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心脏病治疗的最新前沿

更新时间:2013-12-11 21:38:41 来源:华尔街日报中文网 作者:佚名

The Next Frontier in Heart Care
心脏病治疗的最新前沿

Scientists from two landmark heart-disease studies are joining forces to wield the power of genetics in battling the leading cause of death in the U.S.

参加过两项具有里程碑意义的心脏病研究项目的科学家现在正通力合作,运用遗传学的力量来对抗这种在美国导致死亡的主要疾病。

Cardiologists have struggled in recent years to score major advances against heart disease and stroke. Although death rates have been dropping steadily since the 1960s, progress combating the twin diseases has plateaued by other measures.

心脏病医生近年来付出了很大努力,争取在治疗心脏病和中风方面获得重大进展。虽然死亡率从1960年代以来就一直在稳步下降,但是从其它标准来看,与这对兄弟疾病的斗争没有再取得更多的进步。

Genetics has had a profound impact on cancer treatment in recent years. Now, heart-disease specialists hope genetics will reveal fresh insight into the interaction between a person's biology, living habits and medications that can better predict who is at risk of a heart attack or stroke.

遗传学近年来对癌症的治疗产生了深远的影响。如今,心脏病专家希望遗传学可以揭开新的奥秘,让人深入了解一个人的生命机理、生活习惯和药物治疗之间的相互作用,以此更好地预测谁有心脏病发作或中风的危险。

'There's a promise of new treatments with this research,' said Daniel Jones, chancellor of the University of Mississippi and former principal investigator of the 15-year-old Jackson Heart Study, a co-collaborator in the new genetics initiative.

美国密西西比大学(the University of Mississippi)校长丹尼尔·琼斯(Daniel Jones)说:“这项研究可望找到新的治疗方法。”他是历时15年的杰克逊心脏研究项目(Jackson Heart Study)的前首席研究员,也是新的遗传学研究项目的共同合作伙伴。

Prevention efforts also could improve with the help of genetics research, Dr. Jones said. For example, an estimated 75 million Americans currently have high blood pressure, or hypertension, but only about half of those are able to control it with medication. It can take months of trial-and-error for a doctor to get the right dose or combination of pills for a patient. Researchers hope genetic and other information might enable doctors to identify subgroups of hypertension that respond to specific treatments and target patients with an appropriate therapy.

琼斯说,在遗传学研究的帮助下,预防工作也可以得到提升。比如,目前估计有7,500万美国人患有高血压,但是只有大约一半人能够使用药物进行控制。医生为病人确定恰当的用药剂量或者药物组合可能需要好几个月的反复尝试。研究人员希望遗传学及其它信息可以帮助医生找到对特定治疗方法产生疗效反应的高血压亚组,对病人实行对症下药。

Also collaborating on the genetics project is the 65-year-old Framingham Heart Study. Its breakthrough findings decades ago linked heart disease to such factors as smoking, high blood pressure and high cholesterol. Framingham findings have been a foundation of cardiovascular disease prevention policy for a half-century.

参与遗传学项目合作的还有历时65年的弗雷明汉心脏研究 (Framingham Heart Study)团队。该研究在几十年前取得的突破性发现将心脏病与吸烟、高血压和高胆固醇等因素联系起来。弗雷明汉的研究发现半个世纪以来一直是心血管疾病预防政策的基本根据。

More than 15,000 people have participated in the Framingham study. The Jackson study, with more than 5,000 participants, was launched in 1998 to better understand risk factors in African-Americans, who were underrepresented in Framingham and who bear a higher burden of cardiovascular disease than the rest of the population. Both studies are funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.

超过15,000人参与了弗雷明汉研究。参加人数达5,000多人的杰克逊研究是1998年启动的,目的是为了更好地弄清楚非洲裔美国人面临的危险因素,这个群体在弗雷明汉研究中代表人数不足,而且他们承受的心血管疾病负担高于其它人群。上述两项研究都是由美国国家卫生研究院(the National Institutes of Health)所属的国家心脏、肺和血液研究所(the National Heart, Lung, and Blood Institute,简称NHLBI)提供的资金支持。

Exactly how the collaboration, announced last week, will proceed hasn't been determined. One promising area is the 'biobank,' the collection of more than one million blood and other biological samples gathered during biennial checkups of Framingham study participants going back more than a half century.

上周公布的这项合作计划如何具体地进行还没有决定。很有希望的一个领域是“生物样本库”(biobank),一个拥有超过100万个血液及其它生物样本的数据库。这些生物样本是在对过去半个多世纪中参与弗雷明汉研究的人员进行两年一度的体检时采集来的。

The samples are stored in freezers in an underground earthquake-proof facility in Massachusetts, said Vasan Ramachandran, a Boston University scientist who takes over at the beginning of next year as principal investigator of the Framingham Heart Study. Another 40,000 samples from the Jackson study are kept in freezers in Vermont. By subjecting samples to DNA sequencing and other tests, researchers say they may be able to identify variations linked to progression of cardiovascular disease -- or protection from it.

波士顿大学(Boston University)科学家瓦桑·拉马钱德兰(Vasan Ramachandran)说,这些样本储存在马萨诸塞州(Massachusetts)一个抗震的地下设施内的冷藏库中,拉马钱德兰即将于明年年初接任弗雷明汉心脏研究的首席研究员。杰克逊研究中的另外40,000个样本保存在佛蒙特州(Vermont)的冷库中。研究人员说,通过对样本进行DNA测序和其它测试,他们或许能够确认心血管疾病发展过程中出现的各种变体──或者预防心血管疾病的因素。

Each study is likely to enroll new participants as part of the collaboration to allow tracking of risk factors and diet and exercise habits, for instance, in real time instead of only during infrequent checkups.

作为合作项目的一部分,每一项研究都很可能要招募新的参与者,对他们的危险因素、饮食习惯和锻炼习惯进行跟踪,跟踪采取实时的形式,而不是仅在并非经常进行的体检时才进行。

Heart disease is linked to about 800,000 deaths a year in the U.S. In 2010, some 200,000 of those deaths could have been avoided, including more than 112,300 deaths among people younger than 65, according to a recent analysis by the Centers for Disease Control and Prevention. But those avoidable deaths reflected a 3.8% per year decline in mortality rates during the previous 10 years.

在美国,一年大约有80万例死亡病例与心脏病有关。根据美国疾病控制与预防中心(the Centers for Disease Control and Prevention)最近的一份分析资料,2010年,那些死亡病例中大约有20万例本来是可以避免的,其中超过112,300例的死亡病人年龄低于65岁。不过那些可以避免的死亡病例在过去十年中让死亡率每年下降了3.8%。

Now, widespread prevalence of obesity and diabetes threatens to undermine such gains. And a large gap remains between how white patients and minorities -- especially African-Americans -- benefit from effective strategies.

现在,普遍存在的肥胖和糖尿病对取得的这些成绩构成了威胁,而且白人患者和少数民族──尤其是非洲裔美国人──在从有效的治疗策略中获益的程度上存在很大的差异。

There have been few new transformative cardiovascular treatments since the mid-1980s to early 1990s, when a stream of large-scale trials of new agents ranging from clot-busters to treat heart attacks to the mega class of statins electrified the cardiology field with evidence of significant improvements in survival from the disease. One reason: Some of those remedies have proven tough to beat with new treatments.

从1980年代中期到1990年代初期,治疗心血管疾病的方法就没有多少新的改变(自那以后,对治疗心脏病发作的溶血剂和大量降低胆固醇的他汀类药物等新药进行的一系列大规模试验证明患心脏病的生存几率可以大大提高,这让心脏病学界兴奋不已)。其中一个原因是:那些疗法中有些被证明很难被新的治疗手段所超越。

What's more, use of the current menu of medicines for reducing heart risk remains an imprecise art. Besides blood pressure drugs, cholesterol-lowering statins also are widely prescribed. Drug-trial statistics show that to prevent a single first heart attack in otherwise healthy patients can require prescribing a statin to scores of patients, but no one knows for sure who actually benefits and who doesn't.

此外,使用现行的药物目录来降低心脏病风险还是一件没有把握的事情。除了降血压的药物之外,处方里大量出现的还有降低胆固醇的他汀类药物。药物试验统计数字表明,为了防止在其它方面十分健康的病人出现第一次心脏病发作,数十位病人可能都会被开据他汀类药物的处方,但是没人确切知道这药对谁真正有用,对谁没有作用。

'It would be great if we could make some more paradigm-shifting discoveries,' said Michael Lauer, director of cardiovascular sciences at the NHLBI, which is a part of the National Institutes of Health.

美国国家卫生研究院下属 NHLBI的心血管学科主任迈克尔·劳尔(Michael Lauer)说:“如果我们能够在转变思维模式方面做出更多发现的话,那就太好了。”

Finding new treatments isn't the only aim of the new project. 'You could use existing therapies smarter,' said Joseph Loscalzo, chairman of medicine at Brigham and Women's Hospital in Boston.

找到新的治疗方法并不是新研究项目的唯一目的。波士顿布里格姆妇科医院(Brigham and Women's Hospital)的医务委员会主席约瑟夫·洛斯卡尔佐(Joseph Loscalzo)说:“你可以更高明地使用现存的疗法。”

The American Heart Association launched the initiative and has committed $30 million to it over the next five years. The AHA sees the project as critical to its goal to achieve a 20% improvement in cardiovascular health in the U.S. while also reducing deaths from heart disease and stroke by 20% for the decade ending in 2020, said Nancy Brown, the nonprofit organization's chief executive.

美国心脏病学会(The American Heart Association,简称AHA)发起了本次研究行动,并答应在今后的五年中拨付3,000万美元(约合人民币1.83亿元)的资金。AHA打算在2020年之前的十年时间里将美国的心血管健康水平提升20%,同时将心脏病和中风引起的死亡病例减少20%,它把本项目看成是实现目标的关键。

The Jackson study has already identified characteristics of cardiovascular risk among African-American patients 'that may have promise for new insights' in a collaborative effort, said Adolfo Correa, professor of medicine and pediatrics at University of Mississippi Medical Center and interim director of the Jackson study.

密西西比大学医学中心(Mississippi Medical Center)的医学及儿科学教授、杰克逊研究项目的临时主管阿道夫·科雷亚(Adolfo Correa)说,杰克逊研究已经找到了非洲裔美国人心血管疾病患病危险的特征,这在合作项目中“也许有望让人获得新的认识”。

For instance, there is a higher prevalence of obesity among Jackson participants than seen in the Framingham cohorts. Obesity is associated with high blood pressure, diabetes and cardiovascular risk. Diabetes is also more prevalent among blacks than whites.

比如,杰克逊研究的参与者中肥胖者所占比例比弗雷明汉研究队伍中的人高。肥胖与高血压、糖尿病和心血管疾病危险有关。黑人中患糖尿病的人也比白人普遍。

But African-Americans of normal weight appear to have higher rates of hypertension and diabetes than whites of normal weight. 'The question is, should [measures] for defining diabetes be different or the same for the [different] populations and are they associated with the same risk of cardiovascular disease?' said Dr. Correa. The collaboration, he said, may provide better comparisons.

然而体重正常的非洲裔美国人相比体重正常的白人似乎有更高的高血压及糖尿病患病率。“问题在于,定义糖尿病(的手段)对于(不同的)人群来说应该是相同的还是不同的?他们面临的心血管疾病危险是否是相同的?”科雷亚如是说。他说这个合作项目也许会提供更好的比较。

Researchers, who plan to use tools other than genetics, think more might be learned about blood pressure and heart and stroke risk by monitoring patients in real time using mobile devices rather than taking readings only in periodic office visits. For example, high blood pressure during sleep or spikes during exercise could indicate risks that don't show up in a routine measurement in the doctors' office.

研究人员还打算利用遗传学之外的其它工具。他们认为,通过利用移动设备对病人进行实时监测而不是只在病人定期到诊室就诊时才读取数据,人们可以对血压、心脏和中风了解得更多。比如,睡眠期间血压升高或者运动期间血压陡增可能预示着危险,这在医生诊室的常规测量中是不会出现的。

A big challenge is making sense of the huge amounts of data involved in sequencing DNA and linking it to medical records, diet and exercise habits and other variables that influence risk.

一个巨大的挑战是要弄清DNA测序中大量数据代表的意义并将它与病历、饮食和锻炼习惯以及影响到患病危险的其它变量关联起来。

'The analytical methods for sorting out these complex relationships are still in evolution,' said Dr. Loscalzo, of Brigham and Women's Hospital. 'The cost of sequencing is getting cheaper and cheaper. The hard part is analyzing the data.'

“整理这些复杂关系的分析方法尚在逐步完善之中,”布里格姆妇科医院的洛斯卡尔佐说,“DNA测序的成本越来越低了,难的部分是对数据进行分析。”

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