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1.
Curr Med Sci ; 41(1): 69-76, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33582908

RESUMEN

The infectious coronavirus disease 2019 (COVID-19) has spread all over the world and been persistently evolving so far. The number of deaths in the whole world has been rising rapidly. However, the early warning factors for mortality have not been well ascertained. In this retrospective, single-centre cohort study, we included some adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Renmin Hospital of Wuhan University who had been discharged or had died by Apr. 8, 2020. Demographic, clinical and laboratory data at admission were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable analysis, Cox proportional hazard model analysis and receiver operating characteristic (ROC) curve to explore the early warning factors associated with in-hospital death. A total of 159 patients were included in this study, of whom 86 were discharged and 73 died in hospital. Hypertension (52.1% vs. 29.1%, P=0.003) and coronary heart disease (28.8% vs. 12.8%, P=0.012) were more frequent among non-survived patients than among survived patients. The proportions of patients with dyspnoea (67.1% vs. 25.6%, P<0.001), chest distress (58.9% vs. 26.7%, P<0.001) and fatigue (64.4% vs. 25.6%, P<0.001) were significantly higher in the non-survived group than in the survived group. Regression analysis with the Cox proportional hazards mode revealed that increasing odds of in-hospital death were associated with higher IL-6 (odds ratio 10.87, 95% CI 1.41-83.59; P=0.022), lactate (3.59, 1.71-7.54; P=0.001), older age (1.86, 1.03-3.38; P=0.041) and lower lymphopenia (5.44, 2.71-10.93; P<0.001) at admission. The areas under the ROC curve (AUCs) of IL-6, lymphocyte, age and lactate were 0.933, 0.928, 0.786 and 0.753 respectively. The AUC of IL-6 was significantly higher than that of age (z=3.332, P=0.0009) and lactate (z=4.441, P<0.0001) for outcome prediction. There was no significant difference between the AUCs of IL-6 and lymphocyte for outcome prediction (z=0.372, P=0.7101). It was concluded that the potential risk factors of higher IL-6, lactate, older age and lower lymphopenia at admission could help clinicians to identify patients with poor prognosis at an early stage.


Asunto(s)
/mortalidad , Enfermedad Coronaria/epidemiología , Hipertensión/epidemiología , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
2.
Angiology ; 72(1): 86-92, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32840113

RESUMEN

We investigated the role of vitamin D on glycemic regulation and cardiac complications in patients with type 2 diabetes mellitus (T2DM). A total of 1139 patients (49.3% males vs 50.7% females) were included. Information on sociodemographic lifestyle, family history, blood pressure (BP), and coronary heart disease (CHD) complications was collected. Significant differences were found between males and females regarding age-groups (P = .002), body mass index (BMI; P = .008), physical activity (P = .010), sheesha smoking (P = .016), cigarette smoking (P = .002), hypertension (P = .050), metabolic syndrome (P = .026), and CHD (P = .020). There were significant differences between vitamin D deficiency, insufficiency, and sufficiency in relation to age-group (P = .002), income (P = .002), waist circumference (P = .002), hip circumference (P = .028), waist-hip ratio (P = .002), and BMI (P = .002). Further, mean values of hemoglobin, magnesium, creatinine, hemoglobin A1c (HbA1c), total cholesterol, uric acid, and diastolic BP were significantly higher among patients with vitamin D deficiency compared with those with insufficiency and sufficiency. Multiple logistic regression analysis revealed that 25-hydroxy vitamin D, 25(OH)D, HbA1c, waist circumference, uric acid, duration of T2DM, total cholesterol, systolic and diastolic BP, and BMI were strong predictor risk factors for CHD among patients with T2DM. The present study supports that 25(OH)D may have a direct effect on CHD and on its risk factors.


Asunto(s)
Enfermedad Coronaria/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Vitamina D/análogos & derivados , Adulto , Presión Sanguínea , Índice de Masa Corporal , Colesterol/sangre , Estudios de Cohortes , Femenino , Hemoglobina A Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Turquia/epidemiología , Ácido Úrico/sangre , Vitamina D/sangre , Circunferencia de la Cintura
3.
Angiology ; 72(1): 24-31, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32762347

RESUMEN

Even though abdominal aortic aneurysm (AAA) and coronary heart disease (CHD) are both related to atherosclerosis, there could be important differences in risk factors. Based on Malmö Diet and Cancer Cohort, the incidence of AAA and CHD was followed prospectively. Cox regression was used to calculate the association of each factor with AAA and CHD and hazards ratio were compared using a modified Lunn-McNeil method; 447 participants developed AAA and 3129 developed CHD. After multivariate adjustments, smoking, antihypertensive medications, lipid-lowing medications, systolic and diastolic blood pressures, apolipoprotein (Apo) A1 (inversely), ApoB, ApoB/ApoA1 ratio, total leukocyte count, neutrophil count, and neutrophil to lymphocyte ratio were associated with the risks of both AAA and CHD. When comparing risk factor profiles for the 2 diseases, smoking, diastolic blood pressure, ApoA1, and ApoB/ApoA1 ratio had stronger associations with risk of AAA than with risk of CHD, while diabetes and unmarried status showed increased risk of CHD, but not of AAA (all P values for equal association <.01). The results from this big population study confirm that the risk factor profiles for AAA and CHD show not only many similarities but also several important differences.


Asunto(s)
Aneurisma de la Aorta Abdominal/epidemiología , Enfermedad Coronaria/epidemiología , Anciano , Apolipoproteína A-I/sangre , Apolipoproteínas B/sangre , Presión Sanguínea , Estudios de Cohortes , Diabetes Mellitus/epidemiología , Diástole , Femenino , Humanos , Masculino , Estado Civil , Persona de Mediana Edad , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Suecia/epidemiología
4.
JAMA ; 324(23): 2396-2405, 2020 12 15.
Artículo en Inglés | MEDLINE | ID: mdl-33320224

RESUMEN

Importance: It is uncertain whether depressive symptoms are independently associated with subsequent risk of cardiovascular diseases (CVDs). Objective: To characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood. Design, Setting, and Participants: A pooled analysis of individual-participant data from the Emerging Risk Factors Collaboration (ERFC; 162 036 participants; 21 cohorts; baseline surveys, 1960-2008; latest follow-up, March 2020) and the UK Biobank (401 219 participants; baseline surveys, 2006-2010; latest follow-up, March 2020). Eligible participants had information about self-reported depressive symptoms and no CVD history at baseline. Exposures: Depressive symptoms were recorded using validated instruments. ERFC scores were harmonized across studies to a scale representative of the Center for Epidemiological Studies Depression (CES-D) scale (range, 0-60; ≥16 indicates possible depressive disorder). The UK Biobank recorded the 2-item Patient Health Questionnaire 2 (PHQ-2; range, 0-6; ≥3 indicates possible depressive disorder). Main Outcomes and Measures: Primary outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD (composite of the 2). Hazard ratios (HRs) per 1-SD higher log CES-D or PHQ-2 adjusted for age, sex, smoking, and diabetes were reported. Results: Among 162 036 participants from the ERFC (73%, women; mean age at baseline, 63 years [SD, 9 years]), 5078 CHD and 3932 stroke events were recorded (median follow-up, 9.5 years). Associations with CHD, stroke, and CVD were log linear. The HR per 1-SD higher depression score for CHD was 1.07 (95% CI, 1.03-1.11); stroke, 1.05 (95% CI, 1.01-1.10); and CVD, 1.06 (95% CI, 1.04-1.08). The corresponding incidence rates per 10 000 person-years of follow-up in the highest vs the lowest quintile of CES-D score (geometric mean CES-D score, 19 vs 1) were 36.3 vs 29.0 for CHD events, 28.0 vs 24.7 for stroke events, and 62.8 vs 53.5 for CVD events. Among 401 219 participants from the UK Biobank (55% were women, mean age at baseline, 56 years [SD, 8 years]), 4607 CHD and 3253 stroke events were recorded (median follow-up, 8.1 years). The HR per 1-SD higher depression score for CHD was 1.11 (95% CI, 1.08-1.14); stroke, 1.10 (95% CI, 1.06-1.14); and CVD, 1.10 (95% CI, 1.08-1.13). The corresponding incidence rates per 10 000 person-years of follow-up among individuals with PHQ-2 scores of 4 or higher vs 0 were 20.9 vs 14.2 for CHD events, 15.3 vs 10.2 for stroke events, and 36.2 vs 24.5 for CVD events. The magnitude and statistical significance of the HRs were not materially changed after adjustment for additional risk factors. Conclusions and Relevance: In a pooled analysis of 563 255 participants in 22 cohorts, baseline depressive symptoms were associated with CVD incidence, including at symptom levels lower than the threshold indicative of a depressive disorder. However, the magnitude of associations was modest.


Asunto(s)
Enfermedades Cardiovasculares/psicología , Depresión/complicaciones , Anciano , Enfermedades Cardiovasculares/epidemiología , Estudios de Cohortes , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/psicología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/psicología
5.
Medicine (Baltimore) ; 99(51): e23573, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33371087

RESUMEN

ABSTRACT: To Investigate the recent effects of small dose of folic acid on lipoprotein-associated phospholipase A2 (LP-PLA2) and systolic blood pressure variability in coronary heart disease (CHD) patients with hyperhomocysteinemia.In this prospective cohort study, a total of 167 CHD patients with hyperhomocysteinemia were consecutively enrolled, and they were divided into Group A (without folic acid intervention, n = 99), Group B (with 0.4 mg of folic acid intervention, n = 34), Group C (0.8 mg of folic acid intervention, n = 34). General information, fasting blood glucose, and blood lipid, folic acid, homocysteine, Lp-PLA2, and blood pressure variability were compared among 3 groups. The above indicators were reviewed after 3 months of treatment.There were no statistically significant differences of age, gender, blood pressure, incidence of type 2 diabetes mellitus, fasting blood glucose, folic acid, homocysteine, Lp-PLA2, total cholesterol, 3 acyl glycerin, apolipoprotein B, lipoprotein (a), high density lipoprotein cholesterol, and low density lipoprotein cholesterol were found among 3 groups (P > .05); however, after being treated for 3 months, there was statistically significant difference in folic acid among 3 groups (P < .05), there was statistically significant difference in apolipoprotein A between Group A and Group B (t = 0.505, P = .039), and also between Group A and Group C (t = 0.052, P = .017). There were statistically significant differences in Lp-PLA2 (t = 24.320, P = .016) and systolic blood pressure variability (t = 0.154, P = .018) between Group A and Group C.For CHD patients with hyperhomocysteinemia, the higher dose (0.8 mg) of folic acid supplement was beneficial for increasing the apolipoprotein A, reducing the Lp-PLA2, and improving the systolic blood pressure variation, which might help to improve the prognosis in these patients.


Asunto(s)
Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/epidemiología , Ácido Fólico/farmacología , Ácido Fólico/uso terapéutico , Hiperhomocisteinemia/epidemiología , 1-Alquil-2-acetilglicerofosfocolina Esterasa/efectos de los fármacos , Factores de Edad , Anciano , Apolipoproteínas A/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Ácido Fólico/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores Sexuales
6.
Medicine (Baltimore) ; 99(50): e23195, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327236

RESUMEN

BACKGROUND: Angina pectoris in coronary heart disease (CHD) is a common ischemic heart disease clinically. During the onset, patients often have symptoms such as chest discomfort or paroxysmal crushing pain in the posterior sternum, which seriously affects the quality of life of patients, and even can lead to myocardial infarction and endanger the lives of patients. Clinical studies have shown that the compound Chinese prescription Xuefu Zhuyu decoction combined with western medicine has a certain therapeutic effect on angina pectoris in CHD, but lack of evidence of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of Xuefu Zhuyu decoction combined with western medicine in the treatment of angina pectoris in CHD. METHODS: Use computer to retrieve English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (CNKI, Wan Fang, VIP, Chinese biomedical database), from the establishment of database to October 2020, for randomized controlled trials (RCTs) of Xuefu Zhuyu decoction combined with Western medicine for angina pectoris in CHD. Two investigators independently conducted data extraction and assessed the literature quality of the included studies. The Revman5.3 software was used for meta-analysis of the included literatures. RESULTS: The efficacy and safety of Xuefu Zhuyu decoction combined with western medicine in the treatment of angina pectoris in CHD were evaluated by total effective rate, angina pectoris pain score, TCM syndrome score, electrocardiogram effect, hemorheology index (including whole blood viscosity, plasma viscosity, hematocrit, and fibrinogen), and the incidence of adverse reactions. CONCLUSION: This study will provide reliable evidence-based evidence for the clinical application of Xuefu Zhuyu decoction combined with western medicine in the treatment of angina pectoris in CHD. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605 / OSF.IO / GFEQ7.


Asunto(s)
Angina de Pecho/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Medicamentos bajo Prescripción/uso terapéutico , Angina de Pecho/etiología , Estudios de Casos y Controles , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/epidemiología , Quimioterapia Combinada/métodos , Femenino , Humanos , Masculino , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Seguridad , Resultado del Tratamiento
7.
Medicine (Baltimore) ; 99(46): e23148, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33181686

RESUMEN

To evaluate the perfusion of coronary circulation and its related factors and the difference in the peak filling times in aortic sinus and coronary sinus by coronary computed tomography angiography (CCTA).From January 1 to August 1, 2018, 61 outpatients with angina pectoris were recruited, completed a questionnaire about risk factors and underwent CCTA, which was also used to assess the stenosis of different coronary artery segments.The duration of circulation was 9.50 ±â€Š2.43 seconds in patients with flat T wave, which was shorter than the duration in normal subjects (P = .021). However, other cardiovascular risk factors showed no effect on the duration of circulation. In addition, the duration of circulation was closely related to the peak filling time of coronary sinus [r(s) = 0.681]. We further divided the circulation time difference (delta) values into 3 levels (<6, 6-12, and ≥12 seconds).It showed that the circulation duration (Y) was associated with:Therefore, the cardiac circulation duration was negatively related to the degree of stenosis in the 1 diagonal and proximal LCA.It compensates for the inability of CCTA to assess circulation at rest simply by determining the peak filling time in the aortic sinus and the coronary sinus. Moderate cardiac microcirculation duration was related to a low incidence of clinical symptoms and electrocardiogram disorders, which was determined mainly by the diagonal and left circumflex branch 1 of LCA.


Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad Coronaria , Vasos Coronarios , Circulación Coronaria/fisiología , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/fisiopatología , Estenosis Coronaria/patología , Estenosis Coronaria/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Vasos Coronarios/fisiopatología , Electrocardiografía/métodos , Electrocardiografía/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen de Perfusión Miocárdica/métodos , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
8.
Medicine (Baltimore) ; 99(40): e22334, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33019409

RESUMEN

This study aims to establish a diagnostic model of coronary heart disease (CHD) for diabetic foot (DF) patients.The clinical data of 489 hospitalized patients with DF were retrospectively analyzed in this case-control study. The patients were divided into the CHD group (DF with CHD, n = 212) and the control group (DF without CHD, n = 277). Univariate analysis was performed to screen for CHD-related risk factors, and multivariate logistic regression analysis was conducted to determine significant CHD risk factors. Scores were assigned according to the ratio of risk factors (OR) to establish a diagnostic model of CHD for patients with DF. The area under the ROC curve was used to test the application value of the diagnostic model.The logistic regression analysis showed that the risk factors for CHD in DF patients were age, duration of diabetes, toe-brachial index, hyperuricemia, and chronic renal insufficiency. The area under the ROC curve of the diagnostic model was 0.798 (0.759-0.837), the diagnostic point of CHD was 6 points, the diagnostic sensitivity was 69.3%, and the specificity was 76.5%.The established model has good diagnostic value and provides the basis for preliminary screening for CHD in patients with DF.


Asunto(s)
Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/epidemiología , Pie Diabético/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice Tobillo Braquial , Estudios de Casos y Controles , Femenino , Humanos , Hiperuricemia/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
10.
Biomed Environ Sci ; 33(8): 573-582, 2020 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-32933609

RESUMEN

Objective: To investigate the relationship between human cytomegalovirus (HCMV) infection and peripheral blood CD14 +CD16 + monocytes in the pathogenesis of coronary heart disease (CHD), and to elucidate the mechanism of pathogenesis in CHD by analyzing the correlation between infection, inflammation, and CHD, to provide a basis for the prevention, evaluation, and treatment of the disease. Methods: In total, 192 patients with CHD were divided into three groups: latent CHD, angina pectoris, and myocardial infarction. HCMV-IgM and -IgG antibodies were assessed using ELISA; CD14 +CD16 + monocytes were counted using a five-type automated hematology analyzer; mononuclear cells were assessed using fluorescence-activated cell sorting; and an automatic biochemical analyzer was used to measure the levels of triglyceride, cholesterol, high- and low-density lipoprotein cholesterols, lipoprotein, hs-CRp and Hcy. Results: The positive rates of HCMV-IgM and -IgG were significantly higher in the CHD groups than in the control group. HCMV infection affects lipid metabolism to promote immune and inflammatory responses. Conclusion: HCMV infection has a specific correlation with the occurrence and development of CHD. The expression of CD14 +CD16 + mononuclear cells in the CHD group was increased accordingly and correlated with acute HCMV infection. Thus, HCMV antibody as well as peripheral blood CD14 +CD16 + mononuclear cells can be used to monitor the occurrence and development of CHD.


Asunto(s)
Angina de Pecho/epidemiología , Enfermedad Coronaria/epidemiología , Infecciones por Citomegalovirus/complicaciones , Citomegalovirus/fisiología , Inflamación/epidemiología , Infarto del Miocardio/epidemiología , Angina de Pecho/virología , China/epidemiología , Enfermedad Coronaria/virología , Humanos , Incidencia , Inflamación/etiología , Recuento de Leucocitos , Monocitos/metabolismo , Infarto del Miocardio/virología
11.
BMJ Open ; 10(9): e038976, 2020 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-32948572

RESUMEN

OBJECTIVE: Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. SETTING: A nested case-control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020. PARTICIPANTS: Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province. OUTCOME MEASURES: Patient demographics, survival time and status, and history of comorbidities. METHOD: A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak. RESULTS: Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001). CONCLUSION: Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.


Asunto(s)
Enfermedad Coronaria/epidemiología , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Bronquitis Crónica/epidemiología , Estudios de Casos y Controles , Infarto Cerebral/epidemiología , China/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Fallo Hepático/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Modelos de Riesgos Proporcionales , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Insuficiencia Renal/epidemiología , Adulto Joven
12.
Nutr Metab Cardiovasc Dis ; 30(10): 1706-1713, 2020 09 24.
Artículo en Inglés | MEDLINE | ID: mdl-32811737

RESUMEN

BACKGROUND AND AIMS: Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio may play a role in predicting cardiovascular events. We aimed to prospectively explore the association between the TG/HDL-C ratio and atherosclerotic cardiovascular disease (ASCVD), ischemic stroke, as well as coronary heart disease (CHD) in a Chinese population. METHODS AND RESULTS: This prospective cohort study included 9368 participants from four Chinese populations in the People's Republic of China-United States of America (PRC-USA) Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology. Over a follow-up period of 20 years, 624 cases of ASCVD events including 458 ischemic stroke events and 166 CHD events were recorded. The relationship between the TG/HDL-C ratio and the endpoints was evaluated through multivariate Cox proportional hazard models adjusted for potential confounding variables, including age, sex, urban or rural residence, northern or southern China, occupational type, education, physical exercise, smoking status, drinking status, body mass index, hypertension, high low-density lipoprotein cholesterol, diabetes, and antihypertensive medication use at baseline. With the lowest TG/HDL-C tertile as the reference, the middle and highest tertiles had the hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.13 (0.91, 1.40), 1.36 (1.10, 1.67) respectively for ASCVD (p for trend = 0.0028), and 1.19 (0.93, 1.54),1.47 (1.15, 1.87) respectively for ischemic stroke (p for trend = 0.0016). However, no significant association was found for CHD events. CONCLUSION: TG/HDL-C ratio was positively associated with the risk of ASCVD and ischemic stroke events in the Chinese population.


Asunto(s)
Aterosclerosis/epidemiología , Isquemia Encefálica/epidemiología , HDL-Colesterol/sangre , Enfermedad Coronaria/epidemiología , Dislipidemias/epidemiología , Accidente Cerebrovascular/epidemiología , Triglicéridos/sangre , Adulto , Aterosclerosis/diagnóstico , Aterosclerosis/mortalidad , Biomarcadores/sangre , Isquemia Encefálica/mortalidad , China/epidemiología , Enfermedad Coronaria/mortalidad , Dislipidemias/sangre , Dislipidemias/diagnóstico , Dislipidemias/mortalidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Factores de Tiempo
13.
Rev. esp. cardiol. (Ed. impr.) ; 73(8): 652-659, ago. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-ET1-6256

RESUMEN

INTRODUCCIÓN Y OBJETIVOS: Analizar la supervivencia de los pacientes con insuficiencia cardiaca (IC) tratados en una unidad especializada. MÉTODOS: Estudio prospectivo de una cohorte de pacientes con IC tratados en una unidad especializada entre 2011 y 2017. Se comparó la mortalidad observada a 1 y 3 años con la mortalidad pronosticada por la puntuación de riesgo del Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC). RESULTADOS: Se estudió a 1.280 pacientes, con una mediana de la puntuación MAGGIC de 19 [intervalo intercuartílico, 13-24]. Las tasas de prescripción de bloqueadores beta, inhibidores de la enzima de conversión de la angiotensina, antagonistas del receptor de la angiotensina II, antagonistas del receptor de mineralcorticoides y sacubitrilo-valsartán fueron del 93, el 67, el 22, el 73 y el 16% respectivamente. La puntuación MAGGIC mostró una discriminación adecuada de la mortalidad a 1 año (estadístico c=0,71) y a 3 años (estadístico c=0,76). La mortalidad observada fue significativamente menor que la pronosticada, tanto a 1 año (el 6,2 frente al 10,9%; cociente observada/pronosticada=0,57; p < 0,001) como a 3 años (el 16,7 frente al 27,7%; cociente observada/pronosticada=0,60; p < 0,001). Esta discrepancia se observó en diversos subgrupos, excepto en los pacientes mayores de 70 años (el 29,9 frente al 34,7%; cociente observada/pronosticada=0,86; p = 0,126) y en pacientes con fracción de eyección> 40% (el 19,6 frente al 20,7%; cociente observada/pronosticada=0,95; p = 0,640). CONCLUSIONES: Los pacientes con IC tratados en una unidad especializada presentaron una mortalidad inferior a la pronosticada por la puntuación MAGGIC


INTRODUCTION AND OBJECTIVES: To analyze survival in heart failure (HF) patients treated at a specialized unit. METHODS: Prospective cohort-based study of HF patients treated at a specialized unit from 2011 to 2017. Observed 1- and 3-year mortality rates were compared with those predicted by the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score. RESULTS: We studied 1280 patients, whose median MAGGIC risk score was 19 [interquartile range, 13-24]. Prescription rates of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists, and sacubitril-valsartan were 93%, 67%, 22%, 73%, and 16%, respectively. The MAGGIC risk score showed good discrimination for mortality at 1 year (c-statistic=0.71) and 3 years (c-statistic=0.76). Observed mortality was significantly lower than predicted mortality, both at 1 year (6.2% vs 10.9%; observed/predicted ratio=0.57; P<.001) and at 3 years (16.7% vs 27.7%; observed/predicted ratio=0.60; P<.001). This discrepancy was found in several subgroups, except in patients aged> 70 years (29.9% vs 34.7%; observed/predicted ratio=0.86; P=.126) and in patients with ejection fraction> 40% (19.6% vs 20.7%; observed/predicted ratio=0.95; P=.640). CONCLUSIONS: Mortality in HF patients treated at a specialized clinic was significantly lower than that predicted by the MAGGIC risk score


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Insuficiencia Cardíaca/mortalidad , Corazón Auxiliar/estadística & datos numéricos , Trasplante de Corazón/estadística & datos numéricos , Fármacos Cardiovasculares/uso terapéutico , Enfermedad Coronaria/epidemiología , Infarto del Miocardio/epidemiología , Hipertensión/epidemiología , Unidades de Cuidados Coronarios/estadística & datos numéricos , Análisis de Supervivencia , Factores de Riesgo , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Pronóstico
14.
Biosci Rep ; 40(8)2020 08 28.
Artículo en Inglés | MEDLINE | ID: mdl-32725148

RESUMEN

The new 2019 coronavirus disease (COVID-19), according to the World Health Organization (WHO), has been characterized as a pandemic. As more is being discovered about this virus, we aim to report findings of the complete blood count (CBC) of COVID-19 patients. This would serve in providing physicians with important knowledge on the changes that can be expected from the CBC of mild and normal COVID-19 patients. A total of 208 mild and common patients were admitted at the Dongnan Hospital located in the city of Xiaogan, Hubei, China. The CBCs of these patients, following a confirmed diagnosis of COVID-19, were retrospectively analyzed and a significant P<0.05 was found after a full statistical analysis was conducted using the Statistical Package for the Social Sciences (IBM SPSS). CBC analysis revealed changes in the levels of red blood cells (RBCs), hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), and C-reactive protein (CRP). Clinicians should expect similar findings when dealing with the new COVID-19.


Asunto(s)
Betacoronavirus/patogenicidad , Enfermedad Coronaria/diagnóstico , Infecciones por Coronavirus/diagnóstico , Diabetes Mellitus/diagnóstico , Hipertensión/diagnóstico , Neumonía Viral/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Adulto , Anciano , Enfermedades Asintomáticas , Recuento de Células Sanguíneas , Proteína C-Reactiva/metabolismo , China/epidemiología , Comorbilidad , Enfermedad Coronaria/sangre , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/fisiopatología , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Índices de Eritrocitos , Eritrocitos/patología , Eritrocitos/virología , Femenino , Hematócrito , Hemoglobinas/metabolismo , Humanos , Hipertensión/sangre , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Insuficiencia Respiratoria/sangre , Insuficiencia Respiratoria/epidemiología , Insuficiencia Respiratoria/fisiopatología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
15.
PLoS One ; 15(7): e0235839, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32634156

RESUMEN

Given recent slowing of declines in national all-cause, heart disease, and stroke mortality, examining spatiotemporal distributions of coronary heart disease (CHD) death rates and trends can provide data critical to improving the cardiovascular health of populations. This paper documents county-level CHD death rates and trends by age group, race, and gender from 1979 through 2017. Using data from the National Vital Statistics System and a Bayesian multivariate space-time conditional autoregressive model, we estimated county-level age-standardized annual CHD death rates for 1979 through 2017 by age group (35-64 years, 65 years and older), race (white, black, other), and gender (men, women). We then estimated county-level total percent change in CHD death rates during four intervals (1979-1990, 1990-2000, 2000-2010, 2010-2017) using log-linear regression models. For all intervals, national CHD death rates declined for all groups. Prior to 2010, although most counties across age, race, and gender experienced declines, pockets of increasing CHD death rates were observed in the Mississippi Delta, Oklahoma, East Texas, and New Mexico across age groups and gender, and were more prominent among non-white populations than whites. Since 2010, across age, race, and gender, county-level declines in CHD death rates have slowed, with a marked increase in the percent of counties with increasing CHD death rates (e.g. 4.4% and 19.9% for ages 35 and older during 1979-1990 and 2010-2017, respectively). Recent increases were especially prevalent and geographically widespread among ages 35-64 years, with 40.5% of counties (95% CI: 38.4, 43.1) experiencing increases. Spatiotemporal differences in these long term, county-level results can inform responses by the public health community, medical providers, researchers, and communities to address troubling recent trends.


Asunto(s)
Enfermedad Coronaria/mortalidad , Adulto , Afroamericanos , Factores de Edad , Anciano , Teorema de Bayes , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Análisis Multivariante , Factores Sexuales , Estados Unidos/epidemiología , Estados Unidos/etnología
16.
BMC Public Health ; 20(1): 1034, 2020 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-32600440

RESUMEN

BACKGROUND: A recent community-based disease management (CBDM) pilot study reported a 20.5% prevalence of hypertension and a 0.5 and 3.6% prevalence of stroke and coronary heart disease (CHD), respectively, in an elderly population (mean age 65 years) in the Xin Jiang autonomous region of China. The CBDM was initiated in 2013 as an essential public health service; however, the potential long-term impact of CBDM on cardiovascular (CV: CHD and stroke) events is unknown. The objective of the study was to understand the long-term impact of CBDM interventions on CV risk factors using disease-model simulation based on a single-arm experimental study. METHODS: A discrete event simulation was developed to evaluate the impact of CBDM on the long-term CV risk among patients with hypertension, in China's Xin Jiang autonomous region. The model generated pairs of identical patients; one receives CBDM and one does not (control group). Their clinical courses were simulated based on time to CV events (CHD and strokes), which are estimated using published risk equations. The impact of CBDM was incorporated as improvement in systolic blood pressure (SBP) based on observations from the CBDM study. The simulation estimated the number of CV events over patients' lifetimes. RESULTS: During a 2-year follow up, the CBDM led to an average reduction of 8.73 mmHg in SBP from baseline, and a 42% reduction in smoking. The discrete event simulation showed that, in the control group, the model estimated incidence rates of 276, 1789, and 616 per 100,000 individuals for lifetime CHD, stroke, and CV-related death, respectively. The impact of CBDM on SBP translated into reductions of 8, 28, and 23% in CHD, stroke, and CV-related deaths, respectively. Taking into account CBDM's reduction of both SBP and smoking, deaths from CHD, stroke, and CV-related deaths were reduced by 12, 30, and 26%, respectively. CONCLUSIONS: The implementation of CBDM in China's Xinjiang autonomous region is expected to significantly reduce incidences of CHD, strokes, and CV-related deaths.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Servicios de Salud Comunitaria/estadística & datos numéricos , Enfermedad Coronaria/complicaciones , Hipertensión/complicaciones , Accidente Cerebrovascular/complicaciones , Anciano , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , China/epidemiología , Simulación por Computador , Enfermedad Coronaria/epidemiología , Manejo de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Proyectos Piloto , Factores de Riesgo , Conducta de Reducción del Riesgo , Accidente Cerebrovascular/epidemiología
17.
Chemosphere ; 260: 127399, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32668362

RESUMEN

There is increasingly concern that PM2.5 constituents play a significant role in PM2.5-related cardiovascular outcomes. However, little is known about the associations between specific constituents of PM2.5 and risk for cardiovascular health. To evaluate the exposure to specific chemicals of PM2.5 from various sources and their cardiac effects, a longitudinal investigation was conducted with four repeated measurements of elderly participants' HRV and PM2.5 species in urban Beijing. Multiple chemicals in PM2.5 (metals, ions and PAHs) were characterized for PM2.5 source apportionment and personalized exposure assessment. Five sources were finally identified with specific chemicals as the indicators: oil combustion (1.1%, V & PAHs), secondary particle (11.3%, SO42- & NO3-), vehicle emission (1.2%, Pd), construction dust (28.7%, Mg & Ca), and coal combustion (57.7%, Se & As). As observed, each IQR increase in exposure to oil combustion (V), vehicle emission (Pd), and coal combustion (Se) significantly decreased rMSSD by 13.1% (95% CI: -25.3%, -1.0%), 27.4% (95% CI: -42.9%, -7.6%) and 24.7% (95% CI: -39.2%, -6.9%), respectively, while those of PM2.5 mass with decreases of rMSSD by 11.1% (95% CI: -19.6%, -1.9%) at lag 0. Elevated exposures to specific sources/constituents of PM2.5 disrupt cardiac autonomic function in elderly and have more adverse effects than PM2.5 mass. In the stratified analysis, medication and gender modify the associations of specific chemicals from variable sources with HRV. The findings of this study provide evidence on the roles of influential constituents of ambient air PM2.5 and their sources in terms of their adverse cardiovascular health effects.


Asunto(s)
Contaminantes Atmosféricos/análisis , Enfermedad Coronaria/epidemiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Material Particulado/análisis , Anciano , Beijing/epidemiología , Carbón Mineral , Polvo/análisis , Monitoreo del Ambiente , Femenino , Frecuencia Cardíaca , Humanos , Emisiones de Vehículos/análisis
18.
BMJ ; 370: m2297, 2020 07 15.
Artículo en Inglés | MEDLINE | ID: mdl-32669282

RESUMEN

OBJECTIVE: To evaluate the associations between prediabetes and the risk of all cause mortality and incident cardiovascular disease in the general population and in patients with a history of atherosclerotic cardiovascular disease. DESIGN: Updated meta-analysis. DATA SOURCES: Electronic databases (PubMed, Embase, and Google Scholar) up to 25 April 2020. REVIEW METHODS: Prospective cohort studies or post hoc analysis of clinical trials were included for analysis if they reported adjusted relative risks, odds ratios, or hazard ratios of all cause mortality or cardiovascular disease for prediabetes compared with normoglycaemia. Data were extracted independently by two investigators. Random effects models were used to calculate the relative risks and 95% confidence intervals. The primary outcomes were all cause mortality and composite cardiovascular disease. The secondary outcomes were the risk of coronary heart disease and stroke. RESULTS: A total of 129 studies were included, involving 10 069 955 individuals for analysis. In the general population, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.13, 95% confidence interval 1.10 to 1.17), composite cardiovascular disease (1.15, 1.11 to 1.18), coronary heart disease (1.16, 1.11 to 1.21), and stroke (1.14, 1.08 to 1.20) in a median follow-up time of 9.8 years. Compared with normoglycaemia, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 7.36 (95% confidence interval 9.59 to 12.51), 8.75 (6.41 to 10.49), 6.59 (4.53 to 8.65), and 3.68 (2.10 to 5.26) per 10 000 person years, respectively. Impaired glucose tolerance carried a higher risk of all cause mortality, coronary heart disease, and stroke than impaired fasting glucose. In patients with atherosclerotic cardiovascular disease, prediabetes was associated with an increased risk of all cause mortality (relative risk 1.36, 95% confidence interval 1.21 to 1.54), composite cardiovascular disease (1.37, 1.23 to 1.53), and coronary heart disease (1.15, 1.02 to 1.29) in a median follow-up time of 3.2 years, but no difference was seen for the risk of stroke (1.05, 0.81 to 1.36). Compared with normoglycaemia, in patients with atherosclerotic cardiovascular disease, the absolute risk difference in prediabetes for all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke was 66.19 (95% confidence interval 38.60 to 99.25), 189.77 (117.97 to 271.84), 40.62 (5.42 to 78.53), and 8.54 (32.43 to 61.45) per 10 000 person years, respectively. No significant heterogeneity was found for the risk of all outcomes seen for the different definitions of prediabetes in patients with atherosclerotic cardiovascular disease (all P>0.10). CONCLUSIONS: Results indicated that prediabetes was associated with an increased risk of all cause mortality and cardiovascular disease in the general population and in patients with atherosclerotic cardiovascular disease. Screening and appropriate management of prediabetes might contribute to primary and secondary prevention of cardiovascular disease.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Enfermedad Coronaria/mortalidad , Estado Prediabético/complicaciones , Accidente Cerebrovascular/mortalidad , Anciano , Aterosclerosis/complicaciones , Aterosclerosis/epidemiología , Aterosclerosis/mortalidad , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/patología , Enfermedades Cardiovasculares/prevención & control , Estudios de Casos y Controles , Ensayos Clínicos como Asunto , Enfermedad Coronaria/epidemiología , Femenino , Humanos , Incidencia , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Persona de Mediana Edad , Estudios Observacionales como Asunto , Estado Prediabético/epidemiología , Riesgo , Factores de Riesgo , Prevención Secundaria/métodos , Accidente Cerebrovascular/epidemiología
19.
Eur J Clin Microbiol Infect Dis ; 39(12): 2309-2315, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32683596

RESUMEN

During the COVID-19 outbreak, the mobile cabin hospital has effectively isolated and treated patients diagnosed as mild-moderate disease. However, a detailed clinical course has not been well described. We included 483 patients who were isolated and treated from Feb 6, 2020, to Feb 15, 2020, including definite outcome (discharge or deterioration). Sixty-two patients were transferred to severe cases, of whom were trasfered to designated hospital for intensive care. By March 9, 2020, all patients were discharged without dead. The mobile cabin hospital provides feasible strategy of isolation of mild-moderate cases and timely intervention during the virus outbreak.


Asunto(s)
Enfermedad Coronaria/diagnóstico , Infecciones por Coronavirus/diagnóstico , Enfermedades Pulmonares/diagnóstico , Pandemias , Alta del Paciente/estadística & datos numéricos , Aislamiento de Pacientes/métodos , Neumonía Viral/diagnóstico , Anciano , Betacoronavirus/patogenicidad , Índice de Masa Corporal , China/epidemiología , Técnicas de Laboratorio Clínico , Comorbilidad , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/fisiopatología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/fisiopatología , Masculino , Persona de Mediana Edad , Unidades Móviles de Salud , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
20.
Int J Antimicrob Agents ; 56(4): 106093, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32653618

RESUMEN

This study was conducted to assess the spread of SARS-CoV-2 in Russia and the adaptation of the population to the virus in March to June 2020. Two groups were investigated: 1) 12 082 individuals already proven positive for SARS-CoV-2 (clinical information was studied); 2) 7864+4458 individuals with suspected respiratory infections (polymerase chain reaction [PCR] tests and clinical information were studied). In the latter, SARS-CoV-2-positive individuals comprised 5.37% in March and 11.42% in June 2020. Several viral co-infections were observed for SARS-CoV-2. Rhinoviruses accounted for the largest proportion of co-infections (7.91% of samples were SARS-CoV-2-positive); followed by respiratory syncytial virus (7.03%); adenoviruses (4.84%); metapneumoviruses (3.29%); parainfluenza viruses (2.42%); enterovirus D68 (1.10%) and other viruses (entero-, echo-, parecho-) (<1%). Average SARS-CoV-2 case fatality rate in the group of 12 537 individuals was determined to be 0.6% (in contrast to official Russian government statistics of 1.5% mortality). This rate is within the range of mortality caused by other common seasonal respiratory viruses (0.01-2.21% in Russia in 2012 to 2020). Most fatalities occurred in individuals with comorbidities, as for other respiratory viruses. The proportion of SARS-CoV-2 asymptomatic carriers was 56.68% in March and 70.67% in June 2020. This new pathogen presents a substantial risk to human beings as it was not contained at the start of its outbreak in Wuhan and spread worldwide. However, surveillance, prevention and treatment must be strictly evidence-based and not dictated by fear.


Asunto(s)
Betacoronavirus/patogenicidad , Enfermedades Cardiovasculares/epidemiología , Enfermedad Coronaria/epidemiología , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/epidemiología , Obesidad/epidemiología , Pandemias , Neumonía Viral/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades Asintomáticas , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Niño , Preescolar , Comorbilidad , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/mortalidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidad , Miedo/psicología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/mortalidad , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/mortalidad , Infecciones del Sistema Respiratorio/transmisión , Estudios Retrospectivos , Federación de Rusia/epidemiología , Índice de Severidad de la Enfermedad , Análisis de Supervivencia
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