The Prevention of Cardiovascular Disease in Older Adults

Cardiovascular disease (CVD) is common in older adults. CVD is a significant cause of both death and disability in old age. Though the prevention and treatment of CVD have been extensively studied, historically older adults and especially those older than 75 years have been underrepresented in clinical investigations designed to determine the best way to prevent or treat CVD. As a result, geriatrics clinicians frequently need to decide which interventions to recommend for their patients by extrapolation from existing data, which may or may not be applicable to the patients they are caring for. This narrative review summarizes existing data regarding the prevention of three common CVDs in older adults: stroke, coronary artery disease, and peripheral artery disease. Special emphasis is given to the prevention of CVD in those aged 75 years or older. J Am Geriatr Soc 68:1098–1106, 2020     

阿司匹林抵抗

阿司匹林抵抗是指阿司匹林不能：（1）保护服用者不发生血栓性并发症;（2）延长出血时间;（3）抑制血栓素的生物合成或（4）在体外试验中对血小板功能发挥预期影响.阿司匹林抵抗的可能机制包括：（1）5%～40%的缺血性血管病并非动脉粥样硬化所致;（2）依从性差或剂量不足.阿司匹林抵抗尚无特异性治疗方法.对于不能耐受阿司匹林或出现阿司匹林抵抗的患者,应选择ADP受体拮抗剂氯吡格雷或其他抗血小板药治疗.     

他汀在女性心血管疾病一级预防中的作用

冠心病是发达国家男性和女性的首要死亡原因。低密度脂蛋白胆固醇（LDL-C）升高是重要、独立的心血管危险因素。他汀能够有效地降低LDL-C水平,能够减少心血管发病率和病死率,他汀是冠心病预防策略必不可少的组成部分。但女性患者在一级和二级预防中,他汀处方使用明显不足。一度认为对于女性心脏病的预防,尤其是未诊断为冠心病的女性,无证据证明使用他汀能获益。现回顾他汀在预防女性冠心病中的作用。累积的证据显示,在一些研究中,女性受试者代表性不足,后续统计分析有限。目前的指南对于血管性疾病建议无论男性和女性,血脂异常的处理策略相似。因此,他汀治疗对于男性和女性标准一致,目标也一致。     

阿司匹林与心脑血管疾病一级预防:2011新进展

充分的循证医学证据证实阿司匹林在心脑血管疾病的一级预防、二级预防及急性期治疗中有明确的疗效,从而使得阿司匹林成为心脑血管疾病防治的基础用药。因证据充分,阿司匹林是目前惟一被指南推荐用于一级预防的抗血小板药物。在过去的     

阿司匹林心血管病一级预防新证据

本文详细介绍了阿司匹林在心血管疾病一级预防的新证据：高血压最佳治疗研究（HOT）的肾功能异常亚组分析和澳大利亚Fremantle糖尿病研究,并对美国3个学会的声明进行评述,认为这些最新的证据进一步证实了阿司匹林的一级预防效益。     

Aspirin for the Primary Prevention of Cardiovascular Disease in Women

Primary prevention of cardiovascular disease, which is the leading cause of death of women in the United States, focuses on treating or eliminating risk factors and often includes the use of aspirin to prevent thrombotic complications of atherosclerosis or atrial fibrillation. Recent evidence reveals sex-based differences in the benefits of aspirin in individuals without established cardiovascular disease. Although use of aspirin does not affect total mortality in either sex, aspirin lowers the risk of ischemic stroke in women and decreases the risk of myocardial infarction in men. Unfortunately, the use of aspirin comes at the expense of an increase in bleeding events, mostly gastrointestinal, that occurs at roughly similar rates in women and men. Aspirin may not be beneficial for primary prevention of cardiovascular events in women with diabetes. The benefits, as well as the risks, of aspirin therapy should be discussed when contemplating the use of aspirin in the primary prevention of cardiovascular disease in women.     

脂肪细胞因子在心血管疾病中的研究新进展

脂肪组织可分泌众多脂肪细胞因子如脂联素、瘦素、抵抗素、网膜素以及视黄醇结合蛋白4等以及其它的生物活性物质如脂肪酸,类固醇激素、生长因子及前列腺素等。目前的研究主要聚焦于这些脂肪细胞因子在胰岛素抵抗、物质代谢、抗炎或促炎及遗传变异中等中的作用。这些脂肪因子在许多心血管疾病的病理生理过程中起着重要作用,现在就近年来的最新进展综述如下。     

老年冠心病患者抗血小板治疗

随着老龄社会的到来,老年冠心病患者显著增加,且常伴有一种或多种合并症.血小板在动脉粥样硬化的进展和冠脉事件的发生中起着关键性作用,因此在老年患者中充分评估病情,合理应用抗血小板药物不仅可以显著降低不良心血管事件的发生,同时也可以减少药物所带来的不良影响.现就对老年冠心病患者抗血小板治疗的临床现状做一综述.     

Cardiovascular Disease Prevention During the COVID-19 Pandemic: Lessons Learned and Future Opportunities

The coronavirus disease 2019 (COVID-19) pandemic has been the defining healthcare issue since its outbreak, consuming healthcare systems and disrupting all aspects of human life throughout 2020 and continuing through 2021. When reviewing cardiovascular disease (CVD) prevention throughout the COVID-19 pandemic, the first tendency may be to focus on the negative disruption. Months of quarantine, isolation, and missed healthcare visits or delayed care may have exacerbated the epidemic of CVD in the United States. Looking back, however, perhaps it wasn’t a lost year as much as a health crisis that better prepared us for the battle to improve cardiovascular health. The pandemic brought new platforms for interacting with patients eager to engage, presenting a unique opportunity to reset how we approach preventive care.In this review, we discuss what the pandemic has taught us about caring for those vulnerable patients who were most afflicted—older adults, persons of color, and people facing adverse socioeconomic circumstances—and who continue to be impacted by CVD. We also identify opportunities for enhanced CVD prevention now boosted by the overnight adoption of telemedicine and other innovative cardiac care models. Lastly, we discuss how the COVID-19 pandemic has motivated physicians and patients alike to prioritize our health above all else, if only transiently, and how we can leverage this increased health awareness and investment into long-term, meaningful disease prevention.     

缺血性卒中二级预防中的抗血小板治疗

抗血小板治疗是缺血性卒中二级预防的重要措施之一。在缺血性卒中二级预防中，阿司匹林仍然是最常用的抗血小板药。氯吡格雷的疗效优于阿司匹林，但因其价格昂贵，目前仅在阿司匹林不能耐受或阿司匹林无效者中使用。联合用药只推荐缓释型双嘧达莫加小剂量阿司匹林。     

慢性肾脏病心血管疾病的新危险因素

心血管传统危险因素已不能完全解释慢性肾脏病（CKD）患者心血管疾病的高发率。CKD本身是一种血管病变状态,一系列新危险因素的研究为CKD心血管疾病的防治提供了新的干预靶点。     

缺血性心血管疾病的基因治疗研究进展

基因治疗是缺血性心血管疾病有希望的治疗方法之一,目前缺血性心血管疾病基因治疗的靶点多为内皮细胞、平滑肌细胞、心肌细胞以及与他们有关的细胞和组织等。基因治疗的方向主要包括:治疗冠状动脉的病变、作为其它治疗的辅助治疗手段、缓解或治疗血管疾病导致的并发症。具体措施是:靶向治疗血管病变、治疗性血管生成、心肌保护性治疗、细胞或组织的再生与修复、靶向致病基因的治疗、靶向细胞周期的治疗、靶向治疗导致心血管病变的原发病、冠状动脉再狭窄的预防与治疗等。     

Secondary Prevention of Cardiovascular Disease in Older Adults

Atherosclerotic cardiovascular disease is extremely common in older adults and the potential benefits of secondary prevention are perhaps greater in this population than in younger patients. While there is good evidence that secondary prevention efforts are justified in patients up to 80 years of age, limited data are available on secondary prevention in octogenarians and there is no evidence to guide treatment in patients ≥ 90 years of age. Further, the value of secondary prevention may be confounded by prevalent comorbidities, polypharmacy, and limited life expectancy. It is therefore essential that all management decisions be made in relation to individual preferences and goals of care, with understanding by patients that benefits as well as risks may increase with age. Furthermore, research is needed to refine markers to better delineate which older adults are most likely to benefit from preventive therapies.     

他汀类药物,从心血管疾病到肾脏病

随着他汀类药物在临床上的广泛应用,其降脂和各种降脂外作用能在很大程度上减少心血管事件发生的风险;同时,人们也对他汀类药物在慢性肾脏疾病中的肾保护作用产生了浓厚的兴趣,开展了一系列的试验研究来揭示他汀类药物的多效性,现就此做一综述。     

慢性阻塞性肺疾病与心血管疾病相关性研究进展

众所周知,慢性阻塞性肺疾病是一种常伴随有显著肺外表现的慢性炎症性疾病,心血管疾病风险增加即此类肺外表现之一。慢性阻塞性肺疾病与心血管疾病之间相关机制复杂,吸烟、衰老、缺氧、全身性炎症、氧化应激及用药等多种因素均可能参与其中。现就其潜在关联机制的研究现状予以综述。     

低血糖与心血管疾病的研究进展

低血糖和心血管疾病的关系受到越来越多的关注,低血糖事件增加有无潜在心脏病患者的心血管死亡及全因死亡的发生风险,低血糖的危害在临床上不容忽视,然而有关低血糖和心血管疾病的研究资料不多.现将从低血糖的发生原因、临床意义、其诱发心血管疾病的病理生理机制等相关进展进行综述.在临床上提高对低血糖的认知,同时积极探索心血管病患者低...