Gohlke Helmut
Herz-Zentrum, Bad Krozingen, Germany.
Herz. 2004 Feb;29(1):139-44. doi: 10.1007/s00059-004-2546-8.
The Western lifestyle contributes significantly to the high prevalence of coronary artery disease in Western nations. Smoking, a fat-loaded diet, low physical activity, obesity, diabetes, increased alcohol consumption contribute in a variable combination to the incidence and progression of coronary artery disease. The conventional risk factors are responsible for > 80% of cardiovascular events. Coronary artery disease is therefore a highly preventable disease. Randomized studies evaluating changes and lifestyle are difficult to conduct. Lifestyle is in many respects not governed by the intellect but the result of education, life long habits and possibly also genetically determined. Nevertheless, there is increasing evidence that modification of life style has a significant influence on the incidence and the course of coronary artery disease.
Smoking is responsible for 50% of all avoidable death. There is a significant relation between the number of smoked cigarettes and the increase of cardiovascular risk. Despite the lack of randomized end point studies there is universal agreement that the advise for smoking cessation is a class-1-recommendation.
Prospective studies on different components and principles of nutrition (Western vs. Mediterranean diet) demonstrate a significant influence of the diet on the development of coronary artery disease and sudden death. Several randomized studies show evidence that consumption of fish or a Mediterranean diet have a significant influence on the improvement of prognosis.
There is a correlation between weight and cardiovascular disease and cardiovascular death. A body mass index of > 30 doubles the incidence of sudden death. A moderate increase of body mass index quadruples the risk for diabetes in males, in females the risk is 8-fold increased. Weight reduction improves endothelial function and decreases systemic inflammatory reaction.
There is a significant inverse relation between physical fitness or habitual physical activity on the one hand, and the incidence of coronary artery disease on the other hand. Physical activity improves exercise capacity, decreases angina pectoris and decreases cardiac events and hospital admissions after PTCA. Physical activity also decreases insulin resistance and delays the occurrence of diabetes.
Moderate alcohol consumption was associated with a decrease of cardiovascular events in patients with increased cardiovascular risk. Nevertheless, alcohol consumption in the population is a significant source for avoidable premature death.
The knowledge resulting from observational studies on the importance of lifestyle for the development of coronary artery disease is increasingly validated by prospective randomized studies. Despite the fact that much more research needs to be done the recommendation for improvement of lifestyle in terms of increasing physical activity decreasing overweight, using a Mediterranean diet and smoking cessation are class-1-recommendations. A nationwide improvement in lifestyle could result in a significant decrease in health care expenditures and could also have an important role in preventing or delaying coronary artery disease.
西方生活方式在很大程度上导致了西方国家冠状动脉疾病的高发病率。吸烟、高脂饮食、缺乏体育锻炼、肥胖、糖尿病以及饮酒量增加等多种因素综合作用，影响着冠状动脉疾病的发生和发展。传统危险因素导致了超过80%的心血管事件。因此，冠状动脉疾病是一种高度可预防的疾病。评估生活方式变化的随机研究很难开展。生活方式在很多方面并非由理智主导，而是教育、长期习惯以及可能的基因决定的结果。然而，越来越多的证据表明，生活方式的改变对冠状动脉疾病的发病率和病程有重大影响。
吸烟导致了所有可避免死亡的50%。吸烟数量与心血管风险的增加之间存在显著关联。尽管缺乏随机终点研究，但普遍认为戒烟建议是一级推荐。
对营养的不同成分和原则（西方饮食与地中海饮食）的前瞻性研究表明，饮食对冠状动脉疾病的发展和猝死有重大影响。多项随机研究表明，食用鱼类或采用地中海饮食对改善预后有显著影响。
体重与心血管疾病及心血管死亡之间存在关联。体重指数大于30会使猝死发生率翻倍。体重指数适度增加会使男性患糖尿病的风险增加四倍，女性则增加八倍。减轻体重可改善内皮功能并降低全身炎症反应。
一方面，身体健康状况或习惯性体育活动与另一方面冠状动脉疾病的发病率之间存在显著的负相关。体育锻炼可提高运动能力，减轻心绞痛，减少心脏事件以及经皮冠状动脉腔内血管成形术后的住院次数。体育锻炼还可降低胰岛素抵抗并延缓糖尿病的发生。
适度饮酒与心血管风险增加的患者心血管事件减少有关。然而，人群中的饮酒是可避免过早死亡的一个重要原因。
关于生活方式对冠状动脉疾病发展重要性的观察性研究所得出的知识，越来越多地得到前瞻性随机研究的验证。尽管仍有更多研究需要开展，但就增加体育锻炼、减轻超重、采用地中海饮食和戒烟而言，改善生活方式的建议是一级推荐。全国范围内生活方式的改善可能会导致医疗保健支出显著减少，并且在预防或延缓冠状动脉疾病方面也可能发挥重要作用。
