老年脑梗死患者急性期全脑血管造影及脑动脉狭窄的危险因素分析

目的:探究老年脑梗死患者急性期全脑血管造影(DSA)及脑动脉狭窄的危险因素。方法:选择2010年1月~2016年9月期间我院收治的562例老年脑卒中患者为研究对象。经DSA造影观察脑血管动脉造影脉狭窄情况,并收集患者一般资料,采用单因素分析及多因素logistics回归分析脑动脉狭窄的危险因素。结果:562例脑卒中患者经DSA检查共发现469例患者出现脑动脉狭窄,中度狭窄301例,血管重度狭窄168例;颅内段发生率显著高于颅外段(P0.05);高龄(OR=1.434,P0.05)、高血压(OR=2.084,P0.05)、糖尿病(OR=2.235,P0.05)及吸烟(OR=2.734,P0.05)是老年脑卒中患者脑血管狭窄的危险因素。结论:DSA显示老年人脑卒中患者多存在脑血管动脉狭窄的发生,年龄、高血压、糖尿病及吸烟是老年脑卒中患者脑血管狭窄的危险因素。     

Gender Difference in the Interaction Effects of Diabetes and Hypertension on Stroke among the Elderly in the Shih-Pai Study,Taiwan

Aims

To investigate the interaction effects of diabetes and hypertension on stroke, and also investigate the independent and interaction effects of parental history and environmental factors on diabetes and hypertension in a cross-sectional elderly population.

Methods

The Shih-Pai Community Medical Service Program was a community-based, fixed cohort study conducted between June 1999 and November 2002. Socio-demographic and clinical data of subjects aged 65 years and older were collected by well-trained interviewers during home visits. Interaction effects were analyzed using Rothman’s synergy index (SI).

Results

In total, 4,124 subjects were included in the study, with 2,284 males and 1,840 females. The synergistic interaction of diabetes and hypertension on stroke was statistically significant in women (SI = 3.16, 95% CI: 1.35–7.39). The synergistic interaction of parental diabetes and being overweight on diabetes was only statistically significant in men, and not in women (SI = 3.30, 95% CI: 1.00–10.83 in men, and SI = 1.15, 95% CI: 0.30–4.39 in women).

Conclusions

A synergistic interaction was found for diabetes and hypertension in both sexes when parental history and being overweight were combined. Furthermore, combining diabetes and hypertension in elderly women was significant in terms of the risk of stroke. Strategies to control risk factors in individuals at additional high risk are urgently needed.     

老年维持性血液透析患者认知功能障碍的影响因素及其对脑血流动力学、肠道菌群和预后的影响

摘要 目的：探讨老年维持性血液透析（MHD）患者认知功能障碍（CI）的影响因素及其对脑血流动力学、肠道菌群和预后的影响。方法：选取2017年2月～2021年1月长治医学院附属晋城医院收治的411例老年MHD患者,根据蒙特利尔认知评估量表（MoCA）评分结果,将其分为CI组（n=321）和非CI组（n=90）。收集所有老年MHD患者临床资料,检测、分析其脑血流动力学和肠道菌群水平。采用Logistic回归分析老年MHD患者CI的影响因素。随访18个月,采用Kaplan-Meier法绘制两组患者生存曲线,对比其生存预后情况。结果：411例老年MHD患者CI发生率为78.10％（321/411）。单因素分析显示,CI组年龄大于非CI组,体质指数（BMI）、单室尿素清除指数（spKt/V）、白蛋白水平低于非CI组,受教育年限＞12年比例少于非CI组,透析龄长于非CI组,高血压、糖尿病比例和全段甲状旁腺素高于非CI组（P＜0.05）。多因素Logistic回归分析显示,年龄及透析龄增加和高血压、糖尿病为老年MHD患者CI的独立危险因素,受教育年限＞12年和BMI、spKt/V、白蛋白水平升高为其独立保护因素（P＜0.05）。与非CI组比较,CI组大脑中动脉-平均血流速度（MCA-Vm）、大脑前动脉-平均血流速度（ACA-Vm）降低,大脑中动脉-搏动指数（MCA-PI）、大脑前动脉-搏动指数（ACA-PI）升高（P＜0.05）。与非CI组比较,CI组肠球菌和大肠埃希菌数量增加,乳杆菌和双歧杆菌数量减少（P＜0.05）。Kaplan-Meier生存曲线分析显示,CI组累积生存率低于非CI组（P＜0.05）。结论：年龄、BMI、受教育年限、透析龄、高血压、糖尿病、spKt/V、白蛋白是老年MHD患者CI的影响因素,CI与老年MHD患者脑血流动力学紊乱、肠道菌群失衡和预后不良有关。     

Application of Framingham risk estimates to ethnic minorities in United Kingdom and implications for primary prevention of heart disease in general practice: cross sectional population based study

ObjectiveTo compare the 10 year risk of coronary heart disease (CHD), stroke, and combined cardiovascular disease (CVD) estimated from the Framingham equations.DesignPopulation based cross sectional survey.SettingNine general practices in south London.Population1386 men and women, age 40-59 years, with no history of CVD (475 white people, 447 south Asian people, and 464 people of African origin), and a subgroup of 1069 without known diabetes, left ventricular hypertrophy, peripheral vascular disease, renal impairment, or target organ damage.ResultsPeople of African origin had the lowest 10 year risk estimate of CHD adjusted for age and sex (7.0%, 95% confidence interval 6.5 to 7.5) compared with white people (8.8%, 8.2 to 9.5) and south Asians (9.2%, 8.6 to 9.9) and the highest estimated risk of stroke (1.7% (1.5 to 1.9), 1.4% (1.3 to 1.6), 1.6% (1.5 to 1.8), respectively). The estimate risk of combined CVD, however, was highest in south Asians (12.5%, 11.6 to 13.4) compared with white people (11.9%, 11.0 to 12.7) and people of African origin (10.5%, 9.7 to 11.2). In the subgroup of 1069, the probability that a risk of CHD ⩾15% would identify risk of combined CVD ⩾20% was 91% in white people and 81% in both south Asians and people of African origin. The use of thresholds for risk of CHD of 12% in south Asians and 10% in people of African origin would increase the probability of identifying those at risk to 100% and 97%, respectively.ConclusionPrimary care doctors should use a lower threshold of CHD risk when treating mild uncomplicated hypertension in people of African or south Asian origin.     

Independent Association of HbA1c and Incident Cardiovascular Disease in People Without Diabetes

Recent studies have reported no association between elevated glycated hemoglobin (HbA_1c) and incident cardiovascular disease (CVD) among women without diabetes. This study describes associations between HbA_1c and new onset CVD in a representative adult population cohort. Assessment of participants in The North West Adelaide Health Study (NWAHS), a population study of randomly selected adults (age ≥18 years, n = 4,060), included measurement of height, weight, blood pressure, fasting lipids, glucose, and HbA_1c. A self‐completed questionnaire assessed doctor‐diagnosed diabetes, CVD and stroke, smoking status, and demographics. The cohort was followed for an average 3.5 years. Of the 2,913 adults free of diabetes at baseline and follow‐up, 94 (3.5%) reported new onset coronary heart disease (CHD) and/or stroke. Compared with those with an HbA_1c ≤5.0%, risk of new onset CVD was increased in those with HbA_1c 5.4–5.6% (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.4, 4.6), and ≥5.7% (OR 1.9, 95% CI 1.1, 3.4), after adjustment for other risk factors. The association was stronger in women than men (P = 0.03), and attenuated to only a small degree by addition of impaired fasting glucose (IFG), hypertension, hypercholesterolemia, BMI, waist circumference, or smoking to the model. Elevated HbA_1c is related to new onset CVD over a relatively short follow‐up period in both men and women without diabetes and who do not develop diabetes, after adjustment for other major risk factors. Unlike previous studies, this relationship was not substantially attenuated by other traditional risk factors.     

Risk Factors for Late-Life Cognitive Decline and Variation with Age and Sex in the Sydney Memory and Ageing Study

Introduction

An aging population brings increasing burdens and costs to individuals and society arising from late-life cognitive decline, the causes of which are unclear. We aimed to identify factors predicting late-life cognitive decline.

Methods

Participants were 889 community-dwelling 70–90-year-olds from the Sydney Memory and Ageing Study with comprehensive neuropsychological assessments at baseline and a 2-year follow-up and initially without dementia. Cognitive decline was considered as incident mild cognitive impairment (MCI) or dementia, as well as decreases in attention/processing speed, executive function, memory, and global cognition. Associations with baseline demographic, lifestyle, health and medical factors were determined.

Results

All cognitive measures showed decline and 14% of participants developed incident MCI or dementia. Across all participants, risk factors for decline included older age and poorer smelling ability most prominently, but also more education, history of depression, being male, higher homocysteine, coronary artery disease, arthritis, low health status, and stroke. Protective factors included marriage, kidney disease, and antidepressant use. For some of these factors the association varied with age or differed between men and women. Additional risk and protective factors that were strictly age- and/or sex-dependent were also identified. We found salient population attributable risks (8.7–49.5%) for older age, being male or unmarried, poor smelling ability, coronary artery disease, arthritis, stroke, and high homocysteine.

Discussion

Preventing or treating conditions typically associated with aging might reduce population-wide late-life cognitive decline. Interventions tailored to particular age and sex groups may offer further benefits.     

冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的相关危险因素分析

目的:探究冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的相关危险因素。方法:选取2014年6月～2017年6月期间我院收治的行PCI的CHD患者200例为研究对象,术后随访一年再行冠脉造影检测,根据患者是否发生ISR分为观察组(38例,发生ISR)和对照组(162例,未发生ISR),收集并比较两组患者基线资料及生化指标,采用多因素logistic回归分析CHD患者PCI术后发生ISR的危险因素。结果:观察组吸烟、饮酒、高血压、糖尿病的人数占比、病程及支架直径均高于对照组,差异有统计学意义(P0.05)。观察组脂蛋白(a)[LP(a)]、纤维蛋白原(FIB)及尿酸(UA)水平显著高于对照组,总胆红素(TBIL)水平显著低于对照组,差异有统计学意义(P0.05)。多因素logistic回归分析显示,吸烟、糖尿病、支架直径(小)以及高水平LP(a)、低水平UA为CHD患者行PCI术后发生ISR的危险因素。结论:CHD患者行PCI术后发生ISR的危险因素有吸烟、糖尿病、支架直径以及高水平LP(a)、低水平UA,因此在PCI术中应尽可能选用较大的支架,同时戒烟、控制血糖有利于预防ISR的发生,定期检测血清LP(a)、UA水平变化,并采取有效的医疗与保健措施能够减少ISR的发生风险。     

Immunohistochemical study of N-epsilon-carboxymethyl lysine (CML) in human brain: relation to vascular dementia

Background  

Advanced glycation end-products (AGEs) and their receptor (RAGE) occur in dementia of the Alzheimer's type and diabetic microvascular disease. Accumulation of AGEs relates to risk factors for vascular dementia with ageing, including hypertension and diabetes. Cognitive dysfunction in vascular dementia may relate to microvascular disease resembling that in diabetes. We tested if, among people with cerebrovascular disease, (1) those with dementia have higher levels of neuronal and vascular AGEs and (2) if cognitive dysfunction depends on neuronal and/or vascular AGE levels.     

Consumption of coffee and tea and risk of developing stroke,dementia, and poststroke dementia: A cohort study in the UK Biobank

BackgroundPrevious studies have revealed the involvement of coffee and tea in the development of stroke and dementia. However, little is known about the association between the combination of coffee and tea and the risk of stroke, dementia, and poststroke dementia. Therefore, we aimed to investigate the associations of coffee and tea separately and in combination with the risk of developing stroke and dementia.Methods and findingsThis prospective cohort study included 365,682 participants (50 to 74 years old) from the UK Biobank. Participants joined the study from 2006 to 2010 and were followed up until 2020. We used Cox proportional hazards models to estimate the associations between coffee/tea consumption and incident stroke and dementia, adjusting for sex, age, ethnicity, qualification, income, body mass index (BMI), physical activity, alcohol status, smoking status, diet pattern, consumption of sugar-sweetened beverages, high-density lipoprotein (HDL), low-density lipoprotein (LDL), history of cancer, history of diabetes, history of cardiovascular arterial disease (CAD), and hypertension. Coffee and tea consumption was assessed at baseline. During a median follow-up of 11.4 years for new onset disease, 5,079 participants developed dementia, and 10,053 participants developed stroke. The associations of coffee and tea with stroke and dementia were nonlinear (P for nonlinear <0.01), and coffee intake of 2 to 3 cups/d or tea intake of 3 to 5 cups/d or their combination intake of 4 to 6 cups/d were linked with the lowest hazard ratio (HR) of incident stroke and dementia. Compared with those who did not drink tea and coffee, drinking 2 to 3 cups of coffee and 2 to 3 cups of tea per day was associated with a 32% (HR 0.68, 95% CI, 0.59 to 0.79; P < 0.001) lower risk of stroke and a 28% (HR, 0.72, 95% CI, 0.59 to 0.89; P = 0.002) lower risk of dementia. Moreover, the combination of coffee and tea consumption was associated with lower risk of ischemic stroke and vascular dementia. Additionally, the combination of tea and coffee was associated with a lower risk of poststroke dementia, with the lowest risk of incident poststroke dementia at a daily consumption level of 3 to 6 cups of coffee and tea (HR, 0.52, 95% CI, 0.32 to 0.83; P = 0.007). The main limitations were that coffee and tea intake was self-reported at baseline and may not reflect long-term consumption patterns, unmeasured confounders in observational studies may result in biased effect estimates, and UK Biobank participants are not representative of the whole United Kingdom population.ConclusionsWe found that drinking coffee and tea separately or in combination were associated with lower risk of stroke and dementia. Intake of coffee alone or in combination with tea was associated with lower risk of poststroke dementia.

In a cohort study, Yuan Zhang and colleagues investigate the associations between coffee and tea consumption and risk of stroke and dementia among participants older than 50 years of age in the UK Biobank.     

Application and Revision of Montreal Cognitive Assessment in China's Military Retirees with Mild Cognitive Impairment

ObjectiveIn an effort to accommodate MOCA to better fit for the Chinese context, this study was designed to employ the MOCA criteria to screen mild cognitive impairment (MCI) and analyze associated risk factors in military retirees.MethodsThree hundred and four retired military cadres were recruited using a random cluster sampling technique with information collected including personal, prevalence, MOCA scale, and related neuropsychiatry scale. Thirty retirees were randomly chosen to be further analyzed one month later using the revised MOCA scale.Results①Our data indicated an incidence rate of 64.8% for mild cognitive impairment in retired military cadres. The incidence rate for MCI was significantly higher in those aged 80 or above compared with those 80 years of age or younger (P<0.05). The incidence rate of MCI was significantly higher in those with fewer than 6 years of education compared with those with over 7 years of education (P<0.05). The MCI incidence was higher for those with little exercise than those taking regular exercise (P<0.01). Moreover, the MCI incidence was higher in stroke patients than those who never had a stroke episode (P<0.05). ②There was a significant correlation between MOCA and MMSE scale scores (r = 0.81). MOCA scale scores were negatively correlated with ADL and CES-D scores (although not PSQI scores). ③ MOCA recension Cronbach’s alpha value was 0.862. The related coefficient of MOCA and MOCA recension was 0.878(P<0.01). When the Score of cut-off -point of the MOCA recension was 28, the area in ROC curve analyses was 0.859, as well as the largest area.ConclusionRetired cadres exhibited a greater incidence of MCI (than general population), which was closely associated with age, level of education and physical exercise and cerebral apoplexy. Revised MOCA scale displays a better validity and reaction degree of reliability and is more suitable for screening and diagnosis of MCI in the elderly in China.     

The effect of oral glucose tolerance testing on changes in arterial stiffness and blood pressure in elderly women with hypertension and relationships between the stage of diabetes and physical fitness levels

[Purpose] The purpose of this study was to assess changes in blood glucose level, blood pressure, and arterial stiffness after a 75 g oral glucose tolerance test (OGTT) in elderly women aged over 65 years with hypertension and either normal glycemic control, impaired fasting glucose tolerance, or diabetes mellitus. We also wished to investigate the relationship between stages of diabetes and physical fitness.[Methods] A total of 24 elderly women with hypertension were assigned to a control group (CON; n=7), impaired fasting glucose group (IFG; n=9), and diabetes mellitus group (DM; n=8). In each group, blood glucose level, brachial ankle pulse wave velocity (PWV), and blood pressure were measured at baseline as well as 60 and 120 minutes after a 75 g OGTT. Physical fitness factors such as hand grip strength, balance test, 4 m gait speed test, chair stand test, short physical performance battery, and 6-minute walking test were subsequently assessed.[Results] In all three groups, blood glucose levels were significantly increased at 60 and 120 minutes after a 75 g OGTT. In the DM group, blood glucose levels were significantly higher before and after a 75 g OGTT than in the CON group. In the CON group, PWV was significantly increased at 60 minutes after a 75 g OGTT; however, there were no changes in other groups after glucose ingestion. In the CON group, systolic and diastolic blood pressures were significantly decreased at 60 and 120 minutes after a 75 g OGTT compared to baseline. However, there was no change in blood pressure after ingestion in the DM group. The IFG group had greater grip strength than the CON group; however, there were no differences in other variables between the groups.[Conclusion] After a 75 g OGTT, elderly women with hypertension and diabetes maintain higher blood glucose levels compared to those with hypertension alone. Unlike elderly women with hypertension alone, those with hypertension and diabetes did not show changes in arterial stiffness and blood pressure after a 75 g OGTT. Therefore, elderly women with hypertension and diabetes may not be able to control their blood vessels following a 75 g OGTT due to impaired vascular endothelial function. Moreover, there was no association between diabetes stage and physical fitness in elderly women with hypertension.     

老年轻度认知障碍患者生活高危因素探讨

目的:探讨生活高危因素对老年轻度认知障碍的影响。方法:应用简明精神状态量表(MMSE)、蒙特利尔认知测验量表(MoCA)、临床痴呆评定量表(CDR)和生活高危因素量表对219例老年人进行调查,分析生活高危因素对老年轻度认知障碍的影响。结果:女性患MCI风险高于男性(P=0.03);文盲组患MCI风险高于小学组,小学组高于初中及以上组(P=0.00);农民组患MCI风险高于工人组,工人组高于管理人员组(P=0.01);农村居民患MCI风险高于城市居民(P=0.01);运动影响MCI发病,不运动组患MCI风险高于运动组(P=0.00),运动频率<4次/周高于运动频率≥4次/周(P=0.00),运动年数≤10年组高于运动>10年组(P=0.01);业余爱好影响MCI发病,无业余爱好组患MCI风险高于有业余爱好组(P=0.00),业余爱好史≤10年组高于业余爱好史>10组(P=0.00)。不同年龄的老年人其MCI发病风险无统计学差异(P>0.05);吸烟、饮酒、喝茶等不同年数及频率的老年人其MCI发病风险无统计学差异(P>0.05);是否午休及不同午休频率和不同每晚睡眠时间的老年人其MCI发病风险无统计学差异(P>0.05)。结论:性别、教育程度、职业、居住地、运动时间及频率、业余爱好时间等因素与老年MCI发病有关。     

Association between Psoriasis Vulgaris and Coronary Heart Disease in a Hospital-Based Population in Japan

BackgroundPsoriasis vulgaris is a chronic inflammatory skin disease with an immune-genetic background. It has been reported as an independent risk factor for coronary heart disease (CHD) in the United States and Europe. The purpose of this study was to investigate the association between psoriasis and CHD in a hospital-based population in Japan.MethodsFor 113,065 in-hospital and clinic patients at our institution between January 1, 2011 and January 1, 2013, the diagnostic International Classification of Diseases (ICD)-10 codes for CHD, hypertension, dyslipidemia, diabetes, and psoriasis vulgaris were extracted using the medical accounting system and electronic medical record, and were analyzed.ResultsThe prevalence of CHD (n = 5,167, 4.5%), hypertension (n = 16,476, 14.5%), dyslipidemia (n = 9,236, 8.1%), diabetes mellitus (n = 11,555, 10.2%), and psoriasis vulgaris (n = 1,197, 1.1%) were identified. The prevalence of CHD in patients with hypertension, dyslipidemia, diabetes, and psoriasis vulgaris were 21.3%, 22.2%, 21.1%, and 9.0%, respectively. In 1,197 psoriasis patients, those with CHD were older, more likely to be male, and had more number of the diseases surveyed by ICD-10 codes. Multivariate analysis showed that psoriasis vulgaris was an independent associated factor for CHD (adjusted odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.01–1.58; p = 0.0404) along with hypertension (adjusted OR: 7.78; 95% CI: 7.25–8.36; p < 0.0001), dyslipidemia (adjusted OR: 2.35; 95% CI: 2.19–2.52; p < 0.0001), and diabetes (adjusted OR: 2.86; 95% CI: 2.67–3.06; p < 0.0001).ConclusionPsoriasis vulgaris was independently associated with CHD in a hospital-based population in Japan.     

Submitting articles to the BMJ

ObjectiveTo determine whether people whose marital partners have depression, diabetes, hypertension, ischaemic heart disease, stroke, hyperlipidaemia, peptic ulcer disease, or asthma or chronic obstructive pulmonary disease are at increased risk of the same disease.DesignCross sectional study.Setting10 practices from the Trent Focus Collaborative Research Practice Network.Participants8386 married couples (16 772 individuals) from a population of 29 014 participants aged 30-74 years.OutcomesRisk of disease in participants whose marital partner had that disease compared with those whose partner did not.ResultsAfter both partners'' age, smoking, and obesity and which general practice they attend were adjusted for, participants whose marital partner had asthma, depression, hypertension, hyperlipidaemia, and peptic ulcer disease were at increased risk of having the same disease. The adjusted odds ratios were 1.69 (95% confidence interval 1.43 to 2.98) for asthma, 2.08 (1.71 to 2.54) for depression, 1.32 (1.04 to 1.67) for hypertension, 1.44 (1.19 to 1.75) for hyperlipidaemia, and 2.01 (1.48 to 2.73) for peptic ulcer disease.ConclusionPartners of people with specific diseases are at increased risk of the disease themselves—at least 70% increased risk for asthma, depression, and peptic ulcer disease. This implicates shared environmental causes in some diseases in addition to any genetic or distant exposure or shared behaviours with respect to seeking health care.

What is already known on this topic

People whose spouses have hypertension are at increased risk of hypertensionLittle is known about the risks of disease for spouses of patients with diseases other than hypertension

What this study adds

People whose marital partner had asthma, depression, and peptic ulcer disease were at increased risk of having the same diseaseShared environmental factors contribute to the risk of diseasesThe costs and benefits of screening people for diseases of their spouses needs to be considered     

不同年龄老年轻度认知功能障碍患者的中医体质分布及其影响因素分析

摘要 目的：分析不同年龄老年轻度认知功能障碍（MCI）患者的中医体质分布及发生MCI的影响因素。方法：将我院2018年12月至2020年12月期间收治的100例老年MCI患者作为观察组，同期选择100例认知功能正常的健康体检者作为对照组；统计两组受试者一般临床资料，观察组结合临床表现并参照中华中医药学会颁布实施的《中医体质分类与判定》相关标准对其中医体质进行判定和评估，采用多元logistics回归模型分析发生MCI的影响因素。结果：60~70岁和71~80岁MCI患者中医体质以气虚质为主，80岁以上MCI患者中医体质以阳虚质、气虚质和痰湿质为主；观察组和对照组的居住情况、家庭关系和中医体质存在明显差异（P<0.05）；多元logistics回归模型分析结果显示，居住情况、家庭关系和中医体质是发生MCI的影响因素（OR值=1.923、2.002、1.964，P<0.05）。结论：80岁或以下的老年MCI患者中医体质以气虚质为主，80岁以上老年MCI患者中医体质以阳虚质、气虚质和痰湿质为主，且患者居住情况、家庭关系和中医体质是影响MCI发生的因素。     

Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study: baseline characteristics and short-term effects of fenofibrate [ISRCTN64783481]

Objective

The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study is examining the effects of long-term fibrate therapy on coronary heart disease (CHD) event rates in patients with diabetes mellitus. This article describes the trial's run-in phase and patients' baseline characteristics.

Research design and methods

FIELD is a double-blind, placebo-controlled trial in 63 centres in 3 countries evaluating the effects of fenofibrate versus placebo on CHD morbidity and mortality in 9795 patients with type 2 diabetes mellitus. Patients were to have no indication for lipid-lowering therapy on randomization, but could start these or other drugs at any time after randomization. Follow-up in the study was to be for a median duration of not less than 5 years and until 500 major coronary events (fatal coronary heart disease plus nonfatal myocardial infarction) had occurred.

Results

About 2100 patients (22%) had some manifestation of cardiovascular disease (CVD) at baseline and thus high risk status. Less than 25% of patients without CVD had a (UKPDS determined) calculated 5-year CHD risk of <5%, but nearly all had a 5-year stroke risk of <10%. Despite this, half of the cohort were obese (BMI > 30), most were men, two-thirds were aged over 60 years, and substantial proportions had NCEP ATP III features of the metabolic syndrome independent of their diabetes, including low HDL (60%), high blood pressure measurement or treatment for hypertension (84%), high waist measurement (68%), and raised triglycerides (52%). After a 6-week run-in period before randomisation with all participants receiving 200 mg comicronized fenofibrate, there were declines in total and LDL cholesterol (10%) and triglycerides (26%) and an increase in HDL cholesterol (6.5%).

Conclusion

The study will show the effect of PPAR-alpha agonist action on CHD and other vascular outcomes in patients with type 2 diabetes including substantial numbers with low to moderate CVD risk but with the various components of the metabolic syndrome. The main results of the study will be reported in late 2005.     

老年轻度认知障碍患者生活高危因素探讨

目的：探讨生活高危因素对老年轻度认知障碍的影响。方法：应用简明精神状态量表（MMSE）、蒙特利尔认知测验量表（MoCA）、临床痴呆评定量表（CDR）和生活高危因素量表对219例老年人进行调查,分析生活高危因素对老年轻度认知障碍的影响。结果：女性患MCI风险高于男性（P=0．03）;文盲组患MCI风险高于小学组,小学组高于初中及以上组（P=0．00）;农民组患MCI风险高于工人组,工人组高于管理人员组（P=O．01）;农村居民患MCI风险高于城市居民（P=O．01）;运动影响MCI发病,不运动组患McI风险高于运动组（P=0．00）,运动频率〈4次／周高于运动频率≥4次／周（P=0．00）,运动年数≤10年组高于运动〉10年组（P=O．01）;业余爱好影响MCI发病,无业余爱好组患MCI风险高于有业余爱好组（P=O．00）,业余爱好史≤10年组高于业余爱好史〉10组（P=O.00）。不同年龄的老年人其MCI发病风险无统计学差异（P〉O．05）;吸烟、饮酒、喝茶等不同年数及频率的老年人其MCI发病风险无统计学差异（P〉0．05）;是否午休及不同午休频率和不同每晚睡眠时间的老年人其MCI发病风险无统计学差异俨（〉O．05）。结论：性别、教育程度、职业、居住地、运动时间及频率、业余爱好时问等因素与老年MCI发病有关。     

Menopausal Hormone Therapy and Chronic Disease Risk in the Women’S Health Initiative: is Timing Everything?

ObjectiveThis review provides a comprehensive overview of the most recent findings from the Women’s Health Initiative (WHI) hormone therapy (HT) trials and highlights the role of age and other clinical risk factors in risk stratification.MethodsWe review the findings on cardiovascular disease, cancer outcomes, all-cause mortality, and other major endpoints in the two WHI HT trials (conjugated equine estrogens [CEEs, 0.625 mg/day] with or without medroxyprogesterone acetate [MPA, 2.5 mg/day]).ResultsThe hazard ratio (HR) for coronary heart disease (CHD) was 1.18 (95% confidence interval [CI], 0.95 to 1.45) in the CEE + MPA trial and 0.94 (95% CI, 0.78 to 1.14) in the CEE-alone trial. In both HT trials, there was an increased risk of stroke and deep vein thrombosis and a lower risk of hip fractures and diabetes. The HT regimens had divergent effects on breast cancer. CEE + MPA increased breast cancer risk (cumulative HR, 1.28; 95% CI, 1.11 to 1.48), whereas CEE alone had a protective effect (cumulative HR, 0.79; 95% CI, 0.65 to 0.97). The absolute risks of HT were low in younger women (ages 50 to 59 years) and those who were within 10 years of menopause onset. Furthermore, for CHD, the risks were elevated for women with metabolic syndrome or high low-densitylipoprotein cholesterol concentrations but not in women without these risk factors. Factor V Leiden genotype was associated with elevated risk of venous thromboembolism on HT.ConclusionHT has a complex pattern of benefits and risks. Women in early menopause have low absolute risks of chronic disease outcomes on HT. Use of HT for management of menopausal symptoms remains appropriate, and risk stratification will help to identify women in whom benefits would be expected to outweigh risks. (Endocr Pract. 2014;20:1201-1213)     

Obesity in 70‐Year‐Old Subjects as a Risk Factor for 15‐Year Coronary Heart Disease Incidence

Objective: To investigate the role of obesity in general and waist circumference (WC) and BMI in particular as risk factors for 15‐year incidence of coronary heart disease (CHD) in the elderly. Research Methods and Procedures: This prospective study was based on 1597 (737 males and 860 females) 70‐year‐olds free from CHD and participants of three birth cohorts examined in 1971 to 1972 (Cohort I), 1976 to 1977 (Cohort II), and 1981 to 1982 (Cohort III) at Göteborg, Sweden. Fifteen‐year incidence of CHD (fatal and nonfatal) was ascertained from follow‐up examinations and registers. Relative risk (RR) for first ever CHD in reference to the lowest quartiles of WC and BMI was calculated from Cox regression. Results: In males, RRs for CHD in the highest WC and BMI quartiles were 1.36 [95% confidence interval (CI) 1.00 to 1.85] and 1.42 (95% CI 1.04 to 1.92), respectively, after adjustment for cohorts, smoking habits, diabetes, systolic blood pressure, and total cholesterol. In men, the risk associated with WC was independent of BMI. Neither WC nor BMI was related to CHD risk in females. After exclusion of first 5‐year all‐cause deaths, the adjusted RRs in the highest WC and BMI quartiles in males were 1.47 (95% CI 1.06 to 2.04) and 1.42 (1.04 to 1.92), respectively. In females, a significantly higher RR of 1.41 (95% CI 1.02 to 1.94) was observed in the second BMI quartile only after such exclusions. Discussion: WC, an indicator of both central and general obesity, appears to be a stronger predictor of CHD than BMI in elderly males, but in females, obesity was not a risk factor for CHD.     

蚌埠市蚌山区老年人群骨质疏松症流行病学调查及对跌倒风险和认知功能的影响

摘要 目的：对蚌埠市蚌山区老年人群骨质疏松症进行流行病学调查,并探讨骨质疏松症对跌倒风险和认知功能的影响。方法：于2019年11月~2021年4月采用多阶段分层随机抽样的方法,抽取蚌埠市蚌山区的常住居民,调查老年人群骨质疏松症发生率,共发放960份调查问卷,回收941份,回收率为98.02%。根据有无骨质疏松症分为骨质疏松症组和无骨质疏松症组,观察两组跌倒风险和认知功能状况。应用多因素logistic回归分析老年人群发生骨质疏松症的危险因素和保护因素。结果：941例研究对象中,检查出存在骨质疏松症者325人,发病率为34.54%。根据有无骨质疏松症分为骨质疏松症组（n=325）和无骨质疏松症组（n=616）。单因素分析结果显示,老年人群发生骨质疏松症与乳制品和钙片摄入情况、年龄、连续服用类固醇激素超过3个月情况、骨折史、性别、其他慢性病患病情况、体质量指数、婚姻状况、饮茶情况、每天运动情况有关（P<0.05）。多因素logistic回归性分析,结果显示：年龄≥70岁、性别为女性、连续服用类固醇激素超过3个月情况是老年人群发生骨质疏松症的危险因素,而每天运动情况≥30 min、有乳制品和钙片摄入情况、体质量指数≥24 kg/m²是老年人群发生骨质疏松症的保护因素（P<0.05）。骨质疏松症组的跌倒风险评估工具（FROP-Com）评分高于无骨质疏松症组,跌倒效能量表（MFES）评分低于无骨质疏松症组（P<0.05）。骨质疏松症组的简明精神状态检查量表（MMSE）评分低于无骨质疏松症组,画钟试验（CDT）评分高于无骨质疏松症组（P<0.05）。结论：蚌埠市蚌山区老年人群骨质疏松症患病率较高,且受到年龄、性别、连续服用类固醇激素超过3个月情况等因素的影响,而每天运动情况≥30 min、乳制品和钙片摄入情况、体质量指数≥24 kg/m²可减少骨质疏松症患病率,同时存在骨质疏松症的患者其跌倒风险升高,认知功能下降。