Risk factors distribution and cardiovascular disease prevalence in the Italian population: The CHECK study

Objective: To evaluate the distribution of cardiovascular risk factors and the prevalence of cardiovascular disease in a sample of the Italian population. Methods: CHECK (Cholesterol and Health: Education, Control and Knowledge) is a cross-sectional observational study in a randomised sample of the Italian adult population aged 40 - 79 years, in the setting of general practice. Results: 5846 subjects (50.3% male) were included in the analysis. The mean age [±SD] of the observed cohort was 57.8 (±10.3) years. One out of five subjects smoked cigarettes and almost 80% didn’t engage in regular leisure-time physical activity. The mean blood pressure was 132.0 [±14.7]/81.2 [±7.9] mmHg. The total and LDL-cholesterol levels were respectively 205.3 [±35.9] mg/dL and 124.9 [±29.9] mg/dL. The mean glucose concentration was 98.3 [±28.2] mg/dL. The prevalence rate of hypertension, hypercholesterolemia, and type 2 diabetes were respectively 51.8%, 55.6%, and 13.0%. 8.9% of the observed subjects had a history of cardiovascular events, while in the primary prevention group the 10-year-risk of coronary heart disease (Framingham algorithm) was 10.1% [±8.3%] and of cardiovascular disease (CUORE algorithm) was 5.2% [±5.9%]. Conclusion: The CHECK study provides a detailed description of a randomised sample of the Italian population, contributing to evaluate the prevalence of cardiovascular risk factors and the main cardiovascular disease in Italy and to provide a baseline to set priorities and objectives for future intervention of health policy.

Living with liver disease in the era of COVID-19-the impact of the epidemic and the threat to high-risk populations

The cardinal symptoms of severe acute respiratory syndrome coronavirus 2 infection as the pandemic began in 2020 were cough,fever,and dyspnea,thus characterizing the virus as a predominantly pulmonary disease.While it is apparent that many patients presenting acutely to the hospital with coronavirus disease 2019(COVID-19)infection have complaints of respiratory symptoms,other vital organs and systems are also being affected.In fact,almost half of COVID-19 hospitalized patients were found to have evidence of some degree of liver injury.Incidence and severity of liver injury in patients with underlying liver disease were even greater.According to the Centers of Disease Control and Prevention,from August 1,2020 to May 31,2022 there have been a total of 4745738 COVID-19 hospital admissions.Considering the gravity of the COVID-19 pandemic and the incidence of liver injury in COVID-19 patients,it is imperative that we as clinicians understand the effects of the virus on the liver and conversely,the effect of underlying hepatobiliary conditions on the severity of the viral course itself.In this article,we review the spectrum of novel studies regarding COVID-19 induced liver injury,compiling data on the effects of the virus in various age and high-risk groups,especially those with preexisting liver disease,in order to obtain a comprehensive understanding of this disease process.We also provide an update of the impact of the new Omicron variant and the changing nature of COVID-19 pathogenesis.

Lipoprotein(a)and Atherosclerotic Cardiovascular Diseases:Evidence from Chinese Population

Cardiovascular disease(CVD)is the leading cause of mortality worldwide.Multiple factors are involved in CVD,and emerging data indicate that lipoprotein(a)(Lp(a))may be associated with atherosclerotic cardiovascular disease(ASCVD)independent of other traditional risk factors.Lp(a)has been identified as a novel therapeutic target.Previous studies on the influence of Lp(a)in CVD have mainly used in western populations.In this review,the association of plasma Lp(a)concentration with ASCVD was summarized,with regards to epidemiological,population-based observational,and pathological studies in Chinese populations.Lp(a)mutations and copy number variations in Chinese populations are also explored.Finally,the impact of plasma Lp(a)levels on patients with type 2 diabetes mellitus,cancer,and familial hypercholesterolemia are discussed.

Non-alcoholic steatohepatitis and the risk of myocardial infarction: Apopulation-based national study

BACKGROUNDNon-alcoholic fatty liver disease (NAFLD) is a systemic disease with bidirectionalrelationships with cardiovascular disease (CVD). Non-alcoholic steatohepatitis(NASH) is a more severe subtype of NAFLD. Patients with NASH exhibit moreintra and extrahepatic inflammation, procoagulant imbalances andproatherogenic lipid profiles. Whether NASH increases the risk of ischemic heartdisease is currently unclear.AIMTo investigate the relationship between acute myocardial infarction (MI) andNASH in a large cohort of subjects in the United States.METHODSWe reviewed data from a large commercial database (Explorys IBM) thataggregates electronic health records from 26 large nationwide healthcare systems.Using systemized nomenclature of clinical medical terms (SNOMED CT), weidentified adult with the diagnosis of NASH from 1999-2019. We includedpatients with the diagnosis of acute MI from 2018-2019. Comorbidities known tobe associated with NASH and MI such as obesity, diabetes mellitus,hyperlipidemia, smoking, male gender, and hypertension were collected.Univariable and multivariable analyses were performed to investigate whetherNASH is independently associated with the risk of MI.RESULTSOut of 55099280 patients, 43170 were diagnosed with NASH (0.08%) and 107000(0.194%) had a MI within 2018-2019. After adjusting for traditional risk factors,NASH conferred greater odds of MI odds ratio (OR) 1.5 [95% confidence interval(CI): 1.40-1.62]. Hyperlipidemia had the strongest association with MI OR 8.39(95%CI: 8.21-8.58) followed by hypertension OR 3.11 (95%CI: 3.05-3.17) andsmoking OR 2.83 (95%CI: 2.79-2.87). NASH had a similar association with MI asthe following traditional risk factors like age above 65 years OR 1.47 (95%CI: 1.45-1.49), male gender OR 1.53 (95%CI: 1.51-1.55) diabetes mellitus OR 1.89 (95%CI:1.86-1.91).CONCLUSIONMI appears to be a prevalent disease in NASH. Patients with NASH may needearly identification and aggressive cardiovascular risk modification.

心血管运动医学指南

心血管运动医学指南旨在为心血管疾病的预防和治疗提供科学、实用的运动建议和管理策略。本指南由心血管代谢病学与运动医学专家编写,涵盖了运动相关定义、运动处方的基本内容、一般人群与高危心血管疾病患者的运动建议以及运动时心血管风险的筛查与评估、运动的禁忌证,强调了适量和规律运动在降低心血管疾病发病风险和改善患者生活质量方面的重要性,以期为心血管运动医学相关从业人员提供重要的参考依据。

不同糖代谢人群中血红蛋白糖化指数与非致死性心脑血管疾病的关系:一项基于REACTION数据的横断面研究

背景心脑血管疾病危害巨大,缺乏早期干预的预测指标。糖尿病是心脑血管疾病的主要病因之一,血红蛋白糖化指数(hemoglobin glycation index,HGI)可反映个体糖化能力。目的探讨总体及不同糖代谢人群的HGI与非致死性心脑血管疾病的关系。方法本研究为横断面研究,纳入中国2型糖尿病患者恶性肿瘤发生风险的流行病学研究(Risk Evaluation of Cancers in Chinese Diabetic Individuals:A Longitudinal Study,REACTION)北京分中心2011年受试者16470例,采集受试者一般特征以及非致死性心肌梗死、非致死性脑卒中(缺血性脑卒中和出血性脑卒中)等非致死性心脑血管疾病患病情况。在总体人群中依据基线HGI四分位切点进行四分位分组,使用Logistic回归分析HGI与非致死性心脑血管疾病的关系。结果16470例受试者依据HGI四分位切点分为Q1组(≤-0.26)4242例、Q2组(-0.26~-0.02)3915例、Q3组(-0.02~0.24)4223例、Q4组(>0.24)4090例;按照糖代谢状态分组后,糖耐量正常(normal glucose tolerance,NGT)9710例,糖尿病前期[糖耐量受损(impaired glucose tolerance,IGT)+空腹血糖受损(impaired fasting glucose,IFG)]4273例,糖尿病(diabetes mellitus,DM)2487例。总体人群中随着HGI升高,非致死性心脑血管疾病发生例数从Q1至Q4组分别为131例(3.1%)、125例(3.2%)、169例(4.0%)、174例(4.3%),逐渐升高(P=0.008);在NGT人群中,随着HGI升高,非致死性心脑血管疾病发生例数从Q1至Q4组分别为58例(2.5%)、63例(2.5%)、93例(3.5%)、75例(3.4%),呈上升趋势(P=0.046);而在空腹血糖受损和糖尿病人群中,非致死性心脑血管疾病发生情况在不同HGI组间差异无统计学意义(P=0.054、0.523);建立Logistic回归模型,校正相关影响因素后,发现在总体人群、糖耐量正常人群、糖尿病人群中,HGI与非致死性心脑血管疾病发生间无显著相关性。而在糖尿病前期人群中,相较于Q1组,Q2组(OR=1.762,95%CI:1.098~2.825,P=0.019)、Q3组(OR=2.005,95%CI:1.272~3.160,P=0.003)、Q4组(OR=1.513,95%CI:0.941~2.432,P=0.087)非致死性心脑血管疾病发生风险均增加。结论在糖尿病前期人群中,HGI与非致死性心脑血管疾病有显著相关性,在糖耐量正常和糖尿病人群中未发现相关性。

乌鲁木齐市35~75岁体检人群心血管病高危预测模型的建立与验证

目的了解乌鲁木齐市35~75岁体检人群心血管病(CVD)高危人群检出情况并建立多因素Logistic回归模型与决策树模型预测CVD高危人群,对比分析模型预测效果及准确率,为CVD的预防控制提供参考依据。方法于2023年6月-2024年1月采用便利抽样方法在乌鲁木齐市某三甲医院体检中心抽取40364名35~75岁体检者进行问卷调查和体格检查,分析CVD高危人群检出情况;应用多因素Logistic回归分析方法以及决策树模型建立CVD高危预测模型,并对模型的预测效果和准确性进行比较和分析。结果40364名35~75岁体检人群中,检出CVD高危人群10858名,CVD高危人群检出率为26.9%。多因素Logistic回归分析结果显示,年龄>40岁、商业服务业、退(离)休人员、吸烟、饮食中肉食摄入过多或过少是35~75岁体检人群CVD高危人群检出的危险因素。女性、初高中以上文化程度、专业技术人员、办事人员或职员、农林牧渔生产人员以及生产运输设备操作工人、每周运动1次及以上是乌鲁木齐市35~75岁体检人群CVD高危人群检出的保护因素。CVD高危人群体质指数、收缩压、舒张压、臀围、腰围、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白和低密度脂蛋白胆固醇中除高密度脂蛋白低于非高危人群外,其余均高于非高危人群,差异有统计学意义(均P<0.001)。以人口学特征(年龄、吸烟习惯、饮食习惯)和体检指标(收缩压、舒张压、空腹血糖、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白)为自变量,通过多因素Logistic回归以及决策树模型建立CVD高危预测模型,两个模型均具有较好的预测准确率,多因素Logistic回归模型与决策树模型的AUC值均为0.867(95%CI=0.864~0.871,P<0.001)。结论乌鲁木齐市35~75岁体检人群CVD高危人群检出率相对较高。构建的多因素Logistic回归模型以及可视化的决策树模型均具有较好的预测效果。可以预测个体未来成为心血管病高危人群的可能性,为识别CVD高危人群提供了筛查工具,对推进心血管疾病的零级预防有一定的指导作用。

基于心血管疾病死亡效应的亚热带地区最佳热浪定义研究

目的本研究探索亚热带地区的热浪定义,系统评估热浪对福建省心血管疾病(cardiovascular disease,CVD)及其亚型死亡率的影响。方法收集2007-2015年福建省9个市66854例心血管疾病死亡数,联合分布滞后非线性模型(distributed lag non-linear model,DLNM)和类泊松回归模型评估热浪对各个市每日心血管疾病死亡的影响,然后用多元Meta分析计算综合效应。按CVD亚型、性别、年龄、婚姻和教育水平进行分层分析。结果热浪定义为连续≥4天日平均温度≥P 95拟合心血管疾病死亡的模型最佳。热浪效应是急剧的,热浪发生当天对CVD死亡的相对危险度为1.06(95%CI:1.01~1.12)、滞后1天为1.04(95%CI:1.00~1.07)、累计滞后0-1天相对危险度为1.10(95%CI:1.05~1.16)。热浪增加缺血性心脏病、慢性缺血性心脏病、脑血管疾病的死亡率,累计滞后0-1天的相对危险度分别为1.13(95%CI:1.04~1.23)、1.24(95%CI:1.08~1.43)和1.09(95%CI:1.02~1.16)。此外,≥65岁人群更容易受到热浪效应的影响。结论本研究认为在福建省热浪最佳定义为连续≥4天且日平均温度≥P 95,在该定义下热浪会增加CVD、缺血性心脏病、慢性缺血性心脏病、脑血管疾病的死亡率。此外,≥65岁人群是热浪对心血管疾病死亡效应的脆弱人群。

Life’s Essential 8 and risk of non-communicable chronic diseases:Outcome-wide analyses

Background:Life’s Simple 7,the former construct of cardiovascular health(CVH)has been used to evaluate adverse non-communicable chronic diseases(NCDs).However,some flaws have been recognized in recent years and Life’s Essential 8 has been established.In this study,we aimed to analyze the association between CVH defined by Life’s Essential 8 and risk of 44 common NCDs and further estimate the population attributable fractions(PAFs)of low-moderate CVH scores in the 44 NCDs.Methods:In the UK Biobank,170,726 participants free of 44 common NCDs at baseline were included.The Life’s Essential 8 composite measure consists of four health behaviours(diet,physical activity,nicotine exposure,and sleep)and four health factors(body mass index,non-high density lipoprotein cholesterol,blood glucose,and blood pressure),and the maximum CVH score was 100 points.CVH score was categorized into low,moderate,and high groups.Participants were followed up for 44 NCDs diagnosis across 10 human system disorders according to the International Classification of Diseases 10th edition(ICD-10)code using linkage to national health records until 2022.Cox proportional hazard models were used in this study.The hazard ratios(HRs)and PAFs of 44 NCDs associated with CVH score were examined.Results:During the median follow-up of 10.85 years,58,889 incident NCD cases were documented.Significant linear dose-response associations were found between higher CVH score and lower risk of 25(56.8%)of 44 NCDs.Low-moderate CVH(<80 points)score accounted for the largest proportion of incident cases in diabetes(PAF:80.3%),followed by gout(59.6%),sleep disorder(55.6%),chronic liver disease(45.9%),chronic kidney disease(40.9%),ischemic heart disease(40.8%),chronic obstructive pulmonary disease(40.0%),endometrium cancer(35.8%),lung cancer(34.0%),and heart failure(34.0%)as the top 10.Among the eight modifiable factors,overweight/obesity explained the largest number of cases of incident NCDs in endocrine,nutritional,and metabolic diseases(35.4%),digestive system disorders(21.4%),mental and behavioral disorders(12.6%),and cancer(10.3%);however,the PAF of ideal sleep duration ranked first in nervous system(27.5%)and neuropsychiatric disorders(9.9%).Conclusions:Improving CVH score based on Life’s Essential 8 may lower risk of 25 common NCDs.Among CVH metrics,avoiding overweight/obesity may be especially important to prevent new cases of metabolic diseases,NCDs in digestive system,mental and behavioral disorders,and cancer.

上海市宝山区心血管病高危人群颈动脉健康状况调查

目的了解宝山区心血管病高危人群颈动脉健康情况及其相关影响因素,为加强宝山区居民心血管病的预防干预提供科学依据。方法于2018年7月—2019年3月采用分层抽样法,对宝山区常住居民进行问卷调查、体格检查及快速血糖血脂检测,选出高危人群1738人,并进行统计学分析。结果在高危对象中,男性有570(32.8%),女性有1168例(67.2%)。颈动脉血管正常人群的平均年龄为(60.15±8.12)岁。71~75岁年龄组左右颈动脉的CCA-IMT增厚与斑块的发病比例较高。CCA-IMT增厚的影响因素有年龄、性别、户籍、是否抽烟、高血压、体重变化明显、空腹血糖、LDL-C/HDL-C。颈动脉斑块的影响因素包括年龄、性别、户籍、抽烟、糖尿病、高血压、高龄亲属、体重变化。结论上海市宝山区心血管病高危人群中存在颈动脉异常,需要在控制传统的高血压、糖尿病等危险因素的基础上,加强慢病患者的分层管理,对不同特征的居民采用针对性防制举措。

绿地暴露与心血管代谢性疾病的关联研究及PM_(2.5)的中介效应

目的描述我国社区自然人群心血管代谢性疾病(cardiovascular metabolic disease,CMD)的流行现状,探讨绿地暴露与CMD的关联及细颗粒物(fine particulate matter,PM_(2.5))的中介效应。方法采用多阶段分层整群抽样方法,选取2017—2019年“京津冀地区生活社区自然人群慢性病队列研究”的社区自然人群(≥18岁),采用归一化植被指数(normalized difference vegetation index,NDVI)和增强植被指数(enhanced vegetation index,EVI)评估人群的绿地暴露水平。采用广义线性混合效应模型进行绿地暴露与CMD的关联性分析,并分析PM_(2.5)在其中的中介效应。结果36429名研究对象中男16095名(44.2%),女20334名(55.8%);年龄18~92岁,平均(51.3±14.7)岁;其中CMD患者18025例,患病率为49.5%;同时患两种及以上CMD患者6232例(17.1%),其中高血压合并糖尿病患病率最高,为2584例(7.1%)。绿地与CMD呈负相关(主模型:NDVI500m,OR=0.951,95%CI:0.908~0.995;EVI500m,OR=0.907,95%CI:0.844~0.975)。PM_(2.5)在NDVI500m、EVI500m与CMD关联的中介效应占比分别为17.300%、22.370%。结论我国社区自然人群CMD患病率较高,较高的绿地暴露水平与自然人群CMD患病风险呈负相关,PM_(2.5)在其中发挥中介效应。增加居民住宅周围绿地可能是预防社区自然人群CMD患病的有效措施。

公共卫生护理应用于心血管疾病患者及心血管疾病高危人群的效果分析

目的:分析公共卫生护理应用于心血管疾病患者及心血管疾病高危人群的效果。方法:选取2021年7月—2022年7月泰安市妇幼保健院收治的心血管疾病患者及心血管疾病高危人群90例作为研究对象,采用随机数字表法分为对照组及观察组,各45例。对照组实施常规护理干预,观察组实施公共卫生护理干预。比较两组护理效果。结果:护理后,两组血脂、血糖、血压水平,依从性、生活质量评分优于护理前,且观察组优于对照组,差异有统计学意义(P<0.05);观察组满意率高于对照组,差异有统计学意义(P=0.010)。结论:公共卫生护理应用于心血管疾病患者及心血管疾病高危人群的效果显著,能够控制血压、血脂、血糖,加强依从性,改善生活质量,提高满意度。

基于中国动脉粥样硬化性心血管疾病风险预测模型的新疆两个城市社区队列心脑血管疾病风险预测研究

目的:利用中国动脉粥样硬化性心血管疾病风险预测(China-PAR)模型探讨新疆两个城市社区队列10年心脑血管疾病风险预测及危险因素特征分析。方法:2019年7月至2021年9月采用两阶段随机抽样的方法随机选取北疆乌鲁木齐市、南疆库尔勒市两个社区的30~74岁居民,进行问卷调查、生理生化指标检查,排除既往患脑卒中和(或)冠心病患者后,运用China-PAR模型进行10年心脑血管疾病风险预测。结果:共抽取10520名参与者,平均年龄为(46.58±8.92)岁,男性5367名(51.02%),女性5153名(48.98%)。男性的年龄、汉族比例、体重指数、腰围、身体活动理想比例、当前吸烟比例、糖尿病比例、服用降压药比例、收缩压/舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇均高于女性(P均<0.001);女性中膳食理想比例、高密度脂蛋白胆固醇、心脑血管疾病家族史比例均高于男性(P均<0.001)。总人群10年心脑血管疾病平均风险为3.9%,男性平均风险高于女性(P<0.001)。总人群10年心脑血管疾病风险高危比例为9.3%,男性中高危风险占比高于女性(P<0.001)。总人群风险随年龄增长而增加,不同年龄段10年心脑血管疾病风险对比中,男性均高于女性(P均<0.001)。结论:这两个新疆城市社区有9.3%的人群处于心脑血管疾病高发病风险。男性的平均发病风险及不同年龄段发病风险均高于女性。男性糖脂代谢紊乱、腰围、体重指数、血压等危险因素水平增高是导致这两个新疆城市社区整体心脑血管疾病高发病风险的重要原因。

基于China-PAR模型的不同体重指数体检人群的心血管病风险评估

目的研究不同体重指数体检人群动脉粥样硬化性心血管疾病(ASCVD)的风险分层以及危险因素状况。方法采用横断面调查方法,选择2018年1月至2020年12月于三家三级甲等综合性医院健康管理中心进行年度健康体检的受试者30281例,采用China-PAR模型进行心血管事件风险评估,分析不同性别、年龄和体重指数(BMI)人群的心血管病风险及相关影响因素。结果入组受检者中超重11191例(36.96%)、肥胖3774例(12.46%)。其中,男性超重、肥胖比例显著高于女性,年龄≥45岁者超重、肥胖比例显著高于年龄<45岁者。该人群心血管病10年心血管病风险高危、中危和低危比例分别为2.03%、7.46%、90.51%。男性中、高危人群比例显著高于女性。随着年龄、BMI水平的增长,中危、高危人群比例逐渐增加(P<0.001)。该人群心血管疾病终生发病风险为高危和低危的比例分别为2.61%、97.39%。其中,BMI>28 kg/m2组终生ASCVD风险高危比例显著高于BMI<24 kg/m2组和24 kg/m2≤BMI<28 kg/m2组(P<0.001)。年龄升高、收缩压升高、吸烟史是超重者未来10年ASCVD风险的独立危险因素(P<0.001);男性、高龄、收缩压升高、空腹血糖升高、总胆固醇升高、吸烟史是肥胖者未来10年ASCVD风险的独立危险因素(P<0.05)。结论体检人群中超重、肥胖检出率较高,超重、肥胖是ASCVD的危险因素。对于高龄男性且合并超重或肥胖的体检人群尤其需要关注ASCVD的发病风险。

南宁市青秀区心血管疾病高危人群电子健康素养现状及其影响因素研究

目的:调查了解南宁市青秀区心血管疾病高危人群电子健康素养状况及其影响因素,以改善该区心血管疾病高危人群电子健康素养状况,提高疾病管理能力。方法:随机纳入南宁市青秀区心血管疾病高危筛查项目人群,采用简单抽样法,使用自行设计的一般资料调查表和电子健康素养量表(eHEALS)对调查人群进行问卷调查。采用单因素分析和多重线性回归分析方法分析心血管病高危人群电子健康素养的影响因素。结果:本研究共纳入213例心血管疾病高危人群,电子健康素养评分22分(8~30分),低于电子健康素养分值分界点26分,处于低水平。单因素分析结果显示,不同年龄段、婚姻状况、文化程度、有无网络获取途径、网络使用的频率、医疗费用支付方式及家庭年收入人群的电子健康素养评分比较,差异均有统计学意义(P<0.05)。多元线性回归分析显示,文化程度越高、网络使用频率越多及家庭收入越高,则电子健康素养评分越高。结论:调查对象电子健康素养水平较低,受到多种因素影响,应该针对人群个性化制定有效的干预措施来提高心血管病高危人群的电子健康素养水平。

基于健康生态学模型的健康管理干预对心血管病危险人群影响的Meta分析

目的分析、评价基于健康生态学模型的健康管理对心血管病危险人群的干预研究。方法系统检索中国知网、中国生物医学文献数据库、万方数据库、维普中文科技期刊、PubMed、Proquest、Cochrane Library、Web of Science,收集有关基于健康生态学模型的健康管理对心血管病危险人群进行干预的研究,检索时限为建库至2021年9月。由2名研究者根据纳排标准独立筛选文献和提取数据,应用Cochrane Handbook5.1.0危险偏倚评估量表分析纳入文献的偏倚危险,采用RevMan 5.3统计软件对资料进行Meta分析。结果最终纳入8篇研究,合计样本量10545例。Meta分析结果显示,基于健康生态学模型的健康管理能有效降低心血管病危险人群的BMI(MD=-0.45,95%CI:-0.71~-0.2),但是在改善血压(收缩压,MD=-1.66,95%CI:-5.95~2.63;舒张压,MD=-0.84,95%CI:-1.75~0.06),提高心血管病危险人群中等身体活动水平(SMD=0.67,95%CI:-0.07~1.4)方面,差异均无统计学意义(P>0.05)。结论基于健康生态学模型的健康管理干预能改善心血管病危险人群的身体质量指数水平,但在中等程度活动水平、血压方面的干预效果还需进一步验证。

健康小屋人群心血管病风险预测特征分析

目的 了解10家健康小屋人群心血管病的风险程度、分布情况及影响因素,为防控心血管病提供参考依据。方法 选取2022年1月-2023年3月在乌鲁木齐市某三甲医院健康体检中心管理的10家健康小屋职工作为研究对象,对入选的1 678例职工分别进行问卷调查、体格检查和生化指标检测,按照《中国心血管病一级预防指南》的“三步”风险评估流程判定低、中、高风险人群,应用中国心脑血管病风险评估工具(China-PAR)计算短期(10年)和长期(终生)的发病风险,采用多因素二元Logistic回归分析高风险人群的影响因素。结果 1 678例研究对象中,高风险人群有83例,发病率为4.95%,标化发病率为4.56%。短期(10年)心血管病风险评估≥10.0%的高风险人群有242例,发病率为15.17%,标化发病率为13.07%,在CVD风险人群中,性别、年龄、文化程度、吸烟、职业、BMI、腰臀比、高血压和血脂异常等因素与CVD风险程度的高低密切相关,差异有统计学意义(P<0.01)。与男性相比,女性CVD高危风险降低;大专或本科学历人群CVD高危风险较高中及以下人群降低;CVD高危风险随年龄增长而增加;(离)退休人员CVD高危风险是企事业单位工作人员的2.863倍;吸烟者CVD高危风险是非吸烟者的1.964倍。与正常体重者相比,超重和肥胖者CVD高危风险增加。与血压和血脂正常者相比,高血压和血脂异常者CVD高危风险均增加。结论 健康小屋心血管病高风险人群的一级防控应将男性、高龄、低文化程度、吸烟、超重/肥胖、高血压和血脂异常人群等列为重点关注对象,采取针对性的健康教育、干预及规范化管理,以降低职工心血管病的发病风险。

血糖和血脂指标检测在老年人群5年内心脑血管疾病发病风险评估中的作用

目的 探讨血糖和血脂指标检测在老年人群5年内心脑血管疾病发病风险评估中的作用。方法 选择2016年1—8月在哈尔滨市第四医院进行健康体检的2 400名健康体检者作为研究对象,使用全自动生化分析仪检测所有受检者的血糖和血脂指标[包括空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]。进行5年随访,应用Cox比例回归分析方法评估全部研究对象的心脑血管疾病发生风险。结果 通过5年的随访观察,在2 400名健康体检者中,有186例(占7.8%)出现心脑血管疾病。随着对受检者随访时间的延长,相应疾病的发生率也呈逐年上升趋势。与发病前比较,186例心脑血管疾病患者在发病后的TC、TG、FBG、LDL-C水平均明显上升,HDL-C水平明显下降[TC(mmol/L):5.62±0.37比4.81±0.23,TG(mmol/L):3.96±1.04比1.72±0.15,FBG(mmol/L):7.21±0.76比5.19±0.28,LDL-C(mmol/L):3.70±0.36比2.88±0.13,HDL-C(mmol/L):0.88±0.09比1.02±0.08,均P<0.05]。与未发生心脑血管疾病的患者比较,心脑血管疾病患者的TC、TG、LDL-C和FBG水平均呈逐年上升趋势,HDL-C呈逐年下降趋势。Cox分析结果表明,高TC水平[风险比(HR)为2.256,95%可信区间(95%CI)为1.372~3.720]、高TG水平(HR为1.201,95%CI为1.022~1.407)、高FBG水平(HR为1.391,95%CI为1.152~1.682)和高LDL-C水平(HR为3.425,95%CI为2.091~5.608)均为导致心脑血管疾病发生的危险因素,高HDL-C水平(HR为0.030,95%CI为0.001~0.516)为心脑血管疾病发生的保护因素。结论 在老年人群中,血糖和血脂指标异常者在5年内具有较高的心脑血管疾病发生率,应予以高度重视,第一时间加以干预。

对心脑血管疾病高风险人群进行干预的最新进展

心脑血管病是当前全球范围内伴随着人口老龄化而日益增多的一类疾病。其中高血压、冠状动脉粥样硬化性心脏病、脑卒中以及心力衰竭等疾病是主要表现。针对高风险人群的干预模型是预防心脑血管疾病的重要策略之一,通过对高风险人群开展早期干预,能够有效降低疾病的发生率和病死率,提高全民健康水平。本文对建立心脑血管疾病高风险人群的干预模型进行文献综述。

Association of cardiovascular diseases with milk intake among general Chinese adults

Background:The association of milk intake with cardiovascular disease(CVD)and cause-specific mortality remained controversial and evidence among the Chinese population was limited.We aimed to study the relationship between milk intake and CVDs among general Chinese adults.Methods::A total of 104,957 participants received questionnaire survey.Results of physical examination such as anthropometric measurements and biochemical tests during 2007 to 2008,demographic data and their information on milk intake were collected through standardized questionnaires.Cox proportional hazard regression models were used to calculate hazard ratios(HRs)and their corresponding 95%confidence intervals(CIs)of CVD incidence,cause-specific mortality and all-cause mortality related to milk intake.Restricted cubic splines(RCSs)were applied to examine dose-response associations.Results::Among the 91,757 participants with a median follow-up period of 5.8 years,we documented 3877 CVD cases and 4091 all-cause deaths.Compared with participants who never consumed milk,the multivariate-adjusted HRs(95%CIs)of CVD incidence for 1 to 150 g/day,151 to 299 g/day,and≥300 g/day were 0.94(0.86-1.03)(P>0.05),0.77(0.66-0.89)(P<0.05),and 0.59(0.40-0.89)(P<0.05),respectively;each 100 g increase of daily milk intake was associated with 11%lower risk of CVD incidence(HR,0.89;95%CI:0.85-0.94;P<0.001),and 11%lower risk of CVD mortality(HR,0.89;95%CI:0.82-0.97;P=0.008)after adjustment for age,sex,residential area,geographic region,education level,family history of CVD,smoking,alcohol drinking,physical activity level,body mass index,and healthy diet status(ideal or not).RCS analyses also showed a linear dose-response relationship with CVD(P for overall significance of the curve<0.001;P for non-linearity=0.979;P for linearity<0.001)and stroke(P for overall significance of the curve=0.010;P for non-linearity=0.998;P for linearity=0.002)incidence,and CVD mortality(P for overall significance of the curve=0.045;P for non-linearity=0.768;P for linearity=0.014)within the current range of daily milk intake.Conclusions::Daily milk intake was associated with lower risk of CVD incidence and mortality in a linear inverse relationship.The findings provide new evidence for dietary recommendations in CVD prevention among Chinese adults and people with similar dietary pattern in other countries.