Assessment of plasma cell-free DNA and ST2 as parameters in gestational hypertension and preeclampsia.

The objective of this study was to evaluate the differences and predictive efficacy of circulating cell-free DNA (cfDNA) and human suppression of tumorigenesis 2 (ST2) among women with uncomplicated pregnancies and patients with gestational hypertension (GH) or preeclampsia (PE). This study included patients with GH (n = 41), patients with PE (n = 62), and women with uncomplicated pregnancies (n = 148). The cfDNA concentration was determined by qPCR, and the ST2 levels were measured by ELISA. A receiver operating characteristic curve was employed to measure the diagnostic performance of cfDNA and ST2. Our results showed that ST2 but not cfDNA was increased in the middle and third trimesters of normal pregnancy; ST2 and cfDNA were increased in GH and PE patients compared to women with uncomplicated pregnancies. More importantly, plasma cfDNA and ST2 served as diagnostic biomarkers for GH and PE, and the AUCs were 0.883 and 0.734 for GH and 0.838 and 0.816 for PE, respectively. Moreover, their combination significantly elevated the diagnostic efficiency for GH and PE, with AUCs of 0.906 and 0.916, respectively. Plasma cfDNA and ST2 could be used as parameters for GH and PE.

Efficacy and safety of rivaroxaban plus aspirin in women and men with chronic coronary or peripheral artery disease.

AIMS: The COMPASS trial demonstrated that the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily compared with aspirin 100 mg once daily reduced major adverse cardiovascular events (MACE) in patients with chronic coronary artery disease or peripheral artery disease by 24% during a mean follow-up of 23 months. We explored whether this effect varies by sex. METHODS AND RESULTS: The effects were examined in women and men using log-rank tests and Kaplan-Meier curve. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were obtained from stratified Cox proportional hazards models to explore subgroup effects including subgroup of women and men according to baseline modified REACH risk score. Of 27 395 patients randomized, 18 278 were allocated to receive rivaroxaban plus aspirin (n = 9152) or aspirin alone (n = 9126), and of these, 22.1% were women. Women compared with men had similar incidence rates for MACE and major bleeding but borderline lower rates for myocardial infarction (1.7% vs. 2.2%, P = 0.05). The effect of combination therapy compared with aspirin in women and men was consistent for MACE (women: 3.8% vs. 5.2%, HR 0.72, 95% CI 0.54-0.97; men: 4.2% vs. 5.5%, HR 0.76, 95% CI 0.66-0.89; P interaction 0.75) and major bleeding (women: 3.1% vs. 1.4%, HR 2.22, 95% CI 1.42-3.46; men: 3.2% vs. 2.0%, HR 1.60, 95% CI 1.29-1.97; P interaction 0.19). There was no significant interaction between randomized treatment and baseline modified REACH score above or below the median for MACE or major bleeding. CONCLUSION: In patients with stable coronary artery disease or peripheral artery disease, the combination of rivaroxaban (2.5 mg twice daily) and aspirin compared with aspirin alone appears to produce consistent benefits in women and men, independent of baseline cardiovascular risk.

Validation and Assessment of Three Methods to Estimate 24-h Urinary Sodium Excretion from Spot Urine Samples in Chinese Adults.

24-h urinary sodium excretion is the gold standard for evaluating dietary sodium intake, but it is often not feasible in large epidemiological studies due to high participant burden and cost. Three methods--Kawasaki, INTERSALT, and Tanaka--have been proposed to estimate 24-h urinary sodium excretion from a spot urine sample, but these methods have not been validated in the general Chinese population. This aim of this study was to assess the validity of three methods for estimating 24-h urinary sodium excretion using spot urine samples against measured 24-h urinary sodium excretion in a Chinese sample population. Data are from a substudy of the Prospective Urban Rural Epidemiology (PURE) study that enrolled 120 participants aged 35 to 70 years and collected their morning fasting urine and 24-h urine specimens. Bias calculations (estimated values minus measured values) and Bland-Altman plots were used to assess the validity of the three estimation methods. 116 participants were included in the final analysis. Mean bias for the Kawasaki method was -740 mg/day (95% CI: -1219, 262 mg/day), and was the lowest among the three methods. Mean bias for the Tanaka method was -2305 mg/day (95% CI: -2735, 1875 mg/day). Mean bias for the INTERSALT method was -2797 mg/day (95% CI: -3245, 2349 mg/day), and was the highest of the three methods. Bland-Altman plots indicated that all three methods underestimated 24-h urinary sodium excretion. The Kawasaki, INTERSALT and Tanaka methods for estimation of 24-h urinary sodium excretion using spot urines all underestimated true 24-h urinary sodium excretion in this sample of Chinese adults. Among the three methods, the Kawasaki method was least biased, but was still relatively inaccurate. A more accurate method is needed to estimate the 24-h urinary sodium excretion from spot urine for assessment of dietary sodium intake in China.

Influence of socioeconomic status on acute myocardial infarction in the Chinese population: the INTERHEART China study.

BACKGROUND: Many researches report that low socioeconomic status (SES) is associated with a higher risk of coronary heart disease (CHD). This study aimed to determine whether levels of education, family income, and other SES were associated with acute myocardial infarction (AMI) in the Chinese population, and to compare the difference in this association between northern and southern regions in China. METHODS: We conducted a case-control study. Cases were first AMI (n = 2909). Controls (n = 2947) were randomly selected and frequency matched to cases on age and sex. SES was measured using education, family income, possessions in the household, and occupation. RESULTS: Low levels of education (8 years) were more common in cases compared to controls (53.4% and 44.1%; P = 0.0001). After adjusting all risk factors, the level of education was associated with AMI risk in the Chinese population (P = 0.0005). The odds ratio (OR) associated with education of 8 years or less, compared with more than 12 years (trade school/college/university) was 1.33 (95%CI 1.12 - 1.59), and for education of 9 - 12 years 1.04 (95%CI 0.88 - 1.33). The proportion of higher income population was more in controls than cases (39.4% and 35.3%). Number of possessions and non-professional occupation were only weakly or not at all independently related to AMI. The adjusted OR associated with the lower education was 2.38 (95%CI 1.67 - 3.39) in women, and 1.18 (95%CI 0.99 - 1.42) in men (P = 0.0001, for heterogeneity). The interaction between levels of education and different regions was significant (P = 0.0206, for interaction). CONCLUSION: Several socioeconomic factors including levels of education and income were closely associated with increase of AMI risk in China, most markedly in northeast and southern area. The effect of education was stronger towards AMI in women than men.

Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials.

BACKGROUND: Although erectile dysfunction (ED) is associated with cardiovascular risk factors and atherosclerosis, it is not known whether the presence of ED is predictive of future events in individuals with cardiovascular disease. We evaluated whether ED is predictive of mortality and cardiovascular outcomes, and because inhibition of the renin-angiotensin system in high-risk patients reduces cardiovascular events, we also tested the effects on ED of randomized treatments with telmisartan, ramipril, and the combination of the 2 drugs (ONTARGET), as well as with telmisartan or placebo in patients who were intolerant of angiotensin-converting enzyme inhibitors (TRANSCEND). METHODS AND RESULTS: In a prespecified substudy, 1549 patients underwent double-blind randomization, with 400 participants assigned to receive ramipril, 395 telmisartan, and 381 the combination thereof (ONTARGET), as well as 171 participants assigned to receive telmisartan and 202 placebo (TRANSCEND). ED was evaluated at baseline, at 2-year follow-up, and at the penultimate visit before closeout. ED was predictive of all-cause death (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.21 to 2.81, P=0.005) and the composite primary outcome (HR 1.42, 95% CI 1.04 to 1.94, P=0.029), which consisted of cardiovascular death (HR 1.93, 95% CI 1.13 to 3.29, P=0.016), myocardial infarction (HR 2.02, 95% CI 1.13 to 3.58, P=0.017), hospitalization for heart failure (HR 1.2, 95% CI 0.64 to 2.26, P=0.563), and stroke (HR 1.1, 95% CI 0.64 to 1.9, P=0.742). The study medications did not influence the course or development of ED. CONCLUSIONS: ED is a potent predictor of all-cause death and the composite of cardiovascular death, myocardial infarction, stroke, and heart failure in men with cardiovascular disease. Trial treatment did not significantly improve or worsen ED. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT 00153101.

Effects of telmisartan, ramipril, and their combination on left ventricular hypertrophy in individuals at high vascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease.

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers reduce left ventricular hypertrophy (LVH). The effect of these drugs on LVH in high-risk patients without heart failure is unknown. METHODS AND RESULTS: In the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET), patients at high vascular risk and tolerant of ACE inhibitors were randomly assigned to ramipril, telmisartan, or their combination (n=23 165). In the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND), patients intolerant of ACE inhibitors were randomized to telmisartan or placebo (n=5343). Prevalence of LVH at entry in TRANSCEND was 12.7%. It was reduced by telmisartan (10.5% and 9.9% after 2 and 5 years) compared with placebo (12.7% and 12.8% after 2 and 5 years) (overall odds ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.0017). New-onset LVH occurred less frequently with telmisartan compared with placebo (overall odds ratio, 0.63; 95% CI, 0.51 to 0.79; P=0.0001). LVH regression was similar in the 2 groups. In ONTARGET, prevalence of LVH at entry was 12.4%. At follow-up, it occurred slightly less frequently with telmisartan (odds ratio, 0.92; 95% CI, 0.83 to 1.01; P=0.07) and the combination (odds ratio, 0.93; 95% CI, 0.84 to 1.02; P=0.12) than with ramipril, but differences between the groups were not significant. New-onset LVH was associated with a higher risk of primary outcome during follow-up (hazard ratio, 1.77; 95% CI, 1.50 to 2.07). CONCLUSIONS: In patients at high vascular risk, telmisartan is more effective than placebo in reducing LVH. New-onset LVH is reduced by 37%. The effect of combination of the 2 drugs on LVH is similar to that of ramipril alone.

Disparity and its time trends in stroke mortality between urban and rural populations in China 1987 to 2001: changing patterns and their implications for public health policy.

BACKGROUND AND PURPOSE: The purposes of this study were to describe stroke mortality in urban and rural populations in China and to monitor the transition using the best available surveillance data during the past 2 decades. METHODS: Age- and sex-specific mortality data were obtained from the death registration and classification system covering 100 million population in selected urban and rural areas in China. The age-adjusted stroke mortality and its time trends for population at aged 35 years and over were compared between urban and rural populations during the period of 1987 to 2001. RESULTS: The age-adjusted stroke mortality was higher in urban than in rural populations until the end of 1990 s. The urban:rural ratio was 1:16 for men and 1:21 for women in 1987, but this dropped to 0:77 and 0:79, respectively, in 2001 due to a remarkable decrease in stroke mortality in urban areas (-2.0% for men and -2.5% for women annually, P<0.001), but with little change in rural men (P=0.969) and women (-0.7%, P=0.021) over the period. The decrease is mainly observed in the elderly population. It increased in the population aged 35 to 54 years for all area-gender groups except for urban women. CONCLUSIONS: The heavier burden of stroke shifted from urban to rural areas where a larger population resides and healthcare services are less developed than in urban areas in China. The increasing trend in the younger population will impose a greater burden in the near future. Healthcare policymakers need to focus their attention on this situation and take suitable measures to cope with the challenges it poses.