·推荐论文摘要·

·推荐论文摘要·

城市社区常见慢性病综合防治模式探索

刘盈，张开金，汤仕忠，等

本文探讨了运用疾病管理策略开展城市社区慢性病综合防治。通过构建慢性病管理指导网络，组建可持续发展的慢性病管理队伍并进行系统培训，集成社区慢性病防治干预技术及医疗卫生保健技术；通过建立城市社区慢性病信息系统、实行分级诊疗和双向转诊、建立科学的评价体系等社区慢性病支持性环境建设，以实现社区慢性病综合防治的可持续发展。

社区；慢性病；健康管理；双向转诊

来源出版物：中国全科医学, 2013, 16(1A): 76-78

居民高血压、糖尿病及知信行社区干预效果评价

张磊，史中锋，迟阿鲁，等

摘要：目的：探讨社区干预 11 年对城区居民高血压和糖尿病患病率及知信行（KAP）影响，为进一步完善慢性病社区干预模式提供理论依据。方法：采用多阶段抽样方法于 1999 年 1 月对慢性病综合防治示范点山东省济南市槐荫区≥15岁常住居民作进行基线调查，通过控盐、控烟、平衡膳食和推动全民健身等措施进行了 11年的慢性病综合社区干预，于 2010 年 5 月再次以相同方法进行慢性病及相关 KAP调查，对 2次调查居民慢性病患病率及相关 KAP 得分进行比较。结果：1999 和2010 年分别获得有效问卷 1998、2042 份；1999 年调查槐荫区≥15 岁常住居民高血压患病率为 16.3%，糖尿病患病率为 3.1%，2010 年高血压患病率为 25.6%，糖尿病患病率为 7.3%，均有升高（P＜0.05）；1999 年居民慢性病 KAP 平均得分（27.94±6.95）分，2010 年慢性病 KAP平均得分（30.62±7.98）分，2010 年较 1999 年提高了 2.68分（t=11.397, P＜0.001）。结论：≥15 岁居民高血压和糖尿病患病率均有所增长，慢性病相关 KAP得分提高。

关键词：慢性病；社区干预；知识、态度和行为（KAP）；高血压；糖尿病

来源出版物：中国公共卫生, 2013. 29(4): 608-611

中国慢性病防控策略和体系建设探索

王陇德

摘要：慢性非传染性疾病已成为当前人类的重大威胁。国际研究表明，2008年全球5700万人死亡，其中的63%（3600万人）死于慢性非传染性疾病；80%的非传染性疾病所致死亡（2900万人）发生在低收入和中等收入国家。WHO 预测，如果按目前的情况继续发展，到2030年每年死于慢性非传染性疾病的人数将增加至5500万人。在中国，伴随着工业化、城镇化、老龄化进程的加快和国民生活方式的快速变迁，居民慢性病患病率、死亡率呈持续快速增长趋势。因此，慢性非传染性疾病流行的应对，是中国当前必须尽快考虑的重大问题。本文在总结中国重大慢性病流行状况、分析中国慢性病防控中存在的主要问题和关键影响因素以及总结前期项目探索经验的基础上，对中国慢性病防控应制定和采取的策略及防控体系建设工作要点提出了建议：如相关政府部门都应制定相应政策；建立结构合理、系统内任务分工明确，协调、高效的工作体系；从制度、工作规范与要求上推行“整合医学”的发展，从而提高中国慢性病防控工作效能与效益等。

关键词：慢性病防控；策略与体系建设

来源出版物：中国工程科学, 2014, 16(10): 22-30

成年人体质指数、腰围与高血压、糖尿病和血脂异常的关系

苏健，向全永，吕淑荣，等

摘要：目的：探讨成人体质指数（body mass index, BMI）、腰围（waist circumference，WC）与高血压、糖尿病和血脂异常的关系。方法：采用方差分析、偏相关和非条件 Logistic 回归模型研究 BMI、WC 与血压、血糖、血脂、高血压、糖尿病和血脂异常的关系。结果：调查人群新检出高血压、糖尿病和血脂异常患病率为 35.3%、4.3%和 28.4%。不同 BMI、WC 组间血压、血糖和血脂差异有统计学意义（均有 P＜0.05）。BMI、WC 与收缩压、舒张压、空腹血糖、总胆固醇、甘油三酯和低密度脂蛋白胆固醇正相关，与高密度脂蛋白胆固醇负相关（均有 P＜0.05）。随着 BMI和 WC 增加，高血压、糖尿病和血脂异常患病风险上升（均有 P＜0.05），且 BMI、WC每增加 1 个标准差,高血压患病风险分别增加 57%和58%，糖尿病增加 53%和 64%，血脂异常增加 61%和67%。结论：BMI、WC 与高血压、糖尿病和血脂异常密切相关，且WC对患病风险影响更大。

关键词：高血压；糖尿病；血脂异常

来源出版物：中华疾病控制杂志, 2015, 19(7): 969-700

关键词：心血管疾病；危险因素；患病率；死亡率

来源出版物：中国循环杂志, 2016, 31(6): 521-528

我国慢性病管理现状、问题及发展建议

中国居民慢性病防治素养水平及其影响因素

聂雪琼，李英华，陶茂萱，等

摘要：目的：了解我国居民慢性病防治素养水平及其影响因素，为制定卫生政策和健康教育干预措施提供依据。方法：采用分层多阶段与人口规模成比例抽样（PPS抽样）方法，对全国31个省（区、市）336个监测点非集体居住的15～69岁常住人口进行调查，以问卷调查方式对调查对象慢性病防治素养水平进行测评。结果：2012年健康素养监测共调查全国15～69岁常住人口102985人，收回有效问卷98448份，有效率为95.59%。其中，城市人口占44.32%，农村人口占55.68%；男性占51.72%，女性占48.28%。2012年我国居民慢性病防治素养水平的点估计值为9.07%，其95%可信区间为8.82%～9.34%，城市居民为13.23%,高于农村居民的6.75%；东部地区居民为10.74%，高于中部地区居民的8.69%，高于西部地区居 民 的 7.08% ； 男 性 为 8.85% ， 女 性 为 9.20%。 多 因 素Logistic回归分析结果显示：农村居民慢性病防治素养水平低于城市居民，OR值为0.698（95%CI：0.567～0.859），文化程度越高，慢性病防治素养水平越高，以不识字/少识字者为参照，小学、初中、高中/职高/中专、大专/本科及以上文化程度者具备慢性病防治素养的OR分别为1.717（95%CI：1.324～2.228）、2.554（95%CI：1.935～3.371）、4.507（95%CI：3.383～6.005）、8.224（95%CI：6.097～11.095）。结论：我国居民慢性病防治素养水平较低，其中农村居民、文化程度较低者是健康教育的重点人群。

关键词：慢性病防治素养；监测；居民；影响因素

来源出版物：中国健康教育, 2015, 31(2): 108-111

吕兰婷，邓思兰

摘要：慢性非传染性疾病对我国居民健康造成较大威胁，慢性病管理工作是我国卫生工作的重点。本文通过文献和相关政策研究，从宏观—政策，中观—组织机构间的协调，微观—患者和人群三个层面对我国慢性病管理工作进程进行梳理归纳，并立足我国慢性病管理实际提出我国慢性病管理仍存在的一些问题。建议未来的慢性病管理工作应注重提炼慢性病管理理论模型；结合医改分级诊疗工作的推行，构建整合式慢性病管理服务网络；加快提升慢性病管理“终端”能力建设。

关键词：慢性病管理；卫生服务；现状

来源出版物：中国卫生政策研究, 2015, 35(11): 1-7

慢性病管理研究进展

王荣英，贺振银，赵稳稳，等

摘要：随着经济、社会的快速发展，慢性病患病率、病死率逐年升高。本文参阅了国内外有关慢性病管理的最新研究文献，对慢性病管理的概念、意义、对象及国内外慢性病管理研究进展进行了综述，同时对我国未来慢性病管理模式进行了展望，提出：以社区为依托，综合性三级甲等医院全科医疗科联合各专科及基层医院对慢性病进行持续、综合性的管理，有利于提高社区全科医生规范化管理慢性病的水平，有利于提高慢性病的知晓率和控制率。

关键词：慢性病； 疾病管理； 全科医生； 综述

来源出版物：中国全科医学, 2016, 19(17): 1989-1993

《中国心血管病报告 2015》概要

陈伟伟，高润霖，刘力生，等

摘要：我国心血管病危险因素流行趋势明显，导致了心血管病的发病人数增加。总体上看，我国心血管病患病率及死亡率仍处于上升阶段。心血管病占居民疾病死亡构成的 40%以上，为我国居民的首位死因。心血管病负担日渐加重，已成为重大的公共卫生问题，防治心血管病刻不容缓。

“慢性病管理”专家主题研讨

曾学军，王芳，沙悦，等

摘要：本文组织多位全科医学专家对慢性病管理展开主题研讨，曾学军教授认为全科医生应做真正的“健康守门人”，促进以慢性病患者为中心的分级诊疗；王芳主任探讨分级诊疗制度下慢性病防治一体化模式；沙悦提出慢性病管理是从疾病管理到人的健康管理；沈蔷分析信息化支撑下的慢性病管理；于国泳分析中西医结合的慢性病管理；李广顺提出慢性病管理对社区卫生服务中心的挑战和对策；赵春山提示提高全民健康意识，健康教育先行；崔殿柱分析如何加强慢性病防治，发展社区卫生服务；赵辉探讨如何依靠慢性病管理来助力分级诊疗；王海龙分析社区卫生服务中心慢性病防治专科建设思考。旨在促进社区卫生服务机构有效地开展慢性病管理，探索适应新医改的慢性病管理工作模式，提升社区卫生服务机构慢性病管理效果。

关键词：慢性病；病例管理；社区卫生服务；分级诊疗；家庭医生签约

来源出版物：中国全科医学, 2016, 19(29): 3517-3523

错位：当代人类慢性病发病率飙升的病理生理学基础——基于人类进化过程中饮食-体力活动-基因的交互作用

乔玉成

摘要：有证据表明，当代人类慢性病的高发与基因和环境的交互作用有关，但关于两者的关系机制尚未完全明晰。基于人类进化过程中饮食-体力活动-基因间的交互作用以及表观遗传学的研究证据，从“匹配”的视角梳理和探讨了当代人类慢性病发病率飙升的原因与机制。人类生物进化与文化进化的不同步，基因型与饮食、体力活动、物质能量代谢方面的不匹配、不适应、不兼容等造成的基因与环境之间的错位，是导致当代人类慢性病高发的原因。过度饮食和体力活动不足通过影响基因的表观遗传修饰，进而影响到相关基因的表达，是导致慢性病高发的机制。在此基础上,提出了限制热量摄入，增加体力活动消耗，促使生活方式与基因型相匹配的慢性病防治策略。

关键词：慢性病；基因；饮食；体力活动； 交互作用；节俭基因；表观遗传学

来源出版物：体育科学, 2017, 37(1): 28-44

来源出版物：Kidney International, 2014, 85(3): 529-535

Chronic obstructive pulmonary disease in heart failure: Accurate diagnosis and treatment

Gueder, Guelmisal; Brenner, Susanne; Stoerk, Stefan; et al.

Abstract: Coincidence of COPD and heart failure (HF) is challenging as both diseases interact on multiple levels with each other, and thus impact significantly on diagnosis, disease severity classification, and choice of medical therapy. The current overview aims to educate caregivers involved in the daily management of patients with HF and (possibly) concurrent COPD in how to deal with clinically relevant issues such as interpreting spirometry, the potential role of extensive pulmonary function testing, and finally, the potential beneficial, but also detrimental effects of medication used for HF and COPD on either disease.

Keywords: Heart failure; COPD misdiagnosis; Severity classification

来源出版物： European Journal of Heart Failure, 2014, 16(12): 1273-1282

Recent clinical trials for the etiological treatment of chronic chagas disease: Advances, challenges and perspectives

Urbina, Julio A

Abstract: Chagas disease, a chronic systemic parasitosis caused by the Kinetoplastid protozoon Trypanosoma cruzi, is the first cause of cardiac morbidity and mortality in poor rural and suburban areas of Latin America and the largestparasitic disease burden in the continent, now spreading worldwide due to international migrations. A recent change in the scientific paradigm on the pathogenesis of chronic Chagas disease has led to a consensus that all T. cruziseropositive patients should receive etiological treatment. This important scientific advance has spurred the rigorous evaluation of the safety and efficacy of currently available drugs (benznidazole and nifurtimox) as well as novel anti-T. cruzi drug candidates in chronic patients, who were previously excluded from such treatment. The first results indicate that benznidazole is effective in inducing a marked and sustained reduction in the circulating parasites’ level in the majority of these patients, but adverse effects can lead to treatment discontinuation in 10-20% of cases. Ergosterol biosynthesis inhibitors, such as posaconazole and ravuconazole, are better tolerated but their efficacy at the doses and treatment duration used in the initial studies was significantly lower; such results are probably related to suboptimal exposure and/or treatment duration. Combination therapies are a promising perspective but the lack of validated biomarkers of response to etiological treatment and eventual parasitological cures in chronic patients remains a serious challenge.

Keywords: Adverse side effects; antiparasitic; benznidazole; efficacy; posaconazole; randomized trial; ravuconazole; Trypanosoma cruzi

来源出版物：Journal of Eukaryotic Microbiology, 2015, 62(1): 149-156

Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: The CSPPT randomized clinical trial

Y Huo; J Li; X Qin; et al.

Abstract: Uncertainty remains about the efficacy of folic acid therapy for the primary prevention of stroke because of limited and inconsistent data. To test the primary hypothesis that therapy with enalapril and folic acid is more effective in reducing first stroke than enalapril alone among Chinese adults with hypertension. The China Stroke Primary Prevention Trial, a randomized, double-blind clinical trial conducted from May 19, 2008, to August 24, 2013, in 32 communities in Jiangsu and Anhui provinces in China. A total of 20702 adults with hypertension without history of stroke or myocardial infarction (MI) participated in the study. Eligible participants, stratified by MTHFRC677T genotypes (CC, CT, and TT), were randomly assigned to receive double-blind daily treatment with a single-pill combination containing enalapril, 10 mg, and folic acid, 0.8 mg (n = 10348) or a tablet containing enalapril, 10 mg, alone (n = 10354). The primary outcome was first stroke. Secondary outcomes included first is chemic stroke; first hemorrhagic stroke; MI; a composite of cardiovascular events consisting of cardiovascular death, MI, and stroke; and all-cause death. During a median treatment duration of 4.5 years, compared with the enalapril alone group, the enalapril-folic acid group had a significant risk reduction in first stroke (2.7% of participants in the enalapril-folic acid group vs 3.4% in the enalapril alone group; hazard ratio [HR], 0.79; 95% CI,.68-0.93), first ischemic stroke (2.2% with enalapril-folic acid vs 2.8% with enalapril alone; HR, 0.76; 95% CI, 0.64-0.91), and composite cardiovascular events consisting of cardiovascular death, MI, and stroke (3.1% with enalapril-folic acid vs 3.9% with enalapril alone; HR, 0.80; 95% CI, 0.69-0.92). The risks of hemorrhagic stroke (HR, 0.93; 95% CI, 0.65-1.34), MI (HR, 1.04; 95% CI, 0.60-1.82), and all-cause deaths (HR, 0.94; 95% CI, 0.81-1.10) did not differ significantly between the 2 treatment groups. There were no significant differences between the 2 treatment groups in the frequencies of adverse events. Among adults with hypertension in China without a history of stroke or MI, the combined use of enalapril and folic acid, compared with enalapril alone, significantly reduced the risk of first stroke. These findings are consistent with benefits from folate use among adults with hypertension and low baseline folate levels.

来源出版物：JAMA, 2015, 313(13):1325-35

Early chronic obstructive pulmonary disease: Definition, assessment, and prevention

Rennard, Stephen I; Drummond, M. Bradley

Abstract: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. COPD, however, is a heterogeneous collection of diseases with differing causes, pathogenic mechanisms, and physiological effects. Therefore a comprehensive approach to COPD prevention will need to address the complexity of COPD. Advances in the understanding of the natural history of COPD and the development of strategies toassess COPD in its early stages make prevention a reasonable, if ambitious, goal.

来源出版物：Lancet, 2015, 385(9979): 1778-1788

Antioxidant phytochemicals for the prevention and treatment of chronic diseases

Zhang, Yujie; Gan, Renyou; Li, Sha; et al.

Abstract: Overproduction of oxidants (reactive oxygen species and reactive nitrogen species) in the human body is responsible for the pathogenesis of some diseases. The scavenging of these oxidants is thought to be an effective measure to depress the level of oxidative stress of organisms. It has been reported that intake of vegetables and fruits is inversely associated with the risk of many chronic diseases, and antioxidant phytochemicals in vegetables and fruits are considered to be responsible for these health benefits. Antioxidant phytochemicals can be found in many foods and medicinal plants, and play an important role in the prevention and treatment of chronic diseases caused by oxidative stress. They often possess strong antioxidant and free radical scavenging abilities, as well as anti-inflammatory action, which are also the basis of other bioactivities and health benefits, such as anticancer, anti-aging, and protective action for cardiovascular diseases, diabetes mellitus, obesity and neurodegenerative diseases. This review summarizes recent progress on the health benefits of antioxidant phytochemicals, and discusses their potential mechanisms in the prevention and treatment of chronic diseases.

Keywords: antioxidant phytochemicals; health benefits; mechanism; cardiovascular disease; cancer

来源出版物： Molecules, 2015, 20(12): 21138-21156 interventions will prevent, mitigate, and treat obesity and its related diseases. Challenges with the implementation of this model include provider training, the need to provide incentives for health systems to move beyond clinical care to link with community systems, and addressing the multiple elements necessary for integration within clinical care and with social systems. The Affordable Care Act, with its emphasis on prevention and new systems for care delivery, provides support for innovative strategies such as those proposed here.

来源出版物：Health Affairs, 2015, 34(9): 1456-1463

An integrated framework for the prevention and treatment of obesity and its related chronic diseases

Dietz, William H.; Solomon, Loel S; Pronk, Nico; et al.

Abstract: Improved patient experience, population health, and reduced cost of care for patients with obesity and other chronic diseases will not be achieved by clinical interventions alone. We offer here a new iteration of the Chronic Care Model that integrates clinical and community systems to address chronic diseases. Obesity contributes substantially to cardiovascular disease, type 2 diabetes mellitus, and cancer. Dietary and physical activity

Oxidative stress in chronic vascular disease: From prediction to prevention

Santilli, Francesca; D’Ardes, Damiano; Davi, Giovanni; et al.

Abstract: This review article is intended to describe the strong relationship between oxidative stress and vascular disease. Reactive oxygen species (ROS) play an important role in the pathogenesis of vascular disease: oxidative stress is intimately linked to atherosclerosis, through oxidation of LDL and endothelial dysfunction, to diabetes, mainly through advanced glycation end-products (AGEs)/ receptor for AGE (RAGE) axis impairment, protein kinase C (PKC), aldose reductase (AR) and NADPH oxidase (NOX) dysfunction, and to hypertension, through reninangiotensin system (RAS) dysfunction. Several oxidative stress biomarkers have been proposed to detect oxidative stress levels and to improve our current understanding of the mechanisms underlying vascular disease. These biomarkers include ROS-generating and quenching molecules, and ROS-modified compounds, such as F-2-isoprostanes. An efficient therapeutic approach to vascular diseases cannot exclude evaluation and treatment of oxidative stress. In fact, oxidative stress represents an important target of several drugs and nutraceuticals, including antidiabetic agents, statins, renin-angiotensin system blockers, polyphenols and other antioxidants. A better understanding of the relations between atherosclerosis, diabetes, hypertension and ROS and the discovery of new oxidative stress targets will translate into consistent benefits for effective vascular disease treatment and prevention.

Keywords: Oxidative stress; Isoprostanes; Biomarkers; Hypertension; Diabetes; Antioxidants

来源出版物：Vascular Pharmacology, 2015, 74: 23-37

Canakinumab for the treatment of chronic obstructive pulmonary disease

Liu, Na; Zhuang, Shougang

Abstract: Histone deacetylases (HDACs) induce deacetylation of both histone and non-histone proteins and play a critical role in the modulation of physiological and pathological gene expression. Pharmacological inhibition of HDAC has been reported to attenuate progression of renal fibrogenesis in obstructed kidney and reduce cyst formation in polycystic kidney disease. HDAC inhibitors (HDACis) are also able to ameliorate renal lesions in diabetes nephropathy, lupus nephritis, aristolochic acid nephropathy, and transplant nephropathy. The beneficial effects of HDACis are associated with their anti-fibrosis, anti-inflammation, and immunosuppressant effects. In this review, we summarize recent advances on the treatment of various chronic kidney diseases with HDACis in pre-clinical models.

Keywords: histone deacetylases; chronic kidney diseases; renal fibrosis; renal fibroblasts

来源出版物：Frontiers in Physiology, 2015, (6): 121

Cardiac effects of current treatments of chronic obstructive pulmonary disease

Lahousse, Lies; Verhamme, Katia M; Stricker, Bruno H; et al.

Abstract: We review the cardiac safety of the drugs available at present for the maintenance treatment of chronic obstructive pulmonary disease (COPD) in stable disease, focusing on inhaled long-acting muscarinic antagonists (LAMA) and long-acting beta 2 agonists (LABA), used either as a monotherapy or as a fixed-dose combination. We report the difficulties of, and pitfalls in, the investigation of the safety of drug treatments in COPD, which is hampered by the so-called COPD trial paradox: on the one hand, COPD is defined as a systemic disease and is frequently associated with comorbidities (especially cardiovascular comorbidities), which have an important effect on the prognosis of individual patients; on the other hand, patients with COPD and cardiovascular or other coexisting illnesses are often excluded from participation in randomised controlled clinical trials. In these trials, inhaled long-acting bronchodilators, both LAMA or LABA, or both, seem to be safe when used in the appropriate dose in adherent patients with COPD without uncontrolled cardiovascular disease or other notable comorbidities. However, the cardiac safety of LAMA and LABA is less evident when used inappropriately (eg, overdosing) or in patients with COPD and substantial cardiovascular disease, prolonged QTc interval, or polypharmacy. Potential warnings about rare cardiac events caused by COPD treatment from meta-analyses and observational studies need to be confirmed in high quality large randomised controlled trials. Finally, we briefly cover the cardiac safety issues of chronic oral drug treatments for COPD, encompassing theophylline, phosphodiesterase inhibitors, and macrolides.

来源出版物：Lancet Respiratory Medicine, 2016, 4(2): 149-164

Chronic low-dose melatonin treatment maintains nigrostriatal integrity in an intrastriatal rotenone model of Parkinson’s disease

Carriere, Candace H; Kang, Na Hyea; Niles, Lennard P

Abstract: Quantitative risk assessment and risk management processes are critically examined in the context of their applicability to the statistically infrequent and sometimes unforeseen events that trigger major disasters. While of value when applied at regional or larger scales by governments and insurance companies, these processes do not provide a rational basis for reducing the impacts of major disasters at the local (community) level because in any given locality disaster events occur too infrequently for their future occurrence in a realistic timeframe to be accurately predicted by statistics. Given that regional and national strategies for disaster reduction cannot be effective without effective local disaster reduction measures, this is a significant problem. Instead, we suggest that communities, local government officials, civil society organisations and scientists could usefully form teams to co-develop local hazard event and effects scenarios, around which the teams can then develop realistic long-term plans for building local resilience. These plans may also be of value in reducing the impacts of other disasters, and are likely to have the additional benefits of improving science development, relevance and uptake, and of enhancing communication between scientists and the public.

Keywords: disaster risk quantification; risk management; community resilience; event and effects scenarios; coproduction of knowledge

来 源 出 版 物 ： International Journal of Disaster Risk Reduction, 2015, 13: 242-247

Cardiac effects of current treatments of chronic obstructive pulmonary disease

Lahousse, Lies; Verhamme, Katia M; Stricker, Bruno H; et al.

Abstract: We review the cardiac safety of the drugs available at present for the maintenance treatment of chronic obstructive pulmonary disease (COPD) in stable disease, focusing on inhaled long-acting muscarinic antagonists (LAMA) and long-acting beta 2 agonists (LABA), used either as a monotherapy or as a fixed-dose combination. We report the difficulties of, and pitfalls in, the investigation of the safety of drug treatments in COPD, which is hampered by the so-called COPD trial paradox: on the one hand, COPD is defined as a systemic disease and is frequently associated with comorbidities (especially cardiovascular comorbidities), which have an important effect on the prognosis of individual patients; on the other hand, patients with COPD and cardiovascular or other coexisting illnesses are often excluded from participation in randomised controlled clinical trials. In these trials, inhaled long-acting bronchodilators, both LAMA or LABA, or both, seem to be safe when used in the appropriate dose in adherent patients with COPD without uncontrolled cardiovascular disease or other notable comorbidities. However, the cardiac safety of LAMA and LABA is less evident when used inappropriately (eg, overdosing) or in patients with COPD and substantial cardiovascular disease, prolonged QTc interval, or polypharmacy. Potential warnings about rare cardiac events caused by COPD treatment from meta-analyses and observational studies need to be confirmed in high quality large randomised controlled trials. Finally, we briefly cover the cardiac safety issues of chronic oral drug treatments for COPD, encompassing theophylline, phosphodiesterase inhibitors, and macrolides.

来源出版物：Lancet Respiratory Medicine, 2016, 4(2): 149-164 on 3367 hypertensive participants in the Chronic Renal Insufficiency Cohort (CRIC) to determine prevalence, associations, and clinical outcomes of ATRH in nondialysis chronic kidney disease patients. ATRH was defined as blood pressure 140/90 mm Hg on 3 antihypertensives, or use of 4 antihypertensives with blood pressure at goal at baseline visit. Prevalence of ATRH was 40.4%. Older age, male sex, black race, diabetes mellitus, and higher body mass index were independently associated with higher odds of having ATRH. Participants with ATRH had a higher risk of clinical events than participants without ATRHcomposite of myocardial infarction, stroke, peripheral arterial disease, congestive heart failure (CHF), and all-cause mortality (hazard ratio [95% confidence interval], 1.38 [1.22-1.56]); renal events (1.28 [1.11-1.46]); CHF (1.66 [1.38-2.00]); and all-cause mortality (1.24 [1.06-1.45]). The subset of participants with ATRH and blood pressure at goal on 4 medications also had higher risk for composite of myocardial infarction, stroke, peripheral arterial disease, CHF, and all-cause mortality (hazard ratio [95% confidence interval], (1.30 [1.12-1.51]) and CHF (1.59 [1.28-1.99]) than those without ATRH. ATRH was associated with significantly higher risk for CHF and renal events only among those with estimated glomerular filtration rate 30 mL/min per 1.73 m2. Our findings show that ATRH is common and associated with high risk of adverse outcomes in a cohort of patients with chronic kidney disease. This underscores the need for early identification and management of patients with ATRH and chronic kidney disease.

Keywords: antihypertensive agents; hypertension; hypertension resistant to conventional therapy; myocardial infarction; renal insufficiency; chronic

来源出版物：Hypertension, 2016, 67(2): 387-396

Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease report from the chronic renal insufficiency cohort study

Thomas, George; Xie, Dawei; Chen, Hsiangyu; et al.

Abstract: The association between apparent treatment resistant hypertension (ATRH) and clinical outcomes is not well studied in chronic kidney disease. We analyzed data

Chronic disease prevention tobacco avoidance, physical activity, and nutrition for a healthy start

Qamar, Arman; Bhatt, Deepak L

Abstract: The efficacy of adjusted-dose warfarin for prevention of stroke in atrial fibrillation patients with stage 3 chronic kidney disease (CKD) is unknown.Patients with stage 3 CKD participating in the Stroke Prevention in Atrial Fibrillation 3 trials were assessed to determine the effect of warfarin anticoagulation on stroke and major hemorrhage, and whether CKD status independently contributed to stroke risk. High-risk participants (n = 1044)in the randomized trial were assigned to adjusted-dose warfarin (target international normalized ratio 2 to 3) versus aspirin (325 mg) plus fixed, low-dose warfarin (subsequently shown to be equivalent to aspirin alone). Low-risk participants (n = 892) all received 325 mg aspirin daily. The primary outcome was ischemic stroke (96%) or systemic embolism (4%). Among the 1936 participants in the two trials, 42% (n = 805) had stage 3 CKD at entry. Considering the 1314 patients not assigned to adjusted-dose warfarin, the primary event rate was double among those with stage 3 CKD (hazard ratio 2.0, 95% CI 1.2, 3.3) versus those with a higher estimated GFR (eGFR). Among the 516 participants with stage 3 CKD included in the randomized trial, ischemic stroke/systemic embolism was reduced 76% (95% CI 42, 90; P＜0.001) by adjusted-dose warfarin compared with aspirin/low-dose warfarin; there was no difference in major hemorrhage (5 patients versus 6 patients, respectively).Among atrial fibrillation patients participating in the Stroke Prevention in Atrial Fibrillation III trials, stage 3 CKD was associated with higher rates of ischemic stroke/systemic embolism. Adjusted-dose warfarin markedly reduced ischemic stroke/systemic embolism in high-risk atrial fibrillation patients with stage 3 CKD.

来源出版物：Circulation, 2016, 133(15):1512-1515

Burden and prevention of adverse cardiac events in patients with concomitant chronic heart failure and coronary artery disease: A literature review

Lavoie, Louis; Khoury, Hanane; Welner, Sharon; et al.

Abstract: Background: Chronic heart failure (HF) or coronary artery disease (CAD) confers risk for thromboembolism and secondary adverse cardiac events (ACEs) (e. g., mortality, myocardial infarction, and stroke). When HF and CAD occur concomitantly, ACE risk is reported to be elevated. We investigated ACEs, their epidemiology, and the resulting burden among patients with concomitant HF and CAD through a structured review of recent literature. Antithrombotic treatment for ACE prevention was assessed. Methods: Pertinent databases (PubMed, other) were searched for relevant articles published from January 2004 to March 2015. Data collected included ACE incidence, healthcare resource use, costs, change in quality of life attributed to ACEs, and treatment practice for prevention of ACEs in patients with concomitant HF and CAD. Results: Mortality rates for patients with both HF and CAD ranged from 4.9%-12.3% at 30 days to 13.7%-86% for periods between 9.9 months and 10 years. Incidence of ACEs among HF patients with CAD is, respectively, at least 82% and 15% higher than for patients without HF or without CAD, except for stroke investigated in two studies. All-cause and HF-related hospitalization is the main driver of the economic burden in patients with HF, the majority of whom had CAD origin. Despite high prevalence of ischemic complications, there is limited evidence to support the use of warfarin-type antithrombotics among HF patients. Conclusion: This study confirms that patients with concomitant HF and CAD are at elevated risk for ACEs and suggests the need for effective new antithrombotic treatments to further decrease ischemic complication rates in this population.

Keywords: adverse cardiac events; antithrombotics; coronary artery disease; heart failure

来源出版物：Cardiovascular Therapeutics, 2016, 34(3): 152-160

Cause-specific mortality for 240 causes in China during 1990-2013: A systematic subnational analysis for the Global Burden of Disease Study 2013

Zhou M; Wang H; Zhu J; et al.

Abstract: Background: China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China. Methods: Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013. Findings: All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4.0 years in Hebei province to 14.2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0-14, 15-49, and 50-74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990. Interpretation: Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems.

来源出版物：Lancet, 2016, 387(10015): 251-272

Fresh fruit consumption and major cardiovascular disease in China

H Du; L Li; D Bennett

Abstract: In Western populations, a higher level of fruit consumption has been associated with a lower risk of cardiovascular disease, but little is known about such associations in China, where the consumption level is low and rates of stroke are high. Between 2004 and 2008, we recruited 512891 adults, 30 to 79 years of age, from 10 diverse localities in China. During 3.2 million personyears of follow-up, 5173 deaths from cardiovascular disease, 2551 incident major coronary events (fatal or nonfatal), 14579 ischemic strokes, and 3523 intracerebral hemorrhages were recorded among the 451,665 participants who did not have a history of cardiovascular disease or antihypertensive treatments at baseline. Cox regression yielded adjusted hazard ratios relating fresh fruit consumption to disease rates. Overall, 18.0% of participants reported consuming fresh fruit daily. As compared with participants who never or rarely consumed fresh fruit (the “nonconsumption” category), those who ate fresh fruit daily had lower systolic blood pressure (by 4.0 mm Hg) and blood glucose levels (by 0.5 mmol per liter [9.0 mg per deciliter]) (P＜0.001 for trend for both comparisons). The adjusted hazard ratios for daily consumption versus nonconsumption were 0.60 (95% confidence interval [CI], 0.54 to 0.67) for cardiovascular death, and 0.66 (95% CI, 0.58 to 0.75), 0.75 (95% CI, 0.72 to 0.79), and 0.64 (95% CI, 0.56 to 0.74), respectively, for incident major coronary events, ischemic stroke, and hemorrhagic stroke. There was a strong log-linear dose-response relationship between the incidence of each outcome and the amount of fresh fruit consumed. These associations were similar across the 10 study regions and in subgroups of participants defined by baseline characteristics. Among Chinese adults, a higher level of fruit consumption was associated with lower blood pressure and blood glucose levels and, largely independent of these and other dietary and nondietary factors, with significantly lower risks of major cardiovascular diseases.

来源出版物：New England Journal of Medicine, 2016, 374(14): 1332

责任编辑：卫夏雯

Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA

Wieland, M.; Pittore, M; Parolai, S; et al.

With non-communicable conditions accounting for nearly two-thirds of deaths worldwide, the emergence of chronic diseases as the predominant challenge to global health is undisputed. In the USA, chronic diseases are the main causes of poor health, disability, and death, and account for most of health-care expenditures. The chronic disease burden in the USA largely results from a short list of risk factors-including tobacco use, poor diet and physical inactivity (both strongly associated with obesity), excessive alcohol consumption, uncontrolled high blood pressure, and hyperlipidaemia-that can be effectively addressed for individuals and populations. Increases in the burden of chronic diseases are attributable to incidence and prevalence of leading chronic conditions and risk factors (which occur individually and in combination), and population demographics, including ageing and health disparities. To effectively and equitably address the chronic disease burden, public health and health-care systems need to deploy integrated approaches that bundle strategies and interventions, address many risk factors and conditions simultaneously, create population-wide changes, help the population subgroups most affected, and rely on implementation by many sectors, including public-private partnerships and involvement from all stakeholders. To help to meet the chronic disease burden, the US Centers for Disease Control and Prevention (CDC) uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programmes; (2) environmental approaches that promote health and support healthy behaviours; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. Establishment of community conditions to support healthy behaviours and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system. Collectively, these four strategies will prevent the occurrence of chronic diseases, foster early detection and slow disease progression in people with chronic conditions, reduce complications, support an improved quality of life, and reduce demand on the health-care system. Of crucial importance, with strengthened collaboration between the public health and health-care sectors, the health-care system better uses prevention and early detection services, and population health is improved and sustained by solidifying collaborations between communities and health-care providers. This collaborative approach will improve health equity by building communities that promote health rather than disease, have more accessibleand direct care, and focus the health-care system on improving population health.来源出版物：Lancet, 2014, 384(9937): 45-52Towards a paradigm shift in the treatment of chronic chagas diseaseViotti, R; Alarcon de Noya, B; Araujo-Jorge, T; et al.Abstract: Treatment for Chagas disease with currently available medications is recommended universally only for acute cases (all ages) and for children up to 14 years old. The World Health Organization, however, also recommends specific antiparasite treatment for all chronic-phase Trypanosoma cruzi-infected individuals, even though in current medical practice this remains controversial, and most physicians only prescribe palliative treatment for adult Chagas patients with dilated cardiomyopathy. The present opinion, prepared by members of the NHEPACHA network (Nuevas Herramientas parael Diagnóstico y la Evaluación del Paciente con Enfermedad de Chagas/New Tools for the Diagnosis and Evaluation of Chagas Disease Patients), reviews the paradigm shift based on clinical and immunological evidence and argues in favor of antiparasitic treatment for all chronic patients. We review the tools needed to monitor therapeutic efficacy and the potential criteria for evaluation of treatment efficacy beyond parasitological cure. Etiological treatment should now be mandatory for all adult chronic Chagas disease patients.来源出版物：Antimicrobial Agents and Chemotherapy, 2014, 58(2): 635-639Bicarbonate therapy for prevention of chronic kidney disease progressionLoniewski, Igor; Wesson, Donald E; et al.Abstract: Kidney injury in chronic kidney disease (CKD) is likely multifactorial, but recent data support that a component is mediated by mechanisms used by the kidney to increase acidification in response to an acid challenge to systemic acid-base status. If so, systemic alkalization might attenuate this acid-induced component of kidney injury. An acid challenge to systemic acid-base status increases nephron acidification through increased production of endothelin, aldosterone, and angiotensin II, each of which can contribute to kidney inflammation and fibrosis that characterizes CKD. Systemic alkalization that ameliorates an acid challenge might attenuate the contributions of angiotensin II, endothelin, and aldosterone to kidney injury. Some small clinical studies support the efficacy of alkalization in attenuating kidney injury and slowing glomerular filtration rate decline in CKD. This review focuses on the potential that orally administered NaHCO3prevents CKD progression and additionally addresses its mechanism of action, side effects, possible complications, dosage, interaction, galenic form description, and contraindications. Current National Kidney Foundation guidelines recommend oral alkali, including NaHCO－3, in CKD patients with serum HCO－3＜22mmol/L. Although oral alkali can be provided by other medications and by base-inducing dietary constituents, oral NaHCO3will be the focus of this review because of its relative safety and apparent efficacy, and its comparatively low cost.

alkali therapy; bicarbonate; chronic kidney disease