儿童青少年外周动脉顺应性、血管内皮功能的年龄变化规律及与心血管疾病危险因素的关系

目的 探讨儿童青少年外周动脉顺应性和内皮功能的年龄变化规律及其与肥胖相关测量指标和心血管疾病危险因素的关系。方法 在上海市闵行区儿童青少年血压流行病学调查人群中选取7~17岁体重正常和超重/肥胖者,分别采用动脉硬化检测仪、Endopat2000无创内皮功能检测仪测定动脉顺应性、血管内皮功能,测量肱踝脉搏波速度(baPWV)、充血反应指数(RHI)及体格、血压和空腹血生化指标。分析baPWV、RHI随年龄的变化规律。对相关测量指标进行年龄标准化以及偏态分布的指标正态化转换后,使用简单线性相关分析观察baPWV、RHI与肥胖相关测量指标、心血管疾病危险因素的关系。结果 452名体重正常和94名超重/肥胖者完成动脉顺应性和血管内皮功能检测,其中299名(54.76%)为男性。简单线性相关分析显示,正常体重者中baPWV、RHI与年龄呈弱正相关关系(r=0.33,P<0.01;r=0.36,P<0.01)。baPWV与标准化(z_)BMI(r=0.13,P=0.002)、SBP(r=0.20,P<0.01)、DBP(r=0.27,P<0.01)、TG(r=0.11,P=0.010)、胰岛素(r=0.21,P=0.004)、胰岛素抵抗指数(r=0.21,P=0.005)呈正相关关系,与HDL-C呈负相关关系(r=-0.09,P=0.039)。RHI与z_BMI呈正相关关系(r=0.10,P=0.018),与DBP呈弱的负相关关系(r=-0.10,P=0.016),与其他测量指标无显著性相关。baPWV在男性略高于女性,而RHI无性别差异。结论 baPWV、RHI测量值在7~17岁间随年龄增长整体呈上升趋势,提示动脉顺应性和血管内皮功能在此期间处在不断发育的过程。动脉顺应性的变化与心血管疾病危险相关测量指标的变化具有相关性,而血管内皮功能则仅在超重/肥胖儿童中表现出提前发育的现象,与血压、胰岛素抵抗等心血管疾病的危险因素未表现出相关性。对儿童青少年人群心血管疾病危险的早期评估,测量动脉顺应性可能比血管内皮功能指标更敏感。     

Serum carotenoids and vitamins in relation to markers of endothelial function and inflammation

Background: Endothelial cell dysfunction may be related to an increase in cellular oxidative stress. Carotenoids and vitamins could have an antioxidant-mediated tempering influence on endothelial function and inflammation, thereby reducing the risk of atherosclerosis. Methods: We measured serum carotenoids, $\ralpha$-tocopherol and Vitamin C concentrations in 379 subjects sampled from the general population. High-sensitive C-reactive protein (CRP), fibrinogen (Fbg) and leukocytes were measured as markers of inflammation. Furthermore, soluble intercellular adhesion molecule-1 (sICAM-1) and flow-mediated vasodilation (FMD; n=165) were measured as markers of endothelial function. Relationships between serum carotenoids and vitamins and markers of endothelial function and inflammation were analysed after adjustment for confounding. Results: In the total study group, lutein and lycopene were inversely related to sICAM-1 with regression-coefficients of –0.38 $\pm$ 0.19 (p=0.04) and –0.16 $\pm$ 0.08 (p=0.04) per 1 $\rmu$mol/l, respectively. $\rbeta$-Carotene was inverse related to leukocytes (–0.23 $\pm$ 0.07; p=0.007) and CRP (–1.09 ± 0.30; p=0.0003) per 1 $\rmu$mol/l. Vitamin C was inverse related to CRP (–0.01 $\pm$ 0.005; p=0.04) per 1 $\rmu$mol/l, whereas $\ralpha$-tocopherol was positively related to CRP (0.03 $\pm$ 0.01; p=0.02) per 1 $\rmu$/l. Zeaxanthin was inversely related to FMD (31.2 $\pm$ 15.3; p=0.04) per 1 $\rmu$mol/l. Conclusion: The inverse relations between carotenoids, Vitamin C and sICAM-1, CRP and leukocytes may help to explain the possible protective effect of carotenoids and Vitamin C on atherosclerosis through an influence on inflammatory processes and endothelial function.     

Daily physical activity,cardiorespiratory fitness,nutritional status,endothelial function,and autonomic modulation in school-age adolescents: A principal component analysis

PurposeThis study evaluated the association between cardiorespiratory fitness, abdominal obesity, blood pressure, endothelial function, and autonomic modulation in school-age adolescents exhibiting different levels of habitual physical activity and nutritional status, through a multivariate statistical approach.Methods101 adolescents aged 15–18 years (54 females) underwent assessments of daily physical activity, body mass index, cardiorespiratory fitness, reactive hyperemia, and heart rate variability. Based on BMI adjusted for age and sex (z-BMI), 21 adolescents were classified as ‘overweight’ (9 girls), and 9 as ‘obese’ (4 girls). The common variation between those variables was assessed through Principal Component Analysis (PCA).ResultsMain axis of common variation of outcomes analyzed defined four principal components (PCs) accounting for 69.7% of overall variance, related to ‘abdominal obesity and blood pressure’ (PC1; eigenvalue = 2.76), ‘cardiorespiratory fitness, endothelial function, and autonomic modulation’ (PC2, eigenvalue = 1.98), ‘cardiorespiratory fitness’ (PC3, eigenvalue = 1.21), and ‘sedentary behavior’ (PC4, eigenvalue = 1.02). Girls reported longer screen time and sedentary behavior than boys. Notwithstanding, in both sexes poorer cardiorespiratory fitness corresponded to lower reactive hyperemia and vagal modulation, irrespective of the nutritional status. Overall, adolescents classified as ‘obese’ and ‘sedentary’ exhibited poorer CRF concomitantly to autonomic and endothelial dysfunctions.ConclusionIn school-age adolescents, endothelial and autonomic dysfunctions related to poor cardiorespiratory fitness, irrespective of the nutritional status and physical activity level. However, endothelial and autonomic dysfunctions were more prevalent among adolescents combining poor cardiorespiratory fitness, reduced levels of daily physical activity, and overweight/obesity.     

Both a combined oral contraceptive and depot medroxyprogesterone acetate impair endothelial function in young women

Background

The study was conducted to determine whether the use of a combined oral contraceptive (COC) or depot medroxyprogesterone acetate (DMPA) interferes with endothelial function.

Study Design

The study was conducted on 100 women between the ages of 18 and 30 years. Fifty women had not used hormonal contraception (control group) for at least 12 months, 25 were current users of a COC (ethinylestradiol 30 mcg+levonorgestrel 150 mcg) and 25 were current users of DMPA (150 mg) for at least a 6-month period. All women were evaluated for brachial flow-mediated dilation (FMD), intima-media thickness, carotid distensibility and stiffness index, arterial pressure, body mass index, waist circumference, heart rate and lipid profile.

Results

A significant difference in FMD was observed between the COC and control groups (6.4±2.2% vs. 8.7±3.4%, p<.01) and between the DMPA and control groups (6.2±2.1% vs. 8.7±3.4%, p<.01). The DMPA group had lower values of total cholesterol (TC) and low-density lipoprotein (LDL-C) than COC users and the control group (TC: DMPA=139.9±21.5 mg/dL vs. controls=167.1±29.2 mg/dL vs. COC=168.2±37.5, p=.001; LDL-C: DMPA=85.3±20.1 mg/dL vs. controls=102±24.5 mg/dL vs. COC=106.7±33.3 mg/dL, p=.01). The control group had higher levels of high-density lipoprotein (HDL-C) than the DMPA and COC groups (controls=52.4±14.1 mg/dL vs. DMPA=42.2±7.2 mg/dL vs. COC=45.4±9.1 mg/dL, p=.001). No significant differences were observed regarding the other variables.

Conclusions

FMD was lower among COC and DMPA users, suggesting that these hormonal contraceptives may promote endothelial dysfunction.     

Effects of omega-3 polyunsaturated fatty acids on fibrosis,endothelial function and myocardial performance,in ischemic heart failure patients

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L-arginine improves endothelial function and reduces LDL oxidation in patients with stable coronary artery disease

BACKGROUND: We investigated the effects of oral L-arginine on endothelial function, intravascular oxidative stress, and circulating inflammatory markers in patients with stable coronary artery disease (CAD). METHODS: Thirty-one stable CAD patients were randomly assigned to oral L-arginine (10 g) or vitamin C (500 mg, an antioxidant, as active control) daily for 4 weeks, with crossover to the alternate therapy after 2 weeks off therapy, in this study. Brachial artery endothelial function studies were performed and serum concentrations of lipids and inflammatory markers were measured at baseline, at the end of each 4-week treatment period and at the 2-week wash-out period. Susceptibility of low-density lipoprotein (LDL) particles to oxidation, a marker of oxidative stress, was determined in 11 patients at random before and after 4-week treatment of oral L-arginine. RESULTS: We demonstrates that consumption of either L-arginine or vitamin C significantly increased brachial artery flow-mediated dilatation (mean diameter change from baseline of 4.87%, P<0.0001 and of 3.17%, P=0.0003, respectively). Neither oral L-arginine nor vitamin C affected lipid profiles and circulating levels of inflammatory markers. However, in the 11 patients whose LDL susceptibility to oxidation was determined, lag time significantly increased by 27.1% (P=0.045) after consumption of L-arginine for 4 weeks. CONCLUSIONS: Oral L-arginine supplement improved endothelial function and reduced LDL oxidation in stable CAD patients.     

阿托伐他汀与曲美他嗪联合治疗对冠心病患者心功能、炎性因子和内皮功能的影响分析

目的 分析阿托伐他汀与曲美他嗪联合治疗对冠心病患者心功能、炎性因子和内皮功能的影响。方法 选取本院2018年6月—2019年6月收治的64例冠心病患者作为研究对象,随机分为两组,其中32例采用曲美他嗪治疗,记为对照组,32例采用阿托伐他汀联合曲美他嗪治疗,记为观察组,对比两组患者治疗后的心功能、炎性因子和内皮功能。结果 治疗后,观察组的心功能指标为:左心室射血分数(37.55±5.27)%,左心室舒张末期内径(46.52±4.28)mm,左室后壁厚度(8.61±0.13)mm,优于于对照组的左心室射血分数(44.62±6.04)%,左心室舒张末期内径(55.21±5.07)mm,左室后壁厚度(10.86±0.94)mm(P<0.05);观察组的炎性因子指标超敏C反应蛋白(2.37±0.63)ng/L,基质金属蛋白酶(32.04±10.31)ng/L,肿瘤坏死因子(95.17±21.74)ng/L,低于对照组的超敏C反应蛋白(4.19±0.87)ng/L,基质金属蛋白酶(40.45±11.28)ng/L,肿瘤坏死因子(157.33±32.51)ng/L(P<0.05);观察组的内皮功能为外周血循环内皮微颗粒(847.68±12.57)×106/L,一氧化氮(389.37±5.16)μg/mL,血管内皮素-1(63.71±2.31)μg/mL,优于对照组的外周血循环内皮微颗粒(1005.68±11.44)×106/L,一氧化氮(317.54±5.05)μg/mL,血管内皮素-1(79.68±2.55)μg/mL(P<0.05)。结论 相比单纯采用曲美他嗪治疗,对冠心病患者采用阿托伐他汀与曲美他嗪联合治疗,更能有效改善患者的心功能和血管内皮功能,减少炎性因子,疗效确切,值得推广。     

上海市杨浦区居民中心型肥胖与心血管疾病危险因素及聚集性的关系

【目的】探讨上海市杨浦区居民中心型肥胖与心血管疾病危险因素及聚集性的关系,为制定心血管疾病预防控制措施和策略提供科学依据。【方法】以社区为单位,对35~75岁居民进行问卷调查、体格检查和血生化检测,对其中资料完整的11321人进行数据分析。【结果】杨浦区居民中心型肥胖率为60.50%,标化率为56.09%。不同腰围人群的收缩压、舒张压、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白和高密度脂蛋白的差异均有统计学意义(均P<0.01)。随着腰围的增加,高血压、糖尿病、血脂异常及心血管病危险因素聚集比例均呈上升趋势(均P<0.01)。多因素logistic回归结果显示,轻度、重度中心型肥胖组发生高血压、糖尿病、血脂异常和危险因素聚集的风险是正常组的1.78(OR=1.78,95%CI:1.63~1.94)和3.36倍(OR=3.36,95%CI:3.00~3.75)、1.67(OR=1.67,95%CI:1.49~1.88)和2.67倍(OR=2.67,95%CI:2.34~3.03)、1.68(OR=1.68,95%CI:1.54~1.82)和2.20倍(OR=2.20,95%CI:1.97~2.44)、2.04(OR=2.04,95%CI:1.86~2.24)和3.62倍(OR=3.62,95%CI:3.23~4.04)。【结论】上海市杨浦区居民中心型肥胖患病率高,肥胖程度与心血管疾病危险因素及其聚集风险有关,应当及时采取控制肥胖的干预措施。     

Metabolic syndrome in children and adolescents in Crete, Greece, and association with diet quality and physical fitness

Aim  To determine the prevalence of metabolic syndrome in children and adolescents in Crete (Greece) and examine associations with diet quality and physical fitness. Subjects and Methods  A representative sample of 1,209 Cretan children and adolescents aged 3–17 1/2 years participated in this cross-sectional survey. The study took place in kindergartens, primary and secondary schools in the cities of Heraklion and Chania and kindergartens and schools in semi-urban and rural regions outside Heraklion. The metabolic syndrome was defined as the presence of ≥3 of: impaired fasting blood glucose, hypertension, abdominal obesity, hypertriglyceridaemia, and low HDL-cholesterol. Diet quality was assessed by the Healthy Eating Index score (USDA) and physical fitness by the 20-m shuttle run test. Results  Approximately 4% of Cretan children and adolescents assessed (4.2% of boys, 3.6% of girls) had three or more metabolic syndrome factors. Over 25% of the subjects had a “poor” diet, defined as Healthy Eating Index <51, and higher diet quality scores correlated with decreased mean body mass index, waist/height ratio, systolic blood pressure, total cholesterol, and number of metabolic syndrome risk factors present. Clustering of metabolic syndrome risk factors was also associated with decreased physical fitness, as well as increased body mass index, waist/height ratio and total cholesterol/HDL-cholesterol ratio. Conclusions  Presence of three or more factors related to the metabolic syndrome was strongly associated with poor diet quality and low physical fitness, as well as overweight, in Cretan children and adolescents. Health promotion strategies in childhood should encourage weight control, the establishment of healthier dietary patterns, and adequate physical activity, as a means of preventing the increase in the prevalence of this public health issue.     

中国成年人中心性肥胖与缺血性心脏病发病风险的前瞻性研究

目的 分析中心性肥胖评价指标腰围与发生缺血性心脏病（IHD）、急性冠心病事件（MCE）以及死于IHD风险的关联。方法 研究对象来自中国慢性病前瞻性研究,基线调查开展于2004年6月至2008年7月,剔除基线时患有冠心病、脑卒中、恶性肿瘤、慢性阻塞性肺疾病和糖尿病的个体,共纳入428 595人进行分析。统计学分析采用Cox比例风险模型。结果 研究人群平均随访9.1年,累积随访3 803 637人年,期间新发IHD 26 900例,MCE 4 320例,IHD死亡2 787例。调整了多种混杂因素和BMI后,与非中心性肥胖者（男性<85.0 cm,女性<80.0 cm）相比,中心性肥胖前期者（男性85.0～89.9 cm,女性80.0～84.9 cm）发生IHD、MCE和死于IHD的风险HR值（95% CI）分别为1.13（1.09～1.17）、1.15（1.05～1.26）、1.11（0.98～1.24）,中心性肥胖者（男性≥90.0 cm,女性≥85.0 cm）对应的风险效应值更高,HR值（95% CI）分别为1.29（1.24～1.34）、1.30（1.17～1.44）、1.32（1.16～1.51）。按BMI分层,即使在BMI正常的人群中,与非中心性肥胖者相比,中心性肥胖前期和中心性肥胖人群发生IHD、MCE或死于IHD的风险也会增加。结论 中心性肥胖是IHD风险独立的危险因素,IHD风险随中心性肥胖测量指标腰围的增加而增加。     

A systematic review of air pollution as a risk factor for cardiovascular disease in South Asia: Limited evidence from India and Pakistan

Cardiovascular diseases (CVD) are major contributors to mortality and morbidity in South Asia. Chronic exposure to air pollution is an important risk factor for cardiovascular diseases, although the majority of studies to date have been conducted in developed countries. Both indoor and outdoor air pollution are growing problems in developing countries in South Asia yet the impact on rising rates of CVD in these regions has largely been ignored. We aimed to assess the evidence available regarding air pollution effects on CVD and CVD risk factors in lower income countries in South Asia. A literature search was conducted in PubMed and Web of Science. Our inclusion criteria included peer-reviewed, original, empirical articles published in English between the years 1990 and 2012, conducted in the World Bank South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka). This resulted in 30 articles. Nine articles met our inclusion criteria and were assessed for this systematic review. Most of the studies were cross-sectional and examined measured particulate matter effects on CVD outcomes and indicators. We observed a bias as nearly all of the studies were from India. Hypertension and CVD deaths were positively associated with higher particulate matter levels. Biomarkers of oxidative stress such as increased levels of P-selection expressing platelets, depleted superoxide dismutase and reactive oxygen species generation as well as elevated levels of inflammatory-related C-reactive protein, interleukin-6 and interleukin-8 were also positively associated with biomass use or elevated particulate matter levels. An important outcome of this investigation was the evidence suggesting important air pollution effects regarding CVD risk in South Asia. However, too few studies have been conducted. There is as an urgent need for longer term investigations using robust measures of air pollution with different population groups that include a wider range of air pollutants and outcomes, including early indicators of CVD. These regions are facing burdens from increasing urbanization, air pollution and populations, generally weaker health infrastructure, aging populations and increased incidence of non-communicable diseases, included CVD. The extent to which the problem of air pollution and CVD will impact these countries will depend largely on the information available to inform policy and programs, which are still lacking, political will as well as social and economic development.