Clinical misconceptions dispelled by epidemiological research.
Clinical misconceptions dispelled by epidemiological research.
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流行病学研究消除了临床误解。
DOI：
10.1161/01.cir.92.11.3350
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发表时间：
1995
期刊：
影响因子：
37.8
通讯作者：
W. B. Kannel
中科院分区：
文献类型：
--
作者：
W. B. Kannel
1948年，Ancel Keys的《七国研究》和T.R.道伯的《弗雷明汉心脏研究》创新了用流行病学方法调查心血管疾病的方法。这些调查是在普通人群的代表性样本中进行的，提供了对心血管疾病的临床谱、发病率和预后、易患心血管疾病的生活方式和个人属性以及发病机制的线索的客观认识。获得的许多见解纠正了来自临床研究的许多广泛持有的误解。例如，人们了解到高血压的不良后果并非主要来自舒张压，左心室肥厚不是偶然的代偿现象，少量蛋白尿不仅仅是直立性的琐事。运动被认为对心血管疾病候选人有危险；吸烟、胆固醇和高脂肪饮食被认为是引起动脉粥样硬化的可疑因素。猝死和未被识别的心肌梗死的实体没有被广泛认识为冠状动脉疾病的突出特征，心衰和房颤的致残性和致命性被低估。流行病学研究创造了“风险因素”这一术语，并消除了心血管疾病必须有单一起源的观念。流行病学调查为卫生专业人员提供了多因素风险概况，以便更有效地针对心血管疾病候选者采取预防措施。临床医生现在指望流行病学研究提供关于心血管疾病可能诱发因素和合理预防措施的明确信息。因此，临床医生不太倾向于将通常或平均值视为可接受的值，而更倾向于将最佳值视为“正常”值。心血管事件逐渐被视为一种医疗失败，而不是治疗的第一指征。
The epidemiological approach to investigation of cardiovascular disease was innovated in 1948 by Ancel Keys' Seven Countries Study and T.R. Dawber's Framingham Heart Study. Conducted in representative samples of the general population, these investigations provided an undistorted perception of the clinical spectrum of cardiovascular disease, its incidence and prognosis, the lifestyles and personal attributes that predispose to cardiovascular disease, and clues to pathogenesis. The many insights gained corrected numerous widely held misconceptions derived from clinical studies. It was learned, for example, that the adverse consequences of hypertension do not derive chiefly from the diastolic pressure, left ventricular hypertrophy was not an incidental compensatory phenomenon, and small amounts of proteinuria were more than orthostatic trivia. Exercise was considered dangerous for cardiovascular disease candidates; smoking, cholesterol, and a fatty diet were regarded as questionable promoters of atherosclerosis. The entities of sudden death and unrecognized myocardial infarction were not widely appreciated as prominent features of coronary disease, and the disabling and lethal nature of cardiac failure and atrial fibrillation was underestimated. It took epidemiological research to coin the term "risk factor" and dispel the notion that cardiovascular disease must have a single origin. Epidemiological investigation provided health professionals with multifactorial risk profiles to more efficiently target candidates for cardiovascular disease for preventive measures. Clinicians now look to epidemiological research to provide definitive information about possible predisposing factors for cardiovascular disease and preventive measures that are justified. As a result, clinicians are less inclined to regard usual or average values as acceptable and are more inclined to regard optimal values as "normal." Cardiovascular events are coming to be regarded as a medical failure rather than the first indication of treatment.
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纤维蛋白原作为心血管危险因素的最新进展。
影响因子：
5.6
作者：
Kannel,WB;D'Agostino,RB;Belanger,AJ
通讯作者：
Belanger,AJ
DOI：
10.1001/jama.1992.03490070059042
发表时间：
1992-08
期刊：
JAMA
影响因子：
--
作者：
M. Stampfer;M. Malinow;W. Willett;L. Newcomer;B. Upson;D. Ullmann;P. Tishler;C. Hennekens
通讯作者：
M. Stampfer;M. Malinow;W. Willett;L. Newcomer;B. Upson;D. Ullmann;P. Tishler;C. Hennekens
影响因子：
8.3
作者：
WOLF, PA;DAGOSTINO, RB;KANNEL, WB
通讯作者：
KANNEL, WB
DOI：
10.1001/jama.1994.03510350050036
发表时间：
1994-03-16
影响因子：
120.7
作者：
BENJAMIN, EJ;LEVY, D;WOLF, PA
通讯作者：
WOLF, PA