Objective: To explore the associations of plasma acylcarnitine and bile acid levels with the risk of incident coronary heart disease (CHD) in Chinese adults. Methods: The baseline survey of China Kadoorie Biobank (CKB) took place in 10 areas across China during 2004-2008, and the first resurvey took place from July to October 2008, with collection of data via questionnaire, physical examination and blood samples. The current study was based on 2 159 individuals with targeted mass spectrometry metabolomic measurements from the first resurvey of CKB. The associations of acylcarnitines and bile acids with incident CHD were assessed using Cox proportional hazards regression models. Unweighted metabolites scores were constructed to assess the overall effect of acylcarnitines and bile acids on incident CHD. The impact of metabolites on the performance of CHD prediction model was evaluated with the receiver operating characteristic (ROC) area under the curve (AUC). Follow-up for CHD incidence was censored on December 31, 2018. Results: The mean age of the participants was (53.1±9.8) years and 754 were males (34.9%). During (10.5±0.1) years of follow-up, 140 cases of CHD were recorded. Four metabolites including acylcarnitines C3-OH, C5:1, C5:1-DC, and deoxycholic acid (DCA) showed associations with CHD incidence and the HR (95%CI) were 1.474 (1.230-1.767), 0.761 (0.637-0.909), 0.773 (0.650-0.918), and 1.309 (1.113-1.539), respectively [false discovery rate (FDR)0.05]. All metabolite scores, including short-chain, medium-chain, long-chain acylcarnitines, primary and secondary bile acids scores were associated with the risk of CHD (FDR0.05). Compared to the traditional models, the addition of DCA or 4 key metabolites increased the AUC of the predictive model from 0.803 (0.761-0.845) to 0.812 (0.772-0.852) and 0.817 (0.778-0.857), respectively (all P0.05). Conclusions: Acylcarnitine and bile acid levels are associated with the risk of CHD, and DCA or 4 key metabolites can improve the predictive ability for CHD incidence.
With the acceleration of global population aging, the incidence and mortality of cardiovascular disease (CVD) among the older adults are continuously rising, posing an essential public health challenge that severely threatens their health and quality of life. In recent years, significant progress has been made in the research on epidemiological characteristics, risk factors, and prevention strategies of CVD in older adults. This review aims to summarize the current research status of CVD in the old adults, explore key factors affecting cardiovascular health, including genetic factors, lifestyle, and metabolic abnormalities, and evaluate the effectiveness of novel interventions. The goal is to provide a scientific basis for developing CVD prevention and management strategies tailored to the old adults.
The World Health Organization's (WHO) International Agency for Research on Cancer (IARC) released the fifth edition of the Classification of Tumors of the Hematopoietic and Lymphoid Tissues, renaming myelodysplastic syndrome (MDS) to myelodysplastic neoplasm (still abbreviated as MDS). This new classification integrates next-generation sequencing data to standardize the disease's nature. The name change reflects a deeper understanding of the disease, transitioning from the vague "syndrome" to a clearly defined neoplastic disease. The new classification divides MDS into two major categories: cytogenetic abnormalities and morphological abnormalities. Cytogenetic abnormalities include MDS with low blasts and isolated 5q deletion, MDS with low blasts and SF3B1 mutation, and MDS with biallelic TP53 alterations. Morphological abnormalities include MDS with low blasts, MDS with increased blasts and hypoplastic MDS. This revision provides a foundation for precise diagnosis and treatment of MDS, further restricting the application of immunosuppressive therapy and advancing genetic research in diagnostics and therapeutics.
Objective: To analyze the treatment situation at each time node in the standard in-hospital-stroke(IHS) in the general hospital compared with that in the emergency(community)-onset stroke (COS) group. Methods: A single-center retrospective case-control study was performed.The clinical cases of acute COS group and IHS group who were treated by the same stroke green channel team at Peking Union Medical College Hospital from Jan.2021 to Apr.2024 were included. The treatment process of acute stage of stroke was divided into four time nodes (onset, recognition, admission, and treatment), and the time of each time node was compared and analyzed. Results: A total of 219 ischemic stroke cases were included, comprising 83 and 136 cases in IHS and COS groups, respectively. There were 134 male patients (61.2%) with a mean onset age of (66.3±15.1) years. IHS occurred across various departments, mainly in surgical departments(55/83, 66.2%). Of the perioperative IHS events, 93.7% (45/48) occurred after the surgery. Compared with the COS group, the IHS group showed a higher rate of post-waking stroke[11/32(34.4%) vs 18/136(13.2%), P=0.004], a lower rate of intravenous thrombolysis[9/32 (29.0%) vs 128/136 (94.8%), P0.001], and a higher rate of mechanical thrombectomy [11/32(34.4%) vs 4/136 (2.9%), P0.001].The overall median onset-CT time in the IHS group was shorter than that in the COS group[M (Q1, Q3)] [100 (59, 189)min vs 135(75, 210)min, P=0.030]. In different stages, median time from stroke onset to recognition[25(1, 140) vs 1(1, 30)min,P=0.005] and the on-site/reception CT [30 (19, 40) min vs 16 (11, 26) min, P=0.001] in the IHS group were longer than those in the COS group, while the median time from recognition to admission[30 (10, 48) min vs 76 (53, 137)min, P0.001]was shorter than that in the COS group. Conclusions: By using the standard ischemic stroke care system, the overall treatment time for IHS group is shorter than that of COS groups. However, compared with COS patients, the onset-recognition and admission to examination/treatment time was significantly prolonged for IHS patients, reflecting the need for further optimization of the standardized in-hospital stroke treatment process.
Objective: To explore the impact of adherence to plant-based and animal-based dietary patterns on blood lipid level in Chinese older adults aged≥65. Methods: The study subjects were from the Chinese Longitudinal Health Biomarker Survey on Aging conducted between 2008 and 2018. The project carried out a baseline survey on elderly people in nine longevity areas of China from 2008 to 2009, and conducted 3 follow-up visits respectively in 2011-2012, 2014, and 2017-2018. The information about their demographic characteristics, lifestyles, physical examinations and fasting venous blood samples were collected. Food Frequency Questionnaire was used to collect data on food intake frequency. Priori plant-based and priori animal-based dietary patterns were constructed, and plant-based diet index (PDI) and animal-based diet index (ADI) were calculated in 2 011 older adults. Linear mixed-effects models were used to analyze the associations of different dietary pattern indices with blood lipid level in older adults. Results: The average age of 2 011 subjects was (83.1±11.5) years, 52.8% (1 061) of them were women. The PDI and ADI [M (Q1, Q3)] were 41.0 (38.0, 45.0) and 43.0 (39.0, 46.0), respectively. After adjusting for covariates, the results of the linear mixed effects model analysis showed that for each increment of 10-unit in PDI, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels decreased by 0.097 (95%CI:-0.151--0.042) mmol/L and 0.078 (95%CI:-0.118--0.038) mmol/L, respectively. For each increment of 10-unit in ADI, TC and LDL-C levels increased by 0.096 (95%CI: 0.042-0.151) mmol/L and 0.078 (95%CI: 0.038-0.118) mmol/L, respectively. Conclusions: In Chinese older adults≥65 years, higher adherence to the plant-based dietary pattern may lead to reductions in TC and LDL-C levels, while higher adherence to the animal-based dietary pattern may lead to increases in TC and LDL-C levels.
Objective: To analyze the thyroid stimulating hormone (TSH) levels in different genders and ages, and the association between TSH level and the risk of coronary heart disease. Methods: The baseline survey was conducted using a multi-stage cluster random sampling method from September to December 2015, in Jurong City, Jiangsu Province. A total of 10 703 participants were included in the analysis. The proportion of participants with abnormally elevated TSH defined by three cut-off values (4.5, 7.0, and 10.0 mU/L) were calculated. The cohort was followed up until August 2023 to collect and verify new cases of coronary heart disease. The population was divided into age-and gender-specific quintile subgroups based on TSH. Multivariate Cox regression analysis was used to examine the relationship between TSH and the risk of coronary heart disease. Results: The median age was [M (Q1, Q3)] 61.1(51.8, 67.9) years-old, and there were 4 168 males (38.94%) in the study. The proportions of participants with abnormally increased TSH rose with aging in different genders, and was higher in females than in males (all Ptrend0.05). A total of 206 participants with coronary heart disease at baseline were excluded, and the other 10 497 were followed up for an average of (7.33±1.49) years, during which 350 new cases of coronary heart disease occurred, and the cumulative incidence rate was 3.34%. The cumulative incidence rates among TSH quintile Q1-Q5 groups were 3.62%, 3.32%, 3.56%, 3.28% and 2.57% respectively. Multivariate Cox regression analysis indicated that compared with TSH Q1 group, participants in Q5 group had a lowest risk of coronary heart disease (HR=0.704, 95%CI: 0.498-0.994). The TSH Q5 group was associated with a reduced risk of coronary heart disease in individuals60 years old (HR=0.484, 95%CI: 0.243-0.965), and the risk of coronary heart disease decreased as TSH levels increased (Ptrend=0.008). Conclusions: TSH level increases with aging, and is higher in females than in males. In individuals 60 years old, higher levels of TSH may assaciate with a lower incidence rate of coronary heart disease.
Objective: To compare the short-and medium-term ischemia and bleeding risk between unfractionated heparin and bivalirudin in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: A total of 742 patients with ACS who underwent emergency PCI in Xinxiang Central Hospital of Henan Province from January 2016 to June 2022 were selected and divided into unfractionated heparin group (385 cases) and bivalirudin group (357 cases) according to the anticoagulant regimen. All patients were followed up for 6 months. The incidence of ischemic and bleeding events at 30 days and 6 months after operation were compared between the two groups. Multivariate Cox proportional regression model was used to analyze the risk factors of ischemic and bleeding events in the two groups. Kaplan Meier method was used to calculate the cumulative survival rate, and log rank method was used to analyze the difference in survival rates. Results: The age of 742 patients was (62.5±14.8) years old, and male accounted for 58.5% (434 cases). The age of unfractionated heparin group was (61.8±14.8) years old, and male accounted for 59.2% (228 cases); The age of bivalirudin group was (63.3±14.8) years old, and male accounted for 57.7% (206 cases). The incidence of bleeding events at 30 days and 6 months in the unfractionated heparin group were 6.8% (26 cases) and 9.9% (38 cases), respectively, which were higher than 3.4% (12 cases) and 4.5% (16 cases) in the bivalirudin group (all P0.05); The incidence of ischemic events at 30 days and 6 months in the unfractionated heparin group were 7.5% (29 cases) and 11.2% (43 cases), respectively, which were not observed to be significantly different with those in the bivalirudin group [6.2% (22 cases) and 9.5% (34 cases)] (all P0.05). Compared with patients using bivalirudin, the HR value (95%CI) of bleeding events after emergency PCI in patients using unfractionated heparin was 1.964 (1.317-3.125) (P0.05), and the HR value (95%CI) of ischemic events was 0.948(0.595-1.510) (P0.05). The cumulative incidence of bleeding events was 9.9% in unfractionated heparin group and 4.5% in bivalirudin group (P=0.005); The cumulative incidence of ischemic events was 11.2% in unfractionated heparin group and 9.5% in bivalirudin group (P=0.459). Conclusions: The incidence of short-term hemorrhage events in ACS patients treated with bivalirudin anticoagulation after emergency PCI is lower than that of unfractonated heparin, which can reduce the risk of short-term hemorrhage.
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