中国专家就血脂相关性心血管剩留风险控制达成共识（二）

“高TG（〉150mg／dl或1．7mmol／L）很普遍,影响着50％既往有心血管疾病的成人患者a在美国,大约2／3接受他汀类药物治疗控制LDL—C水平的冠状动脉粥样硬化性心脏病（冠心病）或冠心病等危症患者伴有低HDL—C水平（男性〈1．0mmol／L或40mg／dl,     

中国专家就血脂相关性心血管剩留风险控制达成共识（一）

“循证依据显示,经目前标准治疗,低密度脂蛋白胆固醇（LDL—c）、血压、血糖等传统危险因素得到控制后,血脂异常患者仍存在较高的心血管事件的剩留风险。致动脉粥样硬化性血脂异常,特别是升高的甘油三酯（TG）和较低的高密度脂蛋白-胆固醇（HDL—C）在心血管病、2型糖尿病、代谢综合征或肥胖患者中很常见,与患者大血管事件和微血管事件的剩留风险相关。     

心血管剩留风险的研究进展

2008年11月在瑞士成立了R3i(Residual Risk ReductionInitiative,剩留血管风险减少行动)国际专家指导委员会,2009年9月24日R3i中国专家指导委员会在上海成立,该委员会是全球R3i项目的一个分支机构.R3i是一个全球性、学术的、多学科、非盈利组织,宗旨是强调致动脉粥样硬化(AS)血脂异常在剩留血管风险中的重要作用,并推荐多危险因素全面干预策略.     

关注致动脉粥样硬化血脂异常的剩留血管风险

2008年11月成立了减少剩留风险行动(Residual Risk Reduction Initiative:R3i)的国际指导委员会,这是一个全球性、学术的、多学科、非盈利组织.     

甘油三酯增高的血脂异常防治中国专家共识

血脂异常是心血管系统最重要的危险因素之一。大量临床研究证实,应用他汀类药物降低胆固醇水平可以降低动脉粥样硬化性心血管疾病的发生率与致死致残率。然而近年研究显示,血脂异常患者即使经过大剂量他汀强化降胆固醇治疗后仍面临很高的心血管剩留风险Ⅲ,而在2型     

有效管理高甘油三酯血症 降低血管剩留风险——高甘油三酯血症治疗 我国众多专家达成共识

“关注高甘油三酯（TG）血症和心血管剩留风险,综合调控血脂异常,可能进一步降低心血管和微血管事件风险。”胡人一教授在《甘油三酯增高的血脂异常防治中国专家共识》（以下简称《共识》）媒体见面会上如是强调。     

有效管理高甘油三酯血症 降低血管剩留风险——高甘油三酯血症治疗 我国众多专家达成共识

“关注高甘油三酯（TG）血症和心血管剩留风险,综合调控血脂异常,可能进一步降低心血管和微血管事件风险。”胡大一教授在《甘油三酯增高的血脂异常防治中国专家共识》（以下简称《共识》）媒体见面会上如是强调。     

心血管剩留风险防治的血脂干预对策

随着糖尿病、肥胖、代谢综合征等代谢性高危因素的流行,心血管疾病的防治受到了前所未有的挑战.尽管当前的标准治疗包括使低密度脂蛋白胆同醇(LDL-C)达标、强化控制血压和血糖,但大血管事件(包括心肌梗死和脑卒中)和微血管并发症(视网膜病变、肾脏病变和神经病变)的风险仍然在大多数患者中显著剩留.     

心血管病合并糖代谢异常患者心血管风险综合管理中国专家共识

流行病学数据显示,我国心血管病与糖尿病共病现状十分严峻,而此类患者的心血管风险综合管理却严重不足且缺乏规范。近几年,多项大规模、随机对照、心血管结局临床试验证实两类新型降糖药物——钠-葡萄糖共转运蛋白-2抑制剂、胰高血糖素样肽-1受体激动剂,可显著降低主要不良心血管事件风险。在此背景下,欧美相继发布了糖尿病伴心血管病相...     

中国女性心血管疾病预防专家共识

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）第一次发表的女性心血管病预防建议,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。2007年,心血管疾病每分钟仍会导致一名美国女性死亡。2011年,AHA对女性心血管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”的指南,更加关注预防治疗的有效性。     

甘油三酯与心血管疾病相关性研究的现状

由于人们生活水平的提高、过多热量的摄入和缺少运动,导致血脂代谢异常发病率逐渐增多。同时,缺血性心血管疾病的发生率也在增加,人们必然将血脂异常与缺血性心血管疾病相联系。国内外大量循证医学证据和流行病学调查研究显示,总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）升高和高密度脂蛋白胆固醇（HDL—C）降低是冠心病和缺血性脑卒中的独立危险因素。     

Serum C-peptide as a key contributor to lipid-related residual cardiovascular risk in the elderly

ObjectivesThe serum levels of C-peptide, an important risk factor for cardiovascular disease (CVD), increase with age. This study aimed to investigate the association between serum C-peptide and increased risk for CVD with altered lipid metabolism in the elderly.MethodsThis was a population-based cross-sectional study that included 3091 elderly participants aged ≥65 years. Serum C-peptide and lipid levels were measured according to standard protocols. Sampling weights were used to estimate the characteristics of study participants. Stratified analysis of covariance was used to evaluate the changes in the serum lipid levels according to quartiles of serum C-peptide levels, and the linear trend was assessed using a linear model. The logistic regression model was carried out to determine the association between the serum C-peptide levels and serum lipid levels.ResultsThe results of the analysis of covariance stratified by sex and serum insulin level showed that the serum triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels were significantly associated with changes in the serum C-peptide levels, independent of the serum insulin level. The logistic regression analyses indicated that the serum C-peptide levels were positively associated with the serum TG levels, and negatively associated with the serum HDL-C levels. A significant dose-response association was obtained in both men and women.ConclusionsSerum C-peptide levels were strongly associated with increased serum TG and reduced HDL-C levels in the elderly. Our results suggest that serum C-peptide increases the risk of CVD via a pathway that increases TG or decreases HDL-C levels.     

医院主导的家庭心脏康复中国专家共识

心脏康复(cardiac rehabilitation,CR)是心血管疾病(CVD)慢性期循证结构化干预技术,包括患者教育、健康行为矫正、社会心理因素管理、药物治疗和运动训练,证据显示其进一步改善了CVD患者的二级预防疗效。我国CR使用率明显不足,符合条件的患者只有少数接受到CR治疗,迫切需要提出新的策略提高CR参与度。医院主导的家庭心脏康复(center guided home-based cardiac rehabilitation,CHBCR)模式是一种可能的有效策略。与医疗监督下的心脏康复中心(center-based cardiac rehabilitation,CBCR)模式服务不同,CHBCR依靠远程指导和间接的运动监督,患者接受CR的场所不在传统的心脏康复中心而在家庭。本共识的目的是明确CHBCR的优势、适应证、禁忌证,以及CHBCR中心建设、核心构成和质量控制等,以推动CHBCR在我国的科学实施,让更多CVD患者获益。     

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,     

Risk factors for primary prevention of cardiovascular disease and risk reduction by lipid control: the OMEGA study risk factor sub-analysis

To identify risk factors for cardiovascular disease (CVD) in hypertensive patients with no history of CVD being treated with antihypertensive drugs, we examined subgroup data (n?=?13?052) from the prospective, observational Olmesartan Mega Study to Determine the Relationship between Cardiovascular Endpoints and Blood Pressure Goal Achievement (OMEGA) study. Risk factors for CVD, stroke and coronary heart disease (CHD) were examined using a Cox proportional hazards model. In addition, the effect of statin therapy at baseline on CHD prevention was analyzed in dyslipidemic patients. The factors significantly related to CVD were female (hazard ratio [HR]?=?0.637, 95% confidence interval [CI] 0.428–0.948), older age (65–69 years: HR?=?2.165, 95% CI 1.214–3.861; 70–74 years: HR?=?2.324, 95% CI 1.294–4.174; ≥75 years: HR?=?2.448, 95% CI 1.309–4.578), family history of CHD (HR?=?1.993, 95% CI 1.249–3.179), diabetes (HR?=?2.287, 95% CI 1.700–3.078), current smoking (HR?=?2.289, 95% CI 1.512–3.466) and alcohol drinking socially (HR?=?0.589, 95% CI 0.379–0.913). Diabetes was a risk factor for both stroke and CHD, while age, family history of CHD, and sodium intake score were risk factors for stroke alone. Sex, dyslipidemia, smoking and exercise habits were risk factors for CHD alone. The risk of CHD in dyslipidemic patients on statin treatment was comparable to the risk in patients without dyslipidemia (HR?=?1.134, 95% CI 0.604–2.126). However, in dyslipidemic patients not on statin treatment, the HR increased to 1.807 (95% CI 1.156–2.825). In conclusion, some risk factors for CVD in hypertensive patients being treated with antihypertensive drugs with no history of CVD differed between CHD and stroke. These results suggest the importance of managing dyslipidemia with a statin for primary prevention of CHD, as well as the importance of hypertension therapy.     

Recommendations for the management of cardiovascular risk in patients with rheumatoid arthritis: Scientific evidence and expert opinion

Objectives

Last recommendations regarding cardiovascular risk (CVR) in rheumatoid arthritis (RA) patients were developed by the EULAR group in 2010. The aim is to update evidence-based recommendations about this worrying health problem.

Methods

We assembled a multidisciplinary workgroup (rheumatologists, endocrinologist, cardiologist, and epidemiologist) and a panel of 28 expert rheumatologists. The study was carried out in two big phases: identifying key areas in the prevention and management of CVR and developing a set of recommendations based on a review of the available scientific evidence and use of the Delphi consensus technique. All this has been developed according to an updating process of evidence-based recommendations.

Results

Overall, 25 recommendations were made addressing three complementary areas: CVR assessment tools, patient eligibility for assessment, and treatment strategies for control of CVR. The grade of the recommendations was not substantially modified compared to the original EULAR recommendations, except in two of them, which were upgraded from C to B. These two recommendations are the ones related to the use of corticosteroids and smoking cessation. The new developed recommendations address these two areas: CVR assessment and treatment strategies for control of CVR.

Conclusions

There are substantial gaps in the current knowledge that do not allow classifying properly RA patients based on their actual CVR and to accurately identify those patients who would benefit from CVR assessment. Consequently, studies designed to determine the causal effects of RA disease characteristics on cardiovascular morbidity/mortality and to identify patients at high risk of cardiovascular disease are still needed.     

Association of myeloperoxidase with cardiovascular disease risk factors in prediabetic subjects

IntroductionPrediabetes is a chronic low-grade inflammatory disease and considered as a risk factor for the development of diabetes mellitus and cardiovascular disease. Myeloperoxidase (MPO) is a leukocyte-derived enzyme, linked to both oxidative stress and inflammation and has been proposed as a possible mediator of atherosclerosis, the major cause of cardiovascular disease. The objective of the present study was to evaluate the level of MPO in prediabetic subjects and correlate it with other cardiovascular disease risk factors.Materials and methodsIn this cross-sectional study, a total of 400 subjects were recruited. Of them, 200 were prediabetic subjects and 200 were age and gender-matched controls. For each subject, blood pressure, weight, height, waist circumference, hip circumference and lipid parameters were measured. In addition, MPO was determined.ResultsMPO was significantly increased in prediabetic subjects as compared to controls. In correlation analysis, MPO was found to be significantly and positively correlated with all the cardiovascular disease risk factors i.e. age, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure [both systolic blood pressure (SBP) and diastolic blood pressure (DBP)], lipid parameters except high density lipoprotein (HDL) to which it was negatively correlated.ConclusionIn conclusion, MPO is well correlated with cardiovascular disease risk factors in prediabetes. Hence, MPO could be used to detect cardiovascular risk among prediabetic subjects and also can be used as an early biomarker of oxidative stress and inflammation in prediabetes.