Nutrient deficiency patterns and all-cause and cardiovascular mortality in older adults with hypertension: a latent class analysis.

BACKGROUND: Previous researches examining the impact of dietary nutrition on mortality risk have mainly focused on individual nutrients, however the interaction of these nutrients has not been considered. The purpose of this study was to identify of nutrient deficiencies patterns and analyze their potential impact on mortality risk in older adults with hypertension. METHODS: We included participants from the National Health and Nutrition Examination Survey (NHANES) study. The latent class analysis (LCA) was applied to uncover specific malnutrition profiles within the sample. Risk of the end points across the phenogroups was compared using Kaplan-Meier analysis and Cox proportional hazard regression model. Multinomial logistic regression was used to determine the influencing factors of specific malnutrition profiles. RESULTS: A total of 6924 participants aged 60 years or older with hypertension from NHANES 2003-2014 was followed until December 31, 2019 with a median follow-up of 8.7 years. Various nutrients included vitamin A, vitamin B1, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K, fiber, folate, calcium, magnesium, zinc, copper, iron, and selenium, and LCA revealed 4 classes of malnutrition. Regarding all-cause mortality, "Nutrient Deprived" group showed the strongest hazard ratio (1.42 from 1.19 to 1.70) compared with "Adequate Nutrient" group, followed by "Inadequate Nutrient" group (1.29 from 1.10 to 1.50), and "Low Fiber, Magnesium, and Vit E" group (1.17 from 1.02 to 1.35). For cardiovascular mortality, "Nutrient Deprived" group showed the strongest hazard ratio (1.61 from 1.19 to 2.16) compared with "Adequate Nutrient" group, followed by "Low Fiber, Magnesium, and Vit E" group (1.51 from 1.04 to 2.20), and "Inadequate Nutrient" group (1.37 from 1.03 to 1.83). CONCLUSIONS: The study revealed a significant association between nutrients deficiency patterns and the risk of all-cause and cardiovascular mortality in older adults with hypertension. The findings suggested that nutrients deficiency pattern may be an important risk factor for mortality in older adults with hypertension.

Association between serum uric acid levels and coronary artery disease in different age and gender: a cross-sectional study.

BACKGROUND: The association between uric acid (UA) and coronary artery disease (CAD) was controversial. It was still unclear how the UA level changes with age and gender. AIMS: To confirm the relationship between the change of UA with age and gender and CAD, especially in elderly people. METHODS: 8285 individuals were investigated. The changes of UA and hyperuricemia in female and male with age were analyzed. The associations of UA, and hyperuricemia with CAD in different age and sex were assessed. RESULTS: Individuals were stratified into four groups according to their age: ≤ 39 years; 40-59 years; 60-79 years, and ≥ 80 years. The level of UA and the proportion of hyperuricemia increased significantly with age in female (P < 0.001), but showed a downward trend in male (P < 0.001). After adjusting for confounding factors, hyperuricemia remained an independent risk factor for the incident of CAD in all women (P = 0.029). In ≥ 80 year groups of female, UA and hyperuricemia became independent risk factors for the incident of CAD in the univariate and multivariate logistic regression analyses (all P ≤ 0.001). DISCUSSION: The level of UA showed significantly different changes with age in different gender. The relationship between UA and CAD showed differences in different age and sex. CONCLUSIONS: There were significant correlations between UA, hyperuricemia, and CAD only in female, particularly in the ≥ 80 year elderly women, but not in men.

MicroRNA-21 mediates high phosphate-induced endothelial cell apoptosis.

Hyperphosphatemia, the elevated level of inorganic phosphate (Pi) in serum, is associated with increased cardiovascular morbidities and mortality. The effects of high Pi on endothelial cells are not well studied. This study investigated high Pi-induced endothelial cell apoptosis and the role of microRNA-21. Mouse myocardial endothelial cells (MEC) were cultured in normal (1 mM) and high (5 mM) Pi conditions. Apoptosis was detected by TUNEL staining and flow cytometry. MicroRNA profiles of MEC response to changes in Pi concentration were obtained using gene expression arrays. Expression levels of the microRNA-21 target genes, programmed cell death gene 4 ( PDCD4), poly(ADP-ribose) polymerase ( PARP), and phosphatase and tensin homolog ( PTEN), as well as NF-κB were measured by Western blotting and RT-PCR. MicroRNA-21-specific inhibitors and mimics were used to study effects of microRNA-21 on MEC apoptosis and gene expression regulations. High Pi induced MEC apoptosis and upregulated microRNA-21 expression. MicroRNA-21-specific mimics reproduced high Pi-induced apoptosis in normal Pi medium, and microRNA-21 inhibitors ameliorated the high Pi induction of apoptosis, suggesting that microRNA-21 mediated high Pi-induced MEC apoptosis. The microRNA-21 targets PDCD4, PTEN, PARP, and NF-κB were significantly downregulated in high Pi conditions. High Pi-induced downregulation of PDCD4 was abolished by microRNA-21 inhibitors and selective ERK inhibitor (selumetinib) and was reproduced by microRNA-21 mimics. Inhibitors and mimics of microRNA-21 did not have effects on high Pi-induced NF-κB downregulation. Selumetinib blocked high Pi-induced NF-κB downregulation. MicroRNA-21 mediates high Pi-induced endothelial cell apoptosis, which involves an ERK1/2/microRNA-21/PDCD4 pathway. High Pi-induced downregulation of NF-κB expression is mediated by an ERK1/2 signaling-dependent but microRNA-21-independent mechanism.

The protease inhibitor E64d improves ox-LDL-induced endothelial dysfunction in human aortic endothelial cells.

Oxidized low-density lipoprotein (ox-LDL)-induced endothelial dysfunction in human vascular endothelial cells contributes to the development of atherosclerosis. E64d, a cysteine protease inhibitor, blocks the elastolytic activity of cathepsin essential for vascular matrix remodeling and reduces neurovascular endothelial apoptosis. The objective of this study was to investigate the effects and the underling mechanisms of E64d on ox-LDL-induced endothelial dysfunction in human aortic endothelial cells (HAECs). HAECs were treated with various concentrations of ox-LDL (0-200 mg/L) for 24 h with or without E64d. The results showed that E64d attenuated ox-LDL-induced increase in soluble intercellular adhesion molecule-1 (sICAM-1) concentration and reduction in endothelial nitric oxide synthase (eNOS) expression, prevented ox-LDL-induced reduction in cell viability and migration ability of HAECs. E64d decreased the protein expression of cathepsin B (CTSB), Beclin 1, and microtubule-associated protein light chain 3 (LC3)-II, but not p62. LC3 puncta and autophagosome formation were also reduced by E64d in HAECs. Moreover, E64d decreased the production of MDA and increased the activity of SOD. The results showed that E64d ameliorated ox-LDL-induced endothelial dysfunction in HAECs.

Gender and Age Differences Associated With Prehospital Delay in Chinese Patients Presenting With ST-Elevation Myocardial Infarction.

BACKGROUND AND OBJECTIVES: A limited number of studies have examined the interaction between gender and age with regard to extent of prehospital delay. Our aim was to examine gender and age differences associated with prehospital delay in Chinese patients presenting with ST-elevation myocardial infarction (STEMI). METHODS: A total of consecutive 1429 records from patients presenting with STEMI were analyzed between June 1, 2009, and June 1, 2010. We compared hospital care data by gender and age for inpatients with acute STEMI presenting within 24 hours of symptom onset. RESULTS: The overall median duration of prehospital delay was 150 minutes (mean, 266 minutes). For patients 54 years or younger, 55 to 64 years old, and 75 years or older, women were more likely to experience longer delays compared with men (P < .05) even after controlling for medical history and risk factors. For male patients, compared with groups 54 years or younger, with the exception of men 55 to 64 years old, older male patients were more likely to have greater delays (P < .05) even after controlling for medical history and risk factors. However, after controlling for other variables, these gender and age differences in prehospital delay were no longer statistically significant. Among patients 65 to 74 years old, there were no gender differences in prehospital delay. Among female patients, there were no age differences in prehospital delay. CONCLUSIONS: Male elderly patients (aged ≥65 years) and women (aged ≤64 and ≥75 years) with STEMI were more likely to delay seeking timely medical care. These gender and age differences were explained by different education, stable income, medical insurance, typical chest pain, and cognition toward heart diseases.

Renal insufficiency was correlated with 2-year mortality for rural female patients with ST-segment elevation acute myocardial infarction after reperfusion therapy: a multicenter, prospective study.

BACKGROUND: Renal insufficiency (RI) following ST-segment elevation acute myocardial infarction (STEMI) is associated with a worse clinical prognosis. We investigated the impact of RI on long-term mortality in rural female patients with STEMI and evaluated prognostic factors. METHODS: A prospective cohort study of 436 consecutive rural female patients who were successfully treated with reperfusion therapy for STEMI between May 2009 and August 2011 in secondary care hospitals in Liaoning province northeastern China and followed up for 2 years. Patients were divided into three groups by estimated glomerular filtration rate (eGFR): Normal group, eGFR ≥90 mL/min/1.73 m(2) (n = 233). Moderate group, eGFR 60-90 mL/min/1.73 m(2) (n = 108). RI group, eGFR <60 mL/min/1.73 m(2) (n = 95). The primary outcome was 2-year mortality. RESULTS: During follow-up (mean 741 ± 118 days), the RI group had a significantly higher mortality than the other groups (24.21 % vs. 6.87 % and 10.19 %, p < 0.001). The RI group had significantly higher hospital mortality (7.37 % p = 0.045 vs. Normal group). RI increased the risk of hospital mortality (hazard ratio (HR) 1.832, 95 % CI 1.017-3.091, p = 0.033), and increased the risk of 2-year mortality (HR 3.872, 95 % CI 2.004-6.131, p < 0.001). Multivariate analysis showed eGFR <90 ml/min/1.73 m(2) and age ≥75 years as independent predictors of mortality at 2 years. In detail these were eGFR 60-90 ml/min/1.73 m(2) with HR 2.081, 95%CI 1.250-2.842, p < 0.001; eGFR <60 ml/min/1.73 m(2) with HR 3.872, 95%CI 2.004-6.131, p < 0.001; age ≥75 with HR 1.461, 95%CI 1.011-1.952, p = 0.024. CONCLUSIONS: RI had a powerful correlation with long-term mortality for rural female patients with STEMI after reperfusion therapy.

[Correlation between cystatin C and properties and features of coronary plague].

OBJECTIVE: To explore the correlation between cystatin C (Cys C) and properties and features of coronary plague using 256-slice coronary computed tomography angiography (CTA). METHODS: From January 2013 to October 2013, a total of 184 patients with suspected coronary artery disease undergoing CTA for coronary artery lesions were enrolled. Based on the results of cystatin C levels, they were divided into normal Cys C concentration group ( ≤ 0.95 mg/L) and high Cys C concentration group (>0.95 mg/L). Based on the results of CTA, they were divided into single-vessel, 2-vessel and 3-vessel groups according to the number of diseased coronary arteries. And they were divided into mild stenosis (<50%), moderate stenosis ( ≥ 50%, <75%) and severe stenosis ( ≥ 75%) groups according to the severity of coronary artery disease. The Hounsfield units were used to determine the soft, fibrous and calcified plaques for assessing the relationship between cystatin C levels and narrow severity score, pathological changes limits, plague properties. RESULTS: There were 95 with normal concentrations of Cys C and 89 with high concentrations of Cys C. A total of 1 112 plaques were detected and those with high concentrations of Cys C showed a higher proportion of non-calcified plaque (13.5% vs 8.8%, P < 0.01) compared with normal group. The proportion of those with 1-vessel disease was lower (22.5% vs 37.9%, P < 0.05) but 3-vessel disease higher (48.3% vs 33.7%, P < 0.05) than in normal group. Multiple Logistic regression analysis revealed that high Cys C was a significant risk factor for multi-vessel disease (OR = 17.483, 95%CI:2.218-143.627; P < 0.01). CONCLUSION: For patients with coronary artery lesions, a high level of Cys C may be associated with severity of coronary atherosclerosis and plaque instability.

[Prevalence, severity, characteristics and coronary calcified score of coronary artery plaques are different in women than men with suspected coronary artery disease].

OBJECTIVE: To validate the prevalence, severity, characteristics and coronary calcified score(CACS) of coronary artery plaques in women are different from men. METHODS: A total of 3 752 patients with suspected coronary artery disease in the First Affiliated Hospital of China Medical University were enrolled between September 2011 and December 2013. Patients with suspect CAD underwent 256-detecter coronary computed tomography (CCTA) and CACS measurement were enrolled. The differences of sex-associated coronary artery plaques were assessed. The univariable and multivariable Logistic regression were employ to assess the association female and male with coronary artery plaques. RESULTS: A total of 3 752 patients including 1 832 females and 1 920 males, the average age of the patients was (56 ± 11) years. Women were older and less smoker than men. The prevalences of any plaque, 2-,3-/LM disease and significant/severe stenosis significantly decreased in female than male (all P<0.01). The proportion of non-calcified plaques significantly higher and mixed plaque significantly lower in female than male (all P<0.01). the proportion of women were significantly lower than men in CACS>0 (all P<0.01). The similar tendency also happened in four age-matched female and male subgroups. After adjustment, female was the significant protective factor for significant and severe stenosis, 2- and 3-/LM vessel disease, calcified and mixed plaques, and CACS>100 (all P<0.01); female was the significant protective factor for non-calcified plaques in the univariate analysis (P<0.01). When the age ≥ 65, female became the significant risk factor for coronary artery plaques (all P<0.01). CONCLUSIONS: Women have less prevalence and extensive coronary artery plaques and lower CACS, the plaque characteristics in women is more frequently composed by non-calcified plaques than men, even after matched by age. With age, female change from a protective factor to a risk factor for coronary artery plaques.

[Clinical values of ST-segment changes in ST-segment elevated myocardial infarction patients within 24 hours post primary percutaneous coronary interventions].

OBJECTIVE: To explore the clinical values of ST-segment changes in ST-segment elevated myocardial infarction (STEMI) patients within 24 hours after primary percutaneous coronary intervention (PCI). METHODS: A total of 225 patients with STEMI underwent primary PCI were enrolled, the ST segment resolution 1 hour after PCI was calculated and the patients were divided into group A (n = 135, Sgr;STE resolved ≥ 50%) and group B (n = 90, Sgr;STE resolved < 50%). The patients in group B were further divided into group C (n = 56, Sgr;STE resolved ≥ 50%) and group D (n = 34, Sgr;STE resolved < 50%) according to the ST segment resolution at 24 hours after PCI. TIMI flow after PCI, in-hospital major adverse cardiac events (MACE) and cardiac function about 7 days post PCI were analyzed. RESULTS: Data between group A and group B were similar except the incidence of pre-PCI Killip ≥ II was significantly higher in group B than in group A (37.8% (34/90) vs. 17.0% (23/135), P < 0.05). Incidence of complicated diabetes (P < 0.05), pre-PCI Killip ≥ II (55.9% (19/34) vs. 26.8% (15/56), P < 0.05) and multivessel disease (70.6% (24/34) vs. 35.7% (20/56), P < 0.05) were significantly higher in group D than in group C. TIMI 3 and the opening time of IRA was similar between group A and group B and between group C and group D. The incidence of in-hospital MACE was significantly higher in group B than in group A (14.4% (13/90) vs. 3.0% (4/135), P < 0.05) which was similar between group C and group D. CONCLUSION: Early (1 hour) but not late (24 hours) ST resolution post PCI is related to a favorable clinical outcome in STEMI patients.

Influence of Cigarette Smoking on Burden and Characteristics of Coronary Artery Plaques in Chinese Men.

BACKGROUND: It is generally well-known that smoking has a substantial impact on general health, and cardiovascular health in particular. The purpose of this study was to analyze the effects of different smoking status on the burden and characteristics of coronary artery plaques in Chinese men. METHODS: Our study enrolled 1920 individuals with suspected coronary artery disease undergoing 256-detector-row computed tomography scan after clinical assessment. These study participants were stratified into three groups: never smoker, current smoker, and former smoker, according to their smoking status. Thereafter, the associations of different smoking status with the coronary artery plaques were assessed using both univariable and multivariable logistic regression. RESULTS: The prevalences of any plaque, significant stenosis and coronary artery calcium score (CACS) ≥ 10 were highest in the current smokers (all p < 0.05). The proportion of calcified plaques was the lowest and the prevalence of non-calcified plaques was the highest in current smokers (p = 0.004). The higher pack-years group had significantly elevated percentages of any plaque, significant stenosis, ≥ 2/LM vessel disease and CACS ≥ 10 than the lower pack-years group (all p < 0.001). The percent of calcified plaques was lower and the percent of non-calcified plaques was higher in the higher (> 20) pack-years group than in the lower pack-years group (≤ 20) (p = 0.024). Current smoking with higher pack-years was the independent risk factor for any plaque, significant stenosis, CACS ≥ 10, non-calcified and mixed plaques (all p < 0.05) after multivariate adjustments. CONCLUSIONS: The current smokers had the most serious burden of coronary artery plaques and the highest percentage of non-calcified plaques. Current smoking with higher pack-years was a significant risk factor for coronary artery plaque burden and non-calcified and mixed plaques. KEY WORDS: Chinese men; Cigarette smoking; Coronary artery calcium score; Coronary artery plaques; Non-calcified plaques.

ABCA1 rs4149313 polymorphism and susceptibility to coronary heart disease: a meta-analysis.

Many existing studies have demonstrated that common polymorphisms in the ABCA1 gene may play important roles in the development and progression of coronary heart disease (CHD), but individually published results are inconclusive. This meta-analysis aimed to derive a more precise estimation of the relationship between the ABCA1 rs4149313 polymorphism and CHD risk. We searched the CISCOM, CINAHL, Web of Science, PubMed, Google Scholar, EBSCO, Cochrane Library, and CBM databases from inception through 1 September 2013. Meta-analysis was performed using the STATA 12.0 software. Odds ratios (OR) and their 95% confidence intervals (CI) were estimated. Eleven case-control studies were included with a total of 5416 CHD patients and 20,897 healthy controls. Our meta-analysis results revealed that the ABCA1 rs4149313 polymorphism may be associated with an increased risk of CHD. Subgroup analysis by ethnicity suggested that there were significant associations between the ABCA1 rs4149313 polymorphism and an increased risk of CHD in Asian populations, but not in Caucasian populations (all P > 0.05). Meta-regression analyses showed that ethnicity may be a main source of heterogeneity. The present meta-analysis suggests that the ABCA1 rs4149313 polymorphism may contribute to the risk of CHD, especially in Asian populations.

Effect of intracoronary nitroprusside in preventing no reflow phenomenon during primary percutaneous coronary intervention: a meta-analysis.

BACKGROUND: Adjunctive therapy with intracoronary nitroprusside (NTP) in primary percutaneous coronary intervention (PPCI) had controversial benefits in patients with ST segment elevation myocardial infarction (STEMI). OBJECTIVES: To evaluate the effect of intracoronary NTP on no reflow phenomenon (NR) and clinical outcomes in STEMI patients undergoing PPCI. METHODS: We searched the following databases without language or time limitation in January 2014: PubMed, EMBASE, CENTRAL, ISI Web of Science, and CNKI. Trials compared the effect of intracoronary NTP with control group (placebo or no NTP treatment) on NR in STEMI patients undergoing PPCI enrolled for analyzing. RESULTS: A total of 7 trials involving 781 patients were included into this meta-analysis. Intracoronary NTP significantly reduced the incidence of thrombolysis in myocardial infarction (TIMI) flow grade (TFG) ≤2 (RR: 0.47, 95% CI: 0.30-0.73, P = 0.001); the corrected TIMI frame count (CTFC) (WMD: -5.28, 95% CI: -6.79 to 3.78, P = 0.000) increased the events of myocardial blush grade (MBG) ≥2 (RR: 1.12, 95% CI: 1.01-1.24, P = 0.038), and reduced the incidence of major adverse cardiac events (MACE) (RR: 0.43, 95% CI: 0.27-0.70, P = 0.001). Although the events of the complete ST segment resolution (STR) did not reach statistical significance, there was a trend indicating improvement in the intracoronary NTP group (RR: 1.143, 95% CI: 0.97-1.34, P = 0.101). CONCLUSIONS: Intracoronary NTP can significantly reduce the incidence of angiographic NR during PPCI, as well as the incidence of MACE. It seems to be a promising adjunctive therapy for NR during PPCI.

A cross-sectional analysis of the relationship between uric acid and coronary atherosclerosis in patients with suspected coronary artery disease in China.

BACKGROUND: Although many studies have examined the relationship between uric acid (UA) and coronary artery disease (CAD), whether UA is an independent risk factor contributing to progression of CAD is still controversial. Whether UA plays a different role in different sexes is also unclear. METHODS: A total of 1116 individuals with suspected CAD were stratified into four groups according to their serum UA quartiles in total (men and women combined), in men, and in women. The association of UA with coronary atherosclerosis was assessed by univariable and multivariable logistic regression. RESULTS: In total and in women, the prevalence of any plaques and significant/severe stenosis was significantly increased with an increase in quartiles of UA (all P < 0.05). The proportion of triple-vessel disease and left main artery lesion was highest in the fourth quartile (both p < 0.05). Increasing quartiles of UA were significantly associated with a coronary artery calcium score (CACS) >10 (all P < 0.01). As UA levels increased in women, the incidence of double-vessel lesions (p = 0.017) and the proportion of mixed plaques (p = 0.022) were significantly increased. The proportion of a CACS of 0 in total, in men and women was highest in the first quartile (all P < 0.01). UA was the strongest predictor of significant stenosis, multivessel disease, and mixed plaques in women (all p < 0.05). UA was the only risk factor for mixed plaques in total (P = 0.046). CONCLUSION: The level of UA was significantly associated with coronary atherosclerosis in women, but not men.

Interactive association of the dietary oxidative balance score and cardiovascular disease with mortality in older adults: evidence from NHANES.

Objectives: We conducted an assessment to explore potential associations of the dietary oxidative balance score (DOBS), cardiovascular disease (CVD), with all-cause mortality among older adults, while also exploring the potential moderating effect of DOBS on the relationship between CVD and mortality. Methods: This study included 9059 older adults (≥60 years) from NHANES 2003-2014. Determination of DOBS involves scoring the combination of 16 nutrients, comprising 2 pro-oxidants and 14 anti-oxidants. Cox regression analysis was used to assess the individual associations of CVD and DOBS status with all-cause mortality. Additional evaluations were conducted to assess the combined impact of CVD and DOBS status on mortality, and the interaction were estimated. Sensitivity analyses were performed by excluding participants who died within two years. Results: The findings demonstrated a significant association between pro-oxidant diet (lower DOBS) or CVD and elevated mortality risk among older adults. It is also suggested that older adults with CVD and pro-oxidant diet exhibit the highest risk of all-cause mortality (HR = 1.96, 95% CI: 1.64-2.34), compared to individuals without CVD who follow an antioxidant-rich diet. Further stratified analysis based on CVD status revealed a different pattern in the correlation between pro-oxidant diet and all-cause mortality risk (P for interaction = 0.015). The results of sensitivity analysis were consistent. Conclusions: The lower levels of DOBS and/or CVD were significantly associated with an increased risk of all-cause mortality in older adults. Notably, we also identified a significant interaction between DOBS and CVD affecting all-cause mortality.

[The prospective register study of domestic tirofiban for clinical application in acute coronary syndrome].

OBJECTIVE: To evaluate the current clinical application of domestic tirofiban in patients with acute coronary syndrome (ACS) and to explore its safety profile focused on the common causes and correlation factors for the hemorrhagic events. METHODS: The patients diagnosed as ST-elevation myocardial infarction (STEMI) and medium to high risk non-ST-elevation myocardial infarction (NSTEMI)/unstable angina(UA) in 15 hospitals from September 2009 to December 2011 and given domestic tirofiban, were enrolled in this study. The following data were carefully collected: demographic data, comorbidities, concomitant medications, laboratory data, interventional treatment, application of tirofiban, hemorrhagic events and major adverse cardiac events(MACE) in hospital and at day 30 after discharge. RESULTS: (1) A total of 927 patients were enrolled in the study. The domestic tirofiban was given to 241 subjects (26.0%) before the intervention, 567 subjects (61.2%) during the intervention and 89 subjects (9.6%) after the intervention. The standardized application was performed in 737 subjects (79.5%) with the loading dose of 10 µg/kg and the maintenance dose of 0.15 µg·kg(-1)·min(-1). In all the subjects, the average maintenance time was (30.4 ± 14.2) hours with the average dose of (339.3 ± 182.9)ml. (2)During hospitalization, major bleeding happened in 4 cases (0.4%) and major adverse cardiac events (MACE) in 37 cases (4.0%). (3)At day 30 after discharge, 1 cases (0.1%) was reported with major bleeding and 9 cases (1.0%) with MACE. (3)The least MACE was showed in the preoperative tirofiban group (2.5%) and followed by the intraoperative group (4.1%) and the postoperative group (9.0%). Compared with the non-standardized application group, MACE was significantly decreased in the standardized application group (2.44% vs 10.00%, P < 0.05). CONCLUSIONS: The standardized application of the domestic tirofiban could decrease the incidence of MACE. Taken into account the combination therapy of clopidogrel and aspirin in the vast majority of patients, the domestic tirofiban exhibits a good safety profile with a relatively lower incidence of bleeding than the similar clinical studies.

Combined association of dietary fibre and cognitive function with all-cause and cause-specific mortality in older adults.

BACKGROUND: Dietary fibre and cognitive function are associated with the risk of mortality, respectively. Inadequate dietary fibre intake and cognitive impairment frequently co-occur in older adults, but the combined effect of dietary fibre and cognitive function on mortality remains unknown. The study was to investigate the combined effect of dietary fibre and cognitive function on mortality over a 13-year follow-up in a representative of older adults from the U.S. METHODS: We analyzed data from two cycles of the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002 with mortality follow-up data through 13 December 2015 obtained from Public-use Linked Mortality Files. Low dietary fibre intake was defined as the lowest quartile of dietary fibre intake. Cognitive impairment was defined as below the median of Digit Symbol Substitution Test. The separate and combined effects of low dietary fibre intake and cognitive impairment on all-cause and cause-specific mortality were assessed in older adults using weighted Cox proportional hazard models adjusting for potential confounders. RESULTS: A total of 2012 participants (weighted sample was 32,765,094) aged 60 years and older were enrolled in the study. After a median follow-up of 13.4 years, 1017 participants (50.4%) were identified as all-cause deaths, including 183 (9.1%) participants dying from cancer, 199 (9.9%) participants dying from cardiovascular disease, and 635 (31.5%) participants dying from non-cancer/non-cardiovascular disease. Participants with low dietary fibre intake and cognitive impairment had nearly twice the risk of all-cause (HR, 2.030; 95% CI, 1.406-2.931) and non-cancer/non-cardiovascular (HR, 2.057; 95% CI, 1.297-3.262) mortality, and over triple cancer (HR, 3.334; 95% CI, 1.685-6.599) mortality, compared to those without both. CONCLUSIONS: The combination of low dietary fibre intake and cognitive impairment was associated with an increased risk of all-cause, cancer and non-cancer/non- cardiovascular mortality in older adults.

Key MessagesThe inadequate dietary fibre intake and cognitive impairment often coexist in older adults, but the combined effect of dietary fibre and cognitive function on mortality is still unknown.This study evaluated the combined effect of dietary fibre and cognitive impairment on mortality among older adults with a 13-year follow-up in the United States, based on the National Health and Nutrition Examination Survey (NHANES).The results provided evidence of the importance of early screening and intervention for dietary fibre intake and cognitive function, and suggested the joint effect of dietary fibre and cognitive function on mortality could be significant for public health in older adults.

Effect of hypoxia-inducible factor 1-alpha on hypoxia/reoxygenation-induced apoptosis in primary neonatal rat cardiomyocytes.

We studied the role of hypoxia-inducible factor 1-alpha (HIF-1α) in hypoxia/reoxygenation (H/R)-induced apoptosis in primary neonatal rat cardiomyocytes and its possible molecular mechanisms. Isolated neonatal and adult rat cardiac myocytes were cultured for 48h and were submitted to 5h of hypoxia followed by 2, 6, or 12h of reoxygenation. Small interfering RNA was used to target the HIF-1α gene. Cardiac myocyte apoptosis induced by H/R was assessed by Annexin V-FITC apoptosis assay. HIF-1α, Bnip3 and caspase-3 levels were determined by real-time reverse transcription polymerase chain reaction and western blot for mRNA and protein, respectively. H/R resulted in severe injury in cultured rat cardiomyocytes and it upregulated HIF-1α and proapoptotic Bnip3 mRNA and protein expression. HIF-1α activity inhibited by siRNA significantly decreased (P<0.01) the rate of apoptotic cardiomyocytes induced by 5h of hypoxia followed by 6h of reoxygenation compared with cardiomyocytes without siRNA treatment. Additionally, the expression of Bnip3 and caspase-3 was also markedly reduced. We conclude that HIF-1α is a key regulator of apoptosis of cardiomyocytes induced by H/R. H/R enhances primary neonatal rat cardiomyocyte apoptosis through the activation of HIF-1α and the mechanism might involve Bnip3 and caspase-3. HIF-1α may be a possible therapeutic target to limit myocardial injury after myocardial infarction.

Impact of obesity on the outcome of Chinese patients with ST-segment myocardial infarction undergoing urgent percutaneous coronary intervention.

OBJECTIVE: The aim of the present study was to analyse the impact of obesity on the outcomes of Chinese patients with ST-segment myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). METHODS AND RESULTS: A total of 421 patients with STEMI having urgent PCI and who were admitted to the 20 hospitals in the LiaoNing region during the period of 2009 until 2010, were enrolled. The patients were stratified according to body mass index (BMI) as normal weight (18.5 kg/ m2 < or = BMI < 24.0 kg/m2, n = 149), overweight (24.0 kg/m2 < or = BMI < 28.0 kg/m2, n = 196), or obese (BMI 28.0 kg/m2, n = 76). At follow-up, the main adverse cardiac cerebrovasular events (MACCE, including cardiac death, non-fatal myocardial infarction, revascularization, and stroke) and readmission for cardiovascular events were assessed. The median duration of the follow-up was 367.34 +/- 109.00 days. Obesity was found to be associated with younger age (P < 0.001), a higher prevalence of male gender (P < 0.001), hypertension and hyperlipidaemia (both P = 0.001), and higher levels of low-density lipoprotein (P = 0.01), cholesterol (P = 0.001), and triglycerides (P < 0.001). The PCI characteristics and treatments were similar across the BMI categories. At follow-up, it was found that MACCE/readmission for cardiovascular events-free survival rate was not significantly different among the three groups. Further, after adjustment of confounders, obesity was determined as an independent risk factor for cardiac death (P = 0.04) and non-fatal myocardial infarction (P = 0.04). CONCLUSIONS: At follow-up, after urgent PCI, obese patients with STEMI have similar MACCE/readmission for cardiovascular events as their normal weight and overweight counterparts. Further, obesity was independently associated with a higher incidence of cardiac death and non-fatal myocardial infarction. However, the "obesity paradox"was not observed in the outcomes.

[Effects of smoke on clinical prognosis of patients with acute ST-segment elevation myocardial infarction].

OBJECTIVE: To explore the effects of smoke on the clinical prognosis of patients with acute ST-segment elevation myocardial infarction (ASTEMI). METHODS: A total of 1213 consecutive ASTEMI patients were admitted into 20 hospitals in Liaoning province between May 2009 and May 2010. They were stratified into smoke (n = 588) and non-smoke (n = 625) groups. Basic demographic profiles, treatment data and clinical outcomes were compared between two groups. The primary endpoint was cardiac death and the secondary endpoints included non-fatal myocardial infarction, stroke and revascularization. Cox proportional hazard analyses were performed. RESULTS: The proportion of percutaneous coronary intervention (PCI) in the smoke group was significantly higher than that in the non-smoke group (40.8% vs 22.1%, P < 0.001). During the follow-up period, the medication rate was significantly higher in the smoke group than that in the non-smoke group (aspirin: 75.3% vs 62.2%, P < 0.001; clopidogrel: 40.5% vs 32.2%, P = 0.003; ß receptor blockade: 45.4% vs 36.0%, P = 0.001; angiotensin-converting-enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB): 38.3% vs 32.2%, P = 0.026; statins: 57.3% vs 44.2%, P < 0.001). During the follow-up period, the rate of cardiac death was lower in the smoke group than that in the non-smoke group (10.2% vs 24.2%, P < 0.001). No significant differences existed between two groups. During the follow-up period, the rate of cardiac death was significantly correlated with smoke (HR 2.777, 95%CI 1.113 - 6.928, P = 0.029), PCI (HR 0.208, 95%CI 0.062 - 0.700, P = 0.011), age (HR 1.049, 95%CI 1.005 - 1.095, P = 0.028), aspirin (HR 0.165, 95%CI 0.061 - 0.446, P < 0.001) and statins (HR 0.382, 95%CI 0.317 - 0.462, P < 0.001). CONCLUSION: Among the ASTEMI patients, the rate of cardiac death is significantly lower in the smoke group than that in the non-smoke group. And it is significantly correlated with such independent risk factors as smoke, PCI, age, aspirin and statins.

[Value of coronary CT angiography in assessment of bifurcation lesions].

OBJECTIVE: To evaluate the value of coronary CT angiography in assessment of bifurcation lesions. METHODS: The original image of 79 established and suspected coronary artery disease patients who underwent both coronary CT angiography and conventional artery angiography (CAG) sequentially were included in this analysis. Bifurcation lesions were assessed on primary and secondary vessels with diameter ≥ 2.0 mm, bifurcation lesions were graded according to Chen's classification. CAG was used as golden standard. The sensitivity, specificity, positive predictive value and negative predictive value were calculated. Spearman's test and Kappa test were used to evaluate the correlation and classification identity of the two methods. RESULTS: CAG evidenced 177 bifurcation lesions out of 445 bifurcation vessels and coronary CT detected 168 bifurcation lesions out of 404 bifurcation vessels with satisfactory imaging quality and 390 bifurcation vessels could be analyzed by both CAG and coronary CT. Sensitivity, specificity, positive predictive value and negative predictive value of coronary CT angiography were 94.2%, 94.6%, 90.7%, 96.1%, respectively. The results for the lesions at LM-LAD/LCX + LAD/Mid, LAD/Diag, RCA/PDA were more satisfactory and the sensitivity and specificity were as high as: 97.1% and 94.2%, 95.7% and 89.5%, 92.3% and 98.7%, respectively. There were significant correlations for evaluating the narrow degree of the opening of the bifurcation branch with these two methods (r = 0.799 58, P < 0.01) and for identifying I, II, III type bifurcation lesions (Kappa coefficient = 0.7959, P < 0.01) as well as for identifying the subtype bifurcation lesions (Kappa coefficient = 0.6328, P < 0.01) using the two methods. CONCLUSION: Coronary CT angiography is efficient in identifying the bifurcation lesions and offers a reasonable indication for bifurcation lesion classification.