体检人群脉搏波传导速度与心血管病危险因素的关系研究

目的 探讨体检人群脉搏波传导速度与其他心血管病危险因素的关系。方法 采用回顾性研究,选择2015年10 月- 2016 年10 月于某院体检中心进行体检者1 806 例作为研究对象,测量身高、体重、血压等,检测血脂、空腹血糖（Fasting Plasma Glucose,FPG）、尿酸（Uric Acid,UA）等,测量上臂脚踝脉搏波传导速度(brachial - ankle Pulse Wave Velocity ,baPWV)。结果 baPWV异常组较正常组年龄大,体重指数（Body Mass Index,BMI）、收缩压（Systolic Blood Pressure,SBP）、FPG、低密度脂蛋白胆固醇（Low Density Lipoprotein Cholesterol,LDL - C）、UA等水平增高。相关分析结果表明baPWV与年龄(r = 0.55,P＜0.001)、收缩压(r = 0.63,P＜0.001)、空腹血糖(r = 0.30,P＜0.001)正相关,与其他心血管病危险因素关系不大。中年组baPWV轻度增高检出率最多（27.87%）。老年组baPWV中、重度升高检出率（63.28%）明显高于青年组（3.49%）和中年组（15.40%）。Logistics回归结果表明中、老年人baPWV增高风险增加,老年人较青年人baPWV增高风险明显增大（OR = 23.04）,血压增高者baPWV增高风险较血压正常者明显增大（OR = 30.71）,男性baPWV增高风险较女性稍高,血糖增高者baPWV增高风险较血糖正常者稍高。结论 高龄、高血压、高血糖是baPWV增高的独立危险因素,男性比女性baPWV更易增高。45岁以上的中老年人,特别是男性群体,高血压、高血糖者应为baPWV重点检测对象。     

Family-oriented prevention of cardiovascular disease: a social epidemiological approach

A social epidemiological approach has been used to study social factors associated with chronic disease, as well as to promote community-oriented intervention programs to modify risk for cardiovascular disease. The present review suggests using a social epidemiological approach in a third way; to promote efforts directed toward family-oriented primary prevention of cardiovascular disease. Evidence is presented which shows an association between three family social factors (marital status, family socioeconomic status, family size) and risk for cardiovascular disease. The real determinants of risk, however, may be the underlying health-related behaviors indicated by each of these factors. Evidence is also presented which shows the importance of a fourth family social factor (family age) in promoting effective health education efforts to modify risk. Thus, a social epidemiological approach is more valuable than a single discipline-based approach in identifying, understanding, and modifying family social influences on cardiovascular risk.     

Relations of cardiovascular risk factors to aortic pulse wave velocity in asymptomatic middle-aged women

Cross-sectional associations between aortic elasticity assessed by carotid to femoral pulse wave velocity (PWV) and cardiovascular risk factors were examined in 429 apparently healthy middle-aged women. PWV was strongly and positively related to blood pressure and hypertension. Weak but significant positive associations were also found between PWV and age, heart rate, some lipids and lipoproteins, blood glucose (either as a continuous or dichotomous variable), body mass index, haematocrit, leucocyte count and family history of diabetes. No associations were observed between PWV and high density lipoprotein cholesterol, apolipoprotein Al, fibrinogen, cigarette smoking, menopausal status and a family history of hypertension or myocardial infarction. After adjustment for systolic blood pressure, PWV remained significantly related to heart rate, leucocyte count, blood glucose (as a dichotomous variable) and a family history of diabetes. Multiple regression analysis showed that systolic blood pressure and, to a lesser extent, heart rate, leucocyte count and a family history of diabetes were all independent determinants of PWV. This pattern of associations suggests that arterial stiffness measured by PWV reflects the sclerotic rather than the atherotic component of atherosclerosis. The potential influence of a family history of diabetes on the elastic properties of the aorta needs to be ascertained in further studies.     

初潮年龄与脉搏波速度及心血管危险因素的关系

目的 探讨绝经后女性初潮年龄与脉搏波速度（pulse wave velocity,PWV）及心血管相关危险因素的关系。方法 选取2011-2014年间参与贵阳地区调查的女性7 330人,排除已确诊糖尿病和心血管疾病、未绝经女性和非正常绝经女性、初潮年龄和绝经年龄信息不确定者,最终纳入2 682例女性分析,通过问卷、体格检查、血清学及多普勒超声检测,获得初潮年龄、体质指数、血糖、血脂、PWV等指标,并依初潮年龄分为6组,采用SPSS 20.0软件分析。结果 本组研究人群平均初潮年龄为（14.6±1.9）岁,随初潮年龄增加,6组PWV异常率依次为88%、76%、71%、75%、76%、80%,呈近U型分布趋势（χ²=121.20,P=0.040）;13～14岁初潮年龄组PWV异常率是U分布的谷值;PWV的危险因素为初潮年龄、实际年龄、体质指数、腰围、空腹血糖、糖负荷后2小时血糖、收缩压、舒张压、甘油三酯（均有P<0.05）;不同年代出生女性初潮年龄对PWV异常风险影响不同。结论 贵阳地区40岁以上自然绝经女性的初潮年龄与脉搏波速度及心血管危险因素有关。     

Primary prevention of cardiovascular disease using validated risk scores: A systematic review

Objectives The high prevalence of cardiovascular disease (CVD) and the increased cost of treatment have prompted strategies for the primary prevention of CVD in the UK to move towards the use of validated CVD risk scores to identify individuals at the highest risk. There are no reviews evaluating the effectiveness of this strategy as a means of reducing CVD risk or mortality. This review summarizes current evidence for and against the use of validated CVD risk scores for the primary prevention of CVD. Design We utilized an in depth search strategy to search MEDLINE, EMBASE and the Cochrane database of clinical trials, expert opinions were sought and reference lists of identified studies and relevant reviews were checked. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies. Setting The majority of included trials were carried out in a primary care setting. 2 trials were carried out in North America, 2 in Scandinavia and 1 in the UK. Participants 31,651 participants in total were recruited predominantly from a primary care setting. Participants were aged 18-65 years old and were free from CVD at baseline. Main outcome measures Outcome measures used in the included studies were change in validated CVD risk score and CVD/All-cause mortality. Results We identified 16 papers which matched the inclusion criteria reporting 5 unique trials. Due to a lack of homogeneity in outcomes and risk scores used it was not possible to conduct a meta-analysis of the identified studies. Only one study reported a significant difference in risk score at follow up and one study reported a significant difference in total mortality, however significant differences in individual risk factors were reported by the majority of identified studies. Conclusions This review demonstrates the potential for multifactorial interventions aimed at individuals selected by CVD risk scores for lowering CVD risk and mortality. However, the majority of studies in this area do not provide an intensity of intervention which is sufficient in significantly reducing CVD mortality or validated CVD risk.     

脉搏波传导速度与脑血管疾病发病风险的相关关系的病例对照研究

摘要:目的　探讨颈股脉搏波传导速度（cfPWV）和颈桡动脉搏波传导速度（crPWV）与脑血管损伤的相关关系。方法　从2012年1月-2013年12月在凉山州州一医院神经内科诊断为急性脑梗死患者98例和脑出血患者92例,并纳入同期对照96例。采用脉搏波速测定仪进行测定一侧颈动脉-股动脉脉搏波速度（cfPWV）和颈动脉-桡动脉脉搏波速度（crPWV）。结果　脑梗死组和脑出血组与对照组相比,更易吸烟、饮酒、患高血压和糖尿病,差异有统计学意义（P＜0.05）。脑梗死组和脑出血组与对照组相比,TG、TC、HDL-C和LDL-C水平均高于对照组,差异有统计学意义（P＜0.05）。脑梗死组和脑出血组的cfPWV和crPWV水平与对照组相比,差异有统计学意义（P＜0.05）。急性脑梗死患者不同面积PWV和脑出血不同部位PWV水平差异无统计学意义（P＞0.05）。结论　PWV测定是一种无创性检测动脉弹性的方法,能够提供中心大动脉的弹性参数,对评估血管功能状态有重要的价值,能够采用该方法对脑血管疾病进行提前筛查,达到二级预防的效果。     

A dynamic family approach for the prevention of cardiovascular disease

Social and behavioral learning methods, combined with nutrition counseling and innovative education modules, provide a well-rounded approach to eating behavior intervention. Dietitians can apply this multifaceted approach in various settings to maximize eating behavior change.     

A review of epidemiological studies about the incidence and etiological factors of cryptorchidism--relevance to endocrine-disrupting chemicals

Recently, it has been reported that the incidence of male genitourinary abnormalities (such as cryptorchidism) has been increasing because of the presence of endocrine-disrupting chemicals (EDCs) in the environment. This report reviews the papers related to cryptorchidism beginning in the 1960s to clarify the trends in incidence of cryptorchidism and to discuss the association between cryptorchidism and risk factors, including EDCs. The incidence of cryptorchidism tended to increase in almost researched countries until the mid-1980s, but has shown regional differences since 1990. In Japan, the trend of the incidence of cryptorchidism is unclear because there is no monitoring system for cryptorchidism. It is necessary to establish both criteria and a monitoring system to research the incidence of cryptorchidism. The risk factors in epidemiological studies include low birth weight, being small for gestational age, a short gestation period, high maternal body weight, the change during pregnancy of maternal hormones (by exposure to diethylstilbestrol DES or estrogen), and exposure to chemicals. However, the associations between children with cryptorchidism and exposure to EDCs as well as between cryptorchidism and exposure to estrogen of the fetus are not clear because very few reports have quantitatively evaluated EDCs. It is known that some EDCs act as estrogen receptor agonists and change hormonal mobility as exogenous estrogen. It has also been suggested that hormonal drugs such as DES affect the maternal endocrine system in pregnancy and are associated with the incidence of cryptorchidism. In the future, epidemiological studies that clarify the association between cryptorchidism and EDCs such as daidzein and genistein and the quantitative evaluation of exposure factors using biological materials are necessary.     

颈-股动脉脉搏波传导速度与空腹血糖受损的相关性研究

目的分析本地区成年人颈一股动脉脉搏波速度（cf-PWV）与空腹血糖受损（IFG）风险的相关性,探讨年龄、体重指数（BMI）、体脂率、颈围、腰围及血脂对空腹血糖受损风险相关因素的影响。方法对5099例本地区来自社区的健康体检人群测量cf-PWV、BMI、体脂率、颈围、腰围、血压、空腹血糖、空腹胰岛素及血脂水平。分析影响空腹血糖受损的相关因素。结果对年龄、性别、血脂、血压等多因素进行校正后,通过升高分组变量cf-PWV水平,计算cf-PWV各五分位组的空腹血糖受损（impairedfastingglucose,IFG）风险,IFG风险的比值比及95％的可信区间（ORs,95％CI）分别为1．00,1．07（0．83-1．39）,1．20（1．08-1．34）,1．13（1．04-1．23）,1．14（1．05-1．25）（P〈0．01）。cf-PWV与年龄、颈围交互作用对IFG风险产生影响（P〈0．01）。结论cf-PWV与IFG密切相关,并独立于其他代谢危险因素,cf-PWV与年龄、颈围交互作用影响IFG风险。     

Diagnostic technology in cardiovascular disease: review of noninvasive methods for population studies

To aid the selection of appropriate diagnostic technologies, the literature on noninvasive methods for population studies of cardiovascular diseases was reviewed. Indications, limitations and cost-effectiveness are discussed. Most widely applicable are the standardized medical history, blood pressure and other measurements, resting electrocardiogram, chest X-ray, and selected tests of blood and urine. Useful in specialized studies are exercise testing, ambulatory monitoring, and peripheral arterial flow measurements. Ultrasound is valuable in the study of hypertensive and other myocardial diseases. Further methodological research is needed.     

Lifestyle intervention for the prevention of cardiovascular disease

The high cardiovascular disease prevalence in western countries is largely attributable to the contemporary lifestyle. Interventions in the area of nutrition and physical activity have been shown to be effective in the prevention of cardiovascular disease. Successful implementation of lifestyle intervention programmes may be just as effective as drug treatment. In combination with drug treatment, intervention in the area of nutrition and physical activity is the recommended treatment for patients at a high risk of cardiovascular disease. Addition of new drugs to those presently available is associated with low absolute risk reductions and high costs, particularly in the presence of successful lifestyle interventions.     

The relation between green tea consumption and cardiovascular disease as evidenced by epidemiological studies

Although substantial evidence from in vitro and animal studies indicates that green tea preparations inhibit cardiovascular disease processes, the possible protective role of green tea consumption against this disease in humans remains unclear. We conducted a population-based prospective cohort study (the Ohsaki Study) to examine the association between green tea consumption and mortality from cardiovascular disease (CVD), cancer, and all causes with 40,530 persons in Miyagi prefecture, in northern Japan. Previously published work has shown that green tea consumption was inversely associated with mortality from CVD and all causes. The inverse association of mortality from CVD was more pronounced in women (P = 0.08 for interaction with sex). In women, the multivariate hazard ratios (95% confidence intervals) of CVD mortality across increasing green tea consumption categories were 1.00, 0.84 (0.63-1.12), 0.69 (0.52-0.93), 0.69 (0.53-0.90) (P for trend = 0.004). Within CVD mortality, the stronger inverse association was observed for stroke mortality. Because our observational study has found the inverse association, I report here the results of a review of epidemiological evidence from randomized controlled trials (RCT) of the association between green tea or green tea extracts and CVD risk profiles. More than half of the RCT have demonstrated the beneficial effects of green tea on CVD risk profiles. These results from RCT suggest a plausible mechanism for the beneficial effects of green tea and provide substantial support for our observations.     

Physical activity and coronary heart disease in older adults. A systematic review of epidemiological studies

BACKGROUND: While there is good evidence to suggest an inverse relation of physical activity and cardiorespiratory fitness with coronary heart disease (CHD) in middle-aged men and women, much less is known about this association in older adults. The purpose of this paper was to explore the relation of physical activity and cardiorespiratory fitness with CHD in older adults by reviewing relevant studies. METHODS: Publications were identified in two ways: i) conducting a PUBMED search from its inception in 1966 until January 2001; and ii) scrutinizing the reference sections of identified papers. RESULTS: Ten studies relating physical activity and two relating cardiorespiratory fitness in older people to CHD met the inclusion criteria. With one exception, the studies were observational in nature and the majority of these were of prospective cohort design. Most studies featured men only. Of the eleven studies that presented data on older men, eight reported an inverse relation between physical activity or cardiorespiratory fitness and CHD, and statistical significance was seen in five of these. There were too few data on older women to draw clear conclusions regarding the association in this group. CONCLUSIONS: This review suggests that, in older adult men, physical activity and cardiorespiratory fitness are inversely related to CHD risk. This association is unlikely to be attributable to reverse causality or confounding. Except where such advice is contraindicated, older adult men may benefit from physical activity in terms of reduced CHD risk.     

Nutrition protocols for the prevention of cardiovascular disease

Cardiovascular disease is the number one cause of death in the United States, and prevention of cardiovascular disease is at the top of the public health agenda. Evidence shows that reducing the incidence of coronary heart disease with diet is possible. More than a half century of evidence from epidemiologic, experimental, and clinical trials pinpoints a positive correlation between lifestyle and dietary factors as they relate to blood lipids, blood pressure, and coronary heart disease risk, and a number of evidence-based nutrition guidelines have emerged. The National Cholesterol Education Program's Therapeutic Lifestyle Changes diet includes unsaturated fats, fiber, and plant sterols/stanols. The whole foods approach incorporates increased consumption of fruits, vegetables, whole grains, and fish; and the American Heart Association guidelines emphasize functional foods like soy protein, nuts, and alcohol. These guidelines display the rationale for nutrition intervention as a primary prevention for cardiovascular disease. In addition, body weight, body mass index, waist circumference, and waist-to-hip ratio are examined as risk factors for cardiovascular disease. This article highlights key nutrients and lifestyle factors in preventing cardiovascular disease and identifies practical applications for clinicians.     

脉搏波传导速度危险因素相关性及创伤感染分析

目的探讨公安干警脉搏波传导速度(PWV)的危险因素与公安干警受伤原因及术后感染情况。方法应用脉搏波速度自动测量系统测定肱踝脉搏波传播速度(BaPWV),依据健康人群动脉弹性功能参考标准,将公安干警分为BaPWV异常组和正常组,观察患者的年龄、总胆固醇、空腹血糖等危险因素的同时记录公安干警受伤原因及感染情况。结果 BaPWV异常组的年龄、总胆固醇、空腹血糖、收缩压(SBP)、舒张压和脉压(PP)明显高于对照组,而BaPWV明显高于对照组,差异有统计学意义(P<0.05);单因素相关分析,收缩压、脉压、年龄分别与BaFWV呈正相关;1085名公安干警曾经因各种原因受伤200例,术后发生感染19例,感染率9.5%。结论年龄、SBP、PP水平增加、外伤导致大量出血是大动脉弹性下降的主要危险因素,多种危险因素并存时,可通过协同作用使大动脉弹性降低更明显;公安干警术后发生感染概率较高,应加强公安干警术后抗感染的预防。     

职业与心血管疾病流行病学研究导言

职业环境可促发心血管疾病（ＣＶＤ）。职业场所的化学、物理或社会心理等多种因素可单独或联合地造成ＣＶＤ高发（发病率,患病率或死亡率增高）。虽然目前尚未把 ＣＶＤ列入职业病名单,但ＷＨＯ技术报告里,工作有关疾病中ＣＶＤ是三个重点病种之一。职业人群中的ＣＶＤ从临床治疗角度与一般人群的ＣＶＤ相比均无特殊性,在职业人群中研究ＣＶＤ主要是从病因流行病学及人群防治方面着眼的。 ＣＶＤ是个集合词,这里统指高血压、动脉粥样硬化、冠心病、心肌病、心律失常等。这些病中有许多是多因素疾病,如膳食不合理、吸烟、饮酒、高血脂…