The Problem: We have previously suggested that an alternative approach to preventing cardiovascular disease is necessary because atherosclerotic cardiovascular disease (ASCVD) has been increasing for the last 50 years...The Problem: We have previously suggested that an alternative approach to preventing cardiovascular disease is necessary because atherosclerotic cardiovascular disease (ASCVD) has been increasing for the last 50 years and has now reached epidemic status. Since the year 2000, approximately 600,000 heart attacks and ASCVD related deaths have occurred annually in the United States. It is the most common cause of death in the U.S., more than all cancers combined. The financial costs are staggering, amounting to 555 billion dollars per year in direct and indirect costs. Outlook for an improvement in these statistics is not encouraging as the U.S. population continues to become more obese and to develop diabetes. The Question: Why is ASCVD continuing to be a major challenge to healthcare providers when the pathogenesis is known and inexpensive preventative treatment is available? The reasons are multiple and complex. First, present financial reimbursement policies of healthcare organizations reward treatment of a disease and its complications instead of preventing the disease. Second, professional guidelines and treatment goals are often too complex, subject to interpretation, and time-consuming to be useful in the clinical setting. Third, no specific follow-up of patients at risk for ASCVD is recommended when the risk assessment changes. Fourth, many expensive cardiovascular diagnostic tests are utilized without meeting appropriate guidelines for their use. Fifth, treatment of individuals without first proving the presence of disease results in poor adherence to therapy. The Solution: This article describes the rationale for a new approach to the prevention of ASCVD in asymptomatic individuals. It is based upon preventing ASCVD by identifying all asymptomatic individuals with subclinical disease before an ASCVD event occurs. It recommends that all adults be screened for ASCVD on or before the age of 50 using a non-invasive atherosclerosis specific coronary artery calcium heart scan. Further recommendations include treating all calcium positive individuals to reverse their atherosclerotic coronary artery plaques with a combination of a low cholesterol diet, rosuvastatin 10 mg/day, and ezetimibe 10 mg/day. The therapeutic goal is a low-density lipoprotein cholesterol below 50 mg/dl to ensure regression of atherosclerosis. For individuals who have a zero calcium score, a repeat scan in 3 to 5 years is recommended. This new approach can easily be integrated into ongoing heart disease prevention programs to reduce the burden of ASCVD within the next five years. Conclusion: The mortality, morbidity, and cost of ASCVD have reached unacceptable levels. Reducing this disease to a rare condition will require the efforts of many individuals to organize, educate, and facilitate the goal of identifying all individuals with subclinical ASCVD. Once identified, aggressive therapy is required to reverse their atherosclerotic plaques in order to prevent heart attacks and atherosclerotic strokes. If successful, within 5 years the majority of the patients with asymptomatic ASCVD can be identified and if treated appropriately, reduce the prevalence and cost of ASCVD by 90%.展开更多
目的了解长寿地区献浆人群中动脉粥样硬化性心血管疾病相关指标水平及影响因素。方法随机选取2018年611月1 027名长寿地区(广西巴马)及1 816名非长寿地区(湖南石门)献浆者,检测其甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)...目的了解长寿地区献浆人群中动脉粥样硬化性心血管疾病相关指标水平及影响因素。方法随机选取2018年611月1 027名长寿地区(广西巴马)及1 816名非长寿地区(湖南石门)献浆者,检测其甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、载脂蛋白A1(Apo-A1)、载脂蛋白B(Apo-B)及果糖胺(FUN),并对两组的检测结果进行统计分析。结果与非长寿区组相比,长寿区组TG、TC及FUN水平降低(1.41±0.96 vs 2.31±1.28, 3.89±0.92 vs 4.04±0.82, 176.65±26.60 vs 200.33±34.19;均P<0.05),HDLC、LDLC、Apo-A1及Apo-B水平升高(1.11±0.32 vs 0.96±0.25, 2.53±0.70 vs 2.29±0.56, 1.56±0.28 vs 1.23±0.18, 0.80±0.27 vs 0.72±0.19;均P<0.05);长寿区组高TG(12.07%vs 40.01%)、低HDLC(24.63%vs 43.90%)、低Apo-A1(1.66%vs 22.56%)及高FUN(0.58%vs 2.48%)检出率较低,高LDLC(2.73%vs 0.28%)及高Apo-B(4.09%vs 0.22%)检出率较高(P<0.05)。长寿区献浆人群TC、HDLC、LDLC、Apo-A1及Apo-B水平在不同年龄组中存在差异(P<0.05)且与年龄正相关;性别及民族差异对TC、HDLC、LDLC、Apo-A1及Apo-B水平影响较大;血型对各指标水平影响较小。结论长寿地区(广西巴马)献浆者动脉粥样硬化性心血管疾病相关指标水平与非长寿地区(湖南石门)均有一定差异,且长寿地区(广西巴马)献浆者的年龄、民族、性别及血型对以上指标水平均有一定影响。展开更多
文摘The Problem: We have previously suggested that an alternative approach to preventing cardiovascular disease is necessary because atherosclerotic cardiovascular disease (ASCVD) has been increasing for the last 50 years and has now reached epidemic status. Since the year 2000, approximately 600,000 heart attacks and ASCVD related deaths have occurred annually in the United States. It is the most common cause of death in the U.S., more than all cancers combined. The financial costs are staggering, amounting to 555 billion dollars per year in direct and indirect costs. Outlook for an improvement in these statistics is not encouraging as the U.S. population continues to become more obese and to develop diabetes. The Question: Why is ASCVD continuing to be a major challenge to healthcare providers when the pathogenesis is known and inexpensive preventative treatment is available? The reasons are multiple and complex. First, present financial reimbursement policies of healthcare organizations reward treatment of a disease and its complications instead of preventing the disease. Second, professional guidelines and treatment goals are often too complex, subject to interpretation, and time-consuming to be useful in the clinical setting. Third, no specific follow-up of patients at risk for ASCVD is recommended when the risk assessment changes. Fourth, many expensive cardiovascular diagnostic tests are utilized without meeting appropriate guidelines for their use. Fifth, treatment of individuals without first proving the presence of disease results in poor adherence to therapy. The Solution: This article describes the rationale for a new approach to the prevention of ASCVD in asymptomatic individuals. It is based upon preventing ASCVD by identifying all asymptomatic individuals with subclinical disease before an ASCVD event occurs. It recommends that all adults be screened for ASCVD on or before the age of 50 using a non-invasive atherosclerosis specific coronary artery calcium heart scan. Further recommendations include treating all calcium positive individuals to reverse their atherosclerotic coronary artery plaques with a combination of a low cholesterol diet, rosuvastatin 10 mg/day, and ezetimibe 10 mg/day. The therapeutic goal is a low-density lipoprotein cholesterol below 50 mg/dl to ensure regression of atherosclerosis. For individuals who have a zero calcium score, a repeat scan in 3 to 5 years is recommended. This new approach can easily be integrated into ongoing heart disease prevention programs to reduce the burden of ASCVD within the next five years. Conclusion: The mortality, morbidity, and cost of ASCVD have reached unacceptable levels. Reducing this disease to a rare condition will require the efforts of many individuals to organize, educate, and facilitate the goal of identifying all individuals with subclinical ASCVD. Once identified, aggressive therapy is required to reverse their atherosclerotic plaques in order to prevent heart attacks and atherosclerotic strokes. If successful, within 5 years the majority of the patients with asymptomatic ASCVD can be identified and if treated appropriately, reduce the prevalence and cost of ASCVD by 90%.
文摘目的了解长寿地区献浆人群中动脉粥样硬化性心血管疾病相关指标水平及影响因素。方法随机选取2018年611月1 027名长寿地区(广西巴马)及1 816名非长寿地区(湖南石门)献浆者,检测其甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、载脂蛋白A1(Apo-A1)、载脂蛋白B(Apo-B)及果糖胺(FUN),并对两组的检测结果进行统计分析。结果与非长寿区组相比,长寿区组TG、TC及FUN水平降低(1.41±0.96 vs 2.31±1.28, 3.89±0.92 vs 4.04±0.82, 176.65±26.60 vs 200.33±34.19;均P<0.05),HDLC、LDLC、Apo-A1及Apo-B水平升高(1.11±0.32 vs 0.96±0.25, 2.53±0.70 vs 2.29±0.56, 1.56±0.28 vs 1.23±0.18, 0.80±0.27 vs 0.72±0.19;均P<0.05);长寿区组高TG(12.07%vs 40.01%)、低HDLC(24.63%vs 43.90%)、低Apo-A1(1.66%vs 22.56%)及高FUN(0.58%vs 2.48%)检出率较低,高LDLC(2.73%vs 0.28%)及高Apo-B(4.09%vs 0.22%)检出率较高(P<0.05)。长寿区献浆人群TC、HDLC、LDLC、Apo-A1及Apo-B水平在不同年龄组中存在差异(P<0.05)且与年龄正相关;性别及民族差异对TC、HDLC、LDLC、Apo-A1及Apo-B水平影响较大;血型对各指标水平影响较小。结论长寿地区(广西巴马)献浆者动脉粥样硬化性心血管疾病相关指标水平与非长寿地区(湖南石门)均有一定差异,且长寿地区(广西巴马)献浆者的年龄、民族、性别及血型对以上指标水平均有一定影响。
