在过去50年的二次预防试验中,中风和血管事件复发率的下降以及对当前试验设计的后果
相关实验视频
Keun-Sik Hong1, Sharon Yegiaian, Meng Lee
1Department of Neurology, Clinical Research Center, Ilsan Paik Hospital, Inje University, Goyang, Korea.
Circulation
|May 4, 2011
概括
50年来,由于更好的血压控制和抗血小板治疗,复发性中风和心血管事件的发生率显著下降. 这一趋势需要进行更大规模的试验,以检测未来的预防改进.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 临床试验 临床试验
背景情况:
- 人们普遍认为,标准护理的进步可以减少复发性中风和心血管事件.
- 证明二次预防试验中这种减少的证据有限.
研究的目的:
- 在二次中风预防试验中分析复发性中风和主要血管事件的趋势.
- 识别导致随着时间的推移观察到事件速率变化的因素.
主要方法:
- 针对医学二次中风预防的随机对照试验 (RCT) 的系统搜索 (1960-2009).
- 排除的试验集中在单次中风机制上.
- 从控制臂提取了基线特征和年度事件率的数据.
- 使用多重回归分析趋势.
主要成果:
- 分析了59个与66157名患者在对照组中的RCT.
- 在过去的五十年中,每年事件发生率显著下降:每十年中,复发性中风减少0.996%,致命性中风减少0.282%,主要血管事件减少1.331%.
- 增加抗血栓使用和降低血压是减少中风复发的关键因素.
- 回复性中风率从20世纪60年代的8.71%下降到21世纪的4.98%.
- 试验所需的样本大小增加了2.2倍.
结论:
- 在过去的五十年中,复发性中风和血管事件的发生率大幅下降.
- 改善血压控制和增加抗血小板治疗的使用是这种下降的主要驱动因素.
- 现在,证明二次中风预防的增量改进需要更大的样本大小.
相关概念视频
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...