Partnerships for promoting prevention.
Partnerships for promoting prevention.
复制标题
促进预防的伙伴关系。
DOI：
10.1161/circulationaha.113.001288
复制
发表时间：
2013
期刊：
影响因子：
37.8
通讯作者：
Jahn,JaquelynL
中科院分区：
文献类型：
--
作者：
Stampfer,Meir;Jahn,JaquelynL
吸烟和BMI的测量具有相当高的精确度。因此，如果能够避免上述方法陷阱，就可以量化这些风险因素的影响。相比之下，体力活动的测量要精确得多。在某种程度上，测量的不精确度与健康结果无关，估计的活动水平与心血管疾病(CVD)和癌症的关联可能低估了真正的影响。越来越多的证据表明，体育锻炼可以降低不同部位(包括乳腺癌、结直肠癌和致命性前列腺癌)的癌症发病率，并可能提高癌症诊断后的存活率。目前还不清楚同样的活动参数是否会对癌症和心血管疾病产生类似的益处。例如，适度的步行对心血管疾病有很强的保护作用，10但只有剧烈运动，包括快走，才与前列腺癌的更好生存相关。11拉斯穆森-托维克健康饮食评分的组成部分是水果和蔬菜、鱼、富含纤维的全谷物，以及对钠和含糖饮料的限制。虽然促进水果和蔬菜摄取的早期动力大部分来自癌症预防的目标，但降低心血管疾病，特别是中风的风险的证据更有力。然而，最近的数据表明，水果和蔬菜可以降低雌激素受体阴性乳腺癌的风险。12 Chiuve和他的同事13描述了一个更全面的饮食指数，即另类健康饮食指数，它与较低的心血管疾病和糖尿病风险密切相关。有趣的是，坚持这一指数与女性患癌症的风险较低显著相关，但与男性无关。完全癌症是一种非常不同的结果，人们可能会认为不同的癌症部位存在不同的关联。心血管疾病危险因素的重叠可能在糖尿病、结直肠癌14和认知能力下降方面最为明显。15大自然并没有如此乐于助人，以至于安排所有风险因素协调行动。一个值得注意的反例是适度饮酒，这与较低的心脏病风险密切相关，但也与乳腺癌风险增加密切相关。16尽管如此，对看似不同的疾病的预防策略有如此多的重叠，这一发现表明了一些共同的基本分子途径或网络，它们的扰动产生了多效性效应。用网络医学的方法仔细研究这些共同风险因素的共同因素可能是卓有成效的。17这项工作的一个例子是发现叶酸代谢途径的基因改变与叶酸摄入量不足的人患心血管疾病和结直肠癌的风险较高有关。在对个别患者进行咨询时，临床医生应该提醒患者，许多健康的行为可以降低患多种疾病的风险，一些患者可能更多地出于预防癌症的动机，而另一些患者可能更多地出于预防心血管疾病的动机。尽管公众可能普遍意识到体育锻炼和保持健康体重对心血管的好处，但它们的癌症预防作用可能被低估了。此外，关于慢性病预防的综合建议可以从个人延伸到机构一级。Rasmussen-Torvik和他的同事最后提出了一个实际的建议，即美国心脏协会应该与癌症和其他慢性病倡导团体建立伙伴关系，创建一个广泛而强大的联盟，以促进慢性病的初级预防。为了最大限度地发挥作用，这样的方法应该是…
Smoking and BMI are measured with a reasonably high degree of precision. Therefore, if one can avoid the methodologic pitfalls described above, one can quantify the impact of these risk factors. In contrast, physical activity is measured much less precisely. To the extent that the imprecision in measurement is unrelated to the health outcomes, the association of estimated activity levels with cardiovascular disease (CVD) and cancer are likely to underestimate the true impact. Growing evidence suggests that physical activity may reduce the risk of cancer incidence at various sites (including breast, colorectal, and lethal prostate cancer) and may improve survival after cancer diagnosis. 10 It is unclear whether the same activity parameters will have similar benefits for cancer and CVD. For example, walking at a moderate pace is strongly protective for CVD, 10 but only vigorous activity, including brisk walking, was associated with better survival for prostate cancer. 11 The components of the Rasmussen-Torvik healthy diet score are fruits and vegetables, fish, fiber-rich whole grains, and limitations on sodium and sugar-sweetened beverages. Although much of the early impetus for promoting the intake of fruits and vegetables came from a goal of cancer prevention, the evidence is stronger for reducing the risk of CVD, especially stroke. However, recent data suggest that fruits and vegetables reduce the risk of estrogen-receptor–negative breast cancer. 12 Chiuve and colleagues13 have described a more comprehensive dietary index, the Alternative Healthy Eating Index, which is strongly associated with lower risk of CVD and diabetes mellitus. Interestingly, adherence to that index was significantly associated with lower risk of cancer in women, but not in men. Total cancer is a very heterogeneous outcome, and one might expect different associations for different cancer sites. The overlap of CVD risk factors is perhaps most pronounced for diabetes mellitus, colorectal cancer, 14 and perhaps cognitive decline. 15 Nature has not been so obliging as to arrange all risk factors to move in concert. A notable counter example is moderate alcohol consumption, which is strongly linked to a lower risk of heart disease, but also with an increased risk of breast cancer. 16 Nonetheless, the finding of so much overlap in preventive strategies for seemingly diverse diseases suggests some common basic molecular pathways or networks, whose perturbations yield pleiotropic effects. A network medicine approach to scrutinize the common elements of these shared risk factors may be fruitful. 17 An example of such work is the finding that genetic alterations in the folate metabolism pathway are associated with higher risk of both CVD and colorectal cancer in those with inadequate folate intake. 18, 19 In counseling individual patients, clinicians should remind patients that many of the healthy behaviors can reduce risk of multiple diseases, and some patients may be more motivated by cancer prevention and others by CVD prevention. Although the public is likely generally aware of the cardiovascular benefits of physical activity and the maintenance of a healthy weight, their cancer prevention effects are probably underappreciated. Furthermore, combined advice for chronic disease prevention could be extended from the individual to the institutional level. Rasmussen-Torvik and colleagues conclude with the practical suggestion that the American Heart Association should form partnerships with cancer and other chronic disease advocacy groups to create a broad and powerful coalition to promote primary prevention of chronic disease. To be maximally effective, such an approach should …