[Relation between aortic root dimension and cardiovascular disease]

OBJECTIVE

To analyze the relation among aortic root dimension (ARD) measured by echocardiography, cardiovascular disease risk factors and cardiovascular disease in adult Beijing community population.

METHODS

Echocardiography was performed in 1041 individuals in a suburban community of Beijing from 2004 to 2005. ARD and other echocardiographic parameters including left atria dimension, left ventricular mass, septal and posterior wall thickness and dimension were analyzed. Histories of cardiovascular disease as well as risk factors were obtained. Spearman correlation was used to determine the relation between ARD and other cardiovascular risk factors. Multifactorial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of ARD and cardiovascular disease.

RESULTS

Ascending aortic dimension (AAD) and mean root dimension (MRD) were positively associated with age, weight, BMI, systolic and diastolic blood pressure, left atria dimension, left ventricular mass, left ventricular septal and posterior wall thickness, and left ventricular dimension. With the lowest quintile of AAD and MRD as the reference, ORs for the highest quintile of AAD for specific cardiovascular diseases in female were as follows: stroke (OR = 2.20, 95%CI: 1.03 - 4.72, P = 0.04), chronic heart failure (OR = 2.62, 95%CI: 1.49 - 4.61, P = 0.001), total cardiovascular disease (OR = 2.52, 95%CI: 1.51 - 4.21, P < 0.001). ORs of MRD were as follows: chronic heart failure (OR = 2.19, 95%CI: 1.26 - 3.80, P = 0.01), total cardiovascular disease (OR = 2.20, 95%CI: 1.32 - 3.68, P = 0.002). After adjustment for age, BMI, smoking status, TC, hypertension, diabetes mellitus, the ORs were not statistically significant (P > 0.05).

CONCLUSION

ARD was positively associated with several CHD risk factors, but was not independent risk factor for cardiovascular disease. ARD may act as an intermediate risk factor for cardiovascular disease. Combined ARD and traditional cardiovascular disease risk factors might enhance the predict power for cardiovascular disease.

A prospective multicenter parallel-controlled trial of TIVOLI biodegradable-polymer-based sirolimus-eluting stent compared to ENDEAVOR zotarolimus-eluting stent for the treatment of coronary artery disease: 8-month angiographic and 2-year clinical follow-up results

BACKGROUND

Available drug-eluting stents (DES) have achieved great success in reducing restenosis rates. Recently, investigators have demonstrated that the durable polymer carrier plays a significant role in DES-related hypersensitive reaction and delays vessel healing. TIVOLI stent is a novel sirolimus-eluting coronary stent with biodegradable coating containing sirolimus and polylactic-co-glycolic acid (PLGA) polymer. The present study sought to evaluate the effectiveness and safety of the TIVOLI biodegradable-polymer-based sirolimus-eluting stent in treating patients with coronary artery disease.

METHODS

A prospective, multicenter clinical trial comparing TIVOLI biodegradable coated sirolimus-eluting stent with ENDEAVOR zotarolimus-eluting stent was conducted in 324 patients (TIVOLI group: 168 patients; ENDEAVOR group: 156 patients) at 12 centers in China to demonstrate the non-inferiority of in-stent late loss with TIVOLI stent compared to ENDEAVOR stent in subjects with a maximum of two de novo native coronary artery lesions (lesion length ≤ 40 mm, reference vessel diameter 2.25-4.00 mm). The primary end point was angiographic in-stent late loss at 8-month. The secondary end points were clinical outcomes at 2 years, including major adverse cardiac events (cardiac death, myocardial infarction, or target-lesion revascularization) and stent thrombosis.

RESULTS

Angiographic late lumen loss at 8 months in the TIVOLI group was superior to the ENDEAVOR group (in-stent (0.25 ± 0.33) mm vs. (0.57 ± 0.55) mm, diff (95%CI) -0.23 (-0.32, -0.14), P < 0.0001; in-segment (0.25 ± 0.33) mm vs. (0.42 ± 0.55) mm, diff (95%CI) -0.13 (-0.23, -0.02), P = 0.0083). The rate of in-stent binary restenosis at 8 months was reduced from 8.6% in the ENDEAVOR group to 2.9% in the TIVOLI group (P = 0.0229). Compared to ENDEAVOR stent, TIVOLI stent resulted in a significant reduction in target-lesion revascularization (4.2% vs. 9.6%, P = 0.0495) at 2 years. The two-year major adverse cardiac events (MACE) rate was lower for the TIVOLI group, but not significantly different (6.6% vs. 10.9%, P = 0.1630).

CONCLUSIONS

TIVOLI was superior to ENDEAVOR stent with respect to late lumen loss at 8 months, and it yielded both lower rates of angiographic binary restenosis at 8 months and target lesion revascularization (TLR) at 2 years. The MACE rate at 2 years was comparable in both groups.

A randomized phase II study of gemcitabine (G) plus the cardiac glycoside huachansu (H) in the treatment of patients with locally advanced (LAPC) or metastatic pancreatic cancer (MPC)

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Background: Wild toad venom has been used for over 1,000 years as a traditional Chinese medicine; H, the extract of dried toad skin glands, is a potent cardiac glycoside without significant toxicity. H has demonstrated preliminary evidence of antitumor activity in phase I clinical trial evaluation (Cancer 2009, 115:5309-18).

Methods: We conducted a randomized, single-blind, phase II clinical trial of G + H versus G + placebo in patients with LAPC or MPC. Plasma bufalin levels were performed in H-treated subjects. 80 evaluable subjects accrued from October 2007 to May 2010 and were treated with G 1,000mg/m2 (iv on days 1, 8, 15, q 28d) plus either H (20 mL/m2 iv daily for 21 days followed by 7 days off, q 28d) or placebo. Demographic data is demonstrated in the table below.

Results: Grade 3/4 adverse events, objective radiographic response rates (ORR), time to progression (TTP), quality of life (QOL), and overall survival (OS) were similar in the two groups (Table). There was not a statistically significant difference in the average plasma bufalin levels in patients with a radiographic partial response (PR) or stable disease versus those with progressive disease (PD) (0.098 ± 0.093 ng/mL vs. 0.071 ± 0.048 ng/mL, p=0.679).

Conclusions: H when added to G was well tolerated but did not improve OS, TTP, QOL, or ORR. Further investigation of a more potent oral formulation of H is planned. H provided by Shenzhen 999 Traditional Chinese Medicine & Development Co., Ltd. Supported by NIH U19CA121503-01.

[Table: see text]

No significant financial relationships to disclose.

Sonochemotherapy inhibits the adhesion, migration and invasion of human ovarian cancer cells with highly metastatic potential

PURPOSE

Preclinical trials have shown that sonochemotherapy is effective for human ovarian cancers. Therefore, the effects of sonochemotherapy on cell adhesion and motility were investigated in this study, considering their roles in cancer metastasis.

MATERIALS AND METHODS

Cell lines, HO-8910 and its highly metastatic potential subline HO-8910PM, were subjected to cisplatin, paclitaxel and sonochemotherapy (anticancer drugs followed by insonation). Cytotoxicity was determined, and then cell adhesion, migration and invasion assays were performed.

RESULTS

Neither cisplatin (0.5 μg/ml) nor paclitaxel (6.0 μg/ml) alone led to cell death. The addition of ultrasound did not potentiate an anticancer drug, suggesting that there was a threshold dose for a cytotoxic agent employed in sonochemotherapy. The survival rate was decreased when combining cisplatin and paclitaxel followed by insonation. 6.0 μg/ml of paclitaxel completely suppressed cell adhesion and motility, thus the concentration was decreased to 1.2 μg/ml. Migration and invasion assays were only successfully performed in HO-8910PM cells. Cisplatin and paclitaxel inhibited adhesion, migration and invasion, resulting in lower rates, which were additionally decreased by insonation. No cell traveled through the membrane when cisplatin, paclitaxel and ultrasound were combined. Quantitative evaluations indicated that ultrasound enhanced anticancer agents via synergistic and/or additive effects.

CONCLUSION

Ultrasound synergized a combined regime and sonochemotherapy was a measure to suppress cancer spread.

A right heart angiosarcoma with rapidly progressing hemorrhagic pericardial effusion

Primary tumors of the heart are rare. Among them angiosarcoma is the most common malignant tumor of the heart and is characterized by rapid growth, local invasion, and distant metastasis. Its clinical presentation is variable. We describe a 66-year-old man who suffered from cough and hemoptysis and then experienced rapidly progressing hemorrhagic pericardial effusion. After a set of examinations he was diagnosed as right heart angiosarcoma. His outcome was poor.

[Using the combination of traditional risk factors and quantitative coronary angiography (QCA) in predicting the risk of individuals with subclinical artherosclerosis]

OBJECTIVE

To determine whether the combination of traditional risk factors and quantitative coronary angiography (QCA) assessment could provide accurate prognostic information on a population-based study including 1137 adults with subclinical artherosclerosis and with coronary risk factors.

METHODS

Participants underwent coronary angiography examination before the minimal stenotic diameters, segment diameters, percent stenosis, plaque areas. Other parameters were analyzed by the computer-assisted Coronary Angiography Analysis System. The Framingham Risk Score for each participant was assessed. During the 1 year follow-up period, all kinds of endpoint cardiovascular events were screened. Endpoint events were defined as death from coronary heart disease, nonfatal myocardial infarction (MI) or unstable angina pectoris.

RESULTS

During the 1 year of follow-up period, a total of 124 participants developed an endpoint event, which was significantly associated with the Framingham Risk Score, calcium of plaques and the plaque areas (all Ps<0.05). The QCA score incorporated with the QCA parameters was related to the endpoint events. The Framingham Risk Score was combined with QCA score through logistic regression for prediction of end-point events. Data from the ROC analysis showed the accuracy of this prediction algorithm was superior to the accuracy when variables themselves were used. The event-free survival rate was inferior to the control group in participates under high risk, when being screened with this prediction algorithm (P<0.05).

CONCLUSION

The risk of cardiovascular attack in subclinical artherosclerosis individual seemed to be associated with the Framingham Risk Score, calcium of plaques and the plaque areas. When the traditional risk factors (the Framingham Risk Score) were combined with QCA, the new method could provide more prognostic information on those adults with subclinical artherosclerosis.

[Prediction value of blood lipid levels on newly identified carotid plaque in middle-aged and elderly Chinese population]

OBJECTIVE

To evaluate the prediction value of blood lipid levels on the newly-identified carotid plaque in middle-aged and elderly Chinese population.

METHODS

All study subjects were recruited from two cohorts from 2002 to 2007 [the People's Republic of China/United States of America collaborative study (USA-PRC study) and the Chinese multi-provincial cohort study (CMCS)]. The baseline examination including cardiovascular disease risk factors and B-mode ultrasound of carotid artery was performed in 2002 and the second examination was made in September to October, 2007. The relationship between baseline lipids and carotid plaque incidence was analyzed in a total of 2000 subjects aged 47 to 79 years (mean 63 years).

RESULTS

(1) During these 5 years, the prevalence of carotid plaque increased from 30.3% to 62.2% and from 21.5% to 51.5% for men and women, respectively. The newly-identified carotid plaque incidence was 41.8% for men and 34.1% for women. (2) The incidence of artery plaque significantly increased in both sexes in proportion to increase of baseline total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and total to high-density cholesterol ratio (TC/HDL-C) levels (P < 0.05 or P < 0.01). (3) Cross-stratification analysis of LDL-C, triglyceride (TG) and HDL-C for carotid plaque incidence indicated the existence of conjoint effects between LDL-C and HDL-C, LDL and TG, as well as between TG and HDL-C, on the increased incidence of carotid plaque. (4) Multi-factorial analysis showed that higher LDL-C, non-HDL-C and TC/HDL-C were independent risk factors for development of new carotid plaque [OR = 1.44 (95%CI = 1.07 - 1.94), OR = 1.45 (95% CI = 1.08 - 1.96), OR = 1.59(95% CI = 1.14 - 2.23) in men;OR = 1.47 (95% CI = 1.13 - 1.92), OR = 1.35 (95% CI = 1.04 - 1.75), OR = 1.64 (95% CI = 1.20 - 2.23) in women].

CONCLUSIONS

The prevalence of carotid plaque increased rapidly in this cohort between 2002 and 2007. Elevated LDL-C, non-HDL-C and TC/HDL-C levels were independent predictors of newly developed carotid plaque.

Folic acid therapy and cardiovascular disease in ESRD or advanced chronic kidney disease: a meta-analysis

BACKGROUND AND OBJECTIVES

The efficacy of folic acid therapy to lower homocysteine (Hcy) levels in an effort to reduce cardiovascular disease (CVD) risk in patients with ESRD or advanced chronic kidney disease (ACKD; creatinine clearance, <30 ml/min) remains inconclusive. We conducted a meta-analysis of relevant randomized trials to further examine this issue.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This meta-analysis included 3886 patients with ESRD/ACKD from seven qualified randomized trials using folic acid therapy and with CVD reported as one of the end points.

RESULTS

When pooling the seven trials, folic acid therapy reduced the risk of CVD by 15% (RR, 0.85; 95% CI, 0.76 to 0.96; P = 0.009). A greater beneficial effect was observed among those trials with a treatment duration >24 months (RR, 0.84; 95% CI, 0.72 to 0.98; P = 0.02), a decrease in Hcy level >20% (RR, 0.83; 95% CI, 0.73 to 0.95; P = 0.007), and no or partial folic acid fortification (RR, 0.80; 95% CI, 0.65 to 0.99; P = 0.04). The beneficial effect also was seen when Hcy levels decreased >20%, even in the presence of folic acid fortification (RR, 0.85; 95% CI, 0.73 to 0.99; P = 0.04). In the corresponding comparison groups, the estimated RRs were attenuated and insignificant.

CONCLUSIONS

Folic acid therapy can reduce CVD risk in patients with ESRD/ACKD by 15%. A greater beneficial effect was observed among those trials with no or partial folic acid fortification or a decrease in Hcy level >20% regardless of folic acid fortification.

Current status and development of percutaneous coronary intervention in China

Dr. Gruntzig et al. (1979) successfully completed the world's first percutaneous coronary intervention (PCI), a percutaneous transluminal coronary angioplasty (PTCA), in 1977. The first reported PTCA in China was in 1984. With the development of PCI techniques, while more and more patients have benefited, there are ongoing challenges as well.

Effect of enalapril on plasma homocysteine levels in patients with essential hypertension

OBJECTIVE

To investigate the effect of enalapril on plasma homocysteine (Hcy) levels and the association of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism with the changes of Hcy levels in response to enalapril among patients with essential hypertension.

METHODS

A total of 130 patients with mild-to-moderate essential hypertension were enrolled and enalapril was orally administered at a dose of 10 mg/d for eight weeks. Plasma Hcy levels were measured by denaturing high-performance liquid chromatography (DHPLC) at baseline and after eight weeks of treatment. Genotyping of MTHFR C677T polymorphism was performed by TaqMan probe technique.

RESULTS

Compared with baseline, plasma Hcy levels did not change significantly after eight weeks (P=0.81). Stratified by baseline Hcy levels, a significant increase in plasma Hcy levels (P=0.02) among those with Hcy <10 micromol/L was observed, in contrast to no significant changes in plasma Hcy levels (P=0.54) among those with Hcy > or =10 micromol/L. No significant association was observed between MTHFR C677T polymorphism and changes in Hcy levels in response to enalapril.

CONCLUSIONS

Enalapril may cause an increase in plasma Hcy levels among the hypertensives with low baseline Hcy levels. There was no significant association between MTHFR C677T genotypes and changes in Hcy levels in response to enalapril among subjects with essential hypertension.

[Distribution characteristics and risk factors of carotid atherosclerosis in middle-aged and elderly Chinese]

OBJECTIVE

To describe the distribution characteristics of carotid atherosclerosis and to analyze its association with cardiovascular risk factors in middle-aged and elderly Chinese.

METHODS

In 2007, the second cross-sectional examination for cardiovascular risk factors and B-mode ultrasound imaging on carotid arteries were performed in a Chinese population consisting of 2681 subjects aged 43-81 years old from two cohorts participants of the People's Republic of China/United States of America collaborative study (USA-PRC study) and the Chinese multi-provincial cohort study (CMCS). The association of cardiovascular risk factors with intima-media thickening (ITM) and plaque of carotid arteries was analyzed.

RESULTS

(1) The mean intima-media thickening (Mean-IMT) of carotid artery was 0.68 mm, the maximal intima-media thickening (Max-IMT) was 1.07 mm. (2) The prevalence rate of carotid plaque was 60.3% in all subjects. As for the different sites of carotid arteries, the plaque prevalence rate at carotid bulb was 61.2% for male and 51.6% for female (chi2 = 23.44, P < 0.01), and at the internal carotid artery was 24.7% for male and 12.2% for female (chi2 = 69.57, P < 0.01), at the common carotid artery was 20.9% for male and 13.8% for female (chi2 = 23.18, P < 0.01). (3) After adjusting for age and other cardiovascular risk factors, the Mean-IMT and Max-IMT increased with elevated levels of systolic blood pressure, plasma glucose and low density lipoproteins cholesterol (LDL-C) (all P < 0.05). Hypertension, diabetes, smoking and high LDL-C (P < 0.05) were independent predict factors for the risk of carotid plaque.

CONCLUSION

The carotid atherosclerosis was common in middle and older age Chinese and was positively associated with classical cardiovascular disease risk factors.

Strongly anisotropic elastic moduli of nematic elastomers: analytical expressions and nonlinear temperature dependence

Exact formulae for the elastic moduli of the nematic elastomers are obtained by the implicit function method based on somewhat general energy functions. The formulae indicate that both the moduli parallel and perpendicular to the director of the nematic elastomers are smaller than the modulus of the classical elastomers because of the mechanical-nematic coupling. Moreover, the moduli are generally anisotropic due to the biaxiality induced by stretching the nematic elastomers perpendicular to the director. Then we get the explicit analytical expressions of the parallel and perpendicular moduli by making use of the Landau-de Gennes free energy and the neo-classical elastic energy. Very different from the classical elastomers, they are both strongly nonlinear functions of the temperature in the nematic phase. Furthermore, their ratio, the degree of anisotropy, changes with the temperature as well. The results agree qualitatively with some experiments. Better quantitative agreement is obtained by some modifications of the constitutive relation of the elastic energy.

Sphingosine kinase 1 regulates the expression of proinflammatory cytokines and nitric oxide in activated microglia

Microglial activation has been implicated as one of the causative factors for neuroinflammation in various neurodegenerative diseases. The sphingolipid metabolic pathway plays an important role in inflammation, cell proliferation, survival, chemotaxis, and immunity in peripheral macrophages. In this study, we demonstrate that sphingosine kinase1 (SphK1), a key enzyme of the sphingolipid metabolic pathway, and its receptors are expressed in the mouse BV2 microglial cells and SphK1 alters the expression and production of proinflammatory cytokines and nitric oxide in microglia treated with lipopolysaccharide (LPS). LPS treatment increased the SphK1 mRNA and protein expression in microglia as revealed by the RT-PCR, Western blot and immunofluorescence. Suppression of SphK1 by its inhibitor, N, N Dimethylsphingosine (DMS), or siRNA resulted in decreased mRNA expression of TNF-alpha, IL-1beta, and iNOS and release of TNF-alpha and nitric oxide (NO) in LPS-activated microglia. Moreover, addition of sphingosine 1 phosphate (S1P), a breakdown product of sphingolipid metabolism, increased the expression levels of TNF-alpha, IL-1beta and iNOS and production of TNF-alpha and NO in activated microglia. Hence to summarize, suppression of SphK1 in activated microglia inhibits the production of proinflammatory cytokines and NO and the addition of exogenous S1P to activated microglia enhances their inflammatory responses. Since the chronic proinflammatory cytokine production by microglia has been implicated in neuroinflammation, modulation of SphK1 and S1P in microglia could be looked upon as a future potential therapeutic method in the control of neuroinflammation in neurodegenerative diseases.

E112D polymorphism in the prolylcarboxypeptidase gene is associated with blood pressure response to benazepril in Chinese hypertensive patients

BACKGROUND

Marked interindividual variation exists in blood pressure response to benazepril, which is considered to have genetic basis. Our objectives were to evaluate whether the E112D polymorphism in the prolylcarboxypeptidase (PRCP) gene has impact on blood pressure response to benazepril.

METHODS

Hypertensive patients from Huoqiu County and Yuexi County of Anhui Province received daily treatment with an oral dosage of 10 mg benazepril for 15 days. Genotypes of the E112D polymorphism in the PRCP gene were determined by TaqMan SNP genotyping assay. Multivariate linear and Logistic regressions using generalized estimating equation model were performed in a total of 1092 patients to evaluate the association of PRCP genotypes and blood pressure response to benazepril.

RESULTS

Patients carrying ED or DD genotype had a less systolic blood pressure reduction (adjusted beta = -3.7 + or - 1.1, P < 0.001), a less diastolic blood pressure reduction (adjusted beta = -3.1 + or - 0.8, P < 0.001) and a lower percentage of reaching target blood pressure defined as SBP lower than 140 mmHg and DBP lower than 90 mmHg (adjusted OR = 0.6, P = 0.005) than those patients carrying EE genotype. In addition, the results from stratified analysis by county (Huoqiu or Yuexi) were similar to those observed in the pooled population.

CONCLUSIONS

Our data suggest that the E112D polymorphism in the PRCP gene may be a useful genetic marker to predict the antihypertensive effect of short-term benazepril treatment in hypertensive patients of Anhui Province, China.

Rationale and design of China intensive lipid lowering with statins in acute coronary syndrome: the CHILLAS study

BACKGROUND

Current guidelines recommended intensive low-density lipoprotein cholesterol lowering with statins, aiming at the target of 70 mg/dL (1.81 mmol/L) of low-density lipoprotein cholesterol for those with 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 Chinese population.

METHODS

An open-label multicenter study is planned to evaluate whether intensive treatment with statins for 2 to 5 years results in more reduction of cardiovascular events in patients with ACS compared to the standard statin therapy. A total of 1,600 patients will be randomly assigned to receive intensive statin therapy (atorvastatin, 20 or 40 mg/d, or equivalent dose of other statins) or standard statin therapy (atorvastatin, 10 mg/d, or equivalent dose of other statins). Both groups will receive dietary counseling. Over the follow-up period, the primary outcome measure is the time to occurrence of cardiac death, nonfatal acute myocardial infarction, revascularization with either percutaneous coronary intervention or coronary-artery bypass grafting, documented unstable angina or severe heart failure requiring emergency hospitalization, and stroke. The planned duration for enrollment is between December 2006 and December 2009.

CONCLUSIONS

The CHILLAS study will be the first multicenter study in a Chinese population using a patient-level analysis to compare the effects and safety of intensive statin therapy with that of standard-dose statin therapy, which may provide new evidence and therapeutic standards for the treatment of ACS.

Familial aggregation and heritability of electrocardiographic intervals and heart rate in a rural Chinese population

BACKGROUND

Estimates of the genetic influences on electrocardiographic (ECG) parameters are inconsistent in previous reports, and no such studies have been performed in China. So we estimated genetic contributions to PR and QRS intervals and the rate-adjusted QT interval (Bazett's QTc) in a Chinese rural population.

METHODS

A total of 2909 subjects from 847 families were enrolled in the current study. Genetic contributions to ECG parameters were estimated in two ways: correlation coefficients among family members (father-mother, parent-offspring, first sibling-other sibling) and the heritability of each of the ECG parameters.

RESULTS

Our results showed significant correlations among family members on theses parameters: the correlation coefficients for PR interval, QRS duration, QTc interval, and HR, between parent-sibling, and sibling-sibling were 0.17 and 0.13, 0.18 and 0.23, 0.22 and 0.28, 0.19 and 0.18, respectively. The heritability for PR interval, QRS duration, QTc interval, and HR were estimated as 0.34, 0.43, 0.40, and 0.34, respectively.

CONCLUSION

Genetic factors, together with the environmental and other cofactors contribute no more than 60% to the variance of the ECG intervals, supporting the concept that multiple factors, including gene-gene and gene-environment interactions could influence ECG interval phenotypes, and genetic factors play a major role.

Effect of hepatocyte growth-promoting factors on myocardial ischemia during exercise in patients with severe coronary artery disease

Hepatocyte growth-promoting factor (pHGF) has the greatest potential as a therapeutic agent for vascular growth factor. The aim of this study was to investigate the effect of pHGF on myocardial ischemia and exercise capacity in patients with severe coronary artery disease (CAD). Forty-nine patients were enrolled for a two week treatment period. Treadmill graded exercise tests with gas analysis were conducted before and after therapy. Serum levels of HGF were significantly elevated after therapy. The degrees of exercise-induced ST segment depression were decreased more significantly in the pHGF group. Similar differences were also found in the maximum heart rate and the maximum heart rate when the ST segment was depressed 1 mm while undergoing the treadmill graded exercise test. Both were increased more significantly in the pHGF group. Total exercise time, systolic blood pressure in the peak of exercise, the length of time that ST segment depression of 1 mm is needed, and total work all were increased in both groups after intervention. Furthermore, total exercise time and total work were increased more significantly in the pHGF group. The levels of HGF increased significantly after pHGF treatment. pHGF could favorably improve exercise-induced myocardial ischemia and enhance exercise capacity in patients with severe CAD.

Efficacy and safety of nifedipine GITS in Chinese patients with hypertension – A post‐marketing surveillance study

PURPOSE

This post-marketing surveillance study assessed the efficacy, safety and tolerability of the treatment with nifedipine GITS (gastro-intestinal therapeutic system) in hypertensive patients under normal daily practice conditions in China.

PATIENTS AND METHODS

A total of 3003 patients were included in 174 outpatient clinics. Patients received 30 mg or 60 mg of nifedipine GITS. Data were collected at up to three follow-up visits.

RESULTS

At the end of the observation period, mean treatment duration was 13.3 weeks. Mean blood pressure reduction was 27.6/13.6 mmHg, 62.1% of patients had a systolic blood pressure <140 mmHg, and 82.2% had a diastolic blood pressure <90 mmHg. Blood pressure control according to international guidelines was achieved in 45.0% of all patients. A total of 1515 patients received additional antihypertensive medications, of which angiotensin-converting enzyme (ACE) inhibitors were mostly used (42.2%) followed by beta-blockers (33.7%). Twenty-two patients (0.7%) experienced 27 adverse events. Physicians' assessments of efficacy, tolerability and patient acceptance had ratings of "very good" and "good" in 88.7% (efficacy), 92.8% (tolerability) and 89.1% (patient acceptance) of patients.

CONCLUSIONS

Nifedipine GITS proved to be effective and well tolerated for the treatment of hypertension in 3003 Chinese patients. The results confirm the findings of previously performed clinical studies.

Arg347Cys polymorphism of alpha1A-adrenoceptor gene is associated with blood pressure response to nifedipine GITS in Chinese hypertensive patients

Our objectives were to evaluate whether polymorphisms in the alpha1A- and beta2-adrenoceptor genes influence blood pressure response to nifedipine gastrointestinal therapeutic system (GITS). Hypertensive patients received daily treatment with an oral dosage of 30 mg nifedipine GITS for 16 days. Genotypes of the Arg347Cys polymorphism in the alpha1A-adrenoceptor gene and the Arg16Gly and Gln27Glu polymorphisms in the beta2-adrenoceptor gene were determined by TaqMan single-nucleotide polymorphism genotyping assay. The sixteenth-day steady-state plasma concentration of nifedipine was measured using HPLC with UV detection. Multivariate linear regression was performed in a total of 447 patients to evaluate the effects of these polymorphisms on blood pressure response to nifedipine GITS. Patients carrying the Cys347 allele of the alpha1A-adrenoceptor gene had a greater systolic blood pressure reduction than did those carrying two Arg347 alleles of the alpha1A-adrenoceptor gene (32.5+/-14.0 versus 27.3+/-15.5 mm Hg, respectively, P=0.006). However, diastolic blood pressure reduction was not associated with the Arg347Cys polymorphism in the alpha1A-adrenoceptor gene. In addition, no significant associations were observed between blood pressure reduction and two polymorphisms in the beta2-adrenoceptor gene. Our data suggest that the Arg347Cys polymorphism in the alpha1A-adrenoceptor gene may be used to predict blood pressure response to nifedipine GITS in Chinese hypertensive patients.

[Effects of in vivo transfer of human chemokine-like factor 1 gene on cardiac function after acute myocardial infarction in rats]

OBJECTIVE

To study the effects of chemokine-like factor 1(CKLF1)-plasmid transfer on cardiac function in a rat acute myocardial infarction (AMI) model.

METHODS

Thirty male SD rats were randomly devided into 3 groups. One hundred micrograms of CKLF1-plasmid, empty plasmid or saline were injected intramuscularly with in vivo electroporation, respectively. Rats were subjected to left coronary artery ligation on the 6th day after gene transfer. Ultrasonic cardiography and hemodynamics were conducted and evaluated on the 22nd day after gene transfer. Then, the animals were sacrificed for determination of percentage of myocardial infarcion.

RESULTS

The left ventricular ejection fraction in CKLF1 group (67.02% +/- 12.24%) was significantly higher than that in the saline group (43.64% +/- 7.82%) and empty plasmid group (47.56% +/- 4.10%), P<0.05. Fractional shortening of left ventricle in CKLF1 group (33.83% +/- 10.15%) was higher than that in saline group (18.49% +/- 3.96%) and empty plasmid group (20.85% +/- 2.24%), P<0.05. The maximal velocity of left ventricular pressure ascensus was higher in CKLF1 group [(5 720.01 +/- 826.32) mmHg/s, 1 mmHg=0.133 kPa] than in saline group [(3 955.69 +/- 685.91) mmHg/s] and in empty plasmid group [(4 412.03 +/- 500.74) mmHg/s)], P<0.05. And the maximal velosity of left ventricular pressure descensus was higher in CKLF1 group [(4 636.23 +/- 407.17) mmHg/s] than in saline group [(2 984.82 +/- 615.24) mmHg/s] and in empty plasmid group [(2 963.87 +/- 419.36) mmHg/s], P<0.05. While the percentage of myocardial infarction in CKLF1 group (29.63% +/- 3.93%) was smaller than that in saline group (38.01% +/- 5.48%) and in empty plasmid group (37.50% +/- 6.33%), P<0.05.

CONCLUSION

CKLF1 gene transfer can limit the mass of myocardial infarction and improve post-infarction cardiac function.

[Role of adiponectin and its receptors in anti-atherosclerotic effects of pioglitazone on ApoE knocked out mice]

OBJECTIVE

To study the effects of pioglitazone on atherosclerosis on ApoE-/- mice, and to investigate the roles of adiponectin and its receptors.

METHODS

ApoE-/- mice were fed with high-fat chow for the induction of atherosclerosis and were divided into three subgroups: placebo(n=10), low-dose[10 mg/( kg.d), n=10] pioglitazone therapy, and high-dose[20 mg/( kg.d), n=10] pioglitazone therapy. C57BL/6J wild type mice (n=9) were used as control. Aortic atherosclerosis and intimajmedia thickness (intima-media thickness , IMT) of abdominal aorta were monitored, and plasma adiponectin was also measured. Expression levels of the adiponectin receptor 1(AdipoR1)and adiponectin receptor 2 (AdipoR2) in vessels were analyzed(RT-PCR).

RESULTS

(1) Aortic atherosclerotic lesions were observed in ApoE-/- mice but not in wild type mice. Interestingly, these lesions were significantly prevented by high-dose pioglitazone therapy. Compared with wild type mice, ApoE-/- mice had increased IMT of abdominal aorta [(0.290+/-0.063 vs 0.178+/-0.012) cm, P<0.01] that was significantly reversed by high-dose pioglitazone therapy [(0.208+/-0.012 vs 0.290+/-0.063) cm, P<0.05]. (2) The level of plasma adiponectin was significantly lower in ApoE-/- mice [(12.41+/-3.84 vs 18.96+/-4.89) microg/L, P<0.05), which could be increased by low-and high-dose pioglitazone therapy (18.78+/-7.24 microg/L vs 12.41+/-3.84 microg/L, P<0.05; and 24.00+/-4.71 microg/L vs 12.41+/-3.84 microg/L, P<0.05). (3) Compared with wild type mice, ApoE-/- mice had reduced AdipoR1 mRNA level(0.789+/-0.167 vs 0.950+/-0.071, P<0.05) and reduced the ratio of AdipoR1/AdipoR2 (0.940+/-0.102 vs 1.039+/-0.062, P<0.05); high dose pioglitazone therapy could upregulate AdipoR1, AdipoR2 mRNA expression and increase the ratio of AdipoR1/AdipoR2 (1.063+/-0.051 vs 0.940+/-0.102,P<0.01).

CONCLUSION

Pioglitazone inhibits aortic atherosclerosis in ApoE-/- mice, and these effects are correlated with increased plasma adiponectin level and the expression of AdipoR1 mRNA in vessels.

[An analysis of clinical factors for coronary artery calcification score]

OBJECTIVE

To evaluate the correlating clinical factors of coronary artery calcification score (CACS).

METHODS

141 patients suspected of coronary artery disease were included. They underwent multi-slice row computed tomography, pulse wave velocity (PWV), UCG and blood biochemistry within a period of 3 months. The subjects were divided into three groups according to CAC score: A (CACS = 0 - 10), B (CACS = 11 - 400), C (CACS > 400).

RESULTS

CACS was significantly associated with age, history of hypertension and diabetes mellitus. It was also associated with the presence of mitral annular calcification and aortic valve calcification, low ankle brachial pressure index (ABI) and high mean artery pressure (MAP) as well as high values of brachial ankle PWV (baPWV) and Upstroke time (UT). Multifactorial logistic regression analysis showed that the presence of aortic valve calcification and mitral annular calcification, the history of diabetes mellitus and high value of UT were independently correlated with severe coronary artery calcification.

CONCLUSIONS

Aortic valve calcification, mitral annular calcification, history of diabetes mellitus, high value of UT were independently correlated with severe coronary artery calcification. Measurement of PWV and UCG should be performed before multi-slicerow computed tomography, because the assessment of coronary artery lumen narrowing with multi-slice row computed tomography can not be carried out accurately in the presence of severe coronary artery calcification.

Chemical constituents and pharmacological properties of Radix Inulae

Radix Inulae is used as a gastric and antibacterial agent in traditional Chinese and Tibetan medicines. Most of its chemical constituents have been identified and include a series of sesquiterpenes with various carbon skeletons such as: eudesmanolide, elemanolide, germacranolide, sesquicaranolide, guaianolide and humulane. Certain organic solvent fractions and sesquiterpenes from Radix Inulae have been found to significantly inhibit the growth of tumor cell strains in vitro. They also show antibacterial, cardiovascular and hypoglycaemic as well as insulin-sensitization activities. The present review summarizes research on the chemistry and biological activity of Radix Inulae.

Clinical profile and outcomes of atrial fibrillation in elderly patients with acute myocardial infarction

BACKGROUND

Atrial fibrillation (AF) occurs commonly in patients with acute myocardial infarction (MI) and is associated with an increased long-term mortality. This study aimed to investigate the clinical characteristics and outcomes of AF in in-hospital elderly Chinese patients with acute MI.

METHODS

A total of 967 patients with acute MI, aged >/= 65 years, were categorized on the basis of the absence or presence of AF. Patients with documented AF were classified into two subgroups: the ongoing AF group and the new-onset AF group. We retrospectively evaluated the clinical profile, in-hospital outcomes, and effects of revascularization on the incidence of AF in elderly patients with acute MI.

RESULTS

AF was documented in 100 (11.53%) patients and the incidence of new-onset AF was 6.51% during hospitalization. History of old MI and cerebrovascular events were more common in patients with AF than in those without AF (P < 0.001, P < 0.01, respectively). The incidence of AF was higher in patients with non-ST elevated MI (P = 0.014), inferior wall MI (P = 0.004) and cardiac function of Killip class III or IV (P = 0.008). Patients with AF had more complication of pneumonia (P = 0.003) and longer hospital stay. Left circumflex coronary artery involvement was more common in patients with AF (compared with patients without AF, P < 0.001). Percutaneous coronary intervention or coronary artery bypass grafting significantly decreased the incidence of new-onset AF from 7.97% to 3.82% (P = 0.017). AF depended to heart failure, increased the in-hospital mortality.

CONCLUSIONS

AF is common in elderly patients with acute MI and is associated with poorer clinical outcomes. Revascularization reduces the incidence of AF and thus improves the clinical outcomes in these patients.

[The effect of baseline homocysteine level on the efficacy of enalapril maleate and folic acid tablet in lowering blood pressure and plasma homocysteine]

OBJECTIVE

To investigate the effect of baseline homocysteine (Hcy) level on the efficacy of enalapril maleate and folic acid tablet in lowering blood pressure and plasma Hcy in patients with mild or moderate essential hypertension.

METHODS

456 patients with mild or moderate essential hypertension were from 7 hospitals in Southern and Northern China, 196 males and 260 females, aged 18-75, were randomly assigned to one of the 3 groups: Group 1 treated with enalapril 10 mg (n=153); Group 2 treated with enalapril maleate and folic acid tablet at the ratio of 10/0.4 (n=151); and Group 3 treated with enalapril maleate and folic acid tablet at the ratio of 10/0.8 (n=152). Blood pressure was measured every 2 weeks and plasma Hcy level was measured before the experiment, 4 weeks after the beginning of experiment, and by the end of experiment.

RESULTS

Compared with the baseline levels, the blood pressures of the 3 groups were all well controlled (all P<0.01). There was no significant difference among the 3 groups in the efficacy in lowering blood pressure, even after stratification by the baseline Hcy level. 75% of all the subjects had elevated plasma Hcy level (>or=10 micromol/L). The blood pressure and Hcy lowering rates of the subjects with hyperhomocysteinemia in Groups 2 and 3 were 70.9% and 67.0% respectively, both significantly higher than that of Group 1 [45.6%, OR(95%CI): 3.0 (1.7-5.5), P=0.000 and OR=3.3 (1.8-5.9), P=0.000], and in lowering Hcy [OR(95%CI): 7.5 (2.6-21.2), P=0.000 and 3.5 (1.4-8.7), P=0.007] subjects with hyperhomocy steinemia. The Hcy lowering efficacy in the patients without hyperhomocysteinemia of Group 3 was significantly higher than that of Group 1 (P=0.016).

CONCLUSION

Hyperhomocysteinemia is s extremely common in Chinese hypertensive patients. Enalapril maleate combine with folic acid tablet shows better efficacy in lowering either blood pressure or Hcy in hypertensive patients with hyperhomocysteinemia.

[Analysis of prognostic patients with non-ST-segment elevation acute myocardial infarction and clinical characteristics of those with renal dysfunction]

OBJECTIVE

To evaluate the clinical features of non-ST-segment-elevation myocardial infarction (NSTEMI) patients with renal dysfunction and investigate correlation factor for in-hospital death and 6 months adverse events of NSTEMI patients.

METHODS

One hundred and sixteen patients presenting with NSTEMI were enrolled between January 2006 and September 2007. Estimation of glomerular filtrate rate (eGFR) was conducted by the modified abbreviated MDRD equations based on the Chinese CKD patients. Renal dysfunction was defined as eGFR < 60 mL/(min.1.73 m2) and/or as having the other evidence of chronic kidney damage over 3 months or more. All the clinical data were collected. Correlation factors of in-hospital death and 6-month adverse events were evaluated.

RESULTS

29.3 percentage of patients presented with renal dysfunction (34/116), patients with renal dysfunction were older, more likely to have history of hypertension, diabetes mellitus and angina compared with those with normal renal function, and more likely to be with heart function killip grades III-IV, higher level of the plasma fibrinogen on admission, lower left ventricular ejection. Patients with renal dysfunction experienced less angiography, more coronary artery calcification, and less percutaneous coronary interventional treatment. Multifactorial logistic regression analysis showed that killip grades III-IV on admission (OR = 13.12, P = 0.000) were independently correlated with the in hospital death, killip grades III-IV on admission (OR = 6.265, P = 0.002) and renal dysfunction (OR = 3.545, P = 0.007) might be independent risk factors of 6-month adverse events in patients with NSTEMI.

CONCLUSION

Patients with renal dysfunction were older, more likely to have history of hypertension, diabetes mellitus and angina, and more likely to be with heart function killip grades III-IV, more coronary artery calcification; killip grades III-IV on admission were independently correlated with the in-hospital death; killip grades III-IV on admission and renal dysfunction might be independent risk factors of 6-month adverse events in patients with NSTEMI.

[Location and expression of apo(a) and apoB in peripheral blood of patients with cardiovascular disease]

OBJECTIVE

To explore the relationship between the severity of cardiovascular disease with the expression of apolipoprotein(a) [apo(a)] and apolipoprotein B (apoB) in peripheral blood and their location in peripheral blood cells.

METHODS

In this report, we selected 4 patients with angiography which indicated that three coronary arteries were narrowed and 5 control patients with normal angiography. Arterial blood was collected and analyzed for lipid parameters in plasma. The mRNA expression of apo(a) and apoB in peripheral white blood cells and platelets were determined by RT-PCR and their protein expression by western blot. Moreover, the expression and location of apo(a) and apoB in white blood cells were determined by confocal microscopy and computer 3D analysis.

RESULTS

In plasma, levels of high density lipo-protein-cholesterol (HDL-C) and polipoprotein A-I(apoA-I) in cardiovascular disease (CVD) patients were significantly less than those in the control patients[(0.62+/-0.05) mmol/L, (0.78+/-0.08) mmol/L vs (0.81+/-0.15) mmol/L, (0.9+/-0.07) mmol/L, P<0.05], but the concentration of other plasma lipid parameters was not different. The size of apo(a) isoforms was not reversely related to the severity of cardiovascular disease and the most commonly occurring phenotype of apo(a) was S4.The expression of apoB in platelets in cardiovascular disease patients was less than that in the control patients by 25.1% (optical density value 0.67+/-0.18 vs 1.00+/-0.10, P<0.05),but the expression of apo(a) was not different between the two groups (optical density value 0.43+/-0.18 vs 0.61+/-0.40, P>0.05). Studies with confocal microscopy indicated that proteins of apo(a) and apoB were co-expressed by a few cells of leukocytes and the ratio of apoB/apo(a) in cardiovascular disease patients was significantly less than that in the control patients (optical density value 1.60+/-0.12 vs 4.40+/-0.35, P<0.05). In platelets and leukocytes, mRNA of apo(a) or apoB was not detectable.

CONCLUSION

Our studies indicate that peripheral blood cells can carry apo(a) and apoB, furthermore the contents of apoB and apo(a) in cells are different between cardiovascular disease patients and patients with normal coronary artery.

Sirolimus-eluting cobalt-chromium stents: two-year clinical results from first-in-man study on the Firebird 2 stent

BACKGROUND

Drug-eluting stents (DES) have been shown to significantly reduce clinical events and angiographic restenosis in the treatment of coronary artery disease (CAD). This study was conducted to assess the long-term efficacy and safety of the polymer-based sirolimus-eluting cobalt-chromium Firebird 2 stents in the treatment of patients with CAD.

METHODS

This first-in-man study using the Firebird 2 stent is a prospective, historically-controlled multicenter clinical study, which enrolled 67 patients with CAD who were treated with the sirolimus-eluting cobalt-chromium stent (Firebird 2, Microport Shanghai, Firebird 2 group), compared to another 49 patients treated with a bare cobalt alloy stent (Driver, Medtronic, control group). Continued 2-year clinical follow-up was performed after getting the initial 6-month angiographic and 1-year clinical follow-up. The incidence of major adverse cardiac events (MACE) including cardiac death, reinfarction and target lesion revascularization (TLR) and stent thrombosis were compared between the two groups.

RESULTS

All patients in the Firebird 2 group (100.0%) and 48 patients in the control group (98.0%) completed the 2-year clinical follow-up. At the 1-year follow-up the use of the Firebird 2 stent was highly effective, resulting in a significant 94% decrease of TLR (26.5% in the control group and 1.5% in the Firebird 2 group, P<0.0001). A significant difference in TLR was maintained at 2-year follow-up, Firebird 2 group 1.5% and the control group 31.3% (P<0.0001). Between 1- and 2-year post-stenting, no more TLR occurred in the Firebird 2 group compared with two cases in the control group (P>0.05). There was a 1.5% incidence of MACE at 1- and 2-year follow-up in the Firebird 2 group, compared with 26.5% and 33.3% in the control group, respectively (all P<0.0001). The cumulative 1- and 2-year MACE free survival rates were 98.5% in the Firebird 2 group vs 73.5% and 66.7% in the control group (log rank P<0.0001). No case of stent thrombosis occurred during 2-year follow-up in the Firebird 2 group, compared with one case that suffered a definite stent thrombosis in the control group at 19-month post-stenting: this patient presented with unstable angina pectoris and was treated by balloon angioplasty.

CONCLUSIONS

Compared with the bare cobalt alloy stent, the Firebird 2 sirolimus-eluting cobalt-chromium stent is safe and effective in treating patients with CAD. The use of this stent was associated with a sustained clinical benefit and significantly lower rate of TLR and MACE up to 2 years post-stenting.

[Activities of circulating endothelial progenitor cells in patients with in-stent restenosis]

OBJECTIVE

To observe the number and activities of circulating endothelial progenitor cells (EPCs) in patients with in-stent restenosis.

METHODS

Peripheral blood samples were collected from 15 patients with angiographically restenosis, and 17 baseline characteristics-matched patients without angiographically restenosis (control group). Mononuclear cells were isolated by Ficoll density-gradient centrifugation and plated on dishes coated with human fibronectin. After 7 days in culture, the nature of EPCs was characterized with anti-CD34 and anti-KDR, specific surface antibodies of EPC, and confirmed further with the use of fluorescein isothiocyanate-labeled ulex europaeus agglutinin-I (FITC-UEA-I) and DiI (1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine percolate)-labeled acetylated low-density lipoprotein (DiI-acLDL) by laser scanning confocal microscopy. The number of EPCs was counted in a blinded manner. EPCs were inoculated onto the culture plate and 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl-2H-tetrazolium bromide assay was used to measure the A value by enzyme labeling instrument to evaluate the proliferation. The migration of EPCs was assayed by scratch assay. EPC adhesion was performed by replating cells on fibronectin-coated dishes and then counting the adherent cells. Results The number of EPCs of the patients with in-stent restenosis was 4.97 +/- 1.42/well, significantly lower than that of the control group (17.2 +/- 3.90/well, P = 0.001). MTT assay showed that the proliferative activities of the in-stent restenosis group was 1.37 +/- 0.32 times the baseline value, significantly lower than that of the control group (2.01 +/- 0.62, P < 0.05). The number of migrating EPCs of the in-stent restenosis group was remarkably lower than that of the control group. There was no significant difference in the adherent activity between the two groups. Conclusion The number, proliferation activity, and migration activity of the EPCs patients with in-stent restenosis are all significantly lower, which may contribute to the mechanism of in-stent restenosis.

[Renal insufficiency and clinical outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a multi-centre study]

OBJECTIVE

To investigate the association of renal insufficiency and clinical outcomes in patients with acute coronary syndrome(ACS).

METHODS

The study was a multi-centre register study including 3,589 ACS patients coming from 39 centers across China who had received percutaneous coronary intervention(PCI) prior to 1st February, 2007. Estimated glomerular filtration rate (eGFR) was calculated for all patients using the 4-variable MDRD equation with the serum creatinine obtained before angiography. The association between renal insufficiency and clinical outcomes and the presence of in-hospital death and bleeding was studied by Fisher's exact test. Multi-variable analysis on the risk factors of in-hospital bleeding was done by logistic regression test.

RESULTS

The mean age of the study population was (61.74+/-11.37) years (ranging from 23 years to 92 years)and 76.5% (2,746/3,589) of the population was male. Only 90 patients (2.51%) were known to have chronic kidney disease at the time of admission and 144 patients(4.01%) had serum creatinine levels above 133 micromol/L. However, after the evaluation of renal status by the MDRD equation, 2,250 patients (63.1%)showed a reduction in eGFR of less than 90 mL/min, of whom, 472 (13.1%) even reached the level of moderate renal insufficiency (eGFR<60 mL/min) and above. Seven patients(0.20%) were proved to have chronic total occlusion lesions(CTO) and eight (0.22%) needed shift to coronary artery bypass grafting (CABG) after angiography. Both the presence of CTO lesions and CABG were proved to be associated with decrease of renal function through Fisher's exact test (P= 0.005 8 and 0.041, respectively). The in-hospital mortality rate was 0.47%(17/3 589) which was associated with the degree of renal insufficiency (P=0.001 3). A total of 75 patients(2.09%) of in-hospital bleeding were recorded with 26 patients(0.72%) diagnosed as major bleeding events. 92% (69/75) of the bleeding events occurred after PCI. Bleeding was found to be associated with the degree of renal insufficiency in every type of antithrombotic therapy (P<0.001). After adjusting with other variables by logistic regression test, renal insufficiency (eGFR per 10 mL/min decrease, OR=1.133, 95% CI 1.011- 1.27, P=0.032)and age (above 65 years, OR=1.907, 95% CI 1.107-3.28, P=0.02) were proved to be the risk factors of in-hospital bleeding.

CONCLUSION

Renal insufficiency is very common in ACS patients but self-report rate is low among this population. Renal function evaluated by eGFR should be carried out for every patient hospitalized for ACS for risk stratification. Patients with severer renal insufficiency usually have more complicated clinical manifestations and a higher rate of in-hospital bleeding.

[Efficacy and safety of Enalapril-Folate acid tablets in lowering blood pressure and plasma homocysteine]

OBJECTIVE

To investigate the efficacy and safety of Enalapril-Folic acid tablets in lowering blood pressure and plasma homocysteine(Hcy) level.

METHODS

A randomized, double blind, multicenter clinical trial was performed. Subjects with mild-moderate hypertension were randomly assigned to the following three groups: group 1, Enalapril 10.0 mg/d; group 2, Enalapril 10.0 mg+ Folic acid 0.4 mg/d; group 3, Enalapril 10.0 mg + Folic acid 0.8 mg/d. Blood pressure and plasma Hcy level were examined every two weeks, for a total period of 8 weeks.

RESULTS

A total of 480 hypertensives were enrolled. All analyses were performed according to the intention to treat and included all randomized patients. Compared to group 1, both group 2 and group 3 had significantly higher effectiveness in lowering both blood pressure and plasma Hcy level, or in lowering either blood pressure or plasma Hcy level. The proportions of subjects showing obvious reduction in both blood pressure and plasma homocysteine level in group 1, group 2, group 3, were 4.6%, 13.2%, 17.1%, respectively; the proportions of subjects showing obvious reduction in either blood pressure or plasma homocysteine level in group 1, group 2, group 3, were 45.8%, 59.6%, and 65.1%, respectively; Effects on blood pressure, as well as the safety profile were not significantly different among the three regimens.

CONCLUSION

Enalapril-Folic acid tablets could be used to reduce both blood pressure and plasma Hcy level in mild to moderate hypertensive subjects.

Efficacy of folic acid supplementation in stroke prevention: a meta-analysis

BACKGROUND

The efficacy of treatments that lower homocysteine concentrations in reducing the risk of cardiovascular disease remains controversial. Our aim was to do a meta-analysis of relevant randomised trials to assess the efficacy of folic acid supplementation in the prevention of stroke.

METHODS

We collected data from eight randomised trials of folic acid that had stroke reported as one of the endpoints. Relative risk (RR) was used as a measure of the effect of folic acid supplementation on the risk of stroke with a random effect model. The analysis was further stratified by factors that could affect the treatment effects.

FINDINGS

Folic acid supplementation significantly reduced the risk of stroke by 18% (RR 0.82, 95% CI 0.68-1.00; p=0.045). In the stratified analyses, a greater beneficial effect was seen in those trials with a treatment duration of more than 36 months (0.71, 0.57-0.87; p=0.001), a decrease in the concentration of homocysteine of more than 20% (0.77, 0.63-0.94; p=0.012), no fortification or partly fortified grain (0.75, 0.62-0.91; p=0.003), and no history of stroke (0.75, 0.62-0.90; p=0.002). In the corresponding comparison groups, the estimated RRs were attenuated and insignificant.

INTERPRETATION

Our findings indicate that folic acid supplementation can effectively reduce the risk of stroke in primary prevention.

[Distribution of serum folic acid level of patient suffered mild and moderate hypertension in six cities in China]

OBJECTIVE

To describe distribution of serum folic acid concentrations and differences among age, gender groups and geography in Chinese population with mild-to-moderate hypertension.

METHODS

455 subjects aged 28 to 75 years were randomly recruited from six cities in China. Serum folic acid concentrations were measured by electrochemiluminescence.

RESULTS

(1)The mean of serum folic acid in male (12.39nmol/L) was lower than that in female (14.61nmol/L) (P <0.01). The folic acid deficiency rate and lower folic acid rate in male were also significantly higher than those in female (P < 0.05). (2) Subjects from Nanjing city could have relatively higher level in serum of folic acid (P < 0.05), when compared with those from other cities. Additionally, there were no differential distributions of folic acid levels among different age groups.

CONCLUSION

Serum folic acid distribution in Chinese mild-to-moderate hypertensive patients could have gender and geography differences.

Safety and efficacy of the CYPHER Select Sirolimus-eluting stent in the "Real World"--clinical and angiographic results from the China CYPHER Select registry

OBJECTIVE

This post-marketing surveillance registry is aimed at determining the safety and reliability of the CYPHER Select Sirolimus-eluting stent (SES) in routine clinical practice.

BACKGROUND

Little information and angiographic follow-up data in large-scale "real world" registry is available for the CYPHER Select SES, an advanced-generation SES.

METHODS

This was a prospective multicenter (20 centers) registry. 1189 consecutive patients who received at least 1 CYPHER Select SES during daily clinical practice were enrolled. Patients who underwent emergency stenting for acute myocardial infarction were excluded.

RESULTS

The procedure's success rate was 98.3% for CYPHER Select SES implantation, and follow-up rates were 98% with 100% data auditing. Target lesion revascularization (TLR) at 12 months occurred in 60 (5.14%) cases, cardiac death in 13 cases (1.11%), Q wave myocardial infarction (MI) in 5 cases (0.43%), non-Q-MI in 9 cases (0.77%), target vessel revascularization (TVR) in 67 cases (5.74%), and MACE defined as cardiac death, nonfatal MI and TLR in 76 cases (6.51%). MACE-free survival rate at 12 months was 93.7%. Angiographic follow-up at 9 months was performed in 418 (68.3%) lesions treated by CYPHER Select SES. The binary restenosis rate was 4.8% in-stent and 9.6% in-segment. Subgroup analysis showed diabetes, bifurcation lesion and combined use of different stents were independent risk factors of cumulative MACE. In-segment MLD </=2.25 mm at post-procedure and ostial lesion was independent predictors of in-segment restenosis.

CONCLUSIONS

In this registry, the MACE, TLR, angiographic late loss and binary restenosis rates of CYPHER Select SES were similar to those reported in SES randomized trials and "real world" registries. The safety and efficacy of CYPHER Select SES shown in this registry are consistent with those seen in SES studies.

Sirolimus-eluting cobalt alloyed stents in treating patients with coronary artery disease: six-month angiographic and one-year clinical follow-up result. A prospective, historically controlled, multi-center clinical study

BACKGROUND

The emergence of drug-eluting stents (DES) has dramatically reduced the incidence of in-stent restenosis. This study was conducted to evaluate the safety and efficacy of sirolimus-eluting cobalt-chrome stents (Firebird 2) for treating patients with coronary artery disease.

METHODS

Sixty-seven patients with de novo or non-stented restenostic coronary lesions were chosen to receive the Firebird 2 stent as the final treatment (Firebird 2 group). Another 49 consecutive patients were implanted with bare cobalt alloyed stents (Driver, Medtronic) within the previous six months and served as historical controls (control group). Baseline clinical characteristics, angiographic features, procedural results, 30-day, 6-month and 12-month clinical follow-up regarding the occurrence of major adverse cardiac events (MACE), as well as the primary endpoint of late lumen loss at 6-month angiographic follow-up were compared between the two groups.

RESULTS

The demographic characteristics were similar between the two groups despite more patients in the Firebird 2 group who underwent previous percutaneous coronary intervention (22.4% vs 8.2%, P = 0.0418) and who had diabetes mellitus (29.9% vs 12.2%, P = 0.0253). In the Firebird 2 group, the mean diameter of the reference vessel was smaller ((2.79 +/- 0.46) mm vs (2.98 +/- 0.49) mm, P = 0.0175) and more stents were implanted for each lesion (1.28 +/- 0.52 vs 1.10 +/- 0.30, P = 0.0060). Other angiographic, procedural results and the device success rate were similar between the two groups. The MACE rate at 30-day and 3-month was the same, but significantly fewer MACE occurred in the Firebird 2 group at 6- and 12-month follow-up (1.5% vs 12.2% at 6 month, P = 0.0168; 1.5% vs 26.5% at 12 month, P < 0.0001). The primary endpoint of late lumen loss at 6-month angiographic follow-up was significantly reduced in the Firebird 2 group (in-stent: (0.05 +/- 0.09) mm vs (0.98 +/- 0.61) mm; in-segment: (0.05 +/- 0.18) mm vs (0.72 +/- 0.59) mm; P < 0.0001) than the control group. One patient in the Firebird 2 group had in-segment restenosis (1.3%) while the rate in the control group (38.1%) was significantly higher, P < 0.0001. Intravascular ultrasound examination was performed in 70.1% of patients in the Firebird 2 group and revealed that the percentage of volumetric obstruction was (1.26 +/- 1.05)%. No stent thrombosis was observed in either group at 12-month follow-up.

CONCLUSION

The Firebird 2 sirolimus-eluting cobalt alloyed stent is safe and feasible in treating patients with coronary artery disease.

Antinociceptive activity and chemical composition of constituents from Caragana microphylla seeds

This investigation was undertaken to ascertain the antinociceptive activity of Caragana microphylla Lam. seeds and isolate and characterize the constituents. Antinociceptive activity was screened using acetic acid-induced abdominal constriction in ICR mice. The 75% ethanol extract and some fractions showed analgesic activity, but the antinociceptive activity of chloroform fraction was the strongest and was more productive than other fractions. Seven compounds were isolated from it and identified as: (1) machaeric acid, (2) beta-sitosterol, (3) stigmasterol, (4) pratol, (5) dehydrocavidine, (6) formononetin and (7) sucrose. Caragana microphylla Lam. seeds showed analgesic activity, with the chloroform fraction showing the strongest analgesic activity among the fractions.

[The effect of different loading doses of clopidogrel on platelet aggregation]

OBJECTIVE

To compare the short-term efficacy and safety of high loading dose (600 mg) clopidogrel treatment with those of routine loading dose (300 mg) in patients with acute coronary syndrome and provide evidence for planning clopidogrel treatment.

METHODS

60 patients were randomized into two groups, One group received 300 mg loading dose clopidogrel, while the other received 600 mg and both were followed by 75 mg daily thereafter. Adenosine diphosphate (ADP) (5 micromol/L and 20 micromol/L) induced platelet aggregation was examined at baseline (before administration), 2 hours and 6 hours after administration and the count of white blood cell and platelet 3 days after loading dose. The primary end points were hemorrhagic events, granulocytopenia and thrombocytopenia within 3 days after administration.

RESULTS

With a high-dose agonist (20 micromol/L ADP), loading doses of clopidogrel at 300 mg and 600 mg both produced greater inhibition of baseline ADP (20 micromol/L) induced aggregation 6 hours after administration than 2 hours [group of 300 mg: (29.75+/-12.11)% vs (43.63+/-14.31)%, P<0.05. Group of 600 mg: (28.86+/-10.24)% vs (34.86+/-10.84)%, P<0.05]. Treatment with clopidogrel at 600 mg loading dose had a marked earlier effect on platelet aggregation 2 hours after administration than that of 300 mg [(34.86+/-10.84)% vs (43.63+/-14.31)%, P<0.05]. The platelet aggregation of the two groups tended towards similar at 6 hours after the procedure [(28.86+/-10.24)% vs (29.75+/-12.11)%, P>0.05]. There were no episodes of hemorrhagic events, granulocytopenia and thrombocytopenia within 3 days after the procedure.

CONCLUSIONS

In Chinese patients with acute coronary syndrome platelet aggregation can be inhibited more rapidly and more effectively with clopidogrel at 600 mg loading dose when compared with that at 300 mg loading dose and the safety aspect between the two different loading doses is equivalent.

[In vivo transfer of human chemokine-like factor 1 gene increases peripheral blood CD34+ stem cells after myocardial infarction in rats]

OBJECTIVE

To assess the influence of different doses of CKLF1 plasmid on the dynamics and magnitude of the mobilization of the mobilization bone of marrow stem cells in a rat AMI model.

METHODS

Different doses of plasmid DNA encoding CKLF1 gene, empty plasmid or saline were injected into male SD rats intramuscularly with in vivo electroporation. Rats were subjected to left coronary artery ligation 6 days after gene transfer. Peripheral blood samples were drawn and CD34+ cells were assayed by FACS calibur flow-cytometer. The changes in absolute number of CD34+ cells were evaluated.

RESULTS

Expressions of CKLF1 mRNA and protein were detected in the injection site 7 days after gene transfer. Five days after gene transfer, the CD34+ cells numbers in CKLF1 groups were significantly higher than those in empty plasmid group, especially in CKLF1 100 microg group (16.63x10(6)/L vs 4.98x10(6)/L, P<0.01). On the 5-7 days, the CD34+ cell numbers in CKLF1 groups reached the peak and the peak number was 3.88 times that of baseline in CKLF1 100 microg group (P<0.01). After AMI, the cell numbers of 1 day to 7 days were significantly higher than those of the baseline in empty plasmid group and saline group. In comparison to empty plasmid group, CKLF1 groups were associated with still higher numbers of cells 1 day after AMI (P< 0.05), especially in CKLF1 100 microg group (14.61x10(6)/L vs 7.85x10(6)/L, P<0.01).

CONCLUSION

CKLF1 gene transfer significantly increases the mobilization of CD34+ stem cells in acute myocardial infarction rats.