2010 Vol. 7, No. 3
Objective Global cardiovascular risk assessment has been incorporated into current Chinese guidelines for the management of hypertension and hypercholesterolemia. The aim of our study is to determine the distribution of 10-year risk for ischemic cardiovascular disease (ICVD) among middle-aged Chinese adults, and to evaluate the usefulness of global risk assessment tools in the primary prevention of ICVD in Chinese population. Methods Simplified prediction tools derived from the USA-PRC Collaborative Study of Cardiovascular Epidemiology cohort were applied to the Chinese Health Examination Database (CHED) 2008. 10-year risk for ICVD was estimated in 461 157 ICVD-free subjects (264 432 male and 196 725 female) aged 35 to 59 years. Results Among the male subjects, 82.4% had a 10-year risk for ICVD of <5%, 14.4% of 5% to 12.1% and 3.4 of≥12.2%, and in female subjects, 86.7% had a 10-year risk for ICVD of <5%, 12.1% of 5% to 12.0% and 1.2% of ≥12.1%. All subjects with predicted high level ICVD risk (≥12.2% in male or ≥12.1% in female) had either remarkably elevated (≥160 mmHg) blood pressure, significantly increased (≥6.22 mml/L) total serum cholesterol or diabetes. Conclusion Using the currently recommended prediction tools, only very small proportions of middle-aged Chinese men and women who were free of ICVD would be classified into high level risk group. These prediction tools are unlikely to help for the medical intervention decision making in Chinese adult patients with hypertension and/or hypercholesterolemia.
Objective Several previous studies have shown androgens deficiency in men with CHF, and 2 studies on the prognostic significance of serum levels of androgens in CHF patients have yielded conflicting results. The aim of this study was to examine the relationship between serum concentration of testosterone and mortality in men with systolic CHF. Methods A total of 175 elderly (age≥60 years) men with CHF were recruited. Total testosterone (TT) and sex hormone binding globulin (SHBG) were measured, and free serum testosterone (eFT) was calculated. The median follow-up time was 1262 days. Results During follow-up 54 (30.9%) patients died. TT and eFT deficiency was found in 21.7% (38/175) and 27.4% (48/175) patients, respectively. Both TT and eFT were inversely associated with LVEF and NT-proBNP (all P<0.01). Kaplan-Meier curves for patients in low, medium and high tertiles according to TT and eFT level showed significantly different cumulative survival rate (both P<0.01 by log-rank test). However, after adjustment for clinical variables, there were no significant associations between either TT or eFT levels or survival time (OR=0.97, 95% CI, 0.84-1.12, P=0.28; and OR=0.92, 95% CI, 0.82-1.06, P=0.14, respectively). Conclusion Our study showed that although levels of TT and eFT are commonly decreased in elderly patients with systolic CHF and related to disease severity, they are not independent predictors for mortality (J Geriatr Cardiol 2010; 7:138-142).
Objective To examine the changes of red blood cell levels in the obese and non-obese patients with coronary heart disease (CHD) and its clinical significance. Methods 230 cases of coronary heart disease were selected and divided into the obese group and the nonobese group. Obesity and non-obesity were defined based on the body mass index (BMI 28.0kg/m2), or waist-hip ratio (men> 0.9, women> 0.85). In addition, 130 healthy subjects were recruited as controls. The pathological status of coronary lesions was quantitatively analyzed according to the Coronary Vascular Image Segmentation Evaluation Criteria (American Heart Association 1984) and the Gensini scoring system. Results of the changes of both the hemoglobin levels and the red blood cell count in the obese group, the nonobese group with CHD and the control group were compared. Besides, Multivariant Logistic Regression Analysis was applied to assess the correlation between the red blood cells and the coronary artery disease. Results The red blood cell count and the level of hemoglobin in the obese group with CHD was higher than that in the non-obese group with CHD [(4.35±0.55) and (4.13±0.56) 109/L; (136.71 ±15.87) and (129.96±16.23) g/L, P < 0.05 in both]; the proportion of acute coronary syndrome in the obese group with CHD was higher in the obese group with CHD than that in the non-obese group with CHD (P<0.05); Multivariant logistic regression analysis also showed that the red blood cell count was positively correlated with obesity with CHD. Conclusion The red blood cell count and the level of hemoglobin in the obese group were higher than those in the non-obese group; the increase of red blood cell count and hemoglobin level is one of the independent risk factors for the obese patients with CHD (J Geriatr Cardiol 2010; 7:143-146).
Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 (PAI-1) levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction (ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI). Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI-1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI (80.12ng/ml VS.73.01ng/ml, P0.05). PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels (J Geriatr Cardiol 2010; 7:147-151).
Objective Coronary heart disease (CHD) is a multifactorial disease. This meta-analysis was performed to evaluate the relationship between angiotensinogen gene polymorphisms and CHD in the Chinese population. Methods We searched literature in pubmed (1990-2010.8) and CNKI (1990-2010.8) for all the relevant studies on 2 angiotensinogen polymorphisms (M235T and T174M) and risk of CHD. The meta-analysis software Stata 10.0 was used for ascertaining heterogeneity among individual studies and for combining all the studies. Furthermore,Egger's test and sensitivity analysis were performed to insure authenticity of the outcome.Results Ten associations studies on 2 angiotensinogen polymorphisms (M235T and T174M) were included in this meta-analysis. In a combined analysis, the summary per-allele odds ratio for CHD of the M235T polymorphism was 1.374 (95% confidence interval, 1.019 to 1.852) and T174M polymorphism was 4.089 (95% confidence interval, 1.697 to 9.851). Conclusions The M235T polymorphism had weak but statistically significant association with CHD while the T174M polymorphism was more strongly associated with a CHD risk in Chinese population, but further confirmation studies are needed (J Geriatr Cardiol 2010; 7:152-156).
Objective Brachial-ankle pulse wave velocity (baPWV) is widely used as a simple noninvasive measure of arterial stiffness. The aim of this study was to evaluate the usefulness of baPWV as a predictor of the carotid artery atherosclerosis in the elderly. Methods A total of 721 elderly participants (mean±SD age, 70.3±5.6years) were enrolled in the current study. All participant underwent both baPWV measurement and B-mode ultrasound for the intima-media thickness. Carotid atherosclerosis (CAS) was defined as the present of carotid plaque or and/or intima media thickness for at least 1.1 mm. Results A multivariate logistic regression analysis reveals that age, sex, brachial-ankle pulse wave velocity, smoking and LDL-C level showed a significant correlation with the presence of CAS. The odds ratios of CAS associated with a 500cm/s increase of brachial-ankle pulse wave velocity were 2.378 [95% confidence interval, 1.36 to 4.00, P<0.05], 3.733 [95% confidence interval, 1.729 to 8.058, P<0.01], 4.438 [95% confidence interval, 1.659 to 11.803, P<0.01]. The baPWV significantly correlated with IMT by bivariate correlation analysis (r=0.39; p=0.001). After adjusting for factors influencing, baPWV all the same correlated with IMT (r=0.35; p=0.001).Conclusion These results indicate that brachial-ankle PWV is an independent predictor of CAS in the elderly.It also means that the direct measurement of arterial stiffness by this simple method may be of great help for the evaluation of carotid artherosclerosis , at least in the elderly (J Geriatr Cardiol 2010; 7:157-160).