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血管疾病患者应用叶酸及B族维生素降低同型半胱氨酸水平治疗

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世界核心医学期刊文摘（心脏病学分册） 2006年第7期2卷 5-6页

作者： Lonn E. Yusuf S. Arnold M.J. 罗亮 Population Health Research Institute Hamilton General Hospital 237 Barton St. East Hamilton Ont. L8L 2X2 Canada Dr.

BACKGROUND: In observational studies, lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B6 and B12 lower homocysteine levels. We assessed whether supplementation reduced the risk of major cardiovascular events in patients with vascular disease. METHODS: We randomly assigned 5522 patients 55 years of age or older who had vascular disease or diabetes to daily treatment either with the combination of 2.5 mg of folic acid, 50 mg of vitamin B6, and 1 mg of vitamin B12 or with placebo for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. RESULTS: Mean plasma homocysteine levels decreased by 2.4 μmol per liter(0.3 mg per liter) in the active-treatment group and increased by 0.8 μmol per liter(0.1 mg per liter) in the placebo group. Primary outcome events occurred in 519 patients(18.8 percent) assigned to active therapy and 547(19.8 percent) assigned to placebo(relative risk, 0.95; 95 percent confidence interval, 0.84 to 1.07; P=0.41). As compared with placebo, active treatment did not significantly decrease the risk of death from cardiovascular causes(relative risk, 0.96; 95 percent confidence interval, 0.81 to 1.13), myocardial infarction(relative risk, 0.98; 95 percent confidence interval, 0.85 to 1.14), or any of the secondary outcomes. Fewer patients assigned to active treatment than to placebo had a stroke(relative risk, 0.75; 95 percent confidence interval, 0.59 to 0.97). More patients in the active-treatment group were hospitalized for unstable angina(relative risk, 1.24; 95 percent confidence interval, 1.04 to 1.49). CONCLUSIONS: Supplements combining folic acid and vitamins B6 and B12 did not reduce the risk of major cardiovascular events in patients with vascular disease.

关键词：血管疾病患者 B族维生素心血管事件观察性研究不稳定型心绞痛次要终点安慰剂终点事件随机分

氯吡格雷联合阿司匹林与单用阿司匹林预防动脉粥样硬化血栓性事件的比较

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世界核心医学期刊文摘（心脏病学分册） 2006年第7期2卷 6-7页

作者： Bhatt D.L. Fox K.A.A. Hacke W. E.J. Topol 罗亮 Department of Genetics Case Western Reserve University BRB 724 10900 Euclid Ave. Cleveland OH 44106-4955 United States Dr.

BACKGROUND: Dual antiplatelet therapy with clopidogrel plus low-dose aspirin has not been studied in a broad population of patients at high risk for atherothrombotic events. METHODS: We randomly assigned 15,603 patients with either clinically evident cardiovascular disease or multiple risk factors to receive clopidogrel(75 mg per day) plus low-dose aspirin(75 to 162 mg per day) or placebo plus low-dose aspirin and followed them for a median of 28 months. The primary efficacy end point was a composite of myocardial infarction, stroke, or death from cardiovascular causes. RESULTS: The rate of the primary efficacy end point was 6.8 percent with clopidogrel plus aspirin and 7.3 percent with placebo plus aspirin(relative risk, 0.93; 95 percent confidence interval, 0.83 to 1.05; P=0.22). The respective rate of the principal secondary efficacy end point, which included hospitalizations for ischemic events, was 16.7 percent and 17.9 percent(relative risk, 0.92; 95 percent confidence interval, 0.86 to 0.995; P=0.04), and the rate of severe bleeding was 1.7 percent and 1.3 percent(relative risk, 1.25; 95 percent confidence interval, 0.97 to 1.61 percent; P=0.09). The rate of the primary end point among patients with multiple risk factors was 6.6 percent with clopidogrel and 5.5 percent with placebo(relative risk, 1.2; 95 percent confidence interval, 0.91 to 1.59; P=0.20) and the rate of death from cardiovascular causes also was higher with clopidogrel(3.9 percent vs. 2.2 percent, P=0.01). In the subgroup with clinically evident atherothrombosis, the rate was 6.9 percent with clopidogrel and 7.9 percent with placebo(relative risk, 0.88; 95 percent confidence interval, 0.77 to 0.998; P=0.046). CONCLUSIONS: In this trial, there was a suggestion of benefit with clopidogrel treatment in patients with symptomatic atherothrombosis and a suggestion of harm in patients with multiple risk factors. Overall, clopidogrel plus aspirin was not significantly more effective than aspirin alone

关键词：血栓性疾病联合终点联合小剂量心血管疾病安慰剂死亡发生率亚组高危人群出血发生率随机分

冠状动脉内注射骨髓源性祖细胞治疗急性心肌梗死

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世界核心医学期刊文摘（心脏病学分册） 2007年第3期3卷 12-13页

作者： Schchinger V. Erbs S. Elssser A. A.M.Zeiher 郭俊 Dr.Department of Internal Medicine III J.W. Goethe University Theodor-Stern-Kai 7 D-60590 Frankfurt Germany

背景:初步试验提示,冠状动脉内给予自体祖细胞可改善急性心肌梗死后的左室功能。方法:在一项多中心试验中,204例急性心肌梗死患者被随机分配在成功再灌注治疗后3～7d针对梗死动脉予冠状动脉内注射骨髓(BMC)源性祖细胞或安慰剂。

关键词：急性心肌梗死祖细胞再灌注治疗左室功能多中心试验临床终点安慰剂血运重建射血分数随机分