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| 1 | 将卒中纳入心血管风险预测工具美国心脏协会/美国卒中协会对医疗卫生专业人员的声明显示文摘背景和目的目前美国针对心血管事件风险预测以及一级和二级预防的指南声明均使用绝对风险估计值来识别血管事件高危患者以及可从特定干预措施中获益的患者。然而,这些指南并未明确地包括卒中患者。本指南对现有证据和争论进行概述以支持:(1)将卒中(尤其是动脉粥样硬化性卒中)患者纳入心血管病绝对风险增高的患者群体;(2)将卒中纳入血管性疾病风险预测工具的转归预测因素。方法和结果写作组成员由委员会联合主席基于先前在相关领域的研究成果来提名,并得到美国心脏协会(American Heart Association,AHA)卒中委员会科学声明监督委员会以及文稿监督委员会的批准。作者采用系统文献回顾(覆盖1980年1月至2010年3月期间的文献)并参考以往公布的指南、个人资料以及专家观点,以归纳现有证据,提出当前知识的不足,并根据AHA标准对适当的问题制定推荐意见。所有写作组成员均有机会对推荐意见进行评论并批准了最终版本。经广泛的AHA内部同行评议以及卒中委员会领导阶层和科学声明监督委员会的审阅后,最终获得AHA科学咨询和协调委员会的批准。将卒中患者(尤其是动脉粥样硬化性卒中患者)纳入冠状动脉和心血管病绝对高危人群的原因如下。首先,有证据显示,缺血性卒中患者发生致死性和非致死性心肌梗死或猝死的绝对风险增高,10年绝对风险≥20%,这一风险阈值已被一些指南用于定义冠状动脉疾病风险等危症。其次,纳入动脉粥样硬化性卒中的原因与纳入糖尿病、周围血管病、慢性肾脏病以及其他动脉粥样硬化性疾病的原因相同,尽管尚缺乏在所有人群或患者中风险增高的统一证据。再次,缺血性卒中的大动脉粥样硬化性卒中亚型与其他这些疾病的病理生理学机制相同。将卒中纳入高危因素将导致高危人群的数量扩大约10%。然而,由于卒中的异质性,尚不确定其他卒中亚型,包括出血性卒中以及非动脉粥样硬化性卒中亚型,是否应被视为具有相同水平的风险,因此有待进一步研究。鉴于卒中对残疾和死亡的影响、卒中与其他血管性疾病预防措施的相似性以及卒中在某些人群中较冠状动脉疾病更高的重要性,将卒中、心肌梗死和猝死纳入心血管事件风险预测工具的转归预测因素是合适的。美国以外的指南常常将卒中患者纳入心血管高危人群,并将卒中作为心脏终点的一个相关转归事件。结论动脉粥样硬化性卒中患者应被纳入会进一步发生冠状动脉粥样硬化事件的高危患者(10年≥20%)。是否应纳入非动脉粥样硬化卒中亚型尚不确定。对于一级预防,缺血性卒中应被纳入绝对风险评估方案的心血管疾病转归事件。将动脉粥样硬化性卒中作为一个高危因素或者更宽泛地将缺血性卒中视作一种转归事件纳入,可能对心血管病的预防具有重要意义,因为被评定为高危风险的患者数量将大幅增加。 | Daniel T. Lackland Mitchell S.V. Elkind Ralph D'Agostino Sr Mandip S. Dhamoon David C. Goff Jr Randall T. Higashida Leslie A. McClure Pamela H. Mitchell Ralph L. Sacco Cathy A. Sila Sidney C. Smith Jr David Tanne David L. Tirschwell Emmanuel Touze Lawrence R. Wechsler 4:~ 尤寿江(译) 于海龙(译) 刘慧慧(译) 张霞(译) 刘春风(译) | 2012 | 国际脑血管病杂志2012，20，11： | 13 |
| 2 | Trends in Management and Outcome of Hospitalized Patients With Acute Stroke and Transient Ischemic Attack: The National Acute Stroke Israeli (NASIS) Registry显示文摘 | David Tanne Silvia Koton Noa Molshazki Uri Goldbourt Tamar Shohat Rakefet Tsabari Ehud Grossman Natan M. Bornstein | 2012 | Stroke2012，，： | 2 |
| 3 | Blood lipids are important independent risk factors for isehemie stroke or T1A: a prospective follow up of over 11,000 patients in the BIP registry显示文摘 | David Tanne Nira Koren U Goldbourt | 1999 | Stroke1999，30，9： | 1 |
| 4 | Insulin resistance is associated with increased risk of major cardiovascular events in patients with preexisting coronary artery disease显示文摘 | Alexander Tenenbaum Yehuda Adler Valentina Boyko Helena Tenenbaum Enrique Z. Fisman David Tanne Mordechai Lapidot Ehud Schwammenthal Micha S. Feinberg Zipora Matas Michael Motro Solomon Behar | 2007 | American Heart Journal2007，，： | 1 |
| 5 | Blood lipids are important independent risk factors for ischemic stroke or TIA:a prospective follow -up of over 11,000patients in the BIP registry显示文摘 | Nira Koren U Goldbourt | 1999 | Stroke1999，30，9： | 1 |
| 6 | Long-term changes in serum cholesterol level does not influence the progression of coronary calcification显示文摘 | Alexander Tenenbaum Joseph Shemesh Nira Koren-Morag Enrique Z. Fisman Yehuda Adler Ilan Goldenberg David Tanne Ilan Hay Ehud Schwammenthal Michael Motro | 2010 | International Journal of Cardiology2010，，2： | 1 |
| 7 | Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in Patients Aged 80 Years and Older: The tPA Stroke Survey Experience显示文摘 | David Tanne Mark J. Gorman Vernice E. Bates Scott E. Kasner Phillip Scott Piero Verro Jeffrey R. Binder Jeffrey M. Dayno Lonni R. Schultz Steven R. Levine | 2000 | Stroke: Journal of the American Heart Association2000，，2： | 1 |
| 8 | Inclusion of Stroke in Cardiovascular Risk Prediction Instruments显示文摘 | Daniel T. Lackland Mitchell S.V. Elkind Ralph D’Agostino Mandip S. Dhamoon David C. Goff Randall T. Higashida Leslie A. McClure Pamela H. Mitchell Ralph L. Sacco Cathy A. Sila Sidney C. Smith David Tanne David L. Tirschwell Emmanuel Touzé Lawrence R. Wech | 2012 | Stroke2012，，7： | 1 |
| 9 | Blood lipids and first-ever ischemic stroke/transient ischemic attack in the Bezafibrate Infarction Prevention(BIP) Registry: High triglycerides constitute an independent risk factor显示文摘 | David Tanne Nira Koren Eran Graff | 2001 | Ournal of the American Heart Association2001，104，11： | 1 |
| 10 | Serum uric acid and long-term mortality from stroke, coronary heart disease and all causes显示文摘 | Yariv Gerber David Tanne Jack H. Medalie Uri Goldbourt | 2006 | European Journal of Cardiovascular Prevention & Rehabilitation2006，，2： | 1 |
| 11 | Relation of nonobstructive aortic valve calcium to carotid arterial atherosclerosis显示文摘 | Yehuda Adler Uriel Levinger Arnon Koren David Tanne Noam Fink Mordehay Vaturi Zaza Iakobishvili Alexander Battler Avigdor Zelikovski Alex Sagie | 2000 | The American Journal of Cardiology2000，，10： | 1 |
| 12 | Fasting plasma glucose and risk of incident ischemic stroke or transient ischemic attaeks显示文摘 | David Tanne Nira Koren-Morag Uri Goldbourt | 2004 | Stroke2004，35，9： | 1 |
| 13 | Homocysteine, B-Vitamin supplement, and stroke prevention: from observational to interventional trials 显示文摘 | Tanne David | 2004 | Lancet Neurol2004，3，： | 1 |
| 14 | Taking care of volunteers in a stroke trial: a new assisted-management strategy显示文摘Background and purpose:Providing participants with evidence-based care for secondary prevention is an ethical and scientific priority for trials in stroke therapy.The optimal strategy,however,is uncertain.We report the performance of a new approach for delivering preventive care to trial participants.Methods:Participants were enrolled in the Insulin Resistance Intervention after Stroke trial,which examined the insulin sensitiser,pioglitazone versus placebo for prevention of stroke and myocardial infarction after ischaemic stroke or transient ischaemic attack.Preventive care was the responsibility of the participants’personal healthcare providers,but investigators monitored care and provided feedback annually.We studied achievement of 8 prevention goals at baseline and 3 annual visits,with a focus on 3 priority goals:blood pressure<140/90 mm Hg,lowdensity lipoprotein(LDL)cholesterol<2.59 mmol/L and antithrombotic therapy.Results:The proportion of participants achieving the priority goals was highest for antithrombotic use(96–99%in each year)and similar for blood pressure(66–72%in each year)and LDL(68–70%in each year).All 3 priority goals were achieved by 47–52%of participants in any given year.However,only 22%of participants achieved all 3 goals in each year.Conclusions:A strategy of monitoring care and providing feedback was associated with high average yearly achievement of 3 priority secondary prevention goals,but the majority of trial participants did not persist in being at goal over time.Trial registration number:NCT00091949. | Amber C Stuart Jason J Sico Catherine M Viscoli Ashis H Tayal Silvio E Inzucchi Gary A Ford Karen L Furie Robert Cote J David Spence David Tanne Walter N Kernan on behalf of the IRIS Trial Investigators | 2016 | Stroke & Vascular Neurology2016，1，3： | 0 |
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