心臟病治療的最新前沿消息大綱

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.

參加過兩項具有里程碑意義的心臟病研究項目的科學家現在正通力合作，運用遺傳學的力量來對抗這種在美國導致死亡的主要疾病。

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.

心臟病醫生近年來付出了很大努力，爭取在治療心臟病和中風方面獲得重大進展。雖然死亡率從1960年代以來就一直在穩步下降，但是從其它標準來看，與這對兄弟疾病的鬥爭沒有再取得更多的進步。

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.

遺傳學近年來對癌症的治療產生了深遠的影響。如今，心臟病專家希望遺傳學可以揭開新的奧祕，讓人深入瞭解一個人的生命機理、生活習慣和藥物治療之間的相互作用，以此更好地預測誰有心臟病發作或中風的危險。

'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.

美國密西西比大學(the University of Mississippi)校長丹尼爾・瓊斯(Daniel Jones)說：“這項研究可望找到新的治療方法。”他是歷時15年的傑克遜心臟研究項目(Jackson Heart Study)的前首席研究員，也是新的遺傳學研究項目的共同合作伙伴。

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.

瓊斯說，在遺傳學研究的幫助下，預防工作也可以得到提升。比如，目前估計有7,500萬美國人患有高血壓，但是隻有大約一半人能夠使用藥物進行控制。醫生爲病人確定恰當的用藥劑量或者藥物組合可能需要好幾個月的反覆嘗試。研究人員希望遺傳學及其它信息可以幫助醫生找到對特定治療方法產生療效反應的高血壓亞組，對病人實行對症下藥。

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.

參與遺傳學項目合作的還有歷時65年的弗雷明漢心臟研究 (Framingham Heart Study)團隊。該研究在幾十年前取得的突破性發現將心臟病與吸菸、高血壓和高膽固醇等因素聯繫起來。弗雷明漢的研究發現半個世紀以來一直是心血管疾病預防政策的基本根據。

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.

超過15,000人蔘與了弗雷明漢研究。參加人數達5,000多人的傑克遜研究是1998年啓動的，目的是爲了更好地弄清楚非洲裔美國人面臨的危險因素，這個羣體在弗雷明漢研究中代表人數不足，而且他們承受的心血管疾病負擔高於其它人羣。上述兩項研究都是由美國國家衛生研究院(the National Institutes of Health)所屬的國家心臟、肺和血液研究所(the National Heart, Lung, and Blood Institute,簡稱NHLBI)提供的資金支持。

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.

上週公佈的這項合作計劃如何具體地進行還沒有決定。很有希望的一個領域是“生物樣本庫”(biobank)，一個擁有超過100萬個血液及其它生物樣本的數據庫。這些生物樣本是在對過去半個多世紀中參與弗雷明漢研究的人員進行兩年一度的體檢時採集來的。

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.

波士頓大學(Boston University)科學家瓦桑・拉馬錢德蘭(Vasan Ramachandran)說，這些樣本儲存在馬薩諸塞州(Massachusetts)一個抗震的地下設施內的冷藏庫中，拉馬錢德蘭即將於明年年初接任弗雷明漢心臟研究的首席研究員。傑克遜研究中的另外40,000個樣本保存在佛蒙特州(Vermont)的冷庫中。研究人員說，通過對樣本進行DNA測序和其它測試，他們或許能夠確認心血管疾病發展過程中出現的各種變體――或者預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.

作爲合作項目的一部分，每一項研究都很可能要招募新的參與者，對他們的危險因素、飲食習慣和鍛鍊習慣進行跟蹤，跟蹤採取實時的形式，而不是僅在並非經常進行的體檢時才進行。

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.

在美國，一年大約有80萬例死亡病例與心臟病有關。根據美國疾病控制與預防中心(the Centers for Disease Control and Prevention)最近的一份分析資料，2010年，那些死亡病例中大約有20萬例本來是可以避免的，其中超過112,300例的死亡病人年齡低於65歲。不過那些可以避免的死亡病例在過去十年中讓死亡率每年下降了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.

現在，普遍存在的肥胖和糖尿病對取得的這些成績構成了威脅，而且白人患者和少數民族――尤其是非洲裔美國人――在從有效的治療策略中獲益的程度上存在很大的差異。

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.

從1980年代中期到1990年代初期，治療心血管疾病的方法就沒有多少新的改變（自那以後，對治療心臟病發作的溶血劑和大量降低膽固醇的他汀類藥物等新藥進行的一系列大規模試驗證明患心臟病的生存機率可以大大提高，這讓心臟病學界興奮不已）。其中一個原因是：那些療法中有些被證明很難被新的治療手段所超越。

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，使用現行的藥物目錄來降低心臟病風險還是一件沒有把握的事情。除了降血壓的藥物之外，處方里大量出現的還有降低膽固醇的他汀類藥物。藥物試驗統計數字表明，爲了防止在其它方面十分健康的病人出現第一次心臟病發作，數十位病人可能都會被開據他汀類藥物的處方，但是沒人確切知道這藥對誰真正有用，對誰沒有作用。

'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.

美國國家衛生研究院下屬 NHLBI的心血管學科主任邁克爾・勞爾(Michael Lauer)說：“如果我們能夠在轉變思維模式方面做出更多發現的話，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.

找到新的治療方法並不是新研究項目的唯一目的。波士頓布里格姆婦科醫院(Brigham and Women's Hospital)的醫務委員會主席約瑟夫・洛斯卡爾佐(Joseph Loscalzo)說：“你可以更高明地使用現存的療法。”

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.

美國心臟病學會(The American Heart Association,簡稱AHA)發起了本次研究行動，並答應在今後的五年中撥付3,000萬美元（約合人民幣1.83億元）的資金。AHA打算在2020年之前的十年時間裏將美國的心血管健康水平提升20%，同時將心臟病和中風引起的死亡病例減少20%，它把本項目看成是實現目標的關鍵。

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.

密西西比大學醫學中心(Mississippi Medical Center)的醫學及兒科學教授、傑克遜研究項目的臨時主管阿道夫・科雷亞(Adolfo Correa)說，傑克遜研究已經找到了非洲裔美國人心血管疾病患病危險的特徵，這在合作項目中“也許有望讓人獲得新的認識”。

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，傑克遜研究的參與者中肥胖者所佔比例比弗雷明漢研究隊伍中的人高。肥胖與高血壓、糖尿病和心血管疾病危險有關。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.

然而體重正常的非洲裔美國人相比體重正常的白人似乎有更高的高血壓及糖尿病患病率。“問題在於，定義糖尿病（的手段）對於（不同的）人羣來說應該是相同的還是不同的？他們面臨的心血管疾病危險是否是相同的？”科雷亞如是說。他說這個合作項目也許會提供更好的比較。

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.

研究人員還打算利用遺傳學之外的其它工具。他們認爲，通過利用移動設備對病人進行實時監測而不是隻在病人定期到診室就診時纔讀取數據，人們可以對血壓、心臟和中風瞭解得更多。比如，睡眠期間血壓升高或者運動期間血壓陡增可能預示着危險，這在醫生診室的常規測量中是不會出現的。

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.

一個巨大的挑戰是要弄清DNA測序中大量數據代表的意義並將它與病歷、飲食和鍛鍊習慣以及影響到患病危險的其它變量關聯起來。

'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.'

“整理這些複雜關係的分析方法尚在逐步完善之中，”布里格姆婦科醫院的洛斯卡爾佐說，“DNA測序的成本越來越低了，難的部分是對數據進行分析。”