颈动脉内膜中层厚度与血糖浓度的相关性

颈动脉内膜中层厚度（Carotid Intima-MediaThickness CIMT）是用于评价早期动脉粥样硬化的指标之一。横断面研究结果显示CIMT的增加与心肌梗死及脑卒中发病率增加是显著相关的。前瞻性研究亦显示，在普通人群中，无论是否存在心血管疾病，CIMT的增厚均与心血管事件的发生率相关。CIMT在糖尿病人群中显著高于非糖尿病人群，糖尿病前期即空腹血糖受损（Impairedfastingslucose，IFG）或糖耐量减低（Impaired glucose tolerance，IGT）状态时有研究发现CIMT已显著增加,     

老年男性慢性躯体疾病合并抑郁患者新生肿瘤和死亡的随访研究

目的探讨伴有抑郁情绪的老年男性慢性躯体疾病与新生肿瘤和死亡的相关性。方法在前期以老年抑郁量表和一般生活资料调查表对1020例老年男性进行研究的基础上，通过3年的随访，分析合并抑郁人群与非抑郁人群新生肿瘤的发生率及死亡率。结果老年男性慢性躯体疾病合并抑郁人群新生肿瘤的发生率OR=2．163（95％CI 1．394～3．357），危险程度明显高于非抑郁人群，差异有统计学意义；抑郁人群风险明显高于非抑郁人群（OR=5．207，95％CI 2．487～10．902），差异有统计学意义。经Logistic多元线性回归分析，结果显示，是否抑郁和抑郁的严重程度分别与新生肿瘤率和死亡率成正相关。结论老年男性慢性躯体疾病合并抑郁的患者易发新生肿瘤，且死亡率明显高于同组疾病人群未合并抑郁者。     

动脉粥样硬化性肾动脉狭窄的早期发现

探讨冠状动脉造影同时行肾动脉造影的必要性及动脉粥样硬化性肾动脉狭窄的相关危险因素分析。共 4 91例临床疑似冠心病患者行冠状动脉造影同时行非选择性或选择性肾动脉造影 ,并对相关的临床因素进行评价 ,筛选出动脉粥样硬化性肾动脉狭窄的独立危险因素。冠心病组患者中动脉粥样硬化性肾动脉狭窄的发病率为2 0 % ,显著高于非冠心病组 (2 .6 % )。冠心病、外周血管疾病是动脉粥样硬化性肾动脉狭窄的独立危险因素 (多元Logistic回归分析示 ,P <0 .0 0 1、P =0 .0 0 3) ,是其早期发现的指标。对怀疑有冠心病的患者 ,在冠状动脉造影同时行肾动脉造影有助于动脉粥样硬化性肾动脉狭窄的早期发现。     

非酒精性脂肪性肝病促进动脉粥样硬化的发生

非酒精性脂肪性肝病系与遗传易感和胰岛素抵抗密切相关的代谢应激性肝病。脂肪肝本身就是一种胰岛素抵抗状态,非酒精性脂肪性肝病患者发生危险因素聚集、动脉粥样硬化和糖尿病的概率显著高于对照人群,非酒精性脂肪性肝病患者的主要死因是心脑血管事件而非肝硬化。非酒精性脂肪性肝病可促进代谢紊乱和动脉粥样硬化发病率增加,其机制涉及肝脏胰岛素抵抗、脂肪激素、系统性低度炎症反应以及内皮功能障碍和肝细胞功能改变等方面。     

中国急性冠脉综合征患者高强度他汀治疗的安全性研究进展

他汀类药物是经典的羟甲基戊二酸单酰辅酶A还原酶抑制剂,能明显降低动脉粥样硬化性心血管疾病事件的发生率。最近,部分指南和共识均推荐急性冠脉综合征(ACS)患者应早期启动高强度他汀类药物治疗。但中国人群他汀副作用的发生率显著高于白种人。因此,应高度关注中国人群高强度他汀类药物治疗的不良反应。本文对中国ACS患者使用高强度他汀类药物治疗的安全性进行了综述,为临床用药提供参考。     

冠心病合并糖尿病老年患者高脂肪餐后三酰甘油水平变化

<正>冠心病不仅是全身动脉粥样硬化在心血管中的表现,常常伴有高脂血症等〔1〕。此类患者是心脏不良事件的高发人群,如不积极控制,心肌梗死、严重心律失常等致死性心血管意外的发生率将显著高于正常人群〔2〕。冠心病的发病机制较为复杂,目前认为与高脂血症、脂质代谢紊乱密切相关〔3〕。临床上老年     

他汀类抗动脉粥样硬化的非降脂作用

许多大规模的临床试验证实,无论是在冠心病一级预防或是在二级预防中,他汀类药物即3-羟基3-甲基戊二酰辅酶A(HMG-CoA)还原酶抑制剂(简称他汀)均可明显降低心血管事件的发生率和死亡率.对不同胆固醇水平的人群,他汀都能产生良好的益处,在血浆低密度脂蛋白-胆固醇(LDL-C)水平较低的心血管高危人群中,他汀治疗也同样能获益[1].这些临床研究结果提示他汀可能存在抗动脉粥样硬化的非降脂作用[2].大量体外研究的结果均支持他汀存在多效性作用,如抗炎、抗氧化和抑制细胞增殖等,他汀的这些非降脂作用可能在抗动脉粥样硬化方面起重要功效.     

将卒中纳入心血管风险预测工具美国心脏协会/美国卒中协会对医疗卫生专业人员的声明

背景和目的 目前美国针对心血管事件风险预测以及一级和二级预防的指南声明均使用绝对风险估计值来识别血管事件高危患者以及可从特定干预措施中获益的患者.然而,这些指南并未明确地包括卒中患者.本指南对现有证据和争论进行概述以支持:(Ⅰ)将卒中(尤其是动脉粥样硬化性卒中)患者纳入心血管病绝对风险增高的患者群体;(2)将卒中纳入血管性疾病风险预测工具的转归预测因素.方法和结果 写作组成员由委员会联合主席基于先前在相关领域的研究成果来提名,并得到美国心脏协会(American Heart Association,AHA)卒中委员会科学声明监督委员会以及文稿监督委员会的批准.作者采用系统文献回顾(覆盖1980年1月至2010年3月期间的文献)并参考以往公布的指南、个人资料以及专家观点,以归纳现有证据,提出当前知识的不足,并根据AHA标准对适当的问题制定推荐意见.所有写作组成员均有机会对推荐意见进行评论并批准了最终版本.经广泛的AHA内部同行评议以及卒中委员会领导阶层和科学声明监督委员会的审阅后,最终获得AHA科学咨询和协调委员会的批准.将卒中患者(尤其是动脉粥样硬化性卒中患者)纳入冠状动脉和心血管病绝对高危人群的原因如下.首先,有证据显示,缺血性卒中患者发生致死性和非致死性心肌梗死或猝死的绝对风险增高,10年绝对风险≥20％,这一风险阈值已被一些指南用于定义冠状动脉疾病风险等危症.其次,纳入动脉粥样硬化性卒中的原因与纳入糖尿病、周围血管病、慢性肾脏病以及其他动脉粥样硬化性疾病的原因相同,尽管尚缺乏在所有人群或患者中风险增高的统一证据.再次,缺血性卒中的大动脉粥样硬化性卒中亚型与其他这些疾病的病理生理学机制相同.将卒中纳入高危因素将导致高危人群的数量扩大约10％.然而,由于卒中的异质性,尚不确定其他卒中亚型,包括出血性卒中以及非动脉粥样硬化性卒中亚型,是否应被视为具有相同水平的风险,因此有待进一步研究.鉴于卒中对残疾和死亡的影响、卒中与其他血管性疾病预防措施的相似性以及卒中在某些人群中较冠状动脉疾病更高的重要性,将卒中、心肌梗死和猝死纳入心血管事件风险预测工具的转归预测因素是合适的.美国以外的指南常常将卒中患者纳入心血管高危人群,并将卒中作为心脏终点的一个相关转归事件.结论 动脉粥样硬化性卒中患者应被纳入会进一步发生冠状动脉粥样硬化事件的高危患者(10年≥20％).是否应纳入非动脉粥样硬化卒中亚型尚不确定.对于一级预防,缺血性卒中应被纳入绝对风险评估方案的心血管疾病转归事件.将动脉粥样硬化性卒中作为一个高危因素或者更宽泛地将缺血性卒中视作一种转归事件纳入,可能对心血管病的预防具有重要意义,因为被评定为高危风险的患者数量将大幅增加.     

老年男性骨质疏松与动脉粥样硬化相关性的研究

目的 探讨老年男性人群中骨质疏松与动脉粥样硬化之间的相关性. 方法 以93例老年医学科住院男性患者为研究对象,采用双能X线吸收法(dual-energy X-ray absorptiometry,DXA)测定腰椎骨和股骨区的骨密度(BMD);同时采用超声探查颈动脉内中膜厚度(intima-media thickness,IMT)及粥样斑块的情况. 结果 在骨质疏松组(46例)中,存在内膜增厚者38例(82.61%),粥样斑块34例(73.91%),与非骨质疏松组比较,骨质疏松组在动脉内中膜增厚(IMT≥0.9 mm)及粥样斑块的发生率上均明显升高(P<0.05);而内中膜增厚组(67例)及斑块组(57例)的BMD分别较其对照组低,并在NECK、WARDs三角、TORCH等部位具有统计学差异(P<0.05). 结论 老年男性骨质疏松人群较非骨质疏松人群更易发生动脉粥样硬化病变,同时存在动脉粥样硬化病变的人群也易致骨量的丢失.提示骨质疏松与动脉粥样硬化之间可能存在着共同危险因素.     

前言——加强老年高血压及其合并症的防治

高血压是动脉粥样硬化性心血管疾病的主要危险因素之一.流行病学研究显示,≥60岁老年人群中高血压的患病率达60%左右,在≥80岁老年人群中此数值高达90%,显著高于中青年人群.随着我国人口老龄化进程的持续加速,老年高血压患者在所有高血压人群中所占比例亦迅速增加,高血压已成为危害老年人生命健康的重要原因.因此,加强老年人高血压及其合并症的防治对于改善我国老年人群的健康状况具有重要意义.     

免疫细胞与动脉粥样硬化斑块研究进展

动脉粥样硬化性疾病是导致人类死亡和致残的主要原因之一,动脉粥样硬化易损斑块破裂导致血栓形成是多种急性心脑血管疾病发生的共同病理基础。有关其发病确切机制众说纷纭,本文对目前研究热门的免疫学说的最新研究进展进行综述,探讨免疫在动脉粥样硬化发生发展过程中的作用。     

Alcohol consumption: Risks and benefits

Alcohol has had a long and complicated role in human society and health. Excessive use of alcohol causes enormous morbidity and mortality worldwide, but the health effects of alcohol use within recommended guidelines are diverse and complex. Established effects include increased high-density lipoprotein cholesterol and antithrombotic activity, providing plausible mechanisms for the observed association of moderate drinking with lower risk of coronary heart disease but higher risk of hemorrhagic stroke. However, moderate drinking increases sex steroid hormone levels and may interfere with folate metabolism, both of which are potential mechanisms for the observed associations of moderate drinking with several forms of cancer, particularly breast and colorectal. Genetic susceptibility to the effects of alcohol on cancer and coronary heart disease also differs across the population. Recommendations regarding moderate drinking must be individualized to reflect the potentially competing effects of alcohol on several chronic diseases.     

A pathomorphological study on atherosclerotic regression with references between apoptosis and atherosclerotic plaque with central depression in rabbit aorta]

Atherosclerotic plaque with central depression (depressed lesions) have been proposed as one morphological feature of atherosclerotic regression in the elderly. We have also revealed that depressed lesions have been found not only in the aorta of elderly human but also in rabbit aorta. In this study a relationship between apoptosis and atherosclerotic regression was immunohistochemically studied to clarify the possibility of the pathogenesis of depressed lesion in rabbit aorta. Twenty male New Zealand White rabbit (NZW) were fed with a 1.0% cholesterol diet during a 12-week atherogenic induction period. Then they were fed only with a basic diet for 36-week (n = 6) and 48-week (n = 6, experimental group) regression periods. A control group was fed with 1.0% cholesterol diet for 12-week (n = 2) and 60-week (n = 6). They were killed and aortas were fixed with formalin. Sections obtained from aortas were processed for histological and immunohistochemical studies including the TUNEL method, staining with Ki-67 and others. Several depressed lesions were found in the aortas of NZW animal, but none were noted in control aortas. Results of surface involvement in the experimental groups were significantly lower than in the control, and the aortas of the experimental group had atherosclerotic regression. Apoptosis was found in the depressed lesions, which had more apoptotic cells than non-regressed atherosclerotic plaques. Furthermore, the apoptotic cells were significantly greater in the center of depressed lesions than in marginal areas. Ki-67 staining was positive in the atherosclerotic plaque, but negative in the depressed lesions. It appears that the NZW aortic atherosclerotic plaques may transform to depressed lesions with apoptosis. Atherosclerotic regression has been associated with apoptosis.     

Increased leukotriene concentrations in gingival crevicular fluid from subjects with periodontal disease and atherosclerosis

Recent studies indicate that periodontal disease is associated with the development of early atherosclerotic lesions in the carotid artery. Since inflammation is a key feature in both atherosclerosis and periodontal disease, a common mediator of the two diseases could be anticipated. Leukotrienes are lipid-derived inflammatory mediators recently implicated in the pathogenesis of atherosclerosis and previously shown to be produced in periodontitis. The aim of the present study was to detect leukotrienes in gingival crevicular fluid (GCF) from subjects with atherosclerosis. Carotid ultrasonography and oral clinical examination were performed in 19 periodontitis patients and 16 healthy subjects. Atherosclerotic plaques were detected on ultrasound examination in 13 subjects with periodontis, and in 5 of the healthy subjects. Elevated concentrations of leukotriene B(4) and cysteinyl-leukotrienes were detected in GCF from subjects with a high dental plaque index (PLI>0.3), supporting an increased leukotriene formation in periodontitis. In addition, subjects with atherosclerotic plaques had significantly elevated concentrations of cysteinyl-leukotrienes in their GCF as compared with subjects without a visible plaque. Finally, the increased cysteinyl-leukotriene concentrations in GCF from atherosclerotic subjects were observed also when sub groups of periodontis patients and healthy subjects were compared separately. In summary, increased GCF concentrations of cysteinyl-leukotrienes were correlated to measures of both periodontitis and atherosclerosis. These results suggest that increased leukotriene formation may represent a possible link between periodontitis and atherosclerosis and a risk factor marker for both diseases.     

Plasma apolipoproteins B and AI in healthy individuals and patients with coronary atherosclerosis in a male population from Lithuania]

The paper discusses the results from a study into apolipoproteins B (apo-B) and AI (apo-AI) and apoB/apo-AI ratios in the blood of 188 healthy donors and 122 male patients with coronary atherosclerosis. Atherosclerotic lesions were coronary angiographically documented. The study was performed (in two age groups of patients: 1) those under 45 years and 2) those over 45 years. A relationship was examined between the levels of apolipoproteins and the lesion of one, two, three or more coronary arteries in the two age groups. The studies indicate that there are various mechanisms responsible for the pathogenesis of atherosclerosis in the age groups in question. It is concluded that the younger a patient is, the higher probability that elevated blood apo-B levels are essential in the pathogenesis of coronary atherosclerosis is. Determination of plasma apo-B and apo-AI levels and apo-B/apo-AI ratios enables a potential number of diseased coronary arteries to be predicted.     

Atherosclerosis monitoring in the elderly using magnetic resonance imaging: is the extra step needed?

Atherosclerotic disease represents an enormous burden in the elderly population, yet elderly patients are underrepresented in clinical trials and receive lower standard-of-care treatment compared with similar-risk younger individuals. Magnetic resonance imaging (MRI) is a powerful noninvasive imaging technique that can target atherosclerotic lesions and help better understand the pathophysiologic process of this disease in the elderly. Cholesterol-targeted interventions have improved the outcomes in patients with atherosclerotic disease, but clearly additional efforts are needed. Whether medical therapy can be effectively adjusted based on atherosclerosis progression revealed by MRI is still to be proven, but the technique certainly looks promising.     

Potential mechanisms of impaired endothelial function in arterial hypertension and hypercholesterolemia

This review focuses on the role of impaired endothelial function for the development of atherosclerosis in human arterial hypertension and hypercholesterolemia in vivo. Potential mechanisms underlying impaired endothelial function and decreased bioavailability of nitric oxide under these clinical conditions are discussed. It further addresses therapeutic strategies aimed at improving the bioavailability of nitric oxide in these patients. The overall conclusion is that the bioavailability of nitric oxide is probably impaired, not by a single defect, but by various mechanisms affecting nitric oxide synthesis as well as nitric oxide breakdown. In both diseases increased superoxide anion production and oxidative stress represent a major mechanism. Decreased bioavailability of nitric oxide not only impairs endothelium-dependent vasodilation, but also activates other mechanisms that play an important role in the pathogenesis of atherosclerosis. Thus, therapeutic strategies should aim to restore bioavailability of nitric oxide, which has been demonstrated for lipid-lowering therapy in hypercholesterolemia and blood pressure control in hypertension. In addition, antioxidative strategies will represent a major therapeutic tool against atherosclerotic diseases in the future. Statins and blockers of the renin-angiotensin system seem to have such antioxidative effects independent from their effects on lipid profiles or blood pressure control.     

Biology of atherosclerotic plaques: what we are learning from proteomic analysis

Atherosclerotic plaque rupture triggers the onset of cardiovascular complications such as myocardial infarction and stroke, which represent the main cause of death in western countries. Atherogenesis is a complex process characterized by lipid retention, proteolytic injury and a chronic inflammatory response. The resulting pathological vascular remodeling involves inflammatory cell recruitment, fibrosis, smooth muscle cell proliferation, neovascularization and intraplaque hemorrhage. However, the cellular and molecular mechanisms underlying cardiovascular dysfunction remain widely unknown. The development of differential proteomics allows the identification of novel proteins whose association with the genesis of atherosclerotic plaques is at present unforeseen in the light of available data. Moreover, different strategies have been used to discover new potential biomarkers which could be related to cardiovascular risk. The multi-factorial nature of cardiovascular diseases necessitates the use of biomarkers for early detection, for monitoring the response to therapy and to predict clinical outcome. In this review, we summarize the different proteomic approaches and recent findings that will help us to understand the mechanisms implicated in the pathogenesis of atherothrombosis.     

Elevated C-reactive protein: a common marker for atherosclerotic cardiovascular risk and subclinical stages of pulmonary dysfunction and osteopenia in a healthy population

Atherosclerotic cardiovascular disease, osteopenia, and pulmonary dysfunction are the serious health problems, and several experimental studies have suggested that inflammation has a role in them. The present study was conducted to evaluate the usefulness of the plasma CRP is as a common marker for detecting these diseases in the general population in their subclinical stages. In a cross-sectional study, we measured the pulse wave velocity (PWV), quantitative osteo-sono-assessment index (OSI), pulmonary functions, and the plasma level of C-reactive protein (CRP) in 7283 consecutive healthy subjects (age 50+/-11 years). The PWV was higher and the OSI and pulmonary function parameters were below normal in subjects with an elevated CRP level (> or =0.2 mg/dl) than in subjects with a CRP level within the normal range. We divided the subjects into quartiles for each of these parameters and found that the first quartiles represented patients with subclinical states of the aforementioned abnormal conditions. Logistic regression analysis demonstrated that the odds ratios of an elevated CRP level were individually significant in subjects with an elevated CRP level for each abnormality in women and for abnormal PWV and pulmonary dysfunction in men. In conclusion, in addition to being a marker of elevated atherosclerotic cardiovascular risk, elevated plasma CRP seems to be a marker of the early stages of osteopenia and pulmonary dysfunction in healthy subjects.     

Papillomavirus humain et lupus érythémateux systémique

Infection with human papillomavirus (HPV) is one of the most widespread sexually transmitted diseases and the main risk factor for cervical cancer. Underlying conditions, like immunosuppression, favour the persistence and the progression of cervical lesions to an aggressive form. Patients with autoimmune diseases, and particularly systemic lupus erythematosus (SLE), may be prone to HPV infection and cervical dysplasia. However, the risk factors for developing persistent HPV-related infection, dysplasia and cancer are not identified for patients with SLE. The existence of an increased risk of cervical cancer compared to the general population remains debated. Thus, HPV vaccine is recommended for SLE patients as well as for the general population. Vaccine coverage of SLE patients is not known in France. Adolescents with chronic health condition seem to be insufficiently vaccinated regarding their vulnerability to infectious diseases. Strategies are required to decrease HPV vaccination barriers.