Current Status of the Epidemiology of Brain Infarction Associated with Occlusive Arterial Disease
Current Status of the Epidemiology of Brain Infarction Associated with Occlusive Arterial Disease
复制标题
闭塞性动脉疾病相关脑梗死的流行病学现状
作者：
W. Kannel
尽管我们对脑血管疾病流行病学的了解明显存在巨大差距，但仔细检查所有现有数据现在可以发现某些模式，这些模式表明中风的某些危险因素。虽然不同类别脑血管疾病的鉴别诊断问题是从死亡证明死亡率数据中获得中风流行病学特征的一个主要障碍，但前瞻性研究（包括马萨诸塞州弗雷明汉的研究）的证据表明，各种类型的动脉闭塞伴脑梗死是迄今为止最常见的中风类型。动脉粥样硬化的任何具体起源仍然不清楚，因为可能的病因包括盐、脂肪和精制碳水化合物的饮食改变、久坐的生活、导致肥胖的过量热量、吸烟习惯，甚至除了婚姻状况之外，水中的矿物质含量也都受到影响。无论最终答案如何不确定，动脉粥样硬化的某些前兆，如高血压、糖尿病和高脂血症，都很重要。其中，高血压显然是导致中风发病的最重要因素。某些项目的组合比单独使用相同的项目带来的风险更大。例如，糖尿病合并高血压患者发生脑梗塞的风险可能是正常人的六倍左右。在测量时50岁以下的人群中，患有高血压和血脂升高的人患脑梗塞的风险可能比没有升高的人高十倍。这种风险的复合具有发病、预防和公共卫生方面的影响。仅就中风筛查而言，最有效和实用的方法是确定临时血压，但必须指出的是，如果治疗这种血压，风险的变化目前还存在不确定性。
Although large gaps in our knowledge concerning the epidemiology of cerebrovascular disease are apparent, careful inspection of all existing data now makes it possible to see certain patterns emerging which suggest certain risk factors for stroke. While the problem of differential diagnosis of the various categories of cerebrovascular disease presents a major obstacle to obtaining an undistorted picture of the epidemiological features of stroke from death certificate mortality data, the addition of evidence from prospective studies, including those in Framingham, Massachusetts, reveals that various types of arterial occlusion with cerebral infarction are by far the most prevalent type of stroke. Any specific origin of atherosclerosis remains obscure, as possible etiological candidates including dietary alterations in salt, fat and refined carbohydrate, sedentary living, excessive calories promoting obesity, the cigarette habit and even the mineral content of water in addition to marital status have all been incriminated. However uncertain the final answer is, certain precursors for atherosclerosis, such as hypertension, diabetes, and hyperlipidemia, are important. Of these, hypertension is clearly the most important contributor to stroke incidence. Certain combinations of items carry more risk than do the same items singly. For example, the risk of a brain infarction in diabetics with hypertension is probably about six times that of normal subjects. In persons under 50 at the time of measurement risk of cerebral infarction is possibly ten times higher in those with hypertension and elevated lipids than in those without either elevated. This compounding of risk has pathogenetic, preventive and public health implications. For purposes of stroke screening alone the most efficient and practical method would be to determine casual blood pressure, although it must be stated that as yet there is uncertainty concerning the change in the risk if such blood pressure is treated.