Influence of Renal Sympathetic Denervation in Patients with Early-Stage Heart Failure Versus Late-Stage Heart Failure.

Renal sympathetic denervation (RDN) is currently being investigated in multiple studies of heart failure (HF). Our aim was to assess the safety and effectiveness of RDN in patients with HF, and determine which patients could achieve more beneficial effects of RDN. A total of 17 consecutive patients with HF were enrolled in the study. Clinical symptoms, office blood pressure, and laboratory results were obtained and echocardiography was performed before and 12 months after RDN. Changes from baseline to 12 months were analyzed for all patients and for two subgroups based on HF duration (group 1: HF duration ≤ 3 years, n = 9; group 2: HF duration > 3 years, n = 8). The RDN procedure was successful in all patients and no procedure-related complications were documented. In comparison to baseline, there was a significant increase in left ventricular ejection fraction (LVEF) in all patients and group 1 (P < 0.05 for both), which did not happen in group 2. LAD, LVDs, and RVD also showed a significant reduction in group 1 (P < 0.05 for both). At 12 months, the reductions in TNF-α and CRP were significant for all patients and for patients in group 1 separately. No obvious changes in echocardiographic parameters, 6-minute walking distance, TNF-α, or CRP were recorded in group 2. No changes in BNP in either group were observed at the 12th month of follow-up. RDN could improve cardiac function and led to a significant drop in inflammatory markers in patients with HF. We also found that patients in early-stage HF could benefit more from RDN.

Renal sympathetic denervation improves rate control in patients with symptomatic persistent atrial fibrillation and hypertension.

AIM: The aim of this study was to investigate whether renal sympathetic denervation (RSD) improves ventricular heart rate (HR) control in patients with persistent atrial fibrillation (AF). METHODS AND RESULTS: Twenty-one patients (aged 57.5 ± 10.2 years, 76.2% male) with persistent AF and hypertension underwent RSD and completed 7-days follow-up evaluations, including 24-hour Holter monitoring (Holter), blood pressure (BP), 24-hour ambulatory BP monitoring (ABPM). Patients were grouped into tertiles of average HR at baseline Holter recording for evaluation of RSD effects on atrioventricular (AV) node (group 1: HR ≧ 90 bpm; group 2: 80 bpm ≦ HR < 90 bpm; group 3: HR < 80 bpm). RESULTS: All patients successfully underwent RSD without any complications. The clinical and procedural characteristics were similar in all groups of patients. No significant changes in BP were observed in the three groups before and after RSD. Compared with baseline, the average HR (Holter) of patients in group 1, 2 and 3 had a reduction of 22.6 ± 13.2 bpm (83.3 ± 4.9 vs 106.0 ± 14.6, P = 0.004), 9.7 ± 7.8 bpm (75.7 ± 7.6 vs 85.4 ± 3.7, P = 0.017) and 2.3 ± 2.9 bpm (71.4 ± 4.0 vs 73.7 ± 4.7, P = 0.089) at 7 days after RSD, respectively. CONCLUSIONS: RSD could improve ventricular HR control in patients with persistent AF. RSD slowed AV node conduction in baseline HR-dependent manner. RSD may become an alternative non-pharmaceutical tool for rate control in patients with persistent AF.

Level of proinsulin in association with cardiovascular risk factors and sleep snoring.

AIM: To explore the relationship between the level of proinsulin with cardiovascular risk factors and sleep snoring. METHODS: Based on the random stratified sampling principle, 1 193 Chinese residents in Pizhou City, Jiangsu Province (530 males and 663 females, aged 35-59 years with an average age of 46.69 years) were recruited. Their sleep snoring habits were investigated. Biotin-avidin based double mAbs ELISA was used to detect specific insulin and proinsulin, and a risk factor score was established to evaluate the individuals according to the number of their risk factors. RESULTS: The results of Spearman correlation analysis and covariate ANOVA analysis after age and sex were controlled, indicated that not only the level of proinsulin (r = 0.156, P = 0.000, F = 5.980 P = 0.000), but also cardiovascular risk factors score (r = 0.194, P = 0.000, F = 11.135, P = 0.000) significantly associated with the frequency of sleep snoring, and the significant relationship between true insulin and frequency of sleep snoring was only shown in the covariate ANOVA analysis (F = 2.868, P = 0.022). The result of multivariate stepwise logistic regression after age, sex, body mass index, waist circumference and true insulin were controlled showed that proinsulin (division by interval of quartile) was an independent risk factor for sleep snoring (OR = 1.220, 95%CI: 1.085-1.373, P = 0.001). CONCLUSION: The interaction of cardiovascular risk factors clustering, high proinsulin level and sleep breathing disorder may be a syndrome, which has not been recognized in human beings so far.

Significant association of insulin and proinsulin with clustering of cardiovascular risk factors.

AIM: To investigate the association between true insulin and proinsulin and clustering of cardiovascular risk factors. METHODS: Based on the random stratified sampling principles, 1196 Chinese people (533 males and 663 females, aged 35-59 years with an average age of 46.69 years) were recruited. Biotin-avidin based double monoclonal antibody ELISA method was used to detect the true insulin and proinsulin, and a risk factor score was set to evaluate individuals according to the number of risk factors. RESULTS: The median (quartile range) of true insulin and proinsulin was 4.91 mIu/L (3.01-7.09 mIu/L) and 3.49 pmol/L (2.14-5.68 pmol/L) respectively, and the true insulin level of female subjects was significantly higher than that of male subjects (P = 0.000), but the level of proinsulin displayed no significant difference between males and females (P = 0.566). The results of covariate ANOVA after age and sex were controlled showed that subjects with any of the risk factors had a significantly higher true insulin level (P = 0.002 for hypercholesterolemia, P = 0.021 for high low-density lipoprotein cholesterol, P = 0.003 for low high-density lipoprotein cholesterol, and P = 0.000 for other risk factors) and proinsulin level (P = 0.001 for low high-density lipoprotein cholesterol, and P = 0.000 for other risk factors) than those with no risk factors. Furthermore, subjects with higher risk factor scores had a higher true insulin and proinsulin level than those with lower risk factor scores (P = 0.000). The multiple linear regression models showed that true insulin and proinsulin were significantly related to cardiovascular risk factor scores respectively (P = 0.000). CONCLUSION: True insulin and proinsulin are significantly associated with the clustering of cardiovascular risk factors.

[Relationship between insulin resistance and cardiovascular risk factors clustering: an epidemiological study].

OBJECTIVE: To study the relationship between insulin resistance and cardiovascular risk factor clustering. METHODS: The height, body weight, waist circumference, and hip circumference were measured, and fasting venous blood was drawn among 1 196 rural residents, 533 males (44.57%) and 663 females (55.43%), aged 35 approximately 59 with the average age of 46.69, in Pizhou City, Jiangsu Province, selected by random sampling. Fasting serum true insulin (TI) was determined by ELISA. Blood lipids were measured by completely automatic biochemical analyzer. Homeostasis model assessment (HOMA) index was calculated and used as the indicator to evaluate insulin resistance. The statistic methods, such as Spearman correlation, partial correlation and multivariate Logistic regression were used to study the relationship between insulin resistance and hypertension, overweight, visceral obesity, dyslipidemia and cardiovascular risk factors clustering. RESULTS: The median (Q(R)) of TI and HOMA index were 4.89 (3.02 approximately 7.09) mIU/L and 0.98 (0.57 approximately 1.44) respectively, and TI and HOMA index of the female subjects were significantly higher than those of the male subjects (P < 0.01). The correlation coefficient between HOMA index and cardiovascular risk factors number was 0.290 (P < 0.01) by Spearman correlation analysis and 0.177 6 (P < 0.01) by partial correlation analysis after adjustment by age, sex, body mass index and waist circumference respectively. The results of non-conditional multivariate stepwise Logistic regression indicated that insulin resistance associated with cardiovascular risk factors aggregation and was independent of age, sex, body mass index and waist circumference, and the odds ratio (95% CI) was 1.250 (1.089 approximately 1.434). CONCLUSION: Insulin resistance may be a common pathogenetic mechanism of cardiovascular risk factor dustering.

General and central obesity, combined oral contraceptive use and hypertension in Chinese women.

BACKGROUND: Asians have different body fat distributions and disease characteristics compared with Caucasians. The purpose of this study was to evaluate general and central obesity, combined oral contraceptive (COC) use, and their joint effects on the risk of hypertension in Chinese women. METHODS: A case-control study including 1,760 women (878 hypertensive cases and 882 normotensive controls) was conducted in China. Body weight, height, waist circumference (WC), blood pressure, serum lipids, and apolipoproteins were measured. History of contraceptive use and relevant factors were investigated. Odds ratio (OR) with 95% confidence interval (CI) was estimated for hypertension-related factors under unconditional logistic regression model. RESULTS: Our study showed that increased body mass index (BMI), increased WC, and COC use were risk factors for hypertension with an OR (95% CI) of 2.19 (1.69-2.83), 1.46 (1.13-1.88), and 1.26 (1.02-1.56), respectively. Compared with WC, BMI was more strongly associated with hypertension risk (OR 3.40, 95% CI 2.28-5.05, for highest vs. lowest quartile) and was a better predictor for blood pressure. COC users had a 1.39-fold (OR 1.39, 95% CI 1.14-1.69) increased risk compared with the nonusers, while stopping COC was associated with a 36% reduced risk (OR 0.64, 95% CI 0.42-0.98). The risk increased dramatically in combination of COC use with a BMI ≥28 kg/m(2) or WC ≥90 cm (OR 8.02, 95% CI 5.05-12.74; OR 5.76, 95% CI 3.65-9.12, respectively). CONCLUSIONS: General and central obesity, COC use, and their joint effects significantly increased the risk of hypertension in Chinese women.