Long-Term Epidemiologic Prediction of Coronary Disease
Long-Term Epidemiologic Prediction of Coronary Disease
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冠心病的长期流行病学预测
DOI：
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发表时间：
1993
期刊：
影响因子：
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通讯作者：
M. Larson
中科院分区：
文献类型：
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作者：
W. Kannel;M. Larson
动脉粥样硬化性心血管疾病是一个复杂的问题，涉及脂肪沉积、压力、流变力、碳水化合物耐受性和血栓形成。通过流行病学研究确定的主要因素包括导致动脉粥样硬化的个人属性、促进它们的生活习惯、冠状动脉循环受损的迹象以及宿主对这些危险因素的易感性。导致动脉粥样硬化的风险属性，如血脂、血压、糖耐量和纤维蛋白原，每一个都独立地导致风险，与任何一个相关的风险因其他因素的存在而变得更加复杂。与高血压、高脂血症或糖尿病相关的风险大不相同，取决于相关风险因素的水平。此外，在给定的总胆固醇水平上，风险很大程度上受总胆固醇/高密度脂蛋白比率的影响，这为评估胆固醇的双向流动提供了一种实用的手段。此外，吸烟或缺乏锻炼等生活习惯可以独立地影响与任何导致动脉粥样硬化的特征相关的风险。这些生活习惯、肥胖和饮食也会影响导致动脉粥样硬化的风险因素的水平，在评估风险和实施预防措施时必须加以考虑。最后，无症状心肌缺血的临床前指标极大地增加了与不良心血管风险相关的风险。因此，监测时应考虑到心电图左室肥厚、室内传导受阻、复极异常和运动反应异常。最佳的风险预测需要将风险因素量化地综合成一个综合估计。基于多种后勤风险公式，设计了供办公室使用的手册、手持计算器和PC软件。这些已被证明在各种美国人群样本中准确预测疾病风险，无论是在老年人还是年轻的冠心病候选患者中。如果要取得最佳结果，预防管理和风险评估应是多因素的。预防策略应包括采取公共卫生措施改变生态，将危险因素的分布转移到更有利的水平，开展健康教育，使人们能够保护自己的健康，并为高危候选人提供预防药物。必须发展更高的技能来进行这种干预。在选择纠正高血压、糖尿病和血脂紊乱的药物时，重要的是选择不会对综合风险状况产生不利影响的药物。
Atherosclerotic cardiovascular disease is a complex problem involving lipid deposition, pressure, rheologic forces, carbohydrate tolerance and thrombogenesis. The major contributors identified through epidemiologic research include atherogenic personal attributes, living habits which promote them, signs of a compromised coronary circulation and host susceptibility to these risk factors. Of the atherogenic risk attributes, such as blood lipids, blood pressure, glucose tolerance and fibrinogen, each independently contributes to risk, and the risk associated with any one is compounded by the presence of the others. The risk associated with hypertension, hyperlipidemia or diabetes varies widely depending on the level of associated risk factors. Also, at a given level of total cholesterol, risk is greatly affected by the total/HDL cholesterol ratio, which provides a practical means for assessing the two-way traffic of cholesterol. In addition, living habits, such as cigarette smoking or lack of exercise, can independently affect the risk associated with any of the atherogenic traits. These living habits, obesity and diet can also affect the level of atherogenic risk factors and must be taken into account in assessing risk and implementing preventive measures. Finally, preclinical indicators of silent myocardial ischemia greatly augment the risk associated with a poor cardiovascular risk profile. Hence, ECG left ventricular hypertrophy, blocked intraventricular conduction, repolarization abnormalities and abnormal response to exercise on monitoring must be taken into consideration. Optimal risk predictions require a quantitative synthesis of risk factors into a composite estimate. Handbooks, hand calculators and PC software have been devised for office use based on multiple logistic risk formulations. These have been shown to accurately predict disease risk in a variety of American population samples, in elderly as well as young coronary candidates. Preventive management as well as risk estimation should be multifactorial if optimal results are to be achieved. Preventive strategies should include public health measures to alter the ecology so as to shift the distribution of risk factors to a more favorable level, health education to enable people to protect their own health and preventive medicine for high-risk candidates. Greater skill must be developed to carry out such interventions. In selecting drugs to correct hypertension, diabetes and lipid disorders, it is important to choose agents which do not adversely affect the composite risk profile.