Serum Lipid Profiles and All-Cause Mortality: A Retrospective Single Center Study on Chinese Inpatient Centenarians.

Objectives: To analyze the serum lipid profiles and investigate the relationship between the lipoprotein cholesterol levels and all-cause mortality in Chinese inpatient centenarians. Design: Retrospective study. Methods: Centenarians aged 100 years and older were admitted from January 2010 to January 2021 in our hospital. All centenarians completed a follow up visit till April 2021 of all-cause mortality and serum lipid profiles, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) levels. Cox proportional hazard models were used to assess the association between lipid profiles and all-cause mortality. Results: (1) These 121 centenarians on average were 100.85 ± 1.37 years old (100~107 years), including 114 males and 7 females. (2) The rate of treatment with lipid-lowering drugs was 69.4%, and the lipid-lowering drugs were mainly statins (63.6%). (3) The results of serum lipid profiles were as follows: TC 3.90 ± 0.69 mmol/L, TG 1.36 ± 0.55 mmol/L, HDL-C 1.14 ± 0.24 mmol/L, and LDL-C 2.05 ± 0.46 mmol/L. (4) The median follow-up time was 589 days (95% CI: 475, 703), and the all-cause mortality rate was 66.1%. (5) Multivariable analysis showed that higher TC level (HR = 1.968, 95% CI = 1.191-3.253, P = 0.008), lower LDL-C level (HR = 0.379, 95% CI = 0.212-0.677, P = 0.001) was independent factors contributed to all-cause mortality. Sensitivity analysis showed that the above results were stable. The therapy and complication morbidity did not present significant publication bias. Conclusions: The serum lipid profiles of Chinese inpatient centenarians were lower than those of the previous studies. Low LDL-C level was associated with an increased risk of all-cause mortality, which may indicate that more intensive lowering of LDL-C had a potential adverse effect on all-cause mortality for centenarians.

The prognostic values of beta-2 microglobulin for risks of cardiovascular events and mortality in the elderly patients with isolated systolic hypertension.

BACKGROUND: The present study aimed to investigate the effects of serum beta-2 microglobulin (B2M) on the risks of major cardiovascular events (MACEs) and all-cause death in Chinese elderly isolated systolic hypertension (ISH) patients without severe renal insufficiency (estimated glomerular filtration rate [eGFR] <30 ml/min/1.73 m2). MATERIALS AND METHODS: Serum B2M concentration, creatinine-eGFR, and blood pressure variability were evaluated in 460 elderly patients (mean age, 82.6 years; 28 women) with ISH in this observational study. The Cox proportional hazard model was adopted to calculate adjusted hazard ratios (HRs) of risk factors for cardiovascular events and all-cause deaths. RESULTS: During a median follow-up period of 37.6 months, 63 patients (13.7%) died, and 65 patients (14.1%) had MACEs. Multivariable analysis showed that the higher serum B2M concentration (B2M ≥0.28 mg/dl) was an independent predictor of increased risk of MACEs (nonfatal acute myocardial infarction, acute heart failure, ischemic stroke, and cardiovascular deaths) and all-cause death (HR: 2.62, 95% confidence interval [CI]: 1.46-4.69, P = 0.001 and HR: 3.40, 95% CI: 1.78-6.48, P < 0.001, respectively) adjusting for other multiple confounders including creatinine-eGFR and cystatin C. In addition, blood pressure variability derived from ambulatory blood pressure measurement was not associated with incidence of MACEs and all-cause mortality (P > 0.05). CONCLUSION: Our data suggest that serum B2M concentration may be individually associated with MACEs and all-cause death in elderly ISH patients without severe renal insufficiency even after adjusted for creatinine-eGFR and cystatin C.

Association between urinary sodium excretion and coronary heart disease in hospitalized elderly patients in China.

Objective This study was performed to evaluate the association between urinary sodium excretion and coronary heart disease (CHD) in hospitalized elderly patients in China. Methods The 24-h urinary excretion specimens of 541 patients were collected, and the serum creatinine concentration and urinary sodium/potassium ratio were measured. Associations were explored by multivariate logistic regression analysis. Results The mean 24-h urinary sodium excretion was 200.4 mmol, corresponding to 11.7 g of salt intake. Both of these values were higher in men than in women. The salt intake of 80- to 89-year-old patients was significantly lower than that of 70- to 79-year-old patients. The 24-h urinary sodium excretion and spot urine Na/K ratios were significantly higher in overweight/obese and hypertensive patients. The 24-h urinary sodium excretion of men who smoked was significantly higher than that of women. The spot urine Na/K ratio was significantly higher in patients with cerebral thrombosis. The urinary Na/K ratio, smoking status, and hypertension were independent risk factors for CHD. Conclusions This cross-sectional survey suggests that the Na/K ratio may better represent salt loading than Na excretion alone in studying the association between sodium intake and CHD. There was no association between sodium and CHD prevalence.

[Effects of left atrial enlargment on the recurrence of atrial fibrillation in elderly paroxysm alatrial fibrillation patients after pacemaker implantation].

OBJECTIVE: To investigate the incidence of recurrent atrial fibrillation, including asymptomatic atrial fibrillation, and the effect of left atrial volume index (LAVI) on recurrence of atrial fibrillation in elderly paroxysmal atrial fibrillation patients with implanted cardiac pacemakers. METHODS: One hundred and forty eight elderly paroxysmal atrial fibrillation patients without antiarrhythmic drug therapy after car-diac pacemaker implantation were selected from January 2012 to December 2013 in this study. The baseline characteristics, echocardiography parameters, the incidence of recurrent atrial fibrillation and the burden of atrial fibrillation were recorded. The patients were divided into groups according to the burden of atrial fibrillation and the left atrial volume index. Multivariate Cox regression analysis was adopted to calculate the adjusted hazard ratio (HR) of left atrial volume index for the device-detected recurrence of atrial fibrillation and atrial fibrillation burden. RESULTS: During an average of 22.79 months follow-up period, 57.43% of the patients with recurrence of atrial fibrillation, 22.97% of the pa-tients with high intensity burden of atrial fibrillation, and 15.54% of the patients with asymptomatic atrial fibrillation were found. Multivariate Cox regression analysis demonstrated left atrial enlargement (LAVI > 28 ml/m2) was an independent risk factor for the device-detected recur-rence of atrial fibrillation (P < 0.05) and atrial fibrillation burden (P < 0.01)respectively. CONCLUSIONS: Left atrial volume index is an inde-pendent risk factor for the recurrence of atrial fibrillation and atrial fibrillation burden in elderly patients with paroxysmal atrial fibrillation after pacemaker implantation.

The future of remote ECG monitoring systems.

Remote ECG monitoring systems are becoming commonplace medical devices for remote heart monitoring. In recent years, remote ECG monitoring systems have been applied in the monitoring of various kinds of heart diseases, and the quality of the transmission and reception of the ECG signals during remote process kept advancing. However, there remains accompanying challenges. This report focuses on the three components of the remote ECG monitoring system: patient (the end user), the doctor workstation, and the remote server, reviewing and evaluating the imminent challenges on the wearable systems, packet loss in remote transmission, portable ECG monitoring system, patient ECG data collection system, and ECG signals transmission including real-time processing ST segment, R wave, RR interval and QRS wave, etc. This paper tries to clarify the future developmental strategies of the ECG remote monitoring, which can be helpful in guiding the research and development of remote ECG monitoring.

Effects of body mass index on risks for ischemic stroke, thromboembolism, and mortality in Chinese atrial fibrillation patients: a single-center experience.

BACKGROUND: Obesity is considered to be related to recurrence of atrial fibrillation (AF), left atrial thrombus formation, and atrial remodeling. However, whether obesity is an independent risk factor for stroke and other thromboembolic events is still controversial. OBJECTIVE: This study aimed to investigate the effects of body mass index (BMI) on the risks of stroke, thromboembolism, and mortality in AF patients. METHODS: Patients who were diagnosed with nonvalvular AF were included in this observational, retrospective study. The study population was stratified by BMI at baseline. The Cox proportional hazard model was adopted to calculate adjusted hazard ratios of risk factors for adverse clinical events (stroke, thromboembolism, and mortality). RESULTS: A total of 1286 AF patients (males, 78.30%; mean age, 74.50 years; 94.48% paroxysmal AF) were followed up for a median of 2.1 years (IQR: 1.5-2.9 years). Overall, 159 patients died. A total of 84 strokes and 35 thromboembolic events occurred. Multivariate analysis showed that overweight (25.0≤BMI<30.0 kg/m2) and age ≥75 years were independent risk factors for ischemic stroke (both P<0.01). Obesity (BMI ≥30.0 kg/m2), age ≥75 years, persistent/permanent AF, and prior thromboembolism were independent risk factors for thromboembolism (all P<0.05). Underweight (BMI <18.5 kg/m2), age ≥75 years, prior ischemic stroke/transient ischemic attack, renal dysfunction, and heart failure were independent risk factors for all-cause deaths (all P<0.05). CONCLUSIONS: Overweight or obesity may be a risk factor of ischemic stroke and thromboembolism in AF patients. Excessive low weight is significantly associated with increased all-cause mortality.

Prevalence of and risk factors for postprandial hypotension in older Chinese men.

OBJECTIVE: To assess the prevalence of and risk factors for postprandial hypotension (PPH) among old and very old Chinese men. METHODS: The study included 349 Chinese men aged 65 and older, grouped into two age categories: group 1 (old) included 163 men aged 65 to 80 years; group 2 (very old) included 186 men aged over 80 years. Blood pressure changes after meals were assessed every 15 min by ambulatory blood pressure monitoring. Symptoms after meal ingestion and after standing up and changes in the baseline condition relative to blood pressure changes were observed continuously. Additional baseline data included body mass index, medical history, and medication use. RESULTS: The prevalence of PPH was 59.3% overall and was significantly higher in group 2 than group 1 (63.4% vs. 54.6%, P < 0.05). In group 2, the prevalence of PPH after breakfast (33.8%) and lunch (32.1%) were higher than that after supper (20.9%), P < 0.05. Hypertension and age were significant risk factors for PPH (OR = 2.188, 95% CI: 1.134-4.223, P = 0.02; OR = 1.86, 95% CI: 1.112-3.11, P = 0.018, respectively). In contrast, acarbose use was protective against PPH (OR = 0.4, 95% CI: 0.189-0.847, P = 0.017). The decrease in blood pressure during PPH was 20-40 mmHg and the maximum was 90 mmHg. PPH usually occurred at 30-60 min after a meal and lasted 30-120 min. CONCLUSIONS: These findings demonstrate that the prevalence of PPH in men aged over 80 years is significantly higher than those in men aged 65 to 80 years, and the blood pressure decline is also higher for men aged over 80 years. In addition, hypertension and age were main risk factors for PPH in the older men, which suggest that preventing and treating PPH is worthwhile.

[Effects of recombinant human growth hormone on serum lipid in aged male patients with chronic heart failure].

OBJECTIVE: To investigate the effects of recombinant human growth hormone on serum lipid in aged male patients with chronic heart failure (CHF). METHODS: Eighty seven patients with chronic heart failure(> or = 60 years old) were randomly divided into 2 groups: the CHF control group (n = 46) who received regular therapy and the CHF experimental group (n = 41) who received regular therapy and recombinant human growth hormone. The treatment would be continued for 3 months. Another group was normal control group (n = 10). The detection of serum growth hormone (GH), insulin-like growth factor (IGF-1), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) was carried out before and after treatment in the participants. RESULTS: Before treatment, the levels of GH and IGF-1 were not significantly different among groups. After treatment, the levels of GH (0.71 +/- 0.34 vs 0.96 +/- 0.48) and IGF-1 (95.64 +/- 21.11 vs 111.64 +/- 23.14)in CHF experimental group were higher than those before the treatment. In CHF control group, the levels of GH(0.81 +/- 0.32 vs 0.79 +/- 0.29) and IGF-1 (97.82 +/- 19.74 vs 99.65 +/- 20.11) had no significant change after the treatment. After treatment, the levels of GH (0.96 +/- 0.48 vs 0.79 +/- 0.29) and IGF-1 (111.64 +/- 23.14 vs 99.65 +/- 20.11) in CHF experimental group were higher compared with that of CHF control group. Before treatment, the serum levels of LDL-C, HDL-C, TC and TG had no significant difference among groups. After treatment,the levels of LDL-C (2.11 +/- 0.82 vs 1.76 +/- 0.51) and TC (3.78 +/- 1.34 vs 3.21 +/- 1.17) in CHF experimental group were lower than those before the treatment. However, the levels of HDL-C (1.10 +/- 0.31 vs 0.99 +/- 0.28)and TG (1. 89 +/- 1.07 vs 1.66 +/- 0.95) had no significant change after the treatment compared with before treatment. In CHF control group, the serum lipid levels had no significant change after the treatment. CONCLUSION: As the treatment of rhGH for aged male patients with chronic heart failure, GH influences lipid metabolism, which reduces the level of LDL-C, TC. However GH has no effects on the serum HDL-C and TG level. With the treatment of rhGH for long-term, lipid metabolism should be paid attention,and the treatment for blood lipid reduction should be adjusted in time.

[Changes of sex hormones and risk factors associated with atherosclerosis in old patients with castrated prostatic cancer].

OBJECTIVE: To detect the relationship between changes of sex hormone levels and risk factors for atherosclerosis in old patients with castrated prostatic cancer. METHODS: Two hundred and forty-seven patients, over 65 years old, were divided into three groups: 64 non-prostatic cancer patients (group I), 61 non-castrated prostatic cancer patients (group II) and 122 castrated prostatic cancer patients (group III). Group I and group II served as controls. Testosterone (T), estradiol (E2), luteal hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), progesterone (P), C-reactive protein (CRP), serum homocysteine (Hcy), glucose (GLU), uric acid (UA), total cholesterol (TC), triglyceride (TG), low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein-cholesterol (HDL), were measured and compared between any two groups. RESULTS: In patients with castrated prostatic cancer, T, E2, and P levels decreased significantly, LH and FSH increased significantly, change of PRL was not significant, E2/T was elevated significantly; levels of CRP, Hcy, GLU, UA, TC, TG and LDL-C increased significantly compared with those in control groups. CONCLUSION: Sex hormone levels were imbalanced significantly after castration in old prostatic cancer patients, and the risk factors for atherosclerosis also increased accordingly. There might be relationship between decreased sex hormone levels and risk factors for atherosclerosis in old male patients.

Is combined lipid-regulating therapy safe and feasible for the very old patients with mixed dyslipidemia?

OBJECTIVES: To detect the efficacy and safety of combined lipid-regulating therapies in the very old patients with mixed dyslipidemia and determine an appropriate therapy for them. METHODS: Four hundred and fifty patients aged over 75 with mixed dyslipidemia were divided into five groups according to different combination therapies. Lipid levels and drug related adverse events were tested during the study. RESULTS: Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels were reduced in every group compared to baseline: statin + ezetimibe: -30.0% and -55.5%; statin + policosanol: -31.1% and -51.2%; statin + fibrates: -23.7% and -44.6%; statin + niacin: -25.2% and -43.0%; and niacin + fibrates: -11.3% and -23.5%. The target achievement rates of LDL-C all exceeded 50%, except in niacin + fibrates (42.0%); statin + ezetimibe: 57.0%; statin + policosanol: 56.0%; statin + niacin: 52.0%; and statin + fibrates: 50.0%. However, overall, the niacin + fibrates group was the most effective in decreasing triglyceride (TG) and increasing high-density lipoprotein cholesterol (HDL-C) as follows: niacin + fibrates: -39.3% and 28.6%; statin + fibrates: -29.3% and 18.4%; statin + niacin: -18.5% and 16.7%; statin + ezetimibe: -17.1% and 7.1%; and statin + policosanol: -15.6% and 9.5%. The achievement rates of TG and HDL-C levels in niacin + fibrates (58.0% and 39.0%) were better than the other four groups: statin + niacin (34.0% and 34.0%), statin + fibrates (43.0% and 28.0%), statin + policosanol (30.0% and 24.0%) and statin + ezetimibe (28.0% and 25.0%). Patients in all five groups experiencing drug adverse events were only 2% and no severe adverse events occurred. CONCLUSIONS: Statin + ezetimibe was the most effective group in lowering TC and LDL-C levels, while niacin + fibrates was the most effective in decreasing TG and increasing HDL-C levels. The commonly used combined lipid-regulating therapies with common dosages in this study were all quite safe and feasible for the very old patients with mixed hyperlipidemia.

[The metabolism characteristics of blood lipids and the correlation analysis of blood lipids and related factors such as age in the middle-aged and elderly men].

OBJECTIVE: To investigate the relationship between the blood lipids and risk factors such as age in middle-aged and elderly men. METHODS: 1603 men aged over 50 years old who took health examinations in June 2006 in the Chinese PLA General hospital were taken into the study. The total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c), fasting serum glucose (FBG), serum creatinine (Cr) and blood uric acid (UA) were detected, and the clinical data such as age, body height, body weight and blood pressure were recorded. RESULTS: (1) The detection rates of hyperlipidemia, abnormal TC, abnormal TG, abnormal HDL-c and abnormal LDL-c were 56.27%, 36.74%, 28.20%, 10.79% and 6.92% respectively, and the TC and/or TG abnormality were the majority. (2) Compared with the 50 59 years old group, the elderly men aged over 80 years old had lower detection rates of abnormal TC and abnormal HDL-c, lower levels of TC and TG and higher levels of HDL-c (P < 0.05). After adjusting for BMI, SBP, DBP, UA, FBG and CCr, the multiple regression analysis showed that the levels of TC and TG decreased by 0.097 mmol/L and 0.087 mmol/L respectively every 10 years older, while the level of HDL-c increased by 0.113 mmol/L. CONCLUSION: The study showed that the majority types of hyperlipidemia in middle-aged and elderly men were abnormal TC and abnormal TG. The levels of TC, TG were correlated with age positively and the HDL-c was negatively correlated with age. The blood lipids metabolism characteristics of elderly men aged over 80 years old should be considered before the treatment of hyperlipidemia.

[The correlation analysis of carotid stenosis and pulse pressure in the elderly men with essential hypertension].

OBJECTIVE: To investigate the relationship between the carotid stenosis (CS) and the pulse pressure (PP) in elderly men with essential hypertension. METHODS: According to the Color Doppler Flow Imaging (CDFI), 157 elderly men with essential hypertension and carotid atherosclerosis were divided into five classifications and two groups: CS < 50% group (n = 66) and CS > or = 50% group (n = 91). The blood pressures were measured within one year before the CDFI was taken and clinical data were recorded. RESULTS: (1) The systolic blood pressure (SBP) and the PP in CS > or = 50% group were significantly increased than those in CS < 50% group, while the diastolic blood pressure (DBP) was converse. The independent risk factors of CS > or = 50% were peripheral arterial disease (OR: 4.543, 95%CI: 1.415-14.590) and PP (OR: 1.096, 95% CI: 1.038-1.157). (2) CS classifications positively correlated with PP (r = 0.402, P < 0.01) and fibrinogen (FIB) (r = 0.200, P < 0.05). After adjusting for age, body mass index (BMI), SBP, DBP, total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c), fasting serum glucose (FBG), blood uric acid (UA), D-dimer, amino-terminal pro-brain natriuretic peptide (NT-proBNP), total bilirubin (TBIL) and direct bilirubin (DBIL), multiple regression analysis showed that PP and FIB remained as predisposing risk factors for CS classifications. CONCLUSION: The pulse pressure was correlated with carotid stenosis in elderly men with essential hypertension and it was justified for concurrent inhibition of PP in the treatment of high blood pressure.

[Effects of cholesterol rich diet on blood coagulative and fibrinolytic activities in male rabbits].

AIM: To explore the effects of cholesterol rich diet on the activities of blood coagulative and fibrinolytic systems in male rabbits. METHODS: 14 male New Zealand white rabbits were randomized to cholesterol rich diet(CRD) group and common diet (control) group. Rabbits in CRD group were fed with 1% cholesterol embedded diet and those in the control group were fed with common diet. Levels of blood TG, TC, LDL, HDL, Lp(a), apoA1, apoB, FIB, D-dimers and FDP, PT and APTT, activity of ADP, AT-III, PLG and alpha2-PI were tested in all rabbits before given cholesterol rich diet and after 12 weeks' feeding with different kinds of diet. RESULTS: Levels of blood TG, TC, LDL, HDL, Lp(a), apoA1, apoB, FIB, D-dimers in CRD group were all elevated significantly compared with those in the control group and the baseline levels. PT and APTT were shortened, ADP, PLG and alpha2-PI activity were increased in CRD group. CONCLUSION: Cholesterol rich diet not only is the direct cause of hyperlipidemia but also can increase the coagulative activity and inhibit the fibrinolytic activity and promoting the evolution of arteriosclerosis.

[Investigations of the urinary sodium excretion in elderly men].

AIM: To explore the characteristics of the urinary excretion in the elderly patients and to offer some advice for the prevention and treatment of hyponatremia in the elderly patients. METHODS: 42 inpatients aged over 80 were divided into tow groups according to their creatinine clearance rate (CCR). Meanwhile, 24 patients aged 45-59 and 31 patients aged 60-79 were chosen as the control groups. All patients were examined 24h urinary electrolytes and CCR. RESULTS: (1) The CCR in the elderly group was lower than in the middle-aged and old group and the 24 h urinary sodium excretion was accordingly diminished than the two groups. 24 h urinary sodium excretion in CCR abnormal group was also diminished than in CCR normal group. The urinary sodium excretion was not linearly correlate with the CCR in middle-aged group and old group but was linearly correlate in the elderly group. (2) The elderly patients' capability of holding blood sodium and excreting potassium was declined in the CCR normal group. But the urinary excretion of sodium, potassium and phosphonium were all diminished in CCR abnormal group. (3) All patients' sodium intake was higher than the criteria made by China Hypertension Association. CONCLUSION: Their urinary sodium excretion is linearly correlate with CCR. Urinary sodium excretion is increased when the elderly patients' renal function is relative normal but when the renal function is severely damaged, urinary sodium excretion is diminished.