心血管疾病

求闻百科，共笔求闻

心血管疾病（英语：Cardiovascular disease，缩写：CVD）是一类涉及心脏或血管的疾病。[1] CVD包括冠状动脉疾病（CAD），如心绞痛和心肌梗死（俗称心脏病发作）。[1] 还包括中风、心脏衰竭、高血压心脏病、风湿性心脏病、心肌病、心律失常、先天性心脏病、瓣膜性心脏病、心脏炎、主动脉瘤、周围动脉疾病、血栓栓塞性疾病和静脉血栓。[1][2]

其基本机制因疾病而异。[1] 据估计，饮食风险因素与53%的心血管疾病死亡有关。[3] 冠状动脉疾病、中风和周围动脉疾病涉及动脉粥样硬化。[1] 这可能是由高血压、吸烟、糖尿病、缺乏运动、肥胖、高血脂、不良饮食、过度饮酒[1]和睡眠不良[4][5]等引起的。据估计，高血压约占心血管疾病死亡的13%，而烟草占9%，糖尿病占6%，缺乏运动占6%，肥胖占5%。[1] 链球菌性咽炎如不及时医治可能会引发风湿性心脏病。[1]

据估计，高达90%的心血管疾病可能是可以预防的。[6][7] 预防心血管疾病包括通过以下方式改善危险因素：健康饮食、运动、避免吸烟和限制酒精摄入。[1] 治疗危险因素，如高血压、高血脂和糖尿病也是有益的。[1] 用抗生素治疗患有链球菌性咽炎的人可以减少风湿性心脏病的风险。[8] 在其他方面健康的人中，使用阿司匹林的好处并不明确。[9][10]

除非洲外，心血管疾病是全世界死亡的主要原因。[1] 2015年，心血管疾病共导致1790万人死亡（32.1%），比1990年的1230万人（25.8%）有所增加。[11][2] 在特定年龄段，死于心血管疾病的情况更加普遍，并且在大部分发展中国家一直在增加，而自20世纪70年代以来，大多数发达国家的比率已经下降。[12][13] 冠状动脉疾病和中风占男性心血管疾病死亡的80%，占女性心血管疾病死亡的75%。[1] 大多数心血管疾病影响到老年人。在美国，20至40岁的人中有11%患有心血管疾病，而40至60岁的人中有37%，60至80岁的人中有71%，而80岁以上的人中有85%患有心血管疾病。[14] 发达国家死于冠状动脉疾病的平均年龄为80岁左右，而发展中国家则为68岁左右。[12] 与女性相比，男性确诊患病通常早7至10年。[1]:48

类型

2004年每10万居民中，因炎症性心脏疾病导致的失能调整生命年数。[15]

 无数据

 低于70

 70–140

 140–210

 210–280

 280–350

 350–420

 420–490

 490–560

 560–630

 630–700

 700–770

 高于770

有许多涉及血管的心血管疾病。

还有许多涉及心脏的心血管疾病。

风险因素

心脏病的风险因素有很多：年龄、性别、吸烟、缺乏运动、非酒精性脂肪肝、过量饮酒、不健康饮食、肥胖、遗传倾向和心血管疾病家族史、血压升高（高血压）、血糖升高（糖尿病）、血胆固醇升高（高脂血症）、未诊断的乳糜泻、社会心理因素、贫困和低教育状况、空气污染以及睡眠不佳。[1][16][17][18][19][20] 虽然每个风险因素的个别贡献在不同的社区或种族群体中有所不同，但这些风险因素的总体贡献是非常一致的。[21] 其中一些风险因素，如年龄、性别或家族史/遗传倾向，是不可改变的；然而，许多重要的心血管风险因素是可以通过改变生活方式、社会变革、药物治疗（例如预防高血压、高脂血症和糖尿病）来改变的。[22] 肥胖的人患冠状动脉粥样硬化的风险增加。[23]

遗传

一个人的父母患有心血管疾病会使其风险增加~3倍，[24] 遗传是心血管疾病的重要风险因素。遗传性心血管疾病的发生可以是单一变体（孟德尔）或多基因影响的结果。[25] 有超过40种遗传性心血管疾病可以追溯到单一的致病DNA变体，尽管这些情况是罕见的。[25] 大多数常见的心血管疾病是非孟德尔式的，被认为是由成百上千的遗传变异体（被称为单核苷酸多态性）引起的，每个变异体都与小的影响有关。[26][27]

年龄

一位患有心脏肿大的老年妇女的钙化心脏

年龄是患心血管或心脏疾病的最重要的风险因素，每过十年，风险大约增加两倍。[28] 冠状动脉脂肪条纹在青少年时期就可以开始形成。[29] 据估计，82%死于冠心病的人是65岁及以上的人。[30] 同时，55岁以后，中风的风险每十年增加一倍。[31]

人们提出了多种解释来说明为什么年龄会增加心血管/心脏疾病的风险。[32] 其中之一与血清胆固醇水平有关。在大多数人群中，血清总胆固醇水平随着年龄增长而增加。在男性中，这种增长在45至50岁左右趋于平稳。在女性中，这种增加一直持续到60至65岁。[32]

衰老也与血管壁的机械和结构特性的变化有关，这导致了动脉弹性的丧失和动脉顺应性的降低，随后可能导致冠状动脉疾病。[33]

性别

与绝经前的女性相比，男性患心脏病的风险更大。[28][34] 一旦过了更年期，有人认为女性的风险与男性相似，[34] 尽管世卫组织和联合国的最新数据对此有异议。[28] 如果女性患有糖尿病的话，她比男性糖尿病患者更有可能患上心脏病。[35]

冠心病在中年男性中比女性常见2至5倍。[32] 在世界卫生组织所做的一项研究中，性别在冠心病死亡率的性别比例变化中约占40%。[36] 另一项研究报告了类似的结果，发现性别差异解释了与心血管疾病相关的近一半的风险。[32] 对心血管疾病性别差异的一种解释是荷尔蒙差异。[32] 在女性中，雌性激素是最主要的性激素。雌激素可能对葡萄糖代谢和止血系统有保护作用，并可能对改善内皮细胞功能有直接作用。[32] 绝经后，雌激素的分泌减少，这可能使女性的脂质代谢朝着更容易引起动脉粥样硬化的方向发展，降低高密度脂蛋白胆固醇水平，同时增加低密度脂蛋白和总胆固醇水平。[32]

在男性和女性中，体重、身高、身体脂肪分布、心率、卒中量和动脉顺应性都存在差异。[33] 在非常年长的人中，与年龄有关的大动脉脉动和僵硬在女性中比男性更明显。[33] 这可能是由女性较小的身体尺寸和动脉尺寸造成的，这与绝经无关。[33]

吸烟

香烟是熏制烟草的主要形式。[1] 吸烟对健康造成的风险不仅来自于吸烟本身，而且来自于接触二手烟。[1] 大约10%的心血管疾病是由吸烟引起的；[1] 然而，在30岁之前戒烟的人的死亡风险几乎与从不吸烟的人一样低。[37]

缺乏运动

体力活动不足（定义为每周少于5次30分钟的适度活动，或每周少于3次20分钟的剧烈活动）是目前全世界第四大死亡风险因素。[1] 2008年，31.3%的15岁或以上的成年人（28.2%的男性和34.4%的女性）体力活动不足。[1] 每周参加150分钟的适度体育活动（或同等活动）的成年人，患缺血性心脏病和糖尿病的风险几乎减少三分之一。[38] 此外，体育活动有助于减轻体重，并改善血糖控制、血压、血脂状况和胰岛素敏感性。这些影响至少可以部分解释其对心血管的益处。[1]

饮食

饱和脂肪、反式脂肪和盐的高膳食摄入量以及水果、蔬菜和鱼类的低摄入量与心血管风险有关，尽管所有这些关联是否表明原因是有争议的。世界卫生组织将全世界大约170万例死亡归因于水果和蔬菜的低消费。[1] 经常食用高能量的食物，如高脂肪和高糖的加工食品，会促进肥胖并可能增加心血管风险。[1] 饮食中盐的摄入量也可能是决定血压水平和整体心血管风险的一个重要因素。[1] 有中等质量的证据表明，至少在两年内减少饱和脂肪的摄入量可以降低心血管疾病的风险。[39] 反式脂肪的高摄入量对血脂和循环炎症标志物有不利影响，[40] 消除饮食中的反式脂肪已被广泛提倡。[41][42] 2018年，世界卫生组织估计，反式脂肪是每年超过50万例死亡的原因。[42] 有证据表明，较高的糖消费与较高的血压和不利的血脂有关，[43] 糖的摄入也会增加糖尿病的风险。[44] 加工肉类的高消费与心血管疾病的风险增加有关，部分原因可能是饮食中盐的摄入量增加。[18]

饮酒

饮酒和心血管疾病之间的关系很复杂，可能取决于饮酒的数量。[45] 高水平饮酒与心血管疾病之间有直接关系。[1] 在没有大量饮酒的情况下，低水平饮酒可能与心血管疾病的风险降低有关，[46] 但有证据表明，适度饮酒与保护中风之间的关联是非因果关系。[47] 在人群中，饮酒的健康风险超过任何潜在的好处。[1][48]

乳糜泻

未经治疗的乳糜泻可导致许多类型的心血管疾病的发生，其中大多数在无麸质饮食和肠道愈合后得到改善或解决。然而，对乳糜泻的认识和诊断的延误会造成不可逆的心脏损伤。[19]

睡眠

没有良好的睡眠，无论是数量还是质量，都会增加成人和青少年的心血管风险。建议表明，婴儿通常每天需要12小时或更多的睡眠时间，青少年至少需要8或9小时，而成年人需要7或8小时。大约三分之一的美国成年人每晚的睡眠时间少于建议的7小时，在一项对青少年的研究中，只有2.2%的被研究者有足够的睡眠，其中许多人没有得到良好的睡眠质量。研究表明，每晚睡眠时间短于7小时的人患心血管疾病的风险高出10%至30%。[4][49]

睡眠障碍，如睡眠障碍性呼吸和失眠，也与较高的心脏代谢风险有关。[50] 估计有5000万到7000万美国人有失眠、睡眠呼吸暂停或其他慢性睡眠障碍。

此外，睡眠研究显示了种族和阶层的差异。少数民族的睡眠时间短和睡眠质量差的报告往往比白人更频繁。非裔美国人报告的睡眠时间短的情况是白人的五倍，这可能是社会和环境因素的结果。黑人儿童和生活在贫困地区的儿童的睡眠呼吸暂停率要高得多。[5]

社会经济方面不利条件

心血管疾病对中低收入国家的影响甚至超过了高收入国家。[51] 关于中低收入国家心血管疾病的社会模式的信息相对较少，[51] 但在高收入国家，低收入和低教育状况一直与心血管疾病的风险较大有关。[52] 导致社会经济不平等加剧的政策与后来心血管疾病[51]的社会经济差异较大有关，这意味着一种因果关系。社会心理因素、环境暴露、健康行为以及医疗服务的获取和质量都会导致心血管疾病的社会经济差异。[53] 健康问题社会决定因素委员会建议，需要在权力、财富、教育、住房、环境因素、营养和保健方面进行更平等的分配，以解决心血管疾病和非传染性疾病的不平等问题。[54]

空气污染

颗粒物已被研究其对心血管疾病的短期和长期暴露影响。目前，直径2.5微米以下的空气颗粒物（PM2.5）是主要焦点，其中的梯度被用来确定心血管疾病风险。总的来说，长期接触PM会增加动脉粥样硬化和炎症的比率。关于短期暴露（2小时），每25 μg/m3的PM2.5会导致心血管疾病死亡风险增加48%。[55] 此外，仅在接触5天后，每10.5 μg/m3的PM2.5就会导致收缩压（2.8 mmHg）和舒张压（2.7 mmHg）上升。[55] 其他研究表明，PM2.5与心律不齐、心率变异性降低（迷走神经张力降低），以及最明显的心力衰竭有关。[55][56] PM2.5还与颈动脉增厚和急性心肌梗塞的风险增加有关。[55][56]

心血管风险评估

现有的心血管疾病或以前的心血管事件，如心脏病发作或中风，是未来心血管事件的最强预测因素。[57] 年龄、性别、吸烟、血压、血脂和糖尿病是未知心血管疾病患者未来心血管疾病的重要预测因素。[58] 这些指标，有时还有其他的指标，可以组合成综合风险分数，以估计一个人未来的心血管疾病风险。[57] 目前有许多风险评分，尽管它们各自的优点还存在争议。[59] 其他诊断性测试和生物标志物仍在评估中，但目前这些都缺乏明确的证据来支持其常规使用。它们包括家族史、冠状动脉钙化评分、高敏C反应蛋白（hs-CRP）、踝臂压力指数、脂蛋白亚类和颗粒浓度、脂蛋白（a）、载脂蛋白A-I和B、纤维蛋白原、白细胞计数、同型半胱氨酸、N-末端前B型钠尿肽（NT-proBNP）和肾脏功能的标志。[60][61] 高血磷也与风险增加有关。[62]

抑郁症和创伤性压力

有证据表明，精神健康问题，特别是抑郁症和创伤性压力，与心血管疾病有关。虽然已知精神健康问题与心血管疾病的风险因素有关，如吸烟、饮食不规律和久坐不动的生活方式，但这些因素本身并不能解释抑郁症、压力和焦虑所带来的心血管疾病的风险增加。[63] 此外，即使在调整了抑郁症和其他协变量后，创伤后应激障碍也与冠心病发病风险的增加独立相关。[64]

职业暴露

主条目：Occupational cardiovascular disease

人们对工作和心血管疾病之间的关系知之甚少，但某些毒素、极热和极冷、接触烟草烟雾以及压力和抑郁症等心理健康问题之间已经建立了联系。[65]

非化学风险因素

2015年SBU-报告对非化学因素的研究发现，这些因素存在关联：[66]

  • 工作压力大，对自己的工作状况缺乏控制 — 努力与回报不平衡[66]
  • 在工作中遇到的社会支持少的人；遇到不公正待遇或个人发展机会不足的人；或遇到工作不稳定的[66]
  • 那些在夜间工作的人；或者工作周长的人[66]
  • 暴露在噪音中的人[66]

具体来说，接触电离辐射也会增加中风的风险。[66] 高血压在经历工作压力和轮班工作的人中更经常发生。[66] 女性和男性之间的风险差异很小，但是男性在工作期间发生和死于心脏病发作或中风的风险是女性的两倍。[66]

化学风险因素

2017年SBU的一份报告发现，有证据表明工作场所暴露于硅尘、发动机废气或焊接烟尘与心脏病有关。[67] 接触砷、苯并芘、铅、炸药、二硫化碳、一氧化碳、金属加工液和职业性接触烟草烟雾也存在关联。[67] 从事铝的电解生产或使用硫酸盐制浆工艺的纸张生产与心脏病有关。[67] 还发现心脏病与暴露于某些工作环境中不再允许的化合物之间有关联，如含有TCDD（二恶英）的苯氧基酸或石棉。[67]

工作场所暴露于硅尘或石棉也与肺心病有关。有证据表明，工作场所接触铅、二硫化碳、含有TCDD的苯氧基酸，以及在电解铝的环境中工作，都与中风有关。[67]

体细胞突变

截至2017年，有证据表明，某些与白血病相关的血细胞突变也可能导致心血管疾病风险增加。多个大规模的人类基因数据研究项目发现，这些突变的存在（一种称为克隆造血的状况）与心血管疾病相关事件和死亡之间存在密切联系。[68]

放射治疗

正如在乳腺癌治疗中观察到的，癌症的放射疗法会增加患心脏病和死亡的风险。[69] 治疗性放射会使随后心脏病发作或中风的风险增加1.5至4倍。[70] 这种增加是与剂量有关的，取决于剂量强度、体积和位置。

放射疗法引起的心血管疾病的副作用被称为辐射诱导心脏病或辐射诱导血管病。症状与剂量有关，包括心肌病、心肌纤维化、瓣膜心脏病、冠状动脉疾病、心律失常和周围动脉疾病。[71] 辐射诱导纤维化、血管细胞损伤和氧化应激可导致这些和其他晚期副作用症状。[71]

病理生理学

心血管钙化的密度依赖性彩色扫描电子显微照片 (DDC-SEM)，显示为橙色磷酸钙球形颗粒（密度较高的材料），绿色为细胞外基质（密度较低的材料）[72]

基于人口的研究表明，动脉粥样硬化是心血管疾病的主要前兆，始于儿童时期。青年动脉粥样硬化的病理生物学决定因素 (PDAY) 研究表明，内膜病变出现在7-9岁青年的所有主动脉和超过一半的右冠状动脉中。[73]

肥胖和糖尿病与心血管疾病有关，[74] 慢性肾病和高胆固醇血症的病史也是如此。有慢性和高胆固醇血症也是如此。[75] 事实上，心血管疾病是糖尿病并发症中对生命威胁最大的，糖尿病患者死于心血管相关原因的可能性比非糖尿病患者高2到4倍。[76][77][78]

筛查

对于没有症状的低风险人群，不建议进行心电图筛查（无论是在休息时还是在运动时）。[79] 这包括那些没有危险因素的年轻人。[80] 对于高危人群，用心电图进行筛查的证据尚不确定。[81] 此外，对于没有症状的低危人群，不建议进行超声心动图、心肌灌注成像和心脏负荷测试。[82] 在预测未来心血管疾病的风险方面，一些生物标志物可能会增加传统的心血管风险因素；然而，一些生物标志物的价值是值得怀疑的。[83][84] 踝肱指数（ABI）、高敏C反应蛋白（hsCRP）和冠状动脉钙，截至2018年，在没有症状的人中也是益处不明确。 [85]

美国国立卫生研究院建议，如果有心脏疾病或血脂问题的家族史，从2岁开始对儿童进行血脂检测。[86] 希望早期检测能改善高危人群的生活方式，如饮食和运动。[87]

传统上，初级预防干预的筛查和选择是通过使用各种评分（如弗雷明汉或雷诺兹风险评分）的绝对风险进行的。[88] 这种分层将接受生活方式干预的人（一般是低度和中度风险）与接受药物治疗的人（高度风险）分开。可供使用的风险评分的数量和种类成倍增加，但根据2016年的一项审查，由于缺乏外部验证或影响分析，其功效并不明确。[89] 风险分层模型往往缺乏对人群的敏感性，没有考虑到中、低风险人群中大量的负面事件。[88] 因此，未来的预防筛查似乎要转向根据每项干预措施的随机试验结果而不是大规模风险评估来应用预防。

预防

如果避免已确立的危险因素，预防心血管疾病的比例可达90%。[6][90] 目前用于预防心血管疾病的措施包括：

  • 保持健康的饮食，例如地中海饮食、素食、纯素食或其他以植物为基础的饮食[91][92][93][94]
  • 用更健康的选择替换饱和脂肪：临床试验表明，用多不饱和蔬菜油替换饱和脂肪可将心血管疾病减少30％。前瞻性观察研究表明，在许多人群中，摄入较少的饱和脂肪并搭配较高的多不饱和和单不饱和脂肪与心血管疾病的发病率较低相关。[95]
  • 如果超重或肥胖，则减少体脂肪。[96] 体重减轻的效果往往难以与饮食变化区分开来，而有关减重饮食的证据有限。[97] 在严重肥胖者的观察性研究中，接受减重手术后，体重减轻与心血管风险降低46％相关。[98]
  • 将饮酒量控制在建议的日常限制范围内[91]；适度饮用酒精饮料的人患心血管疾病的风险降低了25％至30％。[99][100] 然而，那些基因上倾向于少喝酒的人患心血管疾病的比率较低[101]，这表明酒精本身可能并不具有保护作用。饮酒过度会增加心血管疾病的风险，[102][100] 并且在饮酒后的第二天，心血管事件的发生率也会增加[100]
  • 降低非HDL胆固醇。[103][104] 他汀类药物治疗可将心血管死亡率降低约31％。[105]
  • 戒烟和避免二手烟。[91] 戒烟可将风险降低约35％。[106]
  • 每周至少进行150分钟（2小时30分钟）的中等强度运动[107][108]
  • 如果血压升高，则降低血压。血压降低10 mmHg可将风险降低约20％。[109] 即使在正常血压范围内，降低血压似乎也是有效的。[110][111][112]
  • 降低心理社会压力。[113] 这项措施可能会因对心理社会干预的定义不精确而变得复杂。[114] 心理应激引起的心肌缺血与心脏疾病患者的心脏问题风险增加有关。[115] 严重的情绪和身体压力会导致某些人出现所谓的宫水病心脏病。[116] 然而，压力在高血压中的作用相对较小。[117] 具体的放松疗法的效益尚不明确。[118][119]
  • 睡眠不足也会增加高血压的风险。成年人需要约7至9个小时的睡眠。睡眠呼吸暂停也是一个主要风险因素，因为它会导致停止呼吸，从而给身体带来压力，增加心脏疾病的风险。[120][121]

大多数指南建议将预防策略结合起来使用。有证据表明，旨在减少多种心血管风险因素的干预措施可能对血压、身体质量指数和腰围产生有益影响；然而，证据有限，作者无法就心血管事件和死亡的影响得出确定的结论。[122]

有额外的证据表明，仅仅向人们提供心血管疾病风险评分可能会比常规护理稍微降低心血管疾病的风险因素。然而，对于这些评分是否对心血管疾病事件产生任何影响存在一定的不确定性。[123] 目前尚不清楚牙周炎患者是否接受牙科护理会影响他们罹患心血管疾病的风险。[124]

饮食

富含水果和蔬菜的饮食可降低心血管疾病和死亡的风险。[125]

2021年的一项审查发现，如果食用健康的植物性饮食，植物性饮食可以提供心血管疾病的风险降低。与包括肉类在内的常规饮食相比，不健康的植物性饮食并不能提供好处。[92] 一项类似的荟萃分析和系统回顾也研究了饮食模式，发现“动物性食物和不健康植物性食物含量较低、健康植物性食物含量较高的饮食对预防心血管疾病有益”。[93] 2018年一项观察性研究的荟萃分析得出结论：“在大多数国家，与杂食性饮食相比，素食性饮食与更有利的心肺代谢状况有关。”[94]

证据表明，地中海饮食可能会改善心血管的结果。[126] 也有证据表明，地中海饮食可能比低脂饮食更有效地带来心血管风险因素的长期变化（例如，降低胆固醇水平和血压）。[127]

DASH饮食（高坚果、鱼、水果和蔬菜，低甜食、红肉和脂肪）已被证明可以降低血压，[128] 降低总胆固醇[129]和低密度脂蛋白胆固醇，并改善代谢综合征[130]；但其长期益处受到质疑。[131] 高纤维饮食与心血管疾病的低风险有关。[132]

在世界范围内，饮食指南建议减少饱和脂肪，[133] 尽管饮食中的脂肪在心血管疾病中的作用是复杂和有争议的，但有一个长期的共识，即在饮食中用不饱和脂肪取代饱和脂肪是合理的医疗建议。[134] 目前还没有发现总的脂肪摄入量与心血管风险有关。[135][136] 2020年的一项系统综述发现，有中等质量的证据表明，减少饱和脂肪的摄入量至少2年，可以减少心血管事件。[137] 然而，2015年的一项观察性研究的荟萃分析并没有发现饱和脂肪摄入与心血管疾病之间有令人信服的关联。[138] 用什么来替代饱和脂肪的变化可能解释了研究结果的一些差异。[134] 用多不饱和脂肪替代的好处似乎最大，[139] 而用碳水化合物替代饱和脂肪似乎没有有益影响。[139] 反式脂肪酸含量高的饮食与较高的心血管疾病发病率有关，[140] 2015年，美国食品和药物管理局（FDA）确定，"合格的专家不再一致认为部分氢化油（PHO）是工业生产的反式脂肪酸（IP-TFA）的主要饮食来源，对于在人类食品中的任何使用都是公认的安全（GRAS）。[141] 关于饮食中添加Ω-3脂肪酸（油性鱼类中的一种多不饱和脂肪）的膳食补充剂改善心血管风险的证据相互矛盾。[142][143]

对高血压或正常血压的人推荐低盐饮食的好处并不清楚。[144] 对于那些有心力衰竭的人，在一项研究被排除后，其余的试验显示有受益的趋势。[145][146] 另一项关于膳食盐的评论认为，有强有力的证据表明，高膳食盐的摄入会增加血压并使高血压恶化，而且会增加心血管疾病事件的数量；既是血压升高的结果，也很可能是通过其他机制。[147][148] 发现有适度的证据表明，高盐摄入会增加心血管疾病的死亡率；还发现有一些证据表明，总体死亡率、中风和左心室肥大的情况会增加。[147]

间歇性禁食

总体而言，目前科学证据并不确切，无法确定间歇性禁食能否预防心血管疾病。[149] 间歇性禁食可以帮助人们比正常饮食模式多减少一些体重，但和能量限制饮食之间没有明显差别。[149]

治疗

无论年龄[150]、心血管风险的基线水平[151]或基线血压[152]如何，降压药都能减少高危人群的心血管疾病。[109] 常用的药物治疗方案在降低所有主要心血管事件的风险方面的功效相似，尽管不同药物在预防特定结果的能力可能存在差异。[153] 血压降低的幅度越大，风险降低的幅度也就越大，[153] 大多数高血压患者需要不止一种药物才能充分降低血压。[154] 药物治疗的依从性通常很差，虽然有尝试用短信通知来改善依从性，但没有足够的证据表明它可以改变心血管疾病的二级预防。[155]

他汀类药物可有效预防有心血管疾病史的人进一步患心血管疾病。[156] 由于男性的（心血管）事件发生率高于女性，因此男性比女性更容易看到事件的减少。[156] 对于那些有风险但没有心血管疾病病史（一级预防）的人，他汀类药物可降低死亡和合并致命性和非致命性心血管疾病的风险。[157] 然而，这种好处是很小的。[158] 美国的一项指南建议在未来十年内心血管疾病风险为12%或更高的人群使用他汀类药物。[159] 烟酸、贝特类和CETP抑制剂虽然可能会增加高密度脂蛋白胆固醇，但不会影响已经服用他汀类药物的人患心血管疾病的风险。[160] 贝特类药物可降低心血管和冠状动脉事件的风险，但没有证据表明它们可降低全因死亡率。[161]

抗糖尿病药物可降低2型糖尿病患者的心血管风险，但证据尚无定论。[162] 2009年的一项荟萃分析（包括27,049名参与者和2,370例主要血管事件）显示，在平均4.4年的随访期内，心血管疾病的相对风险降低了 15%，但严重低血糖的风险增加。[163]

研究发现，阿司匹林对心脏病风险较低的人益处不大，因为严重出血的风险几乎等于对心血管疾病的益处。[164] 对于风险极低的人群，包括70岁以上的人群，不建议这样做。[165][166] 美国预防服务工作组建议55岁以下的女性和45岁以下的男性不要使用阿司匹林进行预防；但是，对于 部分年龄较大的人建议这样做。[167]

对伴有左心疾病或低氧性肺部疾病的肺动脉高压患者使用血管活性药物可能会造成伤害和不必要的费用。[168]

用于冠心病二级预防的抗生素

抗生素可以帮助冠心病患者降低心脏病发作和中风的风险。[169] 然而，最新证据表明，用于冠心病二级预防的抗生素有害，会增加死亡率和中风的发生率。[169] 因此，目前不支持使用抗生素预防继发性冠心病。

体力活动

心脏病发作后以运动为基础的心脏康复可降低死于心血管疾病的风险并减少住院治疗。[170] 关于运动训练对心血管风险增加但没有心血管疾病史的人的益处的高质量研究还很少。[171]

一项系统回顾估计，全球6%的冠心病疾病负担是由缺乏运动造成的。[172] 作者估计，，如果消除缺乏身体活动的情况，2008年欧洲本可以避免121,000人死于冠心病。来自有限数量研究的低质量证据表明，瑜伽对血压和胆固醇有益。[173] 初步证据表明，以家庭为基础的锻炼计划可能更有效地提高锻炼依从性。[174]

膳食补充

虽然健康的饮食是有益的，但补充抗氧化剂（维生素E、维生素C等）或维生素的效果还没有被证明可以保护心血管疾病，在某些情况下可能会导致伤害。[175][176][177][178] 矿物质补充剂也没有被发现是有用的。[179] 烟酸，一种维生素B3，可能是一个例外，在高风险人群中，心血管事件的风险略有下降。[180][181] 补充镁能以剂量依赖的方式降低高血压。[182] 建议对出现长QT综合征的室性心律失常相关人员进行镁治疗，以及对地高辛中毒引起的心律失常人员进行治疗。[183] 没有证据支持补充Ω-3脂肪酸。[184]

管理

心血管疾病是可以治疗的，初期治疗主要集中在饮食和生活方式的干预上。[1] 流感可能会使心脏病发作和中风的可能性增加，因此接种流感疫苗可能会减少心血管事件和心脏病患者的死亡率。[185]

由于心肌梗死和中风的综合死亡率很高，适当的心血管疾病管理有必要关注心肌梗死和中风病例，同时牢记任何干预措施的成本效益，特别是在中低收入的发展中国家。[88] 关于心肌梗死，有研究比较了中低收入地区使用阿司匹林、阿替洛尔、链激酶或组织纤溶酶原激活剂的策略在质量调整生命年 (QALY) 方面的效果。阿司匹林和阿替洛尔的QALY一年的成本低于25美元，链激酶约为680美元，而t-PA为16000美元。[186] 在QALY一年的成本为350美元的地区，阿司匹林、ACE抑制剂、β-受体阻滞剂和他汀类药物一起用于心血管疾病的二级预防。[186]

还有一些手术或程序干预可以挽救或延长生命。对于心脏瓣膜问题，一个人可以通过手术来更换瓣膜。对于心律失常，可以安装起搏器以帮助减少异常的心律；对于心脏病发作，有多种选择，其中两种是冠状动脉血管成形术和冠状动脉搭桥手术。[187]

在血压控制方面，接受较低血压治疗（目标血压为135/85 mmHg或更低）的高血压和心血管疾病患者的总死亡率和心血管死亡率，相对于标准血压控制目标（140-160/90-100 mmHg）可能几乎没有差异。严重不良事件或总心血管事件也可能几乎没有差异。[188]

流行病学

2012年每百万人中的心血管疾病死亡人数

 318–925

 926–1,148

 1,149–1,294

 1,295–1,449

 1,450–1,802

 1,803–2,098

 2,099–2,624

 2,625–3,203

 3,204–5,271

 5,272–10233
2004年每10万居民中心血管疾病的残疾调整寿命年数[15]

 无数据

 <900

 900–1650

 1650–2300

 2300–3000

 3000–3700

 3700–4400

 4400–5100

 5100–5800

 5800–6500

 6500–7200

 7200–7900

 >7900

心血管疾病是全世界和除非洲以外的所有地区的主要死因。[1] 2008年，全球30%的死亡是由心血管疾病引起的。中低收入国家因心血管疾病导致的死亡也较多，因为全球所有因心血管疾病导致的死亡中，超过80%发生在这些国家。另据估计，到2030年，每年将有超过2300万人死于心血管疾病。


据估计，尽管南亚次大陆仅占世界人口的20%，但世界上60%的心血管疾病负担将发生在该地区。这可能是遗传易感性和环境因素共同作用的结果。印度心脏协会等组织正在与世界心脏联盟合作，以提高对这个问题的认识。[189]

研究

参见：Heart-on-a-chip和Vessel-on-a-chip

有证据表明，心血管疾病在史前就已存在，[190] 而对心血管疾病的研究至少可以追溯到18世纪。[191] 所有形式的心血管疾病的原因、预防和/或治疗仍然是生物医学研究的活跃领域，每周都有数百项科学研究报告发表。

最近的研究领域包括炎症和动脉粥样硬化[192]之间的联系，新型治疗干预的潜力，[193]以及冠心病的遗传学。[194]

参考文献

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外部链接

分类
起源于围产期的某些情况/胎儿疾病(P、760–779)
母体因素及
妊娠并发症、
阵痛及分娩
胎盘疾病:
绒毛膜/羊膜:
脐带:
妊娠和胎儿生长长度
产伤
系统性
呼吸系统疾病
心血管疾病
出血及
血液病
胃肠道疾病
表皮系统及
体温调节
神经系统疾病
肌肉骨骼疾病
传染病
其它情况
医学导航: 产科生理/发育/薄膜病理/条件源/母体传递, 齐名手术, 药物(2A/G2C)
心血管系统（R00–R03, 785）
胸痛
听诊
脉搏
血管疾病
其他
休克
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