简介：Cardiovasculardisease(CVD)isthenumberonecauseofmortalityworld-wideandplacesahighmedicalandsocioeconomicburdenondevelopingcountries.OurunderstandingofCVDanditsevolutionoverthelast100yearshasalteredconsiderably.ReasonsfortheincreasedrateofCVDinthedevelopingworldincluderapidurbanizationandthedemographicshiftknownasthemodernepidemiologictransition.ThecaseforinterventionisbasedonbothmajorhumanandeconomicimpactsofCVD.Ithasbeenestimatedthatcost-effectiveinterventionsindevelopingcountrieswithahighburdenofCVDcouldresultinaprojected24millionlivessaved.ThisreductioninCVDmortalitycouldreduceeconomiccostsby$8billion.Approachestointerventioninclude:1)cardiovascularhealthpromotionandCVDpreventionand2)actionplansadvocatedbytheWorldHealthOrganization.

简介：Cardiovasculardisease(CVD)istheleadingcauseofdeathworldwide.ThisarticlefocusesoncurrentguidelinesfortheprimarypreventionofCVDandaddressesmanagementofkeyriskfactors.Dietarymodification,weightloss,exercise,andtobaccousecessationarespecificareaswherefocusedeffortscansuccessfullyreduceCVDriskonbothanindividualandasocietallevel.Specificareasrequiringmanagementincludedyslipidemia,hypertension,physicalactivity,diabetes,aspirinuse,andalcoholintake.Thesepreventiveeffortshavemajorpublichealthimplications.Astheglobalpopulationcontinuestogrow,healthcareexpenditureswillalsorise,withthepotentialtoeventuallyoverwhelmthehealthcaresystem.ThereforeitisimperativetoapplyourcollectiveeffortsonCVDpreventiontoimprovethecardiovascularhealthofindividuals,communities,andnations.

简介：ObstructiveSleepApnea(OSA)isacommonchronicdisorderthataffects5–10%oftheUSpopulationwithahigherprevalenceinmencomparedtowomenby2:1inpopulationstudies.Bycontrast,inpatientswithcardiovasculardisease,itsprevalencecanexceed50%dependingonthespecificdisordersurveyed.Althoughsexdifferenceshavebeenwelldescribedforcardiovascularriskfactors;existingdataregardingtheimpactofsexontherelationshipbetweenOSAandcardiovascularoutcomesiscontroversial.Similarly,whilethereisstrongevidenceforincreasedprevalenceofcardiovascularconditions,suchassystemichypertension,atrialfibrillation,aswellasheartfailureamongstpatientssufferingfromOSA;conflictingevidenceexistsregardingtheincidenceandbidirectionalrelationshipbetweenthemaswellastheimpactoftreatmentofOSAoncardiovascularoutcomes.Inthispaper,wewillreviewtheassociationsbetweenOSAandcardiovasculardiseasesinwomen.Thedataonsexdifferencesislimited,duetoanumberofreasons,including,butnotlimitedtolatepresentationofOSAinwomen,difficultiesindiagnosingbothOSAandcardiovasculardiseasesinwomenandstillsuboptimalinclusionofadequatenumberofwomeninclinicaltrials.MorestudiesareneededtobetterdelineatesexdifferencesintheclinicalpresentationaswellasthepathophysiologyoftheassociationsbetweenOSAandcardiovasculardiseasessothatwecanprovidepatientswithmorepersonalizedcare.

简介：Depression/anxiety-relateddisordersandpsychosocialstresshavebeenimplicatedascardiovasculardisease(CVD)riskfactors.Womenareatconsiderableriskforaffectivedisordersandreportgreaterseverityfrompsychosocialstress,comparedtomen.Affectivedisordersandcardiovasculardiseaselikelyshareunderlyingpathophysiologicalmechanismsthatarepotentiatedamongwomen–especiallyyoungerwomen.Environmentalstressorsthatthreatenthesafety,security,andstatusofanindividualareappraisedbythebrain,producingacascadeofevokedphysiologicalandcognitiveresponses.Intheshortterm,theseprocessesovercomestressors,butcomewithlong-termhealthimplications.Chronicpsychosocialstressleadstoadysregulationofthestressresponsesystemsthatcanleadtoaheightenedstressappraisalschemacalledtheunpredictabilityschema,aconstructthatmightarguablyplacewomenatheightenedriskforCVD.

简介：AreviewarticlebyHaoetal.(JAmCollCardiol2017;69(24):2952–66)hashadhugerepercussionsamongthosefamiliarwithtraditionalChinesemedicine(TCM)intheinternationalacademiccommunity.ItevaluatedtheefficacyandsafetyofTCMforcardiovasculardiseaseandthepharmacologicaleffectofactiveTCMingredientsonthecardiovascularsystemandpotentialmechanisms.Wehaveseveralcomments:Firstly,wegiveabriefsummaryaddressingnonpharmacotherapyinTCM,includingacupuncture,moxibustion,Qigong,andTaiChi.Secondly,wehaveaddedtraditionalantiarrhythmicdrug–relatedrandomizedcontrolledtrialstomakethecoveragemorecomprehensive.Lastly,wesupporttheconceptthatresearchinto,developmentof,andapplicationofactiveingredientsispartofmodernTCM.

简介：Cardiovasculardisease(CVD)anddepressionandanxietycontributesubstantiallytothecurrentdiseaseburdenworldwideaswellasinChina.BothdepressionandanxietyarehighlyprevalentamongpatientswithCVD.WesystematicallyreviewedtheliteraturetodisentangletheroleofdepressionandanxietydisordersintheonsetandprognosisofCVDwithanemphasisoncohortstudiesconductedintheChinesepopulation.Despitethelackoflarge-scaleprospectivestudiesinChina,theavailableevidenceimpliesthatbothdepressionandanxietyarecloselyassociatedwiththeonsetandprognosisofCVD,includingischemicheartdiseaseandstroke,inChineseadults.Putativebehavioralandbiologicalmechanismsareimplicatedinthelinkbetweendepression/anxietyandCVD.TimelyscreeninganddiagnosisfollowedbypropertreatmentshouldbeimplementedfordepressionandanxietyinboththegeneralpopulationandpatientswithCVD.CurrentstandardtreatmentssuchasselectiveserotoninreuptakeinhibitorsandpsychotherapiesarerecommendedforCVDpatientswithdepression,althoughtheirefficacyforreducingCVDmorbidityandmortalityremainsuncertain.Inconclusion,prospectivestudiesonthelinkbetweendepression/anxietyandtheonsetandprognosisofCVDareurgentlyneededintheChinesepopulation,andmoreeffortsarewarrantedtoexaminetheefficacyofdepressionandanxietytreatmentsforCVDpatients,particularlytheintegratedcaremodelofincludingpsychiatristsinamultidisciplinaryclinicalgroup.

简介：Therecognitionthatpsychosocialriskfactorscontributetothepathogenesisofcardiovasculardiseasehasledtothedevelopmentofanewfieldofbehavioralcardiology.Theinitialimpetusforthisfieldwasstudiesperformedinthe1980sand1990sthatprovidedepidemiologicalevidenceandapathophysiologicalbasisforastronglinkbetweenanumberofpsychosocialriskfactorsandcardiovasculardisease,includingdepression,anxiety,hostility,jobstress,andpoorsocialsupport.Inrecentyears,additionalpsychosocialriskfactorshavebeenidentified,includingpessimism;otherformsofchronicstress,suchaschildhoodabuseandtrauma,andthepsychologicalstressthatmaybeassociatedwithchronicmedicalillness;lackoflifepurpose;andthesyndromeof“vitalexhaustion,”whichconsistsofatriadofexhaustion,demoralization,andirritability.Newresearchinthelastdecadehasalsoestablishedthatpositivepsychosocialfactors,suchasoptimism,positiveemotions,avibrantsociallife,andastrongsenseoflifepurpose,canhaveanimportanthealth-bufferingeffectthroughtheirfavorableinfluenceonhealthbehaviorsandpromotionofpositivephysiologicalfunctioning.Patientscanbescreenedforpsychosocialriskfactorsinclinicalpracticethrougheithertheuseofopen-endedquestions,whichcanbeintegratedintoaphysician’sstandardreviewofsystems,ortheuseofshortquestionnaires.Physicianscanassistinthetreatmentofpsychosocialriskfactorsinvariousways,suchasscreeningpatientsforpsychologicaldistressandmakingappropriatereferralswhenindicated,providingpatientswithpracticallifestylesuggestions,andemployingofficepersonneltoteachpatientsbehavioralorpsychosocialinterventionsthatcanpromoteasenseofwell-beingand/orreducestress.

简介：AbstractCell death occurs in various tissues and organs in the body. It is a physiological or pathological process that has different effects. It is of great significance in maintaining the morphological function of cells and clearing abnormal cells. Pyroptosis, apoptosis, and necrosis are all modes of cell death that have been studied extensively by many experts and scholars, including studies on their effects on the liver, kidney, the heart, other organs, and even the whole body. The heart, as the most important organ of the body, should be a particular focus. This review summarizes the mechanisms underlying the various cell death modes and the relationship between the various mechanisms and heart diseases. The current research status for heart therapy is discussed from the perspective of pathogenesis.

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简介：ObjectivesToassesswhetherstatinsreduceall-causemortalityandCVeventsinelderlypeoplewithoutestablishedCVdisease.BackgroundSinceageingofthepopulationissteadilyraising,preventionofcardiovascular(CV)diseaseintheelderlyisrelevant.InelderlypatientswithpreviousCVevents,useofstatinsisrecommendedbyguidelines,whereasbenefitsofthesedrugsinelderlysubjectswithoutpreviousCVeventsarestilldebated.MethodsRandomizedtrialscomparingstatinsversusplaceboandreportingall-causeandCVmortality,myocardialinfarction(MI),stroke,andnewcanceronsetinelderly(>65yearsold)subjectswithoutestablishedCVdiseasewereincluded.ResultsEighttrialsenrolling24,674subjects(42.7%females;meanage73.0+2.9;meanfollow-up3.5+1.5years)wereincludedinanalyses.Statins,comparedtoplacebo,significantlyreducedtheriskofMIby39.4%(relativerisk[RR]:0.606[95%confidenceinterval(CI):0.434to0.847];P=0.003),aswellastheriskofstrokeby23.8%(RR:0.762[CI:0.626to0.926];P=0.006).Incontrast,theriskofall-causedeath(RR:0.941[CI:0.856to1.035];P=0.210)andofCVdeath(RR:0.907[CI:0.686to1.199];P=0.493)werenotsignificantlyreduced.Newcanceronsetdidnotdifferbetweenstatin-comparedtoplacebotreatedsubjects(RR:0.989[CI:0.851to1.151];P=0.890).ConclusionsPInelderlysubjectsathighCVriskwithoutestablishedCVdisease,statinssignificantlyreducetheincidenceofMIandstroke,butdonotsignificantlyprolongsurvivalintheshort-term.

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简介：AbstractBackground:Cardiovascular disease (CVD) is the major noncommunicable disease (NCD) accounting for 17.9 million deaths. If current trends continue, the annual number of deaths from CVD will rise to 22.2 million by 2030. The United Nations General Assembly adopted a sustainable development goal (SDG) by 2030 to reduce NCD mortality by one-third. The purpose of this study was to analyze the CVD mortality trends in different countries implementing World Health Organization (WHO) NCD Action Plan and emphasize effective ways to achieve SDG.Methods:WHO statistics, based on the Member-States unified mortality and causes-of-death reports were used for analyzing trends and different interventions.Results:Reduction of CVD mortality from 2000 to 2016 in 49 countries was achieved for stroke at 43% and ischemic heart disease at 30%. Smoking prevalence and raised blood pressure (RBP) decreased in 84% and 55% of the countries. Eighty-nine percent of high-income countries (HIC) demonstrated a decline in tobacco smoking against 67% in middle-income countries (MIC). Sixty-nine percent of HIC demonstrated a decline in RBP against 15% in MIC. CVD management, tobacco, and unhealthy diet reduction measures are significantly better in HIC. The air pollution level was higher in MIC.Conclusion:Building partnerships between countries could enhance their efforts for CVD prevention and successful achievement of SDG.

简介：In2014theAmericanCollegeofCardiology/AmericanHeartAssociationissuedfournewguidelinesforcardiovasculardiseasepreventionthatfocusedoncardiovascularriskassessment,lifestylemanagement,obesitymanagement,andbloodcholesterolmanagement.Thedevelopmentofanatheroscleroticcardiovasculardiseaseriskcalculatorformedthebasisoftheriskassessmentguideline,andthelifestylemanagementguidelinefocusedonrecommendinganevidence-baseddietarypattern.Thebloodcholesterolmanagementguidelinespecificallyidentifiedfourgroupsofpatientsshowntobenefitfrommoderate-intensityorhigh-intensitystatintherapyfrompreviousclinicaltrialsandabandonedtheuseofspecificlow-densitylipoprotein(LDL)cholesterol(LDL-C)goallevelsonthebasisofthelackofclinicaltrialevidence.Therecommendationsfortreatmentwithmoderate-intensityorhigh-intensitystatintherapyarebasedonrigorousevidencefromrandomizedclinicaltrials.Guidancehassincebeenprovidedfortheuseofnonstatintherapies,includingcholesterolabsorptioninhibitorandproproteinconvertasesubtilisin/kexintype9monoclonalantibodytherapywhenadequatereductionofLDL-Clevelsisnotachievedwithmaximallytoleratedstatintherapy.TherecentdevelopmentandapplicationofthesetherapieshaveresultedinremarkablereductionsinLDL-Clevelsthatarewelltolerated,andpreliminaryoutcomedataarepromisinginshowingsubstantialatheroscleroticcardiovasculardiseaseeventreductionsbeyondstatintherapy.

简介：瞄准：评估对在有动脉的可勃起的机能障碍(编辑)的病人的sildenafil管理的反应是否与他们的山峰有关收缩速度(PSV)，外部动脉粥样硬化，心血管的风险因素(RF)或在低心血管的风险的comorbidities。方法：我们与12RF和comorbidities注册了97个病人，独自与动脉的编辑结合了(组A，n=27)，编辑正动脉粥样硬化患者颈动脉动脉(组B，n=23)，编辑正更低的手足动脉畸形(组C，n=25)，并且编辑正颈动脉和更低的手足动脉畸形(组D，n=22)。Sildenafil功效(100mg两次为12个星期的一个星期)也与≥在病人被检验3RF，外部动脉粥样硬化和没有心血管的comorbidities(组E，n=20)。结果：中部的PSV分别地是在组A，B，C，D和E的24.1，21.0，19.3，14.5和17.5cm/s。Sildenafil反应在组A是更高的病人(77.8%)，在组B和C(65.2%和56%)中间、在组最低D(45.4%)和E(50%)，和在后者二组的反应比在另外的三个组显著地低。另外，sildenafil反应否定地旁边被影响：≥3RF，外部动脉粥样硬化和没有全身的comorbidity，或与扩大动脉粥样硬化和comorbidities联系的12RF的存在。comorbidities的数字是断然与动脉粥样硬化本地化或扩展有关(25，35，38和47在组A，B，C和D，分别地)。结论：在有动脉的编辑的病人的低sildenafil功效与扩大动脉粥样硬化被联系。这些病人应该经历广泛的ultrasonography和完整的心血管的考试。

简介：AbstractBackground:Non-communicable chronic diseases have become the leading causes of disease burden worldwide. The trends and burden of "metabolic associated fatty liver disease" (MAFLD) are unknown. We aimed to investigate the cardiovascular and renal burdens in adults with MAFLD and non-alcoholic fatty liver disease (NAFLD).Methods:Nationally representative data were analyzed including data from 19,617 non-pregnant adults aged ≥20 years from the cross-sectional US National Health and Nutrition Examination Survey periods, 1999 to 2002, 2003 to 2006, 2007 to 2010, and 2011 to 2016. MAFLD was defined by the presence of hepatic steatosis plus general overweight/obesity, type 2 diabetes mellitus, or evidence of metabolic dysregulation.Results:The prevalence of MAFLD increased from 28.4% (95% confidence interval 26.3-30.6) in 1999 to 2002 to 35.8% (33.8-37.9) in 2011 to 2016. In 2011 to 2016, among adults with MAFLD, 49.0% (45.8-52.2) had hypertension, 57.8% (55.2-60.4) had dyslipidemia, 26.4% (23.9-28.9) had diabetes mellitus, 88.7% (87.0-80.1) had central obesity, and 18.5% (16.3-20.8) were current smokers. The 10-year cardiovascular risk ranged from 10.5% to 13.1%; 19.7% (17.6-21.9) had chronic kidney diseases (CKDs). Through the four periods, adults with MAFLD showed an increase in obesity; increase in treatment to lower blood pressure (BP), lipids, and hemoglobin A1c; and increase in goal achievements for BP and lipids but not in goal achievement for glycemic control in diabetes mellitus. Patients showed a decreasing 10-year cardiovascular risk over time but no change in the prevalence of CKDs, myocardial infarction, or stroke. Generally, although participants with NAFLD and those with MAFLD had a comparable prevalence of cardiovascular disease and CKD, the prevalence of MAFLD was significantly higher than that of NAFLD.Conclusions:From 1999 to 2016, cardiovascular and renal risks and diseases have become highly prevalent in adults with MAFLD. The absolute cardiorenal burden may be greater for MAFLD than for NAFLD. These data call for early identification and risk stratification of MAFLD and close collaboration between endocrinologists and hepatologists.

简介：backgroundStudieshavebeeninconsistentregardingwhetherhyperuricemia,eitherdiuretic-ornondiuretic-induced,isanindependentriskfactorforcardiovascularevents.Thestudyinvestigatedtheassociationofcardiovasculardiseasewithdiuretic-andnondiuretic-inducedelevatedserumuricacid.MethodsAcommunity-basedcross-sectionstudywasconductedin5,235treatedanduntreatedhypertensivepatientsaged40-75years.Conventionalriskfactors,serumuricacidandthepresenceofcardiovasculardiseaseweredetermined.Hyperuricemiawasdefinedasserumuricacidlevels≥420μmol/Linmenor≥360μmol/Linwomen.ResultsHyperuricemiawasmorecommoninmenthaninwomen(21.5%vs.10.2%,P<0.001).Afteradjustmentforageandotherconventionalriskfactors,hyperuricemiawasassociatedwithmetabolicsyndrome,decreasedcreatinineclearance,anduseofdiureticsinbothgenders,aswellasageinwomenandalcoholconsumptioninmen.Thepresenceofcoronaryarterydiseaseorstrokeincreasedsignificantlywiththeincreaseofquartilesofserumuricacid(8.0%,11.0%,13.4%,and16.8%,respectively,P<0.01),andthehighestserumuricacidquartilewasassociatedwitha1.8-foldriskforcardiovasculardisease(OR:1.83,95%CI:1.24-2.71)inuntreatedwomen.Butthisassociationwasnotobservedinuntreatedmenaswellasintreatedpatientsusingdiureticsinbothgenders.ConclusionsHyperuricemiaismarkedlyassociatedwithmetabolicsyndrome,decreasedcreatinineclearance,useofdiureticsbesidesalcoholconsumptioninmenandageinwomen.Elevatedserumuricacid,butnotthatdiuretic-induced,maybeassociatedwithincreasedtheriskofcardiovasculardiseaseinuntreatedhypertensivewomen.

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简介：BackgroundValvularheartdisease(VHD)isdefinedasastructuralorfunctionalabnormalityincardiacvalvewhichencompassesanumberofcommoncardiovascularconditions.ThisstudywasaimedtoanalyzetheepidemiologicalchangesofVHDinasinglecardiovascularcenterofSouthernChina.MethodsAtotalof13,138VHDpatientsofGuangdonggeneralhospitalfromJanuary2011toDecember2013werescreenedbytransthoracicechocardiography(TTE)ortransesophagealechocardiography(TEE)andenrolledforthisstudy.Themorbidity,etiologicalspectrumandmanagementofthesepatientswereanalyzed.Continuousvariableswereexpressedasmean±standarddeviation.Categoricalvariableswereexpressedasratioorpercentage.ResultsPatientsinthisstudyweredividedintodifferentgroupsandwereanalyzedthroughoutchangesinmorbidity,etiologicalspectrumandmanagement.ConclusionsTheprevalenceofVHDremainshighinSouthernChinaandRHDisstilltheleadingetiologyofVHD.Butmorbidityrateisreducedandsurgeryisstillthemaintreatmentoption.

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