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A call for a gender specific approach to address the worldwide cardiovascular burden 呼吁采取针对不同性别的方法来处理全球心血管负担
Pub Date : 2005-09-01 DOI: 10.1016/j.precon.2005.10.003
Nahid Azad , Sania Nishtar

Cardiovascular diseases (CVD) among non-communicable diseases are already a major public health challenge worldwide. A further increase in CVD is projected to occur over the next 25 years as a result of both adverse lifestyle changes and demographic shifts in the population age profile. The adverse impact of these health problems will affect women in particular, given the steady rise in the proportion of the aging population that will be women.

The critical issue presently in the management of CVD is that we are not even adequately using the data that are available. Women still remain unaware that they are at risk, and information about women is not easily accessible to their physicians. This is a global issue and the need remains for worldwide initiatives with greater vigilance to identify these factors and make efforts to control them effectively.

Currently, in scientific research, it is expected that the results of clinical research be analyzed for sex differences, sex- and gender-appropriateness, and sex- and gender-specific approaches for prevention, diagnosis, treatment, and counseling. To address the care discrepancy, the global community needs to develop a conducive environment within a comprehensive policy and operational framework to achieve favorable lifestyles, and CVD risk factor reduction for both men and women.

在非传染性疾病中,心血管疾病已经是全世界面临的一个重大公共卫生挑战。由于不良生活方式的改变和人口年龄结构的变化,预计未来25年心血管疾病的发病率将进一步增加。这些健康问题的不利影响将特别影响到妇女,因为老年人口中妇女的比例将稳步上升。目前心血管疾病管理的关键问题是,我们甚至没有充分利用现有的数据。妇女仍然不知道她们处于危险之中,她们的医生也不容易获得有关妇女的信息。这是一个全球性的问题,仍然需要以更大的警惕采取世界性的主动行动,以查明这些因素并努力有效地加以控制。目前,在科学研究中,期望对临床研究结果进行性别差异、性别和性别适当性以及针对性别和性别的预防、诊断、治疗和咨询方法的分析。为了解决护理差异,国际社会需要在全面的政策和操作框架内创造一个有利的环境,以实现有利的生活方式,并减少男性和女性的心血管疾病风险因素。
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引用次数: 4
Website reviews 网站的评论
Pub Date : 2005-09-01 DOI: 10.1016/j.precon.2005.09.001
Hongbo Liang
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引用次数: 0
UN news
Pub Date : 2005-09-01 DOI: 10.1016/j.precon.2005.06.007
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引用次数: 0
Building awareness through a social marketing project in Russia 在俄罗斯通过社会营销项目建立知名度
Pub Date : 2005-09-01 DOI: 10.1016/j.precon.2005.06.008
Helen Alderson
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引用次数: 1
Building national capacity for cardiovascular disease prevention in low–medium income countries: The Nigerian Heart Foundation experience 建设中低收入国家预防心血管疾病的国家能力:尼日利亚心脏基金会的经验
Pub Date : 2005-09-01 DOI: 10.1016/j.precon.2005.10.004
Kingsley K. Akinroye , Pascal Bovet , Moses Tanimowo
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引用次数: 0
Pub Date : 2005-06-01 DOI: 10.1016/j.precon.2005.06.005
Andy Wielgosz (Editor-in-Chief)
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引用次数: 0
Cardiovascular mortality and risk factors: Is Poland repeating the US experience of 30 years ago? 心血管死亡率和危险因素:波兰是否在重复美国30年前的经验?
Pub Date : 2005-06-01 DOI: 10.1016/j.precon.2005.06.003
Mark W. Massing , Stefan L. Rywik , Grazyna B. Broda , Bogdan Jasinski , Andrzej Pajak , Herman A. Tyroler , O. Dale Williams , Teri A. Manolio

Background

Cardiovascular diseases (CVD) have been leading causes of death in the United States (US) and Poland. CVD and coronary heart disease (CHD) death rates have changed in both countries in recent decades. We examined these mortality trends in the two countries and considered their relations to contemporaneous changes in risk factor exposures.

Methods

Mortality and population data were obtained from the Polish Main Statistical Office (1970–96), the US Community Structures Project (1962–67), and the US National Center for Health Statistics (1968–2000). Best-fit, age-standardized, mortality rate trend curves for ages 35–64 years were generated with local regression and were quantified with piecewise log-linear regression. Contemporaneous risk factor exposures were obtained from published sources and from Pol-MONICA data.

Results

While mortality rates leveled and declined in the US, they increased in Poland resulting in Polish rates exceeding those of US Caucasians and approaching or exceeding those of African Americans. Increasing mortality rate trends in Poland reversed in 1991, and declined thereafter, especially for CHD. US mortality declines were accompanied by reductions in multiple risk factors. Decreased risk factor exposures were noted during CHD declines in Poland, but differed somewhat from the US experience.

Conclusions

The reversal of increasing CVD mortality rate trends in Poland during the 1990s is reminiscent of a similar reversal in the US 30 years earlier and was accompanied by reduced risk factor exposures in both countries. The similarity of experiences comparing the two countries demonstrates the importance of efforts to reduce population exposures to preventable risk factors.

背景:在美国和波兰,心血管疾病(CVD)已成为导致死亡的主要原因。近几十年来,两国心血管疾病和冠心病(CHD)死亡率都发生了变化。我们检查了这两个国家的死亡率趋势,并考虑了它们与同期危险因素暴露变化的关系。方法死亡率和人口数据来自波兰主要统计局(1970 - 1996)、美国社区结构项目(1962-67)和美国国家卫生统计中心(1968-2000)。采用局部回归生成35-64岁年龄段的最佳拟合、年龄标准化死亡率趋势曲线,并采用分段对数线性回归进行量化。从已发表的资料和Pol-MONICA数据中获得同期风险因素暴露。结果美国的死亡率持平并下降,波兰的死亡率上升,导致波兰的死亡率超过美国高加索人,接近或超过非洲裔美国人。波兰死亡率上升的趋势在1991年发生逆转,此后呈下降趋势,特别是冠心病。美国死亡率的下降伴随着多种危险因素的减少。在波兰,冠心病发病率下降期间,风险因素暴露也有所减少,但与美国的经验有所不同。结论:20世纪90年代波兰心血管疾病死亡率上升趋势的逆转与30年前美国的类似逆转相似,并伴随着两国风险因素暴露的减少。比较两国经验的相似性表明,努力减少人口接触可预防危险因素的重要性。
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引用次数: 2
Improving hydrogenated fat for the world population 为世界人口改善氢化脂肪
Pub Date : 2005-06-01 DOI: 10.1016/j.precon.2005.05.003
Fred A. Kummerow

Hydrogenated fat made from vegetable or fish oils has served as an increasing source of calories in both developed and developing countries since its introduction into the diet in 1919. The trans isomers formed during hydrogenation serve as an energy source and have been assumed to act in the same way as the trans fatty acid in butter fat or the tallow rendered from the fat of ruminant animals. More recent studies with porcine fed butter fat vs. hydrogenated fat using corn oil as a control indicated, however, that trans fatty acids in hydrogenated fat inhibit acyl-CoA desaturase enzyme activities. Such activities are involved in the metabolic conversion of essential fatty acids (EFA) to polyunsaturated fatty acids (PUFA), which remodel the vascular cell membrane fatty acids composition resulting in calcification of vascular tissue. The trans fatty acids in butter and ruminant fat do not inhibit acyl-CoA desaturase or remodel vascular cell membrane fatty acid composition. Trans fatty acids in hydrogenated fats increase the production of inflammatory cytokines associated with the pathophysiology of atherosclerosis. Cytokines have a stimulating effect on cyclooxygenase (COX-2) and may inhibit prostacyclin synthase. The elimination of trans fatty acids from hydrogenated fat is desirable for three reasons: they remodel vascular cell membrane fatty acid composition so that the influx of calcium increases; they inhibit prostacyclin synthesis; and they increase the production of proinflammatory cytokines. Vegetable oils can be hydrogenated and rearranged with unhydrogenated vegetable oils to contain no trans or isomeric fatty acids.

自1919年从植物油或鱼油中提取的氢化脂肪被引入饮食以来,无论是在发达国家还是在发展中国家,氢化脂肪都已成为越来越多的卡路里来源。氢化过程中形成的反式异构体作为一种能量来源,被认为与黄油脂肪或反刍动物脂肪中产生的反式脂肪酸的作用相同。然而,最近的研究表明,用玉米油作为对照,用牛油喂养的猪与氢化脂肪相比,氢化脂肪中的反式脂肪酸抑制酰基辅酶a去饱和酶的活性。这些活动涉及必需脂肪酸(EFA)向多不饱和脂肪酸(PUFA)的代谢转化,多不饱和脂肪酸(PUFA)重塑血管细胞膜脂肪酸组成,导致血管组织钙化。黄油和反刍动物脂肪中的反式脂肪酸不会抑制酰基辅酶a去饱和酶或重塑血管细胞膜脂肪酸组成。氢化脂肪中的反式脂肪酸增加了与动脉粥样硬化病理生理相关的炎症细胞因子的产生。细胞因子对环氧化酶(COX-2)有刺激作用,并可能抑制前列环素合成酶。从氢化脂肪中消除反式脂肪酸是可取的,原因有三:它们重塑血管细胞膜脂肪酸组成,使钙的流入增加;它们抑制前列环素的合成;它们会增加促炎细胞因子的产生。植物油可以氢化并与未氢化的植物油重排,不含反式或异构脂肪酸。
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引用次数: 10
Anthropometrical measures are easily obtainable sensitive and specific predictors of insulin resistance in healthy individuals 人体测量测量是健康个体胰岛素抵抗的敏感和特异性预测指标
Pub Date : 2005-06-01 DOI: 10.1016/j.precon.2005.05.001
Juan Ybarra , Joan Sanchez-Hernandez , Jose Maria Pou , Sandra Fernández , Ignasi Gich , Jordi Ordóñez-Llanos , Jeroni Jurado , Alberto de Leiva , Antonio Pérez

Background

To investigate whether user-friendly anthropometrical variables, i.e., waist circumference (WC) and body mass index (BMI) can properly identify insulin resistance (IR) in healthy subjects.

Methods

A cross-sectional study was carried out with 164 disease-free subjects (78 males and 86 females aged 22–50 years) recruited from hospital staff in Barcelona (Spain) over a period of one year. BMI, WC, blood pressure, total cholesterol, triglycerides, HDL-cholesterol, glucose and insulin were measured by standard methods. IR was defined as homeostasis model assessment (HOMA)-IR equal to or greater than 3,8.

Results

The prevalence of IR was 29.9% (males 39.5%, females 21.8%; P = 0.017). Multiple stepwise linear regression analysis identified WC (r2 = 0.496; P < 0.0005) as the only independent predictor of IR in the whole group. WC (r2 = 0.499; P < 0.0005) was the only variable that predicted IR in men and BMI (r2 = 0.506; P < 0.0005) in women. WC above 88 cm for women and 102 cm for men predicted IR with a sensitivity of 90.9% and 100%, and a specificity of 71.7% and 51.6%, respectively. However, receiving operator characteristics (ROC) curve analysis showed optimal WC values of 106.5 and 97.5 cm for men and women, respectively.

Conclusions

WC is a simple, non-invasive and efficient tool for the screening of IR in the general population. Finally, taking into account that cut-off points of WC are population-specific, it will be of considerable interest to establish the relationship of WC with metabolic complications in all ethnic groups in order to generate useful critical values.

背景:探讨方便用户使用的人体测量变量,即腰围(WC)和身体质量指数(BMI)能否正确识别健康受试者的胰岛素抵抗(IR)。方法采用横断面研究方法,从西班牙巴塞罗那的医院工作人员中招募了164名无疾病受试者(男性78名,女性86名,年龄22-50岁),为期一年。采用标准方法测定BMI、WC、血压、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、葡萄糖和胰岛素。IR定义为稳态模型评估(HOMA)-IR等于或大于3,8。结果IR患病率为29.9%,其中男性39.5%,女性21.8%;p = 0.017)。多元逐步线性回归分析发现WC (r2 = 0.496;P & lt;0.0005)是整个组中唯一独立的IR预测因子。WC (r2 = 0.499;P & lt;0.0005)是预测男性IR和BMI的唯一变量(r2 = 0.506;P & lt;0.0005)。女性WC > 88 cm、男性WC > 102 cm预测IR的敏感性分别为90.9%和100%,特异性分别为71.7%和51.6%。然而,接受操作者特征(ROC)曲线分析显示,男性和女性的最佳WC值分别为106.5和97.5 cm。结论swc是一种简便、无创、有效的筛查普通人群IR的工具。最后,考虑到WC的分界点是特定于人群的,为了产生有用的临界值,在所有种族群体中建立WC与代谢并发症的关系将是非常有意义的。
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引用次数: 17
Non-HDL-cholesterol, waist circumference and the HOMA index: Correlations in the healthy 非高密度脂蛋白胆固醇、腰围和HOMA指数:健康人群的相关性
Pub Date : 2005-06-01 DOI: 10.1016/j.precon.2005.05.002
Juan Ybarra, Joan Sanchez-Hernandez, Antonio Pérez
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引用次数: 5
期刊
Prevention and control : the official journal of the World Heart Federation
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