心血管疾病 Cardiovascular Disease 哈尔滨医科大学流行病学教研室 Department of epidemiology ，Harbin Medical University

目 录 Content CVD Epidemic outline 心血管疾病的流行概况 Hypertension 高血压 Stroke Coronary heart disease strategies and measurement for CVD 心血管疾病的流行概况 高血压 脑卒中 冠心病 心血管疾病的预防策略与措施

第一节 概况 overview 广义的心血管疾病（CVD）是一组以心脏和血管异常为主的循环系统疾病，它包括心脏和血管疾病、肺循环疾病以及脑血管疾病 Generalized cardiovascular disease (CVD) is a group of circulatory diseases mainly focusing on cardiac and vascular anomalies, which includes the heart and vascular disease, pulmonary circulation disease, and cerebral vascular disease

该组疾病中以高血压、脑卒中和冠心病对人类健康的危害最为严重 Among them, high blood pressure, stroke and coronary heart disease badly hazards human health hazards

流行状况 Epidemic situation 发达国家CVD流行情况分为四个阶段 Four stages of CVD prevalence in developed countries

The first stage (plague stage) 第一阶段（瘟疫期） 人群主要健康问题是传染性疾病、饥荒和营养缺乏,心血管疾病仅占5%-10%，主要是风湿性心脏病和肺源性心脏病 The first stage (plague stage) The main health problems was infectious diseases, famine and nutritional deficiencies. Cardiovascular disease accounted for only 5% -10%, which were mainly Rheumatic heart disease and pulmonary heart disease

第二阶段 传染病、饥荒和营养缺乏、风湿性心脏病和肺源性心脏病的发病率下降，人口平均年龄增长,饮食结构改变和盐摄入增多，使高血压、高血压性心脏病和出血性脑卒中患病率增加 The second stage Hypertension, hypertensive heart disease and hemorrhagic stroke prevalence rate increased with economic development, and improvement of production and living standards.

第三阶段 随着社会进步，经济发展，冠心病和缺血性脑卒中提早出现于55-60岁的人群，动脉粥样硬化的死亡占总死亡的35%-65%，结果人群平均寿命下降。 The third stage People intake more and more fat and calories with the economic development. coronary heart disease and cerebral ischemic stroke are early onset .As a result Population decline in the average life expectancy.

第四阶段 The forth stage 识到心血管病是严重的公共卫生问题； 全社会采取了积极的防治措施，加上医疗水平的不断提高； 动脉粥样硬化的死亡率降至50%以下。 The forth stage Realizing to the severity of CVD, the whole society actively take prevention and cure measures and the medical standards improve continuously. The mortality of CVD is declining more than 50%.

Epidemic situation of cardiovascular disease 我国心血管疾病流行概况 Epidemic situation of cardiovascular disease in China

The CVD count for the primary cause of death in city. 我国脑卒中发病率和死亡率高居世界第二，以上，成为我国城市人群死亡的主要原因。 Stroke morbidity and mortality rates of our country is the second highest in the world . The CVD count for the primary cause of death in city.

我国心血管疾病流行特征 Epidemiological Characteristics of CVD in China 发病年龄提前，青壮年人群的发病与患病水平明显升高 Age of onset earlier, and the incidence and prevalence of young adults population is increasing.

The incidence, prevalence, mortality, of cardiovascular disease significantly increased not only in city but also in rural. 心血管疾病已不再是城市或经济发达地区人口所特有的“富贵病”，近年来农村和非经济发达地区人口的发病率、患病率和死亡率显著升高

与西方发达国家不同，在我国脑血管病的发病率、患病率和死亡率高于冠心病 Different form western developed countries, the incidence, prevalence and mortality of cerebrovascular disease are higher than coronary heart disease.

因需要终身治疗和医疗费用上涨过快过快，致使该组疾病在我国的治疗率和控制率相当低，从而导致因病引起的残疾乃至残障的情况在我国比较严重 Because of need life long treatment, fast rising of medical care fees, the treatment and control rate are lower in china， the disability and handicap leaded by CVD is very severity

第二节 高血压（Hypertension） 高血压是一种以动脉血压升高为主要表现的心血管疾病 Hypertension is a kind of cardiovascular disease with arterial blood pressure increasing as the main manifestations.

高血压的类型 types 原发性高血压 primary hypertension： 以血压升高为特征，原因不明的独立疾病，占高血压的95%以上。 primary hypertension： Blood increasing are special sign and an independent disease with unclear cause, account 95% of total hypertension.

继发性高血压 secondary hypertension 血压升高是某些疾病的一部分表现，其中肾脏疾病占70%以上。 Blood increase is the express of some disease, 70% of them are kidney disease

一、高血压的流行病学特征 (epidemiological characteristics of Hypertension ) 我国高血压的现状与流行趋势 The status and prevalence trend of hypertension in our country 三高：患病率高、致残率高、死亡率高 三低：知晓率低、服药率低、控制率低 三不：不规律服药、不难受不吃药、不爱用药。

2001年我国高血压的流行情况 The prevalence of hypertension in China in 2001 知晓率（awareness rate）44.7% 服药率（medication rate）28.2% 控制率（control rate）8.1%

一、高血压的流行病学特征 epidemiological characteristics of Hypertension

（一）地区分布(endemic distribution) 总的趋势(general tendency)： 我国各地区高血压患病率差别显著, 北方高于南方，东部高于西部，且有自东北向西南递减的趋势，在同一地区城市高于农村。 Prevalence of hypertension in various regions of China are significant differences, it is higher in the north than the south, the east than the west, and there is decreasing trend from northeast to southwest, urban is higher than rural in the same area.

（二）时间分布(time distribution) 我国1959年-1991年进行了32次全国15岁以上人群高血压患病情况抽样调查：结果显示高血压患病率呈上升趋势。 Sample surveys of hypertension prevalence among age 15 and above population were carried out 32 times in China from 1959 to 1991. The results showed that prevalence of hypertension is on the rise.

（三）人群分布 (population distribution) 1、年龄、性别(age and sex ) 2、职业 (occupation) 3、民族(race) 4、文化程度(education)

(conformed risk factor) （一）确认的危险因素 (conformed risk factor) 肥胖(obesity) 膳食中的钠、钾 (sodium and potassium in the food ) 饮 酒(alcohol) 遗传因素(hereditary factor)

(uncertain risk factors) （二）不确定的危险因素 (uncertain risk factors) 膳食钙（Dietary Calcium） 避孕药（contraceptives） 吸烟（smoking） 体力活动（physical activity） 精神紧张或应激（stress）

第三节 脑卒中（Stroke） 脑卒中又称为脑血管意外或中风，是由于脑血管异常所造成的突发性神经功能损害 A stroke (sometimes called a cerebrovascular accident (CVA)) is the rapidly developing loss of brain functions due to disturbance in the blood supply to the brain, caused by a blocked or burst blood vessel.

中国的脑卒中现状 第一／二大死因 每年新发脑卒中患者1,500,000人 每年死于脑卒中患者1,000,000人 脑卒中存活病6,000,000人 成人致残的主要原因 出院后需长期护理的主要疾病 每年经济损失100亿人民币

一、脑卒中的流行病学特征 epidemic characteristic of stroke （一）地区分布(geographic distribution) 脑卒中在地理分布上存在差异，这种差异不仅仅是国家间，还存在于同一国家的不同地区之间. There is difference in the geographical distribution of stroke, such differences exist not only among countries, but also in different parts of the same country.

（二）时间分布(time distribution) 除东欧国家外，英、法、美、加、澳、日等工业发达国家，在过去40年里脑卒中死亡率持续下降. The mortality rate of stroke continued to decline in Britain, France, United States, Canada, Australia, Japan and other industrialized countries during the past 40 years, except for the Eastern European countries,

（三）人群分布(population distribution) 年龄、性别分布(sex and age) 人群脑卒中的发病率和死亡率均为男性高于女性，男女发病率和死亡率均随年龄增加而上升，在50岁后呈大幅上升趋势 Population morbidity and mortality rates of stroke were higher in male than female, morbidity and mortality rates were increased with age in both male and female, showing a substantial upward trend after age 50 .

（三）人群分布(population distribution) 年龄、性别分布(sex and age) 世界各国的发病率男女之比多数为1.3-2.0：1 我国脑卒中发病率男女之比为1.3-1.5：1 The ratio of male to female for incidence of the most countries in the world is 1.3-2.0:1 The ratio of male to female for incidence of stroke in China is 1.3-1.5:1

种族分布(race) 美国同一地区的黑人脑卒中患病率高于白人 我国汉族脑卒中患病率高于少数民族 The prevalence rate of stroke is higher in black persons than whites in the same area of United States The prevalence rate of stroke is higher in Han ethnic than the minorities of China

职 业(occupation) 经常上夜班者发病率明显高于上白班者 重体力劳动者脑卒中发病率较高 经常上夜班者发病率明显高于上白班者 Heavy manual workers have a higher prevalence of stroke   The incidence rate is significantly higher among the persons with regular night shift work than those with day shift work

二、脑卒中的危险因素 Risk factors of stroke 高血压(hypertension) 心脏病 (heart disease) 糖尿病(diabetes mellitus) 短暂性脑缺血发作（transient ischemic attack） 吸 烟(smoking) 饮 酒(alcohol)

第四节 冠心病 (Coronary heart disease) 冠心病（CHD）是冠状动脉粥样硬化性心脏病的简称，是由于冠状动脉功能性或器质性改变而引起的冠状动脉血流和心肌需求不平衡所导致的心肌缺血性心脏病 Coronary disease (or coronary heart disease) refers to the failure of coronary circulation to supply adequate circulation to cardiac muscle and surrounding tissue.

一、冠心病的流行病学特征 epidemic characteristic of coronary heart disease （一）地区分布(endemic distribution ) 冠心病的发病率和死亡率存在明显的地区差异，不同国家间甚至一个国家内不同地区间存在着很大差别 There is difference in the geographical distribution of incidence an mortality rate of CHD, such differences exist not only among countries, but also in different parts of the same country.

（二）时间分布(time distribution) 同发达国家相比，我国冠心病的发病率和死亡率属于较低水平，但我国冠心病的发病率和死亡率近30年来逐步升高。 The morbidity and mortality rates of coronary heart disease are in low levels in China compared with developed countries, but they are increased gradually in nearly 30 years.

(population distribution) （三）人群分布 (population distribution) 年龄 (age) 男女冠心病发病率均随年龄增加而增加 Incidence rates of coronary heart disease increased with age for both men and women

(population distribution) （三）人群分布 (population distribution) 性别(sex) 在各年龄组冠心病的发病率和死亡率均是男性高于女性 Morbidity and mortality rates of coronary heart disease are higher in male than female in all age groups

(population distribution) （三）人群分布 (population distribution) 种族(race) 据MONICA资料，亚洲黄种人冠心病死亡率，除个别国家外（如新加坡），总的说来是黄种人低于白种人。 According to MONICA data, the mortality of coronary heart disease, apart from several countries (e.g. Singapore), is lower in Asian yellow race than white race in general.

(population distribution) （三）人群分布 (population distribution) 职业(occupation) 脑力劳动者比体力劳动者的冠心病患病率高 Prevalence of coronary heart disease is higher in mental workers than in manual workers.

二、冠心病的危险因素 the risk factor of coronary heart disease 致病性危险因素 (Pathogenic risk factors) 斑块负荷 (Plaque burden) 条件性危险因素 (Conditional risk factors) 促发性危险因素 (Perpetuating risk factors) 易感性危险因素 (Susceptibility risk factors)

二、冠心病的危险因素 the risk factor of coronary heart disease 高血压 (hypertension) 高胆固醇血症 (hypercholesterolemia) 吸烟 (smoking) 糖尿病 (diabetes mellitus) 肥胖 (obesity)

二、冠心病的危险因素 the risk factor of coronary heart disease 体力活动 (physical activity) 遗传 (heredity) A型性格和其它社会因素 (A-type personality and social factor)

第五节 心血管疾病的防治策略与措施 (prevention and care strategy and measure)

prevention and care Strategies of CVD 一、心血管疾病的防治策略 prevention and care Strategies of CVD 维多利亚心脏卫生的宣言指出，心血管疾病的预防应包括一级与二级预防及三级预防 Primary prevention Secondary prevention Tertiary prevention

（一）心血管疾病全人群策略 population policy （二）高危人群策略 high risk group policy

二、心血管疾病的三级预防措施 (tertiary prevention of CVD)

二、心血管疾病的三级预防措施 (tertiary prevention OF CVD) （一）一级预防(Primary prevention)

合理膳食(Reasonable diet ) 限盐增钾 (limit of salt and addition of potassium) 减少脂肪摄入 (reduce fat intake )

禁烟限酒(limit of smoking and alcohol) 主要通过健康教育来实现 Health education 适量运动(Appropriate movement)

心理平衡 (psychological equilibrium) 控制体重 (control weight) 超重和肥胖是心血管疾病的重要危险因素 Overweight and obesity are important risk factors for cardiovascular disease 心理平衡 (psychological equilibrium) 要重视社会心理因素对心血管系统的危害 Should pay attention to the harm of social and psychological factors on cardiovascular system

（二）二级预防 (secondary prevention) 心血管疾病的二级预防就是通过各种途径对高血压等心血管病患者早期检出和诊断 Secondary prevention of cardiovascular disease is to detect and diagnose cardiovascular disease, such as high blood pressure, earlier through various ways

（三）三级预防 (tertiary prevention) 主要是针对发病后期的心血管病患者进行合理、适当的康复治疗措施，防止病情恶化，预防严重并发症，防止伤残的发生，尽量延长有活力健康期望寿命。 Reasonable and appropriate rehabilitation measures to prevent disease progression, prevent serious complications, prevent disability, try to extend the dynamic healthy life expectancy.

三、心血管疾病的社区综合防治 community integrate control of CVD 概念 (concept) 所谓社区综合防治就是以社区为基础，社区人群为目标，动员社区内外各种资源的投入，开展心血管疾病的人群防治 Comprehensive prevention and treatment of CVD in population based on community, aiming at community groups and mobilizing various resources within and outside the community.

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