[Comparison of angiography-guided and fractional flow reserve-guided management strategy of percutaneous coronary intervention for intermediate coronary lesions]

OBJECTIVE

To compare the consistency of angiography-guided and fractional flow reserve (FFR)-guided management strategy for intermediate coronary lesions.

METHODS

The patients whose coronary intermediate lesions were assessed by measuring FFR from November 2012 to August 2014. The stenosis percentage and value of FFR during the procedure were collected. All the image data were collected and four experienced interventional cardiologists were invited to assess the target lesions and make a management strategy independently. The consistency of angiography-guided and fractional flow reserve-guided management strategy were analyzed.

RESULTS

In the study, 151 patients were included, of whom, 70.2% were male, the average age was (62.7±9.6) years, 169 vessels were assessed by measuring FFR, 1 being left main, 116 left anterior descending, 27 left circumflex branch, and 25 right coronary artery. There were some correlationship between the stenosis percentage judged by four interventional cardiologists and the stenosis percentage judged during the procedure (r=0.29-0.38, P<0.001), but the difference was significant. When 0.80 was used as FFR threshold value, the consistency rates of angiography-guided management strategy decision made by the four cardiologists with fractional flow reserve-guided management strategy were 72.78%, 71.60%, 75.15%, and 72.78%, respectively.

CONCLUSION

Angiography-guided management strategy decision is unreliable, FFR is recommended for management strategy decision for intermediate coronary lesions.

Distribution and determinants of plasma homocysteine levels in rural Chinese twins across the lifespan

Plasma homocysteine (Hcy) is a modifiable, independent risk factor for cardiovascular disease (CVD) and is affected by both environmental and genetic factors. This study aimed to describe the gender- and age-specific distribution of Hcy concentration for 1117 subjects aged 10–66 years, a subset of a community-based rural Chinese twin cohort. In addition, we examined environmental and genetic contributions to variances in Hcy concentration by gender and age groups. We found that the distribution pattern for Hcy varied by both age and gender. Males had higher Hcy than females across all ages. Elevated Hcy was found in 43% of male adults and 13% of female adults. Moreover, nearly one fifth of children had elevated Hcy. Genetic factors could explain 52%, 36% and 69% of the variation in Hcy concentration among children, male adults and female adults, respectively. The MTHFR C677T variant was significantly associated with Hcy concentrations. Smokers with the TT genotype had the highest Hcy levels. Overall, our results indicate that elevated Hcy is prevalent in the children and adults in this rural Chinese population. The early identification of elevated Hcy will offer a window of opportunity for the primary prevention of CVD and metabolic syndrome.

[The 10-year stroke risk in hypertensive outpatients combined with diabetes in cardiovascular clinics of 36 tertiary hospitals in China]

OBJECTIVE

To assess the estimated 10-year risk of stroke among hypertensive outpatients known with diabetes from cardiovascular clinics of 36 tertiary hospitals in China and to analyze the characteristics of the risk factors and the 10-year risk of stroke between the southern and the northern patients.

METHODS

A multi-center prevalence survey was conducted from October 2011 to June 2012. Hypertensive outpatients known with diabetes were enrolled from cardiovascular clinics of 36 tertiary hospitals in China. A total of 15 914 outpatients were included in the final analysis. The 10-year probability of stroke was evaluated by the Framingham stroke risk profile. According to the 10-year probability of stroke, patients were divided into low risk ( ≤ 5%), medium risk (6%∼9%) and high risk ( ≥ 10%).

RESULTS

(1) Of all the hypertensive outpatients known with diabetes, the mean age was (64.6 ± 10.1) years and the mean systolic pressure was (138.7 ± 19.3) mmHg (1 mmHg = 0.133 kPa). Among them, 7.4% with atrial fibrillation, 11.2% with left ventricular hypertrophy, 57.2% with cardiovascular diseases, 17.1% smokers and 37.0% using mono-hypoglycemic agent. The southern patients who were older with more smokers had higher proportions of men and left ventricular hypertrophy, lower levels of systolic blood pressure, and lower proportions of other cardiovascular diseases than those of the northern patients ( all P < 0.05). (2) The mean 10-year probability of stroke was (20.9 ± 16.2) %. The southern patients had a higher mean 10-year probability of stroke than that of the northern patients [(22.4 ± 17.1) % vs (19.7 ± 15.2) %] (P < 0.01) . After adjusted by age and sex, the southern patients still had a higher mean 10-year probability of stroke (P < 0.05) . (3) All the patients had 7.7% with low risk, 17.4% with medium risk, and 74.9% with high risk. The southern patients had lower proportions of low and medium risk than those of the northern patients (6.7% vs 8.4%, 15.5% vs 18.9%), but had a higher proportion of high risk than that of the northern patients (77.7% vs 72.7%, all P < 0.01).

CONCLUSIONS

Among the hypertensive outpatients known with diabetes from the cardiovascular clinics of our study, most of them were at the 10-year high risk of stroke. The southern patients had a higher mean 10-year probability of stroke than that of the northern patients.

Age, arterial stiffness, and components of blood pressure in Chinese adults

Blood pressure (BP) changes with age. We conducted a cross-sectional study in rural Chinese adults to investigate: (1) what is the relationship between age, arterial stiffness, and BP in Chinese men and women; and (2) to what degree can the age-BP relationship be explained by arterial stiffness, controlling for other covariables. These analyses included a total of 1688 subjects (males/females: 623/1065), aged 40 to 88 years. Among them, 353 (20.9%) had hypertension (defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg). Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV). baPWV appeared to be more strongly correlated with BP (including SBP, DBP, mean arterial pressure [MAP], pulse pressure [PP]) than age (P < 0.001 for comparisons between Spearman correlation coefficients). Furthermore, baPWV was associated with BP (including SBP, DBP, MAP, and PP) and risk of hypertension in a dose-response fashion, independent of age; in contrast, the age-BP associations were either attenuated or became negative after adjusting for baPWV. Arterial stiffness appears to be an independent contributor to hypertension, even after adjusting for age and other covariables. In contrast, age-BP associations became attenuated or negative after adjusting for baPWV. The utility of baPWV as a diagnostic, prognostic, and therapeutic indicator for hypertension warrants further investigation.

Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group

Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.

Interaction of type 2 diabetes mellitus with chromosome 9p21 rs10757274 polymorphism on the risk of myocardial infarction: a case-control study in Chinese population

Background

Myocardial infarction (MI) is a serious complication of Coronary Artery Disease (CAD). Previous studies have identified genetic variants on chromosome 9p21 and 6p24 that are associated with CAD, but further studies need to be conducted to investigate whether these genetic variants are associated with the pathogenesis of MI. We therefore performed this study to assess the association between the risk of MI and SNP rs10757274 on chromosome 9p21 and SNP rs6903956 on chromosome 6p24, and to explore the gene-environment interactions in a Chinese population.

Methods

A hospital-based case–control study, consisting of 502 MI patients and 308 controls, was conducted in a Chinese population. Demographic, behavioral information and clinical characteristics were collected, and genotyping of the two SNPs was performed using single base primer extension genotyping technology. The unconditional logistic regression (ULR) method was adopted to assess the association of the two SNPs with MI risk. Both generalized multifactor dimensionality reduction (GMDR) and ULR methods were applied to explore the effect of gene-environment interactions on the risk of MI.

Results

After adjusting for covariates, it was observed that SNP rs10757274 on chromosome 9p21 was significantly associated with MI. Compared with subjects carrying the AA genotype, subjects carrying the GA or GG genotypes had a higher MI risk (OR_a = 1.52, 95% CI:1.06–2.19, p_a = 0.0227; OR_a = 2.40, 95% CI:1.51–3.81, p_a = 0.0002, respectively). Furthermore, a two-factor gene-environment interaction model of CDKN2A/B (rs10757274) and type 2 diabetes mellitus (T2DM) was identified to be the best model by GMDR (p = 0.0107), with a maximum prediction accuracy of 59.18%, and a maximum Cross-validation Consistency of 10/10. By using the ULR method, additive interaction analysis found that the combined effect resulted in T2DM-positive subjects with genotype GG/GA having an MI risk 4.38 times that of T2DM-negative subjects with genotype AA (OR_add = 4.38, 95% CI:2.56–7.47, p_add < 0.0001).

Conclusions

These results show that gene polymorphism of CDKN2A/B (rs10757274) is associated with MI risk in a Chinese population. Furthermore, T2DM is likely to have an interaction with CDKN2A/B (rs10757274) that contributes to the risk of MI.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2261-14-170) contains supplementary material, which is available to authorized users.

Predictors of one-year mortality at hospital discharge after acute coronary syndromes: A new risk score from the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) study

Aims:

A reliable prediction tool is needed to identify acute coronary syndrome (ACS) patients with high mortality risk after their initial hospitalization.

Methods:

EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients: NCT01171404) is a prospective cohort study of 10,568 consecutive hospital survivors after an ACS event (4943 ST-segment elevation myocardial infarction (STEMI) and 5625 non-ST-elevation ACS (NSTE-ACS)). Of these cases, 65.1% underwent percutaneous coronary intervention (PCI) and 2.5% coronary artery bypass graft (CABG). Post-discharge mortality was recorded for up to two years. From over 50 potential predictor variables a new risk score for one-year mortality was developed using forward stepwise Cox regression, and examined for goodness-of-fit, discriminatory power, and external validation.

Results:

A total of 407 patients (3.9%) died within one year of discharge. We identified 12 highly significant independent predictors of mortality (in order of predictive strength): age, lower ejection fraction, poorer EQ-5D quality of life, elevated serum creatinine, in-hospital cardiac complications, chronic obstructive pulmonary disease, elevated blood glucose, male gender, no PCI/CABG after NSTE-ACS, low hemoglobin, peripheral artery disease, on diuretics at discharge. When combined into a new risk score excellent discrimination was achieved (c-statistic=0.81) and this was also validated on a large similar cohort (9907 patients) in Asia (c=0.78). For both STEMI and NSTE-ACS there was a steep gradient in one-year mortality ranging from 0.5% in the lowest quintile to 18.2% in the highest decile. NSTE-ACS contributes over twice as many high-risk patients as STEMI.

Conclusions:

Post-discharge mortality for ACS patients remains of concern. Our new user-friendly risk score available on www.acsrisk.org can readily identify who is at high risk.

Correlation between fragmented QRS and the short-term prognosis of patients with acute myocardial infarction

This study is aimed to investigate the clinical significance and the short-term prognostic value of fragmented QRS (fQRS) for patients with acute myocardial infarction (AMI). Three hundred patients with AMI were tested with retrospective analysis on the patients' clinical information, hospitalized treatment, fQRS onset time, location of lesions, and other relevant data, in order to assess the relationship between the presence of fQRS and its prognosis. The rates of malignant cardiac arrhythmia, left ventricular systolic dysfunction (LVSD), and mortality in the positive fQRS group were 13.6%, 29.2%, and 23.7%, respectively, with all showing a p value <0.05. For the ST segment elevation myocardial infarction (STEMI) subgroup, all the rates showed significant differences with a p value <0.01, while for the non-STEMI (NSTEMI) subgroup showed no significant differences. In patients with a positive fQRS, there were no differences in malignant cardiac arrhythmia between patients with and without percutaneous coronary intervention (PCI) (p>0.05). As for the LVSD and mortality, the p values between patients with and without PCI were 0.031 and 0.000, respectively, suggesting statistical significance. The results imply that AMI patients with positive fQRS especially for the patients with STEMI had higher rates of malignant cardiac arrhythmia, LVSD, and mortality than the non-fQRS group. Patients of AMI with positive fQRS, who underwent early revascularization, could lower the incidence of the cardiovascular event. In addition, the presence of fQRS could be used as an indication of early intervention treatment for patients.

[Speckle tracking analysis of left atrial phasic function in patients with hypertension]

OBJECTIVE

To assess left atrial (LA) phasic function in hypertension (HT) and to evaluate its relationship with left ventricular diastolic function.

METHODS

Cross-sectional data of 738 population (149 non-HT as control, and 589 HT were further grouped into normal left ventricular diastolic function, mild diastolic dysfunction and moderate/severe diastolic dysfunction sub-groups) in an urban community of Beijing were used. LA global longitudinal strain in late diastole (Sa), early diastole (Se), and total strain (Stot = Sa+ Se), strain rate in late diastole (SRa), systole (SRs), and early diastole (SRe) were measured using off-line speckle-tracking echocardiography analyzing software, and were compared between non-HT and HT groups, and among HT sub-groups.

RESULTS

LA reservoir [Stot: 22.7% ± 5.9% vs. 21.0% ± 5.8%, P = 0.002; SRs: (1.1 ± 0.3)/s vs. (1.0 ± 0.3)/s, P = 0.033] and conduit [Se: 11.1% ± 4.8% vs. 9.6% ± 4.2%, P = 0.001; SRe: (1.0 ± 0.4)/s vs. (0.9 ± 0.3)/s, P < 0.001] indexes were reduced significantly in HT, while contraction (Sa & SRa) indexes were similar to those of non-HT.

CONCLUSION

LA reservoir and conduit functions are impaired in HT and deteriorate with left ventricular diastolic dysfunction. LA contraction is preserved in HT with normal and mild diastolic dysfunction while impaired in moderate/severe diastolic dysfunction.

[Synergistic effect of hypertension and aging on left atrial volume and function]

OBJECTIVE

To assess the effect of combined hypertension (HT) and aging on left atrial (LA) size and phasic function.

METHODS

This evaluation was based on the data from a cross-sectional study including 738 subjects with high risk for cardiovascular disease from an urban community in Beijing. Subjects were divided into 3 groups according to age (41-59, 60-69 and ≥ 70 years) and further into HT and non-HT sub-groups. LA volume index were calculated and LA global longitudinal strain in late diastole (Sa), early diastole (Se), and total strain (Stot = Sa+ Se), and strain rate in late diastole (SRa), systole (SRs), and early diastole (SRe) were measured using off-line speckle-tracking echocardiography.

RESULTS

LA volume index increased significantly in HT groups with aging, whereas no changes could be viewed in non-HT subjects among all age groups. LA conduit index (Se and SRe) decreased with aging in both HT and non-HT subjects with more sever in HT subjects than in non-HT subjects in all age groups. The LA conduit index in 41-59 year-HT, and in 60-69 year-HT subjects were comparable with that in 60-69 year-non-HT subjects [Se (11.0 ± 4.4)% vs (11.6 ± 4.7)%, SRe (1.0 ± 0.4) s(-1) vs (1.0 ± 0.3) s(-1)], and in ≥ 70 year-non-HT subjects [Se(10.1 ± 4.0)% vs (9.5 ± 5.4)%, SRe (0.9 ± 0.3)s(-1) vs (0.8 ± 0.4) s(-1)], respectively. LA reservoir (Stot and SRs) and contraction (Sa and SRa) index also decreased with aging in HT but not in non-HT subjects.

CONCLUSIONS

Aging along does not lead to LA enlargement in subects, but it does when combined HT. There is synergistic effect of HT and aging on LA volume and phasic function.

Effects of long-term averaging of quantitative blood pressure traits on the detection of genetic associations

Blood pressure (BP) is a heritable, quantitative trait with intraindividual variability and susceptibility to measurement error. Genetic studies of BP generally use single-visit measurements and thus cannot remove variability occurring over months or years. We leveraged the idea that averaging BP measured across time would improve phenotypic accuracy and thereby increase statistical power to detect genetic associations. We studied systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) averaged over multiple years in 46,629 individuals of European ancestry. We identified 39 trait-variant associations across 19 independent loci (p < 5 × 10(-8)); five associations (in four loci) uniquely identified by our LTA analyses included those of SBP and MAP at 2p23 (rs1275988, near KCNK3), DBP at 2q11.2 (rs7599598, in FER1L5), and PP at 6p21 (rs10948071, near CRIP3) and 7p13 (rs2949837, near IGFBP3). Replication analyses conducted in cohorts with single-visit BP data showed positive replication of associations and a nominal association (p < 0.05). We estimated a 20% gain in statistical power with long-term average (LTA) as compared to single-visit BP association studies. Using LTA analysis, we identified genetic loci influencing BP. LTA might be one way of increasing the power of genetic associations for continuous traits in extant samples for other phenotypes that are measured serially over time.

Rationale for and design of the Acarbose Cardiovascular Evaluation (ACE) trial

Patients with cardiovascular disease and impaired glucose tolerance are at increased risk of cardiovascular events and type 2 diabetes mellitus (T2DM). Lifestyle modification or pharmacological intervention can delay progression to T2DM, but there is no clear evidence that they reduce cardiovascular risk in this population. Acarbose, an α-glucosidase inhibitor that lowers postprandial blood glucose, has been shown to reduce T2DM risk by 25%, and possibly cardiovascular risk in impaired glucose tolerance subjects without cardiovascular disease.

[Correlation between anthropometric parameters and arteriosclerosis biomarker in the middle-aged and the elderly]

OBJECTIVE

To investigate the correlation between anthropometric indices and arteriosclerosis detection indicators in the middle-aged and the elderly.

METHODS

A cross-sectional descriptive study was made of 1 626 individuals (diabetics patients 23.37%, hypertensive subjects 39.48% and healthy individuals 37.15%), aged 45 to 90 years [mean age: (61.60 ± 10.22) years)] in Shijingshan District, Beijing. Their measurements: body mass index (BMI), waist circumference (WC), and waist to height ratio (WHtR). Arterial stiffness was assessed according to brachial-ankle pulse wave velocity (baPWV), intima-media thickness (IMT), augmentation index (AI) and ankle-brachial index (ABI), which were measured by noninvasive detectors and equipment. The correlations between the various indicators were analyzed.

RESULTS

The percentages of the hypertensive and diabetic groups of central obesity (male WC>85 cm, female WC>80 cm or WHtR>0.5) and of general obesity (BMI>28 kg/m²) were significantly higher than those of the healthy group (P<0.01). The difference between the two disease groups was not significant (P>0.05). There was a moderate positive correlation between the measures of abdominal obesity (WHtR and WC) and the general obesity indicators (BMI) (r=0.710 and 0.716). In the healthy group, WC and WHtR showed positive correlation with baPWV, IMT and ABI, and negative correlation with AI75. BMI showed positive correlation with IMT and negative correlation with AI75, and no correlation with baPWV and ABI. There was negative correlation between BMI and baPWV in the diabetic group. In the hypertension group, we found negative correlation between BMI and baPWV, maximum IMT, AI75, and also between WC and AI75. The simple regression straight line of baPWV versus the anthropometric parameters showed that the regression equations were y=0.949+1.379 x (baPWV vs. WHtR, R² = 0.046, P<0.001) and y=1.133+0.006x (baPWV vs. WC, R² = 0.027, P<0.001), respectively. baPWV and BMI did not have a linear relationship (P=0.62).

CONCLUSION

WHtR and WC are superior to BMI indices in predicting arteriosclerosis. Anthropometric measurements for central obesity are good predictors of cardiovascular risk.

Association of Carotid Intima-media Thickness and Atherosclerotic Plaque with Periodontal Status

Studies have suggested an association between clinical/subclinical atherosclerosis and periodontal status. The purpose of this study was to investigate the association among maximal carotid intima-media thickness (cIMT), atherosclerotic plaque, and periodontal status in Chinese elderly patients. A cross-sectional study was conducted of 847 participants (age, 70.64 ± 9.03 yr) with ≥10 teeth. A questionnaire survey, routine biochemical tests, a periodontal examination, and maximal cIMT measurement were performed for each. Traditional risk factors for atherogenesis were considered in the statistical analysis. Mean plaque index, which reflects oral hygiene, was correlated with maximal cIMT and atherosclerotic plaque in the study sample overall (β = 0.068, p < .001; OR = 2.051, p < .001) and in euglycemic participants (β = 0.066, p = .008; odds ratio = 2.122, p = .009). In hyperglycemic participants, multiple linear regression analysis (p = .006) and multivariate logistic regression analysis (p = .025) revealed a linear and dose-dependent association between mean clinical attachment loss and maximal cIMT after adjustment for traditional risk factors. Each 1-mm increase in mean clinical attachment loss corresponded to a 0.018-mm increase in maximal cIMT. The risk of atherosclerotic plaque increased by 18.3% with each 1-mm increase in mean clinical attachment loss. Other indicators of periodontal exposure, including percentage of sites with attachment loss ≥ 3 to 5 mm (3%-5%), were also correlated with cIMT and atherosclerotic plaque in hyperglycemic patients. In this elderly population, a linear and dose-dependent association among mean clinical attachment loss, attachment loss 3% to 5%, maximal cIMT, and atherosclerotic plaque was verified in those with hyperglycemia. Poor oral hygiene was correlated with maximal cIMT and atherosclerotic plaque in all participants, including those with normal blood glucose.

[Relationship between high normal blood pressure and carotid artery atherosclerosis in Beijing residents]

OBJECTIVE

To analyze the relationship between normal high blood pressure and carotid artery atherosclerosis.

METHODS

This epidemiological survey was performed in two communities of Shijingshan District of Beijing from 2007 to 2008. A total of 3 324 people were enrolled in the study and 2 895 people with carotid ultrasound survey results were analyzed. Blood lipids, blood pressure, hs-CRP, body mass index (BMI) and other cardiovascular risk factors were obtained. Carotid mean intima-media thickness (IMT) , maximum carotid IMT and carotid plaque were measured by ultrasound. A multiple logistic regression model was used to evaluate the relationship between normal high blood pressure and carotid artery atherosclerosis.

RESULTS

The carotid mean IMT, maximum IMT, incidence of carotid artery plaque increased in proportion to blood pressure level (all P < 0.01) . After adjusting for diabetes, hypercholesterolemia, hypertriglyceridemia, increased hs-CRP, smoking, sex, age, overweight and obesity, multiple logistic regression analysis showed that the OR values of carotid mean IMT and maximum IMT thickening, carotid plaque in high normal blood pressure group were 4.50 (95% CI: 1.04-19.49, P < 0.05), 1.73 (95% CI: 1.35-2.22, P < 0.01), 1.64 (95% CI:1.26-2.13, P < 0.01) compared to normal blood pressure group.

CONCLUSION

High normal blood pressure is related with higher risk of carotid artery atherosclerosis in this cohort.

Connective tissue disease-associated pulmonary arterial hypertension in Chinese patients

We sought to investigate the characteristics, survival and risk factors for mortality in Chinese patients with connective tissue disease (CTD)-associated pulmonary arterial hypertension (APAH) in modern therapy era.

129 consecutive adult patients who visited one of three referral centres in China with a diagnosis of CTD-APAH confirmed by right heart catheterisation during the previous 5 years were enrolled. The end-point was all-cause death or data censoring.

Systemic lupus erythematosus was the most common underlying CTD (49%) and systemic sclerosis just accounted for 6% in this cohort. The overall survival at 1 and 3 years was 92% and 80%, respectively. Pericardial effusion, a shorter 6-min walk distance, lower mixed venous oxygen saturation, higher pulmonary vascular resistance (PVR) and alkaline phosphatase (ALP), and lower total cholesterol levels were all associated with a higher risk of death among the study population. Higher PVR and ALP were independent predictors of mortality.

In conclusion, unlike in western patients, systemic lupus erythematosus is the most common underlying disease in Chinese patients with CTD-APAH. The survival of Chinese patients with CTD-APAH in the modern treatment era is similar to that in western countries. Elevated PVR and ALP are independent risk factors for poor outcomes.

Regulators of G protein signaling are up-regulated in aspirin-resistant platelets from patients with metabolic syndrome

G protein-coupled receptor signaling plays a crucial role in platelet function. Regulators of G protein signaling (RGSs), which accelerate the deactivation of G protein signaling, are expressed in platelets. However, RGS expression has not been studied in the context of aspirin resistance. We compared RGS mRNA levels in platelets from 39 aspirin-resistant patients and 50 aspirin-sensitive patients with metabolic syndrome. Although there were no clinical differences between the two groups, transcripts of RGS2, RGS10, and RGS18 were significantly higher in aspirin-resistant patients than in aspirin-sensitive patients. This study is the first to demonstrate that RGS transcripts are elevated in aspirin-resistant platelets from patients with metabolic syndrome.

A novel high nitrogen nickel-free coronary stents system: evaluation in a porcine model

OBJECTIVE

To study the safety of the novel high nitrogen nickel-free austenitic stainless steel bare metal stents (BMS) in a recognized porcine coronary model and to select a better grid structure of it.

METHODS

Three types of stents were randomly implanted in different coronary arteries of the same pig: 316 L stainless steel BMS (316 L-BMS) (n=12), novel high nitrogen nickel-free stents Grid A (NF-A-BMS) (n=12) and novel high nitrogen nickel-free stents Grid B (NF-B-BMS) (n=12). In total, eighteen animals underwent successful random placement of 36 oversized stents in the coronary arteries. Coronary angiography was performed after 36 d of stents implantation. Nine animals were respectively sacrificed after 14 d and 36 d for histomorphologic analysis.

RESULTS

Quantitative coronary angiography (QCA) showed similar luminal loss (LL) in the three groups: (0.21 ± 0.17) mm for 316 L-BMS, (0.16 ± 0.12) mm for NF-A-BMS, (0.24 ± 0.15) mm for NF-B-BMS (P>0.05). Histomorphomeric analysis after 15 d and 36 d revealed that there was also no significant difference among the three groups in neointimal area (NA) with similar injury scores respectively. High magnification histomorphologic examination showed similar inflammation scores in the three groups, but NF-A-BMS group had poorer endothelialization scores compared with NF-B-BMS group, 2.00 ± 0.63 vs. 2.83 ± 0.41 (P=0.015) at 15 d, which also could be proved by the scanning electron microscope. However, the difference could not been observed at 36 d.

CONCLUSION

The novel NF-BMS showed similar safety as 316 L-BMS during the short-term study. NF-B-BMS had better endothelialization than NF-A-BMS and this may owe to the specific strut units.

Factors underlying the association of body mass index with serum ALT in Chinese hypertensive adults without known hepatic diseases

OBJECTIVE

High body mass index (BMI) is considered as the most important risk factor for elevated serum alanine aminotransferase (ALT) concentration. This study examined an array of factors, including waist circumference (WC) and folate deficiency, which may mediate the association of BMI with serum ALT concentration in Chinese hypertensive adults without known hepatic diseases.

METHODS

A multicenter, cross-sectional study was carried out. A total of 378 patients with mild or moderate hypertension and without known hepatic diseases were recruited from five hospitals in Harbin, Shanghai, Beijing, Xi'an, and Nanjing.

RESULTS

Of the 360 hypertensive patients with complete data in our final analysis, 13.6% had high ALT concentrations (>40 IU/L). Factors including BMI, WC, triglyceride level, and folate concentration were associated with ALT concentration in univariate analysis. Consistently higher prevalence rates of elevated ALT were observed in subjects with lower folate concentrations (≥12 vs. <12 nmol/L, 9.9% vs. 17.8%, P=0.03), with higher BMI (≥28 vs. <28 kg/m(2), 21.5% vs. 11.4%, P=0.02) or higher WC (≥90 vs. <90 cm, 18.5% vs. 10.0%, P=0.02). However, in multivariate analysis, the association between BMI and ALT concentration disappeared (P=0.802 in males and 0.369 in females), while WC in females (P<0.001) and folate concentration (P=0.036 in males and 0.044 in females) remained as significant predictors for ALT concentration.

CONCLUSIONS

This multicenter study demonstrated that WC and low folate concentration were important factors underlying the association between BMI and ALT concentrations in Chinese hypertensive adults without known hepatic diseases.

[A cross-sectional study of factors related to traditional Chinese medicine use for hospitalized acute coronary syndrome patients in China's level 2 hospitals]

OBJECTIVE

To explore the current status on traditional Chinese medicine (TCM) use for hospitalized acute coronary syndrome patients in China's level 2 hospitals, and to explore associated factors of TCM use for these patients.

METHODS

This survey was performed in 102 level 2 hospitals from 15 provinces or autonomous region in China. Patients admitted to these hospitals with acute coronary syndrome during September 2011 to May 2012 were eligible for this study. Information on TCM use was obtained from their medical records. Chi-square test and logistic regression analysis were used to explore the related factors of TCM use in these patients.

RESULTS

We recruited 5 432 acute coronary syndrome patients in this study, TCM was applied to 3 503 patients (64.5%). Multivariable logistic regression showed that pre-hospital TCM use was positively related with in-hospital TCM use (OR = 2.08, P < 0.01) , while pre-hospital use of 4 medicines recommended by the guidelines(including aspirin/clopidogrel, β acceptor blocker, stain and angiotensin converting enzyme inhibitor/angiotensin converting enzyme receptor blocker ), being a smoker and diagnosis of myocardial infarction rather than unstable angina at hospital discharge were negatively related with in-hospital TCM use (the ORs were 0.58, 0.78 and 0.71, respectively, all P < 0.01). The TCM use varied significantly between regions. Taking southwest region as a reference, the ORs varied between 2.98-13.37 (all P < 0.01) in eastern China, south China, central China, north China, northwest and northeast regions.

CONCLUSIONS

TCM is widely used in hospitalized acute coronary syndrome patients in China's resource-constrained level 2 hospitals. Pre-hospital TCM use is positively correlated with in-hospital TCM use for these patients.

Predicting Hyperhomocysteinemia by Methylenetetrahydrofolate Reductase C677T Polymorphism in Chinese Patients With Hypertension

OBJECTIVE

To evaluate the performance of methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism in predicting hyperhomocysteinemia (HHcy) in Chinese patients with hypertension.

METHODS

We measured plasma total homocysteine tHcy level and C677T genotype in 1058 Chinese patients with hypertension from 4 previous studies. We used 10, 15, and 20 μmol/L as cutoff values for the definition of mild, modest, and severe HHcy, respectively. Logistic models for HHcy were built from the study sample using the C677T genotype as well as age and gender as predictors. The receiver-operating characteristics of the models were evaluated.

RESULTS

Our major findings are that (1) C677T TT genotype is consistently associated with a higher tHcy across the 4 studies, with an increase in size ranging from 38% to 68% in the 4 studies and 51% overall. The C677T polymorphism independently explained about 14% of the total variance of the normalized tHcy. (2) The TT genotype is associated with a large increase in odds ratio (OR) for HHcy. Overall, the multivariate-adjusted ORs for the TT genotype are 3.9 (95% confidence interval [CI]: 2.4-6.4), 6.5 (95% CI: 4.0-10.6), and 17.9 (95% CI: 8.4-38.1) for mild, modest, and severe HHcy, respectively. (3) Overall, the predicting performance increased with HHcy severity, with sensitivity improving from 31.0% for mild HHcy to 70.3% for severe HHcy, and with specificity slightly decreasing from 85.4% to 80.3%. Inclusion of gender and age as predictors significantly improves the sensitivity, especially for predicting mild HHcy.

CONCLUSION

With an excellent sensitivity and a modest specificity, C677T could be a useful screening marker for severe HHcy.

Folic acid supplementation with and without vitamin B6 and revascularization risk: a meta-analysis of randomized controlled trials

BACKGROUND & AIMS

There is a growing amount of data and a continuing controversy over the effect of folic acid supplementation with and without vitamin B6 on revascularization risk.

METHODS

We conducted a meta-analysis based on up-to-date published relevant randomized trials to further examine this issue. Relative risk (RR) was used to measure the effect of folic acid supplementation on risk of revascularization using a random-effects model. Total revascularization was defined as any arterial revascularization. Restenosis was defined as stenosis of more than 50 percent of the luminal diameter.

RESULTS

Overall, folic acid supplementation had no significant effect on coronary revascularization (9 trials, n = 27,418, RR = 0.99; 95%CI:0.88-1.11, P = 0.88), coronary artery bypass grafting (CABG) (5 trials, n = 10,703, 0.90; 0.79-1.03, P = 0.11), percutaneous coronary intervention (PCI) (5 trials, n = 10,703, 1.05; 0.89-1.23, P = 0.59), coronary restenosis (3 trials, n = 926, 1.05; 0.89-1.23, P = 0.59) or total revascularization (7 trials, n = 29,314, 1.06; 95%CI: 0.99-1.13, P = 0.10). However, a greater beneficial effect was observed for coronary revascularization among those trials with a moderate dose of vitamin B6 (5-10 mg/d; RR: 0.47; 95%CI: 0.28-0.80, P = 0.005), but not in trials without vitamin B6 or with a high dose of vitamin B6. And a non-significant greater total revascularization risk was observed in trials with a higher folic acid dose (>2 mg/d, RR = 1.11; 95%CI: 0.98-1.25, P = 0.09; ≥5 mg/d, RR = 1.98; 95%CI: 0.93-4.20, P = 0.08).

CONCLUSIONS

Our analyses indicate that folic acid supplementation has no significant effect on coronary revascularization, CABG, PCI, coronary restenosis or total revascularization. However, a combination of folic acid and moderate vitamin B6 may be beneficial in reducing coronary revascularization risk.

The effect of moderate-dose versus double-dose statins on patients with acute coronary syndrome in China: Results of the CHILLAS trial

BACKGROUND

Current guidelines recommend intensive low-density lipoprotein (LDL) cholesterol lowering with statins, with a target of 70 mg/dL (1.81 mmol/L) LDL cholesterol for those with a very high risk of coronary artery events. However, there is no multicenter study assessing the effect of intensive lipid-lowering therapy with statins on acute coronary syndrome (ACS) in a Chinese population with low baseline LDL cholesterol levels.

METHODS AND RESULTS

Patients (n=1355) with ACS were treated with a moderate dose of statin (atorvastatin 10 mg/d, or equivalent dose of other statins, n=675) or with an intensive dose of statin (atorvastatin, 20 or 40 mg/d, or equivalent dose of other statins, n=680) for 2 years. The primary end points were cardiac death, non-fatal acute myocardial infarction (MI), revascularization, ischemic stroke and documented unstable angina or severe heart failure requiring emergency hospitalization. Baseline lipid levels were nearly identical in both groups with a mean LDL cholesterol level of 2.7 mmol/L (103 mg/dL). At 3 months, LDL cholesterol levels declined 20.2% in the moderate dose statin group and 26.6% in the intensive statin group, respectively (P<0.001). In a 2-year follow-up, a primary end point event occurred in 20 patients in the moderate dose statin group and in 28 patients in the intensive statin group. There was no significant between-group difference in the primary outcome (hazard ratio, 1.39; 95% confidence interval [CI], 0.78-2.46; P=0.245).

CONCLUSIONS

For ACS patients with a relatively low baseline LDL cholesterol level who received optimized current medication and interventional therapy, the incremental LDL cholesterol reduction of 6.4% achieved by double-dose statin did not bring significant clinical effectiveness.

Nine-month angiographic and two-year clinical follow-up of polymer-free sirolimus-eluting stent versus durable-polymer sirolimus-eluting stent for coronary artery disease: the Nano randomized trial

BACKGROUND

First generation drug-eluting stents (DES) were associated with a high incidence of late stent thrombosis (ST), mainly due to delayed healing and re-endothelization by the durable polymer coating. This study sought to assess the safety and efficacy of the Nano polymer-free sirolimus-eluting stent (SES) in the treatment of patients with de novo coronary artery lesions.

METHODS

The Nano trial is the first randomized trial designed to compare the safety and efficacy of the Nano polymer-free SES and Partner durable-polymer SES (Lepu Medical Technology, Beijing, China) in the treatment of patients with de novo native coronary lesions. The primary endpoint was in-stent late lumen loss (LLL) at 9-month follow-up. The secondary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction or target lesion revascularization.

RESULTS

A total of 291 patients (Nano group: n = 143, Partner group: n = 148) were enrolled in this trial from 19 Chinese centers. The Nano polymer-free SES was non-inferior to the Partner durable-polymer DES at the primary endpoint of 9 months (P < 0.001). The 9-month in-segment LLL of the polymer-free Nano SES was comparable to the Partner SES (0.34 ± 0.42) mm vs. (0.30 ± 0.48) mm, P = 0.21). The incidence of MACE in the Nano group were 7.6% compared to the Partner group of 5.9% (P = 0.75) at 2 years follow-up. The frequency of cardiac death and stent thrombosis was low for both Nano and Partner SES (0.8% vs. 0.7%, 0.8% vs. 1.5%, both P = 1.00).

CONCLUSIONS

In this multicenter randomized Nano trial, the Nano polymer-free SES showed similar safety and efficacy compared with the Partner SES in the treatment of patients with de novo coronary artery lesions. Trials in patients with complex lesions and longer term follow-up are necessary to confirm the clinical performance of this novel Nano polymer-free SES.

Novel completed biodegradable polymer sirolimus-eluting stent versus durable polymer sirolimus-eluting stent in de novo lesions: nine-month angiographic and three-year clinical outcomes of HOPE trial

BACKGROUND

Drug-eluting stents (DES) with durable polymer have significantly reduced restenosis and target vessel revascularization compared with bare metal stents. Durable polymer has been linked with persistent inflammation of vessel wall and delayed endothelial healing that may increase the risk of late and very late stent thrombosis. This study sought to evaluate the efficacy and safety of HELIOS completed biodegradable polymer sirolimus-eluting stent (SES) in de novo coronary lesions.

METHODS

Totally, 287 patients with one or two de novo coronary lesions (lesion length ≤ 38 mm and reference vessel diameter 2.5-4.0 mm) were enrolled in the HOPE study, a prospective, multicenter, randomized, non-inferiority trial. Patients were randomized to treatment either with HELIOS completed biodegradable polymer SES (n = 142) or PARTNER durable polymer SES (n = 145). The primary endpoint was angiographic in-stent late lumen loss (LLL) at 9-month follow-up. The secondary endpoint included stent thrombosis and major adverse cardiac events including cardiac death, myocardial infarction (MI) and target lesion revascularization (TLR).

RESULTS

The 9-month in-stent LLL in the HELIOS group was similar to the PARTNER group, (0.16 ± 0.22) mm vs. (0.19 ± 0.30) mm (P = 0.28). The difference and 95% confidence interval were -0.03 (-0.09, 0.04), and the P value for non-inferiority <0.01. Major adverse cardiovascular event (MACE) occurred in 7.9% vs. 8.2%, MI in 2.4% vs. 3.0%, TLR in 5.5% vs. 3.0%, and stent thrombosis in 0 vs. 1.5%; and events were comparable between the HELIOS group and PARTNER group at three-year follow-up (all P > 0.05). The three-year cardiac death was lower in the HELIOS group, but with no significant difference, 0 vs. 3.0% (P = 0.12).

CONCLUSIONS

In the HOPE trial, the novel completed biodegradable polymer SES HELIOS was non-inferior to the durable polymer SES PARTNER with respect to nine-month in-stent LLL in de novo coronary lesions. The incidence of other clinical endpoints was low for both of the stents in three-year follow-up.

Safety and efficacy of a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent for the treatment of de novo coronary lesions: 12-month results from the TARGET II trial

BACKGROUND

In the TARGET I randomized controlled trial, the novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent FIREHAWK proved non-inferior to the everolimus-eluting stent in nine-month in-stent late loss in single de novo coronary lesions. This study was aimed at evaluating clinical safety and effectiveness of FIREHAWK in a moderately complex population (including patients with small vessels, long lesions and multi-vessels), and at validating the ability of the SYNTAX score (SS) to predict clinical outcomes in patients treated with this latest generation drug-eluting stent.

METHODS

TARGET II was a prospective, multicenter, single-arm study with primary outcome of 12-month target lesion failure (TLF), including cardiac death, target vessel myocardial infarction (TV-MI) and ischemia-driven target lesion revascularization (TLR). Stent thrombosis was defined according to the Academic Research Consortium (ARC) definition. Patients were grouped by tertiles of SS (≤6, >6 to ≤12, and >12). All patients were exclusively treated with the FIREHAWK stent and were followed up at 1, 6, and 12 months, and annually thereafter up to five years.

RESULTS

A total of 730 patients were included in this registry study. The 12-month incidence of TLF was 4.4% and the incidence of TLF components were, cardiac death 0.5%, TV-MI 3.2%, and TLR 2.2%. One definite/probable stent thrombosis was observed at 12-month follow-up. Mean SS was 10.87±6.87. Patients in the SS >12 tertile had significantly higher TLF (P = 0.02) and TLR (P < 0.01) rates than those in lower SS groups. In COX proportional-hazards regression analyses, TLF incidence was strongly related to lesion length (long lesion vs. non-long lesion patients; HR 3.416, 95% CI, 1.622-7.195), but unrelated to diabetic, small vessel, and multivessel subgroups.

CONCLUSIONS

The low TLF incidence in this study indicates that FIREHAWK is safe and effective in the treatment of moderately complex coronary disease. SS is also able to predict adverse clinical outcomes in FIREHAWK treated patients.

A randomised comparison of a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent with a durable polymer everolimus-eluting stent: clinical and angiographic follow-up of the TARGET I trial

AIMS

The study sought to evaluate the safety and efficacy of FIREHAWK, a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent (SES) for treating patients with single de novo coronary lesions compared with the durable polymer everolimus-eluting stent (EES) XIENCE V.

METHODS AND RESULTS

A total of 458 patients with single de novo native coronary lesions ≤24 mm in length and a coronary artery ≥2.25 to ≤4.0 mm in diameter were enrolled in the TARGET I study, a prospective, randomised, non-inferiority trial. The primary endpoint was in-stent late lumen loss (LLL) at nine-month follow-up. The secondary endpoint, target lesion failure (TLF), was defined as the composite of cardiac death, target vessel myocardial infarction (TVMI), or ischaemia-driven target lesion revascularisation (iTLR). Patients were centrally randomised to treatment with either biodegradable polymer SES (n=227) or durable polymer EES (n=231). The nine-month in-stent LLL of the biodegradable polymer SES was comparable to the EES group (0.13 ± 0.24 mm vs. 0.13 ± 0.18 mm, p=0.94; difference and 95% confidence interval 0.00 [-0.04, 0.04] mm; p for non-inferiority <0.0001). Cardiac death (0.4% vs. 0.0%), TVMI (1.3% vs. 1.7%), iTLR (0.4% vs. 0.4%) and TLF (2.2% vs. 2.2%) were similar between the biodegradable polymer SES and durable polymer EES groups at 12-month follow-up (all p>0.05). No definite/probable stent thrombosis was observed in both of these groups.

CONCLUSIONS

In the multicentre TARGET I trial, the novel abluminal groove-filled biodegradable polymer SES FIREHAWK was non-inferior to the durable polymer EES XIENCE V with respect to the primary endpoint of in-stent LLL at nine months for treating patients with single de novo coronary lesions. The incidences of clinical endpoints were low in both of the stents at 12-month follow-up. (ClinicalTrials.gov identifier: NCT01196819).

[Relationship between radial augmentation index and other indices for evaluating arteriosclerosis]

OBJECTIVE

To investigate the relationship between radial augmentation index (AI) and other noninvasive indices for evaluating arteriosclerosis.

METHODS

From April to June 2010, a cross-sectional survey was performed in two communities of Shijingshan District, Beijing, China. This study involved 1 752 subjects (aged 23 to 90 years). AI was measured using Colin pulse wave detection device HEM9000AI. Brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) were measured using Colin noninvasive arteriosclerosis tester VP-1000. Color Doppler flow imaging was used to measure intima-media thickness (IMT) of the bilateral carotid arteries.

RESULTS

Compared with the control group, baPWV≥14 m/s, ABI≤0.9 and IMT≥0.9 mm groups showed no significant difference in AI75 (P>0.05). Hypertensive individuals had significantly higher baPWV than the healthy group. Elderly hypertensive individuals with diabetes mellitus or (and) dyslipidemia had lower ABI than the control group. There was no significant difference of AI75 between the disease groups and the healthy group (P>0.05). Pearson correlation analysis showed that AI75 was associated with women, central aortic systolic pressure, total cholesterol, low-density lipoprotein, high-density lipoprotein, and inversely associated with body mass index, waist hip ratio, triglycerides, fasting serum glucose, and not associated with age (r=0.045, P=0.064). There was negative correlation between AI75 and ABI, IMT. AI75 was positively correlated with baPWV in the male group (r=0.101, P=0.005), but not correlated in the female group. Partial correlation analysis found that AI75 was inversely associated with ABI, baPWV and IMT. There was negative correlation between AI75 and baPWV, IMT in the female and male groups, and no correlation between AI75 and ABI (P>0.05). Multivariate gradual regression analysis demonstrated that the independent positive correlation factors of AI75 included female, age, waist hip ratio, central aortic systolic pressure, and the negative correlation factors were body mass index, height, fasting serum glucose (R(2)=0.372).

CONCLUSION

The lack of correlation of radial augmentation index with indices for evaluating arteriosclerosis suggests that AI is not a sensitive and reliable index for evaluating the degree of arterial stiffness.

Percentage of circulating CD8+ T lymphocytes is associated with albuminuria in type 2 diabetes mellitus

T lymphocytes have been demonstrated to play a role in the development of diabetic proteinuria. However, the alteration of circulating T lymphocytes has not been investigated in a type 2 diabetic cohort. A cross-sectional study was conducted in Peking University Aerospace Center Hospital. 510 participants were type 2 diabetes mellitus, 30-70 years of age. Patients with immune disease, medical conditions that affect immune function, infection, or end-organ damage were excluded. The percentage of circulating CD8+ T lymphocytes was significantly associated with albuminuria in the cohort. The impact of albuminuria to CD8+ T lymphocytes in a multivariate linear regression model was indicated by the B- coefficient (95% confidence interval) 1.812 (0.204-3.421, P=0.03). Our data first showed that the percentage of circulating CD8+ T cells is associated with albuminuria in type 2 diabetes mellitus, which may support the rationality of systemic inhibition of T lymphocytes in treating albuminuria in these patients.

Adrenomedullin and adrenotensin increase the transcription of regulator of G‑protein signaling 2 in vascular smooth muscle cells via the cAMP‑dependent and PKC pathways

The regulator of G‑protein signaling 2 (RGS2) has been shown to be crucial in the regulation of vascular tone and blood pressure. The vascular activities of adrenomedullin (ADM) and adrenotension (ADT), two natural peptides, are dependent upon the modulation of RGS2 expression. However, the effects and pathways involved in their modulation remain unknown. This study aimed to observe the changes of RGS2 expression in response to ADM and ADT in cultured vascular smooth muscle cells and to clarify the potential signaling pathways in vitro. In the present study, vascular smooth muscle cells (VSMCs) were cultured with ADM and ADT of various concentrations for different time periods, and the gene expression of RGS2 was analyzed by PCR. ADM significantly increased the gene expression at 0.5 h to ~35‑fold of that at baseline, whereas ADT marginally increased the expression after 1‑2 h. SQ22,536 and chelerythrine were used to block the protein kinase A (PKA) and PKC pathways activated by incubation with ADM. The gene expression of RGS2 was reduced by SQ22,536 only. Furthermore, when SQ22,536 and chelerythrine were added to the cells incubated with ADT, the gene expression was markedly reduced by both SQ22,536 and chelerythrine. In conclusion, ADM immediately showed a marked increase in the gene expression of RGS2 in cultured VSMCs via a cAMP‑dependent pathway and ADT gradually showed a marginal increase in the gene expression via a cAMP‑dependent pathway and a PKC pathway.

Patulin induces pro-survival functions via autophagy inhibition and p62 accumulation

Patulin (PAT) is one of the most common mycotoxins found in moldy fruits. Skin contact is one of the most likely exposure routes of PAT. Investigation of dermal toxicity of PAT is clearly needed and has been highlighted by WHO. In the present study, using human keratinocyte HaCaT cells as a model, we found that treatment with PAT caused an increased autophagosome accumulation. Measurements of autophagic flux demonstrated that the accumulation of autophagosomes by PAT was not directly due to enhanced autophagosome formation but due to inhibition of autophagosome degradation. Reductions in the activities of the lysosomal enzymes cathepsin B and cathepsin D by PAT might contribute to this inhibitory effect. Consistent with this, inhibition of autophagosome degradation by PAT resulted in accumulation of p62 that functioned as a pro-survival signal. The pro-survival function of p62 was found to be attributed to reactive oxygen species-mediated cytoprotective endoplasmic reticulum (ER) stress response. ER stress exerted cytoprotective effect via extracellular signal-regulated kinase1/2-dependent B-cell CLL/lymphoma 2-associated agonist of cell death inhibitory phosphorylation. Given the critical role of autophagy and its substrate p62 in carcinogenesis, our findings may have important implications in PAT-induced skin carcinogenesis.

Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients

BACKGROUND

Individually, diabetes mellitus, hypertension, and dyslipidemia have been shown to increase the risk of cardiovascular disease. While traditional management of Type 2 diabetes has focused mainly on glycemic control, robust evidence supports the integration of hypertension and dyslipidemia management to reduce the risk of cardiovascular disease. The primary objective of this study was to assess the level of control of blood glucose, blood pressure, and blood lipids (3Bs) among patients with type 2 diabetes. An additional objective was to investigate the impact of hospital type, physician specialty, treatment pattern, and patient profile on clinical outcomes.

METHODS

This was a cross-sectional, multicenter observational study. A nationally representative sample of outpatients with established type 2 diabetes were enrolled at hospitals representative of geographic regions, tiers, and physician specialties in China. Main clinical measurements were the levels of glycosylated hemoglobin (HbA1c), blood pressure, and total serum cholesterol in reference to target goals.

RESULTS

A total of 25,817 adults with type 2 diabetes (mean age 62.6 years, 47% male) were enrolled at 104 hospitals. Seventy-two percent reported comorbid hypertension, dyslipidemia, or both. Patients with concurrent type 2 diabetes, hypertension, and dyslipidemia were 6 times more likely to report a prior history of cardiovascular disease compared with those with type 2 diabetes alone. The mean HbA1c level was 7.6%. While 47.7%, 28.4%, and 36.1% of patients achieved the individual target goals for control of blood glucose (HbA1c <7%), blood pressure (systolic blood pressure <130 mm Hg, diastolic blood pressure <80 mm Hg), and blood lipids (total cholesterol <4.5 mmol/L), respectively, only 5.6% achieved all 3 target goals. Lower body mass index (<24 kg/m(2)), no active smoking or drinking, higher education, and diabetes duration <5 years were independent predictors of better cardiovascular disease risk control.

CONCLUSION

Achieving adequate control of risk factors for cardiovascular disease in patients with type 2 diabetes remains a clinical challenge. Interventions to achieve control of 3Bs coupled with modification of additional cardiovascular disease predictors are crucial for optimization of clinical outcomes in patients with type 2 diabetes.

Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease

OBJECTIVES

This study sought to evaluate the safety and efficacy of rosuvastatin in preventing contrast-induced acute kidney injury (CI-AKI) in patients with diabetes mellitus (DM) and chronic kidney disease (CKD).

BACKGROUND

CI-AKI is an important complication after contrast medium injection. While small studies have shown positive results with statin therapy, the role of statin therapy in prevention of CI-AKI remains unknown.

METHODS

We randomized 2,998 patients with type 2 DM and concomitant CKD who were undergoing coronary/peripheral arterial angiography with or without percutaneous intervention to receive rosuvastatin, 10 mg/day (n = 1,498), for 5 days (2 days before, and 3 days after procedure) or standard-of-care (n = 1,500). Patients' renal function was assessed at baseline, 48 h, and 72 h after exposure to contrast medium. The primary endpoint of the study was the development of CI-AKI, which was defined as an increase in serum creatinine concentration ≥0.5 mg/dl (44.2 μmol/l) or 0.25% above baseline at 72 h after exposure to contrast medium.

RESULTS

Patients randomized to the rosuvastatin group had a significantly lower incidence of CI-AKI than controls (2.3% vs. 3.9%, respectively; p = 0.01). During 30 days' follow-up, the rate of worsening heart failure was significantly lower in the patients treated with rosuvastatin than that in the control group (2.6% vs. 4.3%, respectively; p = 0.02).

CONCLUSIONS

Rosuvastatin significantly reduced the risk of CI-AKI in patients with DM and CKD undergoing arterial contrast medium injection. (Rosuvastatin Prevent Contrast Induced Acute Kidney Injury in Patients With Diabetes [TRACK-D]; NCT00786136).

[Plasma osteopontin level and left ventricular remodeling in patients with acute myocardial infarction]

OBJECTIVE

To investigate the change of plasma osteopontin level during the progress of acute ST-segment elevation myocardial infarction, as well as its association with the left ventricular remodeling and prognosis.

METHODS

In the study, 61 patients with acute ST-segment elevation myocardial infarction were recruited. Blood samples were taken at admission, on the 3rd day and 7th day of admission, while 63 healthy blood donors were employed as normal controls. There plasma osteopontin levels were measured by ELSIA.

RESULTS

Compared with the normal controls, the plasma osteopontin levels of the patients with acute ST-segment elevation myocardial infarction were significantly higher at admission [(96.51±37.22) μg/L vs. (54.50±28.17) μ g/L, P<0.001], reached the peak value on the 3rd day, and dropped down on the 7th day. The correlation analysis showed that the plasma osteopontin level positively correlated with age and left ventricular end-systolic volume index 3 months after acute myocardial infarction, and negatively correlated with left ventricular ejection fraction 3 months after acute myocardial infarction. The follow-up study found that the plasma osteopontin level did not predict mortality, re-infarction, stroke, revascularization or hospitalization due to heart failure.

CONCLUSION

In patients with acute ST-segment elevation myocardial infarction, the elevated plasma level of osteopontin might be associated with the left ventricular remodeling.

[Blood pressure control and glucose metabolism status in hypertension specialty clinics in China]

OBJECTIVE

To investigate blood pressure control the glucose metabolism, cardiovascular risk factors of patients who were regularly followed up at professional hypertension clinics in China.

METHODS

A cross-sectional survey was conducted in 32 004 patients from 127 professional hypertension clinics across China. The questionnaires included case history and related treatment physical examination and laboratory biochemical tests were also taken at the same time.

RESULTS

The mean blood pressure of overall population was (151 ± 13)/(92 ± 10) mm Hg(1 mm Hg = 0.133 kPa). Totally 3424 patients (10.7%) had never taken any anti-hypertension medicine. Among patients treated with anti-hypertension drugs, 19 818 were of mono-therapy (69.3%) and 8762 were of combination therapy. The most frequently used drug was renin-angiotensin system inhibitor, followed by calcium-channel blocker. Fixed compound preparations accounted for 15.6%. The overall blood pressure control rate (<140/90 mm Hg ) was 26.8%, among them, 27.7%, 30.0%, 25.4% and 21.3% patients were complicated with coronary heart disease, diabetes mellitus, kidney diseases and cerebral stroke respectively. About 70.3% hypertensive patients had abnormal glucose metabolism whose mean glycosylated hemoglobin (GHbA1c) was 7.84%, which was significantly higher than 7.0% , the target value defined by ADA.Even among them, 20.2% patients have never received any anti-diabetic drugs.Low-risk and medium-risk patients accounted for 16.0%. Totally 48.0% patients were classified in high-risk group and 36.0% in very high risk group. About half of all patients had different target organ dysfunction. About 49.0% patients had associated comorbidities.

CONCLUSIONS

Co-existence of hypertension and abnormal glucose metabolism is common in Chinese population. Among these patients, target organ dysfunction and comorbidities are prevalent, but blood pressure is only effectively controlled in less than 30% patients. Low proportion of combination therapy is one of the reasons for unsatisfied control of blood pressure.It indicates that effective management of hypertension is urgent.