2015-05-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/658107摘要：心臟血管疾病是目前世界最重要的疾病，死亡率及罹病率均居於首位，特別是在現今的社會中，高 血壓及冠心病，中風的人口節節上升。雖然過去的研究已經知道和高血壓相關的許多心血管疾病， 但是根據大規模的研究顯示，血壓達到良好控制的比率仍然偏低。要控制好血壓有賴於生活型態的 調整，以及多種藥物的組合使用，目前研發新的電氣燒灼技術可以電燒腎臟血管的交感神經，達到 血壓控制的效果，可是目前研究仍少且不普及。另一方面，高血壓相關疾病如舒張性心衰竭，在目 前所做的研究仍不足，藥物的使用仍然是依臨床的經驗，而沒有大規模資料庫可以作為研究。另外心血管的疾病(CVD)，包括冠心病(CHD)及中風(stroke)，是國人罹病和死亡的主要原因。血脂 異常(dyslipidemia)早就廣為人知是動脈血管粥狀硬化發展過程中最重要的危險因子。台灣的流行病學 研究顯示，高膽固醇血症（hypercholesterolemia,血中總膽固醇〉250毫克/分升）的盛行率在1970年 代是4.3%-5.5% ；在1980年代是12.99% ；在1990年代則上升到17.1%。而高三酸甘油酯血症 (hypertriglyceridemia,血中三酸甘油酯〉200毫克/分升)的盛行率在1970年代是6.5%-11.1% ；在1990 年代則上升到13.0%。血中高密度膽固醇(HDL-C)值過低也是許多台灣人的獨立冠心病危險因子。以statins降低低密度脂蛋白膽固醇(LDL-C)在過去十年已成為血脂異常標準治療的一部分。但是， 令人非常困窘的是台灣的血脂異常治療指引多為參考西方人的標準，因為過去有關降脂葯物治療 (LLT)效果的研究多是在高加索人進行，有關心血管事件終點的大規模研究在亞洲人極為少見，在台 灣更付闕如。為了讓台灣的血脂異常指導方針能植基於我們本土的流行病學資料、臨床和基礎醫學的 研究數據，這項病人登錄研究試圖確定台灣血脂異常病人接受降脂治療之狀況，並藉由大規模登錄台 灣接受初級和次級心血管疾病防治之病人，來探討降脂治療對心血管疾病罹病率及死亡率之影響。本 登錄研究藥物之使用與否及使用何種藥物或劑量均只取決於病人基層照顧醫生所做的決定，病人或者 基層照顧醫生能隨時因任何原因決定從這登錄研究退出。另外我們也將登錄病人在接受降脂治療後其 血中脂值及肝臟酵素值之改變、及是否發生肌肉病變（myopathy)。目前我們的計晝是要建立台灣的高血壓及高血脂兩種最重要的危險因子及疾病相關的生物檢體資 料庫以及臨床試驗聯盟，希望能用合作的方式，在台灣的主要21家醫學中心，建立一個電子及資料 庫收集的平台，使用共通的資料登記軟體，臨床收集病患的共通條件，主要的目的是希望能完成高 品質的臨床試驗，並吸引國外重要的臨床試驗在台灣進行，同時也扶植本土的心血管疾病臨床試驗 研究發展。另外我們也希望能使用嚴格的管控，病患願意將生物檢體提供研究之後，由各個醫院登 入病患的資料到電子系統，定期由中心控管品質，生物檢體以相同嚴格的條件存放在各家醫院中， 資料庫中的病患資料，優先提供給加入的成員使用，並可以作為日後國際的臨床研究使用，也可以 提供給生物科技產業研發新的技術，新的藥物，而改善整體國民的健康。<br> Abstract: Cardiovascular disease (CVD) including hypertension, hyperlipidemia, and the associated disease such as coronary heart disease (CHD, stroke, heart failure remains to be the most important health and public problems for the modern country. Although the influence and impact of hypertension is a well-known, the adequate control rate is low and some hypertension associated disease still lack adequate medical treatment. Successful treatment of raised blood pressure has proven elusive despite availability of various drugs, combination pharmaceutical products, and resources to assist patients’ adherence and lifestyle changes. Recently developed endovascular catheter technology enables selective denervation of the human kidney for better treatment of resistant hypertension. On the other hand, there was over half of patient with heart failure have diastolic heart failure (DHF). Hypertension could result in left ventricular hypertrophy and further diastolic dysfunction. Large randomized trials in selected patients with HF have led to major advances in the medical treatment of systolic HF. On the contrary, few randomized trials have been carried out with regard to medical management of DHF, despite its high prevalence and mortality. Therefore, treatment of DHF is still empirical and there is a scarcity of evidence-based recommendation towards the disease. On the other hand, dyslipidemia has long been recognized to be the most important risk factor in the development of atherosclerosis in human beings. In Taiwan, the rates for hypercholesterolemia (^250mg/dl) were 4.3% and 5.5% in 1970; 12.99% in 1980; and 17.1% in 1990. Those for hypertriglyceridemia (^200 mg/dl) were 6.5% and 11.1% in 1970 and 13.0% in 1990. Low serum HDL-C was an isolated and independent coronary risk factor among a good number of Taiwanese people. Lowering of low-density lipoprotein cholesterol (LDL-C) with statins has in the last decade become part of the standard treatment regimen in patients with dyslipidemia. However, most embarrassing, is the insufficient data for clinical use in Taiwan. It is necessary to have rationalized and balanced guideline for the management of dyslipidemia in Taiwan, based on our local epidemiological, clinical and basic research data. Because all these trials were conducted in Caucasians and no large-scaled end-point research about the lipid lowering therapy (LLT) was published in Asians before, this registry study attempts to define the status of lipid lowering therapy in Taiwan and the effect of LLT on CVD morbidity and mortality in a large population of patients receiving primary or secondary prevention therapy. The medications will only depend on the decision made by the primary care physicians. The patient or physician can decide to be withdrawn from this registry at any time because of any reason. The lipid profile change, myopathy, or liver enzyme change after the LLT will also be recorded.To achieve the above goals, it is important to conduct multicenter trials on the treatment of hypertension and hyperlipidemia associated diseases that take the advantage of more efficient screening and enrollment of cases. Specifically, we can prospectively setup a biospecimen bank with clarified disease phenotype through the conduction of these trials. The biospecimen bank and the clinical information collected from this study could also provide a platform for further investigation of cardiac diseases. We would then coordinate 21 large medical centers in Taiwan and forming a hypertension/hyperlipidemia Consortium and biospecimen banks, recruiting patients with hypertension, resistant hypertension, hyperlipidemia and related cardiac disease. Through the platform, we would like to promote and attract most important worldwide and domestic clinical trial into the consortium.