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Prevalencia de dislipemia aterogénica, factores relacionados y grado de control lipídico en la población general de Galicia. Estudio GALIPEMIAS 加利西亚普通人群动脉粥样硬化性血脂异常的患病率、相关因素和脂质控制程度。加利佩米亚斯研究
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-07-01 DOI: 10.1016/j.arteri.2022.11.002
Carlos Názara , Rosa M. Argüeso , Juan Pedro-Botet , Xavier Pintó , Jesús Millán , Marta Pena Seijo , Pablo A. Fernández , M. Eugenia Ameneiros , Alberto del Alamo , Avelino Rodríguez , José Antonio Díaz-Peromingo , María Rosa Vázquez Freire , Javier Muñiz , Teresa R. Pérez-Castro , José Luis Díaz-Díaz , Antonio Pose Reino

Objectives

GALIPEMIAS is a study designed to establish the prevalence of familial dyslipidemia in the general population of Galicia. The objective of the present study was to assess the prevalence of atherogenic dyslipidemia (AD), its relationship with other cardiovascular risk (CVR) factors, and the degree of lipid control.

Methods

Cross-sectional study carried out in the general population over 18 years of age residing in Galicia and with a health card from the Galician Health Service (N = 1,000). Selection of the sample by means of random sampling by conglomerates. The AD prevalence adjusted for age and sex and the related variables were analyzed.

Results

The prevalence of AD adjusted for age and sex was 6.6% (95% CI: 5.0-8.3%). Arterial hypertension, altered basal glycemia, type 2 diabetes mellitus and cardiovascular disease were more frequent in subjects with AD than in the rest of the population. 47.5% of the subjects with AD had a high or very high CVR. Lipid-lowering drugs were received by 38.9% (30.5% statins) of the participants with AD (46.1% of those with high and 71.4% of those with very high CVR). 25.4% of the subjects with AD had target LDL-c levels, all of them with low or moderate CVR.

Conclusions

The prevalence of AD in the general adult population of Galicia is not negligible, and it was related to several CVR factors and cardiovascular disease. Despite this, this lipid alteration was underdiagnosed and undertreated.

目的研究家族性血脂异常在加利西亚普通人群中的患病率。本研究的目的是评估动脉粥样硬化性血脂异常(AD)的患病率、其与其他心血管风险(CVR)因素的关系以及脂质控制程度。方法对居住在加利西亚并持有加利西亚卫生服务局健康卡(N=1000)的18岁以上普通人群进行横断面研究。通过企业集团随机抽样的方式选择样品。分析了经年龄和性别调整后的AD患病率以及相关变量。结果经年龄和性别校正后的AD患病率为6.6%(95%CI:5.0-8.3%),AD患者动脉高压、基础血糖改变、2型糖尿病和心血管疾病的发生率高于其他人群。47.5%的AD受试者具有高或非常高的CVR。38.9%(30.5%的他汀类药物)的AD患者(46.1%的高CVR患者和71.4%的极高CVR患者)服用了降脂药物。25.4%的AD受试者具有目标LDL-c水平,均具有低或中度CVR。结论在加利西亚的普通成年人群中,AD的患病率不容忽视,它与多种CVR因素和心血管疾病有关。尽管如此,这种脂质改变的诊断和治疗都不足。
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引用次数: 0
Colesterol remanente, riesgo vascular y prevención de la arteriosclerosis 残余胆固醇、血管风险和动脉粥样硬化预防
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-07-01 DOI: 10.1016/j.arteri.2023.02.001
Xavier Pintó , Marta Fanlo , Virginia Esteve , Jesús Millán

In patients who have achieved optimal LDL-C control, there remains a residual risk of atherothrombotic cardiovascular disease (ACVD) related to alterations in lipid metabolism, where alterations in triglyceride-rich lipoproteins and the cholesterol they contain, called remnant cholesterol, play a major role. Remnant cholesterol has an association with residual risk of ACVD that is independent of LDL-C and has been demonstrated in epidemiological and Mendelian randomisation studies, and in analyses of clinical trials of lipid-lowering drugs. Remnant triglyceride-rich lipoproteins particles are highly atherogenic, due to their ability to enter and be retained in the arterial wall, their high cholesterol content, and their ability to generate “foam cells” and an inflammatory response. Assessment of remnant cholesterol may provide information on residual risk of ACVD beyond the information provided by LDL-C, Non-HDL-C, and apoB, particularly in individuals with hypertriglyceridaemia, type 2 diabetes, or metabolic syndrome. In the REDUCE-IT study, icosapent ethyl was shown to have a preventive effect against ACVD in very high cardiovascular risk patients with hypertriglyceridaemia treated with statins and target LDL-C. New lipid-lowering drugs will help to define efficacy and criteria in the treatment of excess remnant cholesterol and hypertriglyceridaemia in the prevention of ACVD.

在达到最佳LDL-C控制的患者中,仍然存在与脂质代谢改变有关的动脉粥样硬化性血栓性心血管疾病(ACVD)的残余风险,其中富含甘油三酯的脂蛋白及其所含胆固醇(称为残余胆固醇)的改变起着主要作用。残留胆固醇与ACVD的残留风险有关,这与LDL-C无关,并已在流行病学和孟德尔随机化研究以及降脂药物临床试验分析中得到证实。残留的富含甘油三酯的脂蛋白颗粒高度致动脉粥样硬化,因为它们能够进入并保留在动脉壁中,胆固醇含量高,并且能够产生“泡沫细胞”和炎症反应。残余胆固醇的评估可以提供LDL-C、非HDL-C和apoB提供的信息之外的ACVD残余风险信息,特别是在患有高甘油三酯血症、2型糖尿病或代谢综合征的个体中。在REDUCE-IT研究中,在接受他汀类药物和靶向LDL-C治疗的高甘油三酯血症高危心血管患者中,icosapent ethyl对ACVD具有预防作用。新型降脂药物将有助于确定治疗ACVD中过量残余胆固醇和高甘油三酯血症的疗效和标准。
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引用次数: 1
La asignación de factor impacto a Clínica e Investigación en Arteriosclerosis: ¡Un objetivo conseguido! 将影响因素分配给动脉硬化症的临床和研究:实现了一个目标!
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-07-01 DOI: 10.1016/j.arteri.2023.07.001
Josep Ribalta, Carlos Lahoz, Xavier Pintó
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引用次数: 0
The benefits of measuring the size and number of lipoprotein particles for cardiovascular risk prediction: A systematic review and meta-analysis 测量脂蛋白颗粒大小和数量对心血管风险预测的益处:一项系统综述和荟萃分析
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-07-01 DOI: 10.1016/j.arteri.2022.11.001
Jose A. Quesada , Vicente Bertomeu-González , Domingo Orozco-Beltrán , Alberto Cordero , Vicente F. Gil-Guillén , Adriana López-Pineda , Rauf Nouni-García , Concepción Carratalá-Munuera

Objective

Cardiovascular risk (CVR) is conventionally calculated by measuring the total cholesterol content of high-density lipoproteins (HDL) and low-density lipoproteins (LDL). The purpose of this systematic review was to assess the CVR associated with LDL and HDL particle size and number as determined by nuclear magnetic resonance (NMR) spectroscopy.

Material and methods

A literature search was performed using the electronic databases MEDLINE and Scopus. All cohort and case–control studies published before January 1, 2019 that met the following inclusion criteria were included: HDL-P, LDL-P, HDL-Z and/or LDL-Z measured by NMR spectroscopy; cardiovascular event as an outcome variable; risk of cardiovascular events expressed as odds ratios or hazard ratios; only adult patients. A meta-analysis was performed for each exposure variable (4 for LDL and 5 for HDL) and for each exposure measure (highest versus lowest quartile and 1-standard deviation increment).

Results

This review included 24 studies. Number of LDL particles was directly associated with CVR: risk increased by 28% with each standard deviation increment. LDL particle size was inversely and significantly associated with CVR: each standard deviation increment corresponded to an 8% risk reduction. CVR increased by 12% with each standard deviation increase in number of small LDL particles. HD, particle number and size were inversely associated with CVR.

Conclusion

Larger particle size provided greater protection, although this relationship was inconsistent between studies. Larger number of LDL particles and smaller LDL particle size are associated with increased CVR. Risk decreases with increasing number and size of HDL particles.

心血管风险(CVR)通常通过测量高密度脂蛋白(HDL)和低密度脂蛋白的总胆固醇含量来计算。本系统综述的目的是评估通过核磁共振(NMR)光谱测定的与LDL和HDL颗粒大小和数量相关的CVR。材料和方法使用电子数据库MEDLINE和Scopus进行文献检索。2019年1月1日之前发表的所有符合以下纳入标准的队列和病例对照研究均被纳入:通过NMR光谱测量的HDL-P、LDL-P、HDL-Z和/或LDL-Z;心血管事件作为结果变量;以比值比或危险比表示的心血管事件风险;仅限成年患者。对每个暴露变量(低密度脂蛋白4个,高密度脂蛋白5个)和每个暴露测量(最高和最低四分位数和1个标准差增量)进行荟萃分析。结果本综述包括24项研究。LDL颗粒的数量与CVR直接相关:每增加一个标准差,风险就会增加28%。LDL颗粒大小与CVR呈反比且显著相关:每增加一个标准差,风险就会降低8%。小LDL颗粒数量每增加一个标准偏差,CVR就会增加12%。HD、颗粒数量和大小与CVR呈负相关。结论较大的颗粒大小提供了更大的保护,尽管研究之间的这种关系不一致。LDL颗粒数量越大,LDL颗粒尺寸越小,CVR越高。风险随着高密度脂蛋白颗粒数量和大小的增加而降低。
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引用次数: 1
Increasing muscular strength to improve cardiometabolic risk factors 增加肌肉力量以改善心脏代谢的危险因素
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-05-01 DOI: 10.1016/j.arteri.2022.12.002
Patricio Lopez-Jaramillo , Jose P. Lopez-Lopez , Maria Camila Tole , Daniel D. Cohen

Cardiovascular diseases (CVDs) remain the leading cause of worldwide death, accounting for significant morbidity, mortality, disability, and reduced quality of life. The global prevalence of cardiovascular (CV) risk factors, such as type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity, has grown exponentially in the last decades, particularly in low-medium income countries, and it's projected to increase rapidly in the coming years as the population progressively ages, leading to increased cardiovascular disease (CVD) and associated mortality. In fact, data from the global burden of disease study shows that CV mortality, associated disability-adjusted life years (DALYs), and years of life lost (YLL) have increased steadily, nearly doubling from 1990 to 2019.

Recent evidence proves the existence of an inverse association between hand grip strength (HGS), as a proxy for global muscle strength, with all-cause mortality, CV mortality, and the development of several chronic diseases. These associations have been demonstrated recurringly across the entire lifespan, beginning in childhood, and carrying on throughout adult life. Mounting evidence strongly indicates that HGS is an early predictor of chronic disease in premorbid populations and a therapeutic target for CVD prevention. Recent clinical trials have consistently shown that resistance exercise, which increases strength and potentially muscle mass, significantly improves the control of known CVD risk factors, reduces the risk of all-cause death and cardiovascular mortality.

In this review, we explore the latest evidence regarding the association between low muscle strength and diverse metabolic alterations, along with the interventions that could improve cardiometabolic risk factors, while simultaneously increasing muscle fitness.

心血管疾病(CVD)仍然是全球死亡的主要原因,造成了严重的发病率、死亡率、残疾和生活质量下降。心血管(CV)危险因素的全球流行率,如2型糖尿病、高血压、血脂异常和肥胖,在过去几十年中呈指数级增长,特别是在中低收入国家,随着人口年龄的增长,预计在未来几年将迅速增加,导致心血管疾病(CVD)和相关死亡率增加。事实上,来自全球疾病负担研究的数据显示,CV死亡率、相关残疾调整生命年(DALYs)和生命损失年(YLL)稳步上升,从1990年到2019年几乎翻了一番。最近的证据证明,作为全球肌肉力量指标的握力(HGS)与全因死亡率、CV死亡率,以及几种慢性疾病的发展。这些关联在整个生命周期中反复出现,从童年开始,一直延续到成年。越来越多的证据有力地表明,HGS是病前人群中慢性病的早期预测因子,也是预防CVD的治疗靶点。最近的临床试验一致表明,阻力运动可以增加力量和潜在的肌肉质量,显著改善对已知心血管疾病危险因素的控制,降低全因死亡和心血管死亡率的风险。在这篇综述中,我们探讨了有关低肌肉力量与多种代谢变化之间关系的最新证据,以及可以改善心脏代谢风险因素的干预措施,同时提高肌肉素质。
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引用次数: 0
Recomendaciones nutricionales en la prevención y tratamiento de la dislipemia aterogénica. Grupo de Trabajo Dislipemia Aterogénica, Sociedad Española de Arteriosclerosis 预防和治疗动脉粥样硬化性血脂异常的营养建议。西班牙动脉硬化学会动脉粥样硬化性血脂异常工作组
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-05-01 DOI: 10.1016/j.arteri.2022.09.002
Vicente Pascual , José Luis Díaz , Jesús Millán Nuñez-Cortés , Pablo Pérez-Martínez

The incorporation of a healthy diet, regular physical exercise and smoking cessation are the initial measures to reduce cardiovascular risk in patients with atherogenic dyslipidemia. In these patients, the nutritional quality of their diet should be improved, replacing foods with a greater atherogenic effect for others with a healthier effect. There is strong evidence that plant-based dietary patterns, low in saturated fatty acids, cholesterol and sodium, with a high content of fiber, potassium and unsaturated fatty acids, are beneficial and reduce the expression of cardiovascular risk factors. This document focuses on the role of nutrition in the prevention and treatment of atherogenic dyslipidemia, providing current evidence to serve as a tool for health professionals in its clinical management. To facilitate the reading of these recommendations, they are presented in a user-friendly table format, with a hierarchy of different levels of evidence.

健康饮食、定期体育锻炼和戒烟是降低动脉粥样硬化性血脂异常患者心血管风险的初步措施。在这些患者中,他们饮食的营养质量应该得到改善,用更健康的效果取代那些对动脉粥样硬化有更大影响的食物。有强有力的证据表明,植物性饮食模式,饱和脂肪酸、胆固醇和钠含量低,纤维、钾和不饱和脂肪酸含量高,有益于降低心血管风险因素的表达。本文件侧重于营养在预防和治疗动脉粥样硬化性血脂异常中的作用,为卫生专业人员的临床管理提供了最新的证据。为了便于阅读这些建议,这些建议以用户友好的表格格式呈现,并有不同级别的证据层次。
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引用次数: 0
Dietary modulation of advanced glycation end products metabolism on carotid intima-media thickness in type 2 diabetes patients: From the CORDIOPREV study 饮食调节2型糖尿病患者晚期糖基化终产物代谢对颈动脉内膜-中膜厚度的影响:来自CORDIOPREV研究
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-05-01 DOI: 10.1016/j.arteri.2022.08.004
Elena M. Yubero-Serrano , Francisco M. Gutiérrez-Mariscal , Purificación Gómez-Luna , Juan F. Alcalá-Diaz , Pablo Pérez-Martinez , José López-Miranda

Background

Advanced glycation end products (AGEs) are pro-oxidant and cytotoxic compounds involved in the progression of chronic diseases as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). The total body burden of AGEs also depend of those consume through the diet. Our aim was to analyze whether the reduction of AGE levels, after the consumption of two-healthy diets were associated with a greater decrease of intima-media thickness of both common carotid arteries (IMT-CC) in patients with T2DM and coronary heart disease (CHD).

Methods

540 CHD patients with T2DM, at baseline, from the CORDIOPREV study, were divided into two groups: (1) Responders, patients whose IMT-CC was reduced or not changed after dietary intervention and (2) Non-responders, patients whose IMT-CC was increased after dietary intervention. A total of 423 completed baseline and the 5-year follow-up carotid ultrasounds were analyzed in this study.

Results

Our data showed that Responders, despite had a higher baseline IMT-CC and serum methylglyoxal (MG) levels than Non-responders, showed a reduction of serum levels of this glycotoxin after dietary intervention. Conversely, in patients whose IMT-CC was increased after dietary intervention (Non-responders), serum MG levels were increased. Moreover, an increase of circulating level of AGEs (and in particular, MG), after dietary intervention, could be considered a risk factor for the progression of atherosclerosis in patients with T2DM and CHD.

Conclusion

These results support the importance of identifying underlying mechanisms in the context of secondary prevention of CVD that would provide therapeutic targets to reduce the high risk of cardiovascular events of these patients.

Clinical Trial registration-URL: https://clinicaltrials.gov/ct2/show/NCT00924937.

Unique Identifier: NCT00924937.

背景晚期糖基化终产物(AGEs)是一种促氧化和细胞毒性化合物,参与心血管疾病(CVD)和2型糖尿病(T2DM)等慢性疾病的进展。AGEs的总身体负担也取决于通过饮食摄入的AGEs。我们的目的是分析两种健康饮食后AGE水平的降低是否与T2DM和冠心病患者颈总动脉内膜-中膜厚度的更大降低有关,饮食干预后IMT-CC降低或未改变的患者和(2)饮食干预后无反应、IMT-CC增加的患者。本研究共分析了423例完成基线检查和5年随访的颈动脉超声。结果我们的数据显示,尽管应答者的基线IMT-CC和血清甲基乙二醛(MG)水平高于非应答者,但在饮食干预后,这种糖毒素的血清水平有所降低。相反,在饮食干预后IMT-CC增加的患者(无应答者)中,血清MG水平增加。此外,在饮食干预后,AGEs(尤其是MG)循环水平的增加,可被认为是T2DM和CHD患者动脉粥样硬化进展的危险因素。结论这些结果支持在心血管疾病二级预防的背景下确定潜在机制的重要性,这将为降低这些患者心血管事件的高风险提供治疗靶点。临床试验注册URL:https://clinicaltrials.gov/ct2/show/NCT00924937.Unique标识符:NCT00924937。
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引用次数: 1
Actualización y validación del riesgo cardiovascular de por vida en España: IBERLIFERISK2 西班牙终身心血管风险的更新和验证:IberLifeRisk2
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-05-01 DOI: 10.1016/j.arteri.2022.09.003
Carlos Brotons , Irene Moral-Peláez , Johanna Vicuña , Cristina Ameixeiras , Carlos Fernández-Lavandera , Miguel Ángel Sánchez-Chaparro

Introduction

The function to estimate lifetime cardiovascular risk –IBERLIFERISK– in Spanish working population, obtained a satisfactory discrimination; however, there was a slight overestimation of the risk in men and an underestimation of the risk in women.

Objective

To recalibrate the current lifetime risk equation after extending the follow-up by 3 years.

Methods

Retrospective cohort study. 762.058 workers who underwent an occupational health examination between 2004 and 2007 were included. All episodes of temporary sickness and cardiovascular mortality up to December 2017 were evaluated. Regression models were combined to take into account the presence of competing risks in estimating cardiovascular risk in the derivation cohort. Calibration was performed by graphically representing the proportion of expected and observed events at 10 years of follow-up in the validation cohort, stratifying by risk deciles and calculating the Spiegelhalter Z statistic. Discrimination was evaluated graphically using the Receiver Operating Curve (ROC) and calculating Harrell's C index.

Results

The mean age was 35.48 years (SD 10.56). 71.14% were men. Harrell's C index was 0.78 (95% CI 0.76-0.79) in men and 0.73 (95% CI 0.69-0.77) in women. In general, there was a slight degree of underestimation in women and overestimation in men in the last decile of risk, although the Spiegelhalter Z statistic was not statistically significant in both sexes (p>0.05).

Conclusions

The updated model continues to discriminate satisfactorily, although the model's calibration has not substantially improved with the new update.

引言在西班牙工作人群中估计终身心血管风险的功能IBERLIFERISK获得了令人满意的判别;然而,男性的风险略有高估,女性的风险则有所低估。目的在延长随访3年后,重新校准当前的终生风险方程。方法回顾性队列研究。762.058名在2004年至2007年期间接受职业健康检查的工人也包括在内。对截至2017年12月的所有暂时性疾病发作和心血管死亡率进行了评估。将回归模型结合起来,以考虑衍生队列中估计心血管风险时存在的竞争风险。通过图形化表示验证队列中10年随访时预期和观察到的事件的比例,按风险十分位数进行分层,并计算Spiegelholter Z统计量来进行校准。使用受试者工作曲线(ROC)并计算Harrell的C指数以图形方式评估辨别度。结果平均年龄35.48岁(标准差10.56),男性71.14%。男性的Harrell C指数为0.78(95%CI 0.76-0.79),女性为0.73(95%CI 0.69-0.77)。总的来说,尽管Spiegelholter Z统计数据在两性中都没有统计学意义(p>0.05),但在最后十分之一的风险中,女性和男性都有轻微的低估和高估。
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引用次数: 2
Actualización y validación del riesgo cardiovascular 心血管风险的更新和验证
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-05-01 DOI: 10.1016/j.arteri.2023.05.004
José Ignacio Cuende
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引用次数: 0
Association between physical activity and coronary artery calcification estimated by computed tomography: A systematic review 计算机断层扫描评估体力活动与冠状动脉钙化的关系:一项系统综述
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2023-05-01 DOI: 10.1016/j.arteri.2022.10.001
Walter Masson, Leandro Barbagelata, Mariano Falconi, Diego Pérez de Arenaza

Background

The relationship between physical activity and coronary artery calcification (CAC) was evaluated in different studies during the last years, although the results were conflicting.

Objective

The main objective of the present systematic review was to assess the association between different levels of physical activity and CAC score estimated by computed tomography (CT).

Methods

This systematic review was performed according to PRISMA guidelines. A literature search was performed to detect studies that evaluated the association between physical activity and CAC score. The levels of physical activity evaluated were those reported by the original publications. The CAC score was estimated by CT and was reported in Agatston units.

Results

Twenty six studies including 89,405 subjects were considered eligible for this research. The studies developed in the general population showed different results regarding the association between physical activity and CAC score: no association (7 studies), a positive association (4 studies), an inverse relationship (6 studies), a U-shaped relationship (2 studies), or different results depending on the subgroup evaluated (2 studies). In the largest studies, a positive association was observed. When we analyzed the studies that evaluated athletes, four studies showed a positive association between exercise intensity and CAC.

Conclusion

This systematic review showed disparate results regarding the association between physical activity and CAC score. The largest studies and most studies developed in athletes suggest that intense physical activity could be associated with high CAC score, although this hypothesis should be confirmed in future research.

背景在过去几年中,不同的研究评估了体育活动与冠状动脉钙化(CAC)之间的关系,尽管结果相互矛盾。目的本系统综述的主要目的是评估不同水平的体力活动与计算机断层扫描(CT)估计的CAC评分之间的关系。方法根据PRISMA指南进行系统综述。进行文献检索,以检测评估体力活动与CAC评分之间相关性的研究。评估的体育活动水平是原始出版物所报告的水平。CAC评分由CT估计,并以Agaston单位报告。结果包括89405名受试者在内的26项研究被认为符合本研究的条件。在普通人群中进行的研究显示,关于体育活动与CAC评分之间的关联,结果不同:无关联(7项研究)、正关联(4项研究),反比关系(6项研究)和U型关系(2项研究)或根据评估的亚组得出不同结果(2项研究)。在规模最大的研究中,观察到了正相关。当我们分析评估运动员的研究时,有四项研究显示运动强度与CAC呈正相关。结论这项系统综述显示,关于体育活动与CAC评分之间的关联,结果各不相同。对运动员进行的最大规模的研究和大多数研究表明,剧烈的体育活动可能与高CAC分数有关,尽管这一假设应在未来的研究中得到证实。
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引用次数: 0
期刊
Clinica e Investigacion en Arteriosclerosis
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