,P<0.05)。结论心血管危险因素及踝臂指数与颈动脉粥样硬化发展相关,有心血管危险因素患者常规测量ABI、IMT对早期发现动脉粥样硬化有重要价值。     

住院高血压患者的糖代谢调查分析

目的检测住院原发性高血压伴糖代谢异常患者的数据,为全面干预危险因素提供科学依据。方法对住院高血压患者均进行空腹血糖（FPG）检测,空腹血糖（FPG）〈6.1mmol/L,确诊为原发性高血压的298例住院患者行口服葡萄糖耐量试验（OGTT）后2h的血糖测定。观察年龄、性别、体重指数、高血压病程、血压水平、血脂等参数与OGTT后2h血糖的关系。结果 （1）298例患者中检出糖尿病患者42例（14%）,空腹血糖受损（IFG）21例（7%）,糖耐量受损（IGT）66例（22%）。（2）正常糖耐量组与糖代谢异常组间比较空腹血糖（FPG）差异有统计学意义。结论原发性高血压患者合并糖代谢异常的比例高,对于空腹血糖正常的高血压患者均应进行OGTT测定,以早期发现可能存在的糖代谢异常,早期干预,降低心血管事件发生的危险。     

杭州市老年人群心血管事件发生风险的危险因素及相关预防干预对策研究

目的探讨杭州市老年人群心血管事件发生风险的危险因素,制定预防干预措施对策提供依据。方法选取2015年2月至2019年2月在我院进行健康体检的老年人278例作为研究对象,统计心血管事件发生情况,并收集相关资料,分析心血管事件发生风险的危险因素。结果278例健康体检的老年人中心血管事件高危风险者100例,发生率35.97%;2组性别、婚姻状况、文化程度及人均收入对比,差异无统计学意义(P>0.05);与无心血管事件风险者比较,年龄(≥80岁)、收缩压(异常)、空腹血糖(异常)、总胆固醇(异常)、吸烟、饮酒占比较高,运动习惯占比较低,差异有统计学意义(P<0.05);经Logistic分析,年龄(≥80岁)、收缩压(异常)、空腹血糖(异常)、总胆固醇(异常)、吸烟、饮酒为老年人心血管事件风险发生的危险因素(OR>1,P<0.05);而运动习惯为老年人心血管事件风险发生的保护因素(OR<1,P<0.05)。结论收缩压、年龄、空腹血糖、总胆固醇、吸烟、饮酒及运动习惯为老年人心血管事件风险发生的影响因素,需采取对应干预措施,控制心血管事件发生率。     

某市15岁以上自然人群糖尿病及其危险因素的现状研究

目的了解肇庆市城乡自然人群糖尿病及其危险因素流行现状。方法采用多阶段随机抽样法抽取肇庆市15岁以上居民3617例进行现况调查。结果肇庆市15岁以上自然人群糖尿病、糖耐量受损和空腹血糖受损现患率分别为10.81%、15.51%和7.82%;年龄、性别、糖尿病家族史、血脂异常和代谢综合征为该地区糖尿病的危险因素。结论肇庆市城乡自然人群糖尿病及其患病风险处于较高水平,应针对该地区糖尿病的危险因素和前期人群大力开展个性化和专科相结合的糖尿病防治工作。     

老年代谢综合征患者动脉弹性的相关研究

目的探讨老年代谢综合征(MS)与动脉弹性的关系。方法根据2005年国际糖尿病联盟MS诊断标准将256例受试者分为健康对照组(无任何指标异常)、非MS组(不满足MS标准但含有1个以上代谢指标异常)、MS组亚组1(腰围+其他2项指标异常)、亚组2(腰围+其他3项或以上指标异常)。应用全自动脉搏波速度测量系统测定臂—踝动脉脉搏波速度(baPWV)作为反映动脉弹性的指标,并与各临床观察指标进行多元回归分析。结果MS各亚组baPWV均显著高于健康对照组(P<0.01)及非MS组(P<0.01),非MS组与对照组间差异也有统计学意义(P<0.01)。ba PWV与年龄(r=0.543,P<0.001)、收缩压(r=0.562,P<0.001)、舒张压(r=0.387,P<0.001)、平均动脉压(r=0.468,P<0.001)、脉压(r=0.487,P<0.001)、空腹血糖(r=0.519,P<0.001)、甘油三酯(r=0.236,P<0.001)、腰围(r=0.136,P=0.029)和尿酸(r=0.162,P=0.010)呈显著正相关。多元逐步回归分析显示,年龄、收缩压和甘油三酯是影响baPWV的独立因素。结论在老年人群中MS组成成分的聚集可能促进动脉硬化的发生和发展。对老年MS患者进行代谢成分聚集的评估及进行脉搏波速度检测有助于心血管事件的一级预防。     

Impact of physical and physiological factors on arterial function

1. Arterial function measurements are increasingly used as surrogate markers of cardiovascular disease and it is important to define which non-pathological factors may influence these measurements. 2. The present study examined the influence of gender, height, body mass index (BMI), waist : hip ratio, heart rate and arterial pressure on pulse wave velocity (PWV), systemic arterial compliance (SAC) and central pressure augmentation index (AI) in 285 normal subjects, 98 males and 187 females, aged 50-82 years. 3. There were significant gender differences in PWV (higher in men), SAC (higher in men) and central pressure AI (lower in men). 4. Both SAC and AI were correlated with height in men and women and height largely accounted for gender differences. 5. Systemic arterial compliance was positively, whereas AI was negatively, correlated with BMI. 6. Both PWV and AI were significantly correlated with heart rate and central pulse pressure. 7. These findings may have implications for cardiovascular disorders. Reduced central arterial compliance and increased central pressure augmentation are potential mediators for the increased cardiovascular risk of short stature. A slow heart rate may contribute to increased central arterial pressure with potentially adverse consequences in older subjects.     

The role of endocannabinoid system blockade in the treatment of the metabolic syndrome

This review considers the use of the first selective blocker of the cannabinoid receptor type 1, rimonabant, to reduce weight and improve cardiovascular disease risk factors in obese patients with metabolic syndrome or multiple cardiovascular disease risk factors. In 4 large trials-Rimonabant in Obesity (RIO)-Lipids, RIO-Europe, RIO-North America, and RIO-Diabetes-after 1 to 2 years of treatment, rimonabant (20 mg/day) led to a significantly greater weight loss and reduction in waist circumference compared with placebo. Treatment with rimonabant was also associated with other favorable changes, including better glycemic control in type 2 diabetes mellitus, improved lipid profile, reduced blood pressure, increased adiponectin levels, fall in high-sensitivity C-reactive protein concentrations, and an overall decrease in the prevalence of the metabolic syndrome. Initial experience with rimonabant shows that it is generally well tolerated with the most common side effect of mild nausea. Rimonabant may be a useful adjunct to lifestyle and behavior modification in the treatment of obese subjects with metabolic syndrome or multiple cardiometabolic risk factors.     

High prevalence of the metabolic syndrome among a Swedish cohort of patients with schizophrenia

Several cardiovascular risk factors have been linked to antipsychotic treatment and cardiovascular mortality is increased in these patients compared to the general population. The full metabolic syndrome (or its components) is associated with an increased risk of cardiovascular disorders. The prevalence of the metabolic syndrome was investigated using a cross-sectional study design in a cohort of 269 patients, aged 20-69 years, with schizophrenia living in Northern Sweden, and was defined according to the criteria of the National Cholesterol Education program. The prevalence of the metabolic syndrome was 34.6% (95% CI = 28.8-40.3) and highest (43%; 95% CI = 32-53) for participants aged 40-49 years. Clozapine treated subjects reached the highest prevalence of the metabolic syndrome (48%; 95% CI = 34-62). The prevalence was similar for men (32.8%; 95% CI = 25.8-39.8) and women (38.0%; 95% CI = 27.9-48.2). Men had a high prevalence of hypertension (49.2%; 95% CI = 41.7-56.6) and women had high prevalence of low high-density lipoprotein cholesterol (40.2%; 95% CI = 30.0-50.4) and abdominal obesity (75.0%; 95% CI = 66.0-84.0). Subjects with the metabolic syndrome had significantly higher mean body mass index (BMI) (P < 0.001), HbA1c (P = 0.002), and fasting serum insulin (P < 0.001) compared to non-metabolic syndrome subject. Subjects with the metabolic syndrome had also significantly more often a positive history of cardiovascular diseases compared to non-metabolic syndrome subjects (25.8% versus 12.5%; P = 0.01). Of all study subjects 36.8% were obese (BMI > 30). These results clearly show that the metabolic syndrome and its components are highly prevalent in patients with schizophrenia. Physicians treating patients with schizophrenia are recommended to monitor the components included in the metabolic syndrome.     

Arterial stiffness and cardiovascular outcome

1. Studies have reported an association between arterial function indices and cardiovascular risk factors, as well as the risk of incident cardiovascular events, including coronary heart disease and stroke. 2. The data are overwhelmingly in favour of an independent role for aortic pulse wave velocity in predicting fatal and non-fatal cardiovascular events in healthy and diseased populations and in the evaluation of cardiovascular risk. 3. Augmentation index may independently predict all-cause mortality and cardiovascular events in coronary and end-stage renal disease patients, but some outcome studies have questioned its usefulness in hypertensive subjects and dialysis patients. 4. Systemic arterial compliance, to this time, has not been shown to independently predict cardiovascular outcome. 5. Future cardiovascular risk is greatly modified by prior disease and risk factors; the greatest additional value in measuring arterial stiffness and compliance may be in those with little or no end-organ disease.     

Large artery stiffness and antihypertensive agents

Purpose of Review: Since in hypertensive populations, concentration on peripheral blood pressure only does not achieve 100% of blood pressure-attributable risk reduction, taking into consideration other hemodynamic parameters than peripheral blood pressure could perhaps improve cardiovascular prevention. The main purpose of this review is to analyse the scientific data in favour of considering arterial stiffness parameters as interesting intermediate cardiovascular endpoints in order to optimise risk assessment and risk reduction strategies. Summary: Aortic pulse wave velocity (PWV), a marker of aortic stiffness, has been shown to be a strong independent predictor of cardiovascular morbid events, cardiovascular and all-cause mortality in numerous studies in different populations. Furthermore, it has been shown in a therapeutic trial that the lack of aortic PWV attenuation despite significant drug-induced reduction in mean blood pressure was a significant predictor of cardiovascular death in subjects with end-stage renal disease. In essential hypertension, the Reason Study has shown that, despite a similar decrease in peripheral diastolic blood pressure, different effects on central hemodynamic parameters were observed between blockade of the renin-angiotensin system and atenolol. Novel therapeutic approaches available to reduce the increase of pulse pressure and arterial stiffness with age involve converting enzyme inhibitors in association with diuretic compounds; nitrate derivatives; agents acting on collagen cross-linking; and finally spironolactone and vasopeptidase inhibitors. Conclusion: These results support the hypothesis that measurement of aortic PWV could then help, not only in risk assessment strategies but also in risk reduction strategies by monitoring arterial stiffness under different pharmacological regimens.     

Dyslipidemia independent of body mass in antipsychotic-treated patients under real-life conditions

OBJECTIVE: Antipsychotic (AP) treatment, in particular with some second-generation drugs, is associated with weight gain and other metabolic side effects. However, the relationship between drug-induced weight gain and dyslipidemia is not well understood. We investigated how cardiometabolic risk factors were related to body mass during treatment with different APs under real-life conditions. METHODS: This cross-sectional naturalistic study included 242 subjects with severe mental disorders who were on monotherapy with olanzapine (OLZ) or clozapine (CLZ) (n = 80), monotherapy with other APs (n = 80), or unmedicated (n = 82). Groups were adjusted for age and compared for prevalence of the metabolic syndrome and its components. Groups were further adjusted for body mass and compared for mean values of blood pressure, lipids, and fasting glucose. RESULTS: There was no significant intergroup difference in the prevalence of metabolic syndrome, obesity, hypertension, or hyperglycemia. Despite similar body mass index, OLZ/CLZ-treated subjects had significantly higher prevalence of dyslipidemia (high triglyceride and low HDL cholesterol levels) than unmedicated subjects. They also had higher mean values of triglycerides (P = 0.003) and lower mean values of HDL cholesterol (P < 0.001). Patients treated with other APs had intermediate values. CONCLUSIONS: Intergroup differences in body mass index were minimal in this naturalistic setting, probably because of awareness of this treatment hazard among clinicians. However, independently of body mass, dyslipidemia was significantly associated with AP treatment, in particular with OLZ and CLZ. These findings indicate a primary effect of APs on lipid regulation, important in understanding their mechanism of action, and with clinical implications.     

Association between reflux oesophagitis and features of the metabolic syndrome in Japan

BACKGROUND: There have been many reports about the relationship between reflux oesophagitis and obesity, but not the metabolic syndrome. AIM: To review upper gastrointestinal endoscopic findings and screening data obtained in healthy subjects, and assess relations between reflux oesophagitis and features of the metabolic syndrome. METHODS: In 3599 men and 1560 women, the prevalence of reflux oesophagitis was assessed in relation to the age, body mass index, blood pressure, triglycerides and fasting blood glucose. Logistic regression analysis was used to calculate odds ratio for risk factors. RESULTS: The overall prevalence of reflux oesophagitis was 4%, and it increased with age in women. Prevalence of reflux oesophagitis increased significantly with an increase of body mass index, blood pressure, triglycerides and fasting blood glucose. On multivariate analysis, male sex (odds ratio: 2.5; 95% confidence interval: 1.6-3.8), obesity (1.9; 1.4-2.5), hyperglycaemia (1.7; 1.2-2.4) and hypertension (1.5; 1.1-2.1) were independent risk factors for reflux oesophagitis. Among both men and women, those with reflux oesophagitis were significantly more likely to have two or more of these risk factors than non-reflux oesophagitis subjects. CONCLUSIONS: Components of the metabolic syndrome are associated with the occurrence of reflux oesophagitis. Therefore, some risk factors may be common to reflux oesophagitis and the metabolic syndrome.     

Amélioration des composantes systolique et pulsée de la pression artérielle,de la rigidite artérielle et de l’hypertrophie ventriculaire gauche chez des patients hypertendus traités par l’association perindopril/indapamide. L’étude REASON

Improving the systolic and pulse pressure components of blood pressure, arterial stiffness and left ventricular hypertrophy in hypertensive patients treated with the perindopril/indapamide combination. The REASON Study.It is now well established, particularly in elderly patients, that systolic blood pressure (SBP) levels represent a more reliable predictor than diastolic blood pressure of hypertension-related morbidity and mortality including coronary heart disease, stroke, heart failure, renal insufficiency and cardiovascular death. Adequate control of SBP has therefore become a major objective of antihypertensive therapies. Indeed, despite the recent focus on the systolic blood pressure component in the latest guidelines, systolic hypertension is frequently neglected in clinical practice. Furthermore, several observational studies have suggested that pulse pressure (PP) may be a superior predictor of cardiovascular complications than mean arterial pressure (MAP) levels in certain populations and in elderly patients in particular. Finally, pulse pressure is a marker of large artery stiffness; in risk assessment and risk reduction strategies, pulse pressure and arterial stiffness are strongly associated with vascular alterations and are therefore more closely related to cardiovascular risk. The REASON Study was initiated from these observations.     

Epidemiology of risk factors for hypertension: implications for prevention and therapy.

We review the present knowledge of risk factors for arterial hypertension. Both genetic and environmental factors as well as their interaction and biological plausibility are reviewed. Recent data confirm that the interaction of genetics with multiple environmental risk factors explains the high prevalence of hypertension in the industrialised countries. The most important modifiable environmental risk factors are high salt intake, alcohol intake, obesity and low physical activity. The role of stress in the aetiology of high blood pressure is still under investigation, but recent clinical experimental and epidemiological data have shed light on how stress could be related to hypertension. The implications for prevention and treatment are discussed both at the population and individual levels. The population approach involves a public health policy aiming at modification of the major risk factors. The individual approach involves nonpharmacological measures to prevent the development of hypertension and to treat high normal blood pressure and mild hypertension with no additional cardiovascular risk factors. Pharmacological treatment of hypertension in most individuals should use agents that have been proven to be effective in randomised controlled trials with 'hard' endpoints such as cardiovascular and cerebrovascular morbidity and mortality.