Association between cumulative blood pressure and long-term risk of cardiovascular disease: findings from the 26-year Chinese Multi-provincial Cohort Study-Beijing Project / 中华医学杂志(英文版)

BACKGROUND@#Cumulative blood pressure (BP), a measure incorporating the level and duration of BP exposure, is associated with the risk of cardiovascular disease (CVD). However, the level at which cumulative BP could significantly increase the risk remains unclear. This study aimed to investigate the association of 15-year cumulative BP levels with the long-term risk of CVD, and to examine whether the association is independent of BP levels at one examination.@*METHODS@#Data from a 26-year follow-up of the Chinese Multi-provincial Cohort Study-Beijing Project were analyzed. Cumulative BP levels between 1992 and 2007 were calculated among 2429 participants free of CVD in 2007. Cardiovascular events (including coronary heart disease and stroke) occurring from 2007 to 2018 were registered. Adjusted hazard ratios (HRs) for CVD incidence associated with quartiles of cumulative systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated.@*RESULTS@#Of the 2429 participants, 42.9% (1042) were men, and the mean age in 2007 was 62.1 ± 7.9 years. Totally, 207 CVD events occurred during the follow-up from 2007 to 2018. Participants with higher levels of cumulative SBP or DBP exhibited a higher incidence rate of CVD (P < 0.001). Compared with the lowest quartile of cumulative SBP, the HR for CVD was 1.03 (95% confidence interval [CI]: 0.59-1.81), 1.69 (95% CI: 0.99-2.87), and 2.20 (95% CI: 1.21-3.98) for the second to the fourth quartile of cumulative SBP, and 1.46 (95% CI: 0.86-2.48), 1.99 (95% CI: 1.18-3.35), and 2.08 (95% CI: 1.17-3.71) for the second to the fourth quartile of cumulative DBP, respectively. In further cross-combined group analyses with BP measurements in 2007, 15-year cumulative BP levels higher than the median, that is, 1970.8/1239.9 mmHg·year for cumulative SBP/DBP, which were equivalent to maintaining SBP/DBP levels of 131/83 mmHg or above on average in 15 years, were associated with higher risk of CVD in subsequent years independent of BP measurements at one-time point.@*CONCLUSION@#Cumulative exposure to moderate elevation of BP is independently associated with increased future cardiovascular risk.

Upregulation of PITX2 Promotes Letrozole Resistance Via Transcriptional Activation of IFITM1 Signaling in Breast Cancer Cells / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although the interferon α (IFNα) signaling and the paired-like homeodomain transcription factor 2 (PITX2) have both been implicated in the progression of breast cancer (BCa), it remains obscure whether these two pathways act in a coordinated manner. We therefore aimed to elucidate the expression and function of PITX2 during the pathogenesis of endocrine resistance in BCa. MATERIALS AND METHODS: PITX2 expression was assessed in BCa tissues using quantitative reverse transcription polymerase chain reaction (RT-qPCR) and immunohistochemistry and in experimentally induced letrozole-resistant BCa cells using RT-qPCR and immunoblotting. Effects of PITX2 deregulation on BCa progression was determined by assessing MTT, apoptosis and xenograft model. Finally, using multiple assays, the transcriptional regulation of interferon-inducible transmembrane protein 1 (IFITM1) by PITX2 was studied at both molecular and functional levels. RESULTS: PITX2 expression was induced in letrozole-resistant BCa tissues and cells, and PITX2 induction by IFNα signaling powerfully protected BCa cells against letrozole insult and potentiated letrozole-resistance. Mechanistically, PITX2 enhanced IFNα-induced AKT activation by transactivating the transcription of IFITM1, thus rendering BCa cells unresponsive to letrozoleelicited cell death. Additionally, ablation of IFITM1 expression using siRNA substantially abolished IFNα-elicited AKT phosphorylation, even in the presence of PITX2 overexpression, thus sensitizing BCa cells to letrozole treatment. CONCLUSION: These results demonstrate that constitutive upregulation of PITX2/IFITM1 cascade is an intrinsic adaptive mechanism during the pathogenesis of letrozole-resistance, and modulation of PITX2/IFITM1 level using different genetic and pharmacological means would thus have a novel therapeutic potential against letrozole resistance in BCa.

Biomechanical study on repair materials of unilateral maxilla defect based on finite element model / 医用生物力学

Objective To study the biomechanical effect from different prosthetic materials used on unilateral maxillary defect repair by three dimensional finite element (FE) analysis method. Methods The maxillary unilateral defect model was reconstructed by medical image processing software MIMICS. The prosthesis was generated by mirroring technology. After processing, the FE unilateral maxillary defect model and healthy maxillary model were established to simulate stress distributions on the maxilla during occlusion. Results The maximum stress on maxilla using different repair materials was always found concentrated on the edge of maxilla connected with zygoma (the positions attaching zygolabialis and levator anguli oris). The minimum stress of from the maxilla edge on the repair side was 8.471 MPa by using tricalcium phosphate (TCP) composite. The maximum stress from the maxilla edge on the repair side was 17.55 MPa by using hydroxyapatite (HA) material. Conclusions Different repair materials had no significant effect on natural side of the maxilla after restoration, while a greater impact of force status on the repair side was found. The elastic modulus of different repair materials can be used as a basis for maxilla restoration in clinic.

Biomechanical study on unilateral maxilla restoration using different retention methods / 医用生物力学

Objective To study the biomechanical effects of 3 different retention methods (clasp, attachment or zygomatic implants) on repairing unilateral maxillary defects by using 3D finite element analysis method. Methods The maxillary unilateral defect model was reconstructed by the medical image processing software Mimics. The prosthesis was generated by mirroring technology. After processing, the finite element model of maxillary model by the three different retention methods was established to simulate stress distributions of maxilla during occlusion. Results Compared with the other methods, by using zygomatic implant retention method, stresses on affected and unaffected palate were the largest as 7.399 and 4.864 MPa, respectively, while those on affected and unaffected maxilla were the smallest as 10.46 and 10.86 MPa, respectively. Stress on zygomatic implant itself was 15.25 MPa, which was also the smallest. Conclusions Different retention methods had an obvious impact on unilateral maxillary defect restoration. The clasp and attachment retention methods could share the stress on palate by carrying bracket. The zygomatic implant retention method could also share the stress on maxilla by passing the stress to the zygoma.

Determination of R(-)- isomer in repaglinide tablets by capillary electrophoresis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To develop a capillary electrophoresis system for enantiomeric impurity test of repaglinide.</p><p><b>METHODS</b>An uncoated fused silica capillary (50 μm×50 cm, with an effective length of 41 cm) was used. The running buffer was composed of 30 mmol/L NaH2PO4 and 5 mg/ml carboxymethyl-β-cyclodextrin(pH 3.5).</p><p><b>RESULTS</b>Linear range was 2.00-80.00 μg/ml (correlation coefficient was 0.9993). The average recovery rate was 92.5% to 105.0%.</p><p><b>CONCLUSION</b>The method is simple, accurate and sensitive and it can be used for determination of enantiomeric impurities in repaglinide tablet.</p>

Determination of enantiomeric impurity in levocetirizine tablets by capillary electrophoresis / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine enantiomeric impurity in levocetirizine tablets by using capillary electrophoresis.</p><p><b>METHODS</b>The effects of pH and the concentrations of sulfated-Β-cyclodextrin (S-Β-CD) and buffer salt on chiral resolution were examined with S-Β-CD as chiral selector.</p><p><b>RESULTS</b>A good enantioseparation of cetirizine was achieved with 30 mmol/L NaH2PO4 buffer solution (pH 7.0) containing 20 g/L of S-Β-CD.</p><p><b>CONCLUSION</b>The method developed in the study is sensitive and reliable for determination of enantiomeric impurity in levocetirizine tablets.</p>

Performance measures for management of chronic heart failure patients with acute coronary syndrome in China: results from the Bridging the Gap on Coronary Heart Disease Secondary Prevention in China (BRIG) Project / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Chronic heart failure (CHF) is a severe clinical syndrome associated with high morbidity and mortality, and with high health care expenditures. No nationwide data are currently available regarding the quality of clinical management of CHF patients in China. The aim of this study was to assess the quality of care of CHF inpatients in China.</p><p><b>METHODS</b>The American College of Cardiology/American Heart Association Clinical Performance Measures for Adults with Chronic Heart Failure (Inpatient Measurement Set) with slight modifications was used to measure the performance status in 612 CHF patients with acute coronary syndrome (ACS) from 65 hospitals across all regions of China.</p><p><b>RESULTS</b>The implementation rates of guideline recommended strategies for CHF management were low. Only 57.5% of the CHF patients received complete discharge instructions, 53.6% of the patients received evaluation of left ventricular systolic function, 62.8% received an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker at discharge, and 52.7% received a β-blocker at discharge, 56.3% of the smokers received smoking cessation counseling. The rate of warfarin utilization was only 9.7% in CHF patients with atrial fibrillation. Most patients (81.4%) did not receive all the first four treatments. There were marked differences in the quality of CHF management among patients with different characteristics.</p><p><b>CONCLUSIONS</b>Performance measures provide a standardized method of assessing quality of care, and can thus highlight problems in disease management in clinical practice. The quality of care for CHF patients with ACS in China needs to be improved.</p>

Impact of gender on lipoprotein-associated phospholipase A2 activity and association with known cardiovascularrisk factors / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the impact of gender on lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) activity and association with known cardiovascular risk factors.</p><p><b>METHODS</b>Participants in this study were recruited from Beijing sub-cohort from the Chinese Multi-provincial Cohort Study (CMCS) database. A total of 1471 participants with complete laboratory data were included in the study (688 male). Lp-PLA(2) activity was determined by colorimetric assay kit.Lp-PLA(2) activity level and correlation between Lp-PLA(2) activity and known risk factors were compared between men and women.</p><p><b>RESULTS</b>(1) Lp-PLA(2) activity was higher in males than in females [(22.73 ± 8.52) nmol·min(-1)·ml(-1) vs.(20.01 ± 8.06) nmol·min(-1)·ml(-1), P < 0.01].(2) Age, waist circumference, systolic blood pressure, diastolic blood pressure and the prevalence of hypertension were higher in males than in females, while total cholesterol, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were higher in females than in males (P < 0.05 or P < 0.01).(3)Pearson correlation showed that Lp-PLA(2) activity was correlated with lipids ( total cholesterol, LDL-C, HDL-C, and triglyceride), blood pressure (systolic blood pressure and diastolic blood pressure), and adiposity associated parameters (waist circumference and body mass index) in males (all P < 0.01) and was correlated with lipid level (total cholesterol, LDL-C, HDL-C, and triglyceride) and age in females( P < 0.05 or P < 0.01). Correlations with variables associated with obesity or blood pressure in females were much weaker than those in males (in females, r = 0.02-0.08; in males, r = 0.10-0.16).(4)After adjustment for age, waist circumference, systolic blood pressure, glucose, LDL-C, HDL-C, triglyceride and high sensitivity C-reactive protein by multiple logistic regression model, Lp-PLA(2) activity was still significantly higher in males than in females (OR = 1.72, 95% confidence interval = 1.34-2.21, P < 0.01).</p><p><b>CONCLUSIONS</b>Lp-PLA(2) activity and association with known cardiovascular risk factors differed in males and females. The gender difference in Lp-PLA(2) activity still presents after adjustment for known cardiovascular risk factors in this cohort.</p>

Clustering of cardiovascular risk factors and hypertension control status among hypertensive patients in the outpatient setting / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the status of the clustering of cardiovascular risk factors and hypertension control among hypertensive patients in the outpatient setting in China.</p><p><b>METHODS</b>This multi-center cross-sectional study was carried out from June to December 2009. Study patients were consecutively recruited from 46 hypertension outpatient clinics in 22 provinces, autonomous regions, and municipalities of China according to identical inclusion criteria. More than 100 consecutive patients should be recruited in each outpatient clinic, and 5206 hypertensive outpatients were included. The patients were examined by questionnaires, physical examinations, and biochemical analyses. Risk factors were defined according to the 2010 Chinese guidelines for the management of hypertension.</p><p><b>RESULTS</b>In this patient cohort, dyslipidemia was found in 61.5% (3203/5206), obesity in 56.0% (2917/5206), and impaired glucose regulation in 27.8% (1449/5206) patients. The prevalence of smoking was 34.9% (910/2605) in male hypertensive patients, 88.9% (4630/5206) hypertensive patients had at least one of the above-mentioned four risk factors and 17.4% (906/5206) had three or more risk factors. Only 4.1% (211/5206) hypertensive outpatients were classified as low cardiovascular risk patients, 72.5% (3774/5206) hypertensive outpatients were classified as high or very high cardiovascular risk patients. The general blood pressure control rate was 44.3% (2304/5206), which was higher in the age group of ≥ 65 years than in those of 35-44 years [51.3% (818/1596) vs. 29.6% (160/541), P < 0.01], higher in low-risk patients than in high-risk patients [65.4% (138/211)vs. 41.9% (1581/3774), P < 0.01] and higher in patients under regular therapy ( ≥ 9 months per year) than in those of irregular therapy (< 6 months per year) [50.7% (1744/3442)vs. 30.0% (391/1305), P < 0.01].</p><p><b>CONCLUSION</b>Clustering of cardiovascular risk factors, especially dyslipidemia and obesity, is common, and cardiovascular risk is high while blood pressure control rate is low among hypertensive outpatients in China.</p>

Association between both triglyceride level, newly identified carotid plaque and middle-aged and elderly population, Beijing / 中华流行病学杂志

Objective To evaluate the association between triglyceride(TG) level and newly identified 5-year carotid plaque and to explore the prediction value of TG level on the newlyidentified carotid plaque with risk factors of traditional atherosclerosis.Methods A cohort study was adopted.The baseline survey including CVD risk factors and B-mode ultrasound of carotid artery was performed in 2002,and the second follow-up examination was performed in 2007.We evaluated 1949participants with lipid measurements and B-mode ultrasound of carotid arteries in the two surveys (with mean age as 57.9 ± 8.1 years and 39.2％ were men).The baseline TG levels were divided into four groups:group 1 (TG＜1.13 mmol/L),group 2 (TG=1.13-1.69 mmol/L),group 3 (TG=1.70-2.25 mmol/L) and group 4 (TG≥2.26 mmol/L).Newly identified carotid plaque was regarded as the indicator of progression of carotid atherosclerosis.New relationship between fasting TG levels and newly identified carotid plaque was analysed.Results Compared to newly identified carotid plaque which including different TG level groups,the incidence of newly artery plaque had significantly increased along with the increase of baseline triglyceride level (30.8％,38.8％,41.9％and 44.2％ respectively,with x2=21.22,P＜0.01 ).Compared to individuals (TG＜ 1.13 mmol/L),TG seemed a risk factor of plaque progression (P＜0.01).After adjusted for age,sex,dyslipidemia and other risk factors,high TG group (TG ≥2.26 mmol/L) appeared a significant independent predictor of newly identified carotid plaque (OR=1.37,95％ CI:1.00-1.86).When further stratifying the traditional atherosclerosis risk factors,we found that high TG group with smoking or hypertension was an independent factor of atherosclerosis progression.Conclusion With the increase of triglyceride levels,the rate of newly identified carotid plaque also increased.After adjusting age,sex,dyslipidemia and other risk factors,serum fasting TG ≥2.26 mmol/L appeared to be an independent predictor of newly developed carotid plaque.

Association between glucose level and carotid plaque among 50-79 year olds from the communities / 中华流行病学杂志

Objective To investigate the association between fasting blood glucose levels and the prevalence of carotid plaque in a community-based population of Beijing and to further explore the association between fasting glucose levels concomitant wand other cardiovascular risk factors as well as the prevalence of carotid plaque.Methods This study was a part of the Chinese Multi-provincial Cohort Study conducted in the communities of Beijing University in 2007.All the members aged 50-79 years from the community were recruited,with 1046 of them qualified as without missing data.Case of diabetes was defined if the fasting glucose level was greater than 7.0 mmol/L or on antidiabetic drugs.Results The mean level of fasting glucose was 5.89 mmol/L,and the prevalence of carotid plaque was 56.3％.For the reference on normal levels of fasting glucose,the risk on carotid plaque had an increase along with the increase of fasting glucose levels only under the univariate and multivariate analyses,after adjusting for age.However,the risk on carotid plaque in women was increased when there was an increase on the levels of fasting glucose.Specifically,for the reference on normal levels of fasting glucose,after adjusting for other cardiovascular risk factors,the odds of developing a carotid plaque was more than two folds in diabetic women.When combining the groups of risk factors (normal and abnormal) among the three groups of fasting glucose and assigning the normal level of risk factors concomitant with normal fasting glucose as a reference for both genders,the risk of developing a carotid plaque in diabetic women with abnormal level of risk factors ranked the highest,with statistical significance.When the diabetic patients combined with a decreased levels of HDL but increased levels of LDL,blood pressure,waist circumference,there appeared 2.8- (P=0.014),2.7- (P=0.010),2.4- (P=0.013) and 2.1-times (P=0.031) higher risks of developing carotid plaque than those in the reference group,respectively.Conclusion In this study,the prevalence of carotid plaque driven by increased fasting glucose was different on gender but the difference was only statistically significant in women.There also appeared a joint association of fasting glucose combined with other cardiovascular risk factors on the risk of developing a carotid plaque.

Hospitalization rates for coronary heart disease from 2007 to 2009 in Beijing / 中华心血管病杂志

<p><b>OBJECTIVE</b>To examine the distribution and trends of hospitalization rates for coronary heart disease (CHD) from 2007 to 2009 in Beijing.</p><p><b>METHODS</b>We calculated hospitalization rates for CHD using data from Beijing Hospital Discharge Information System. Information of census registered population in Beijing was obtained from Beijing Municipal Bureau of Statistics. CHD includes acute myocardial infarction, unstable angina and other forms of CHD. Age-standardized hospitalization rates for CHD per 100 000 population aged 25 years or more were calculated.</p><p><b>RESULTS</b>During 2007 - 2009, a total of 248 049 patients aged 25 years or more hospitalized in Beijing with the primary discharge diagnosis of CHD were enrolled, of whom 73.7% were permanent registered Beijing citizens. The average hospitalization rate for CHD in 2007 - 2009 was 651.2/100 000 for the permanent residences in Beijing (741.2/100 000 in men, 560.9/100 000 in women). The highest average hospitalization rate (671.9/100 000) was seen in exurban area compared to other areas in Beijing. The average hospitalization rate for acute myocardial infarction, unstable angina, and other CHD was 126.4/100 000, 226.4/100 000 and 298.4/100 000, respectively. The hospitalization rate for CHD increased 18.1% from 2007 to 2009 (from 598.1/100 000 to 706.5/100 000). The same trend was seen in women (20.2%) and men (16.6%). The hospitalization rates of CHD in the urban, suburban, and exurban areas of Beijing all increased in the three years, and the greatest increase (36.6%) was found in exurban area. Hospitalization rates of acute myocardial infarction and unstable angina increased 24.5% and 55.3%, respectively, in the three years, while hospitalization rates of other CHD decreased 5.7%.</p><p><b>CONCLUSIONS</b>The hospitalization rate of CHD is higher in men than in women in Beijing. The hospitalization rates for CHD increased from the observation period, especially in those living in exurban area. Awareness of the magnitudes and trends of CHD hospitalization rates is of great importance in evaluating the burden of cardiovascular disease, allocating and utilizing health care resources, and estimating the health insurance for Beijing.</p>

Surveillance on the incidence of acute coronary events in the permanent residents of Beijing aged 25 years and more from 2007 to 2009 / 中华心血管病杂志

<p><b>OBJECTIVE</b>To survey the incidence of acute coronary events and its trend in three years, and explore the distribution of the incidence across Beijing residents aged 25 years and more from 2007 to 2009.</p><p><b>METHODS</b>The present study incorporated and linked the routinely collected data from the Hospital Discharge Information System and Cause of Death Register System in Beijing, estimated the incidence of acute coronary events, and analyzed the distribution of the incidence across gender, age groups and regions. Acute coronary event was defined as non-fatal myocardial infarction and death from coronary heart disease. Numbers of residents by age, gender and area were obtained from the Beijing Statistics Bureau.</p><p><b>RESULTS</b>A total of 68 390 acute coronary events were identified among permanent residents of Beijing aged 25 years and more from 2007 to 2009. The age-standardized incidence was 166.4 per 100 000 people in overall population, with 218.5 in males and 115.2 in females. The age-standardized incidence was 144.3, 154.7, and 195.8 per 100 000 people in urban, suburban, and exurban area, respectively. The incidence was the highest in Huairou district (263.8 per 100 000), while was the lowest in Haidian district (121.5 per 100 000). The age-standardized incidence was 158.4, 169.4, and 171.2 per 100 000 in 2007, 2008, and 2009, respectively. The age-standardized incidence increased by 8.1% in 2009 compared to 2007, increase in men (11.1%) was greater than in women (2.5%). The incidence increased significantly with age in each year. The incidence raised by 30.3% in 2009 compared to 2007 for men aged 35 - 44 years. In 2009, the incidence was 146.7, 155.9, and 207.4 per 100 000 people in urban, suburban, and exurban area, respectively. The rates increased by 3.2% in both urban and suburban areas, and 16.4% in exurban areas in 2009 compared to 2007.</p><p><b>CONCLUSION</b>The incidence of acute coronary events increased from 2007 to 2009 among the permanent residents of Beijing aged 25 years and over, especially in young men, and people living in the exurban areas.</p>

Association between high sensitivity C-reactive protein levels in serum and the 5-year-accumulative-risk of diabetes / 中华流行病学杂志

Objective To analyze the association between hs-CRP(high-sensitivity C-reactive protein) levels in serum and the 5-year-accumulative-risk of diabetes in a general population.Methods Participants were from the cohort of Peking University residential community in the Chinese Multi- provincial Cohort Study(CMCS). Two surveys on cardiovascular risk factors and the measurements of serum hs-CRP levels were conducted in 2002 and 2007, respectively. Individuals with incomplete information and those having infectious diseases at baseline were excluded. A total of 1045 participants aged 45 to 74 years and free of diabetes at baseline were included in this analysis.Results The age-standardized 5-year accumulative incidence rate of diabetes was 8.8% (male:9.8%, female: 8.2% ) and increased significantly with the level of hs-CRP in both women and men (P＜0.01). After adjustment for age, hypertension, low-density liproprotein cholesterol, and high-density liproprotein cholesterol, triglycerides, fasting glucose, smoking status and central obesity,people with hs-CRP≥3 mg/L had a 3.30 times higher risk of developing diabetes in men and 2.58 times for women when compared to those with hs-CRP＜1 mg/L. The areas under the receiver operating characteristic curves of baseline hs-CRP level in predicting the incidence of diabetes were 0.619(95%CI:0.536-0.701 ) in men and 0.667(95%CI:0.585-0.749) in women. Conclusion Serum hs-CRP levels could predict the incidence of diabetes, indicating that inflammation might have great importance in the onset of diabetes.

Distribution characteristics and risk factors of carotid atherosclerosis in middle-aged and elderly Chinese / 中华心血管病杂志

<p><b>OBJECTIVE</b>To describe the distribution characteristics of carotid atherosclerosis and to analyze its association with cardiovascular risk factors in middle-aged and elderly Chinese.</p><p><b>METHODS</b>In 2007, the second cross-sectional examination for cardiovascular risk factors and B-mode ultrasound imaging on carotid arteries were performed in a Chinese population consisting of 2681 subjects aged 43-81 years old from two cohorts participants of the People's Republic of China/United States of America collaborative study (USA-PRC study) and the Chinese multi-provincial cohort study (CMCS). The association of cardiovascular risk factors with intima-media thickening (ITM) and plaque of carotid arteries was analyzed.</p><p><b>RESULTS</b>(1) The mean intima-media thickening (Mean-IMT) of carotid artery was 0.68 mm, the maximal intima-media thickening (Max-IMT) was 1.07 mm. (2) The prevalence rate of carotid plaque was 60.3% in all subjects. As for the different sites of carotid arteries, the plaque prevalence rate at carotid bulb was 61.2% for male and 51.6% for female (chi2 = 23.44, P < 0.01), and at the internal carotid artery was 24.7% for male and 12.2% for female (chi2 = 69.57, P < 0.01), at the common carotid artery was 20.9% for male and 13.8% for female (chi2 = 23.18, P < 0.01). (3) After adjusting for age and other cardiovascular risk factors, the Mean-IMT and Max-IMT increased with elevated levels of systolic blood pressure, plasma glucose and low density lipoproteins cholesterol (LDL-C) (all P < 0.05). Hypertension, diabetes, smoking and high LDL-C (P < 0.05) were independent predict factors for the risk of carotid plaque.</p><p><b>CONCLUSION</b>The carotid atherosclerosis was common in middle and older age Chinese and was positively associated with classical cardiovascular disease risk factors.</p>

Association between the risk factors of cardiovascular diseases and Insulin resistance / 中华流行病学杂志

Objective To explore the association between risk factors of cardiovascular diseases (CVD) and insulin resistance in a cross-sectional study.Methods An investigation on risk factors of CVD was carried out using stratified-random sampling method among 1475 participants in Beijing.Homeostasis model assessment index(HOMA) was calculated to assess the insulin resistance in 1359 non-diabetic subjects aged 25-64 years.Insulin resistance was defined as HOMA index (fasting glucose in mmol/L×fasting insulin in mU/L/22.5) in the top quartile of the studied population.Results The degree of correlation between risk factors and natural logarithm of HOMA index in descending order were glucose,body mass index (BMI),triglyceride ( TG ),waist circumstance,high density lipoprotein- cholesterol (HDL-C),uric acid,diastolic blood pressure,systolic blood pressure and total cholesterol(TC) (all P＜0.01 ).After adjusting factors as sex and age,glucose (r=0.49),BMI(r=0.44),TG (r=0.44),waist circumstance (r=0.41),uric acid (r=0.33) and HDL-C (r=-0.32),the systolic blood pressure (r=0.20),diastolic blood pressure (r=0.18) and TC (r=0.16) were independently correlated with HOMA index (P＜0.001).Sex(OR=1.75) ,low HDL-C(OR= 1.80),hyperuricemia(OR=2.11 ),high TG(OR=2.14) and central obesity(OR=2.68)appeared to be independently correlated to insulin resistance in multiple logistic regression analysis.Conclusion The risk factors of CVD as low HDL-C,high TG,central obesity and hyperuricemia were independently correlated to insulin resistance.

Relationship between serum non-high-density lipoprotein cholesterol and incidence of cardiovascular disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between serum non-HDL-C and incidence of various cardiovascular disease (CVD) in Chinese population aged 35-64 years.</p><p><b>METHODS</b>This prospective study was performed from 1992 to 2004 in 11 provinces of China and the association between baseline non-HDL-C level with the risk of various CVD events was analyzed in 29 937 subjects aged 35-64 years using Cox multivariate proportional hazards regression. CVD events in this study including acute coronary events (ACE), ischemic stroke, hemorrhagic stroke and ischemic cardiovascular disease (ICVD).</p><p><b>RESULTS</b>(1) Adjusted for age, gender, smoking status, diabetes, body mass index and blood pressure, the relative risk of ACE, ischemic stroke and ICVD in groups of non-HDL-C 3.37 - 4.13 mmol/L (130 - 159 mg/dl), 4.14 - 4.91 mmol/L (160 - 189 mg/dl) and ≥ 4.92 mmol/L (190 mg/dl) was 1.24 (0.91 - 1.70), 1.78 (1.25 - 2.53), 2.23 (1.48 - 3.35); 1.34 (1.07 - 1.68), 1.38 (1.04 - 1.83), 1.38 (0.97 - 1.94) and 1.37 (1.12 - 1.63), 1.52 (1.22 - 1.90), 1.70 (1.30 - 2.22), respectively. The risk of hemorrhagic stroke was declined obviously in group > 4.92 mmol/L (190 mg/dl). (2) The correlation between VLDL-C and ACE was the strongest in four CVD events when VLDL-C and LDL-C were joint analyzed, ICVD events ranked the second. The risk for ischemic stroke also borderline increased with increasing VLDL-C and LDL-C (P > 0.05).</p><p><b>CONCLUSION</b>Increased non-HDL-C is associated with increased risk of suffering ACE, ischemic stroke and ICVD and VLDL-C plays a critical role in the development of ICVD events, especially ACS, in middle aged Chinese population.</p>

Prediction value of blood lipid levels on newly identified carotid plaque in middle-aged and elderly Chinese population / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the prediction value of blood lipid levels on the newly-identified carotid plaque in middle-aged and elderly Chinese population.</p><p><b>METHODS</b>All study subjects were recruited from two cohorts from 2002 to 2007 [the People's Republic of China/United States of America collaborative study (USA-PRC study) and the Chinese multi-provincial cohort study (CMCS)]. The baseline examination including cardiovascular disease risk factors and B-mode ultrasound of carotid artery was performed in 2002 and the second examination was made in September to October, 2007. The relationship between baseline lipids and carotid plaque incidence was analyzed in a total of 2000 subjects aged 47 to 79 years (mean 63 years).</p><p><b>RESULTS</b>(1) During these 5 years, the prevalence of carotid plaque increased from 30.3% to 62.2% and from 21.5% to 51.5% for men and women, respectively. The newly-identified carotid plaque incidence was 41.8% for men and 34.1% for women. (2) The incidence of artery plaque significantly increased in both sexes in proportion to increase of baseline total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and total to high-density cholesterol ratio (TC/HDL-C) levels (P < 0.05 or P < 0.01). (3) Cross-stratification analysis of LDL-C, triglyceride (TG) and HDL-C for carotid plaque incidence indicated the existence of conjoint effects between LDL-C and HDL-C, LDL and TG, as well as between TG and HDL-C, on the increased incidence of carotid plaque. (4) Multi-factorial analysis showed that higher LDL-C, non-HDL-C and TC/HDL-C were independent risk factors for development of new carotid plaque [OR = 1.44 (95%CI = 1.07 - 1.94), OR = 1.45 (95% CI = 1.08 - 1.96), OR = 1.59(95% CI = 1.14 - 2.23) in men;OR = 1.47 (95% CI = 1.13 - 1.92), OR = 1.35 (95% CI = 1.04 - 1.75), OR = 1.64 (95% CI = 1.20 - 2.23) in women].</p><p><b>CONCLUSIONS</b>The prevalence of carotid plaque increased rapidly in this cohort between 2002 and 2007. Elevated LDL-C, non-HDL-C and TC/HDL-C levels were independent predictors of newly developed carotid plaque.</p>

Real world use of statins for secondary prevention in patients with high risk coronary heart disease in China / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the real world statins use for secondary prevention in patients with high risk coronary heart disease (CHD) in China.</p><p><b>METHODS</b>Sixty-four hospitals across 31 provinces of China including 32 secondary hospitals and 32 tertiary hospitals were selected for baseline survey. Fifty consecutive outpatients with established history of acute coronary syndrome were recruited in each hospital. Information of these patients including statins use was collected.</p><p><b>RESULTS</b>A total of 2516 high risk CHD outpatients were involved in present report. Mean age of the patients was (65 ± 10) years and 69.4% patients were male. Fifty-seven point nine percent patients were treated with a statin at the time of interview and recommended low-density lipoprotein-cholesterol (LDL-C) target was achieved in 29.8% patients. Percent of statin use and achieving LDL-C goal was significantly higher in male outpatients than in female outpatients. Outpatients admitted in tertiary hospitals were more likely to have achieved their LDL-C targets than those admitted in secondary hospitals. Statin use was more often for patients in South China than patients in North China. The percentage reaching the optimal LDL-C treatment target was the highest in Central China (38.5%) and the lowest in Northeast China (18.5%). At this interview, 68.2% outpatients were prescribed statins and 24.1% prescribed doses of statins were sub-minimal.</p><p><b>CONCLUSION</b>There was a gap between real world statin use and guideline recommendations for secondary prevention in high risk CHD patients in China.</p>

Prevalence, awareness, and treatment of hypercholesterolemia among inpatients with acute coronary syndrome in China / 中华心血管病杂志

<p><b>OBJECTIVE</b>To estimate the current prevalence, awareness and treatment status of hypercholesterolemia among inpatients with acute coronary syndrome (ACS) in China.</p><p><b>METHODS</b>Sixty-four hospitals across China, including 32 secondary hospitals and 32 tertiary hospitals were selected for baseline survey. Fifty inpatients diagnosed with ACS were recruited consecutively in each participated hospitals. Retrospective information for 2751 patients were collected, and the prevalence, awareness, and treatment status of hypercholesterolemia among the patients were analyzed.</p><p><b>RESULTS</b>(1) Mean age of the patients was 65 +/- 11. Sixty-nine percent of the patients were males and 31.2% were females. Among them, 39.4% were diagnosed as ST-segment elevation MI, 8.8% as non-ST-segment elevation MI and 51.8% as unstable angina. Twenty-seven percent of them had previous ACS history. (2) Hypercholesterolemia was found in 19.6% ACS patients. Among 7 geographic districts (north China, east China, south China, middle China, northeast, northwest and southwest), the prevalence rate of hypercholesterolemia was highest (24.7%) in east China and lowest (10.0%) in middle China. Significant difference was observed among these areas. (3) Awareness rate of hypercholesterolemia was 12.2% among patients with hypercholesterolemia, with significant difference among various areas. Treatment rate was 66.7% among patients with known hypercholesterolemia, with the highest (83.3%) seen in south China and lowest (0%) in southwest area. (4) The prevalence, awareness rate and treatment rate of hypercholesterolemia were higher in recurrent ACS patients than in those without ACS history.</p><p><b>CONCLUSIONS</b>Nearly 20% ACS inpatients have hypercholesterolemia.It is essential to pay more attention on the treatment of hypercholesterolemia for the purpose of secondary prevention of cardiovascular disease.</p>