OCC 2020丨顾东风:新冠病毒肆虐下的心血管疾病的预防

2020-06-02 MedSci原创 MedSci原创

OCC2020丨顾东风:新冠病毒肆虐下的心血管疾病的预防

 OCC2020丨顾东风:新冠病毒肆虐下的心血管疾病的预防

席卷全球的新冠肺炎(COVID-19)无疑是对人类应对新型病毒的一次大挑战。积极关注发热和呼吸道症状等典型症状,而肺外表现却往往被忽视。5月28日下午,在第14届东方心脏病学会议(OCC2020)心血管疾病预防论坛上,中国医学科学院阜外医院的顾东风院士关于新冠病毒肆虐下的心血管疾病的预防发表了演讲。

新冠疫情与心血管病

截至2020年5月28日,新冠肺炎波及188个国家,累积确诊569万,死亡人数35.6万。欧州和南美部分国家仍然处于持续流行之中,世界卫生组织和各国都承担着控制疫情和维持经济运行方面的负担。目前我国疫情基本得到控制,进入了“新冠肺炎疫情常态化防控”阶段。虽然已经大面积复工复产,但仍要注意重点场所和重点人群的防控,坚持科学佩戴口罩,勤洗手,减少人员聚集,加强体育锻炼。  

研究证明在新冠肺炎患者中,既往有高血压、糖尿病、心血管疾病的患者超过20%以上,其中新冠肺炎合并心血管病的死亡率明显高于新冠肺炎合并糖尿病、其它呼吸道传染病、高血压等疾病的死亡率。由武汉中南医院发表于JAMA的一项研究表明新冠肺炎患者易患心血管系统并发症。138例COVID-19住院患者中:7.2%并发急性心脏损伤,16.7%并发心律失常,ICU患者心血管系统并发症更常见。关于降压药物对COVID-19感染的影响,顾东风院士表明国际报道降压药种类与COVID-19感染风险无相关性,不会明显增加重症发生风险。

 

中国心血管病流行现状

2017年心血管疾病造成全球近1800万人死亡,在我国死亡人数为380多万。在过去10年内全球心血管疾病负担增长22%,冠心病和脑卒中分居全球死因顺位前两位。根据国内外合作研究表明,今后一段时间老龄化的趋势会加剧,导致的心血管疾病的发生率会增加50%左右。顾东风院士团队开展的一项研究表明:相较于2013年,2030年我国CVD、脑卒中、缺血性心脏病所致的死亡将增长22.3%,19%和42%。

 心血管病危险因素及流行现状

我国心血管疾病的发生率居高不下,多重心血管疾病危险因素聚集。高血压患病率呈持续上升趋势,虽然高血压的知晓率、治疗率和控制率也在逐步提高,但仍低于欧美国家。随着城市化的推进和老龄化的加剧,血脂异常也越来越常见。我国18岁以上成人中,糖尿病患者1.18亿人;糖尿病前期3.88亿人。糖尿病显著增加了缺血性心脏病和脑卒中风险。高糖、高脂饮食的摄入和缺乏锻炼,导致我国肥胖人口不断增加,已超越美国成为全球肥胖人口最多的国家。我国吸烟长期变化趋势呈轻度下降,尤其男性吸烟率有所下降,但整体情况不容客观,年轻女性吸烟率不断升高,电子烟的使用率仍在升高。各个年龄群体中,经常参加体育锻炼率均低于20%,极大多数人缺乏体育锻炼。

心血管病防治策略

2019年7月提出的“健康中国行动”,目标在于形成健康的生活方式。而健康生活方式是预防包括糖尿病、冠心病、脑卒中等在内的心血管代谢性疾病的重要基础“。2020年3月,顾东风院士牵头撰写并在《中国循环杂志》上发布了《中国健康生活方式预防心血管代谢疾病指南》。指南核心要点为:(1)终生坚持健康的生活方式,是心血管代谢疾病一级预防的根本措施;(2)合理膳食,提倡保持“中国居民平衡膳食”模式,戒烟限酒;(3)保持充分的身体活动,减少久坐,合理选择运动类型;(4)65岁以上老年人,代谢风险升高人群或慢性病患者,根据自身状况改善饮食结构,不强调限制老年人蛋白及肉类摄入,选择多样性的身体活动;(5)个体化风险评估与生活方式管理,促进心血管病早期预防。顾东风院士再一次强调仅保持理想血压,就能减少44.1%的ASCVD发病。

另外,近期发布的一项纳入10万多人的长期队列随访结果表明,健康成年人每周进行至少150min中等强度或至少75min高强度有氧身体活动,或相当量的两种强度活动的组合都能够使CVD发病风险率降低,身体活动水平与CVD发病风险呈负相关的剂量反应关系。达到上述推荐水平,CVD发病和死亡风险能分别降低26%和35%。长时间维持上述运动量,CVD发病风险会降低43%。每天久坐高于5小时,会增加CVD发病风险和死亡风险每天久坐高于10小时,CVD发病风险最高。     

关于膳食对心血管疾病的影响,一项鸡蛋摄入量与心血管疾病风险的研究结果表明:鸡蛋摄入过少,出血性卒中风险会增加;鸡蛋摄入过多,冠心病和缺血性卒中风险会增加。每周食用的鸡蛋<1或≥10时都会增加CVD风险。另外,国内外研究均表明经常饮茶(≥3次/周)者,ASCVD发病、死亡、总死亡风险分别降低20%,22%和15%。China-PAR研究表明绿茶获益最显著。

小结

最后顾东风院士结合当前新冠疫情形式和中国心血管病现状,总结:

  1.  新冠疫情防控常态化形势下,心血管疾病预防也要常态化;
  2. 我国心血管疾病负担持续上升,防控形势依然很严峻;
  3. 健康生活方式是预防心血管代谢疾病的重要基础;
  4. 把落实”健康中国2030“战略渗透到每一个人的日常生活活动中,推进健康生活。

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    2021-01-18 wwzzly
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    2020-06-03 zhaojie88
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    2020-06-03 hmwwww
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    2020-06-01 公卫新人

    新冠肺炎,疫情何时才能消失

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