用简单可靠的方法检测心血管病患者的肾脏损害

美国心脏病协会(AHA)推荐对所有罹患心血管疾病或具有心血管病危险因素的成年患者进行肾脏疾病的筛查并认定了2个可靠且简单的检测方法:评价肾小球滤过率(eGFR);测定尿微量白蛋白。慢性肾脏疾病(CKD)是进展期心血管疾病的一个主要危险因素,恰当的干预治疗可以延缓疾病的发展,因     

久坐增绝经后女性心血管病危险

《美国心脏病学会杂志》在2013年4月在线发表了一项有关女性绝经后心血管病危险因素的研究,该研究指出,在无心血管疾病（CVD）病史的绝经后女性中,久坐会增加CVD的发生风险,与休闲体育活动时间无关,如同时存在久坐和体力活动较少可进一步增加CVD风险（JAm Coill Cardiol,2013Aprl0）。     

类风湿关节炎发生动脉粥样硬化的机制研究

类风湿关节炎(rheumatoid arthritis,RA)是一种导致关节功能障碍的慢性炎性疾病。虽然病情改变类药物的使用已经比较积极和普遍,RA患者的病死率却是普通人群的两倍。来自多个国家的研究发现RA患者的主要死亡原因是心血管疾病(表1)。一项基于4635个社区居民和236例RA患者的前瞻性研究发现。RA的心血管病事件发生率为3．43%,而普通人群仅为0．59%。矫正传统的心血管病危险因素如年龄、性别、体重指数、血压、吸烟、糖尿病、高胆固醇血症等以后,     

心血管病的危险因素及其预防

随着现代人膳食结构的改变，罹患肥胖症和高血压、动脉硬化、冠心病及中风等心血管疾病（CVD）的人数日趋增多，死于心血管疾病的人数比任何其他主要传染病和寄生虫病的人数都要多。由于心血管疾病的发生率逐年增加，因此对心血管病危险因素的研究也随之增多。     

女性健康研究——阿斯匹林用于心血管病的一级预防

阿斯匹林已成为上一世纪二级预防的标准药物。它价廉而具有保护作用。但它在一级预防中的作用仍未有共识。     

2011AHA女性心血管疾病预防指南解读

1999年美国心脏病协会（AHA）第一次发表《女性心血管疾病预防建议》,于2007年发表《女性心血管疾病预防指南》（下称2007指南）,推动了全球对女性心血管疾病的关注。1999年以来,美国通过普及教育,提高了美国女性对心血管疾病的关注。美国女性的心血管疾病死亡率2007年较1997年下降了43％,其中一半获益来自女性心血管疾病二级预防,另一半获益来自对女性心血管病危险因素的干预。2011年AHA再次更新《女性心血管疾病预防指南》（下称2011指南）,该指南改进之处在于,不仅强调心血管危险因素干预对女性心血管健康获益的循证汪据,     

1984—1999年北京25～64岁人群心血管病危险因素变化趋势的研究

本研究分析了1984-1999年在北京市自然人群中开展的5次心血管病危险因素调查资料，比较北京市人群15年来心血管病危险因素的变化趋势及心血管病危险因素在不同人群中的变化特点，为人群心血管疾病预防提供依据。     

循证医学指导的女性心血管疾病预防-2007年女性心血管疾病预防指南解读

1999年，美国心脏病协会（AHA）在发表于1997年的AHA“女性心血管病——现状和危险因素治疗”共识基础上发表了新的“女性心脏病预防指南”。随着新的相关研究的发表和认识的进一步深入，AHA于2004年发表了“循证医学指导的女性心血管疾病预防”。     

1992-2002年北京一组队列人群心血管病危险因素变化趋势研究

目的评价北京地区队列人群1992--2002年10年心血管病危险因素变化趋势。方法于1992年和2002年分别对同一组个体,按照世界卫生组织MONICA方案心血管病危险因素调查方法进行调查。对血压、体重指数、腰围、臀围、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和甘油三酯、血糖、高血压患病率、治疗率和控制率的变化进行比较。结果（1）1992-2002年相同年龄组（45～54岁和55～64岁）比较心血管病危险因素水平呈显著升高的趋势。（2）1992年理想血压者,2002年有19．0％的人成为高血压患者;正常血压者,45．3％的人成为高血压患者。（3）1992年血脂正常者,2002年有43．8％的人成为血脂异常者。（4）1992年体重指数正常者,2002年有37．0％的人成为超重者;腰围正常者,有43．7％的人成为高腰围者。（5）1992年无代谢综合征者,2002年有14．6％的人成为有代谢综合征者。结论本队列人群10年心血管病危险因素水平明显上升,其主要危险因素均与生活方式密切相关。改变不良生活方式是控制和减慢主要危险因素上升的速度和减少心血管病发病的关键。     

女性心血管疾病病理生理机制及危险因素特点

心血管疾病是当今威胁女性健康和生命的主要疾病,是导致中国女性死亡的首位原因。1999年,美国心脏病协会（AHA）第一次发布的女性心血管疾病预防建议,提高了美国民众对女性心血管疾病的公众意识,并促进了预防和治疗的进步。据调查2007年美国每分钟就有一位女性死于心血管疾病。因此,2011年AHA对女性心血管疾病预防指南进行了更新,并将“循证为基础”转化为“效果为基础”,更加关注预防治疗的有效性。随着我国经济的发展和生活水平的提高,女性心血管疾病的发病、死亡呈持续增加的趋势。     

烟草与女性心血管疾病

传统观念认为女性冠心病发病比男性晚10年以上,因而较少受到关注。大量的流行病学研究和临床荟萃分析显示,发达国家男性的冠心病死亡率已有明显下降,而女性却呈稳中有升的趋势,已成为女性健康的头号“杀手”。2006年,美国有315000女性死于心脏病,同年巴西69493人死于心肌梗死,其中40．8％为女性。     

The Global Burden of Cardiovascular Disease in Women

Purpose of review

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, accounting for one third of all deaths in 2015. Alarmingly, there has been slowing of the decline in age-standardized CVD mortality over the last 5 years compared to the previous 25 years.

Recent findings

Given the increasing global CVD burden, in 2011, the United Nations declared the goal to reduce premature mortality from the four main non-communicable diseases by 25% from 2010 to 2025, abbreviated as the 25?×?25 goal. The United Nations has further created nine targets to achieve the 25?×?25 goal. These targets emphasize risk factor modification and strengthening of healthcare delivery systems.

Summary

Achieving the nine targets and 25?×?25 goal set by the United Nations will undoubtedly benefit the world as a whole. However, women face additional, unacceptable, disproportionate CVD risk factors that need to be addressed, including psychological stressors contributing to ischemic heart disease, pregnancy-related CVD, environmental and infectious exposures in low socioeconomic settings, and limited healthcare access and delivery. This paper highlights global CVD gender disparities in order to stimulate awareness and discussion of potential interventions to address the rapidly growing burden of heart disease in women.

     

Women and Cardiovascular Disease—Prevention of Heart Disease

The specific characteristics of cardiovascular (CV) disease in women are discussed, emphasizing that coronary heart disease (CHD) is the major health problem in women but, overall, women are still less likely to die of CHD than men. This is clarified by the fact that women under age 75 are more likely to die from a myocardial infarction when one occurs and that CHD, when it is present, is especially malignant in women under the age of 50. Separate from risk are the issues of prevention and treatment. The latest in prevention with aggressive treatment of cholesterol especially is emphasized and discussed. Regardless of gender, the guidelines for low-density lipoprotein (LDL) cholesterol lowering have become more and more intensive with benefit accruing to the patient with high CV risk of either sex at levels of LDL cholesterol below 70 mg/dl. Inflammatory risk factors as well as homocysteine and lipoprotein (a) have been shown to make a difference and their control has assumed increased importance. There are now multiple therapeutic options for attaining blood lipid goals and the major therapeutic options are discussed. Statins are still primary in controlling LDL cholesterol but numerous other medications contribute secondary additional benefits or are primary because of specific metabolic problems such as the metabolic syndrome and hypertriglyceridemia. When CHD is established or the risk for CHD is high, it is essential to treat aggressively all major risk factors: hypercholesterolemia, hypertension, cigarette smoking, diabetes mellitus, and metabolic syndrome. Such management delays development of clinical CHD and saves lives.     

Cardiovascular Disease in Somali Women in the Diaspora

With globalization and transnational migration, there is an increasing need for health systems in destination countries to consider the healthcare needs of diverse immigrant populations. This article reviews the literature on cardiovascular disease and its risk factors in Somali women in the diaspora. Although we found no studies on cardiovascular disease per se, the little extant research demonstrates that Somali women are exposed to multiple risk factors for cardiovascular disease. This important area of research may have been neglected due to an inordinate focus on maternal and reproductive health. We call for a more inclusive approach to Somali women’s health that takes into account social and cultural contexts of women’s lives while addressing health and illness experienced across the lifespan.     

他汀在女性心血管疾病一级预防中的作用

冠心病是发达国家男性和女性的首要死亡原因。低密度脂蛋白胆固醇（LDL-C）升高是重要、独立的心血管危险因素。他汀能够有效地降低LDL-C水平,能够减少心血管发病率和病死率,他汀是冠心病预防策略必不可少的组成部分。但女性患者在一级和二级预防中,他汀处方使用明显不足。一度认为对于女性心脏病的预防,尤其是未诊断为冠心病的女性,无证据证明使用他汀能获益。现回顾他汀在预防女性冠心病中的作用。累积的证据显示,在一些研究中,女性受试者代表性不足,后续统计分析有限。目前的指南对于血管性疾病建议无论男性和女性,血脂异常的处理策略相似。因此,他汀治疗对于男性和女性标准一致,目标也一致。     

Cocaine and the Long-Term Risk of Cardiovascular Disease in Women

BackgroundCocaine is associated with acute cardiovascular complications, but the long-term cardiovascular risks of cocaine use are poorly understood. We examined the association between cocaine use disorders and long-term cardiovascular morbidity in women.MethodsWe analyzed a longitudinal cohort of 1,296,463 women in Quebec, Canada between 1989 and 2020. The exposure included cocaine use disorders prior to or during pregnancy. The outcome was cardiovascular hospitalization up to 31 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of cocaine use disorders with cardiovascular hospitalization.ResultsThe cohort included 2954 women with cocaine use disorders. Compared with women without an identified cocaine disorder, women with cocaine use disorders had 1.55 times greater risk of future cardiovascular hospitalization during 3 decades of follow-up (95% CI, 1.37-1.75). Cocaine use disorders were strongly associated with inflammatory heart disease (HR 4.82; 95% CI, 2.97-7.83), cardiac arrest (HR 2.93; 95% CI, 1.46-5.88), valve disease (HR 3.09; 95% CI, 2.11-4.51), and arterial embolism (HR 2.22; 95% CI, 1.19-4.14). The association between cocaine use disorder and cardiovascular hospitalization was most marked after 5 to 10 years of follow-up (HR 2.15; 95% CI, 1.70-2.72).ConclusionsWomen with cocaine use disorders have a high risk of cardiovascular hospitalization up to 3 decades later. Substance use reduction and cardiovascular risk surveillance may help reduce the burden of cardiovascular disease in women with cocaine use disorders.