冠心病患者血糖管理的新概念

<正>糖尿病与冠心病互为高危因素。当糖尿病与冠心病并存时,患者发生严重不良心血管事件的危险性显著增高。因此,加强心血管病患者的血糖管理,对最大限度改善患者预后具有重要意义。然而,新近结束的糖尿病患者心血管危险因素的控制效果试验(action to control cardiovascular risk in diabetes,ACCORD)、大规模2型糖尿病前瞻性研究-ADVANCE研究     

吡格列酮对2型糖尿病合并冠心病患者动脉粥样硬化相关危险因素及预后的影响

目的探讨吡格列酮治疗2型糖尿病合并冠心病患者对其动脉粥样硬化相关危险因素及预后的影响。方法选取2010年8月至2012年1月在本院进行治疗的2型糖尿病合并冠心病患者202例,随机分为治疗组和对照组,两组均给予常规治疗;在此基础上,治疗组(101例)加用吡格列酮(15mg/次,1次/天)治疗,期间定期随访,1年后比较2组血液动脉粥样硬化相关危险因素及心血管不良事件发生率。结果治疗组血清PAI-1(纤溶酶原激活物抑制物-1)水平为(4.15±0.47)ng/ml,P-选择素水平为(12.38±3.56)ng/ml,对照组血清PAI-1水平为(7.46±1.73)ng/ml,P-选择素水平为(15.84±6.32)ng/ml,两组比较差异显著(P<0.05);治疗组空腹血糖、餐后血糖、空腹胰岛素、糖化血红蛋白水平和胰岛素抵抗指数及急性冠脉综合征、不稳定性心绞痛和靶血管重建发生率显著低于对照组,(P<0.05)。结论吡格列酮用于治疗2型糖尿病合并冠心病,能降低其动脉粥样硬化相关危险因素从而改善预后。     

老年ACS患者PCI术后不良心血管事件影响因素分析

目的探讨老年急性冠状动脉综合征(acute coronary syndrome,ACS)患者行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后发生不良心血管事件的影响因素。方法回顾性收集2014年1月至2016年7月于本院心血管内科确诊为ACS并成功行PCI的150例老年患者的临床资料,了解患者的一般资料、PCI手术情况、术后服药情况及随访期间不良心血管事件的发生情况,对可能影响患者发生不良心血管事件的指标进行单因素分析,进一步选择有统计学意义的指标进行多因素Logistic回归分析。结果 PCI术后随访1年期间,44例(29.3%)患者发生不良心血管事件。多因素Logistic回归分析结果显示,合并高血压(OR=2.579)、合并高脂血症(OR=2.621)、术后慢血流(OR=3.000)、服用替格瑞洛(OR=0.334)、服用β受体阻滞剂(OR=0.344)均为老年ACS患者PCI术后发生不良心血管事件的独立危险因素(P<0.05)。结论老年ACS患者PCI术后发生不良心血管事件的危险因素是合并高血压、合并高血脂、术后慢血流,保护因素是服用替格瑞洛和β受体阻滞剂。     

血液透析治疗尿毒症合并冠心病临床效果观察

目的研究血液透析在尿毒症合并冠心病患者治疗中的临床意义。方法选取本院收治的尿毒症合并冠心病患者27例,维持性血液透析治疗,统计血液透析期间患者的死亡情况及心血管系统并发症发生情况。结果在维持性血液透析期间,3例(11.11%)患者透析3年后死于心肌梗死,2例(7.41%)患者透析16个月死于严重感染,1例(3.70%)患者透析1年后死于脑梗死,患者总死亡率为22.22%,存活率为77.78%。在8925例次血液透析期间,低血压、高血压、心律失常、心绞痛、心力衰竭发生例次分别为1224例次(13.71%)、598例次(6.70%)、315例次(3.53%)、238例次(2.67%)、209例次(2.34%)。治疗后,患者各因子水平明显变化,与治疗前比较差异显著(P<0.05)。结论维持性血液透析可提高尿毒症合并冠心病患者存活率,但心血管系统并发症发生率较高,在透析期间应密切监护,积极防治并发症。     

2型糖尿病合并高血压患者血压控制目标的争议

我国糖尿病患者人数迅猛增加,其中约3/4合并高血压。糖尿病合并高血压患者心血管并发症、卒中与死亡风险显著增加,心脑血管疾病成为糖尿病患者的主要死亡原因,并给社会造成巨大的经济负担。控制血压是全面降低糖尿病心血管危险的重要组成部分。以往UKPDS、HOT等研究提示降低2型糖尿病合并高血压患者的收缩压和(或)舒张压可降低心血管事件发生率,甚至死亡率。以往各学术组织,包括世界卫生组织(World Health Organization,WHO)、美国糖尿病学会(American Diabetes Association,ADA)、美国心脏协会(American Heart Association,AHA)、欧洲高血压学会(European Society of Hypertension,ESH)/欧洲心脏病学会(European Society of Cardiology,ESC)、中华医学会糖尿病学分会和高血压联盟(中国)均建议对糖尿病合并高血压患者控制目标为血压<130/80mm Hg。但近年来ACCORD-BP、ADVANCE、INVEST、ONTARGET等研究提示,与控制收缩压<140mm Hg相比,收缩压<130mm Hg并未显著降低心血管事件与死亡风险,收缩压过低甚至增加了严重不良事件的发生。2009年ESH率先根据新的循证证据,推荐所有高血压患者(包括合并糖尿病者)血压控制目标为130～139/80～85mm Hg。近期有学者综合数个大型随机对照试验(RCT)研究和近年来重要的荟萃分析结果,平衡不同血压水平对卒中、冠脉事件与死亡率的风险与获益,提出2型糖尿病合并高血压患者的强化血压控制目标在130～135/80～85mm Hg较为合理,现将其相关证据进行综述。     

2型糖尿病强化治疗的利与弊

<正>1引言2型糖尿病是一种慢性进展性疾病,长期血糖控制不佳可导致大血管及微血管并发症的发生,其中,心血管并发症是导致2型糖尿病患者死亡的主要原因。与1950～1975年间相比,1976～2001的25年间,糖尿病患者的全因死亡率和心血管死亡率明显下降,但仍高于无糖尿病者。流行病学     

琥珀酸美托洛尔缓释片在糖尿病合并高血压治疗中的应用效果观察

目的探讨琥珀酸美托洛尔缓释片(倍他乐克)在糖尿病合并高血压治疗中的应用效果。方法 2013~2014年间收治的66例2型糖尿病合并高血压患者,随机将其分为观察组与对照组,每组各33例,两组患者均根据个体情况给予口服降糖药或胰岛素皮下注射控制血糖,并常规服用阿司匹林、辛伐他汀。观察组在此基础上给予倍他乐克口服25 mg/次、3次/d,对照组服用非洛地平5 mg/d。观察对比两组患者的治疗效果。结果观察组疗效良好21例、一般10例、差2例,对照组疗效良好9例、一般15例、差9例,组间比较差异均具有统计学意义(P0.05)。结论倍他乐克用于糖尿病合并高血压的治疗,对血糖血压的控制效果较好。     

稳定性心绞痛在骨科关节置换术后致心血管意外的表现

目的研究分析稳定性心绞痛患者经骨科关节置换术治疗致心血管意外的相关因素。方法选取2016年3月—2017年12月本院接收的68例稳定性心绞痛患者作为研究对象。所有患者均经骨科关节置换术治疗,采用Logistic回归模型对心血管意外相关因素进行分析。结果多因素分析显示冠心病合并肥胖、冠心病合并高血压、冠心病合并糖尿病、心功能Ⅱ～Ⅲ级是患者行关节置换术诱发心血管意外的独立危险因素。结论行关节置换术的稳定性心绞痛患者若冠心病合并肥胖、冠心病合并糖尿病、Ⅱ级心功能Ⅲ级,会增加心血管意外的发生风险,临床应加大重视度,对患者进行细致、全面观测,严防心血管意外事件发生。     

左卡尼汀治疗糖尿病并心力衰竭的效果

目的探讨左卡尼汀治疗糖尿病合并心力衰竭老年患者的效果。方法选取本院心血管内科2016年6月—2018年6月收治的116例糖尿病合并心力衰竭老年患者作为研究对象,根据不同治疗方案,将其分成两组,每组各58例。对照组采用常规治疗,观察组在此基础上,加用左卡尼汀(2 g+0.9%生理盐水100 mL,静脉滴注,每天1次)治疗。10 d后,比较两组患者的血糖水平变化情况及临床疗效。结果治疗后观察组餐后2 h血糖、空腹血糖水平低于对照组,差异具有统计学意义(P 0.05);观察组治疗有效率(93.10%)高于对照组(77.59%),差异具有统计学意义(P 0.05)。结论左卡尼汀治疗糖尿病合并心力衰竭老年患者可有效降低患者血糖水平,促进心功能恢复,效果显著。     

行经皮冠状动脉介入治疗的冠心病患者预后影响因素分析

目的分析1500例行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的冠心病(coronary heart dis ease,CHD)患者预后的影响因素。方法选取本院2014年12月至2017年7月收治的1500例行PCI的冠心病患者为研究对象,按是否发生主要不良心脏事件(major adverse cardiac events,MACE)将其分为预后良好组和预后不良组,采用多因素Logistic回归分析探讨影响患者预后的因素。结果 1500例患者均完成1年随访,MACE发生率为16.00%。多因素Logistic回归分析显示:有冠心病家族史、合并糖尿病、左室射血分数、血细胞比容、平均红细胞体积、红细胞分布宽度、N末端B型利钠肽原、高敏C反应蛋白均是影响PCI患者预后的独立危险因素(P_均<0.05)。结论行PCI的患者术后MACE发生风险高,应高度重视合并相关危险因素者,积极预防,以最大限度地改善患者预后。     

Study progress of berberine for treating cardiovascular disease

Berberine (BBR) is a natural alkaloid isolated from the Coptis chinensis. While this plant has been used in Chinese medicine for more than 2500 years, interest in its effects in treating cardiovascular disease has been growing in the last decade. Recent researches showed that BBR had the effect of anti-heart failure, anti-hypertension, anti-hyperlipidemia, anti-insulin resistance, anti-arrhythmias, and anti-platelet aggregation.     

心血管护理中舒适护理的临床应用效果分析

目的观察舒适护理应用在心血管护理的有效性。方法抽取2013年10月~2015年5月于我院接受治疗的92例心血管患者,分成观察组与对照组,对照组采用常规护理,观察组在常规护理基础上联合舒适护理干预,对比护理满意率。结果观察组满意率为97.82%,对照组满意率为76.08%,观察组护理满意率较高,P0.05,差异具有统计学意义。结论舒适护理应用于心血管护理工作中,可提高护理满意率和治疗效果。     

心血管疾病风险与食物血糖指数和血糖负荷相关性分析

目的探究并分析心血管疾病风险与食物血糖指数和血糖负荷的相关性。方法选取2007年1月至2009年1月2137例于本院体检的50~70岁体检者为研究对象。随访5年,统计研究对象并发心血管疾病的例数,并对可能的影响因素进行分析。结果随访结束后,2137例体检者中65例并发心血管疾病,单因素χ2检验显示:高血糖负荷、高血糖指数、肥胖、吸烟、饮酒和负性情绪等因素易诱发心血管疾病,多因素Logistic回归分析得到危险因素由大至小分别为:高血糖指数(OR=20.950,P=0.000)、高血糖负荷(OR=6.716,P=0.000)、肥胖(OR=2.808,P=0.000)和饮酒(OR=1.683,P=0.00)。结论血糖负荷和食物血糖指数可以作为进餐后血糖反应的两项重要指标,引入食物血糖指数、血糖负荷的概念对健康人群进行饮食教育能够改善人体糖化血红蛋白、血脂、胰岛素抵抗水平,具有预防心血管疾病及其并发症的作用,值得临床进一步推广应用。     

Preferences and attitudes of young Chinese clinicians about using a shared decision making tools for communicating cardiovascular risk

ObjectiveThis study assesses the attitudes and preferences of Chinese clinicians toward their involvement in shared decision making (SDM).MethodsFrom May 2014 to May 2015, 200 Chinese clinicians from two hospitals were enrolled to complete a survey on their attitude towards SDM. We conducted the survey via face-to-face interviews before and after an educational intervention on SDM among young Chinese clinicians. The clinicians were asked to give the extent of agreement to SDM. They also gave the extent of difficulty in using decision aids (DAs) during the SDM process. The variation in the range of responses to each question before and after the SDM intervention was recorded. The frequency of changed responses was analyzed by using JMP 6.0 software. Data were statistically analyzed using Chi-square and Mann–Whitney U tests, as appropriate to the data type. Multiple logistic regressions were used to test for those factors significantly and independently associated with preference for an approach for each scenario.ResultsOf the 200 young Chinese clinicians sampled, 59.0% indicated a preference for SDM and a desire to participate in SDM before receiving education or seeing the DA, and this number increased to 69.0% after seeing the DA with the sample video of the SDM process on Statin Choice. However, 28.5% of the respondents still reported that, in their current practice, they make clinical decisions on behalf of their patients. The clinicians who denied a desire to use the DA stated that the main barriers to implement SDM or DA use in China are lack of time and knowledge of SDM.ConclusionsMost young Chinese clinicians want to participate in SDM. However, they state the main barriers to perform SDM are lack of experience and time. The educational intervention about SDM that exposes clinicians to DAs was found to increase their receptivity.     

Association of hemoglobin with arterial stiffness evaluated by carotid-femoral pulse wave velocity among Chinese adults

ObjectiveIncreased hemoglobin (Hb) levels are known to be associated with increased cardiovascular events and mortalities. Therefore, we assumed that high Hb levels were associated with arterial stiffness. Pulse wave velocity (PWV) is a simple and noninvasive method for measuring arterial stiffness to assess cardiovascular disease in general populations. Accordingly, we conducted a cross-sectional study to explore the association of Hb with PWV.MethodsA total of 6642 adults aged 54.5 ± 11.2 years undergoing physical examinations were enrolled, 71.7% of whom were males. Arterial stiffness was evaluated by carotid-femoral PWV (cfPWV). Multivariable regression analyses were performed to determine the relationship between Hb and increased cfPWV.ResultsIn this study, the mean Hb (per 10 g/L increase) was 144.7 ± 13.9 g/L, and the mean cfPWV was 15.1 ± 3.1 m/s. cfPWV was significantly higher in high hemoglobin groups ≥15.4 g/L (Quartile 4) than in the lowest hemoglobin group (Quartile 1 ≤ 13.6 g/L; P < 0.001). Multiple linear regression analysis revealed that Hb positively correlated with cfPWV (β = 0.16, P < 0.01). Univariate Logistic regression analysis revealed that Hb was associated with increased cfPWV, with an odd ratio (OR) of 1.46 (95% confidence interval [CI], 1.39–1.54). After adjusting for potential confounders, Hb and the highest Hb quartile group were also independently associated with increased cfPWV, with a fully adjusted OR of 1.11 (95% CI, 1.02–1.20) and 1.45 (95% CI, 1.01–2.08), respectively.ConclusionThis study demonstrated that Hb levels significantly correlate with increased cfPWV.     

Fasting glucose and its association with 20-year all-cause and cause-specific mortality in Chinese general population

ObjectiveThe aim of this study was to explore the relationship between fasting glucose levels and all-cause and cause-specific mortality in Chinese population.MethodsThe role of fasting blood glucose levels as a predictor of all-cause and cause-specific mortality was estimated in 9930 participants from four Chinese general populations with a 20-year follow-up. Multivariate Cox proportional hazard models were used to identify the relationship between fasting glucose and mortality.ResultsThere were 1471 deaths after a median follow-up of 20.2 years (a total of 187,374 person-years), including 310 cardiovascular deaths, 581 cancer deaths, and 580 other-cause deaths. After adjustment for age, sex, urban or rural, northern or southern of China, types of work, education level, physical exercise, smoking status, drinking status, body mass index, systolic blood pressure, and serum total cholesterol at baseline, the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality in the fasting blood glucose categories of <60, 60–69, 70–79, 90–99, 100–109, 110–125, and ≥126 mg/dl were 1.38 (1.04–1.84), 1.20 (1.01–1.43), 1.18 (1.03–1.36), 1.18 (0.99–1.41), 1.48 (1.16–1.88), 1.17 (0.84–1.62), and 2.23 (1.72–2.90), respectively, in contrast to the reference group (80–89 mg/dl). The HRs and 95% CIs for cardiovascular disease mortality in these groups were 2.58 (1.44–4.61), 1.41 (0.95–2.10), 1.56 (1.15–2.11), 1.29 (0.88–1.89), 1.36 (0.78–2.37), 1.05 (0.52–2.11), and 2.73 (1.64–4.56), respectively.ConclusionsBoth low and high fasting glucose were significantly associated with increased risk of all-cause and cardiovascular mortality in Chinese general population.     

The era of clinical application of gene diagnosis in cardiovascular diseases is coming

Gene diagnosis refers to the use of genetic testing in the diagnosis of inheritable conditions, which has gradually been applied in clinical practice with the completion of the gene sequencing efforts of the Human Genome Project and the advancement of gene detection technology. In the specialty field of cardiology, monogenic cardiovascular diseases are defined as monogenic inherited diseases with cardiovascular damage as the only phenotype, or accompanied by cardiovascular damage. Although the incidence of such diseases is relatively low, in the country of China with its vast population of 1.33 billion, the sheer volume of patients with monogenic cardiovascular diseases is alarming. With early onset, severe symptoms, and poor prognosis, delays in diagnosis and treatment of monogenic cardiovascular diseases often have serious consequences. Gene testing is perfectly suited for early diagnosis of monogenic cardiovascular diseases, especially for “pre-symptomatic” diagnosis. In this article, we generally review the characteristics of common monogenic cardiovascular diseases, summarize the progress of the standardized application of gene testing technology in clinical practice, describe the applicable population and condition of genetic testing for different monogenic cardiovascular diseases, analyze the practicality of genetic diagnosis of these inheritable conditions, and provide guidance on identifying suitable candidates for gene diagnosis. In conclusion, gene diagnosis provides new insights into the way physicians diagnose diseases, and is well-positioned to guide clinical decision making and treatment, especially in cardiology.     

Environmental heavy metals and cardiovascular diseases: Status and future direction

Cardiovascular disease (CVD) and environmental degradation are leading global health problems of our time. Recent studies have linked exposure to heavy metals to the risks of CVD and diabetes, particularly in populations from low- and middle-income countries, where concomitant rapid development occurs. In this review, we 1) assessed the totality, quantity, and consistency of the available epidemiological studies, linking heavy metal exposures to the risk of CVD (including stroke and coronary heart disease); 2) discussed the potential biological mechanisms underlying some tantalizing observations in humans; and 3) identified gaps in our knowledge base that must be investigated in future work. An accumulating body of evidence from both experimental and observational studies implicates exposure to heavy metals, in a dose-response manner, in the increased risk of CVD. The limitations of most existing studies include insufficient statistical power, lack of comprehensive assessment of exposure, and cross-sectional design. Given the widespread exposure to heavy metals, an urgent need has emerged to investigate these putative associations of environmental exposures, either independently or jointly, with incident CVD outcomes prospectively in well-characterized cohorts of diverse populations, and to determine potential strategies to prevent and control the impacts of heavy metal exposure on the cardiometabolic health outcomes of individuals and populations.