梅斯心血管疾病进展 (009期)

2021-07-23 K.K MedSci原创

编者按:梅斯医学将定期进行汇总,帮助大家概览心血管领域最新进展。下面是呈现给大家的最新一期的心血管进展。enjoy~

roche

上一期见:梅斯血管疾病进展(008期)

1. 儿童二手烟暴露对非吸烟女性人群的高脂血症和冠心病有显着影响

在这项横断面研究中,通过问卷调查的方式获得儿童SHS暴露的数据。自述的二手烟(SHS)暴露定义为父母中至少有一人在儿童时期吸烟。该研究共调查了6522例40周岁以上女性,最终有2120例被纳入本次分析。

相关变量校正后儿童SHS暴露与疾病之间的关联

本研究表明,儿童SHS暴露对非吸烟女性人群的高脂血症和冠心病有显着影响,提示儿童SHS暴露可能是在成年后发生高脂血症和冠心病的重要危险因素。同时,这些发现也表明,女性SHS暴露是一项紧急的公共卫生事件,特别是儿童时期的SHS暴露。因此,政府应采取措施提高人们对二手烟暴露的健康危害认识,通过提供无烟草环境来限制二手烟暴露,并完善相关法律法规。

详情参考:BMJ Open:一项横断面研究:中国非吸烟女性儿童时期二手烟暴露与患高脂血症和冠心病的联系

2. 诊室、中心和动态血压可预测老年人首次卒中

近日,血管权威杂志Hypertension上发表了一篇研究文章,研究人员主要基于老年人群的前瞻性队列比较了诊室、中心和动态血压测量在卒中风险预测方面的价值。

在9.6±3.1年的随访期间,76名参与者(9.3%)发生了卒中。在诊室血压变量中,多变量竞争风险模型中只有舒张压与卒中相关(P=0.016)。没有一个中心血压变量与卒中之间存在显著的关联。相反,在调整临床混杂因素后,所有动态收缩压和舒张压变量均与卒中显著相关(所有P<0.005)。在一个额外的多变量竞争风险模型中,纳入了同一天同一时间获得的动态收缩压和舒张压值,在24小时、白天和夜间期间,舒张压与卒中的相关性比收缩压更密切(所有P<0.05 )。

由此可见,在以老年人群为主的队列中,诊室舒张压与卒中发生的相关性较弱;中心血压变量不能预测卒中。然而,在多变量竞争风险分析中,动态收缩压和舒张压值都与卒中显著相关。此外,动态舒张压比动态收缩压能更好地预测卒中。

详情参考:Hypertension:诊室、中心和动态血压可预测老年人首次卒中

3. 血压控制<140/90 mmHg与老年HF患者的死亡风险降低无关

近日,为了评估血压控制在140/90mmHg以下是否与老年高血压是心力衰竭(HF)患者的死亡风险降低有关。来自加拿大McGill大学流行病学系的专家开展了一项基于人群的前瞻性队列研究,最新的结果发表在《年龄与衰老》Age & Ageing杂志上。

柏林倡议研究是一个在2009年启动的社区居住的老年人的前瞻性队列,通过面对面的访谈获得临床信息。使用Cox比例危害模型估计了与HF患者非正常化血压(收缩压≥140 mmHg或舒张压≥90 mmHg)相比,正常化血压(收缩压<140 mmHg和舒张压<90 mmHg)相关的血管死亡和全因死亡的调整危险比。

结果显示,在基线时,544名患者被诊断为HF并接受降压药物治疗(平均年龄82.8岁;45.4%为女性)。在7.5年的中位随访期间,时间固定分析显示,与非正常化血压相比,正常化血压与心血管死亡(HR=1.24;95%CI:0.84-1.85)和全因死亡(HR=1. 16;95% CI:0.89-1.51)的风险类似。但在时间依赖分析中,心血管死亡(HR=1.79;95% CI:1.23-2.61)和全因死亡(HR=1.48;95% CI=1.15-1.90)的风险分别增加79%与48%。

实际上,对于现有或曾经有心衰症状和体征的高血压患者,多数指南建议降压靶目标为<130/80 mmHg。一项研究显示,更低的血压控制水平会增加患者因心衰再入院、各种原因急诊再入院及死亡的发生率。2016年发表于Lancet杂志的一项荟萃分析显示,强化降压(收缩压<120 mmHg)并未降低心衰事件发生率。而新近发表的SPRINT研究发现,强化降压与标准降压相比可有效降低心衰事件发生率。这三项研究的结果并不一致,提示:不同心功能状态患者的降压目标值可能不同,慢性心衰合并高血压的降压目标值得进一步探讨。

由此可见,血压控制<140/90 mmHg与老年HF患者的死亡风险降低无关。同时,时间依赖性分析中的风险增加需要进一步证实。

详情参考:Age & Ageing:老年心衰患者如何控制血压才能最大程度降低死亡风险?

4. 母乳喂养,与3岁时较低的血压相关

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,在加拿大健康婴儿纵向发展队列研究中,研究人员分析了2382名儿童早期母乳喂养和血压的完整数据。从医院记录中记录了婴儿出生后最初几天的喂养情况,并由母亲报告整个婴儿时期的喂养情况。研究人员在婴儿3岁时测量其血压。分析控制了出生体重、胎龄、社会经济状况、母亲体重指数和其他潜在的混杂因素。

研究人员发现几乎所有的儿童(2333/2382;97.9%)均接受了母乳喂养,其中98人(4.2%)在分娩住院期间仅短暂接受母乳喂养("早期有限母乳喂养")。3岁时,从未接受过母乳喂养的儿童的血压(平均收缩压/舒张压为103/60 mmHg)高于曾经接受过母乳喂养的儿童(99/58 mmHg),包括那些早期仅接受过有限母乳喂养的儿童(99/57 mmHg)。

母乳喂养与儿童3岁时血压的关系

这些收缩压差异在调整后的模型中仍然存在(曾经母乳喂养:-3.47 mmHg,95%CI为-6.14至-0.80;早期有限母乳喂养:-4.24 mmHg, 95%CI为-7.45至-1.04)。在母乳喂养的儿童中,根据母乳喂养的持续时间,没有显著的剂量反应关联。这种关联不受儿童体重指数的影响。

由此可见,尽管持续和纯母乳喂养的好处是无可争辩的,但这项研究表明,任何母乳喂养,无论是母乳喂养持续时间还是纯母乳喂养,都与3岁时较低的血压相关。对早期母乳的生物活性成分、潜在机制和长期关联进行进一步的研究很有必要的。

详情参考:JAHA:母乳喂养与儿童血压有关

 

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    2021-07-30 yuyio

    追更!

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    2021-07-25 一闲
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