农村人群脑卒中发病率死亡率趋势研究(1983～1993)

按照WHO－Monica方案要求，在江苏省农村人群中对脑卒中的发病率、死亡率进行了为时11年的监测，结果显示该人群脑卒中平均年发病率男女分别为103．5／10万和71．8／10万，死亡率分别为55．2／10万和40．8／10万；该人群脑卒中发病率随时间的推移呈现明显上升趋势，分析其原因认为同该地区人群心血管病危险因素水平相应增加密切相关，提出应重视预防，控制高血压，以有效降低脑卒中的发生。     

首钢居民区两个时期脑卒中急性心肌梗塞和冠心病猝死发病率死亡率对比

对首钢居民区１９７４～１９８１年和１９８２～１９９１年，两个时期脑卒中，急性心肌梗塞和冠心病猝死的发病率和死亡率进行对比发现：１９８２～１９９１年较１９７４～１９８１年标化发病率、死亡率、分别下降３６．４％、６０．０１％和２３．６０％、５３．５４％，而冠心病猝死率上升５．８２％。前者下降原因可能与长期坚持开展人群高血压防治有关。     

社区人群干预前后冠心病事件发病率和死亡率的变化

目的　了解社区人群干预前后冠心病事件发病率和死亡率的变化。方法　对 1991～ 2 0 0 0年间 ,在我国北京、上海、长沙 3个城区共约 30万人群中开展社区人群心血管病危险因素综合性干预研究。结果　干预社区冠心病事件年平均发病率为 5 1.1 10万 ,明显低于监测社区 (71.3 10万 )。 10年来干预社区和监测社区冠心病事件发病率均有上升趋势 ,但干预社区上升幅度明显低于监测社区。干预社区 1996～ 2 0 0 0年冠心病年平均发病率与 1991～ 1995年相比上升了 2 0 .5 % ,而监测社区年平均发病率上升了 6 2 .0 %。干预社区冠心病事件年平均死亡率为 38.2 10万 ,明显低于监测社区 (5 1.3 10万 )。 1991～ 2 0 0 0年干预社区和监测社区冠心病事件死亡率也有上升趋势 ,但干预社区上升幅度低于监测社区。干预社区 1996～ 2 0 0 0年冠心病年平均死亡率与 1991～ 1995年相比上升了 13.7% ,而监测社区上升了17.9%。 3个地区的发病率和死亡率上海最低 ,长沙次之 ,北京最高。结论　积极控制高血压和开展健康教育的干预措施对降低冠心病事件发病率、死亡率效果较显著     

冠心病患者经皮冠状动脉介入治疗死亡率的性别差异

目的确定经皮冠状动脉介入治疗(PCI)后死亡率是否存在性别差异以及女性是否是影响死亡率的独立预测因素。方法回顾性分析2004年7月1日至2005年9月30日北京安贞医院行单纯PCI治疗的2 493名患者(男性1 860例,女性633例),并进行随访,记录临床特征及随访数据。按照性别分组比较两组之间住院死亡率和总死亡率的差异。结果女性年龄较大,术前合并主要疾病的比例较男性高,而左室射血分数(LVEF)较男性好,既往心肌梗死病史及血运重建史较男性少。女性患者术后住院死亡率约是男性的10倍(女性1.1%,男性0.1%,P<0.001);中位数随访时间555 d,随访率93.4%,女性总死亡率高于男性(5%比2%,P=0.003),总死亡风险是男性的2.6倍(HR2.631,95%CI1.217~5.687,P=0.014)。结论女性PCI术后住院死亡率及总死亡率均高于男性。女性是总死亡率的独立危险因素。     

冠心病与脑卒中发病差异的影响因素

为了探索人群冠心病与脑卒中发病差异的影响因素，于江苏省城乡１８０９名队列人群中进行１２～１５年的冠心病与脑卒中的发病登记，并分析其发病因素。结果表明：脑卒中的年均标化发病率为１４２．３／１０万，较冠心病的年均标化发病率明显为高（４９．１／１０万），前者约为后者的３倍。探索其原因，冠心病的致病因素从多元回归分析所见主要为血胆固醇（ＴＣ）增高，其次为高血压与职业性精神紧张；而脑卒中主要为收缩期血压增高，其次为烟酒嗜好等，血清ＴＣ则与其呈负相关。本组人群的特点为高钠、低动物蛋白饮食，血清ＴＣ偏低，血压水平较高，烟酒嗜好较为普遍，有利于脑卒中的发病，是为两者发病差异的主要原因所在。显示合理调整饮食、戒烟限酒、控制人群高血压是该病防治的主要对策。     

体温对急性脑卒中患者死亡率的影响

目的　探讨体温对脑卒中患者预后的影响。方法　将 14 15例急性脑卒中患者分为两组 ,体温 >37.5℃者 32 4例为发热组 ,≤ 37.5℃者 10 91例为对照组。比较两组急性脑梗死和脑出血患者的死亡率。结果　发热组死亡率明显高于对照组 ,有显著性差异 (P <0 .0 5 )。结论　体温升高可加重脑组织损害 ,增加脑梗死及脑出血患者的死亡率     

中国男性高危冠心病和缺血性脑卒中患者吸烟状况及戒烟影响因素分析

目的 调查中国冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)和缺血性脑卒中(ischemic stroke,IS)患者吸烟现状,分析影响其戒烟的因素.方法 借助一项国际多中心大规模临床试验在中国实施之际,在14座城市的51家医院中对病史超过3个月的男性CHD或IS患者进行调查.利用电子...     

1984～1993年北京市70万人群脑卒中流行趋势的研究

本研究结果显示：北京地区人群脑卒中发病率仍持续在一较高发病水平，10年总的发病趋势略有上升，男性上升更显著（P＜0．035）；农村男性发病率上升趋势较城市明显。北京地区人群死亡率趋势下降明显（P＜0．05），城市较农村更明显。病死率女性明显高于男性，城乡男女两性脑卒中病死率均呈明显下降趋势（P＜0．001），且城市较农村更明显。故我们的医疗、预防工作的重点仍应放在农村。     

体质指数与冠心病、脑卒中发病的前瞻性研究

目的　探讨体质指数水平与冠心病事件和脑卒中发病的关系。方法　 1982～ 1985年在我国不同地区的 10组人群中 (年龄 35～ 5 9岁 )进行心血管病危险因素调查 ,对其中无脑卒中、无心肌梗死及无恶性肿瘤史的研究对象随访至 1999～ 2 0 0 0年 ,登记并核实冠心病事件、脑卒中事件的发生情况以及各种原因的死亡。结果　对共计 2 4 90 0人 ,平均 15 2年的随访中 ,共发生冠心病事件 2 5 3例 ,脑卒中事件 797例 ,其中缺血性脑卒中 4 5 3例 ,出血性脑卒中 311例。用Cox比例风险回归模型(调整年龄、性别、收缩压、血清总胆固醇水平、吸烟和饮酒情况 )估计低体重组 (BMI<18 5 )、正常体重组 (BMI为 18 5～ 2 3 9)、超重组 (BMI为 2 4～ 2 7 9)和肥胖组 (BMI≥ 2 8)发生冠心病事件的相对危险分别为 0 70、1 0、1 33和 1 74 ,缺血性脑卒中的相对危险分别为 0 5 6、1 0、2 0 3和 1 98。与非超重者相比 ,超重和肥胖者冠心病事件和缺血性脑卒中事件的归因危险度百分比分别为 32 0 %和 5 3 3% ,人群归因危险度百分比分别为 7 3%和 16 1%。结论　体质指数与冠心病事件、缺血性脑卒中的发病危险呈明显的正关联。控制体重、降低超重和肥胖率应是预防冠心病和缺血性脑卒中的重要措施。     

1984—1993年北京市70万人群脑卒中流行趋势 研究

本研究结果显示：北京地区人群脑座中发病仍持续在一较高发病水平，１０年总发病趋势略有上升，男性上升更显著；农村男性发病率上升趋势较城市明显。北京地区人群死亡趋势下降明显，城市较农村更明显。病死率女性明显高于男性，城乡男女两性脑座中病死率均呈明显下降趋势，且城市较农村更明显。故我们的医疗，预防工作的重点仍应放在农村。     

Cholesterol and coronary heart disease mortality

The epidemiological relation between increased levels of blood cholesterol and increased risk of future heart disease is clear, both within and between countries. These strong relationships have led to the adoption of consensus statements in most countries which recommend measures such as the reduction of dietary saturated fat/an increase in the polyunsaturated/saturated ratio and other dietary and sometimes drug methods to reduce serum cholesterol. There is controversy as to whether these measures should be targeted at individuals with high levels of cholesterol or whether there should be a public health approach to the whole population. The public and medical debate has become more heated since the data from intervention trials are conflicting. Taken overall the trials do appear to show reduction in risk of coronary which is stronger for non fatal, compared with fatal coronary events. Meta analysis suggests that increasing benefit accrues from larger reductions and also longer reductions in cholesterol by intervention. However, individual trials frequently show variable results and some, especially the recent 15 year follow up of a Finnish five year intervention (by diet, cholesterol lowering and blood pressure lowering drugs) was strikingly adverse—although the total number of events was not large. Total mortality is much harder to influence and the sum of the available trials is hopelessly inadequate in size to address these questions. As a result confusion abounds and is unlikely to be clarified by the present on going trials. The need for more data is clear. The pilot study for the Oxford Cholesterol Study will be presented as a prelude for a proposed main study in about 20 000 high risk individuals.     

Diabetes, mortality and coronary heart disease in the prospective Dubbo study of Australian elderly

Background: A prospective study of Australian elderly living in Dubbo has shown that diabetes is a significant predictor of all-causes mortality and coronary heart disease (CHD). Aim: To examine and contrast clinical and socio-demographic predictors of these outcomes in those with and without diabetes. Methods: The data are derived from a community-based sample of subjects 60 years and older followed over 62 months since 1988. Of 1155 men and 1472 women, 9.2% and 6.9% respectively manifested diabetes at baseline, based on history or fasting hyper-glycaemia. Results: In the presence of diabetes, all-causes mortality was increased twofold in both sexes, CHD incidence was increased twofold in men and threefold in women, stroke incidence was increased twofold in women but little changed in men. Proportional hazards models were derived separately for persons with and without diabetes and risk factors differentially predictive in diabetes were sought. Significant predictors of death in diabetes were old age and current smoking. Those factors differentially predictive were ‘being married’ (Relative Risk [RR] 1.60 with diabetes and 0.69 without diabetes) and higher body mass index (BMI) (RR 1.03 with diabetes and 0.79 without diabetes). Significant predictors of CHD in diabetes were old age, prior CHD, severe hypertension, low HDL cholesterol and self-rated health. Those factors differentially predictive were higher body mass index (RR 1.14 vs 0.83) and physical disability (RR 0.69 vs 1.55). Differential predictions with regard to BMI may relate in part to excess CHD and mortality at low BMI in non-diabetic subjects. Conclusion: The vascular disease burden of diabetes in the elderly has been confirmed, especially in women. A number of conventional risk factors are contributing to this burden and may be amenable to treatment.     

血浆高半胱氨酸对冠心病、脑卒中临床预后的影响

目的探讨高半胱氨酸（Hcy）对冠心病和脑卒中临床预后的影响。方法 234例冠心病、脑卒中患者随机分为对照组和叶酸治疗组。对照组给予降血压、降血脂、降血糖及抗血小板聚集等综合治疗;叶酸治疗组在对照组治疗的基础上加服叶酸片10mg,1次/d。2组疗程均为1年。观察2组治疗前、治疗后6,12个月血浆Hcy水平的变化及治疗后6,12个月冠心病临床事件（急性左心衰竭、急性心肌梗死、猝死、心绞痛发作、心律失常）、脑卒中临床事件（脑梗死、短暂脑缺血发作或可逆性缺血性损伤、脑出血）发病情况,研究其与血浆Hcy水平变化的相关性。结果叶酸治疗组治疗前、治疗后6个月血浆Hcy水平与对照组比较差异均无统计学意义（P〉0.05）,而治疗后12个月血浆Hcy水平明显低于对照组（P〈0.05）。对照组和叶酸治疗组治疗后12个月临床事件发生率分别为26.92%和11.02%,2组比较差异有统计学意义（P〈0.05）。Logistic多元回归分析结果显示,冠心病、脑卒中临床事件发生与糖尿病、高Hcy血症相关（P〈0.05,P〈0.01）;高Hcy血症是冠心病、脑卒中临床事件发生的危险因素。结论高Hcy血症与冠心病、脑卒中临床事件发生明显相关;口服叶酸片能显著降低血浆Hcy水平,减少冠心病、脑卒中临床事件发生率,在二级预防中具有重要意义。     

International differences in coronary heart disease mortality and consumption of fish and other foodstuffs

The relationship between fish consumption and coronary heartdisease mortality was investigated using data on foodstuff consumptionand mortality from 21 countries. A moderate negative associationwas found which appeared stable over different periods. Thisassociation disappeared when the effects of other foodstuffswere controlled for in multiple regression analysis. One featureto emerge was the anomalous position of Japan in consumptionof several foodstuffs. Inclusive or exclusion of this countryfrom regression analysis had a powerful effect on which independentvariables entered the model. This illustrates the danger ofusing single countries, for example Japan with a high fish consumptionand low CHD mortality, to support causal hypotheses about dietand disease.     

Costs of coronary heart disease and stroke: the case of Sweden

Zethraeus N, Molin T, Henriksson P, Jönsson B (Stockholm School of Economics, Stockholm; and Södertälje Hospital, Södertälje; Sweden). Costs of coronary heart disease and stroke: the case of Sweden. J Intern Med 1999; 246: 151–159. Objectives. To estimate the annual costs in Sweden of coronary heart disease (CHD) and stroke, and the potential cost savings if these clinical ‘events’ are avoided. The analysis is undertaken from a societal perspective, including both direct and indirect costs. Costs are calculated for five clinical conditions : (i) acute myocardial infarction (AMI), (ii) angina pectoris (AP), (iii) unstable angina (UA), (iv) congestive heart failure (CHF), and (v) stroke. Design. A retrospective study including patients admitted to the Department of Medicine at Södertälje Hospital during the period January 1993 to March 1995 with CHD or a stroke. Each patient was followed for 1 year after admission to the hospital. To estimate potential cost savings, the patient was used as his or her own control. The potential savings in direct costs if CHD or a stroke is avoided were estimated as the difference between costs for 1 year after and 1 year before the event. The indirect costs were calculated as the difference between the values of market production of goods and services the year before the event and the year after. Setting. The Department of Medicine at Södertälje Hospital, Södertälje, Sweden. Subjects. The patients included in the study were patients at the Department of Medicine at Södertälje Hospital in Sweden. The inclusion criterion was that the patients should have been admitted for the first time for CHD or stroke during the year 1994. To obtain 25 patients for each clinical category we first had to expand the inclusion period to cover January 1993 to March 1995. Secondly, we also had to include 36 patients with an earlier established uncomplicated CHD or stroke. Despite this, no more than 22 patients with UA were found. Interventions. Patients were followed in medical practice. Main outcome measures. Costs, direct and indirect costs, and potential savings. Results. The mean direct costs during the year after a clinical event range between Swedish kronor (SEK) 41 000 for CHF and SEK 96 000 for stroke, whereas the mean potential savings in direct costs range from SEK 36 000 for CHF to SEK 91 000 for UA. The potential mean savings in indirect costs range between SEK 24 000 for CHF and SEK 102 000 for AMI. The direct costs for first-time patients are lower than those for patients with an earlier established CHD or stroke. No systematic differences have been found in potential direct cost savings and indirect costs between the two patient groups. Conclusions. CHD and stroke are associated with high costs during the year after admission to the Department of Medicine. There are also large potential cost savings from the prevention of CHD and stroke. However, further studies, including more patients and costs arising in the municipality, are needed to establish more precise and complete estimates of the costs related to CHD and stroke.     

Long-term prediction of coronary heart disease mortality in two rural Greek populations

In 1960–61 two pooled Greek rural populations totalling1215 men aged 40–59 years were followed-up for 25 years.A Cox model analysis of fatal coronary events over 15 yearsshowed that serum cholesterol in men aged 40–59 years,cholesterol in men aged 45–64 years, and systolic bloodpressure in men aged 50–69 played a predictive role. Thecoefficient of age became more signficant with advancing ageand that of cigarette smoking only at 25 years follow-up. Thecoefficient of cholesterol decreased stepwise and became negativefor men aged 50–69; body mass index was without effectin any follow-up of these cohorts. Systolic blood pressure andserum cholesterol increased in these populations by 5.4 mmHgand 23.5 mg . dl^–1 (0.61 mmol. l^–1), respectivelybetween the years 0 and 10, whereas cigarette consumption decreasedminimally. These changes were used to test the predictabilityof coronary events occurring between years 10 and 25 of follow-upwhen added to the model containing the factors at entry. Ofthese changes only systolic blood pressure significantly increasedthe predictability of coronary deaths. It is concluded thateven minor alterations in systolic blood pressure above or belowthe entry levels can be associated with marked modificationsin coronary mortality above or below those occurring naturallyin the 15 years after the changes occurred.     

冠状动脉粥样硬化性心脏病与缺血性脑卒中相关性研究进展

冠状动脉粥样硬化性心脏病(冠心病)和缺血性脑卒中是动脉粥样硬化性疾病中最主要的2种疾病,二者可以单独或合并发生,是引起死亡和功能缺陷的重要病因。2种疾病存在一些共同的危险因素,在疾病发生上有一定的联系。明确二者之间的相关性有助于动脉粥样硬化性疾病的预防及治疗,减轻疾病不良预后引起的负担,提高国民生存质量。目前有诸多研究致力于探究二者在发病机制、疾病进展、预后以及影像学表现上的关联,其中某些研究结果之间存在差异。现将相关最新研究结果综述如下。     

Alcohol intake and mortality in middle aged men with diagnosed coronary heart disease

OBJECTIVE—To examine the effects of alcohol on risk of mortality from coronary heart disease (CHD), cardiovascular disease, and all causes in men with established CHD.
METHODS AND RESULTS—In a population based prospective study of 7169 men aged 45-64 years followed for a mean of 12.8 years, 655 men (9.1%) had a physician diagnosis of CHD (myocardial infarction 455, angina only 200). In these 655 men, there were 294 deaths from all causes including 175 CHD deaths. Ex-drinkers had the highest risk of CHD, cardiovascular mortality, and all cause mortality even after adjustment for lifestyle characteristics and pre-existing disease. Using occasional drinkers as the reference group, lifelong teetotallers, occasional drinkers, and light drinkers all showed similar risks of mortality from CHD, cardiovascular disease, and all causes. Moderate/heavy drinkers showed increased risk of mortality from CHD, cardiovascular disease, and all causes compared to occasional drinkers. The adverse effect of moderate/heavy drinking was confined to the 455 men with previous myocardial infarction (adjusted relative risk for all cause mortality 1.50, 95% confidence interval 1.01 to 2.23). In contrast to lighter drinking, giving up smoking within five years of the start of follow up was associated with a considerable reduction in risk of all cause and cardiovascular mortality compared to those who continued to smoke.
CONCLUSION—Compared to occasional drinking, regular light alcohol consumption (1-14 units per week) in men with established coronary heart disease is not associated with any significant benefit or deleterious effect for CHD, cardiovascular disease or all cause mortality. Higher levels of intake ( 3 drinks per day) are associated with increased mortality in men with previous myocardial infarction. In contrast, smoking cessation in men with established CHD substantially reduces the risk of mortality.


Keywords: coronary heart disease; alcohol consumption; mortality risk; smoking cessation