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ACCORD亚组分析引发新一轮对降压目标的争论
在新近召开的2010美国高血压学会(ASH)科学年会上,William C Cushman博士(退伍军人事务医疗中心,孟菲斯,田纳西州)发布ACCORD BP研究亚组分析的新数据:"深入研究控制糖尿病心血管风险行动(the Action to Control Cardiovascular Risk in Diabetes,ACCORD)降压实验发现,老年人、非裔美国人和有心血管疾病的人群强化降压治疗,可能给他们带来更多获益,因为他们有较高的绝对卒中风险."
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血管紧张素转换酶I/D多态性与抗高血压治疗血压反应和心血管危险因素的药物遗传学研究
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香港第一届糖尿病与心血管危险因子--东西方学术交流研讨会纪要
为加强东西方在糖尿病与心血管疾病领域的交流与合作,迎接21世纪糖尿病和心血管疾病的挑战,香港中文大学于1999年8月21~22日在香港会展中心主办了第一届糖尿病与心血管危险因子--东西方学术交流研讨会(1st HongkongDiabetes and Cardiovascular Risk Factors-East Meets WestSymposium)。会议特别邀请了来自WHO、美国、英国、澳大利亚、日本、韩国、中国大陆、香港、台湾等地的糖尿病和心血管疾病的专家、教授做了专题报告及论文交流,共300余名代表出席了会议。会议期间,专家们就亚太地区和全球糖尿病的流行情况、糖尿病病因的分子遗传学、代谢综合征基础研究与临床、中医中药治疗糖尿病的研究与应用等专题进行了研讨。现将会议的主要内容扼要介绍如下。一、糖尿病的流行病学来自WHO的Roglic教授和澳大利亚国际糖尿病研究院的Zimmet教授对全球及亚太地区的糖尿病流行状况做了简介。据WHO专家的预测,到2000年全球大约有1.5亿成人糖尿病,2025年将达到3亿,75%的糖尿病患者生活在印度、中国等发展中国家。澳大利亚国际糖尿病研究院资料预测,到2010年,亚太地区2型糖尿病的患病人数将从1995年的65,000,000增至135,000,000。世界各地华人糖尿病的患病率也在急剧上升,中国大陆为2.5%~3.25%,香港为6.7%,台湾为5.7%;毛里求斯华人为16.4%。2型糖尿病年龄构成比东西方存在较大差异,发达国家糖尿病患者年龄大多超过65岁,而发展中国家大多在45~64岁之间,远较发达国家糖尿病患者年轻。香港流调资料显示,35岁以下糖尿病的患病率高达1.7%。这些患者以后发生糖尿病大、小血管并发症的机会必然增加,心血管疾病死亡率也会随之升高。WHO估计,到2000年,将有4,400,000人死于糖尿病,占世界总死亡率的9%,单是印度和中国,死于糖尿病的人数就超过1,000,000。由此可见,在21世纪,东西方均面临着糖尿病及心血管疾病的严峻挑战。
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对糖尿病危险控制研究(ACCORD)的评述
2010年3月美国亚特兰大ACC大会期间,糖尿病危险控制的研究(ACCORD)降压和调脂试验结果公布,引起了较大反响.
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糖尿病与心血管风险
在新奥尔良的第69届美国糖尿病学会(ADA)年会上,一系列报告再次把糖尿病与心血管疾病关系的研讨推向新的高潮,其中包括:评估罗格列酮对糖尿病心脏终点和血糖控制影响(Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes,RECORD)研究和2型糖尿病患者冠状动脉搭桥血运重建(Bypass Angioplasty Revascularization Investigation in Type 2 Diabetics,BAR12D)研究的结果公布;控制糖尿病患者心血管风险因素行动(Action to Control Cardiovascular Risk in Diabetes,ACCORD)研究和退伍军人糖尿病试验(Veterans Affairs Diabetes Trial,VADT)的进一步分析;当前糖尿病心血管风险评估和管理的专题论坛以及干预糖尿病前期心血管风队因子的研究等等.
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从ACCORD与NAVIGATOR试验看高质量管理血压预防心脑血管并发症
降压治疗的依从性不好,是高血压患者血压不能得到有效控制的主要原因之一.近来公布了两项重要的临床试验,分别为合并糖尿病的高血压患者中进行的降压治疗临床试验(action to control cardiovascular risk in diabetes,ACCORD)[1]和在糖耐量异常但没有糖尿病的高血压或正常血压患者中进行的降压治疗临床试验(nateglinide and valsartan in Impaired slucose tolerance outcomes research,NAVIGATOR)[2].
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控制糖尿病患者心血管风险行动的临床试验解读
ACCORD研究(evolution of the lipid trial protocol of the action to control cardiovascular risk in diabetes trial,ACCORD)~([1])的中文全称为"控制糖尿病患者心血管风险行动的临床试验".该研究始于2001年,由美国国立卫生研究院(NIH)资助.该研究旨在明确强化血糖控制、强化血压控制和联合调脂对高危糖尿病患者心血管事件的影响.
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积极迎战他汀时代我国面临的"双重"心血管风险
1 概念文中心血管风险,大血管风险指心肌梗死、脑卒中及心血管死亡风险;微血管风险指糖尿病肾病、视网膜病变及周围神经病变等风险.狭义剩留心血管风险指他汀后剩留血脂异常的心血管风险;广义剩留心血管风险指心血管病的主要危险因素低密度脂蛋白胆固醇(low-densitylipoprotein cholesterol,LDL-C)、血压及血糖下降达到标准靶目标值后剩留的心血管风险,即如糖尿病治疗后剩留心血管风险.
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2011加拿大高血压教育计划解读
2011年,由63位临床高血压专家和统计学家组成的加拿大高血压教育计划委员会(Canadian Hypertension Education Program,CHEP)在检索和分析了2010年8月以前发表的所有大规模随机对照研究和荟萃分析结果后,对血压检测、高血压诊断、心血管危险性评估和治疗领域指南进行了更新[1].其中,两项近期研究结果,ACCORDBP研究(the Action to Control Cardiovascular risk in Diabetes Blood Pressure Intervention Trial)[2]和ACCOMPLISH研究(the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension)[3]糖尿病亚组结果的公布,更为指南所推荐的糖尿病和急性卒中患者血压控制提供了重要依据.以下是对2011年CHEP高血压指南更新内容的解读(以下简称本指南).
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2型糖尿病患者肾病早期病变及早发现的紧迫性和重要性
2003年11月13日,北京及世界各地与在加里福尼亚圣地亚哥举行的美国肾脏病学会第36届年会上同步公布了DEMAND即"德安"检测研究项目的结果(微量白蛋白尿作为糖尿病患者肾病和心血管疾病危险预知因素的教育(Developing Education on Microalbuminuria forAwareness of ReNal and Cardiovascular Risk in Diabetes).
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Current treatment in chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is defined by fixed airflow limitation associated with an abnormal pulmonary and systemic inflammatory response of the lungs to cigarette smoke. COPD represents an increasing burden worldwide, reported to be the sixth leading cause of death in 1990 and the fourth in 2000. Discouragingly, it is projected to jump to third place by the year 2020.There is increasing evidence that COPD is a more complex systemic disease than an airway and lung disease. In particular, cachexia, skeletal muscle abnormalities, diabetes, coronary artery disease, heart failure, cancer and pulmonary vascular disease are the most common comorbidities. It is associated with a wide variety of systemic consequences, most notably systemic inflammation. Because COPD patients have in general ahigher cardiovascular risk than the average population, cardiovascular safety in a COPD medication is of critical importance.SINGH et al performed a systematic review and recta-analysis of 17 clinical trials enrolling 14 783 patients treated with inhaled anticholinergic drugs used for the treatment of COPD. Inhaled anticholinergics significantly increased the risk of cardiovascular death, MI, or stroke ( 1.8 % vs 1.2 % for control; RR, 1.58 (95 % CI,1.21 - 2.06); P < 0.001 ). However, UPLIIFT (Understanding the Potential Long-Term Impacts on Function with Tiotropium) , a large, 4-year, placebo controlled clinical trial with tiotropium in approximately 6 000 patients with COPD. The preliminary results of UPLIFT showed that there was no increased risk of stroke with tiotropium bromide compared to placebo.A meta-analysis is always considered less convincing than a large prospective trial designed to assess the outcome of interest. However, COPD is a systemic disease. COPD management needs to focus on four major areas: smoking cessation, pharmacologic therapy, exercise training, and pulmonary rehabilitation. Clinicians and patients should always carefully consider any potential risks of intervention in the treatment of COPD.
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第45课运动员12导联心电图解释的建议
Electrocardiogram changes in athletes are common and usually reflect structural and electrical remodelling of the heart as an adaptation to regular physical training (athlete's heart).However, abnormalities of athlete's ECG may be an expression of an underlying heart disease which carries a risk of SCD during sport.It is important that ECG abnormalities resulting from intensive physical training and those potentially associated with an increased cardiovascular risk are correctly distinguished.The athlete's ECG changes are divided into two groups: common and training-related and training-unrelated.