Moving Toward Global Primordial Prevention in Cardiovascular Disease: The Heart of the Matter.
Moving Toward Global Primordial Prevention in Cardiovascular Disease: The Heart of the Matter.
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DOI：
10.1016/j.jacc.2015.08.027
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发表时间：
2015-10
影响因子：
24
通讯作者：
M. Vaduganathan;Atheendar S. Venkataramani;Deepak L. Bhatt
中科院分区：
文献类型：
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作者：
M. Vaduganathan;Atheendar S. Venkataramani;Deepak L. Bhatt
在过去的十年中，美国在降低确诊心血管疾病（CVD）患者的死亡率方面取得了逐步进展（1）。这些有利的趋势在很大程度上反映了心血管药物和器械治疗的改善，简化的护理流程以及有效的疾病管理计划的增加。总体而言，这些二级预防方法改善了CVD患者的寿命。尽管趋势令人鼓舞，但这些数据掩盖了相对不变的轨迹和令人担忧的高心血管风险因素（例如血脂异常，高血压和糖尿病）和不良健康行为（例如，身体活动不足，高热量饮食，吸烟和不理想的体重）（1，2）。不幸的是，符合美国心脏协会（AHA）（3）定义的所有理想健康指标的成人和儿童比例近年来没有改善，在大多数当代系列中为1%或更少（4，5）。此外，CVD仍然是全球死亡的主要驱动因素，不成比例地影响低收入国家（6）。随着这些国家在经济、饮食和疾病方面的持续转型，预计CVD、风险因素和健康行为的这些模式将继续演变。
Over the past decade, incremental progress has been made in reducing mortality rates in patients with established cardiovascular disease (CVD) in the United States (1). These favorable trends largely reflect improved uptake of cardiovascular drug and device therapies, streamlined processes of care, and augmented access to effective disease management programs. Collectively, these secondary prevention approaches have improved the longevity of patients with CVD.Despite encouraging trends, these data conceal relatively unaltered trajectories and alarmingly high rates of cardiovascular risk factors (eg, dyslipidemia, hypertension, and diabetes) and adverse health behaviors (eg, physical inactivity, high-calorie diets, smoking, and nonideal body weights)(1, 2). Unfortunately, the proportion of adults and children meeting all ideal health metrics, as defined by the American Heart Association (AHA)(3), has not improved in recent years and is 1% or less in most contemporary series (4, 5). Furthermore, CVD continues to be the major driver of deaths worldwide, disproportionately affecting low-income countries (6). As these countries experience continued transitions in economy, diet, and disease, it is expected that these patterns in CVD, risk factors, and health behaviors will continue to evolve.