防冠心病，每天该睡6.5～7.5 h！河北省人民医院郭艺芳等研究

正睡眠不足和过度睡眠等问题已越来越普遍,目前评估睡眠时间与冠心病风险关系的研究不少,但结果并不完全一致。河北省人民医院郭艺芳等发表的一项新Meta分析显示,睡眠时间与冠心病发病及死亡风险呈U型曲线关系。每天睡眠不足6.5 h是冠心病的危险因素,而睡眠时间超过8 h和7.5 h分别增加冠心病发病及死亡风险,在女士尤其明显。研究者指出,该Meta分析证实,睡眠时间太短或太长均会加速冠心病患者死亡。与每天睡7 h比较,每天睡5 h时,冠心病发病及死亡风险分别增加23%、29%;每天睡10h时,冠心病发病及死亡风险分别增加17%、66%。     

动态动脉硬化指数与冠心病相关性的Meta分析

目的综合评价动态动脉硬化指数与冠心病的相关性,为冠心病的预防和诊治提供循证医学证据。方法检索中国期刊全文数据库、万方数据库、维普中文科技期刊全文数据库、中国生物医学文献数据库、PubMed、Embase、the Cochrane Library等数据库,收集相关文献,提取数据,采用Review Manager 5.3统计学软件进行Meta分析。结果共纳入17篇文献,包括4 912例研究对象。Meta分析结果显示:冠心病组动态动脉硬化指数高于正常对照组,差异有统计学意义。失安全系数Nfs0.05为193.68,提示Meta分析结果稳定可靠。进一步根据病变支数分组行Meta分析,结果显示:动态动脉硬化指数除单支病变组与对照组比较差异无统计学意义外,其余各组间比较差异均有统计学意义。结论动态动脉硬化指数与冠心病有相关性,且随着冠状动脉病变程度的加重,动态动脉硬化指数与冠心病的相关性增强。     

血红素加氧酶-1基因启动子区多态性与冠心病和冠状动脉支架内再狭窄相关性的Meta分析

目的:探讨血红素加氧酶-1(HO-1)基因启动子区多态性与冠心病及冠状动脉支架内再狭窄(ISR)的相关性。方法:计算机检索PubMed、EMbase、CBM、CNKI、VIP和WanFang Data数据库,检索有关HO-1基因多态性与冠心病和冠状动脉ISR风险相关的研究,检索时限至2016年05月,采用Stata12.0软件进行Meta分析。结果:HO-1(GT)n重复序列多态性与冠心病相关性研究:共纳入13个病例-对照研究,包括7 835例冠心病患者和5 372例对照,Meta分析示在亚洲人群中HO-1(GT)n多态性与冠心病发病相关。HO-1(GT)n多态性与冠状动脉ISR相关性研究:共纳入6项前瞻性队列研究,包括972例ISR患者和4 052例对照,Meta分析示在亚洲人群中HO-1(GT)n多态性与ISR的发病风险具有相关性。HO-1T(-413)A单核苷酸多态性与冠心病相关性研究:共纳入4个病例-对照研究,包括3 323例冠心病患者和4 757例对照,Meta分析示HO-1T(-413)A多态性与冠心病的发病风险具有相关性。结论:在亚洲人群HO-1(GT)n重复序列多态性与冠心病和冠状动脉ISR风险具有相关性,携带短重复序列S或SS基因的人群其冠心病和ISR发病风险明显降低。HO-1T(-413)A与冠心病发病相关,携带A或AA基因的人群其冠心病发病风险明显降低。     

睡眠时间与高血压相关性的Meta分析

目的通过对睡眠时间与高血压发生风险进行系统性评价,为高血压防控管理提供科学依据。方法检索数据库为Pubmed、Embase、万方数据库、维普中文期刊数据库及中国期刊全文数据库,筛选关于睡眠时间与高血压相关性的横断面研究文献,检索时间为2012年3月至2018年9月,双人提取信息并评价文献质量,采用Stata12.0软件进行Meta分析,并进行异质性、敏感性及发表偏倚分析等。结果符合纳入标准的文献17篇,样本量共计959 358例,短睡眠时间增加高血压患病风险,当睡眠时间7 h高血压风险会增高55%(OR=1.55,95%CI:1.28～1.87,P0.001),睡眠时间7 h未显示与高血压存在关联(OR=1.02,95%CI:0.78～1.32,P0.05)。亚组分析发现,地区人群不同和睡眠时间定义不同是异质性主要来源。漏斗图进行Begg's和Eegg's检验显示结果不完全一致。敏感性分析提示本研究结果稳定性较好。结论成人短时间睡眠可增加高血压发病风险,而长时间睡眠未提示与高血压发病相关。     

MTHFR基因C677T多态性与中国人群冠心病相关性的Meta分析

目的:探讨亚甲基四氢叶酸还原酶(MTHFR)基因C677T多态性和中国人群冠心病之间的关系。方法:从数据库PubMed、Medline、CNKI及WanFang Data网站上检索并收集中国相关人群的MTHFR基因C677T多态性与冠心病风险的病例-对照研究,检索时限截至2017年10月。按照纳入与排除标准筛选文献、提取资料并评价纳入研究的质量后,用Stata 12.0软件进行Meta分析、发表偏倚评估和敏感性分析。为更好地阐明研究中的异质性,在研究中使用亚组分析。结果:共获得64篇相关文献,15篇纳入研究。MTHFR基因C677T多态性与冠心病病例-对照研究中,共有冠心病患者2 073例,对照组2 072例。MTHFR基因C677T多态性与冠心病相关性经Meta分析结果显示,在5个遗传模型中所有的遗传模型都提示MTHFR基因C677T多态性与冠心病发病风险的相关性具有统计学意义。在隐性遗传模型和杂合子模型中,MTHFR C677T基因多态性与冠心病的联系在中国北方地区具有显著性(P0.001;P=0.003),但在中国南方地区,MTHFR C677T基因多态性与冠心病之间没有显著联系(P=0.082;P=0.060)。在其他3种模型中,MTHFRC677T基因多态性与冠心病的关系在中国的北部和南部地区具有重要意义。结论:MTHFR基因C677T多态性与中国人群冠心病易感性密切相关,TT可能是冠心病易感的危险因素。     

双上肢收缩压差与心血管疾病相关性的Meta分析

目的通过Meta分析来探讨双上肢收缩压差值(IADSBP)与心血管疾病的相关性。方法计算机检索The Cochrane Library、Pub Med、Medline、EMbase、中国知网及万方数据库,检索时间截止至2014年9月30日,查找包含双上肢血压差值与心血管疾病相关数据的队列研究、病例对照研究及观察性研究,阅读并严格按照纳入标准筛选,提取数据,通过Revman5.3软件进行Meta分析。结果共纳入7篇文献,8个横断面观察性研究,均为英文文献,共5263例患者,所纳入研究根据IADSBP≥15 mm Hg,15 mm Hg分为两组,Meta分析显示:IADSBP≥15 mm Hg组与15 mm Hg组冠心病发生率无统计学差异(RR=1.03,95%CI:0.67~1.58,P=0.88)。同步测量亚组分析(RR=0.87,95%CI:0.59~1.30,P=0.51)及非同步测量亚组分析(RR=1.13,95%CI:0.55~2.31,P=0.73),其结果亦提示IADSBP≥15mm Hg与15 mm Hg组冠心病发生率无统计学差异。结论 IADSBP≥15 mm Hg与心血管疾病发病无明显相关性,暂不能较好的作为冠心病的危险预测因素。     

双心模式治疗冠心病合并失眠的Meta分析

目的 应用Meta分析探讨双心模式治疗冠心病合并失眠的疗效。方法 在中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Embase、the Cochrane Library检索获得符合本研究纳入、排除标准的中、英文公开发表文献,时间限定为建库至2022年4月,应用RevMan 5.4.1软件进行Meta分析,从失眠和冠心病方面的指标评价双心模式治疗冠心病合并失眠的效果。结果 纳入的随机对照试验共21个,涉及2 272例患者,其中12篇文献质量相对较高。Meta分析结果显示：在失眠方面,干预组(双心模式治疗)匹兹堡睡眠质量指数(PSQI)评分[MD=-3.55,95%CI(-4.17,-2.93),P<0.05]低于对照组;干预组睡眠质量优良率[OR=4.38,95%CI(2.86,6.72),P<0.05]和失眠疗效有效率[OR=3.70,95%CI(1.70,8.05),P<0.05]均高于对照组;在冠心病方面,干预组心绞痛发作频率[MD=-3.47,95%CI(-4.18,-2.76),P<0.05]和心绞痛持续时间[MD=-3.07,...     

eNOS基因T786-C和4b/a多态性与中国人群冠心病风险相关性的Meta分析

目的评价内皮型一氧化氮合酶基因T786-C和4b/a多态性与中国人群冠状动脉粥样硬化性心脏病(冠心病)的相关性。方法计算机检索PubMed、Embase、CNKI、万方、VIP,搜集内皮型一氧化氮合酶基因多态性与中国人群冠心病相关性的病例-对照研究,检索时间均为建库至2017年10月10日。由两名作者独立提取数据及评价方法学质量后,采用RevMan 5.3软件进行Meta分析。结果最终纳入18个病例-对照研究,共4585例患者,4555例健康对照人群。Meta分析结果显示,内皮型一氧化氮合酶T786-C多态性能够显著增加中国人群冠心病的患病风险(C vs. T:OR=1.67,95%CI:1.45～1.92;CC vs. TT:OR=2.35,95%CI:1.43～3.85;TC vs. TT:OR=1.68,95%CI:1.44～1.97;CC+TC vs. TT:OR=1.73,95%CI:1.49～2.02;CC vs. TC+TT:OR=2.02,95%CI:1.23～3.30);内皮型一氧化氮合酶4b/a多态性能够显著增加中国人群冠心病的患病风险(a vs. b:OR=1.54,95%CI:1.34～1.77;aa vs. bb:OR=3.55,95%CI:2.15～5.86;ab vs. bb:OR=1.32,95%CI:1.12～1.55;aa+ab vs. bb:OR=1.48,95%CI:1.27～1.72;aa vs. ab+bb:OR=3.32,95%CI:2.01～5.49)。结论基于当前证据,内皮型一氧化氮合酶基因T786-C和4b/a多态性均与中国人群冠心病发病风险增加具有相关性。     

肿瘤坏死因子-α基因C-857T多态性与冠心病易感性的Meta分析

目的采用Meta分析的方法探讨肿瘤坏死因子-α(TNF-α)基因C-857T多态性与冠心病(CAD)易感性的关系。方法检索Pub Med、Web of Science、万方、重庆维普和中国知网数据库,截止时间为2015年11月1日。由两名研究者对合格研究进行资料提取、质量评价,并用Stata11.0软件进行Meta分析。结果最终纳入7篇文献(共计8项独立的病例-对照研究),包括2928例CAD患者和3495例对照。Meta分析结果显示TNF-α基因C-857T多态性与CAD易感性在整体人群中无统计学相关性,而在亚洲人群及对照来源于医院的研究中却发现二者之间具有相关性。敏感性分析显示本研究结果稳定性良好,且未检测到发表偏倚。结论 TNF-α基因C-857T多态性与CAD易感性之间可能无相关性,此结果仍需大样本量的病例-对照研究进一步验证。     

三磷酸腺苷结合盒转运体A1基因R219K多态性与冠心病相关性的荟萃分析

目的研究中国人群ATP结合盒转运体A1(ABCA1)基因R219K多态性与冠心病的相关性。方法计算机检索CBM、CNKI、万方数据库、VIP及Medline、PubMed等数据库,收集中国人群ABCA1基因R219K多态性与冠心病相关性的病例对照研究,检索时间从建库(CBM:1978;CNKI 1994;万方数据库:1989年;VIP:1989年;Medline:1966年;PubMed:2000年)至2012年2月。在评价纳入研究质量并提取有效数据后,用RevMan 5.0软件进行Meta分析。结果纳入13个文献,冠心病2363例,对照人群2328例。K等位基因较R等位基因(OR=0.66,95%CI:0.60～0.71,P<0.01)、携带RK+KK较RR基因型(OR=0.60,95%CI:0.53～0.68,P<0.01)、RK较RR基因型(OR=0.67,95%CI:0.59～0.76,P<0.01)、KK较RR基因型(OR=0.45,95%CI:0.38～0.53,P<0.01)人群发生冠心病的风险更低。结论中国人群ABCA1基因R219K多态性与冠心病的发生、发展有一定关联,而ABCA1的K等位基因是冠心病的保护因素。     

东亚男性饮酒与冠心病的关系

目的 探讨东亚男性饮酒对冠心病发病率、病死率和全因死亡率的影响.方法 检索Pubmed等数据库,纳入中国、日本、韩国符合入选条件的前瞻性队列研究.记录研究来源国家,例数,性别,年龄,随访期限,饮酒量,与饮酒相关的冠心病发病率、病死率及全因死亡率的相对风险等资料.应用荟萃分析,系统评价饮酒量与冠心病发病率、病死率及全国死亡率的风险效应.结果 纳入前瞻性队列研究15项;共计汇总冠心病研究对象177 723例,含冠心病患者2406例;全因死亡研究对象216 233例,含各种原因死亡15 462例.与不饮酒者比较,每日饮酒量≤20、21～40、41～60、＞60g/d者冠心病发病风险分别为0.65(95%CI:0.34～1.23,P=0.18)、0.48(95%CI:0.26～0.87,P=0.02)、0.46(95%CI:0.32～0.67,P＜0.01)和0.48(95%CI:0.29～0.78,P＜0.01),冠心病死亡风险分别为0.98(95%CI:0.73～1.31,P=0.87)、0.68(95%CI:0.58～0.79,P＜0.01)、0.64(95%CI:0.43～0.96,P=0.03)和0.75(95%CI:0.54～1.03,P=0.08),全因死亡风险分别为0.83(95%CI:0.79～0.91,P＜0.01)、0.93(95%CI:0.87～0.99,P=0.03)、1.01(95%CI:0.95～1.07,P=0.86)和1.32(95%CI:1.29～1.36,P＜0.01).结论 东亚男性适量饮酒可降低冠心病发病率及病死率.随着饮酒量增加,全因死亡的风险明显增加.每日饮用酒精量不应超过40g.     

Smoking and risk of coronary heart disease among women with type 2 diabetes mellitus

BACKGROUND: Although the association between smoking and increased risk of coronary heart disease (CHD) is well established in the general population, this relationship is less well-defined among individuals with diabetes. OBJECTIVE: To assess the relationship between cigarette smoking and risk of CHD among women with type 2 diabetes mellitus in the Nurses' Health Study cohort. METHODS: The Nurses' Health Study, a prospective cohort study of 121,700 US female registered nurses surveyed in 11 states and followed up from July 1, 1976, through July 1, 1996, involved a total of 6547 women diagnosed as having type 2 diabetes mellitus. Incident cases of CHD were our main outcome measure in this study. RESULTS: We documented 458 incident cases of CHD (200 fatal CHD-related cases and 258 nonfatal myocardial infarctions) during 20 years (68,227 person-years) of follow-up. We found a dose-response relationship between current smoking status and risk of CHD among diabetic women. Compared with never smokers, the relative risks (RRs) for CHD were 1.21 (95% confidence interval [CI], 0.97-1.51) for past smokers, 1.66 (95% CI, 1.10-2.52) for current smokers of 1 to 14 cigarettes per day, and 2.68 (95% CI, 2.07-3.48) for current smokers of 15 or more cigarettes per day in multivariate analyses (P<.001 for trend). The multivariate RR of CHD among diabetic women who had stopped smoking for more than 10 years was similar to that among diabetic women who were never smokers (RR, 1.01; 95% CI, 0.73-1.38). In secondary analyses involving diabetic and nondiabetic women, the multivariate-adjusted RR of CHD for those with diabetes who currently smoked (> or = 15 cigarettes per day) compared with those who never smoked was 7.67 (95% CI, 5.88-10.01). CONCLUSIONS: Cigarette smoking is strongly associated with an increased risk of CHD among women with type 2 diabetes mellitus. Furthermore, quitting smoking seems to decrease this excess risk substantially; women with diabetes should be strongly advised against smoking.CK     

阻塞性睡眠呼吸暂停和心血管事件相关性的Mate分析

目的前期研究表明阻塞性睡眠呼吸暂停(OSA)可能会增加心血管疾病的风险,但基于各种条件的限制,该结论尚无定论。本研究旨在于通过系统性评估前瞻性队列研究来进一步分析OSA与心血管事件的相关性。方法系统性检索PubMed与EMbase等电子数据库,查找关于OSA与成年人冠状动脉粥样硬化性心脏病(CHD,冠心病)、卒中及总心血管疾病(CVD)发生率之间的前瞻性队列研究。结果本研究共计纳入14项研究。与对照组相比,OSA组的心血管死亡率(OR=2.16,95%CI:1.4~3.18,P=0.03)、冠心病发病率(OR=1.49,95%CI:1.16~1.91,P=0.002)及高血压发生率(OR=1.82,95%CI:1.24~2.68,P=0.002)上存在统计学差异,而在心血管事件(OR=1.25,95%CI:0.38~4.13,P=0.72)、卒中发生率(OR=1.17,95%CI:0.75~1.82,P=0.50)及高脂血症发生率(OR=2.06,95%CI:0.96~4.44,P=0.06)方面,两组间无统计学差异。在亚组中,体质指数(BMI)≥30的OSA人群(OR=3.82,95%CI:1.90~7.68,P=0.0002)、OSA持续10年以上(OR=3.66,95%CI:2.07~6.47,P<0.00001)及中重度OSA患者(OR=3.52,95%CI:1.59~7.79,P<0.05)具有更高的心血管死亡率。结论这项研究证实OSA会增加心血管事件的死亡率,同时增加心血管事件的相关风险,尤其是中重度OSA患者。     

Hyperuricemia and coronary heart disease: A systematic review and meta‐analysis

Objective

The role of serum uric acid as an independent risk factor for cardiovascular disease remains unclear, although hyperuricemia is associated with cardiovascular disease such as coronary heart disease (CHD), stroke, and hypertension.

Methods

A systematic review and meta‐analysis using a random‐effects model was conducted to determine the risk of CHD associated with hyperuricemia in adults. Studies of hyperuricemia and CHD were identified by searching major electronic databases using the medical subject headings and keywords without language restriction (through February 2009). Only prospective cohort studies were included if they had data on CHD incidences or mortalities related to serum uric acid levels in adults.

Results

Twenty‐six eligible studies of 402,997 adults were identified. Hyperuricemia was associated with an increased risk of CHD incidence (unadjusted risk ratio [RR] 1.34, 95% confidence interval [95% CI] 1.19–1.49) and mortality (unadjusted RR 1.46, 95% CI 1.20–1.73). When adjusted for potential confounding, the pooled RR was 1.09 (95% CI 1.03–1.16) for CHD incidence and 1.16 (95% CI 1.01–1.30) for CHD mortality. For each increase of 1 mg/dl in uric acid level, the pooled multivariate RR for CHD mortality was 1.12 (95% CI 1.05–1.19). Subgroup analyses showed no significant association between hyperuricemia and CHD incidence/mortality in men, but an increased risk for CHD mortality in women (RR 1.67, 95% CI 1.30–2.04).

Conclusion

Hyperuricemia may marginally increase the risk of CHD events, independently of traditional CHD risk factors. A more pronounced increased risk for CHD mortality in women should be investigated in future research.     

Smoking,alcohol consumption,and the risk of extrahepatic cholangiocarcinoma:A meta-analysis

AIM:To assess the association between smoking and alcohol consumption and extrahepatic cholangiocarcinoma(ECC)through a meta-analysis of clinical observational studies.METHODS:A literature search was conducted using Embase and MEDLINE databases from inception to 31May 2013 without language limitations,and by manually searching the references of retrieved articles.Casecontrol and cohort studies that investigated the association between smoking or alcohol consumption and ECC were included.The quality of these studies was assessed using the Newcastle-Ottawa quality assessment scale.Summary relative risks and corresponding95%CI were calculated using a random-effects model.Publication bias was assessed by Begg’s funnel plot and Egger’s test.RESULTS:A total of 12 eligible articles(11 case-control studies and one cohort study)were included in this meta-analysis.Eleven studies reported the association between smoking and ECC.Pooled analysis indicated that smokers had an increased risk of ECC development as compared with non-smokers(summary RR=1.23;95%CI:1.01-1.50).This correlation was present in population-based studies(n=5;summary RR=1.47;95%CI:1.06-2.05)but not in hospital-based studies(n=6;summary RR=1.10;95%CI:0.88-1.37)and in non-Asian regions(n=7;summary RR=1.39;95%CI:1.03-1.87)but not in Asia(n=4;summary RR=1.08;95%CI:0.85-1.38).Seven studies reported an association between consuming alcohol and ECC.Pooled analysis indicated that alcohol drinkers had a similar risk of ECC development as did individuals who did not drink alcohol(summary RR=1.09;95%CI:0.87-1.37).There was moderate heterogeneity among the studies and no evidence of publication bias.CONCLUSION:Smoking is associated with an increased risk of ECC,but alcohol consumption is not.Further population-based studies,particularly cohort studies,are warranted to enable definitive conclusions.     

Risk of cancer,with special reference to extra-intestinal malignancies,in patients with inflammatory bowel disease

AIM:To determine the incidence and characteristics of intestinal and extra-intestinal cancers among patients with inflammatory bowel disease in a Spanish hospital and to compare them with those of the local population.METHODS:This was a prospective,observational,7-year follow-up,cohort study.Cumulative incidence,incidence rates based on person-years of follow-up and relative risk were calculated for patients with inflammatory bowel disease and compared with the background population.The incidence of cancer was determined using a hospital-based data registry from Hospital Universitario de Fuenlabrada.Demographic data and details about time from diagnosis of inflammatory bowel disease to occurrence of cancer,disease extent,inflammatory bowel disease treatment,cancer therapy and cancer evolution were also collected in the inflammatory bowel disease cohort.RESULTS:Eighteen of 590 patients with inflammatory bowel disease developed cancer[cumulative incidence=3%(95%CI:1.58-4.52)vs 2%(95%CI:1.99-2.11)in the background population;RR=1.5;95%CI:0.97-2.29].The cancer incidence among inflammatory bowel disease patients was 0.53%(95%CI:0.32-0.84)per patient-year of follow-up.Patients with inflammatory bowel disease had a significantly increased relative risk of urothelial carcinoma(RR=5.23,95%CI:1.95-13.87),appendiceal mucinous cystadenoma(RR=36.6,95%CI:7.92-138.4),neuroendocrine carcinoma(RR=13.1,95%CI:1.82-29.7)and rectal carcinoid(RR=8.94,95%CI:1.18-59.7).Colorectal cancer cases were not found.CONCLUSION:The overall risk of cancer did not significantly increase in our inflammatory bowel disease patients.However,there was an increased risk of urinary bladder cancer and,with less statistical power,an increased risk of appendiceal mucinous cystadenoma and of neuroendocrine tumors.Colorectal cancer risk was low in our series.     

Gastric cancer risk in relation to tobacco use and alcohol drinking in Kerala,India-Karunagappally cohort study

AIM: To assess the risk of gastric cancer(GC) in relation to tobacco use and alcohol drinking in the Karunagappally cohort in Kerala, South India.METHODS: This study examined the association of tobacco use and alcohol drinking with GC incidence among 65553 men aged 30-84 in the Karunagappally cohort. During the period from 1990-2009, 116 GC cases in the cohort were identified as incident cancers. These cases were identified from the populationbased cancer registry. Information regarding risk factors such as socioeconomic factors and tobacco and alcohol habits of cohort members were collected from the database of the baseline survey conducted during 1990-1997. The relative risks(RRs) and the corresponding 95% confidence intervals(95%CIs) fortobacco use were obtained from Poisson regression analysis of grouped survival data, considering age, follow-up period, occupation and education.RESULTS: Bidi smoking was associated with GC risk(P = 0.042). The RR comparing current versus never smokers was 1.6(95%CI: 1.0-2.5). GC risk was associated with the number of bidis smoked daily(P = 0.012) and with the duration of bidi smoking(P = 0.036). Those who started bidi smoking at younger ages were at an elevated GC risk; the RRs for those starting bidi smoking under the age of 18 and ages 18-22 were 2.0(95%CI: 1.0-3.9) and 1.8(95%CI: 1.1-2.9), respectively, when their risks were compared with lifetime non-smokers of bidis. Bidi smoking increased the risk of GC among never cigarette smokers more evidently(RR = 2.2; 95%CI: 1.3-4.0). GC risk increased with the cumulative amount of bidi smoking, which was calculated as the number of bidis smoked per day x years of smoking(bidi-year; P = 0.017). Cigarette smoking, tobacco chewing or alcohol drinking was not significantly associated with GC risk. CONCLUSION: Among a male cohort in South India, gastric cancer risk increased with the number and duration of bidi smoking.     

Association of type 2 diabetes mellitus and the risk of colorectal cancer: A meta-analysis and systematic review

AIM: To provide a quantitative assessment of the association between type 2 diabetes mellitus(T2DM)and the risk of colorectal cancer(CRC).METHODS: Systematic review was conducted thorough MEDLINE, EMBASE, Cochrane Library, andISI Web of knowledge databases till 31 st January 2014.This meta-analysis included the cohort studies that illustrated relative risk(RR) or odds ratio estimates with 95%CI for the predictive risk of CRC by T2 DM.Summary relative risks with 95%CI were analyzed by using an effects summary ratio model. Heterogeneity among studies was assessed by the Cochran's Q and I 2statistics.RESULTS: The meta analysis of 8 finally selected studies showed a positive correlation of T2 DM with the risk of CRC as depicted by effects summary RR of 1.21(95%CI: 1.02-1.42). Diabetic women showed greater risk of developing CRC as their effect summary RR of 1.22(95%CI: 1.01-49) with significant overall Z test at 5% level of significance was higher than the effect summary RR of 1.17(95%CI: 1.00-1.37) of men showing insignificant Z test. The effect summary RR of 1.19 with 95%CI of 1.07-1.33 indicate a positive relationship between DM and increased risk of CRC with significant heterogeneity(I 2 = 92% and P-value 0.05).CONCLUSION: Results from this systematic review and meta-analysis report that diabetic people have an increased risk of CRC as compared to non-diabetics.     

Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies

Increased consumption of fruit and vegetables has been shown to be associated with a reduced risk of coronary heart disease (CHD) in many epidemiological studies, however, the extent of the association is uncertain. We quantitatively assessed the relation between fruit and vegetable intake and incidence of CHD by carrying out a meta-analysis of cohort studies. Studies were included if they reported relative risks (RRs) and corresponding 95% confidence interval (CI) of CHD with respect to frequency of fruit and vegetable intake. Twelve studies, consisting of 13 independent cohorts, met the inclusion criteria. There were 278,459 individuals (9143 CHD events) with a median follow-up of 11 years. Compared with individuals who had less than 3 servings/day of fruit and vegetables, the pooled RR of CHD was 0.93 (95% CI: 0.86-1.00, P=0.06) for those with 3-5 servings/day and 0.83 (0.77-0.89, P<0.0001) for those with more than 5 servings/day. Subgroup analyses showed that both fruits and vegetables had a significant protective effect on CHD. Our meta-analysis of prospective cohort studies demonstrates that increased consumption of fruit and vegetables from less than 3 to more than 5 servings/day is related to a 17% reduction in CHD risk, whereas increased intake to 3-5 servings/day is associated with a smaller and borderline significant reduction in CHD risk. These results provide strong support for the recommendations to consume more than 5 servings/day of fruit and vegetables.     

中国35～64岁人群血压水平与10年心血管病发病危险的前瞻性研究

目的探讨我国35～64岁人群血压水平与心血管病发病危险的关系,为《中国高血压防治指南》的修订工作提供流行病学数据。方法采用前瞻性队列研究的方法,对1992年建立的11省市35～64岁队列人群共31728人的基线血压水平和1992～2002年发生的心血管病(包括冠心病和脑卒中)事件的关系进行分析。结果(1)以血压110～119／75～79mmHg(1mmHg=0．133kPa)为对照,血压在120～129／80～84mmHg时,心血管病发病危险增加了1倍(RR=2．09);血压在140～149／90～94mmHg时,心血管病发病危险增加了2倍以上(RR=3．23);当血压≥180／110mmHg时,心血管病发病危险增加了10倍以上(RR=11．81)。(2)与理想血压相比,2级高血压时,急性冠心病事件发病的危险是理想血压组的2．3倍,急性缺血性脑卒中和急性出血性脑卒中发病的危险分别是理想血压组的4．9倍和11．7倍。(3)在总的心血管病事件中,36．1％可归因于高血压;其中44．0％的急性脑卒中事件和23．7％的急性冠心病事件可归因于高血压。(4)不同血压水平时,随着合并其他心血管病危险因素个数的增加,10年心血管病发病的综合危险增加。结论血压水平从110／75mm Hg开始,随着血压水平的增加,心血管病发病危险持续上升,所以将某个血压水平作为高血压的诊断标准是人为制订的。应该加强多重危险因素的综合干预,以减少总的心血管病的发病危险。