Behavioral strategies for cardiovascular risk reduction in diverse and underserved racial/ethnic groups.
Behavioral strategies for cardiovascular risk reduction in diverse and underserved racial/ethnic groups.
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DOI：
10.1161/circulationaha.110.968495
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发表时间：
2012-01-03
期刊：
影响因子：
37.8
通讯作者：
Kumanyika SK
中科院分区：
文献类型：
--
作者：
Stuart-Shor EM;Berra KA;Kamau MW;Kumanyika SK
心血管疾病（CVD）是美国所有种族/族裔群体死亡和残疾的主要原因。 1 CVD 发病率和死亡率的大部分负担与可改变的生活方式危险因素有关。由于一系列社会、环境、生物和系统因素的影响，心血管疾病和代谢/血管危险因素的负担不成比例地落在种族和民族社区身上。 1, 2 与美国白人相比，黑人的差异最为明显。 1 其他种族/少数民族人口的现有数据表明某些 CVD 风险因素或结果存在差异。 1, 3尽管临床医生普遍认识到一级和二级 CVD 预防目标以及通过将生活方式风险降低干预措施融入实践来改善临床结果的潜力，但这些干预措施的应用远非最佳。 4 过去 3 年来，一级和二级预防的治疗目标已得到完善。 5, 6 表 1 源自美国心脏协会 (AHA) 关于原始、4 主要、5 和次要 6 风险降低以及饮食和生活方式建议的科学声明，7 描绘了整个预防范围的目标和风险降低策略。一级预防旨在通过戒烟避免高危人群首次发生心血管疾病；血压 (BP)、血脂和血糖的管理；体重控制；以及饮食和身体活动咨询。 5 二级预防旨在对已确诊的 CVD 患者的危险因素进行强化和全面管理，并与提高生存率和减少复发事件相关。 6 血脂管理的二级预防基准低于一级预防，但血压、吸烟、饮食和体力活动目标相同。人们越来越认识到亚临床疾病会经过多年发展并具有不同程度的风险，因此现在认识到有必要扩大CVD预防的重点，将其纳入原始预防，即首先避免不利水平的风险因素。 4 包括
Cardiovascular disease (CVD) is the leading cause of death and disability in the United States across all racial/ethnic groups. 1 Much of the burden of CVD morbidity and mortality is associated with modifiable lifestyle risk factors. A disproportionate share of the burden of CVD and metabolic/vascular risk factors falls on racial and ethnic communities as a result of a constellation of social, environmental, biological, and systems factors. 1, 2 Disparities are most clearly evident for black compared with white Americans. 1 Available data for other racial/ethnic minority populations indicate disparities for certain CVD risk factors or outcomes. 1, 3Despite widespread awareness among clinicians of primary and secondary CVD prevention goals and the potential for improving clinical outcomes by integrating lifestyle risk reduction interventions into practice, the application of these interventions is far from optimal. 4 Therapeutic goals for primary and secondary prevention have been well established over the last 3 decades. 5, 6 Table 1, derived from the American Heart Association (AHA) scientific statements on primordial, 4 primary, 5 and secondary6 risk reduction and diet and lifestyle recommendations, 7 delineates targeted goals and risk reduction strategies across the spectrum of prevention. Primary prevention seeks to avoid a first occurrence of CVD among individuals at risk through smoking cessation; management of blood pressure (BP), lipids, and glucose; weight control; and dietary and physical activity counseling. 5 Secondary prevention aims for intensive and comprehensive management of risk factors in those with established CVD and is associated with improved survival and a reduction in recurrent events. 6 Secondary prevention benchmarks for lipid management are lower than for primary prevention, but BP, smoking, dietary, and physical activity goals are the same. As a result of a growing recognition that subclinical disease develops over many years and with various levels of risk, the necessity to broaden the focus of CVD prevention to include primordial prevention, the avoidance of adverse levels of risk factors in the first place, is now recognized. 4 Including