“冠心病”是冠状动脉性心脏病的简称,是指冠状动脉粥样硬化导致心肌缺血、缺氧而引起的心脏病.顾名思义,人体内的血管一旦发生狭窄或闭塞,则心绞痛、心梗、心律失常、心力衰竭,甚至猝死等恶性事件都会接踵而来.那么,既然大家对冠心病的危害都略知一二,为何其发生率还是不降反升呢?

相关数据显示,在我国接受降压治疗的患者中,约75％的患者血压没有达到控制目标.那么,降压药到底应该怎样使用?常见的不合理用药习惯又有哪些? 早期合理使用降压药物达标后,可以减少一半脑梗、一半心衰,以及1/3的冠心病、心梗.不合理用药一方面对保护心、脑、肾、血管不利,未能有效防止心脑血管疾病;另一方面可引起一些严重不良反应.

相关数据显示,在我国接受降压治疗的患者中,有约70％患者的血压没有达到控制目标.那么,降压药到底应该怎样使用?常见的不合理用药习惯又有哪些?在这里,我们不去阐述降压药冗杂的分类,而是用另外一种方式简单明了地告诉大家,你正在使用的降压药,究竟适不适合你. 常见的不合理用药习惯 早期合理使用降压药物达标后,可以减少一半脑梗、一半心衰,以及1/3的冠心病心梗.不合理用药一方面对保护心脑肾血管不利,未能有效防治心脑血管病;另一方面可引起死亡等严重不良反应.常见的不合理用药习惯有:

BACKGROUND:Midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare form of hypertrophic cardiomyopathy. Knowledge regarding the diagnosis, morbidity and cardiovascular mortality is limited. In this study, we aimed to describe the long-term outcomes of patients with MVOHCM followed in a tertiary referral centre.Methods A retrospective study of 60 patients with MVOHCM diagnosed at FuWai Hospital was performed. Clinical features, mortality and cardiovascular morbidity were analysed. RESULTS:The 60 patients with MVOHCM represented 2.9% of all the hypertrophic cardiomyopathy cases (n = 2068). At diagnosis, the mean age was 40.2 ± 15.0 years. During 7.1 ± 6.3 years of follow-up after diagnosis, the cardiovascular mortality was 15.0%. The probability of survival at 10 years was 77.0 ± 8.0%. The following two predictors of cardiovascular mortality were identified: severe ventricular septal hypertrophy at least 30  mm (hazard ratio, 3.19; P = 0.031) and unexplained syncope (hazard ratio, 4.59; P = 0.002) at baseline. Thirty patients (50.0%) had one or more morbid events, and the most frequent was nonsustained ventricular tachycardia. Apical aneurysm formation was identified in 20% of patients, and the patients with apical aneurysms were more inclined to experience nonsustained ventricular tachycardia than patients without apical aneurysm (58.3 vs. 16.7%; P = 0.003). Peak pressure gradient at least 70  mm Hg (hazard ratio, 3.00; P = 0.01) at baseline was identified as the only predictor of apical aneurysm. CONCLUSION:In Chinese patients, MVOHCM is associated with an unfavourable prognosis of cardiovascular mortality. One-half of these patients experience major cardiovascular events, and 20% develop an apical aneurysm, which significantly increases arrhythmia events. These data warrant measures to ensure the early recognition of MVOHCM followed by appropriate therapeutic interventions.

OBJECTIVE:To compare the clinical features and long-term outcome of patients with midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) and patients with apical hypertrophic cardiomyopathy (AHCM) in China. METHODS:This retrospective study analyzed clinical data of 66 patients with MVOHCM and 263 patients with AHCM from a consecutive single-center cohort consisting of 2 413 patients with HCM. The clinical features, cardiovascular mortality and morbidity were compared between the two groups. RESULTS:Compared with the AHCM, patients in the MVOHCM group was younger and more likely to be symptomatic over a mean follow-up of 7 years. The proportion of MVOHCM and AHCM were 2.7% (66/2 413) and 10.9% (263/2 413) (P < 0.001), respectively, in this cohort. Cardiovascular mortality of the two groups were 13.6% (9/66) and 0.8% (2/263) (P < 0.001), and cardiovascular morbidity of the two groups were 53.0% (35/66) and 14.4% (38/263) (P < 0.001). CONCLUSION:MVOHCM is rarer, but the clinical manifestations and long-term outcomes are worse compared with AHCM in this patient cohort.

<正>1冠状动脉粥样硬化病1.1病历摘要患者,男,45岁。高血压5年,最高180/110mmHg,高血脂2年。肥胖、缺乏体力活动。有时走路快时气短。否认糖尿病等病史。吸烟20年,每日20支。体检:BP 170/100mmHg、HR84次/分。心电图(-);X线胸片:两肺纹理偏重,C/T 0.55;心脏彩超:

Background Alteration in the protein composition of high-density lipoprotein (HDL) has been proposed as a mechanism for the development of coronary heart disease (CHD). In HDL, an increase in serum amyloid A protein (SAA) accompanying the decrease in apolipoprotein A-I (apoA-I) has been found during the acute inflammation period. However, whether this phenomenon persists in CHD patients, a disease related to inflammation, is unknown. The purpose of the present study was to explore the relationship between SAA and apoA-I in HDL isolated from CHD patients. Methods Overall, 98 patients with confirmed stable CHD and 90 control subjects matched for age and gender were enrolled in this case-control study. Potassium bromide (KBr) density gradient ultracentrifugation was used to isolate HDL from plasma. The levels of SAA and apoA-I in the HDL samples were detected by enzyme-linked immunosorbent assay kits. Pearson's correlation and general linear models were used in the analysis. Results Compared with controls, patients with CHD had a significant decrease in the amount of apoA-I ((14.21±8.44) μg/ml vs. (10.95±5.95) μg/ml, P =0.003) in HDL and a significant increase in the amount of log SAA (1.21±0.46 vs. 1.51±0.55, P <0.00001). Differences were independent of age, body mass index (BMI), HDL cholesterol (HDL-C), and other factors. An independently and statistically significant positive correlation between log SAA and apoA-I in HDL was observed only in the CHD group (β =2.0, P =0.026). In the general linear model, changes in log(SAA), age, age2, gender, BMI and HDL-C could explain a statistically significant 43% of the variance in apoA-I. Conclusions This study provides direct evidence for the first time that there was an independent positive correlation between log SAA and apoA-I in the HDL of CHD patients, indicating the alteration of protein composition in HDL. However, the question of whether this alteration in HDL is associated with impairment of HDL functions requires further research.

Objective To evaluate the related factors and clinical features of coronary artery atherosclerosis proximal to myocardial bridging (MB) in elderly patients.Methods 603 patients with MB-mural coronary artery (MB-MCA) detected by angiography at the first time in our hospital were enrolled.Clinical and angiographic data of them were collected.Patients were divided into the elderly group (n＝229,aged 60 86 years) and young group (n=374,aged 28-59 years).The related factors for coronary artery atherosclerosis proximal to MB were analyzed by multivariate analysis.Clinical features were compared between the two groups.Results The proportion of patients with typical chest pain,acutc coronary syndrome (ACS),hypertension was higher in the elderly group than in the young group (x2 =8.61,41.12,24.97 respectively,all P＜0.01).The courses of hypertension and diabetes were longer in the elderly group than in the young group (t=5.25 and 2.57,P＜0.01 or 0.05).The proportion of atherosclerotic lesions proximal to MB was higher and the degree of atherosclerosis was more serious,lesions were mainly located in vascular bifurcate place,the degree of atherosclerosis in non-MB-MCA was more serious,the number of the coronary non-MB-MCA arteries was much more,and systolic narrow rate was higher in MB-MCA (P＜0.01 or 0.05).The proportion of previous and current smokers were higher,the proportions of patients with family histories of hypertension,diabetes and coronary heart disease were higher,and serum triglyceride level was higher in the young group than in the elderly group (P＜0.01 or 0.05).Multivariate regression analysis suggested that the related factors for first coronary artery atherosclerosis proximal to MB sequenced by β value were narrow rate of non-MB-MCA with the most severe degree of narrow,vascular bifurcation lesions,male,systolic narrow rate of MB-MCA and diabetes and dyslipidemia in the elderly group according to β value (βvalue:0.397,0.273,0.201,0.140,0.120 and 0.109,respectively,all P＜ 0.05).The related factors for the severe degree of coronary artery atherosclerosis proximal to MB sequenced by Beta value were non-MB-MCA,vascular bifurcation lesions,male,diabetes and systolic narrow rate of MB-MCA (β value:0.455,0.246,0.148,0.110 and 0.109,respectively,P＜0.01 or 0.05).Conclusions There are more risk factors for coronary artery disease and a higher incidence of coronary heart disease in elderly patients with MB-MCA.Lesions of non-MB mural coronary artery,vascular bifurcation lesions,male,systolic narrow rate of MB-MCA,diabetes and dyslipidemia may be closely related with coronary artery atherosclerosis proximal to MB.

OBJECTIVE:To explore the imaging and clinical characteristics and related risk factors of patients with coronary artery stenosis located proximally to myocardial bridging.METHODS:This study enrolled 603 patients with angiography evidenced myocardial bridging-mural coronary artery between May 2004 to May 2009. Angiographic and clinic data were collected according to uniform protocol and standard questionnaires were used to obtain patients' demographic and clinical information. Univariate and multivariate analysis were performed to explore related risk factors.RESULTS:Chest pain was present in 247 cases (41.0%). Dynamic ST-T changes were found in 229 cases (38%). A total of 644 myocardial bridging-mural coronary arteries were detected including 382 (62.4%) segments located proximally to myocardial bridging. Diastolic vessel diameters in the myocardial bridging segment were significantly smaller than reference segments (all P < 0.01). Stepwise multiple regression analysis suggested that vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non- myocardial bridging-mural coronary arteries, age, LDL-C/HDL-C, male gender, diabetes, and systolic narrow rate of myocardial bridging-mural coronary arteries were positively related with the narrowing degree of the first coronary artery stenosis located proximally to myocardial bridging (P < 0.05 or P < 0.01). Vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non- myocardial bridging-mural coronary arteries, age, LDL-C/HDL-C, male, diabetes and dyslipidemia were positively related with the narrowing degree of the most severe coronary artery stenosis located proximally to myocardial bridging (P < 0.05 or P < 0.01).CONCLUSIONS:Myocardial ischemia is common in patients with myocardial bridging and the artery segments located proximally to myocardial bridging are prone to stenosis. Systolic narrow rate of myocardial bridging-mural coronary arteries is one of major determinants of coronary artery stenosis located proximally to myocardial bridging. Whereas the other coronary heart disease risk factors are likely to play more important roles.

Background Previous studies on the association between the distribution of left ventricle hypertrophy and the clinical features of hypertrophic cardiomyopathy (HCM) have yielded unclear results. The aim of this study was to investigate the differences in the prevalence, clinical features, management strategies, and long-term outcomes between patients with midventricular hypertrophic obstructive cardiomyopathy (MVHOCM) and patients with apical HCM (ApHCM). Methods A retrospective study of 60 patients with MVHOCM and 263 patients with ApHCM identified in a consecutive single-centre cohort consisting of 2068 patients with HCM was performed. The prevalence, clinical features, and natural history of the patients in these 2 groups were compared. Results Compared with ApHCM patients, patients with MVHOCM tended to be much younger and more symptomatic during their initial evaluation. Over a mean follow-up of 7 years, the probability of cardiovascular mortality and that of morbidity was significantly greater in MVHOCM patients compared with ApHCM patients (log-rank, P < 0.001). Conclusions Our results suggest that, compared with ApHCM, MVHOCM represents an uncommon presentation of the clinical spectrum of HCM that is characterized by progressive clinical deterioration leading to increased cardiovascular mortality and morbidity. Our results also underscore the importance of the timely recognition of MVHOCM for the prediction of prognosis and the early consideration of appropriate management strategies.

OBJECTIVE:To explore the clinical predictive factors of coronary artery stenosis located distally to myocardial bridging (MB).METHODS:A total of 603 patients with MB-mural coronary artery (MB-MCA) diagnosed by angiography initially were enrolled during May 2004 to May 2009. Their angiographic and clinical data were collected according to an uniform protocol. And standard questionnaires were used to acquire demographic information and clinical examinations. Univariate and multivariate analysis were performed to explore the related clinical predictive factors.RESULTS:A total of 644 MB-MCAs were detected. Diastolic vessel diameters in MCAs were significantly smaller than those in reference segments ( (2.29 ± 0.39) vs (2.48 ± 0.40) mm, P < 0.001) . Lesions located distally to MB detected in 36 patients were significantly fewer than those proximally to MB in 382 patients (5.9% vs 62.4%, P < 0.001) . Univariate analysis suggested that the narrowing degree of vessel located proximally to MB, the narrowing degree and the number of diseased coronary vessels of non-MB-MCAs and course of hypertension were positively correlated with the narrowing degree of vessel located distally to MB (all P < 0.05) . Multivariate Logistic regression analysis suggested that the number of cigarettes per day, the narrowing degree of diseased coronary vessels of non-MB-MCAs, the narrowing degree of vessel located proximally to MB and diastolic narrow rate of MCA were positively correlated with the occurrence of coronary artery stenosis located distally to MB (all P < 0.05) . Their standardized coefficients (β) were 0.763, 0.727, 0.420 and 0.403 respectively. And the corresponding Exp (β) were 2.146 (1.089-4.229) , 2.070 (1.371-3.125) , 1.521 (1.050-2.204) and 1.496 (1.094-2.045) .CONCLUSION:The number of cigarettes per day, the narrowing degree of diseased coronary vessels of non-MB-MCAs, the narrowing degree of vessel located proximally to MB and diastolic narrowing rate of MCA are likely to be important clinical predictive factors of coronary artery stenosis located distally to MB.

Objective: The purpose of this study was to determine the prevalence of coronary angiographically evident atherosclerotic stenosis associated with myocardial bridging (MB) and to explore related risk factors of coronary artery stenosis located proximally to MB.Methods: Overall, 603 patients with MB-mural coronary arteries (MB-MCAs) diagnosed by angiography initially were enrolled in this observational study during May 2004 to May 2009. One-way ANOVA, t-test, Pearson correlation test and stepwise multiple regression analysis were performed to explore related risk factors.Results: Totally 644 MB-MCAs were examined. Prevalence of lesions located distally to MBs was significantly lower than those proximally to MBs [36 (5.9%) vs. 382 (62.4%), p<0.001]. Diastolic vessel diameters in MB segments were significantly smaller than reference segments p<0.001. Ulcer-like lesion was found in MB-MCA in 1 patient. Multivariate analysis suggested that vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non-MB-MCA arteries, age, low-density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C), male, course of diabetes, and systolic narrow rate (SNR) of MB-MCAs were positively related with the narrow degree of the first coronary artery stenosis (FCAS) located proximally to MBs (all p<0.05). Vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non-MB-MCA arteries, age, LDL-C/ HDL-C, male, diabetes and dyslipidemia were positively related with the narrow degree of the most severe coronary artery stenosis(MSCAS) located proximally to MB (all p<0.05).Conclusion: The intramural and distal portions of a bridged artery are not the forbidden zone of artery atherosclerosis formation. SNR of MB-MCA may be one of the important decision factors to coronary artery stenosis located proximally to MB.

<正>1正确认识冠心病和冠脉病以前的国内教科书及ICD编码均把冠心病称为"冠状动脉粥样硬化性心脏病"的简称,且要求病历中必须写全称。本人认为,此提法不尽完全,冠心病应该是"冠状动脉性心脏病"(CHD)简称。尽管冠心病中绝大多数(95%以上)由粥样硬化病因引起,但还有炎症、痉挛、栓塞及先天畸形等所致。另一方面,以前国

目的：高密度脂蛋白（high density lipoprotein，HDL）中蛋白组分变化被认为与冠心病的发生发展有关，本研究旨在探讨血浆与高密度脂蛋白中的载脂蛋白A-I（apolipoprotein A-I）与血清淀粉样蛋白A1(serum amyloid A protein1，SAA1)与冠心病的关系。

Objective To retrospectively analyze the clinical features of acute myocardial infarction with or without first ST segment elevation and coronary artery lesions.Methods One hundred myocardial infarction patients were divided into ST segment elevation group(n = 50) and non-ST segment elevation group(n = 50) and underwent coronary arteriography.Characteristics,clinical manifestations,complications of the disease,cardiac function and coronary artery lesions of the patients were retrospectively analyzed.Results The disease was acute in ST segment elevation group and mainly manifested as sharp chest pain,while the symptoms of non-ST segment elevation group were various.The incidence of complications,ventricular arrythythmias,sinoatrial bradycardia,and conduction block was significantly higher while the left ventricular ejection fraction was significantly lower in ST segment elevation group than in non-ST segment group(P<0.05).The number of lesions-involved blood vessels and the proportion of collateral circulation were higher in ST segment elevation group than in non-ST segment group(P<0.05).Conclusion Acute myocardial infarction usually occurs in ST segment elevation patients with more complications, thus inlluencing their cardiac function.It should be treated with active reperfusion in order to promote the circulation of infarction-related blood vessels.The coronary artery lesions are severer in non-ST segment elevation patients.The short-term prognosis of acute myocardial infarction patients is associated with such factors as the onset time,infarction size and myocardial necrosis.

目的 观察川芎素联合坎地沙坦酯治疗高血压的疗效.方法 选取高血压患者80例并分为A、B两组,分别采用川芎素或安慰剂加坎地沙坦酯治疗,治疗前后均检测相关临床及生化指标.结果(1)两组治疗后血压均下降,但A组下降幅度较B组明显.(2)两组治疗后血清ET-1水平较治疗前明显降低,但A组降低较B组显著.(3)经治疗后A组调脂效果显著,而B组调脂效果不明显.结论 A组治疗方案更有利于降压、调脂和改善血管内皮功能.

目的:分析高胆固醇血症患者服用他汀类调脂药前后血清触珠蛋白(haptoglobin,Hp)水平的变化,探讨其与他汀类药物治疗的关系和临床意义。方法:入组原发性高胆固醇血症患者32例,分别服用洛伐他汀/烟酸缓释片(10 mg/500 mg.d-1)和匹伐他汀(2 mg.d-1),治疗8周后,观察药前、药后血清Hp水平的变化。结果:高胆固醇血症患者分别服用2种他汀类调脂药物后,两组Hp水平均高于治疗前(P<0.05)。其中,服用洛伐他汀/烟酸缓释片的患者,Hp增加了17.87%;服用匹伐他汀的患者,Hp增加了19%。结论:服用他汀药物后,高胆固醇血症患者的血清Hp水平增加。

1 临床上常用的调脂药物 临床上常用的调脂药物可分为6类:他汀类;贝特类;烟酸类;树脂类;胆固醇吸收抑制剂(依折麦布);其他(普罗布考、ω-3脂肪酸).对于冠心病及其等危症,最重要的当属他汀类,它不仅降脂,而且对防治动脉粥样硬化的发生和发展更为重要.他汀类可使LDL-C降低18%～55%;HDL-C升高5%～15%;TG降低7%～30%.几种我国已上市他汀类药降低TC、LDL-C和TG以及升高HDL-C的不同剂量疗效比较见表1、表2.他汀类药物降低TC和LDL-C的作用虽与药物剂量有相关性,但不呈直线相关关系.当他汀类药物的剂量增大1倍时,其降低LDL-C的幅度增加6%.

<正>心血管病的早期筛查实施程序寻找心脑血管病的高危人群:凡具有以下危险因素多项时,就应该积极进行筛查,包括高血压、高胆固醇、糖尿病、吸烟、酗酒、肥胖、缺乏体力活动、急躁易怒的性格以及危险年龄(男>40岁,女>55岁或绝经后)。典型心绞痛或合并多项危险因素的不典型胸痛,或者怀疑心血管病且比较紧张者。