関連する実験動画
過去50年間の二次予防試験における脳卒中および血管疾患再発率の減少と,現在の試験設計への影響
Keun-Sik Hong1, Sharon Yegiaian, Meng Lee
1Department of Neurology, Clinical Research Center, Ilsan Paik Hospital, Inje University, Goyang, Korea.
Circulation
|May 4, 2011
まとめ
再発性脳卒中と心血管疾患の発生率は,よりよい血圧制御と抗血小板治療により,50年間で著しく低下しています. この傾向は,将来の予防改善を検出するためにより大きな試験を必要とします.
科学分野:
- 心臓病学 心臓病学
- 神経学 神経学とは
- クリニック・トライアル 臨床試験
背景:
- 標準医療の進歩は,再発性脳卒中と心血管疾患の発生を減少させると広く信じられています.
- この二次予防試験の減少を証明する証拠は限られている.
研究 の 目的:
- 二次性脳卒中予防試験における再発性脳卒中および主要な血管疾患の傾向を分析する.
- 時間の経過とともに観測されたイベント率の変化に寄与する要因を特定する.
主な方法:
- 医学二次脳卒中予防のためのランダム化比較試験 (RCT) の系統的な検索 (1960-2009).
- 除外された試験は,単発性脳卒中メカニズムに焦点を当てたものです.
- ベースラインの特徴と年間イベント率に関するコントロールアームから抽出したデータ.
- マルチプル回帰を用いて傾向を分析した.
主要な成果:
- コントロールアームに66,157人の患者が含まれる59件のRCTを分析した.
- 毎年発生する脳卒中発生率は,過去5十年で著しく減少した:再発性脳卒中は0.996%,致死性脳卒中は0.282%,大血管疾患は10年ごとに1.331%減少した.
- 抗血栓剤の使用の増加と低血圧は,再発性脳卒中の減少に重要な貢献者でした.
- 再発性脳卒中率は,1960年代の8.71%から2000年代の4.98%に減少した.
- 試験に必要なサンプルサイズは2.2倍に増加しました.
結論:
- 再発性脳卒中と血管疾患の発生率は,過去50年間で大幅に低下しています.
- 血圧制御の改善と抗血小板療法の使用の増加は,この減少の主な要因です.
- 二次性脳卒中予防の漸進的な改善を実証するには,今,かなり大きなサンプルサイズが必要です.
関連する概念動画
Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Ischemic Heart Disease: Overview
Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...
Atherosclerosis III: Management
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Regulation of Stroke Volume
The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...