高尿酸血症与冠心病之间的关系

高尿酸血症是一种嘌呤代谢障碍性疾病,早期人们主要关注高尿酸血症对关节及肾脏的影响,但随着尿酸水平的升高,患心血管疾病的风险也相应的增加,近年来越来越多的研究用于证明高尿酸血症与心血管疾病之间的相互作用,人们才逐渐关注高尿酸血症对心血管疾病的影响,并且一直是学者关注的焦点之一,高尿酸血症是否为冠心病的独立危险因素？高尿酸血症是否直接和冠心痛的预后相关？两者之间的关系一直存在争议,本文就高尿酸血症与冠心病关系、高尿酸血症对冠心痛影响的可能机制作一综述.     

Individual differences in cardiovascular reactions to stress and cigarette smoking

The present study examined the stability of cardiovascular reactions to psychological stress and cigarette smoking, and the extent to which cardiovascular reactions to stress were predictive of cardiovascular reactions to smoking. Thirty subjects were given an initial test involving two repetitions of mental arithmetic stress and paced smoking while blood pressure and heart rate were measured. Two months later, 26 of these subjects were retested in the same paradigm. Large and stable individual differences were observed in cardiovascular reactivity to both stress and smoking. Moreover, for systolic and diastolic blood pressure, but not heart rate, reactions to stress were modestly correlated with reactions to cigarette smoking. These results are consistent with the possibility that level of reactivity to cigarette smoking may constitute a risk factor for coronary heart disease, and that one or more common variables may mediate the magnitude of blood pressure reactivity to both stress and cigarette smoking.     

Twin similarity in cardiovascular stress response

Cardiovascular (CV) responses to laboratory stressors were measured in 12 pairs of identical and 21 pairs of fraternal adult male twins. For this study, blood pressure and heart rate were measured during a mental arithmetic task and the Cold Pressor Test. The analyses of cardiovascular responses to these stressors were designed to test for the presence of a genetic component in cardiovascular reactivity in an adult sample of twins aged 54-64 years. The results suggest that certain measures of cardiovascular reactivity to laboratory stressors may be heritable for both physical and psychological stressors. The possible role of this genetic component in the etiology and course of coronary heart disease is discussed.     

遵循指南，恰当进行冠心病的介入治疗

如何遵循指南,结合冠心痛患者实际情况和具体病变,恰如其分地为患者实施经皮冠状动脉介入治疗（PCI）,使获益最大化,而风险最低化,是每一位心血管介入医生的追求和面临的问题。应正确和严格选择冠心病患者PCI适应证,合理运用PCI的各种手段,牢固树立冠心病全面治疗观念。PCI仅仅是冠心病全面治疗的一个组成部分,必要的介入、外科治疗和合理药物治疗的联合应用,是心血管疾病治疗的发展方向。     

Familial environment associated with type A behaviors and psychophysiological responses to stress in children

This study tested two major hypotheses regarding the characteristics of family environments associated with children's Type A behaviors, anger frequency and expression, hostile outlook, hostility displayed during an interview, and cardiovascular responses to laboratory stressors. Two measures of family environment, Positive Affiliation and Authoritarianism, were derived by a factor analysis of the Family Environment Scale completed by parents. The sample consisted of 66 girls and 48 boys enrolled in Grades 2 through 12 from 114 families residing in a predominantly White, upper-middle-class suburb of Pittsburgh. Analyses largely supported the first hypothesis--that a less supportive and positively involved family climate would be associated with attributes of potential coronary heart disease (CHD) risk in children. Families scoring low on Positive Affiliation had children who were assessed as more angry and hostile on the basis of questionnaires and interview. Boys from these families had a more pronounced heart rate response to all laboratory stressors. The second hypothesis--that authoritarianism, in the absence of positive involvement and supportiveness in the family, would be associated with attributes of potential CHD risk in children--received support in regard to boys' heart rate responses to the serial-subtraction and mirror-image-tracing tasks. High Authoritarianism scores in combination with low Positive Affiliation scores in families predicted a heightened heart rate response in boys. Sex differences in the pattern of associations among family and child characteristics were also found. Results suggest that factors in the family environment may be important influences in children's development of characteristics that may, in adulthood, place them at risk for CHD.     

The Incremental Validity of Self-Report and Performance-Based Methods for Assessing Hostility to Predict Cardiovascular Disease in Physicians

We evaluated the utility of an integrative, multimethod approach for assessing hostility-related constructs to predict premature cardiovascular disease (CVD) and premature coronary heart disease (CHD) using participants from the Johns Hopkins Precursors Study, which was designed to identify risk factors for heart disease. Participants were assessed at baseline while in medical school from 1946 to 1962 (M age = 24.6) and have been followed annually since then. Baseline assessment included individually administered Rorschach protocols (N = 416) scored for aggressive imagery (i.e., Aggressive Content, Aggressive Past) and self-reports of 3 possible anger responses to stress. Cox regression analyses predicting morbidity or mortality by age 55 revealed a significant interaction effect; high levels of Aggressive Content with high self-reported hostility predicted an increased rate of premature CVD and CHD, and incrementally predicted the rate of these events after controlling for the significant covariates of smoking (CVD and CHD) and cholesterol (CHD) that were also assessed at baseline. The hostility and anger measures, as well as other baseline covariates, were not predictors of CVD risk factors assessed at midlife during follow-up. Overall, this integrative model of hostility illustrates the potential value of multimethod assessment to areas of health psychology and preventive medicine.     

Hostility predicts metabolic syndrome risk factors in children and adolescents.

The authors tested in 134 African American and European American children whether hostility measured at study entry predicted the metabolic syndrome risk factors an average of 3 years later. Hostility was measured with the Cook-Medley Hostility Scale (W. W. Cook & D. M. Medley, 1954) and with ratings of Potential for Hostility from interview responses. Metabolic syndrome was based on having at least 2 of the following risk factors above the 75th percentile of scores for their age, race, and gender group: body mass index, insulin resistance index, ratio of triglycerides to high-density lipoprotein cholesterol, and mean arterial blood pressure. Children who exhibited high hostility scores at baseline were likely to exhibit the metabolic syndrome at the follow-up. The results highlight the potential importance of early prevention and intervention of behavioral risk factors for cardiovascular disease.     

Type a behavior,irritability, and cardiovascular response

Previous research suggests that high levels of hostility may augment the cardiovascular reactivity and risk of coronary heart disease (CHD) associated with Type A behavior. In contrast, other research indicates that the tendency to deny or suppress anger is associated with enhanced cardiovascular reactivity and risk of CHD. To delineate further the combined role of anger processes and Type A behavior in CHD risk, this study examined the interactive effects of Type A behavior and self-reported irritability on cardiovascular response to a challenging mental task. Type A and Type B college students were further classified as either high or low in self-reported irritability. Type A subjects who were low in self-reported irritability evidenced greater cardiovascular reactivity (i.e., systolic blood pressure and pulse rate) than did Type B subjects low in irritability. However, Type A subjects who were high in irritability tended to demonstrate less cardiovascular response than Type B subjects high in irritability. Further, Type A's low in self-reported irritability evidenced greater cardiovascular response than high-irritability Type A's. It is suggested that reduced reporting of irritability by Type A's may reflect suppression or denial, and further that this reduced reporting is associated with enhanced cardiovascular responsivity.     

The relationship between resting heart rate and aggression in males is racially variant

Although resting heart rate is thought to be a generalizable risk factor for aggression, very little research has examined whether this relationship varies by race. We addressed this limitation using longitudinal data from the Pittsburgh Youth Study. Current data are from 197 men who participated in a teenage biosocial study (mean age = 15.7 years) and adult follow-up study (mean age = 32.1 years). Teenage resting heart rate interacted with race to predict teenage and adult aggression. The relationship between heart rate and aggression was significant in White, but not in Black males. To our knowledge, this is the first study to find that the relationship between resting heart rate and aggression is racially variant, suggesting that resting heart rate may not be a generalizable biomarker for conduct problems. At an intervention-level, findings could contribute to the development of more accurate risk assessment tools that take into account racial variance in risk factors.     

Cognition and incident coronary heart disease in late midlife: The Whitehall II study

The purpose of this study was to investigate whether cognitive function in midlife predicts incident coronary heart disease (CHD), followed up over 6 years. Data on 5292 (28% women, mean age 55) individuals free from CHD at baseline were drawn from the British Whitehall II study. We used Cox regression to model the association between cognition and CHD in analyses adjusted for socio-demographic variables, cardiovascular risk factors and health behaviors. The results show a one standard deviation lower score on the “general” cognitive measure and measures of reasoning and vocabulary to be associated with elevated CHD risk. There was some evidence that these effects differed between high and low socioeconomic status (SES) groups with associations only seen in the low SES group. These results were not explained by threshold effects or by the different SES groups representing different parts of the cognitive test score distribution. Three other possible explanations of these results are discussed: sub clinical vascular disease drives the observed association but no effect is observed in the high SES group due to compensation provided by greater cognitive reserve, cognition is a marker of overall bodily integrity particularly in low-SES groups, and SES is a moderator of the association between cognition and CHD, because it marks a range of other risk factors.     

Psychological risk factors in cardiovascular diseases

Recent research has shown that psychological risk factors play an important role in the pathogenesis of cardiovascular diseases. The so-called ‘coronary prone behaviour pattern’ predominates, an important part of which is the ‘Type A behaviour pattern’. This is characterized by a marked ambition, a constant feeling of being under pressure, due to latent aggression and to a striving to dominate. For cerebrovascular diseases the so-called ‘pressured pattern’ as a risk factor has been found to be typical which is comparable to the Type A behaviour. Psychological risk factors and their components are not equally important for different vascular diseases. Besides the explanation of the question as to how far psychological processes really are involved in the development of vascular diseases, the research on psychological risk factors serves as a foundation for psychosomatic theories.     

Relation between cardiovascular and metabolic disease and cognition in very old age: cross-sectional and longitudinal findings from the berlin aging study.

This study documented findings on the relation between cognitive functioning (perceptual speed, memory, fluency, and knowledge) and cardiovascular and metabolic disease in a sample of very old adults (ages 70 and older), both cross-sectionally (n=516) and longitudinally (n=206) in a 4-year follow-up. After age, SES, sex, and dementia status were controlled for, 4 diagnoses were negatively associated with cognition: congestive heart failure, stroke, coronary heart disease, and diabetes mellitus, with a joint effect of 0.47 standard deviations. The impact of disease status was largest on perceptual speed and fluency, memory was impacted only by diabetes, and knowledge was not related to any somatic diagnosis. There was no differential decline in participants diagnosed with 1 of these 4 diseases and those who were not. The only cardiovascular risk factor associated with cognitive performance was alcohol consumption.     

从冠心病主要危险因素的流行特点谈医学模式的转变

随着人民生活水平的提高,冠心病的发病率呈逐年上升趋势,不仅造成个人很高的致残率或致死率,而且给家庭和社会带来沉重的经济负担,冠心病已成为当前一个重要的公共卫生问题。而冠心病是一个多病因疾病,是可防可控的。充分了解冠心病危险因素的流行现状及危害,转变理念,着眼预防,逐步改变目前"重治轻防"的医学模式,是我们心血管医生神圣的使命。     

高血压左室肥厚的QT离散度及左室Tei指数的关系探讨

心脏是最常见的高血压损伤靶器官,首先引起左心室肥厚,然后导致心功能下降,并可导致心律失常。高血压患者中约有1/3会出现左室肥厚（LVH）,可致心血管病事件发病率增加,病死率升高,是猝死、冠心病和充血性心力衰竭的独立的、主要的危险因素和预后信号。QT间期离散度（QTd）是反映心室肌复极的不均匀性和电不稳定性预测恶性室性心...     

Personality as a risk factor in coronary heart disease

The pioneering work of the authors of the Type A personality concept has now been shown to be seriously flawed, with only the traits of anger, aggression, and hostility remaining as risk factors for coronary heart disease (CHD). There is now evidence for a much stronger relationship between CHD and personality involving a rather different set of concepts and theories. The evidence for such a relationship is summarized, and a causal link suggested. It is also shown that the CHD-prone type of behaviour can be changed by behaviour therapy, decreasing considerably the risk of dying from CHD.     

Perceptions of multiple risk factors for heart attacks

There is increasing evidence that in some diseases such as coronary heart disease, risk factors may interact synergistically, resulting in greater likelihood of disease than would be produced by the sum of the risk factors. These two studies aimed to examine the extent to which 210 undergraduate students and 28 heart attack patients perceive risk factors to combine synergistically. Respondents read one of four vignettes, describing information about risk factors (with high and low smoking and family history), and estimated a man's likelihood of a heart attack in a hypothetical case. In both studies an interaction was found with either a family history or smoking eliciting ratings of high likelihood of heart attack, providing no evidence of synergistic models. This finding may reflect respondents' beliefs or the insensitivity of this paper-and-pencil method in detecting synergistic effects.     

Heart Rate Recovery After Exercise in Outpatients with Coronary Heart Disease: Role of Depressive Symptoms and Positive Affect

Heart rate recovery after 1 min of exercise cessation (HRR-1) is an important prognostic factor in patients with cardiovascular disease (CVD). We aimed to further elucidate the association between HRR-1 and known psychosocial risk factors in patients referred for comprehensive cardiac rehabilitation. We examined 521 patients with coronary heart disease in the first week of an outpatient cardiac rehabilitation program. Depressive and anxiety symptoms were measured with the Hospital Anxiety and Depression Scale, and positive (PA) and negative affect were rated with the Global Mood Scale. Depressive symptoms showed a significant inverse relationship with HRR-1 (p?<?.05), controlling for sociodemographic and medical covariates, whereas anxiety symptoms did not show a significant association. PA made a significant contribution to HRR-1 as well (p?<?.05). Our findings suggest an independent association between HRR-1 and psychosocial risk factors of CVD.     

A critical evaluation of some commonly-employed methods for the assessment of type a coronary-prone behaviour

Type A coronary-prone behaviour has been repeatedly associated with an increased incidence of coronary heart disease (CHD) amongst middle-aged men and women. This association appears to be independent of other standard CHD risk factors such as smoking, high blood pressure and elevated serum cholesterol levels. This paper presents normative and correlational data for a number of commonly-employed self-report measures of Type A behaviour and the structured interview. These data replicate U.S. findings that self-report measures tend to correlate only moderately with the Structured-Interview method of assessment of Type A behaviour. The implications of these data for researchers attempting to assess Type A behaviour, especially with limited resources, are discussed.     

Motivation is not enough: prediction of risk behavior following diagnosis of coronary heart disease from the theory of planned behavior.

Perceived behavioral control (PBC) and intention, the proximal predictors from the theory of planned behavior (TPB), were used to predict cardiovascular risk behaviors in 597 patients 1 year after diagnosis with coronary heart disease. The outcome measures were self-report measures of exercise plus objective measures of fitness (distance walked in 6 min) and cotinine-confirmed smoking cessation. In multivariate analyses incorporating both PBC and intention, PBC predicted exercise, distance walked, and smoking cessation, but intention was not a reliable independent predictor of any health behavior measured. Thus, the effective theoretical component of the TPB was PBC. Similar predictions could derive from social-cognitive theory. In coronary patients, behavioral change needs to address issues of action implementation rather than motivational factors alone.     

Investigating the neurodevelopmental mediators of aggression in children with a history of child maltreatment:An exploratory field study

Maltreatment of children is a chronic community problem that increases the risk of future aggression. Despite several decades of research highlighting this relationship, few studies have explored the potential neuropsychological deficits that are likely to mediate it. This exploratory study aimed to examine how child maltreatment may be associated with aggression via impairment in the developing prefrontal-limbic-autonomic pathways that are implicated in neuropsychological models of aggression. Furthermore, it aimed to investigate the relationship between child maltreatment and both reactive and proactive aggression subtypes. To investigate this non-invasively in an at-risk population, children with a documented protective care history (n = 20) and a community control group (n = 30), aged between 6 and 12 years, were compared on measures of cardiovascular functioning, affect regulation and cognitive functioning aligned with this neuropsychological model. Whilst no group differences were found on cardiovascular functioning (i.e., resting heart rate, heart rate reactivity, heart rate variability), the protective care group performed significantly worse on measures of affect regulation and cognitive functioning (i.e., global intelligence, executive functioning, smell identification and social cognition). The relationship between child maltreatment and aggression was mediated by executive dysfunction and affect dysregulation but not global IQ, social cognition or olfactory identification. The results suggest that interventions targeting aggression in maltreated children will benefit from clinical assessment and psychological strategies that address the executive dysfunction and affect dysregulation that has been associated with this clinical outcome.