The risk factors for ischemic heart disease in young adults

We reviewed the histories and laboratory data of 67 young patients with ischemic heart disease under the age of 40 years. Twenty-three cases were associated with hypercholesterolemia. Of these, 10 were of the familial type. Twenty patients had hypertension, while 14 were diabetics and 13 were heavy smokers. It is noteworthy that 13 of 17 patients with multi-vessel disease and hypercholesterolemia. Significant atherosclerotic coronary stenosis was demonstrated in 51 cases. The incidences of hypercholesterolemia, hypertension and diabetes mellitus in these 51 patients were not only significantly higher than those in age-matched normal health subjects and young patients with non-ischemic heart disease, but also higher than those in patients with ischemic heart disease over the age of 40 years. The results indicated that hypercholesterolemia is the most important risk factor for ischemic heart disease in young patients, although the three previously accepted risk factors (hypertension, diabetes mellitus and cigarette smoking) were all associated with the development of the disease. We could not find any obvious risk factor in 18 young patients with ischemic heart disease, including 12 cases of myocardial infarction. Myocardial infarction in the absence of any obvious risk factor occurred during strenuous physical exercise in 5 patients and following excessive alcohol consumption in 4.     

阻塞性睡眠呼吸暂停低通气综合征对缺血性脑血管病危险因素及认知功能的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对缺血性脑血管病危险因素及认知功能的影响。方法入选缺血性脑血管病及OSAHS患者95例,根据诊断将患者分为缺血性脑血管病合并OSAHS组(合并组)40例,缺血性脑血管病不伴OSAHS组(脑血管病组)35例,单纯OSAHS组(OSSHS组)20例,3组均进行简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)测定。结果合并组合并高血压、饮酒比例及体重指数高于脑血管病组(P<0.05);MMSE、MoCA评分、执行功能和延迟记忆评分显著低于脑血管病组和OSAHS组(P<0.01);定向力、语言能力和积木试验评分低于OSAHS组(P<0.05)。OSAHS组患者MMSE和MoCA评分与呼吸暂停低通气指数(r=-0.371、-0.547,P<0.05)、氧减指数(r=-0.541、-0.594,P<0.01)呈负相关,与夜间平均SaO_2(r=0.404、0.453,P<0.05)呈正相关。结论 OSAHS加重缺血性脑血管病的危险因素和认知功能障碍。     

Genetic factors of risk of ischemic heart disease development in patients with familial hypercholesterolemia

Ischemic heart disease (IHD) develops in patients with familial hypercholesterolemia (FHC) 15-20 years earlier than in general population. However age of onset of the disease, its clinical manifestations are variable and not completely determined by cholesterol level and class of low density lipoprotein receptor mutations. AIM: To elucidate associations of some auxiliary genetic factors -- such as C151565T, C677T, R353Q polymorphisms of glycoprotein IIIa (GPIIIa), methylenetetrahydrofolate reductase (MTHFR) and coagulation factor VII genes, respectively, -- with the presence of IHD in patients with FHC. MATERIAL: Patients with clinical diagnosis of heterozygous FHC (n=198) with (n=106) and without (n=92) IHD. RESULTS: Patients with compared with those without IHD had similar frequency of T-allele of MTHFR gene (p=0.519), more often had T-allele of GPIIIa gene (23 and 12.5%, respectively, p=0.009), and less often -- Q-allele of factor VII gene (13 and 21%, respectively, p=0.048). Multifactorial analysis showed that risk of IHD was higher in patients with TT compared with CC genotype of the GPIIIa gene (OR 1.53, 95%CI 1.12-2.3), and lower in patients with RQ and QQ compared with RR genotype of factor VII gene (OR 0.41, 95%CI 0.19-0.75). CONCLUSION: In patients with FHC polymorphisms in factor VII and GPIIIa genes but not C677T polymorphism of MTHFR gene were associated with the presence of IHD.     

Serum plasmalogens in ischemic cerebrovascular disease.

Plasmalogens, a subclass of glycerophospholipids are ubiquitous constituents of cellular membranes and serum lipoproteins. Comparing concentrations of plasmalogens in sera from patients suffering from ischemic cerebrovascular disease with serum levels in a normal population significantly lower values were found for patient sera.     

青年缺血性卒中的危险因素和病因学

青年缺血性卒中对患者是一个灾难性事件,可导致死亡、残疾、丧失工作能力和生活质量下降。神经科医生在面对疑似青年缺血性卒中患者时,诊断的最大挑战是查明病因。文章就青年缺血性卒中的危险因素、病因学诊断及其相关的一些疾病和功能障碍进行了综述。     

缺血性脑血管病患者认知功能障碍的血管因素分析

目的探讨缺血性脑血管病患者血管因素与认知功能障碍关系。方法将60例缺血性脑血管病患者分为轻危组、中危组和高危组;应用经颅多普勒超声(TCD)检测脑血管血流动力学,蒙特利尔量表进行认知功能评定。结果高危组与低危组在视空间和执行功能、注意力、计算力、抽象概括能力、命名、记忆、时间定向方面有显著差异(P<0.05);中危组与低危组比较在视空间和执行功能、注意力、计算力、抽象概括能力、记忆方面有显著差异(P<0.05);视空间、命名、计算、语言、时间定向各方面中危组较高危组有显著差异(P<0.05)。高危组TCD异常比例明显高于轻危组(P<0.05),主要表现在大脑中动脉、椎动脉、基底动脉流速增快,频谱异常。中危组TCD结果异常比例明显高于轻危组,主要表现在各动脉流速增快;高危组较中危组在流速增快与频谱异常比例显著增高(P<0.05)。结论缺血性脑血管病患者随着危险因素增多,其认知功能障碍越显著,TCD各指标异常率也随之升高。     

皮质下缺血性脑血管病

皮质下缺血性脑血管病是血管性认知功能障碍中最常见的亚型之一.文章就其发病机制、神经心理学表现、影像学改变及生物学标记物等方面的研究进展进行了综述.     

Correlation of hyper-homocysteinemia with coronary artery disease in absence of conventional risk factors among young adults

Objective

Coronary artery disease is major cause of mortality and morbidity. Homocysteine has long been postulated as an underlying factor for atherosclerosis leading to coronary artery disease, yet its role in young patients is uncertain. This study was aimed to analyze the correlation between plasma homocysteine and coronary artery disease among young adults in the absence of conventional risk factors.

应用颈动脉超声分析缺血性脑血管病危险因素与颈动脉斑块的关系

缺血性脑血管病是中老年患者常见病，颈动脉粥样硬化斑块则是其最常见的致病原因之一，可用其反映全身动脉粥样硬化的程度。颈动脉双功能超声具有安全、无创、简便易行及直观准确的特点，在临床得到广泛应用。作者对642例缺血性脑血管病患者进行了颈动脉超声检查，以探讨颈动脉斑块与高血压、糖尿病、血脂异常、白细胞增高等动脉硬化危险因素的关系，以及与脑梗死发生、发展的相互关系。     

Prevalence of cardiovascular risk factors in adults with congenital heart disease.

BACKGROUND: Empirical evidence indicates that patients with congenital cardiac anomalies may be prone to developing coronary heart disease. Although primary prevention of ischaemic heart disease in patients with congenital heart defects is important, data on the prevalence of cardiovascular risk factors in these patients are not available. The aims of this study are therefore to describe the prevalence of risk factors for coronary heart disease in a large sample of adults with congenital cardiac anomalies, and compare this with the prevalence in the general population. DESIGN: A retrospective analysis of computerized patient records. METHODS: At our outpatient clinic, all patients are examined by an advanced practice nurse and a congenital heart disease cardiologist. Data on smoking behaviour, sports participation, blood pressure, body mass index, and the diagnosis of diabetes are recorded systematically. Data on the general population were derived from national health surveys. RESULTS: In a 4-year period, we collected data on 1976 individual patients. Male patients had a significantly higher prevalence of smoking and elevated blood pressure, whereas women were less engaged in sports activities and were more often obese. In comparison with the general population, our patients reported less smoking and more participation in sports, but presented more often with hypertension or diabetes. Only 20.4% of men and 21.0% of women have a fully heart-healthy lifestyle, as they presented without any risk factor. CONCLUSION: A substantial number of patients had one or more cardiovascular risk factors. Therefore, primary prevention by strengthening educational efforts becomes critically relevant in patients with congenital heart disease, to avoid the additional burden of coronary events in this growing population of patients.     

Carotid atherosclerosis as a risk factor for complex aortic lesions in patients with ischemic cerebrovascular disease.

Aortic arch atherosclerotic lesions can cause ischemic cerebrovascular disease (ICVD). The association between carotid and aortic atherosclerosis was examined, and it was investigated whether noninvasive carotid evaluation aids in the identification of aortic lesions as potential ICVD risk. The subjects comprised 147 patients with ICVD who had undergone carotid ultrasonography and transesophageal echocardiography. Carotid and aortic arch atherosclerosis was evaluated by measuring the maximum intima - media thickness (IMT), with aortic IMT of at least 4 mm, mobile plaques and/or ulcers defined as complex aortic lesions with potential ICVD risk. Carotid IMT was linearly associated with aortic IMT (r=0.53, p<0.001), and the association was independent of traditional cardiovascular risk factors (beta =0.36, p<0.001). Also, each 1 SD greater carotid IMT was associated with 4.2-fold (95% confidence interval: 2.5-7.0) higher likelihood of complex aortic lesions, with the likelihood little modified when controlling for cardiovascular risk factors. In particular, complex aortic lesions were found in 78% of patients with the highest carotid IMT tertile, compared with 14% of those with the lowest tertile (p<0.05). Based on these findings, carotid atherosclerosis is associated with aortic atherosclerosis, representing a risk factor for aortic lesions that are a potential ICVD risk.     

Elevation of factor VII activity and mass in young adults at risk of ischemic heart disease

The Northwick Park Heart Study found that elevation of factor VII in middle-aged subjects was an independent risk factor for subsequent ischemic heart disease. The present study was designed to determine whether factor VII elevation is present at a younger age and whether zymogen or activated factor VII is responsible for this elevation. A group of 20 asymptomatic first degree relatives (mean age 34.9 years) of patients with premature ischemic heart disease were compared with 15 age-matched normal subjects at low risk of ischemic heart disease and 15 older subjects with established ischemic heart disease (mean age 49.7 years). Factor VII procoagulant, coupled amidolytic and antigenic assays, as well as fasting serum triglyceride and cholesterol assays, were performed on all three groups. Factor VII antigen and coagulant activity was significantly elevated in first degree relatives, as was factor VII antigen in the patients with ischemic heart disease. The increased factor VII level in these subjects was caused by elevated factor VII zymogen, not activated factor VII. The results of this study, combined with those of previous studies, suggest that factor VII may be a useful additional marker of the risk for ischemic heart disease and merits further investigation.     

青年人卒中的病因和危险因素

青年人卒中发病率有逐年增高的趋势,其病因和危险因素相对于传统的老年人卒中更为复杂.文章针对该领域临床研究进行了综述.     

阿尔茨海默病与脑血管疾病危险因素关系的研究进展

既往研究表明阿尔茨海默病(AD)是一老年神经变性疾病.近年来研究发现脑血管危险因素与AD关系密切,本文就AD与高血压、糖尿病、血脂代谢紊乱等脑血管疾病危险因素的关系进行探讨,脑血管疾病的危险因素与AD的发病有关,甚至加快了AD的发展.     

Strong family history and cigarette smoking as risk factors of coronary artery disease in young adults.

This study is based on 435 consecutive patients age 50 or less who had coronary arteriography. There were 335 patients with coronary artery disease and 100 with normal coronary arteries. Risk factors reviewed were "packet-years" of cigarette smoking, family history of coronary disease in first-degree relatives 50 years of age or less, age- and sex-corrected serum cholesterol and triglycerides, hypertension, and diabetes. By univariate analysis, each risk factor except hypertension and diabetes was significantly more frequent in patients with coronary disease than in those without. By multivariate analysis of all risk factors in patients with and without coronary disease, the male or female patient with coronary disease could best be identified by the strong family history, cigarette smoking history, and age- and sex-corrected serum cholesterol. The percentage of patients with coronary disease when the three risk factors were present was 95%, two factors present 88%, one factor present 67%, none of the three 25%, strong family history alone 90%, smoking alone 66%, and serum cholesterol greater than 80th centile alone 52%.     

Prevalence of risk factors in acute ischemic cerebrovascular disease (CVD) in elderly patients from eastern Sicily

Hundred and forty elderly patients (76 males and 64 females, over 65 years of age) were consecutively admitted to the Institute between November 1989 and April 1993, in order to (i) verify if the risk factors, reported in other Italian areas and regions of the world, are prevalent also in our region, and (ii) outline a secondary prevention strategy against the statistically most important risk factors. There were 111 cases of ischemic stroke (58 males and 53 females) and 29 cases of reversible ischemic attack (RIA) (18 males and 11 females). The percental occurrence of the following risk factors were determined: total cholesterol > 240 mg/dl, HDL cholesterol < 35 mg/dl, triglycerides > 180 mg/dl, fibrinogen > 450 mg/dl, hematocrit > 45%, hypertension, diabetes mellitus, cigarette smoking, familial ischemic events, previous ischemic CVD, ischemic cardiac disease, embolic cardiopathy. In males with ischemic stroke the most frequent risk factors were: hypertension (43%), fibrinogen > 450 mg/dl (37.9%), diabetes mellitus, cigarette smoking and previous ischemic CVD (25.8%). In females with ischemic stroke a clear prevalence of hypertension (69.8%), ischemic cardiopathy and previous ischemic CVD (47%) and diabetes mellitus (41.5%) were observed. In males with RIA hypertension (50%) and cigarette smoking (38%). Females with RIA presented a high prevalence of reduced HDL cholesterol, lower than 35 mg/dl (77.7%), hypertension (63.6%) and ischemic cardiopathy (54.5%). The results indicate that there are no highly significant differences between the data reported by other authors on the most important acute ischemic CVD risk factors in Italy and elsewhere. Arterial hypertension and diabetes mellitus are the most important risk factors of cerebral ischemic events in both sexes. The diffusion of cigarette smoking among women in the last thirty years must be taken into consideration. Although it does not represent a risk factor for elderly women today, it may do in the future. Therefore, antismoking campaigns must be more decisive and targeted at both sexes.