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青年人心肌梗死的危险因素评估。

ASSESSMENT OF RISK FACTORS OF MYOCARDIAL INFARCTION IN YOUNG PERSONS.

机构信息

1Kazakhstan Medical University, «Kazakhstan School of Public Health», Almaty, Kazakhstan.

2Public Health and Social Sciences Department, Kazakhstan Medical University, «Kazakhstan School of Public Health», Almaty, Kazakhstan.

出版信息

Georgian Med News. 2023 Jan(334):71-77.

Abstract

In terms of morbidity and mortality, cardiovascular illnesses are the main cause of death worldwide. Half of all noncommunicable diseases on the earth are caused by them. Due to the steadily rising mortality rates from circulatory diseases in Kazakhstan, our region was identified as having a high cardiovascular risk in 2021 when the updated Score 2 (Systematic COronary Risk Evaluation) scale was developed. There has been a recent increase in this pathology's prevalence among younger people (up to 44 years). In this regard, a large number of scholars are engaged in active research into the variables that affect the onset of coronary heart disease in this population, particularly its acute forms, which frequently mark the onset of the disease in this age group. The research of international experts supports the impact of classic risk factors such arterial hypertension, smoking, dyslipidemia, diabetes mellitus, inactivity, and loaded anamnesis on the early development of atherosclerosis. The Fourth Universal Definition distinguishes five different forms of myocardial infarction, and if the first type is directly linked to atherogenesis, the second type develops as a result of ischemia imbalance in the absence of coronary artery obstructive lesions. There are currently no definite, widely acknowledged standards for the identification and management of type 2 myocardial infarction. Thereby there was a need to research the impact of additional risk factors, such as subclinical systemic inflammation, genetic polymorphism of genes involved in lipid metabolism, thrombosis, and responsible for the development of endothelial dysfunction, given the differences in the pathogenetic mechanisms of different types of myocardial infarction. It's still up for debate whether comorbidity has any impact on the frequency of early cardiovascular events in the population of young individuals. Aim is to study international approach in an assessment of risk factors of the development of myocardial infarction at young population. The review used content analysis on the research topic, national guidelines, WHO recommendations. The electronic databases Pubmed, eLibrary from 1999 to 2022 were used as sources of information. The search was conducted on the keywords «myocardial infarction», «infarction in young», «risk factors» and MeSH terms «myocardial infarction/etiology», «myocardial infarction/young», «myocardial infarction/risk factors». Of the 50 sources found, 37 corresponded to the research request. This field of scientific study is one of the most important today because of the prevalence of formation and poor prognosis of non-atherothrombogenic myocardial infarctions, compared with type 1 infarcts. Numerous foreign and domestic authors have been motivated to look for new markers of the early onset of coronary heart disease, develop adequate risk stratification algorithms, and create efficient primary and secondary prevention strategies at the level of primary healthcare and hospitals as a result of the high mortality and disability rates in this age group that are a significant economic and social problem.

摘要

在发病率和死亡率方面,心血管疾病是全球主要的死亡原因。地球上一半的非传染性疾病都是由它们引起的。由于哈萨克斯坦循环系统疾病的死亡率稳步上升,2021 年在制定更新的 Score 2(系统性冠状动脉风险评估)量表时,我们地区被确定为心血管风险较高。最近,这种病理学在年轻人中的患病率有所上升(高达 44 岁)。在这方面,许多学者正在积极研究影响这一人群冠心病发病的变量,特别是其急性形式,这在该年龄组中经常标志着疾病的发作。国际专家的研究支持经典危险因素(如动脉高血压、吸烟、血脂异常、糖尿病、不活动和加载病史)对早期动脉粥样硬化形成的影响。第四通用定义区分了五种不同形式的心肌梗死,如果第一型与动脉粥样硬化直接相关,第二型则是由于没有冠状动脉阻塞性病变的缺血失衡而发展。目前,对于 2 型心肌梗死的识别和管理,尚无明确的、广泛认可的标准。因此,需要研究亚临床系统性炎症、参与脂质代谢、血栓形成和导致内皮功能障碍的基因遗传多态性等其他危险因素的影响,因为不同类型的心肌梗死的发病机制存在差异。目前还在争论合并症是否会对年轻人心血管事件的早期发生频率产生影响。目的是研究年轻人人群中评估心肌梗死发展的危险因素的国际方法。该综述采用内容分析法对研究课题、国家指南和世界卫生组织的建议进行了研究。电子数据库 Pubmed、eLibrary 从 1999 年至 2022 年被用作信息来源。搜索使用了“心肌梗死”、“年轻人中的梗死”、“危险因素”和 MeSH 术语“心肌梗死/病因”、“心肌梗死/年轻人”、“心肌梗死/危险因素”等关键词。在找到的 50 个来源中,有 37 个符合研究要求。由于与 1 型梗死相比,非动脉粥样硬化性心肌梗死的形成和预后较差,因此该领域的科学研究是当今最重要的研究领域之一。许多国外和国内的作者都受到了激励,希望找到冠状动脉疾病早期发病的新标志物,制定适当的风险分层算法,并在初级保健和医院层面制定有效的一级和二级预防策略,因为该年龄组的高死亡率和残疾率是一个重大的经济和社会问题。

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