Ezetimibe/simvastatin vs simvastatin in coronary heart disease patients with or without diabetes

Background  

Treatment guidelines recommend LDL-C as the primary target of therapy in patients with hypercholesterolemia. Moreover, combination therapies with lipid-lowering drugs that have different mechanisms of action are recommended when it is not possible to attain LDL-C targets with statin monotherapy. Understanding which treatment or patient-related factors are associated with attaining a target may be clinically relevant.     

Declines in coronary heart disease incidence and mortality among middle-aged adults with and without diabetes

PurposeThe purpose of the study was to investigate secular changes in coronary heart disease (CHD) incidence and mortality among adults with and without diabetes and to determine the effect of increased lipid-lowering medication use and reductions in low-density lipoprotein cholesterol (LDL-C) levels on these changes.MethodsWe analyzed data on participants aged 45 to 64 years from the Atherosclerosis Risk in Communities Study in 1987–1996 (early period) and the Reasons for Geographic and Racial Differences in Stroke Study in 2003–2009 (late period). Hazard ratios (HRs) for the association of diabetes and period with incident CHD and CHD mortality were obtained after adjustment for sociodemographics cardiovascular risk factors, lipid-lowering medication use, and LDL-C.ResultsAfter multivariable adjustment, diabetes was associated with an increased CHD risk during the early (HR = 1.99, 95% confidence interval = 1.59–2.49) and late (HR = 2.39, 95% confidence interval = 1.69–3.35) periods. CHD incidence and mortality declined between the early and late periods for individuals with and without diabetes. Increased use of lipid-lowering medication and lower LDL-C explained 33.6% and 27.2% of the decline in CHD incidence and CHD mortality, respectively, for those with diabetes.ConclusionsAlthough rates have declined, diabetes remains associated with an increased risk of CHD incidence and mortality, highlighting the need for continuing diabetes prevention and cardiovascular risk factor management.     

High-density lipoprotein cholesterol concentration and other serum lipids in an isolated island community free of coronary heart disease.

Fasting serum high-density lipoprotein (HDL) cholesterol, other lipid concentrations and related characteristics have been measured in 87% of 261 residents aged over 5 years on the small isolated island of Salt Cay, Turks and Caicos Isles. Only one subject, a hypertensive woman, had a major electrocardiographic Q wave abnormality, and none of the islanders had clinical coronary heart disease. These findings, together with local clinical experience indicated a low incidence of coronary heart disease in this community. Adult mean concentrations of HDL cholesterol (1.6 mmol/l) and serum total triglyceride (0.81 mmol/l) were relatively high and low respectively compared with those of men and women in North American communities. Unlike findings in North America, there was no significant sex difference in HDL cholesterol concentration apparent in adulthood and this was not explained by sex differences in alcohol consumption (positively correlated with HDL cholesterol in both sexes) or adiposity (negatively correlated with HDL cholesterol in men only). Residents who were recovering from an epidemic of mild upper respiratory infection had on average a 9% reduction in HDL cholesterol concentration compared with the remainder of the community. The lipoprotein lipid pattern in these people is consistent with a low cardiovascular risk status, and might account for the apparent absence of coronary heart disease on the island.     

幽门螺杆菌感染与冠心病患者氧化低密度脂蛋白及颈动脉硬化的关系

目的 探讨幽门螺杆菌(Hp)感染与冠心病患者氧化低密度脂蛋白及颈动脉硬化的关系.方法 研究选取医院心内科在2010年10月-2011年10月收治的160例冠心病患者,依据14C呼吸试验结果将患者分为3组,分别检测3组患者的超敏C反应蛋白(hsCRP)、氧化低密度脂蛋白(oxLDL)等血生化指标及颈动脉内膜中层厚度水平.结果 3组患者在hsCRP、oxLDL、胆固醇及低密度脂蛋白胆固醇检测水平方面比较,差异均有统计学意义(P＜0.05);其中重度感染组患者的各项指标检测水平均显著高于阴性及轻度感染组;阴性感染组患者颈动脉内膜中层厚度(IMT)为(0.89±0.19) mm;轻度感染组患者IMT (1.04±0.39) mm;重度感染组患者IMT(1.23±0.49)mm,3组比较差异有统计学意义(P＜0.05),其中重度感染组患者IMT水平最高.结论 Hp感染与冠心病患者颈动脉粥样硬化的发病呈正相关性,同时,Hp感染还可通过影响脂质代谢、促进LDL氧化及诱发炎症反应以增进颈动脉粥样硬化的进展.     

Mortality and coronary heart disease in diabetes mellitus

Abstract: A clinic-based study of 1063 patients with Type 2 diabetes recruited from 1973 to 1982 identified 533 deaths (attributed to coronary heart disease in 268 cases) by 31 December 1989. When compared to the general population of Australia the overall standardised mortality ratio was 1.42 (95 per cent confidence interval (CI) 1.26 to 1.58) for females and 1.19 (CI 1.03 to 1.35) for males. Cox regression analysis showed that having coronary heart disease or absence of foot pulses at the time of entrance to the study were the major independent risk factors for overall mortality after adjustment for initial age. Elevated cholesterol and blood pressure were found to be major independent risk factors for death from coronary heart disease.     

Interactions between diabetes and family history of coronary heart disease and other risk factors for coronary heart disease among adults with diabetes in Utah

We used a unique data base containing medical family history information from representative Utah families to investigate interactions between diabetes and family history of coronary heart disease and other risk factors for coronary heart disease. We compared nonrelated individuals reported to have had diabetes mellitus diagnosed over the age of 19 (948) with 2150 nondiabetic individuals. Among both men and women, diabetes and family history of early coronary heart disease magnified the risk for coronary heart disease, so that in diabetic individuals with a positive family history of coronary heart disease, about 74% of the coronary heart disease could be attributed to interaction. Relative to nondiabetics without a family history of early coronary heart disease, nondiabetics with family history had a relative risk of 4.5 (2.3-8.7), diabetics without a family history had a relative risk of 2.8 (1.6-4.9), and diabetics with a family history had a relative risk of 21.3 (9.1-50.0). Smoking also interacted with diabetes; among smoking diabetics, 47% of early heart disease may be attributable to interaction between smoking and diabetes. Smoking entailed the highest risk for diabetic women. Hypertension and diabetes appeared to act additively, with little interaction. Among women, family history of diabetes was a risk factor for coronary heart disease with a relative risk of 2.5 (1.0-6.4), whereas for men the relative risk was estimated to be 0.4 (0.2-1.1).     

匹伐他汀钙对高龄冠心病合并糖尿病和高血压的疗效

目的 观察匹伐他汀钙治疗高龄冠心病合并糖尿病和高血压患者的疗效及安全性.方法 选择年龄≥80岁冠心病合并糖尿病和高血压患者80例、随机分为匹伐他汀钙(每晚1～2 mg)组和辛伐他汀(每晚10～20 mg)组各40例,分别干服药前,服药后2、4、8周检测总胆固醇(TC),高密度脂蛋白胆固醇、低密度脂蛋白胆固醇(LDL-C)、肌酸磷酸激酶(CPK)及肝肾功能.结果 匹伐他汀钙组降低TC、LDL-C作用与辛伐他汀组相当,肝、肾功能及CPK无明显变化;辛伐他汀组4例谷丙转氨酶和谷草转氨酶轻度升高.结论 高龄冠心病合并糖屎病和高血压患者口服匹伐他汀钙疗效及安全性较好,对肝功能损害较轻.     

冠心病患者血清脂蛋白a、同型半胱氨酸、胱抑素C水平变化及临床价值研究

目的:探讨冠心病患者血清脂蛋白a[Lp(a)]、同型半胱氨酸(Hcy)、胱抑素C(Cys-C)水平变化及临床价值.方法:选取2014年1月-2017年1月在我院心内科住院治疗的冠心病患者145例,纳入观察组,同时选取健康体检者85例,作为对照组进行对比研究.对所有入选者进行Lp(a)、Hcy、Cys-C测定,探讨上述指标在冠心病患者中的表达水平及临床意义.同时描绘ROC曲线,观察上述指标联合诊断在冠心病中的价值.结果:血清Lp(a)、Hcy、Cys-C在冠心病组患者高于对照组,两组分别比较,差异有统计学意义(P＜0.05);对上述指标进行ROC曲线比较,发现联合检测的敏感度、特异性高于单项检测.结论:血清Lp(a)、Hcy、Cys-C表达水平在冠心病患者中明显升高,临床上可通过对上述指标的联合检测,评估冠心病合的严重程度,指导预后及治疗.     

冠心病的药物治疗冠心病的调脂治疗

长期研究表明,冠心病的病理基础是冠状动脉粥样硬化,血中胆固醇水平增高是冠心病发病及其相关心血管病事件最重要的危险因素,冠心病病人需要长期调脂治疗.冠心病一级干预预防研究中,美国Framingham研究显示血清胆固醇每降低1%,冠心病的危险性可减少2%.     

冠心病患者幽门螺杆菌感染对血清氧化低密度脂蛋白及冠状动脉病变的影响

目的探讨冠心病患者幽门螺杆菌(Helicobacter pylori, Hp)感染与血清中氧化低密度脂蛋白( oxidized low density lipoprotein, ox-LDL) 水平及冠状动脉病变严重程度之间的关系。方法选取2012年12月至2013年11月在我院行冠脉造影确诊为冠心病的患者159例作为研究对象。采用¹⁴C尿素呼气试验测定其Hp感染状况,根据¹⁴C尿素呼气试验结果将所有受试者分为Hp感染组和非Hp感染组,同时采用酶联免疫吸附法测定其血清ox-LDL水平。结果冠心病患者Hp感染组血清ox-LDL、TC、LDL、TG水平高于非Hp感染组,差异均具有统计学意义( P<0.05,P<0.01);不同Hp感染程度分组患者血清ox-LDL水平差异具有统计学意义(F= 22.299 ,P< 0.01),随着患者体内Hp感染程度的加重,其血清ox-LDL水平相应增高;不同冠状动脉病变程度分组患者血清ox-LDL水平差异具有统计学意义(F= 8.711 ,P< 0.01),血清ox-LDL水平随着冠状动脉病变严重程度增加而呈递增趋势。多元线性回归分析显示,Hp感染以及血清ox-LDL、LDL、TC、TG、HDL-C均为冠心病患者冠状动脉Gensini评分的影响因素。结论Hp感染可能通过引起脂质代谢紊乱、升高血清ox-LDL水平来增加冠状动脉血管损害程度,从而在冠心病的发生发展中起着至关重要的作用。     

冠心病合并糖尿病患者的知识掌握情况研究及对策

目的了解冠心病合并糖尿病患者对糖尿病疾病相关知识掌握情况,发现其知识缺乏所在,为针对性进行健康教育提供理论依据.方法采用问卷法对2004年5月～2005年7月住入我院心内科病房的糖尿病患者进行调查.结果糖尿病患者对知识掌握情况依次为药物治疗＞饮食治疗＞监测血糖＞运动治疗.结论患者对疾病相关知识的掌握程度不容乐观,因而有针对性的进行疾病健康教育十分重要.     

2型糖尿病与冠心病

1 糖尿病并发心血管病变的危险因素 糖尿病病人中90%～95%是2型糖尿病,2型糖尿病常与代谢综合征伴随发生.代谢综合征表现除血糖增高,糖耐量受损外,还有胰岛素抵抗、高胰岛素血症、腹型肥胖、血脂异常、血压高、血尿酸高和1型纤维蛋白酶原激活物抑制剂(PAI-1)增高等.这些均是2型糖尿病大血管病变发生的原因.     

健康教育干预对老年冠心病合并糖尿病患者的效果评价

目的 探讨老年冠心病合并糖尿病患者健康干预的有效措施.方法 在2339名老年人的生活质量调查中,确定235例冠心病合并糖尿病患者为研究对象,进行2年健康干预,比较干预前后的生活方式、体重、血糖、尿糖、血脂和生活质量.结果 较之干预前,患者干预后形成良好生活方式的比例、生活质量指标的良好率显著增加（P〈0.05）,体重、空腹血糖、TC、TG、LDL-C、尿糖阳性率显著降低（P〈0.05）.结论 健康教育可通过调整老年冠心病合并糖尿病患者的生活方式而有效改善其临床指标和生活质量.     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的探讨冠心病合并2型糖尿病患者的冠状动脉（冠脉）造影特点。方法716例冠心病患者，均行冠脉造影检查。其中冠心病合并2型糖尿病患者340例作为观察组，冠心病不合并2型糖尿病患者376例作为对照组。对两组患者的冠脉造影资料进行分析。结果观察组多支病变高于对照组（56．2％比34．6％，P〈0．05），C型病变高于对照组（54．1％比24．5％，P〈0．05）。结论冠心病合并2型糖尿病患者冠脉病变广泛且复杂。     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的 探讨冠心病合并2型糖尿病患者的冠状动脉(冠脉)造影特点.方法 716例冠心病患者,均行冠脉造影检查.其中冠心病合并2型糖尿病患者340例作为观察组,冠心病不合并2型糖尿病患者376例作为对照组.对两组患者的冠脉造影资料进行分析.结果 观察组多支病变高于对照组(56.2%比34.6%,P＜0.05),C型病变高于对照组(54.1%比24.5%,P＜0.05).结论 冠心病合并2型糖尿病患者冠脉病变广泛且复杂.     

Promoting behaviour change in patients with coronary heart disease

Background: Secondary prevention is an effective strat-egy for reducing coronary heart disease morbidity and mortality. Secondary prevention in primary care has been shown to be suboptimal. Evidence on approaches to behaviour change, suitable for implementation in primary care, is needed.

Objective: To identify approaches to behaviour change in patients with coronary heart disease that are rele-vant to primary care and compare the views of health professionals in two different healthcare systems (United Kingdom and the Republic of Ireland).

Methods: Two nominal groups were conducted in Northeast Scotland and the West of Ireland with expert panels representing core and extended primary care teams. Participants were asked to generate ideas, rank them, and then discuss areas of disagreement before a second round of ranking.

Results: In both groups, there was good consensus on items relating to individual patient assessment (including motivation and understanding), addressing the practitioner's willingness to change, using established principles of behaviour change, and having adequate resources, staff and time. Priorities were, however, different. Emphasis on items relating to resources, staff and organisation was particularly strong in the Irish group; there was more emphasis on approaches to behaviour change in the Scottish group.

Conclusions: When attempting to promote behaviour change and secondary prevention, there are different priorities in different healthcare systems. These should be taken into account in the design of any intervention.     

2型糖尿病合并冠心病患者抵抗素测定及其意义

目的研究抵抗素与2型糖尿病合并冠心病的相关性,探讨抵抗素对2型糖尿病合并冠心病的作用和机制。方法选择正常对照组51例,2型糖尿病组72例和2型糖尿病合并冠心病组75例,测定抵抗素、糖化血红蛋白、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、空腹血糖、空腹胰岛素。结果血清抵抗素浓度与年龄、SBP、DBP、TG呈正相关;与BMI、HOMA—IR等无相关性。结论抵抗素水平的升高与2型糖尿病合并冠心病形成有关。