Over the past two decades, the percentage of Chinese who is 60 years or older has increased from 5.2% in 1995 to 10.5% in 2015. Approximately 16% of the population in China was 60 years old and above in 2015. Since 19...Over the past two decades, the percentage of Chinese who is 60 years or older has increased from 5.2% in 1995 to 10.5% in 2015. Approximately 16% of the population in China was 60 years old and above in 2015. Since 1990, cardiovascular disease(CVD) has been the leading cause of death in China. Cardiovascular medications of older adults are usually more complicated than younger age groups due to polypharmacy, the presence of comorbidities and more susceptible to treatmentrelated adverse outcomes. Therefore, effective primary prevention of CVD for older adults is important in sustaining the health of older adults and reducing the burden of the healthcare system. Proper management of CVD-related risk factors, such as hypertension, dyslipidemia, diabetes and obesity, can remarkably reduce risks of CVDs in older Chinese. These risk factors can be modified by managing blood pressure, glucose and lipids via lifestyle modifications or receiving medications. Smoking cessation, healthy diets, strict alcohol intake and moderate physical exercise are examples of recommended lifestyle changes for remarkably recovering health conditions of older adults who have hypertension, dyslipidemia, obesity, diabetes or complications. Treatment prescriptions of older adults, in general, are recommended to be individualized and to be initiated at a low dose. The future directions for better primary CVD prevention in older adults include establishing guidelines for primary prevention of CVD for different older adults and further research on better management strategies of CVD risks for elderly Chinese.展开更多
Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries...Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.展开更多
Cardiovascular disease(CVD)is the leading cause of death worldwide.This article focuses on current guidelines for the primary prevention of CVD and addresses management of key risk factors.Dietary modifi cation,weight...Cardiovascular disease(CVD)is the leading cause of death worldwide.This article focuses on current guidelines for the primary prevention of CVD and addresses management of key risk factors.Dietary modifi cation,weight loss,exercise,and tobacco use cessation are specifi c areas where focused efforts can successfully reduce CVD risk on both an individual and a societal level.Specifi c areas requiring management include dyslipidemia,hypertension,physical activity,diabetes,aspirin use,and alcohol intake.These preventive efforts have major public health implications.As the global population continues to grow,health care expenditures will also rise,with the potential to eventually overwhelm the health care system.Therefore it is imperative to apply our collective efforts on CVD prevention to improve the cardiovascular health of individuals,communities,and nations.展开更多
Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in r...Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in reducing CVD mortality and improvement of survivability. However, there is a continental variation in recent guidelines directing lipid-lowering therapy in regards to aim, dose, timing as well as the protocol for initiation of therapy. Similar uncertainties exist with regards to the generalizability of the finding from available evidence, a variation of benefits of Statin with respect to age and gender, the validity of the research conducted and actual gain in survivability and mortality benefits. Thus, there is a need for looking at the actual indications, risk-benefit ratios and cost effectiveness before tediously prescribing Statin for the primary prevention of CVDs. This paper will attempt to critically review the evidence behind the uses of Statins in the primary prevention of CVDs.展开更多
The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortali...The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older 〉 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for theft primary cardiovascular disease, with the associated risks and benefits of treatment.展开更多
Cardiovascular disease is the leading cause of mortality in China.Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prev...Cardiovascular disease is the leading cause of mortality in China.Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prevent the occurrence of cardiovascular events.To promote a healthy lifestyle and enhance the detection,diagnosis,and treatment of cardiovascular risk factors such as hypertension,dyslipidemia,and diabetes,and to improve the overall capacity of primary prevention of cardiovascular disease,the Chinese Society of Cardiology of Chinese Medical Association has collaborated with multiple societies to summarize and evaluate the latest evidence with reference to relevant guidelines and subsequently to develop recommendations for primary cardiovascular disease prevention in Chinese adults.The guideline consists of 10 sections:introduction,methodology for developing the guideline,epidemiology of cardiovascular disease in China and challenges in primary prevention,general recommendations for primary prevention,assessment of cardiovascular risk,lifestyle intervention,blood pressure control,lipid management,management of type 2 diabetes,and use of aspirin.The promulgation and implementation of this guideline will play a key role in promoting the practice of primary prevention for cardiovascular disease in China.展开更多
Background:A goal of 10,000 steps per day is widely advocated,but there is little evidence to support that goal.Our purpose was to examine the doseresponse relationships between step count and all-cause mortality and ...Background:A goal of 10,000 steps per day is widely advocated,but there is little evidence to support that goal.Our purpose was to examine the doseresponse relationships between step count and all-cause mortality and cardiovascular disease risk.Methods:Cochrane Central Register of Controlled Trials,EMBASE,OVID,PubMed,Scopus,and Web of Science databases were systematically searched for studies published before July 9,2021,that evaluated the association between daily steps and at least 1 outcome.Results:Sixteen publications(12 related to all-cause mortality,5 related to cardiovascular disease;and 1 article contained 2 outcomes:both allcause death and cardiovascular events)were eligible for inclusion in the meta-analysis.There was evidence of a nonlinear doseresponse relationship between step count and risk of all-cause mortality or cardiovascular disease(p=0.002 and p=0.014 for nonlinearity,respectively).When we restricted the analyses to accelerometer-based studies,the third quartile had a 40.36%lower risk of all-cause mortality and a 35.05%lower risk of cardiovascular event than the first quartile(all-cause mortality:Q1=4183 steps/day,Q3=8959 steps/day;cardiovascular event:Q1=3500 steps/day,Q3=9500 steps/day;respectively).Conclusion:Our meta-analysis suggests inverse associations between higher step count and risk of premature death and cardiovascular events in middle-aged and older adults,with nonlinear doseresponse patterns.展开更多
Background: Our objective was to determine the assessment of cardiovascular risk by family physicians. Methods: A questionnaire was sent by mail or fax regarding both awareness and use of the various CV risk scores in...Background: Our objective was to determine the assessment of cardiovascular risk by family physicians. Methods: A questionnaire was sent by mail or fax regarding both awareness and use of the various CV risk scores in southeastern Ontario. Results: Of 181 family physicians surveyed, 96% were aware of at least one CV risk score and 40% were aware of the JUPITER study. Despite this awareness, 72% simply counted risk factors to assess risk, rather than to calculate risk using established scoring methods. Only 23% used the JUPITER study criteria. This suggests an under-estimated of overall CV risk by family physician’s practicing in southeastern Ontario. Interpetation: Cardiovascular risk in primary care is being underestimated in southeastern Ontario. Additional knowledge translation strategies are required to enhance the family physician’s awareness and use of established risk scoring methods if we are to reduce the burden of CV disease.展开更多
目的:在中国鄞州电子健康档案研究(Chinese electronic health records research in Yinzhou,CHERRY)的队列人群中,评价启动降压药物治疗的不同策略预防心血管病的健康收益与干预效率。方法:采用马尔科夫模型模拟评价的不同策略包括:策...目的:在中国鄞州电子健康档案研究(Chinese electronic health records research in Yinzhou,CHERRY)的队列人群中,评价启动降压药物治疗的不同策略预防心血管病的健康收益与干预效率。方法:采用马尔科夫模型模拟评价的不同策略包括:策略1,对收缩压≥140 mmHg的人群启动降压药物治疗(根据2020年《中国心血管病一级预防指南》);策略2,对收缩压≥130 mmHg的人群启动降压药物治疗;策略3,对收缩压≥140 mmHg以及130~140 mmHg且心血管病高风险人群启动降压药物治疗(根据2017年美国心脏病学会/美国心脏协会《成年人高血压预防、检测、评估和管理指南》);策略4,对收缩压≥160 mmHg以及140~160 mmHg且心血管病高风险人群启动降压药物治疗(根据2019年英国国家卫生与临床优化研究所《成年人高血压诊断与管理指南》)。采用2019年世界卫生组织心血管病风险评估模型进行风险分层。马尔科夫模型的循环周期设为1年,模拟10个周期后计算质量调整生命年(quality-adjusted life year,QALY)、心血管病发病数、全因死亡数等结局事件数以评价策略的健康收益,并计算每预防一例心血管病事件或全因死亡的需治疗人数(number needed to treat,NNT)以评价策略的干预效率。马尔科夫模型的参数主要来源于CHERRY队列与公开发表的文献。采用单因素敏感性分析探讨心血管病发病率对结果的影响,采用概率敏感性分析探讨干预措施效应参数的不确定性对结果的影响。结果:共纳入213987名35~79岁基线无心血管病史的人群。相比于策略1,单纯下调降压起始值的策略2可预防的心血管病发病数增加666(95%UI:334~975)例,但每预防一例心血管病发病的NNT增加10(95%UI:7~20)人;而考虑定量风险评估的策略3可预防的心血管病发病数增加388(95%UI:194~569)例,且每预防一例心血管病发病的NNT减少6(95%UI:4~12)人,提示策略3可增加健康收益并具有更高的干预效率。策略4相比于策略1,可预防的心血管病发病数虽然减少193(95%UI:98~281)例,但每预防一例心血管病事件的NNT减少18(95%UI:13~37)人,效率更高。单因素敏感性分析及概率敏感性分析结果与主分析结果一致。结论:在中国发达地区的社区人群中选择降压药物治疗目标人群时,结合心血管病定量风险评估的策略优于单纯将起始值从140 mmHg降至130 mmHg的策略,前者可提升健康收益且兼顾干预效率;不同地区需因地制宜选择降压起始值并结合定量风险评估的策略,以权衡健康收益与干预效率。展开更多
文摘Over the past two decades, the percentage of Chinese who is 60 years or older has increased from 5.2% in 1995 to 10.5% in 2015. Approximately 16% of the population in China was 60 years old and above in 2015. Since 1990, cardiovascular disease(CVD) has been the leading cause of death in China. Cardiovascular medications of older adults are usually more complicated than younger age groups due to polypharmacy, the presence of comorbidities and more susceptible to treatmentrelated adverse outcomes. Therefore, effective primary prevention of CVD for older adults is important in sustaining the health of older adults and reducing the burden of the healthcare system. Proper management of CVD-related risk factors, such as hypertension, dyslipidemia, diabetes and obesity, can remarkably reduce risks of CVDs in older Chinese. These risk factors can be modified by managing blood pressure, glucose and lipids via lifestyle modifications or receiving medications. Smoking cessation, healthy diets, strict alcohol intake and moderate physical exercise are examples of recommended lifestyle changes for remarkably recovering health conditions of older adults who have hypertension, dyslipidemia, obesity, diabetes or complications. Treatment prescriptions of older adults, in general, are recommended to be individualized and to be initiated at a low dose. The future directions for better primary CVD prevention in older adults include establishing guidelines for primary prevention of CVD for different older adults and further research on better management strategies of CVD risks for elderly Chinese.
基金supported by the Portuguese Foundation for Science and Technology,(UID/DTP/04045/2013)by the European Regional Develop-ment Fund,through COMPETE 2020(POCI--01--0145-FEDER--006969)+4 种基金funded by the European Regional Development Fund,through NORTE 2020(NORTE--01--0145--FEDER--000016)The European Regional Development Fund through the Operational Competitiveness Programthe Foun-dation for Science and Technology(FCT)of Portugal support the research unit CIAFEL within the projects FCOMP--01--0124--FEDER--020180(References FCT:PTDC/DES/122763/2010)and UID/DTP/00617/2013supported by the Portuguese Foundation for Science and Technology(REF:UID/BIM/04501/2013)FEDER/Compete2020 funds
文摘Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.
文摘Cardiovascular disease(CVD)is the leading cause of death worldwide.This article focuses on current guidelines for the primary prevention of CVD and addresses management of key risk factors.Dietary modifi cation,weight loss,exercise,and tobacco use cessation are specifi c areas where focused efforts can successfully reduce CVD risk on both an individual and a societal level.Specifi c areas requiring management include dyslipidemia,hypertension,physical activity,diabetes,aspirin use,and alcohol intake.These preventive efforts have major public health implications.As the global population continues to grow,health care expenditures will also rise,with the potential to eventually overwhelm the health care system.Therefore it is imperative to apply our collective efforts on CVD prevention to improve the cardiovascular health of individuals,communities,and nations.
文摘Use of Statin is a cornerstone in modern day medical practice and an essential component for primary prevention of cardiovascular diseases (CVD). Various evidences exemplify and resonate the importance of Statins in reducing CVD mortality and improvement of survivability. However, there is a continental variation in recent guidelines directing lipid-lowering therapy in regards to aim, dose, timing as well as the protocol for initiation of therapy. Similar uncertainties exist with regards to the generalizability of the finding from available evidence, a variation of benefits of Statin with respect to age and gender, the validity of the research conducted and actual gain in survivability and mortality benefits. Thus, there is a need for looking at the actual indications, risk-benefit ratios and cost effectiveness before tediously prescribing Statin for the primary prevention of CVDs. This paper will attempt to critically review the evidence behind the uses of Statins in the primary prevention of CVDs.
文摘The elderly population is increasing worldwide, with subjects 〉 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older 〉 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for theft primary cardiovascular disease, with the associated risks and benefits of treatment.
文摘Cardiovascular disease is the leading cause of mortality in China.Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prevent the occurrence of cardiovascular events.To promote a healthy lifestyle and enhance the detection,diagnosis,and treatment of cardiovascular risk factors such as hypertension,dyslipidemia,and diabetes,and to improve the overall capacity of primary prevention of cardiovascular disease,the Chinese Society of Cardiology of Chinese Medical Association has collaborated with multiple societies to summarize and evaluate the latest evidence with reference to relevant guidelines and subsequently to develop recommendations for primary cardiovascular disease prevention in Chinese adults.The guideline consists of 10 sections:introduction,methodology for developing the guideline,epidemiology of cardiovascular disease in China and challenges in primary prevention,general recommendations for primary prevention,assessment of cardiovascular risk,lifestyle intervention,blood pressure control,lipid management,management of type 2 diabetes,and use of aspirin.The promulgation and implementation of this guideline will play a key role in promoting the practice of primary prevention for cardiovascular disease in China.
基金The project was funded by National Natural Science Foundation(NSFC 81872711)the Fundamental Research Funds for the Central Universities(2242021S40011)of China。
文摘Background:A goal of 10,000 steps per day is widely advocated,but there is little evidence to support that goal.Our purpose was to examine the doseresponse relationships between step count and all-cause mortality and cardiovascular disease risk.Methods:Cochrane Central Register of Controlled Trials,EMBASE,OVID,PubMed,Scopus,and Web of Science databases were systematically searched for studies published before July 9,2021,that evaluated the association between daily steps and at least 1 outcome.Results:Sixteen publications(12 related to all-cause mortality,5 related to cardiovascular disease;and 1 article contained 2 outcomes:both allcause death and cardiovascular events)were eligible for inclusion in the meta-analysis.There was evidence of a nonlinear doseresponse relationship between step count and risk of all-cause mortality or cardiovascular disease(p=0.002 and p=0.014 for nonlinearity,respectively).When we restricted the analyses to accelerometer-based studies,the third quartile had a 40.36%lower risk of all-cause mortality and a 35.05%lower risk of cardiovascular event than the first quartile(all-cause mortality:Q1=4183 steps/day,Q3=8959 steps/day;cardiovascular event:Q1=3500 steps/day,Q3=9500 steps/day;respectively).Conclusion:Our meta-analysis suggests inverse associations between higher step count and risk of premature death and cardiovascular events in middle-aged and older adults,with nonlinear doseresponse patterns.
文摘Background: Our objective was to determine the assessment of cardiovascular risk by family physicians. Methods: A questionnaire was sent by mail or fax regarding both awareness and use of the various CV risk scores in southeastern Ontario. Results: Of 181 family physicians surveyed, 96% were aware of at least one CV risk score and 40% were aware of the JUPITER study. Despite this awareness, 72% simply counted risk factors to assess risk, rather than to calculate risk using established scoring methods. Only 23% used the JUPITER study criteria. This suggests an under-estimated of overall CV risk by family physician’s practicing in southeastern Ontario. Interpetation: Cardiovascular risk in primary care is being underestimated in southeastern Ontario. Additional knowledge translation strategies are required to enhance the family physician’s awareness and use of established risk scoring methods if we are to reduce the burden of CV disease.
文摘目的:在中国鄞州电子健康档案研究(Chinese electronic health records research in Yinzhou,CHERRY)的队列人群中,评价启动降压药物治疗的不同策略预防心血管病的健康收益与干预效率。方法:采用马尔科夫模型模拟评价的不同策略包括:策略1,对收缩压≥140 mmHg的人群启动降压药物治疗(根据2020年《中国心血管病一级预防指南》);策略2,对收缩压≥130 mmHg的人群启动降压药物治疗;策略3,对收缩压≥140 mmHg以及130~140 mmHg且心血管病高风险人群启动降压药物治疗(根据2017年美国心脏病学会/美国心脏协会《成年人高血压预防、检测、评估和管理指南》);策略4,对收缩压≥160 mmHg以及140~160 mmHg且心血管病高风险人群启动降压药物治疗(根据2019年英国国家卫生与临床优化研究所《成年人高血压诊断与管理指南》)。采用2019年世界卫生组织心血管病风险评估模型进行风险分层。马尔科夫模型的循环周期设为1年,模拟10个周期后计算质量调整生命年(quality-adjusted life year,QALY)、心血管病发病数、全因死亡数等结局事件数以评价策略的健康收益,并计算每预防一例心血管病事件或全因死亡的需治疗人数(number needed to treat,NNT)以评价策略的干预效率。马尔科夫模型的参数主要来源于CHERRY队列与公开发表的文献。采用单因素敏感性分析探讨心血管病发病率对结果的影响,采用概率敏感性分析探讨干预措施效应参数的不确定性对结果的影响。结果:共纳入213987名35~79岁基线无心血管病史的人群。相比于策略1,单纯下调降压起始值的策略2可预防的心血管病发病数增加666(95%UI:334~975)例,但每预防一例心血管病发病的NNT增加10(95%UI:7~20)人;而考虑定量风险评估的策略3可预防的心血管病发病数增加388(95%UI:194~569)例,且每预防一例心血管病发病的NNT减少6(95%UI:4~12)人,提示策略3可增加健康收益并具有更高的干预效率。策略4相比于策略1,可预防的心血管病发病数虽然减少193(95%UI:98~281)例,但每预防一例心血管病事件的NNT减少18(95%UI:13~37)人,效率更高。单因素敏感性分析及概率敏感性分析结果与主分析结果一致。结论:在中国发达地区的社区人群中选择降压药物治疗目标人群时,结合心血管病定量风险评估的策略优于单纯将起始值从140 mmHg降至130 mmHg的策略,前者可提升健康收益且兼顾干预效率;不同地区需因地制宜选择降压起始值并结合定量风险评估的策略,以权衡健康收益与干预效率。
