Residual lifetime risk of cardiovascular diseases in Japan

Risk assessment of cardiovascular diseases (CVD) is shifting from the relative risk to an absolute risk approach. The residual lifetime risk (LTR), which provides an absolute risk assessment, is an epidemiologic measure that expresses the probability of someone of a given age and sex developing a disease condition during their remaining lifespan. The LTR estimation is important because it could be more easily comprehended by clinicians and patients. The LTR for CVD was not estimated for the Japanese population until recently, when the LTR of stroke and acute myocardial infarction (AMI) was reported. The reported LTR of stroke and AMI for middle-aged adults is substantial. The observed probabilities illustrated that approximately 1 in 5 men and women of middle age will suffer from a stroke in their remaining lifetime. On the other hand, approximately 1 in 6 men and 1 in 9 women of middle age will suffer from AMI in their remaining lifetime. Aaginst the backdrop of the aging population and worsening risk factor scenario, these estimates re-emphasize that CVD is a public health burden that requires preventive interventions. These estimates provide a means to communicate the absolute risk of CVD to the lay population, policy makers, as well as health service providers in predicting the disease burden of CVD. This easily comprehended knowledge can be used as an important index to assist in public health education and planning.     

Genetic factors and the risk of cardiovascular diseases

The objective of the study is to summarise the hereditary factors of cardiovascular diseases based on current knowledge, focus will be applied to genetic markers of multifactorial forms of cardiovascular diseases based on atherosclerosis, including their interaction with traditional risk factors.     

Social and professional factors,occupational environmental strain and cardiovascular diseases

In addition to conventional risk factors, environmental and occupational strain is an actor of the development and evolution of cardiovascular diseases. In industrialised countries, cardiovascular mortality is inversely correlated with the socio-economic level and type of occupation. In the French Ihpaf study, systemic hypertension and obesity were correlated with the socio-economic level. Among possible explanations for the importance of occupational environment, psychological stress at work, sedentary jobs, passive smoking and shift working may all play a role. Thus, beyond the conventional approach to individual risk factor management, it appears necessary to consider cardiovascular prevention through collective actions taking into account occupational environment.     

Preventive role of the occupational physician faced with cardiovascular risk factors

The preventive role of the occupational practitioner and occupational medicine no longer has to be demonstrated. As far as cardiovascular risk factors are concerned, on the one hand there are a certain number of cardiovascular diseases which have their origin in certain occupational fields (this concerns 10 pictures of occupational diseases which are entitled to compensation) and, on the other hand, occupational medicine has an important role to play when faced with the usual cardiovascular risks such as sedentary life style, obesity or excess weight, alcohol, tobacco, diabetes, fatigue and stress. Apart from giving advice to employees (health education) and instantly replying to the risk by individual or collective prevention and by medical and technical prevention, there is epidemiological observation and the investigation of quantitative or quantifiable "indicators". All these roles imply interdisciplinary dialogue and community participation so as to be able to counteract environmental hazards, rehabilitate vulnerable subjects, and develop health.     

全面控制糖尿病患者的心血管疾病危险因素

数十年前人们就已经认识到 ,糖尿病 (ｄｉａｂｅｔｅｓｍｅｌｌｉｔｕｓ,ＤＭ )患者罹患心血管疾病 (ｃａｒｄｉｏｖａｓｃｕｌａｒｄｉｓ ｅａｓｅ ,ＣＶＤ)的机率要比非糖尿病的适配人群高出 2～3倍 ,这种差异在白种人和女性中可能更大。大约50 %的患者在做出ＤＭ诊断时就已经有了某些ＣＶＤ的表现 ,更有 75%～ 80 %的ＤＭ患者因并发ＣＶＤ而需住院治疗或最终因此而死亡。有资料表明 ,ＤＭ患者初次发生心肌梗死 (心梗 )的比例与非ＤＭ患者再次发生心梗的比例相当 ,而且在ＤＭ基础上发生心肌梗死的患者院前死亡率极高 ,使很多患者丧失了进…     

Anti-cytomegalovirus antibodies and other atherosclerosis risk factors in patients with cardiovascular diseases

Objective To determine anti-cytomegalovirus (CMV) antibodies along with anti-Chlamydia pneumoniae (CP)antibodies in comparison with inflammatory markers and other risk factors of atherosclerosis in patients with selected cardiovascular diseases(CVD).Methods A total of 228 patients with coronary heart disease (CHD) and/or hypertension (HT), and those who underwent reconstructive vascular surgery (RVS) on carotids or abdominal aorta were tested for the presence of anti-CMV IgG and IgM antibodies as well as for anti-CP IgA antibodies, C-reactive protein (CRP),and interleukin-6 (IL-6). Other risk factors for atherosclerosis, namely age, gender,smoking, hypercholesterolemia, and diabetes mellitus were also analyzed. Results Anti-CMV IgG antibodies were found in 204 patients sera (89.5%),compared with 46 positive of 68 sera in the controls (67.6%), whereas anti-CMV IgM antibodies were detected in 4 of 54 sera of patients tested (7.4%), but not in the controls. The highest proportion of positive sera with not only anti-CMV IgG antibodies (95.6.7%),but also anti-CP IgA antibodies (78.3%), IL-6 (84.8%) and CRP (97.8%), was observed in patients with RVS. The results obtained corresponded to age, hypercholesterolemia, and diabetes. Conclusions The presence of anti-CMV antibodies together with antibodies to CP and markers of inflammation (CRP and IL-6) in our study was associated with CVD, primarily in elderly patients who underwent RVS.     

单中心老年心血管病危险因素控制现状分析

目的了解老年患者心血管病危险因素控制现状。方法选择我院老年内科住院治疗的疑诊冠心病的老年患者256例,测定血糖、血脂水平,进行24h动态血压监测,根据相关指南推荐的血压、血糖及血脂达标值判断达标情况。根据冠状动脉造影结果将入选者分为冠心病组208例与非冠心病组48例,比较2组上述危险因素控制情况。结果 256例患者中,209例(81.6%)合并高血压,24h、昼间及夜间平均血压达标率分别为75.1%、82.8%和59.3%;99例(38.7%)合并糖尿病,血糖达标率70.7%;154例(60.2%)合并血脂异常,LDL-C达标率41.4%。冠心病组与非冠心病组血压、血糖达标率比较,差异无统计学意义(P>0.05),冠心病组LDL-C达标率低于非冠心病组,差异有统计学意义(38.5%vs 54.2%,P<0.05)。结论老年心血管病高危患者中,血压、血糖达标率高,LDL-C达标率较低,尤其心血管病极高危的冠心病患者LDL-C达标率更低,应重视老年患者心血管病风险评估,并进一步加强对血脂的干预力度。     

Correlation of polymorphisms to coagulation and biochemical risk factors for cardiovascular diseases

Currently, the established risk factors for cardiovascular disease (CVD) are largely environmental in nature. Conflicting studies have suggested that mutations in specific coagulation genes may also provide a genetic basis for CVD risk. We reviewed clinical studies that examined the role of single nucleotide polymorphisms in coagulation and platelet factors, and a biochemical factor to determine if specific genotypes are correlated with patients with a history of arterial thrombotic diseases (acute coronary syndromes or stroke). A meta-analysis was performed on studies for factors II (G20210A variant), V Leiden (G1691A), VII (R353Q), glycoprotein (GP) IIIa receptor (PI^A1/A2), and methylenetetrahydrofolate reductase (MTHFR, C677T). There was no correlation for factor II or factor V polymorphisms to coronary artery disease (CAD) in 5,607 and 5,431 patients studied, respectively. There was also no correlation for factor II variants and stroke in 3,451 patients studied. For factor V, statistical significance was achieved for the G1691A variant on 3,399 patients with stroke (odds ratio [OR] 1.43, 95% confidence intervals [CI] 1.03 to 1.97). The GP IIIa PI^A1/A2 genotype was associated with increased risk for CAD in 7,920 patients (OR 1.12, 95% CI 1.01 to 1.24), but not for 1,855 patients who had a stroke (OR 0.80, 95% CI 0.62 to 1.04). The combined RQ and RR genotypes of factor VII R353Q were correlated to a reduced risk for CVD in 2,574 patients (OR 0.78, 95% CI 0.65 to 0.93), whereas the QQ genotype had offered more protection (OR 0.53, 95% CI 0.27 to 1.03). The TT homozygous variant of MTHFR was associated with CAD risk in 5,644 patients studied (OR 1.30, 95% CI 1.11 to 1.52) but not for 3,075 patients with stroke. This study shows that for some genes, further studies are unnecessary, whereas for others, no more enrollments are needed. The impact of certain genotypes must be examined in relation to other established risk factors and potentially new therapeutic strategies.     

脉搏波传导速度与心血管病及其危险因素的相关性分析

目的探讨老年人群脉搏波速度（PWV）与心血管病及危险因素的相关性。方法采用整群抽样方法纳入≥70岁人群1701例,进行问卷调查、体格检查和实验室检验,测量颈-股动脉脉搏波速度（cfPWV）,观察cfPWV与高血压及相关危险因素的关系。结果 cfPWV水平随血压水平升高而升高,在高血压、脑卒中、心肌梗死和糖尿病患者中cfPWV明显高于正常人群,差异有统计学意义。多元逐步回归分析显示在入选者和脑卒中、心肌梗死和糖尿病人群中,年龄、男性、平均动脉压、心率、胰岛素抵抗指数（Homa IR）与cfPWV呈正相关（P〈0.001）,体重指数与cfPWV负相关。结论在老年人群中,cfPWV与高血压及心血管病危险因素密切相关。     

军队疗养员运动状况与心血管疾病危险因素的调查（英文）

目的：了解运动与心血管危险因素之间的联系。方法：选择在广州疗养院疗养的750名军队在职或离退休干部作为调查对象,区分为运动组（488名）和非运动组（262名）。测量其血压、人体质量指数（BMI）、空腹血糖（FBS）、总胆固醇（TC）、甘油三酯（TG）、尿酸等心血管危险因素,通过问卷调查其运动方式、运动频率、每次运动时间及一日累计运动时间。结果：1.非运动组的收缩压、舒张压、BMI、FBS、TC、TG水平均显著高于运动组（P均〈0.05）,两组间年龄、高密度脂蛋白-胆固醇、低密度脂蛋白-胆固醇、尿酸水平差异无显著性（P均〉0.05）;2.（1）两组每次运动时间（≥30min、〈30min）、运动方式（步行、太极拳）的心血管危险因素异常率（简称危险率）无显著差异;（2）一日活动时间大于60min的危险率明显低于活动时间≤60min的（29.41%比45.59%,P〈0.05）;自感运动强度在11～15之间的危险率明显低于运动强度小于11级的（33.67%比44.64%,P〈0.05）;（3）运动频率≥3次/周的危险率显著低于运动频率〈3次/周的（31.47%比48.43%）、运动坚持时间10～19年的心血管危险率显著低于运动坚持时间〈10年的（28.83%比39.89%）,P均〈0.05。结论：1.运动组的心血管危险程度较低,心血管危险因素有叠加作用;2.中老年患者每日运动60min,自感运动强度11～15,运动频率≥3次/周,长期坚持有助于降低心血管病危险性。     

Arterial blood pressure and blood lipids as cardiovascular risk factors and occupational stress in Taiwan.

BACKGROUND: This study is to determine whether occupational stress (defined as high psychological demands and low decision latitude on the job) is associated with increased blood pressure and abnormal level of blood lipids as cardiovascular risk factors. METHODS: We conducted a cross-sectional study at three work sites of 526 white-collar male workers aged 20 to 66 years without evidence of cardiovascular disease. Systolic, diastolic blood pressure, serum total, high-density lipoprotein cholesterol and plasma triglyceride were measured. Occupational stress index was derived from data collected in the job strain questionnaire. RESULTS: In multiple linear regression models, occupational stress index was significantly related to diastolic blood pressure and plasma triglyceride, after adjusting for age, education, smoking, and alcohol consumption. A higher occupational stress index was directly associated with higher systolic, diastolic blood pressure and higher level of plasma triglyceride. CONCLUSIONS: These data from a white-collar working population confirm independent relations between occupational stress defined in the job demand-control model and diastolic blood pressure observed in predominantly Western populations and extend the range of associations to plasma triglyceride than do previous studies.