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Rationale and Design of a Randomized Controlled Trial on Intensive Management of Blood PRESSure and Cholesterol in Elderly Chinese with Hypertension and Atrial FibrillatION (IMPRESSION) 中国老年高血压合并心房颤动患者血压和胆固醇强化管理的随机对照试验的基本原理和设计
Pub Date : 2021-07-08 DOI: 10.1097/CD9.0000000000000026
Wei Zhang, Yi Chen, Qi-Fang Huang, Ji-Guang Wang
Abstract Hypertension significantly increases the risk of embolic stroke and systemic embolism in patients with atrial fibrillation, while statin therapy can improve long-term outcomes in hypertensive patients at high risk. However, it is still unclear whether patients with both hypertension and atrial fibrillation can benefit from intensive management of blood pressure and cholesterol. IMPRESSION is a 3-year prospective, randomized, open-label, blinded-endpoint investigation. A total of 1200 hypertensive patients with atrial fibrillation from about 40 clinical centers nationwide will be included upon confirming the presence of both hypertension and atrial fibrillation and will be randomly assigned to groups for intensive or standard management of blood pressure and cholesterol. Patients in all groups will have office and home blood pressure measured by the end of the first month and every 3 months thereafter. The effects of blood pressure and cholesterol management strategies in patients with hypertension and atrial fibrillation on fatal and non-fatal stroke, acute myocardial infarction, and cardiovascular death at 3 years will be assessed. The IMPRESSION study protocol has received approval from the Ethics Committee of Ruijin Hospital, Shanghai Jiaotong University School of Medicine. The procedures set out in this protocol are in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice guidelines. The results will be published following the CONSORT statement in a peer-reviewed scientific journal (Trial registration number: NCT04111419).
摘要高血压显著增加心房颤动患者发生栓塞性中风和全身栓塞的风险,而他汀类药物治疗可以改善高危高血压患者的长期预后。然而,目前尚不清楚高血压和心房颤动患者是否能从强化血压和胆固醇管理中受益。IMPRESSION是一项为期3年的前瞻性、随机、开放标签、盲法终点调查。来自全国约40个临床中心的1200名高血压心房颤动患者将在确认存在高血压和心房颤动后被纳入研究,并将被随机分配到强化或标准血压和胆固醇管理组。所有组的患者将在第一个月底前和每3个月测量一次办公室和家中的血压 此后数月。高血压和心房颤动患者的血压和胆固醇管理策略对3岁时致命性和非致命性中风、急性心肌梗死和心血管死亡的影响 年将进行评估。印象研究方案已获得上海交通大学医学院瑞金医院伦理委员会的批准。本方案中规定的程序符合《赫尔辛基宣言》的原则和良好临床实践指南。CONSORT发表声明后,研究结果将发表在同行评审的科学期刊上(试验注册号:NCT04111419)。
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引用次数: 1
Implementing the Guideline of the Primary Prevention of Cardiovascular Diseases in China to Daily Practice: Promoting the Transition from “Treatment-Centered” to “People's Health-Centered” 《中国心血管疾病一级预防指南》落实到日常实践:促进从“以治疗为中心”向“以人民健康为中心”的转变
Pub Date : 2021-05-21 DOI: 10.1097/cd9.0000000000000021
D. Hu
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引用次数: 1
Surgical Treatment of Left Atrial Dissection and Severe Mitral Valve Obstruction 左心房夹层合并严重二尖瓣梗阻的外科治疗
Pub Date : 2021-04-12 DOI: 10.1097/cd9.0000000000000022
A. Chen, Guo-qiang Ma, Deyan Yang, Chenyu Wang, Yingxian Liu
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引用次数: 0
Bivalirudin in Primary PCI: Can Its Glory Being Restored? 比伐鲁定在原发性PCI中的应用:它的辉煌还能恢复吗?
Pub Date : 2021-04-06 DOI: 10.1097/CD9.0000000000000016
Yang Li, Yi Li, G. Stone, Yaling Han
Abstract Intravenous anticoagulant therapy is critical to prevent ischemic recurrences and complications without increasing the risk of bleeding in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). It includes the indirect thrombin inhibitor heparins and the direct thrombin inhibitor bivalirudin. However, the ideal anticoagulant for patients undergoing PPCI remains controversial. In this review, we provide an overview of currently available anticoagulant therapies used in STEMI patients undergoing PPCI, including describing the rationale for their use, pivotal clinical trial data, and treatment recommendations of guidelines, providing much-needed clarity to guide the selection of the safest and most effective anticoagulant regimens for PPCI.
静脉抗凝治疗对于st段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PPCI),在不增加出血风险的情况下预防缺血复发和并发症至关重要。它包括间接凝血酶抑制剂肝素和直接凝血酶抑制剂比伐鲁定。然而,对于PPCI患者理想的抗凝剂仍然存在争议。在这篇综述中,我们概述了目前STEMI患者接受PPCI的可用抗凝治疗方法,包括描述其使用的基本原理、关键临床试验数据和指南的治疗建议,为指导选择最安全和最有效的PPCI抗凝治疗方案提供了急需的清晰信息。
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引用次数: 1
Insomnia and Coronary Artery Diseases: A Mendelian Randomisation Study 失眠和冠状动脉疾病:孟德尔随机研究
Pub Date : 2021-04-06 DOI: 10.1097/CD9.0000000000000019
Wen-Jia Zhang, Lingfeng Zha, Jiangtao Dong, Qianwen Chen, Jianfei Wu, T. Tang, N. Xia, Min Zhang, Jiao Jiao, Tian Xie, Chengqi Xu, X. Tu, Shaofang Nie
Abstract Objective: Observational studies indicate that insomnia may increase the risk of developing and/or dying from cardiovascular diseases, especially coronary artery disease (CAD). Our purpose is to explore the underlying causal relationship between genetic variants susceptible to insomnia and the risk of CAD by Mendelian randomization analysis. Methods: The study was conducted using publicly available statistical data on genetic variants identified from a genome-wide association meta-analysis of insomnia (n = 113,006 individuals) and a genome-wide association meta-analysis of CAD (n = 184,305 individuals), which consisted of both cases and non-cases. The genetic association between variants and CAD was assessed by the variants’ association with insomnia, and estimations were integrated by an inverse-variance weighted meta-analysis. Results: Among the Mendelian randomized analytical sample, 8 variants were associated with insomnia complaints and CAD. And there was no pleiotropic association with the latent confounders. In addition, in the inverse-variance weighted meta-analysis (the estimations combined from the 8 variants), the odds ratio was 1.15 (95% CI: 1.05–1.25; P = 0.002) for CAD, and in the weighted method analysis, the odds ratio was 1.14 (95% CI: 1.03–1.27; P = 0.015) for CAD. Conclusions: All of the data indicated that some valuable variants might involve in the development of CAD by leading the insomnia. Therefore, insomnia might be a causal factor for CAD, and improving the quality of sleep might be a new way for populations with insomnia to prevent CAD.
摘要目的:观察研究表明,失眠可能会增加患心血管疾病,尤其是冠状动脉疾病(CAD)的风险。我们的目的是通过孟德尔随机化分析来探索易患失眠的遗传变异与CAD风险之间的潜在因果关系。方法:这项研究使用了从失眠(n = 113006个个体)和CAD的全基因组关联荟萃分析(n = 184305人),包括病例和非病例。变异与CAD之间的遗传相关性通过变异与失眠的相关性进行评估,并通过反向方差加权荟萃分析对估计进行整合。结果:在孟德尔随机分析样本中,有8种变异与失眠症状和CAD有关。和潜在的混杂因素并没有多效性的关联。此外,在反方差加权荟萃分析中(8个变体的估计值相结合),优势比为1.15(95%CI:1.05–1.25;P = 0.002),在加权法分析中,优势比为1.14(95%CI:1.03-1.27;P = 0.015)。结论:所有数据表明,一些有价值的变异可能通过导致失眠而参与CAD的发展。因此,失眠可能是CAD的一个原因,提高睡眠质量可能是失眠人群预防CAD的一种新方法。
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引用次数: 1
Upregulation of Cartilage Oligomeric Matrix Protein and Bone Morphogenetic Protein-2 May Associate with Calcific Aortic Valve Disease 软骨寡聚基质蛋白和骨形态发生蛋白-2的上调可能与钙化性主动脉瓣病有关
Pub Date : 2021-04-06 DOI: 10.1097/CD9.0000000000000015
Yueyue Xu, Yide Cao, Yafeng Liu, Jingsong Wang, Ganyi Chen, ZhongHao Tao, Yiwei Yao, Y. Cai, Yunzhang Wu, Wen Chen
Abstract Objective: Calcific aortic valve disease (CAVD) affects millions of elderly people, and there is currently no effective way to stop or slow down its progression. Therefore, exploring the pathogenesis of CAVD is very important for prevention and treatment. Cartilage oligomeric matrix protein (COMP) have important role in cell phenotype change. This study is aimed to confirm whether COMP participate in CAVD and try to find the possible mechanisms. Methods: Human aortic valve tissues from Nanjing First Hospital (CAVD group, n = 20; control group, n = 11) were harvested. The expression level of COMP was tested by western blot and immunohistochemistry. Dual immunofluorescence staining was used for locating COMP. Bone morphogenetic protein-2 (BMP2) signalling were tested by western blot. The animal model was also used to detect COMP level by immunohistochemistry. Results: The results showed that the expression level of COMP was significantly increased in the calcific valve samples when compared with that of the control valve (P < 0.05); COMP was expressed near the calcific nodules and co-localized with α-smooth muscle actin (α-SMA). The protein levels of BMP2 and p-Smads 1/5/9 were markedly more highly expressed in the CAVD group than the control group (P < 0.05). Furthermore, immunofluorescence detection showed that COMP and BMP2 were co-located in calcific valves. Conclusions: The above results suggested that upregulation of COMP and BMP2 may be associated with aortic valve calcification and that COMP may become a potential therapeutic target in human CAVD.
摘要目的:钙化性主动脉瓣病(CAVD)影响着数百万老年人,目前还没有有效的方法来阻止或减缓其进展。因此,探讨CAVD的发病机制对预防和治疗具有重要意义。软骨寡聚基质蛋白(COMP)在细胞表型变化中具有重要作用。本研究旨在确认COMP是否参与CAVD,并试图寻找可能的机制。方法:取南京市第一医院人主动脉瓣组织(CAVD组 = 20;对照组,n = 11) 被收割。采用免疫组化和蛋白质印迹法检测COMP的表达水平。双免疫荧光染色定位COMP。骨形态发生蛋白2(BMP2)信号传导通过蛋白质印迹进行检测。动物模型采用免疫组织化学方法检测COMP水平。结果:与对照组相比,钙化瓣组织中COMP的表达水平明显升高(P < 0.05);COMP在钙化结节附近表达,并与α-平滑肌肌动蛋白(α-SMA)共定位。CAVD组BMP2和p-Smads1/5/9蛋白表达明显高于对照组(p < 免疫荧光检测显示COMP和BMP2位于钙化瓣膜中。结论:上述结果表明,COMP和BMP2的上调可能与主动脉瓣钙化有关,COMP可能成为人类CAVD的潜在治疗靶点。
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引用次数: 1
Cardiology Discovery—A New English Official Journal of the Chinese Society of Cardiology 《心脏病学发现》中国心脏病学会英文新刊
Pub Date : 2021-03-01 DOI: 10.1097/cd9.0000000000000012
Yaling Han
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引用次数: 0
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Cardiology discovery
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