背景：血管紧张素转换酶（angiotensin-converting enzyme，ACE）抑制剂可降低心肌梗死（myocardial infarction，MI）的危险，但是还不清楚血管紧张素受体拮抗剂是否具有同样的效果。
目的：评价血管紧张素受体拮抗剂坎地沙坦对心力...背景：血管紧张素转换酶（angiotensin-converting enzyme，ACE）抑制剂可降低心肌梗死（myocardial infarction，MI）的危险，但是还不清楚血管紧张素受体拮抗剂是否具有同样的效果。
目的：评价血管紧张素受体拮抗剂坎地沙坦对心力衰竭患者MI和其他冠脉事件的影响。
设计、地点和参试者：“坎地沙坦治疗心力衰竭：降低病死率和发病率评价”（Candesartan in Heart Failure：Assessment of Reduction in Mortality and Morbidity，CHARM）计划是一项随机、安慰剂对照研究。研究入选有纽约心脏病协会分级Ⅱ至Ⅳ级症状的患者（平均年龄，66[SD，11]岁）。在心力衰竭最佳治疗的基础上，随机接受坎地沙坦（目标剂量，32mg每天一次）或匹配的安慰剂。患者入选期为1999年3月至2001年3月。分组的7599例患者中，4004例（53％）有MI病史，1808例（24％）患有心绞痛。基线时，服用ACE抑制剂3125例（41％）；服用β-阻滞剂4203（55％）例；降脂药物3153例（42％）；阿斯匹林4246例（56％）；利尿药6286例（83％）。
主要观测指标：该分析的主要终点为坎地沙坦或安慰剂组心力衰竭患者心血管死亡和非致死性MI复合发生率。
结果：在37．7个月的中位随访期间，坎地沙坦组（775例患者[20．4％]）心血管死亡和非致死性MI主要终点的发生率明显低于安慰剂组（868[22．9％]）（风险比[hazard ratio，HR]，0．87；95％可信区间[confidence interval，CI]，0．79-0．96；P=0．004；所需治疗例数[numbe rneeded to treat，NNT]，40）。与安慰剂组（522[13．8％]）比较，坎地沙坦组（459[12．1％]）单纯非致死性MI也明显降低（HR，0．86；95％CI，0．75-0．97；P=0．02；NNT，59）。在CHARM试验预先设定的不同亚组和分析间，心血管死亡和非致死性MI危险的降低相似。坎地沙坦对不稳定心绞痛或冠脉血运重建导致的住院没有影响。结论：坎地沙坦能明显降低心力衰竭患者发生心血管死亡或非致死性MI复合终点的危险。展开更多
目的探讨非ST段抬高型急性心肌梗死(NSTEMI)患者入院心电图无缺血改变的发生率及其对预后的影响。方法回顾性分析2014年1月至2017年12月于丹阳市人民医院心内科住院的192例NSTEMI患者,根据急诊室12或18导联心电图表现,分为两组,即无缺...目的探讨非ST段抬高型急性心肌梗死(NSTEMI)患者入院心电图无缺血改变的发生率及其对预后的影响。方法回顾性分析2014年1月至2017年12月于丹阳市人民医院心内科住院的192例NSTEMI患者,根据急诊室12或18导联心电图表现,分为两组,即无缺血改变组及ST段压低组。了解NSTEMI患者心电图无缺血改变的发生率,住院期间及出院30 d心血管复合终点事件发生率。结果和ST段压低组相比,无缺血改变组多年纪轻,有近期吸烟史,心血管危险因素少。无缺血性改变组(n=110,57.3%)明显高于ST段压低组(n=82,42.7%)。无缺血改变组3支血管病变发生率低于ST段压低组(28.2%vs.41.5%,P=0.003),左主干(7.3%vs.24.4%,P=0.000)及前降支近端病变发生率(30.9%vs.41.5%,P=0.027)低于ST段压低组,无缺血改变组D-to-B时间(h)明显高于ST段压低组[(30.88±18.29)vs.(14.61±6.25),P=0.000]。住院期间MACE低于ST段压低组,但是30 d MACE两者无明显差别。结论根据入院心电图检查的结果,NSTEMI患者心电图无缺血改变发生率高、短期预后较ST段压低组好,但仍需要引起高度关注,及时实现再灌注治疗可能会改善预后。展开更多
虽然胆固醇是高血压病人的冠心病的重要危险因素，但胆固醇起多大份量还不清楚。该研究目的在于评估胆固醇作用（Am J of Hypertension，2005．18：751-758）。研究用病例一对照法，年龄30～79岁病人用降压治疗，但未用降脂药。在1986～...虽然胆固醇是高血压病人的冠心病的重要危险因素，但胆固醇起多大份量还不清楚。该研究目的在于评估胆固醇作用（Am J of Hypertension，2005．18：751-758）。研究用病例一对照法，年龄30～79岁病人用降压治疗，但未用降脂药。在1986～2000年问，共有1535例诊断为致死性与非致死性心肌梗死，对照组3743例。展开更多
Context: Stable angina pectoris in women has often been considered a “soft”d iagnosis, with less-severe prognostic implications than in men, but large-scal e population studies are lacking. Objective: To determine s...Context: Stable angina pectoris in women has often been considered a “soft”d iagnosis, with less-severe prognostic implications than in men, but large-scal e population studies are lacking. Objective: To determine sex differences in the incidence and prognosis of stable angina in a large ambulatory population. Desi gn: Prospective cohort study using linked national registers. Setting: All munic ipal primary health care centers, hospital outpatient clinics, occupational heal th care services, and the private sector in Finland. Participants: Among ambulat ory patients aged 45 to 89 years who had no history of coronary disease, we defi ned new cases of “nitrate angina”based on nitrate prescription(56 441 women an d 34 885 men) or “test-positive angina”based on abnormal invasive or noninvas ive test results(11 391 women and 15 806 men). Potentially eligible patients wer e evaluated between January 1, 1996, and December 31, 1998. Follow-up ended in December 2001. Main Outcome Measures: Coronary mortality at 4 years(n=7906 death s) and fatal and nonfatal myocardial infarction at 1 year(n=3129 events). Results: The age-standardized annual incidence per 100 population of all cases of ang ina was 2.03 in men and 1.89 in women, with a sex ratio of 1.07(95%confidence i nterval[CI], 1.06-1.09). At every age, nitrate angina in women and men was asso ciated with a similar increase in risk of coronary mortality relative to the gen eral population. Women with test-positive angina who were younger than 75 years had higher coronary-standardized mortality ratios than men; for example, among those aged 55 to 64 years, it was 4.69(95%CI, 3.60-6.11) in women compared wi th 2.40(95%CI, 2.11-2.73) in men(P< .001 for interaction). There was a strong, graded relationship between amount of nitrates used and event rates; women usin g higher doses of nitrates had prognoses comparable with those of men. Among pat ients with diabetes and test-positive angina, age-standardized coronary event rates were 9.9 per 100 person-years in women vs 9.3 in men(P=.69), and the full y adjusted male-female sex ratio was 1.07(95%CI, 0.81-1.41). Conclusions: Wom en have a similarly high incidence of stable angina compared with men. Furthermo re, stable angina in women is associated with increased coronary mortality relat ive to women in the general population and, among easily identifiable clinical s ubgroups, has similarly high absolute rates of prognostic outcomes compared with men.展开更多
Aims: To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index(BMI) and the development of cardiovascular ...Aims: To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index(BMI) and the development of cardiovascular disease(CVD) in middle aged Britishmen. Methods and results: In total, 6452 men aged 40-59 with no prior evidence of CVD were followed for major CVD events(fatal/non-fatal myocardial infarction or stroke)and all-cause mortality over 20 years; lifestyle characteristics were ascertained at regular points throughout the study. A major CVD event within the first 20 years was observed in 1194 men(18.5%). Use of baseline assessments of cigarette smoking and physical activity in analyses resulted in underestimation of the associations between average cumulative exposure to these factors and major CVD risk. After correction for within-person variation, major CVD rates were over four times higher for heavy smokers(≥40 cigarettes/day) compared with never smokers and three times higher for physically inactive men compared with moderately active men. Major CVD risk increased by 6%for each 1 kg/m2 increase in usual BMI. If all men had experienced the risk levels of the men who had never regularly smoked cigarettes, were moderately active, and had a BMI of ≤25 kg/m2(6%of the population), 66%of the observed major CVD events would have been prevented or postponed(63%before adjustment for within-person variation). Adjustment for a range of other risk factors had little effect on the results. Similar results were obtained for all-cause mortality. Conclusion: Failure to take account of within-person variation can lead to underestimation of the importance of lifestyle characteristics in determining CVD risk. Primary prevention through lifestyle modification has a great preventive potential.展开更多
Context: The SYNERGY trial comparing enoxaparin and unfractionated heparin in high-risk patients with acute coronary syndromes(ACS) showed that enoxaparin was not inferior to unfractionated heparin in reducing death o...Context: The SYNERGY trial comparing enoxaparin and unfractionated heparin in high-risk patients with acute coronary syndromes(ACS) showed that enoxaparin was not inferior to unfractionated heparin in reducing death or nonfatal myocardial infarction(MI) at 30 days. Objective: To evaluate continued risk in this patient cohort through 6-month and 1-year follow-up. Design, Setting, and Patients: Overall, 9978 patients were randomized from August 2001 through December 2003 in 487 hospitals in 12 countries. Patients were followed up for 6 months and for 1 year. Main Outcome Measures: Six-month outcomes were death, nonfatal MI, revascularization procedures, stroke, and site-investigator-reported need for rehospitalization; 1-year outcome was all-cause death. Results: Six-month and 1-year follow-up data were available for 9957(99.8% ) and 9608(96.3% ) of 9978 patients, respectively; 541 patients(5.4% ) had died at 6 months and 739(7.4% ) at 1 year. Death or nonfatal MI at 6 months occurred in 872 patients receiving enoxaparin(17.6% ) vs 884 receiving unfractionated heparin(17.8% )(hazard ratio[HR], 0.98; 95% confidence interval[CI], 0.89- 1.07; P=.65). In the subgroup of patients receiving consistent therapy, ie, only enoxaparin or unfractionated heparin during the index hospitalization(n=6138), a reduction in death or nonfatal MI with enoxaparin was maintained at 180 days(HR, 0.85; 95% CI, 0.75- 0.95; P=.006). Rehospitalization within 180 days occurred in 858 patients receiving enoxaparin(17.9% ) and 911 receiving unfractionated heparin(19.0% )(HR, 0.94; 95% CI, 0.85- 1.03; P=.17). One-year all-cause death rates were similar in the 2 treatment groups(380/4974[7.6% ] for enoxaparin vs 359/4948[7.3% ] for unfractionated heparin; HR, 1.06; 95% CI, 0.92- 1.22; P=.44). One-year death rates in patients receiving consistent therapy were also similar(251/3386[7.4% ] for enoxaparin vs 213/2720[7.8% ] for unfractionated heparin; HR, 0.95; 95% CI, 0.79- 1.14; P=.55). Conclusions: In the SYNERGY trial, patients continued to experience adverse cardiac events through long-term follow-up. The effect of enoxaparin on death or MI compared with that of unfractionated heparin at 6 months was similar to that observed at 30 days in the overall trial and in the consistent-therapy group. One-year death rates were also similar in both groups. High-risk patients with ACS remain susceptible to continued cardiac events despite aggressive therapies.展开更多
文摘背景：血管紧张素转换酶（angiotensin-converting enzyme，ACE）抑制剂可降低心肌梗死（myocardial infarction，MI）的危险，但是还不清楚血管紧张素受体拮抗剂是否具有同样的效果。
目的：评价血管紧张素受体拮抗剂坎地沙坦对心力衰竭患者MI和其他冠脉事件的影响。
设计、地点和参试者：“坎地沙坦治疗心力衰竭：降低病死率和发病率评价”（Candesartan in Heart Failure：Assessment of Reduction in Mortality and Morbidity，CHARM）计划是一项随机、安慰剂对照研究。研究入选有纽约心脏病协会分级Ⅱ至Ⅳ级症状的患者（平均年龄，66[SD，11]岁）。在心力衰竭最佳治疗的基础上，随机接受坎地沙坦（目标剂量，32mg每天一次）或匹配的安慰剂。患者入选期为1999年3月至2001年3月。分组的7599例患者中，4004例（53％）有MI病史，1808例（24％）患有心绞痛。基线时，服用ACE抑制剂3125例（41％）；服用β-阻滞剂4203（55％）例；降脂药物3153例（42％）；阿斯匹林4246例（56％）；利尿药6286例（83％）。
主要观测指标：该分析的主要终点为坎地沙坦或安慰剂组心力衰竭患者心血管死亡和非致死性MI复合发生率。
结果：在37．7个月的中位随访期间，坎地沙坦组（775例患者[20．4％]）心血管死亡和非致死性MI主要终点的发生率明显低于安慰剂组（868[22．9％]）（风险比[hazard ratio，HR]，0．87；95％可信区间[confidence interval，CI]，0．79-0．96；P=0．004；所需治疗例数[numbe rneeded to treat，NNT]，40）。与安慰剂组（522[13．8％]）比较，坎地沙坦组（459[12．1％]）单纯非致死性MI也明显降低（HR，0．86；95％CI，0．75-0．97；P=0．02；NNT，59）。在CHARM试验预先设定的不同亚组和分析间，心血管死亡和非致死性MI危险的降低相似。坎地沙坦对不稳定心绞痛或冠脉血运重建导致的住院没有影响。结论：坎地沙坦能明显降低心力衰竭患者发生心血管死亡或非致死性MI复合终点的危险。
文摘目的探讨非ST段抬高型急性心肌梗死(NSTEMI)患者入院心电图无缺血改变的发生率及其对预后的影响。方法回顾性分析2014年1月至2017年12月于丹阳市人民医院心内科住院的192例NSTEMI患者,根据急诊室12或18导联心电图表现,分为两组,即无缺血改变组及ST段压低组。了解NSTEMI患者心电图无缺血改变的发生率,住院期间及出院30 d心血管复合终点事件发生率。结果和ST段压低组相比,无缺血改变组多年纪轻,有近期吸烟史,心血管危险因素少。无缺血性改变组(n=110,57.3%)明显高于ST段压低组(n=82,42.7%)。无缺血改变组3支血管病变发生率低于ST段压低组(28.2%vs.41.5%,P=0.003),左主干(7.3%vs.24.4%,P=0.000)及前降支近端病变发生率(30.9%vs.41.5%,P=0.027)低于ST段压低组,无缺血改变组D-to-B时间(h)明显高于ST段压低组[(30.88±18.29)vs.(14.61±6.25),P=0.000]。住院期间MACE低于ST段压低组,但是30 d MACE两者无明显差别。结论根据入院心电图检查的结果,NSTEMI患者心电图无缺血改变发生率高、短期预后较ST段压低组好,但仍需要引起高度关注,及时实现再灌注治疗可能会改善预后。
文摘虽然胆固醇是高血压病人的冠心病的重要危险因素，但胆固醇起多大份量还不清楚。该研究目的在于评估胆固醇作用（Am J of Hypertension，2005．18：751-758）。研究用病例一对照法，年龄30～79岁病人用降压治疗，但未用降脂药。在1986～2000年问，共有1535例诊断为致死性与非致死性心肌梗死，对照组3743例。
文摘Context: Stable angina pectoris in women has often been considered a “soft”d iagnosis, with less-severe prognostic implications than in men, but large-scal e population studies are lacking. Objective: To determine sex differences in the incidence and prognosis of stable angina in a large ambulatory population. Desi gn: Prospective cohort study using linked national registers. Setting: All munic ipal primary health care centers, hospital outpatient clinics, occupational heal th care services, and the private sector in Finland. Participants: Among ambulat ory patients aged 45 to 89 years who had no history of coronary disease, we defi ned new cases of “nitrate angina”based on nitrate prescription(56 441 women an d 34 885 men) or “test-positive angina”based on abnormal invasive or noninvas ive test results(11 391 women and 15 806 men). Potentially eligible patients wer e evaluated between January 1, 1996, and December 31, 1998. Follow-up ended in December 2001. Main Outcome Measures: Coronary mortality at 4 years(n=7906 death s) and fatal and nonfatal myocardial infarction at 1 year(n=3129 events). Results: The age-standardized annual incidence per 100 population of all cases of ang ina was 2.03 in men and 1.89 in women, with a sex ratio of 1.07(95%confidence i nterval[CI], 1.06-1.09). At every age, nitrate angina in women and men was asso ciated with a similar increase in risk of coronary mortality relative to the gen eral population. Women with test-positive angina who were younger than 75 years had higher coronary-standardized mortality ratios than men; for example, among those aged 55 to 64 years, it was 4.69(95%CI, 3.60-6.11) in women compared wi th 2.40(95%CI, 2.11-2.73) in men(P< .001 for interaction). There was a strong, graded relationship between amount of nitrates used and event rates; women usin g higher doses of nitrates had prognoses comparable with those of men. Among pat ients with diabetes and test-positive angina, age-standardized coronary event rates were 9.9 per 100 person-years in women vs 9.3 in men(P=.69), and the full y adjusted male-female sex ratio was 1.07(95%CI, 0.81-1.41). Conclusions: Wom en have a similarly high incidence of stable angina compared with men. Furthermo re, stable angina in women is associated with increased coronary mortality relat ive to women in the general population and, among easily identifiable clinical s ubgroups, has similarly high absolute rates of prognostic outcomes compared with men.
文摘Aims: To examine the effect that within-person variation has on the estimated risk associations between cigarette smoking, physical inactivity, and increased body mass index(BMI) and the development of cardiovascular disease(CVD) in middle aged Britishmen. Methods and results: In total, 6452 men aged 40-59 with no prior evidence of CVD were followed for major CVD events(fatal/non-fatal myocardial infarction or stroke)and all-cause mortality over 20 years; lifestyle characteristics were ascertained at regular points throughout the study. A major CVD event within the first 20 years was observed in 1194 men(18.5%). Use of baseline assessments of cigarette smoking and physical activity in analyses resulted in underestimation of the associations between average cumulative exposure to these factors and major CVD risk. After correction for within-person variation, major CVD rates were over four times higher for heavy smokers(≥40 cigarettes/day) compared with never smokers and three times higher for physically inactive men compared with moderately active men. Major CVD risk increased by 6%for each 1 kg/m2 increase in usual BMI. If all men had experienced the risk levels of the men who had never regularly smoked cigarettes, were moderately active, and had a BMI of ≤25 kg/m2(6%of the population), 66%of the observed major CVD events would have been prevented or postponed(63%before adjustment for within-person variation). Adjustment for a range of other risk factors had little effect on the results. Similar results were obtained for all-cause mortality. Conclusion: Failure to take account of within-person variation can lead to underestimation of the importance of lifestyle characteristics in determining CVD risk. Primary prevention through lifestyle modification has a great preventive potential.
文摘Context: The SYNERGY trial comparing enoxaparin and unfractionated heparin in high-risk patients with acute coronary syndromes(ACS) showed that enoxaparin was not inferior to unfractionated heparin in reducing death or nonfatal myocardial infarction(MI) at 30 days. Objective: To evaluate continued risk in this patient cohort through 6-month and 1-year follow-up. Design, Setting, and Patients: Overall, 9978 patients were randomized from August 2001 through December 2003 in 487 hospitals in 12 countries. Patients were followed up for 6 months and for 1 year. Main Outcome Measures: Six-month outcomes were death, nonfatal MI, revascularization procedures, stroke, and site-investigator-reported need for rehospitalization; 1-year outcome was all-cause death. Results: Six-month and 1-year follow-up data were available for 9957(99.8% ) and 9608(96.3% ) of 9978 patients, respectively; 541 patients(5.4% ) had died at 6 months and 739(7.4% ) at 1 year. Death or nonfatal MI at 6 months occurred in 872 patients receiving enoxaparin(17.6% ) vs 884 receiving unfractionated heparin(17.8% )(hazard ratio[HR], 0.98; 95% confidence interval[CI], 0.89- 1.07; P=.65). In the subgroup of patients receiving consistent therapy, ie, only enoxaparin or unfractionated heparin during the index hospitalization(n=6138), a reduction in death or nonfatal MI with enoxaparin was maintained at 180 days(HR, 0.85; 95% CI, 0.75- 0.95; P=.006). Rehospitalization within 180 days occurred in 858 patients receiving enoxaparin(17.9% ) and 911 receiving unfractionated heparin(19.0% )(HR, 0.94; 95% CI, 0.85- 1.03; P=.17). One-year all-cause death rates were similar in the 2 treatment groups(380/4974[7.6% ] for enoxaparin vs 359/4948[7.3% ] for unfractionated heparin; HR, 1.06; 95% CI, 0.92- 1.22; P=.44). One-year death rates in patients receiving consistent therapy were also similar(251/3386[7.4% ] for enoxaparin vs 213/2720[7.8% ] for unfractionated heparin; HR, 0.95; 95% CI, 0.79- 1.14; P=.55). Conclusions: In the SYNERGY trial, patients continued to experience adverse cardiac events through long-term follow-up. The effect of enoxaparin on death or MI compared with that of unfractionated heparin at 6 months was similar to that observed at 30 days in the overall trial and in the consistent-therapy group. One-year death rates were also similar in both groups. High-risk patients with ACS remain susceptible to continued cardiac events despite aggressive therapies.
