Pub Date : 2019-10-01DOI: 10.11909/j.issn.1671-5411.2019.10.006
Y. Sui, S. Teng, Jie Qian, Yuan Wu, K. Dou, Yi-da Tang, S. Qiao, Yong-Jian Wu
Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.
目的探讨高龄非st段抬高型心肌梗死(NSTEMI)患者采用有创治疗与保守治疗孰优孰优。方法回顾性研究2014年9月至2017年8月连续190例80岁及以上NSTEMI患者，其中69例采用保守策略，121例采用有创策略。主要结果是死亡。采用多变量Cox回归模型评估策略与死亡率之间的统计相关性。进一步分析存活概率。结果有创组的主要结局发生率为17.4%，保守组为42.0% (P = 0.0002)。有创组再入院率(14.9%)高于保守组(7.2%)。肌酐水平(OR = 1.01, 95% CI: 0.10 ~ 1.03, P = 0.05)和利尿剂的使用(OR = 3.65, 95% CI: 1.56 ~ 8.53, P = 0.003)是影响有创策略的独立因素。多变量Cox回归模型的hr分别为3.45 (95% CI: 1.77 ~ 6.75, P = 0.0003)、3.02 (95% CI: 1.52 ~ 6.01, P = 0.0017)、2.93 (95% CI: 1)。46-5.86, P = 0.0024)和2.47 (95% CI: 1.20-5.07, P = 0.0137)。与有创组相比，保守组治疗后随时间的生存率显著降低(P < 0.001)。结论:在降低80岁及以上NSTEMI患者死亡率方面，有创治疗优于保守治疗。我们的研究结果表明，有创策略更适合中国的老年NSTEMI患者。
{"title":"Invasive versus conservative strategy in consecutive patients aged 80 years or older with non-ST-segment elevation myocardial infarction: a retrospective study in China","authors":"Y. Sui, S. Teng, Jie Qian, Yuan Wu, K. Dou, Yi-da Tang, S. Qiao, Yong-Jian Wu","doi":"10.11909/j.issn.1671-5411.2019.10.006","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.10.006","url":null,"abstract":"Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115857649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Cardiac rehabilitation (CR) has proven beneficial for patients with coronary artery disease. However, adherence to CR programs is the key to the health improvement in those patients. Identifying predictors for adherence, which is very much unknown in China, would be valuable for effective rehabilitation. This study aims to determine the adherence to home-based CR programs in Chinese coronary artery disease patients and determine predictors of adherence. Methods The current study included 1033 outpatients with coronary heart disease in the First Medical Center of Chinese PLA General Hospital in Beijing from July 2015 to June 2017. Participants were given an exercise prescription and took part in home-based exercise training lasting for 3–24 months. A questionnaire was used to evaluate the completion of the CR program, understanding of the program, motivation of the patients, and family/peer support. Results Two thirds of the patients adhered well to the home-based CR program. Elder patients (≥ 65-year-old) adhere to the program better, while men adhered better than women. Patients who used to exercise (B = 6.756, P < 0.001), understood the program (B = 0.078, P = 0.002), with stronger motivation to participate (B = 0.376, P < 0.001), and received better family support (B = 0.487, P < 0.001) also adhere better to the program. Conclusions Understanding the program, self-motivation of patients, and family support help to keep patients engaged in a home-based CR program. Improvement of family support by educating both patients and families may be helpful in improving adherence to home-based CR programs.
背景:心脏康复(CR)已被证明对冠状动脉疾病患者有益。然而，坚持CR计划是这些患者健康改善的关键。确定依从性的预测因素，这在中国是非常未知的，对于有效的康复是有价值的。本研究旨在确定中国冠状动脉疾病患者对家庭CR方案的依从性，并确定依从性的预测因素。方法选取2015年7月至2017年6月在北京解放军总医院第一医疗中心门诊就诊的冠心病患者1033例。参与者获得了运动处方，并参加了持续3-24个月的家庭运动训练。使用问卷来评估CR计划的完成情况、对计划的理解、患者的动机以及家人/同伴的支持。结果三分之二的患者对居家CR方案的依从性良好。老年患者(≥65岁)对该方案的依从性较好，而男性的依从性优于女性。有运动习惯(B = 6.756, P < 0.001)、了解运动计划(B = 0.078, P = 0.002)、参与动机较强(B = 0.376, P < 0.001)、家庭支持较好的患者(B = 0.487, P < 0.001)对运动计划的坚持程度也较好。结论:了解项目、患者自我激励和家庭支持有助于保持患者参与家庭CR项目。通过教育患者和家庭来改善家庭支持可能有助于提高对家庭CR计划的依从性。
{"title":"Predictors of adherence to home-based cardiac rehabilitation program among coronary artery disease outpatients in China","authors":"Cheng Ge, Jing Ma, Yong Xu, Yajun Shi, Chenghui Zhao, Ling Gao, Jing Bai, Yu Wang, Zhi-Jun Sun, Jun Guo, Yun-Dai Chen","doi":"10.11909/j.issn.1671-5411.2019.10.003","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.10.003","url":null,"abstract":"Background Cardiac rehabilitation (CR) has proven beneficial for patients with coronary artery disease. However, adherence to CR programs is the key to the health improvement in those patients. Identifying predictors for adherence, which is very much unknown in China, would be valuable for effective rehabilitation. This study aims to determine the adherence to home-based CR programs in Chinese coronary artery disease patients and determine predictors of adherence. Methods The current study included 1033 outpatients with coronary heart disease in the First Medical Center of Chinese PLA General Hospital in Beijing from July 2015 to June 2017. Participants were given an exercise prescription and took part in home-based exercise training lasting for 3–24 months. A questionnaire was used to evaluate the completion of the CR program, understanding of the program, motivation of the patients, and family/peer support. Results Two thirds of the patients adhered well to the home-based CR program. Elder patients (≥ 65-year-old) adhere to the program better, while men adhered better than women. Patients who used to exercise (B = 6.756, P < 0.001), understood the program (B = 0.078, P = 0.002), with stronger motivation to participate (B = 0.376, P < 0.001), and received better family support (B = 0.487, P < 0.001) also adhere better to the program. Conclusions Understanding the program, self-motivation of patients, and family support help to keep patients engaged in a home-based CR program. Improvement of family support by educating both patients and families may be helpful in improving adherence to home-based CR programs.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"616 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123211407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.11909/j.issn.1671-5411.2019.10.002
Ning Zhang, Wen-ling Zhu, Xiao-hong Liu, Wei Chen, M. Zhu, L. Kang, R. Tian
Background Sarcopenia is a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes, including falls, fractures, physical disability, and mortality. However, there have been few systematic studies of the prevalence and prognostic values of sarcopenia in older patients with coronary heart disease (CHD). This study aimed to investigate the prevalence of sarcopenia in hospitalized older patients with CHD, and to prospectively evaluate the effect of sarcopenia on the short-term prognosis of these patients. Methods Patients aged ≥ 65 years, with the diagnosis of CHD from Peking Union Medical College Hospital between December 2017 and November 2018, were included. Sarcopenia was diagnosed according to consensus of the Asian Working Group for Sarcopenia in 2014. Follow-up items included unscheduled return visits, occurrence of major adverse cardiac and cerebral events (MACCE), and all-cause mortality. The MACCE-free survival curve of sarcopenic and non-sarcopenic older patients with CHD was estimated by the Kaplan-Meier method. Cox regression analysis was used to analyze the association between sarcopenia and an unscheduled return visits, MACCE, and all-cause mortality. Results A total of 345 older patients with CHD were enrolled in the study, with a median age of 74 years. Among the patients, 78 (22.6%) were diagnosed with sarcopenia. During the follow-up time, there were significantly more unscheduled return visits in sarcopenic patients than in non-sarcopenic patients (34.2% vs. 21.8%, χ2 = 4.418, P = 0.036), while there was no significant difference in the occurrence of MACCE (χ2 = 2.869, P = 0.09) or all-cause mortality (χ2 = 1.673, P = 0.196) between these patient groups. The Kaplan-Meier curve showed that the MACCE-free survival time of sarcopenic patients was significantly shorter than that in non-sarcopenic patients (χ2 = 4.102, P = 0.043). After adjusting for sex, age, and the Charlson comorbidity index, sarcopenia was not an independent risk factor of unscheduled return visits (HR = 1.002, 95% CI: 0.556–1.807). However, the complication of anxiety and depression was an independent risk factor (HR = 1.876, 95% CI: 1.012–3.477, P = 0.046) for unscheduled return visits in older patients with CHD. Conclusions There is a high prevalence of sarcopenia among hospitalized older adults with CHD. A shorter MACCE-free survival time and more unscheduled return visits are found in sarcopenic older patients with CHD. Clinicians should pay more attention to the functional status of older patients with CHD, as well as identification and management of geriatric syndromes.
骨骼肌减少症是一种进行性和广泛性骨骼肌疾病，与不良后果的可能性增加有关，包括跌倒、骨折、身体残疾和死亡。然而，关于老年冠心病(CHD)患者肌肉减少症的患病率和预后价值的系统研究很少。本研究旨在调查老年住院冠心病患者肌少症的患病率，并前瞻性评价肌少症对这些患者短期预后的影响。方法选取2017年12月至2018年11月在北京协和医院就诊、年龄≥65岁且诊断为冠心病的患者。骨骼肌减少症是根据2014年亚洲骨骼肌减少症工作组的共识诊断的。随访项目包括计划外回访、主要心脏和大脑不良事件(MACCE)的发生以及全因死亡率。采用Kaplan-Meier法估计老年心肌减少和非心肌减少冠心病患者的无macce生存曲线。采用Cox回归分析分析肌肉减少症与计划外复诊、MACCE和全因死亡率之间的关系。结果共纳入345例老年冠心病患者，中位年龄为74岁。其中78例(22.6%)诊断为肌肉减少症。随访期间，肌少症患者的非计划回访率明显高于非肌少症患者(34.2%比21.8%，χ2 = 4.418, P = 0.036)，而两组间MACCE发生率(χ2 = 2.869, P = 0.09)和全因死亡率(χ2 = 1.673, P = 0.196)差异无统计学意义。Kaplan-Meier曲线显示，肌少症患者无macce生存时间明显短于非肌少症患者(χ2 = 4.102, P = 0.043)。在调整性别、年龄和Charlson合并症指数后，肌肉减少症不是非计划复诊的独立危险因素(HR = 1.002, 95% CI: 0.556-1.807)。然而，焦虑和抑郁并发症是老年冠心病患者不定期复诊的独立危险因素(HR = 1.876, 95% CI: 1.012-3.477, P = 0.046)。结论老年住院冠心病患者肌少症发生率较高。老年心肌减少的冠心病患者无macce生存时间较短，回访次数较多。临床医生应更加重视老年冠心病患者的功能状态，以及老年综合征的识别和处理。
{"title":"Prevalence and prognostic implications of sarcopenia in older patients with coronary heart disease","authors":"Ning Zhang, Wen-ling Zhu, Xiao-hong Liu, Wei Chen, M. Zhu, L. Kang, R. Tian","doi":"10.11909/j.issn.1671-5411.2019.10.002","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.10.002","url":null,"abstract":"Background Sarcopenia is a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes, including falls, fractures, physical disability, and mortality. However, there have been few systematic studies of the prevalence and prognostic values of sarcopenia in older patients with coronary heart disease (CHD). This study aimed to investigate the prevalence of sarcopenia in hospitalized older patients with CHD, and to prospectively evaluate the effect of sarcopenia on the short-term prognosis of these patients. Methods Patients aged ≥ 65 years, with the diagnosis of CHD from Peking Union Medical College Hospital between December 2017 and November 2018, were included. Sarcopenia was diagnosed according to consensus of the Asian Working Group for Sarcopenia in 2014. Follow-up items included unscheduled return visits, occurrence of major adverse cardiac and cerebral events (MACCE), and all-cause mortality. The MACCE-free survival curve of sarcopenic and non-sarcopenic older patients with CHD was estimated by the Kaplan-Meier method. Cox regression analysis was used to analyze the association between sarcopenia and an unscheduled return visits, MACCE, and all-cause mortality. Results A total of 345 older patients with CHD were enrolled in the study, with a median age of 74 years. Among the patients, 78 (22.6%) were diagnosed with sarcopenia. During the follow-up time, there were significantly more unscheduled return visits in sarcopenic patients than in non-sarcopenic patients (34.2% vs. 21.8%, χ2 = 4.418, P = 0.036), while there was no significant difference in the occurrence of MACCE (χ2 = 2.869, P = 0.09) or all-cause mortality (χ2 = 1.673, P = 0.196) between these patient groups. The Kaplan-Meier curve showed that the MACCE-free survival time of sarcopenic patients was significantly shorter than that in non-sarcopenic patients (χ2 = 4.102, P = 0.043). After adjusting for sex, age, and the Charlson comorbidity index, sarcopenia was not an independent risk factor of unscheduled return visits (HR = 1.002, 95% CI: 0.556–1.807). However, the complication of anxiety and depression was an independent risk factor (HR = 1.876, 95% CI: 1.012–3.477, P = 0.046) for unscheduled return visits in older patients with CHD. Conclusions There is a high prevalence of sarcopenia among hospitalized older adults with CHD. A shorter MACCE-free survival time and more unscheduled return visits are found in sarcopenic older patients with CHD. Clinicians should pay more attention to the functional status of older patients with CHD, as well as identification and management of geriatric syndromes.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126039435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.11909/j.issn.1671-5411.2019.10.005
T. Tomioka, Ryokichi Takahashi, Yosuke Ikumi, S. Tanaka, Yoshitaka Ito, H. Shioiri, J. Koyama, Kan-ichi Inoue
Background Cognitive impairment (CI) increases cardiac mortality among very elderly patients. Percutaneous coronary intervention (PCI) for ischemic heart disease (IHD) patients is considered a favorable strategy for decreasing cardiac mortality. Here, we investigated the influence of CI on cardiac mortality after PCI in very elderly patients. Methods We performed a retrospective observational analysis of patients who received PCI between 2012 and 2014 at the South Miyagi Medical Center, Japan. IHD patients over 80 years old who underwent the Mini-Mental State Examination for CI screening during hospitalization and/or who had been diagnosed with CI were included. Participants were divided into CI and non-CI groups, and cardiac mortality and incidence of adverse cardiac events in a 3-year follow-up period were compared between groups. Statistical analyses were performed using the t-test, χ2 test, and multivariable Cox regression analysis, with major comorbid illness and conventional cardiac risk factors as confounders. Results Of 565 patients, 95 were included (41 CI, 54 non-CI). Cardiac mortality during the follow-up period was significantly higher in the CI group (36%) compared with the non-CI group (13%) (OR = 4.3, 95% CI: 1.56–11.82, P < 0.05). CI was an independent cardiac prognostic factor after PCI and, for CI patients, living only with a CI partner was an independent predictor of cardiac death within three years. Conclusions CI significantly affected cardiac prognosis after PCI in very elderly patients, particularly those living with a CI partner. To improve patients' prognoses, social background should be considered alongside conventional medical measures.
{"title":"Influence of cognitive impairment on cardiac mortality after percutaneous coronary intervention in very elderly patients: a retrospective observational study","authors":"T. Tomioka, Ryokichi Takahashi, Yosuke Ikumi, S. Tanaka, Yoshitaka Ito, H. Shioiri, J. Koyama, Kan-ichi Inoue","doi":"10.11909/j.issn.1671-5411.2019.10.005","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.10.005","url":null,"abstract":"Background Cognitive impairment (CI) increases cardiac mortality among very elderly patients. Percutaneous coronary intervention (PCI) for ischemic heart disease (IHD) patients is considered a favorable strategy for decreasing cardiac mortality. Here, we investigated the influence of CI on cardiac mortality after PCI in very elderly patients. Methods We performed a retrospective observational analysis of patients who received PCI between 2012 and 2014 at the South Miyagi Medical Center, Japan. IHD patients over 80 years old who underwent the Mini-Mental State Examination for CI screening during hospitalization and/or who had been diagnosed with CI were included. Participants were divided into CI and non-CI groups, and cardiac mortality and incidence of adverse cardiac events in a 3-year follow-up period were compared between groups. Statistical analyses were performed using the t-test, χ2 test, and multivariable Cox regression analysis, with major comorbid illness and conventional cardiac risk factors as confounders. Results Of 565 patients, 95 were included (41 CI, 54 non-CI). Cardiac mortality during the follow-up period was significantly higher in the CI group (36%) compared with the non-CI group (13%) (OR = 4.3, 95% CI: 1.56–11.82, P < 0.05). CI was an independent cardiac prognostic factor after PCI and, for CI patients, living only with a CI partner was an independent predictor of cardiac death within three years. Conclusions CI significantly affected cardiac prognosis after PCI in very elderly patients, particularly those living with a CI partner. To improve patients' prognoses, social background should be considered alongside conventional medical measures.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121381006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.11909/j.issn.1671-5411.2019.10.008
Cai-Xia Guo, Zhi-yuan Li, Jin-Bang Niu, S. Fan, Si-Yu Yan, P. Lu, Yan-Ni Su, Li-hong Ma
Background Qishen (QS) capsules, a Traditional Chinese Medicine, has been widely used to treat coronary heart disease in China. However, evidence of its effectiveness remains unclear. Methods To explore whether QS has cardioprotective efficacy and/or promotes angiogenesis after myocardial infarction (MI), we performed experiments in a preclinical rat MI model. One month after left anterior descending coronary artery ligation, the rats received either QS solution (0.4 g/kg/day) or the same volume of saline by intragastric injection for four weeks. Results Echocardiographic and hemodynamic analyses demonstrated relatively preserved cardiac function in MI rats administered QS. Indeed, QS treatment was associated with reduced infarct scar size and heart weight index, and these beneficial effects were responsible for enhancing angiogenesis. Mechanistically, QS treatment increased phosphorylation of protein kinase B (Akt) and downregulated phosphorylation of mitogen-activated protein kinase/extracellular-regulated kinase (MEK/ERK). Conclusions QS therapy can improve the cardiac function of rats after MI by an underlying mechanism involving increased angiogenesis, at least partially via activation of the Akt signaling pathway and inhibition of MEK/ERK phosphorylation.
{"title":"Qishen capsule safely boosts cardiac function and angiogenesis via the MEK/ERK pathway in a rat myocardial infarction model","authors":"Cai-Xia Guo, Zhi-yuan Li, Jin-Bang Niu, S. Fan, Si-Yu Yan, P. Lu, Yan-Ni Su, Li-hong Ma","doi":"10.11909/j.issn.1671-5411.2019.10.008","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.10.008","url":null,"abstract":"Background Qishen (QS) capsules, a Traditional Chinese Medicine, has been widely used to treat coronary heart disease in China. However, evidence of its effectiveness remains unclear. Methods To explore whether QS has cardioprotective efficacy and/or promotes angiogenesis after myocardial infarction (MI), we performed experiments in a preclinical rat MI model. One month after left anterior descending coronary artery ligation, the rats received either QS solution (0.4 g/kg/day) or the same volume of saline by intragastric injection for four weeks. Results Echocardiographic and hemodynamic analyses demonstrated relatively preserved cardiac function in MI rats administered QS. Indeed, QS treatment was associated with reduced infarct scar size and heart weight index, and these beneficial effects were responsible for enhancing angiogenesis. Mechanistically, QS treatment increased phosphorylation of protein kinase B (Akt) and downregulated phosphorylation of mitogen-activated protein kinase/extracellular-regulated kinase (MEK/ERK). Conclusions QS therapy can improve the cardiac function of rats after MI by an underlying mechanism involving increased angiogenesis, at least partially via activation of the Akt signaling pathway and inhibition of MEK/ERK phosphorylation.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121329185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.11909/j.issn.1671-5411.2019.10.001
F. Mauro, Ferreri Cinzia, Rossi Arianna, Testa Marzia, R. Gaetano, F. Tassone
Arterial stiffness and wave reflections are widely used in observational studies to analyse the determinants of haemodynamic changes observed in various clinical conditions and to understand the pathogenesis of their cardiovascular complications. A large number of publications and several reviews documented the changes in arterial stiffness and wave reflections after various interventions, either non-pharmacological or pharmacological. Recently , the Consensus Document on the ventricular-arterial coupling in cardiac disease, recognized to pulse wave velocity (PWV) the role of most commonly used non-invasive method for studying the large artery stiffness defining it as a gold-standard. Furthermore, the document explored the meaning of arterial stiffness in heart failure and cardiovascular disease, considering extremely useful the analysis of the ventricular-arterial coupling in the assessment of therapy. A recent systematic review including a meta-analysis of six studies that explored the effects of simvastatin, rosuvastatin, lovastatin and atorvastatin on PWV demonstrated a lower arterial PWV in treated patients in comparison with the placebo groups [standarized mean difference (SMD) = 2.31, 95% CI: 1.15–3.45, Pheterogeneity = 0.07, I = 93%] than concluding for a beneficial effect of statin therapy on arterial stiffness. Alirocumab, a human monoclonal antibody to proprotein convertase subtilisin–kexin type 9 (PCSK9), would improve cardiovascular outcomes after an acute coronary syndrome in patients receiving high-intensity statin therapy and clearly reduced the plasma level of low density lipoprotein (LDL-C) after 24-month treatment. The aim of this preliminary clinical experience was to analyze the time-course of the changing in arterial stiffness in high-risk cardiovascular patients after alirocumab administration. Three consecutive patients started with alirocumab injec-
{"title":"Effects of a short-term alirocumab administration on the aortic stiffness: preliminary results","authors":"F. Mauro, Ferreri Cinzia, Rossi Arianna, Testa Marzia, R. Gaetano, F. Tassone","doi":"10.11909/j.issn.1671-5411.2019.10.001","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.10.001","url":null,"abstract":"Arterial stiffness and wave reflections are widely used in observational studies to analyse the determinants of haemodynamic changes observed in various clinical conditions and to understand the pathogenesis of their cardiovascular complications. A large number of publications and several reviews documented the changes in arterial stiffness and wave reflections after various interventions, either non-pharmacological or pharmacological. Recently , the Consensus Document on the ventricular-arterial coupling in cardiac disease, recognized to pulse wave velocity (PWV) the role of most commonly used non-invasive method for studying the large artery stiffness defining it as a gold-standard. Furthermore, the document explored the meaning of arterial stiffness in heart failure and cardiovascular disease, considering extremely useful the analysis of the ventricular-arterial coupling in the assessment of therapy. A recent systematic review including a meta-analysis of six studies that explored the effects of simvastatin, rosuvastatin, lovastatin and atorvastatin on PWV demonstrated a lower arterial PWV in treated patients in comparison with the placebo groups [standarized mean difference (SMD) = 2.31, 95% CI: 1.15–3.45, Pheterogeneity = 0.07, I = 93%] than concluding for a beneficial effect of statin therapy on arterial stiffness. Alirocumab, a human monoclonal antibody to proprotein convertase subtilisin–kexin type 9 (PCSK9), would improve cardiovascular outcomes after an acute coronary syndrome in patients receiving high-intensity statin therapy and clearly reduced the plasma level of low density lipoprotein (LDL-C) after 24-month treatment. The aim of this preliminary clinical experience was to analyze the time-course of the changing in arterial stiffness in high-risk cardiovascular patients after alirocumab administration. Three consecutive patients started with alirocumab injec-","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133636253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01DOI: 10.11909/j.issn.1671-5411.2019.10.009
Zhaoqing Sun, Yinghua Cui, B. Yan
Zhao-Qing SUN, Ying-Hua CUI, Bo YAN Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China Division of Cardiology, the Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China The Center for Molecular Genetics of Cardiovascular Diseases, the Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, the Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China Shandong Provincial Sino-US Cooperation Research Center for Translational Medicine, the Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
{"title":"Identification of two novel GATA6 mutations in an adult with acute myocardial infarction, diabetes, and atrial fibrillation: a case report","authors":"Zhaoqing Sun, Yinghua Cui, B. Yan","doi":"10.11909/j.issn.1671-5411.2019.10.009","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.10.009","url":null,"abstract":"Zhao-Qing SUN, Ying-Hua CUI, Bo YAN Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China Division of Cardiology, the Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China The Center for Molecular Genetics of Cardiovascular Diseases, the Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, the Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China Shandong Provincial Sino-US Cooperation Research Center for Translational Medicine, the Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126198858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Elevated serum phosphorus levels may be associated with adverse outcomes in cardiovascular disease. This study aimed to investigate the relation between serum phosphorus levels and risk of all-cause mortality in Chinese patients with ST-segment elevation myocardial infarction (STEMI) who had preserved renal function at baseline. Methods We enrolled patients with STEMI who had preserved renal function at baseline in Xuanwu Hospital from January 2011 to December 2016. Those patients were divided into four groups based on serum phosphorus levels. All-cause mortality rates were compared between groups. Mean duration of follow up was 54.6 months. We used Cox proportional-hazards models to examine the relation between serum phosphorus levels and all-cause mortality after adjustment for potential confounders. Results 1989 patients were involved and 211 patients (10.6%) died during follow-up. Based on serum phosphorus levels, patients were categorized into the following groups: < 2.50 mg/dL (n = 89), 2.51–3.50 mg/dL (n = 1066), 3.51–4.50 mg/dL (n = 672) and > 4.50 mg/dL (n = 162), respectively. The lowest mortality occurred in patients with serum phosphorus levels between 2.51–3.50 mg/dL, with a multivariable-adjusted hazard ratio of 1.19 (95% CI: 0.64–1.54), 1.37 (95% CI: 1.22–1.74), and 1.46 (95% CI: 1.35–1.83) in patients with serum phosphorus levels of < 2.50 mg/dL, 3.51–4.50 mg/dL and > 4.50 mg/dL, respectively. Conclusions Elevated serum phosphorus levels were associated with all-cause mortality in Chinese patients with STEMI who had preserved renal function at baseline.
{"title":"The relation between serum phosphorus levels and long-term mortality in Chinese patients with ST-segment elevation myocardial infarction","authors":"Guohua Zhu, Xi-peng Sun, Zhi Liu, Zhen-xing Fan, Yan-ling Wang, Jing Tan, Jing Li, Q. Hua","doi":"10.11909/j.issn.1671-5411.2019.10.004","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.10.004","url":null,"abstract":"Background Elevated serum phosphorus levels may be associated with adverse outcomes in cardiovascular disease. This study aimed to investigate the relation between serum phosphorus levels and risk of all-cause mortality in Chinese patients with ST-segment elevation myocardial infarction (STEMI) who had preserved renal function at baseline. Methods We enrolled patients with STEMI who had preserved renal function at baseline in Xuanwu Hospital from January 2011 to December 2016. Those patients were divided into four groups based on serum phosphorus levels. All-cause mortality rates were compared between groups. Mean duration of follow up was 54.6 months. We used Cox proportional-hazards models to examine the relation between serum phosphorus levels and all-cause mortality after adjustment for potential confounders. Results 1989 patients were involved and 211 patients (10.6%) died during follow-up. Based on serum phosphorus levels, patients were categorized into the following groups: < 2.50 mg/dL (n = 89), 2.51–3.50 mg/dL (n = 1066), 3.51–4.50 mg/dL (n = 672) and > 4.50 mg/dL (n = 162), respectively. The lowest mortality occurred in patients with serum phosphorus levels between 2.51–3.50 mg/dL, with a multivariable-adjusted hazard ratio of 1.19 (95% CI: 0.64–1.54), 1.37 (95% CI: 1.22–1.74), and 1.46 (95% CI: 1.35–1.83) in patients with serum phosphorus levels of < 2.50 mg/dL, 3.51–4.50 mg/dL and > 4.50 mg/dL, respectively. Conclusions Elevated serum phosphorus levels were associated with all-cause mortality in Chinese patients with STEMI who had preserved renal function at baseline.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117262498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.11909/j.issn.1671-5411.2019.09.004
Marie-Isabel K Murray, K. Bode, P. Whittaker
Background Combinations of coronary heart disease (CHD) and other chronic conditions complicate clinical management and increase healthcare costs. The aim of this study was to evaluate gender-specific relationships between CHD and other comorbidities. Methods We analyzed data from the German Health Interview and Examination Survey (DEGS1), a national survey of 8152 adults aged 18-79 years. Female and male participants with self-reported CHD were compared for 23 chronic medical conditions. Regression models were applied to determine potential associations between CHD and these 23 conditions. Results The prevalence of CHD was 9% (547 participants): 34% (185) were female CHD participants and 66% (362) male. In women, CHD was associated with hypertension (OR = 3.28 (1.81-5.9)), lipid disorders (OR = 2.40 (1.50-3.83)), diabetes mellitus (OR = 2.08 (1.24-3.50)), kidney disease (OR = 2.66 (1.101-6.99)), thyroid disease (OR = 1.81 (1.18-2.79)), gout/high uric acid levels (OR = 2.08 (1.22-3.56)) and osteoporosis (OR = 1.69 (1.01-2.84)). In men, CHD patients were more likely to have hypertension (OR = 2.80 (1.94-4.04)), diabetes mellitus (OR = 1.87 (1.29-2.71)), lipid disorder (OR = 1.82 (1.34-2.47)), and chronic kidney disease (OR = 3.28 (1.81-5.9)). Conclusion Our analysis revealed two sets of chronic conditions associated with CHD. The first set occurred in both women and men, and comprised known risk factors: hypertension, lipid disorders, kidney disease, and diabetes mellitus. The second set appeared unique to women: thyroid disease, osteoporosis, and gout/high uric acid. Identification of shared and unique gender-related associations between CHD and other conditions provides potential to tailor screening, preventive, and therapeutic options.
{"title":"Gender-specific associations between coronary heart disease and other chronic diseases: cross-sectional evaluation of national survey data from adult residents of Germany","authors":"Marie-Isabel K Murray, K. Bode, P. Whittaker","doi":"10.11909/j.issn.1671-5411.2019.09.004","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.09.004","url":null,"abstract":"Background\u0000Combinations of coronary heart disease (CHD) and other chronic conditions complicate clinical management and increase healthcare costs. The aim of this study was to evaluate gender-specific relationships between CHD and other comorbidities.\u0000\u0000\u0000Methods\u0000We analyzed data from the German Health Interview and Examination Survey (DEGS1), a national survey of 8152 adults aged 18-79 years. Female and male participants with self-reported CHD were compared for 23 chronic medical conditions. Regression models were applied to determine potential associations between CHD and these 23 conditions.\u0000\u0000\u0000Results\u0000The prevalence of CHD was 9% (547 participants): 34% (185) were female CHD participants and 66% (362) male. In women, CHD was associated with hypertension (OR = 3.28 (1.81-5.9)), lipid disorders (OR = 2.40 (1.50-3.83)), diabetes mellitus (OR = 2.08 (1.24-3.50)), kidney disease (OR = 2.66 (1.101-6.99)), thyroid disease (OR = 1.81 (1.18-2.79)), gout/high uric acid levels (OR = 2.08 (1.22-3.56)) and osteoporosis (OR = 1.69 (1.01-2.84)). In men, CHD patients were more likely to have hypertension (OR = 2.80 (1.94-4.04)), diabetes mellitus (OR = 1.87 (1.29-2.71)), lipid disorder (OR = 1.82 (1.34-2.47)), and chronic kidney disease (OR = 3.28 (1.81-5.9)).\u0000\u0000\u0000Conclusion\u0000Our analysis revealed two sets of chronic conditions associated with CHD. The first set occurred in both women and men, and comprised known risk factors: hypertension, lipid disorders, kidney disease, and diabetes mellitus. The second set appeared unique to women: thyroid disease, osteoporosis, and gout/high uric acid. Identification of shared and unique gender-related associations between CHD and other conditions provides potential to tailor screening, preventive, and therapeutic options.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128476599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Pulse wave velocity (PWV) is a marker of arterial stiffness, which represents sub-clinical atherosclerosis. Pulsatile stress and high-sensitivity C-reactive protein (hs-CRP) are associated with arteriosclerosis. However, there is no prospective data confirming whether changes in pulsatile stress and inflammatory markers affect the progression of arterial stiffness. The aim of this study was to investigate the relationships over time between the effects of changes in pulsatile stress and hs-CRP, and arterial stiffness progression during a 2-year follow-up. Methods We performed a longitudinal study involving 3978 participants. All participants underwent a physical examination in 2010–2011 and 2012–2013, during which we measured participants' hs-CRP levels, brachial–ankle pulse wave velocity (baPWV), and pulsatile stress. Results Baseline hs-CRP was correlated with baPWV (r = 0.18, P = 0.000); however the correlation was weaker than that with systolic blood pressure (r = 0.65), pulsatile stress (r = 0.57), and rate-pressure product (r = 0.58). Multiple linear regression analysis demonstrated that changes in pulsatile stress, mean arterial pressure, and low-density lipoprotein-C (LDL-C) were positively correlated with changes in baPWV, with correlation coefficients of 0.27, 0.25, and 0.07, respectively, but not with changes in hs-CRP. Moreover, each 100-aU increase in pulsatile stress, 1 mmHg increase in mean blood pressure, and 1 mmol/L increase in LDL-C was associated with a 3 cm/s, 4.78 cm/s, and 17.37 cm/s increase in baPWV, respectively. Conclusions Pulsatile stress increases are associated with arterial stiffness progression, but that changes in hs-CRP had no effect on arterial stiffness progression. Hs-CRP may simply be a marker of inflammation in arterial stiffness and has no association with arterial stiffness progression.
{"title":"Changes in pulse pressure × heart rate, hs-CRP, and arterial stiffness progression in the Chinese general population: a cohort study involving 3978 employees of the Kailuan Company","authors":"H. Xue, Jun-juan Li, Jian-li Wang, Shuohua Chen, Jing-sheng Gao, Yun-Dai Chen, Shou-Ling Wu","doi":"10.11909/j.issn.1671-5411.2019.09.010","DOIUrl":"https://doi.org/10.11909/j.issn.1671-5411.2019.09.010","url":null,"abstract":"Background Pulse wave velocity (PWV) is a marker of arterial stiffness, which represents sub-clinical atherosclerosis. Pulsatile stress and high-sensitivity C-reactive protein (hs-CRP) are associated with arteriosclerosis. However, there is no prospective data confirming whether changes in pulsatile stress and inflammatory markers affect the progression of arterial stiffness. The aim of this study was to investigate the relationships over time between the effects of changes in pulsatile stress and hs-CRP, and arterial stiffness progression during a 2-year follow-up. Methods We performed a longitudinal study involving 3978 participants. All participants underwent a physical examination in 2010–2011 and 2012–2013, during which we measured participants' hs-CRP levels, brachial–ankle pulse wave velocity (baPWV), and pulsatile stress. Results Baseline hs-CRP was correlated with baPWV (r = 0.18, P = 0.000); however the correlation was weaker than that with systolic blood pressure (r = 0.65), pulsatile stress (r = 0.57), and rate-pressure product (r = 0.58). Multiple linear regression analysis demonstrated that changes in pulsatile stress, mean arterial pressure, and low-density lipoprotein-C (LDL-C) were positively correlated with changes in baPWV, with correlation coefficients of 0.27, 0.25, and 0.07, respectively, but not with changes in hs-CRP. Moreover, each 100-aU increase in pulsatile stress, 1 mmHg increase in mean blood pressure, and 1 mmol/L increase in LDL-C was associated with a 3 cm/s, 4.78 cm/s, and 17.37 cm/s increase in baPWV, respectively. Conclusions Pulsatile stress increases are associated with arterial stiffness progression, but that changes in hs-CRP had no effect on arterial stiffness progression. Hs-CRP may simply be a marker of inflammation in arterial stiffness and has no association with arterial stiffness progression.","PeriodicalId":285674,"journal":{"name":"Journal of geriatric cardiology : JGC","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129938821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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