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。     

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”。     

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,     

女性心血管病流行趋势及治疗概况

心血管病在男女两性都是主要的死亡原因。以往的流行病学研究发现，男性心血管病的发病率和死亡率明显高于女性，并且男性对心血管病的发生有独立的影响作用。因此，包括美国ACC／AHA指南在内的多项指南把男性列为心血管病的危险因素之一。近年来有研究显示，在过去的20年间，男性心血管病死亡率略有降低，而女性心血管病死亡率保持稳定，甚至有增加的趋势。据世界心脏联盟报道，每年有860万女性死于心血管病，占到女性死亡总人数的1／3。2006年中国统计数据也显示，城乡女性心血管病死亡分别占女性总死亡的37．8％和35．9％。多年来女性心血管病的研究和预防工作一直受到相对的忽视，美国AHA调查显示，仅有不到1／5的内科医生认识到每年死于心血管病的女性人数多于男性人数。     

女性心血管疾病的临床证据和预防指南

随着女性老龄化、肥胖人群的增加,代谢综合征以及糖尿病发病率的增加,女性心血管疾病越来越引起人们的关注。大量的临床证据表明,与男性相比,女性心血管疾病患者更容易表现为症状的多样性和不典型性,经确诊的女性心血管疾病患者预后较差.因此,美国心脏病学会在充实的临床试验证据基础上,制订了第一个针对女性群体的心血管病预防指南。该指南对女性心血管病预防提出专门的指导建议,在心血管病危险分层的标准、心血管病预防和治疗的标准上均针对女性。     

AHA/ADA关于糖尿病患者心血管病一级预防指南

糖尿病相关的循环系疾病包括冠状动脉心脏病(CHD)、中风、外周动脉病、心肌病和充血性心力衰竭。糖尿病所致早期死亡常常由心血管病引起。美国糖尿病协会(ADA)和美国心脏病协会(AHA),于1999年会同美国心肺血液研究所、美国糖尿病消化肾脏研究所、国际少年糖尿病基金会,共同发表声明,指出需要多个组织合作来预防糖尿病患者的心血管病。目前的联合声明所代表的是ADA和AHA对于这种挑战的共同对策。ADA对于糖尿病患者每一个心血管危险因素均提供相应的指南;AHA业已针对糖尿病患者修改了1级和2级心血管病预防指南。目前这个指南试图使得…     

重视心血管疾病诊治，关注女性“心”健康

心血管疾病在男性女性中都是主要的死亡原因,既往的一些流行病学资料认为男性心血管疾病的发病率和死亡率均明显高于女性,为此包括美国心脏病学学院／美国心脏病协会（ACC／AHA）指南在内的多项指南将男性列为心血管疾病的危险因素之一。近些年来研究显示,男性心血管疾病死亡率略微有下降,而女性心血管疾病死亡率却保持稳定,甚至有增加的趋势,女性心血管疾病卫生负担日渐加重,并已引起世界的警觉,     

全国冠心病与糖尿病关系研讨会纪要

最近美国心脏学会 (AHA)提出“糖尿病是心血管疾病” ,美国心脏学会与美国糖尿病学会组成心血管疾病的防治联盟。美国胆固醇教育计划专家委员会 (NCEP)颁布的成人治疗指南Ⅲ (ATPⅢ )也将糖尿病提高到冠心病等危症的高度 ,因此 ,减轻糖尿病危害的重点是控制心血管并发症风险 ,全面控制糖尿病患者的心血管危险因素 ,加强多级预防 ,改善心血管疾病的预后已经成为共识。如何进行多学科联合攻关 ?如何从临床和基础研究中寻找综合防治的突破口 ?2 0 0 3年 12月 5～ 7日在厦门 ,由中华医学会心血管病学分会主办 ,厦门医学会承办的全国冠心病与…     

AHA2016科学声明:女性急性心肌梗死指南

正心血管疾病是美国女性死亡的主要原因,有数据显示自1984年以来,女性心血管疾病年病死率(CVD)一直高于男性。但在过去10年,女性心血管疾病病死率不断下降,这源于健康意识的提升、对危险因素的日趋关注和及时有效的治疗。近日,美国心脏病学会(AHA)发表了首部     

美国心脏学会/美国心脏病学学会心血管疾病预防指南4连发

<正>美国心脏学会/美国心脏病学学会(AHA/ACC)近期发布了4项心血管相关疾病预防指南,指南全文发表于2013年11月12日《循环》(Circulation)杂志和《美国心脏病学学会杂志》(JACC)。这4项指南分别为《2013 ACC/AHA心血管风险评估指南》、《2013 ACC/AHA降低心血管风险之生活方式管理指南》、《2013 ACC/AHA降低成人动脉粥样硬化性心血管疾病(ASCVD)风险之血胆固醇治疗指南》和《2013 AHA/ACC/TOS成人超重和肥胖管理指南》。     

A Seven-year Experience for The Surgical Radiofrequency Ablation in Patients With Atrial Fibrillation

Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, the data of 314 consecutive patients aged 13 -75 （48.70 ± 11.09 ）undergone the radiofrequency ablation procedure for atrial fibrillation （AF） associated with concomitant cardiac surgery were analyzed. Monopolar was used for 91 patients; Medtronic bi-polar RF ablation procedure for 92 patients and Atricure RF ablation procedure for 131 patients. All patients were combined with valve surgery. Regular follow-ups were performed at 3, 6 month after surgery. Results Hospital mortality after combined open heart and surgical RF ablation was 0 %. The success rates for sinus rhythm conversion with monopolar RF were 73.6 % immediately, 74. 7 % at 3 months, 79. 1% at 6 months ; with Medtronic bi- polar RF, the rates were 78.3 % immediately, 82. 8 % at 3 months, 84 % at 6 months ; with Atricure bi-polar RF, the rates were 82. 4 % immediately, 84. 1% at 3 months, 83.9 % at 6 months. Conclusions The use of RF ablation procedures is a safe and efficient option to cure AF during open heart surgery in a selective group of patients.     

Changes in electrocardiogram and cardiac function after minimally invasive surgery for pectus excavatum

Background Thoracoscopic minimally invasive pectus excavatum repair （Nuss operation） features its little trauma, simple, short operation time, and good outcome compared with traditional treatment of pectus excavatum surgery-sternal elevation （Ravitch operation） and sternal turnover. The effect of the operation on patients＇ heart and heart function remains unclear. This study aimed to understand the changes of electrocardiogram and cardiac function after Nuss procedure. Methods From 2008 January to 2013 July, thoracoscopic Nuss operation was performed in 217 patients with pectus excavatum. All the patients underwent the preoperative, postoperative detection of ECG and cardiac function in 3 months to 1 year after operation. Results After 3 months to 1 year follow-up, arrhythmias persisted in 46 out of 135 patients with preoperative symptoms （P 〈 0.05）; Stroke volume and cardiac output significantly increased （P 〈 0.05）; And cardiac parameters greatly improved （P 〈 0.05）. Conclusions Minimally invasive repair of pectus excavatum deformity can correct the chest malformation, alleviate arrhythmia, and improve cardiac function.     

Risk factors related to acute renal failure after cardiac surgery for congenital heart disease in low body weight infants

Background Acute renal failure (ARF) is a common complication and a very important cause of postoperative death in children with congenital heart disease. Large cohort investigation of the morbidity and related risk factors for ARF in very young and low-body-weight children in China is still absent. Methods Data of 518 infants after cardiac surgery were analyzed retrospectively. The correlation between multivariate risk factors and ARF after cardiac surgery was analyzed by logistic regression. Results The incidence of postoperative ARF within 30 days was 6.9% (n = 36). High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output were independent risk factors of ARF. There were statistical significances in intensive care unit staying [(21.73 ± 7.28) days vs (7.41 ± 3.76) days], P 0. 001] and mortality (27.8% vs 7.5%, P 0. 001) between the patients with or without ARF. Conclusions Acute renal failure is a key negative factor for the survivors after cardiac surgery for congenital heart disease in very young patients with low body weight. High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output are independent risk factors for development of ARF.     

心血管疾病戒烟干预中国专家共识

吸烟是心血管疾病的独立危险因素,并且也是患者唯一能够自我控制的致病因素。许多心血管医生已经认识到吸烟的危害和戒烟干预的重要性,但尚缺乏相应的戒烟知识和戒烟技巧。本共识通过全面总结吸烟的危害和戒烟的益处,     

Changes in B-type Natriuretic Peptide Levels before and after Elective Major Non-cardiac Surgery in Patients With Heart Disease

Objectives To measure circulating B-type natriuretic peptide （BNP） levels in patients with heart disease undergoing elective major non-cardiac surgery and to explore the relationship between the changes in BNP level and cardiac events after surgical intervention. Methods Subjects comprised 232 patients with heart disease undergoing elective major non- cardiac surgery. Patients were classified into two groups based on BNP concentrations before surgery： those with BNP plasma levels ≤ 100 pg/mL （ Group A, n = 170） ; and those with BNP plasma levels 〉 100 pg/mL （ Group B, n = 62 ）. Preoperative BNP sampling was undertaken 24h before surgery, and postoperative 2 h after surgery. Screening for cardiac events was performed using clinical criteria, cardiac tropnin I analysis and serial electrocardiography. Results There was no significant difference in BNP concentrations between before surgery （73.5 ± 20. 6） pg/mL and after non- cardiac surgery （69.3 ± 27.5 ） pg/mL in group A （P 〉 0. 05 ）, while there was a significant difference in BNP concentrations between before surgery （ 149.3 ± 73.5 ） pg/mL and after non-cardiac surgery （ 341.5 ± 162. 4 ） pg/mL in group B （P 〈 0. 001 ）. Patients with postoperative cardiac events had significantly higher BNP levels （207.3 ± 99. 1 ） pg/mL before and （416. 9 ± 202. 8） pg/mL after non-cardiac surgery than those in patients with no cardiac events in group B. There was a significant difference in cardiac events between group A, in which no patient had cardiac events, and group B, in which 15 patients had cardiac events （ P 〈 0. 001 ）. Conclusions The changes in BNP levels after non- cardiac surgery were influenced by the preoperative levels of BNP, and relative to cardiac events.     

Increasing Uric Acid Concentration in Elderly With Ischemic Cardiomyopathy

Objectives Plasma uric acid （UA） concentration was suspected to elevate in elderly with ischemic cardiomyopathy （ICM）. Methods We analyzed the data of 235 elderly aged 60 years and older with coronary heart disease： silent myocardial ischemia or angina pectoris confirmed by angiography. Among these patients, 154 had ICM defined as left ventricular end-diastolic diameter （LVDd） male 〉 55 mm, female 〉 50 mm （mean. 63.51 ± 7.70 mm） measured by echocardiography. Difference in UA was analyzed between patients with and without ICM. Results There was significant increase of UA in ICM compared with non-ICM （432.82 ± 143.05 umol/L vs 361. 06 ± 137.35 umol/L, P 〈 0. 05 ） ; and UA was positively related to LVDd （ r = 0. 25, P 〈 0. 05 ）. Conclusions There was significant increase of UA in elderly with ICM due to longterm silent myocardial ischemia and angina pectoris. Moreover, UA was positively related to LVDd. （ S Chin J Cardiol 2009; 10（4） ： 212 -215）     

Ghrelin在冠心病中作用的研究进展

Ghrelin发现于1999年，是从大鼠胃黏膜中分离出来的具有促生长激素释放作用的小分子多肽。随后的研究发现，它还具有增加摄食、调节脂肪代谢、改善胰岛素抵抗、抑制炎症因子释放和降低血压等作用。进一步的研究表明，     

入院即刻血糖与急性冠脉综合征

入院即刻血糖可能反映机体在应激性刺激过程中产生的应激反应的强烈程度。入院即刻血糖的水平与体内炎症反应强度、血容量、血小板聚集及黏附等存在相关性。对入院即刻血糖的研究可以为评估急性冠脉综合征（acute coroary syndrome,ACS）患者的预后提供新的指标。现就入院即刻血糖的特性与急性冠脉综合征的关系作一综述。     

静息心电图正常的心绞痛患者冠脉造影分析

为了解静息心电图正常的心绞痛病例特点,本研究对120例心绞痛患者静息心电图和冠状动脉造影资料进行回顾性分析,旨在提高临床诊断冠心病水平,降低漏诊和误诊.     

误诊为冠心病的甲状腺功能减退性心脏病一例

1病例资料 患者男性,62岁,因“反复胸闷1年,加重1月”入院。胸闷位于心前区,本人手掌大小范围,伴冷汗,无心悸、气促、抽搐、晕厥,持续3～5min后稍缓解,伴肌肉僵硬、疼痛,声音低哑。反复发作,多于劳累、感冒时发作,休息后可缓解。