2-H型高血压与脑卒中.ppt

目 录 目 录 目 录 目 录 目 录 高血压和高Hcy具有协同作用 美国 中国 J Neurol Sci 298,153-157. 1994-2004；12683 北京大学学报(医学版) 2007;39:614-618 P=0.045 P=0.002 P=0.012 P=0.001 Li J et al. 2010 (paper under review) P0.001 P=0.001 P0.001 P=0.002 CVD Stroke CVD death Stroke death Normal BP Normal Hcy Normal BP High Hcy High BP Normal Hcy High BP High Hcy 中国安庆地区，39165人平均随访期：6.2年 BVTT HHCY：“二十一世纪的胆固醇” 2008欧洲卒中指南： Hcy是动脉粥样硬化和脑卒中/TIA的独立危险因素 项目背景 In a meta-analysis of clinical trials evaluating the efficacy of folate supplementation for stroke prevention, folate was associated with an 18% reduction (RR, 0.82; 95% CI, 0.68 to 1.00; P0.045) in primary stroke risk. 378 supplementation also appeared to be beneficial for stroke prevention in patients receiving folate for 36 months, cases with 20% reduction in homocysteine, and in populations without folate grain supplementation. 378. Wang X, Qin X, Demirtas H, Li J, Mao G, Huo Y, Sun N, Liu L, Xu X. Efficacy of folic acid supplementation in stroke prevention: a meta-analysis. Lancet. 2007;369:1876 –1882. 2010年4月美国将高同型半胱氨酸血症及干预写入卒中二级预防指南 Summary and Gaps Hyperhomocysteinemia is associated with an increased risk of stroke. The results of trials that have examined the effect of homocysteine-lowering therapy with B-complex vitamins on risk of stroke are inconsistent. Stroke reduction generally was foun in trials in which the duration of treatment exceeded 3 years, the decrease in plasma homocysteine concentration was 20%, the region did not fortify diet with folate, and participants had no prior history of stroke. Better understanding of the mechanisms through which homocysteine causes atherosclerosis may enable identification of more targeted and effective therapies to reduce risk of stroke in patients with elevated homocysteine levels. ? Recommendation The use of the B-complex vitamins, pyridoxine (B6),cobalamin (B12), and folic acid, might be considered for prevention of ischemic stroke in patients with hyperh