ACC／AHA

摘要： 古语有云,日出而作,日落而息,每日保证6~8 h的睡眠是健康生活的基本要素之一,美国ACC/AHA指南也将睡眠作为CVD一级预防进行了推荐。好的睡眠包含质和量两方面,而现如今,大量的工作、昼夜颠倒的轮班制度、灯光手机等电子产品的影响,这些都在影响着我们的睡眠质量。拥有充足的睡眠对于我们维持健康、降低CVD风险具有重要意义。

摘要： 目的 :探讨慢性心力衰竭不同时期无创血流动力学指标的变化规律。方法 :对本院在2017年12月至2018年12月间收治的慢性心力衰竭患者进行研究,根据ACC/AHA成人慢性心力衰竭分期标准随机抽选120例患者,分为:A、B、C、D组,一组30例。另选择同期健康体检的30名正常人群作为对照组,对比各组受检者的无创血流动力学指标变化情况。结果 :与对照组相比较,A、B、C、D组患者的无创血流动力学指标均存在统计学差异性:P0.05)。结论 :慢性心力衰竭患者不同时期的无创血流动力学指标变化程度不同,随着病情加重其心肌收缩力逐渐下降,心肌负荷明显升高,BNP以及LVEF在早期的慢性心力衰竭患者中临床表现并不明显,随着病情进展逐渐呈现出BNP升高、LVEF降低的情况。因此,无创血流动力学能够作为慢性心力衰竭患者的主要检查指标。

摘要： Background: The American College of Cardiology (ACC), American Heart Association (AHA) and other organizations announced a new hypertension guideline (2017 ACA/AHA Guideline) in November 2017. However, other organizations such as the European Society of Cardiology and European Society of Hypertension maintained their diagnostic thresholds. It is necessary to evaluate the effects of blood pressure (BP) and antihypertensive drugs on the probability of having heart disease (HD). Data and Methods: The effects of BP, antihypertensive drugs and other factors on the probability of undergoing HD treatment were analyzed. We used a dataset containing 83,287 medical check-up and treatment records obtained from 35,504 individuals in 5 fiscal years. The probit models were used in the study. Considering the possibility of endogeneity problems, different types of models were used. Results: We could not find evidence that a higher systolic BP increased the probability of undergoing HD treatment. However, diastolic BP increased the probability in most of the models. Taking antihypertensive drugs also increased the probability of undergoing HD treatment. Diabetes was another important risk factor. Conclusion: The results of this study did not support the new 2017 ACC/AHA Guideline. It is necessary to choose proper drugs and methods to reduce the risks of side effects. Limitations: The dataset was observatory, the data were obtained from just one medical society, and sample selection bias might exist.

摘要： 2019-03-17,《2019 ACC/AHA 心血管疾病一级预防指南》在第68 届美国心脏病学会科学年会(ACC 2019)上正式发布。指南十大要点如下。1.预防动脉粥样硬化性心血管疾病(ASCVD)、心力衰竭和心房颤动最重要的方法是提倡终生的健康生活方式。2.基于团队的医疗方法是预防心血管疾病的有效策略。临床医生应评估影响个体健康的社会决定因素,以便为治疗决策提供信息。

摘要： Background: The American College of Cardiology (ACC), American Heart Association (AHA) and other organizations announced a new hypertension guideline in November 2017. However, previous studies have pointed out that this new guideline might lack sufficient evidence to justify its use. Data and Methods: The effects of blood pressure (BP) on medical costs and on the probability of having heart disease as anamnesis are analyzed. We used a dataset containing 175,123 medical checkups and 6,312,125 receipts from 88,211 individuals obtained from three health insurance societies from April 2013 to March 2016. The dataset was divided into subgroups based on whether the patients had diabetes and took hypertension medications. The power transformation and probit models were used in the study. Results: We observed negative effects of systolic BP (SBP) on medical costs in most subgroups. We could not find evidence that higher SBP made the medical costs and probability of having heart diseases higher. The results raise uncertainty about the reliability of the new guideline, at least for SBP. Conclusion: The results of this study did not support the new 2017 ACC/AHA guideline, at least for SBP. The new guideline must be more carefully reevaluated by additional studies. Limitations: The dataset was observatory, the sample period was only 3 years, and we could not complete a time-series analysis of individuals.

摘要： Background: High blood pressure (BP) or hypertension is considered one of the top global disease burden risk factors. In November 2017, the ACC/AHA and other organizations announced a new hypertension guideline of 130/80 mmHg. Data and Methods: We evaluate the effects of BP on increases in medical expenditures using transformation tobit models and a dataset containing 175,123 medical checkups and 6,312,125 receipts from 88,211 individuals in three health insurance societies. The sample period was April 2013 to March 2016. We first created a database of combined checkup results and medical expenditures. The power transformation tobit model was then used to remove the effects of other variables, and we investigated the relation between medical expenditures and BP, especially systolic BP (SBP). Results: We observed negative effects of SBP on medical expenditures. The results raise uncertainty about the reliability of the new guideline, at least for SBP. Although the simple correlation coefficient of medical expenditures and SBP was positive, the sign of the SBP estimate became negative when a variable representing obesity was included. In terms of other medical checkup items, while LDL is considered the “bad” cholesterol, it reduced medical expenditures. Conclusion: Our results did not support the new 2017 ACC/AHA guideline for SBP. A wide and careful range of reviews not only for heart diseases but also for other disease types will be absolutely necessary. New studies to verify the guideline should also be conducted. Limitations: The dataset was observatory, the sample period only 3 years, and we could not complete a time-series analysis of individuals.

摘要： 目的：高收入国家的动脉粥样硬化性心血管疾病（ASCVD）负担主要集中于老年人。随着预期寿命增长,明确指导合理使用他汀类药物预防首次及潜在毁灭性ASCVD事件,对确保老年人健康至关重要。方法：2013年以来,由5个北美和欧洲的ACC/AHA、英国国家健康与临床卓越研究所、加拿大心血管学会、美国预防医学工作组和ESC/欧洲动脉粥样硬化学会等制定关于他汀类药物预防ASCVD的指南。结果：用他汀类药物预防老年人（年龄〉65岁）ASCVD的指南间有显著差异。结论：作者讨论了指南中的不同建议,结合现有的循证医学证据,来发现哪些不确定性会妨碍老年人适当使用他汀类药物。

摘要： 最近，美国心脏病学会/美国心脏协会（ACC/AHA）联合发布了新的高血压防治指南（以下简称“新指南”）。因为该指南分量超级重磅，一面世已经在医学界引起广泛关注，临床医师即使不是耳熟能详也都略知一二，特别是内科医师。那么，新指南会对中国临床产生什么影响，在执行过程中又会产生什么困难呢？笔者将就医生们关心的问题提出一些个人见解，以供参考。高血压患者会不会明显增加根据新指南，高血压被定义为≥130/80mmHg；收缩压120～129mmHg，舒张压＜80mmHg为血压升高；血压130～139/80～89mmHg为1级高血压；≥140/90mmHg为2级高血压。取消此前“高血压前期”的概念。

摘要： 目的：新一代药物洗脱支架置入后,双重抗血小板治疗的最佳期限仍不确定。同样,对稳定心肌梗死后患者,双重抗血小板长期治疗问题也值得商榷。因此,我们比较了不同期限双重抗血小板治疗的死亡事件、大出血、心肌梗死及支架内血栓形成等主要不良心脏事件的发生率。方法与结果：我们纳入了来自11个随机对照试验的33 051例药物洗脱支架置入后患者,采用传统的频率统计和贝叶斯方法分析。

摘要： 背景：ACC／AHA和ESC一直致力于制定指南帮助临床做出循证医学指引下的决定。材料和方法：目前ACC／AHA和ESC关于NSTE-ACS的指南分别更新于2014年和2015年，比较这两个指南来评价基予推荐等级、证据级别（LOE）、