The forgotten majority - Unfinished business in cardiovascular risk reduction
The forgotten majority - Unfinished business in cardiovascular risk reduction
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DOI：
10.1016/j.jacc.2005.07.006
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发表时间：
2005-10-04
影响因子：
24
通讯作者：
Libby, P
中科院分区：
文献类型：
--
作者：
Libby, P
尽管在确定风险因素以及开发高效临床工具方面取得了重大进展，但全球心血管疾病导致的死亡人数仍在持续增加。由肥胖流行引发的代谢综合征以及2型糖尿病发病率的上升导致心血管风险剧增。尽管他汀类药物的药物治疗降低了胆固醇水平并降低了死亡率，但包括斯堪的纳维亚辛伐他汀生存研究、胆固醇与复发事件试验、美国空军/得克萨斯冠状动脉粥样硬化预防研究以及普伐他汀在缺血性疾病中的长期干预研究在内的几项大型对照临床试验表明，三分之二的患者仍会发生心血管事件。后续研究，如心脏保护研究以及普伐他汀或阿托伐他汀评估和感染治疗/心肌梗死溶栓 - 22试验，进一步强化了这些早期结果。尽管吉非贝齐（一种贝特类药物）治疗在赫尔辛基心脏研究和退伍军人事务部高密度脂蛋白干预试验中显示心血管事件发生减少，但其他研究，如苯扎贝特干预计划和糖尿病动脉粥样硬化干预研究，结果却不太乐观。尽管生活方式的改变，如改善饮食和增加运动量，有益于整体健康，尤其有益于代谢综合征和胰岛素抵抗，但大多数人仍然抗拒改变日常生活习惯。因此，医生必须继续教育患者如何在药物治疗和个人行为之间达到最佳平衡。（美国心脏病学会基金会2005年版权所有）
Despite meaningful progress in the identification of risk factors and the development of highly effiective clinical tools, deaths from cardiovascular disease continue to increase worldwide. Sparked by an obesity epidemic, the metabolic syndrome and the rising incidence of type 2 diabetes have led to an upsurge of cardiovascular risk. Although pharmacologic treatments with the statin class of drugs have reduced cholesterol levels and lowered mortality rates, several large controlled clinical trials, including the Scandinavian Simvastatin Survival Study, the Cholesterol and Recurrent Events trial, the Air Force/Texas Coronary Atherosclerosis Prevention studies, and Long-term Intervention with Pravastatin in Ischemic Disease study, have indicated that cardiovascular events continue to occur in two thirds of all patients. Follow-up studies, such as the Heart Protection Study and the Pravastatin or Atorvastatin Evaluation and Infection Therapy/Thrombolysis In Myocardial Infarction-22 trials, reinforced these earlier results. Although therapy with gemfibrozil, a fibric acid derivative, showed reduced occurrence of cardiovascular events in the Helsinki Heart Study and the Veterans Affairs HDL Intervention Trial, results of other studies, e.g., the Bezafibrate Intervention Program and the Diabetes Atherosclerosis Intervention study, showed less encouraging results. Although lifestyle modifications, such as improved diet and increased exercise levels, benefit general health and the metabolic syndrome and insulin resistance in particular, most people continue to resist changes in their daily routines. Thus, physicians must continue to educate their patients regarding an optimal balance of drug therapy and personal behaviour. (c) 2005 by the American College of Cardiology Foundation.