Changing trends of cardiovascular risk factors among Indians: a review of emerging risks

The global burden of disease due to cardiovascular diseases (CVDs) is escalating, and the changing trends of CVD risk factors are identified among Indians experiencing rapid health transition. Contributory causes include: growing population with demographic shifts and altered age profile, socio-economic factors, lifestyle changes due to urbanization. Indians are also having genetic predisposition to cardiovascular diseases and adult are susceptible to vascular disease linking possible gene-environment interactions influencing ethnic diversity. Altered diets with more of junk foods along with diminished physical activity are additive factors contributing to the acceleration of CVD epidemics, along with all form of tobacco use. The pace of health transition, however, varies across geographical regions from urban to rural population with consequent variations in the relative burdens of the dominant CVDs. A comprehensive public health response must be looked to plan over all strategies to integrate policies and programs that effectively impact on the multiple determinants of CVDs to provide protection over the life span through primordial, primary and secondary prevention. Populations as well as individuals at risk must be protected through initiatives, enable nutrition-based preventive strategies to protect and promote cardiovascular health.     

菠萝蛋白酶治疗心血管疾病的系统综述（英文）

背景：在2004年,全球估计有1710万人死于心血管疾病。根据美国心脏病协会的数据,心脏病与中风是2型糖尿病患者的首要致死及致残因素。寻找更多的安全有效的心血管疾病治疗方案对于该疾病的预防和治疗十分必要,营养补充品是可行方案之一。目的：探讨菠萝蛋白酶（一种食品补充品）对心血管疾病的预防和治疗作用。检索策略：2009年9月至2010年3月进行电子与手工检索。检索的数据库包括Ovid MEDLINE;All EBMReviews-Cochrane Database of Systematic Reviews（Cochrane DSR）、American College of Physicians（ACP）Journal Club、Database of Abstracts of Reviews of Effects（DARE）、Cochrane Central Register ofControlled Trials（CCTR）、Cochrane Methodology Register（CMR）、Health Technology Assessment（HTA）和National Health Service Economic Evaluation Database（NHSEED）;Allied and ComplementaryMedicine（AMED）、British Nursing Index and Archive、EMBASE、Health Management InformationConsortium（HMIC）、ScienceDirect和Electronic Thesis Online Services（ETHOS）。检索语言限定为英文。纳入标准：有关菠萝蛋白酶用于预防或治疗心脑血管疾病的随机对照试验、人体研究、动物研究与实验性研究。资料提取与分析：3位作者分别对检索到的文章进行文献质量评估并提取文献资料。所收集的资料包括实验种类、用药剂量、治疗周期、测量指标、研究结果、菠萝蛋白酶的特征、结果的意义与研究结论。结果：在搜索到的223篇文章中,只有6篇文章符合纳入标准。包括3项动物实验和3项人体试验。菠萝蛋白酶可用来治疗急性血栓性静脉炎,因为它可减少血液中的纤维蛋白原含量,降低血小板聚集度,有保护心脏的作用,并能够改善动脉壁的结构,避免由凝血酶所诱发的血小板聚集,减少血栓的形成。结论：迄今为止,没有菠萝蛋白酶用于心血管疾病治疗的高质量的人体研究。在1948年至2010年间所发表的有关菠萝蛋白酶与心血管疾病的研究的数量极为有限。在未来的心血管疾病研究中这可能是一个值得探索的领域。     

头高位倾斜时心血管反应的仿真

仿真头高位倾斜时心血管系统的反应,进一步研究有关立位应激的生理机制。方法以仿真下体负压时心血管反应的模型为基础,在血液重新分配子模中引入了重力致血液重新转移的环节,在压力反射控制子模型中考虑了心水平与颈动脉压力感受器间的流体静压差。     

The role of FGF21 in the pathogenesis of cardiovascular disease

The morbidity and mortality of cardiovascular diseases (CVDs) are increasing worldwide and seriously threaten human life and health. Fibroblast growth factor 21 (FGF21), a metabolic regulator, regulates glucose and lipid metabolism and may exert beneficial effects on the cardiovascular system. In recent years, FGF21 has been found to act directly on the cardiovascular system and may be used as an early biomarker of CVDs. The present review highlights the recent progress in understanding the relationship between FGF21 and CVDs including coronary heart disease, myocardial ischemia, cardiomyopathy, and heart failure and also explores the related mechanism of the cardioprotective effect of FGF21. FGF21 plays an important role in the prediction, treatment, and improvement of prognosis in CVDs. This cardioprotective effect of FGF21 may be achieved by preventing endothelial dysfunction and lipid accumulating, inhibiting cardiomyocyte apoptosis and regulating the associated oxidative stress, inflammation and autophagy. In conclusion, FGF21 is a promising target for the treatment of CVDs, however, its clinical application requires further clarification of the precise role of FGF21 in CVDs.     

社区动脉硬化早期检测适宜技术应用研究

目的探讨社区人群脉搏波速度(PWV)与心血管疾病危险因素之间的关系及在社区开展动脉硬化早期检测适宜技术的意义。方法选取2009年10月—2010年2月在什刹海社区卫生服务中心就诊的患者,取其资料完整者400例作为本研究对象。按是否患有高血压、糖尿病、脑卒中、冠心病、高脂血症分为慢性病组和对照组,进行流行病学调查,收集相关临床资料并检测相关生化指标。应用日本科林公司的全自动动脉硬化检测仪VP-1000检测研究对象的肱-踝脉搏波速度(baPWV)和踝臂指数(ABI)。采用SAS 6.2统计软件进行数据分析和处理。结果慢性病组的baPWV值显著高于对照组,差异有统计学意义(P<0.01)。Logistic回归分析显示,收缩压和baPWV是慢性病的独立危险因素(P<0.01);年龄和空腹血糖是影响baPWV的独立因子(P<0.01),尤其是45岁以上人群baPWV值显著升高。对照组中有28.05%的人baPWV值异常。结论 baPWV是慢性病的独立预测因子,baPWV与年龄、空腹血糖相关;baPWV测定可作为早期诊断动脉硬化的首选和常规检查手段,适合在社区推广。     

高中心动脉脉压水平与慢性腹膜透析病人的心血管疾病相关

目的了解慢性腹膜透析病人的中心动脉脉压水平,分析其与心血管疾病（CVD）的关系。方法单中心横断面研究,共纳
入234例维持性腹膜透析病人（均接受腹膜透析3月以上）。采用SphygmoCor无创主动脉脉波分析仪检测病人的中心动脉收
缩压和舒张压,脉压=收缩压-舒张压。CVD定义为临床确诊的缺血性心脏病,心力衰竭,脑卒中和外周血管性疾病。结果有
CVD的腹膜透析病人中心动脉脉压水平显著高于无CVD者（51.7±22.5 mmHg vs 43.7±17.8 mmHg,P=0.004）,而肱动脉脉压在
两组病人间无显著差异（66.7±25.3 mmHg vs 61.9±19.7 mmHg,P=0.106）。多因素Logistic回归分析后,中心动脉脉压仍独立与
CVD相关（校正后OR 1.33,95%置信区间1.01-1.73,P=0.04）。结论高中心动脉脉压水平与慢性腹膜透析病人CVD相关。
     

乌拉地尔对风心病肺动脉高压及血气的影响

目的：观察乌拉地尔对合并有肺动脉高压的风心病病人右心血流动力学及动脉血气的影响。方法：以风心病继发肺动脉高压的34例病人为研究对象，观察静脉注射0.4mg/kg乌拉地尔前、后10min、40min、60min右心血流动力学参数、体循环血压及动脉血气的变化。结果：乌拉地尔能显著降低风心病病人的肺动脉压、肺循环阻力、肺毛细血管楔嵌压及体循环血压，但对肺循环的影响要明显强于体循环，并几乎不引起心率，心输出量及动脉血气的改变。无严重副反应性。结论：乌拉地尔治疗术前风心病肺动脉高压可能有很好的临床效果。     

动脉粥样硬化的临床调脂治疗进展

随着人民生活水平的不断提高,饮食结构的改变,高血压、冠心病、脑卒中及外周动脉血管病变等动脉粥样硬化所致的心血管疾病(CVD)已成为常见病、多发病,严重危害人类的健康及生命。此类疾病的共同病理基础是动脉粥样硬化。血脂紊乱为动脉粥样硬化的重要而独立的危险因素。如何合理有效调脂,预防及治疗动脉粥样硬化,已成为近年来临床研究的热点问题。本文主要综述治疗动脉粥样硬化及临床常用调脂药物的应用及进展。     

失重对人体血液循环系统影响的仿真研究

目的:利用计算机仿真失重对人体心血管系统的影响.方法:根据流体力学的基本原理,利用pspice语言建立改进后的多元非线性人体模型,模型包括人体心脏模型、动脉系统模型、静脉系统模型以及外周血管模型等四部分.利用所建立的模型仿真人体在1G环境下心血管系统主要生理参数,与实验资料对比,以验证其有效性,然后仿真0G与微重力环境下动脉血压与静脉血压的变化.结果:模型仿真的1G环境下人体的主动脉压(ABP)、左室压(LVP)、左房压(LAP)、中心静脉压(CVP),结果与实验数据一致;仿真的0G环境下收缩压(SBP)变化不明显,舒张压(DBP)有降低的趋势;0G和微重力环境下CVP值接近,且相对1G环境下CVP有增加的趋势.结论:仿真模型是有效的,可以模拟失重条件下心血管系统的变化.     

Prediction Models for Early Risk Detection of Cardiovascular Event

Cardiovascular disease (CVD) is the major cause of death globally. More people die of CVDs each year than from any other disease. Over 80% of CVD deaths occur in low and middle income countries and occur almost equally in male and female. In this paper, different computational models based on Bayesian Networks, Multilayer Perceptron, Radial Basis Function and Logistic Regression methods are presented to predict early risk detection of the cardiovascular event. A total of 929 (626 male and 303 female) heart attack data are used to construct the models. The models are tested using combined as well as separate male and female data. Among the models used, it is found that the Multilayer Perceptron model yields the best accuracy result.     

Does obesity protect hypertensives against cardiovascular diseases?

Recent studies suggest that obesity may protect hypertensives against cardiovascular disease (CVD). This concept was investigated by the Honolulu Heart Program, a prospective epidemiologic study of CVD in a cohort of Japanese-American men aged 45 to 65 years who have been followed up for 12 years. The combined effect of body mass index (BMI), as a measure of obesity, and blood pressure on coronary heart disease and CVD incidence was examined in 7554 men who were free of CVD and cancer at baseline. Rates of coronary heart disease and CVD were higher in the most obese than in the nonobese men for both normotensives and hypertensives. Blood pressure-BMI interaction was not significant for any CVD end point. Hypertension was associated with higher rates of coronary heart disease and CVD at all levels of BMI. This study supports the conclusion that hypertension is associated with an increased risk of CVD in both obese and nonobese men and that the relationship of blood pressure to CVD incidence does not vary with level of BMI. The inclusion of prevalent cases of CVD and the collapsing of continuous data into two categories may explain the results of earlier studies.     

正常偏高血压对心脑血管病发病危险的影响

目的　探讨不同性别正常偏高血压对心血管病发病的危险。方法　采用 1 1省市队列人群 (35～ 64岁 )共 2 7739人 ,于 1 992年进行基线危险因素调查的资料。计算队列人群不同血压范围构成比、危险因素分布 ,以及在观察终点心脑血管病事件的人年标化发生率 ,用Cox回归模型对不同血压范围心脑血管病发病率的危险进行预测。结果　 (1 )队列人群具有正常偏高血压者为 1 3 4%(男性 1 4 8% ,女性 1 1 8% ) ;(2 )具有正常偏高血压者多种危险因素显著高于具有理想血压者 ;(3)具有正常偏高血压者心脑血管病人年标化发病率显著高于具有理想血压者 ;(4)正常偏高血压者的心脑血管病发病危险为 2 876 5(95 %可信区间 2 0 50 6～ 4 0 35 1 ,P <0 0 1 ) ,男性为 3 2 34 6(95 %可信区间 ,2 1 1 3 1～ 4 951 2 ,P <0 0 1 ) ,女性为 2 335 0 (95 %可信区间 1 31 83～ 4 1 35 9,P <0 0 1 )。结论　具有正常偏高血压者的心血管病危险比具有理想血压者显著高 ,降低正常偏高血压以减少心血管病危险的必要性有待研究     

Controversies and discrepancies in the effect of dietary fat and cholesterol on cardiovascular risk

Cardiovascular disease (CVD) is the leading cause of death worldwide. The top ten causes of death in Singapore include many cardiovascular-related diseases such as ischaemic heart disease. The increasing prevalence of CVD poses a burden to both the economy and healthcare system of a country. Dietary habits, in particular dietary fats and cholesterol intake, have been shown to greatly influence CVD risks. Therefore, reference and adherence to relevant dietary guidelines could be crucial in CVD prevention. Recent research findings have provided novel insights into the relationship between certain dietary fats or cholesterol intake and CVD risks, challenging or reinforcing previous guidelines. These findings may, however, be conflicting, and there are still controversies over the effects of dietary fats and cholesterol as well as their association with cardiovascular risk. This review paper aims to evaluate common controversies, identify gaps in relevant research areas and summarise evidence-based dietary recommendations.     

Report on Cardiovascular Health and Diseases in China 2021: An Updated Summary

In 2019, cardiovascular disease (CVD) accounted for 46.74% and 44.26% of all deaths in rural and urban areas, respectively. Two out of every five deaths were due to CVD. It is estimated that about 330 million patients suffer from CVD in China. The number of patients suffering from stroke, coronary heart disease, heart failure, pulmonary heart disease, atrial fibrillation, rheumatic heart disease, congenital heart disease, lower extremity artery disease and hypertension are 13.00 million, 11.39 million, 8.90 million, 5.00 million, 4.87 million, 2.50 million, 2.00 million, 45.30 million, and 245.00 million, respectively. Given that China is challenged by the dual pressures of population aging and steady rise in the prevalence of metabolic risk factors, the burden caused by CVD will continue to increase, which has set new requirements for CVD prevention and treatment and the allocation of medical resources in China. It is important to reduce the prevalence through primary prevention, increase the allocation of medical resources for CVD emergency and critical care, and provide rehabilitation services and secondary prevention to reduce the risk of recurrence, re-hospitalization and disability in CVD survivors. The number of people suffering from hypertension, dyslipidemia and diabetes in China has reached hundreds of millions. Since blood pressure, blood lipids, and blood glucose levels rise mostly insidiously, vascular disease or even serious events such as myocardial infarction and stroke often already occured at the time of detection in this population. Hence, more strategies and tasks should be taken to prevent risk factors such as hypertension, dyslipidemia, diabetes, obesity, and smoking, and more efforts should be made in the assessment of cardiovascular health status and the prevention, treatment, and research of early pathological changes.     

晚睡影响心血管疾病风险因素的相关性研究进展

心血管疾病(cardiovascular disease,CVD)是导致全球死亡率升高的最大单一因素,其被列为全球重大健康问题。其中载脂蛋白A-I(Apolipoprotein A-I,apo A-I)、载脂蛋白B(Apoprotein B,Apo B)以及Apo B/Apo A-I是CVD的有效预测指标。 在引起CVD的众多原因中,就寝时间是不容忽视的风险因素,长期晚睡易引发失眠、昼夜节律紊乱等一系列睡眠问题,进而通过影响神经递质水平、引发全身慢性炎症反应、影响脂肪酸代谢和血压调节等机制最终促使CVD的发生和发展。因此养成规律、健康的就寝时间对预防CVD至关重要。     

Nesfatin-1与心血管疾病的研究进展

肥胖是导致冠心病的重要危险因素之一。目前,全球的肥胖人数逐年增加,尤其是在中国。脂肪组织分泌的脂肪因子功能紊乱可导致肥胖相关的代谢性疾病和冠心病的发展。Nesfatin-1是新发现的一种新型脂肪因子。目前研究表明,Nesfatin-1具有抑制摄食和调节能量代谢、血压、动脉粥样硬化、心脏功能等心血管疾病的作用。Nesfatin-1等脂肪因子成为近年研究热点。因此,该文对Nesfatin-1在心血管方面的作用作出综述,希望能为心血管疾病的诊疗提供一点新思路和新方法,甚至为心血管疾病的预后提供帮助。     

风湿免疫病患者并发心血管疾病的研究进展

风湿免疫病是一组常见的慢性疾病，主要影响关节、肌腱、韧带、骨骼和肌肉组织，这类疾病可导致身体的残疾。尽管由于早期的诊断，积极有效的治疗，在过去的几十年里，风湿免疫病患者的死亡率明显下降，然而，和正常人群相比，风湿免疫病患者的死亡率仍然很高。流行病学证据显示较高的死亡率归因于风湿免疫病患者较高的并发症，尤其是心血管并发症，如缺血性心脏疾病、心瓣膜疾病、心肌病、心包疾病和心脏传导系统的异常。尽管风湿免疫病患者伴发心血管疾病的机理尚不完全清楚，但是传统心血管病的风险因子如吸烟、缺乏锻炼、高血压、高血脂、高血糖，风湿免疫病患者体内持续的慢性炎症和药物治疗带来的副作用如糖皮质激素的长期应用等可能是风湿免疫病患者伴发心血管疾病的主要原因。风湿免疫病可增加患心血管疾病的风险，而心血管疾病又是风湿病患者死亡的首要原因。因此有效的预防和治疗心血管并发症非常重要，了解风湿免疫病患者的心血管疾病的伴发情况，可以更好的帮助患者预防这些并发症，延长寿命，提高生活质量。本文综述了近年来风湿免疫病患者伴发心血管疾病的临床常见情况及这些伴发疾病的发病机理和预防治疗的研究进展。      

Machine learning–based heart disease prediction system for Indian population: An exploratory study done in South India

BackgroundIn India, huge mortality occurs due to cardiovascular diseases (CVDs) as these diseases are not diagnosed in early stages. Machine learning (ML) algorithms can be used to build efficient and economical prediction system for early diagnosis of CVDs in India.MethodsA total of 1670 anonymized medical records were collected from a tertiary hospital in South India. Seventy percent of the collected data were used to train the prediction system. Five state-of-the-art ML algorithms (k-Nearest Neighbours, Naïve Bayes, Logistic Regression, AdaBoost and Random Forest [RF]) were applied using Python programming language to develop the prediction system. The performance was evaluated over remaining 30% of data. The prediction system was later deployed in the cloud for easy accessibility via Internet.ResultsML effectively predicted the risk of heart disease. The best performing (RF) prediction system correctly classified 470 out of 501 medical records thus attaining a diagnostic accuracy of 93.8%. Sensitivity and specificity were observed to be 92.8% and 94.6%, respectively. The prediction system attained positive predictive value of 94% and negative predictive value of 93.6%. The prediction model developed in this study can be accessed at http://das.southeastasia.cloudapp.azure.com/predict/ConclusionsML-based prediction system developed in this study performs well in early diagnosis of CVDs and can be accessed via Internet. This study offers promising results suggesting potential use of ML-based heart disease prediction system as a screening tool to diagnose heart diseases in primary healthcare centres in India, which would otherwise get undetected.     

高龄老年人髋部骨折合并内科疾病围手术期的治疗策略

目的:探讨高龄老年髋部骨折患者合并内科疾病在围手术期的治疗策略。方法:对合并有原发性高血压、2型糖尿病、冠状动脉粥样硬化性心脏病的高龄老年髋部骨折患者分别采用传统(请相应科室会诊)治疗(对照组190例)与同相应科室组织成立由骨科和相应内科组成的医疗合作团队联合治疗(观察组178例)。分别通过观察血压控制良好率、血糖控制良好率、冠状动脉粥样硬化性心脏病控制良好率CRIS(心脏危险指数系统)、围手术期死亡率、术前准备时间、平均住院时间、手术放弃率、心血管事件发生率、脑梗死发生率、深静脉血栓发生率等指标。结果:与对照组相比,观察组在血压控制良好率、血糖控制良好率、冠状动脉粥样硬化性心脏病控制良好率CRIS(心脏危险指数系统)分级上(均为2级)明显低于对照组(3～4级),而在围手术期死亡率、术前准备时间、平均住院时间、手术放弃率、心血管事件发生率、脑梗死发生率、深静脉血栓发生率等指标上明显低于对照组,差异有统计学意义(P<0.05)。结论:由医疗合作团队全程参与对合并有原发性高血压、2型糖尿病、冠状动脉粥样硬化性心脏病的高龄老年髋部骨折患者的治疗,对降低患者的手术风险,降低围手术期死亡率,促进患者术后的康复起到了很好的医疗保障,是一种值得借鉴的临床医学模式。