Publications by authors named "Xiaoshu Cheng"

136 Publications

Association of waist-to-height ratio with hypertension and its subtypes in southern China.

J Hum Hypertens 2021 Jun 22. Epub 2021 Jun 22.

Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China.

Data regarding the association of the waist-to-height ratio (WHtR) with hypertension (HTN) are conflicting. Moreover, little information is available on the association between WHtR and HTN subtypes. Therefore, we aimed to investigate the associations between WHtR and the prevalence of HTN and its subtypes in a Chinese population. In the cross-sectional analysis, 13,947 adults from the China Hypertension Survey study were analysed. We examined the relationship between WHtR and the prevalence of HTN and its subtypes (isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systodiastolic hypertension (SDH)) using multivariate logistic regression analysis. A generalized additive model (GAM) and smooth curve fitting (penalized spline method) were also used. Overall, the mean WHtR was 0.50. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for HTN, ISH, IDH and SDH for each standard deviation (SD) increase in WHtR were 1.53 (1.45-1.61), 1.36 (1.28-1.44), 1.41 (1.20-1.65) and 1.47 (1.36-1.59), respectively. The fully adjusted smooth curve fitting revealed a linear association between WHtR and HTN, ISH, IDH, and SDH. Moreover, the positive associations between WHtR and HTN and its subtypes were more strong among younger adults (<60 compared with ≥60 years, P values for interaction <0.001). These findings suggested that WHtR was positively associated with HTN and its subtypes, especially among younger adults (<60 years) in southern China.
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http://dx.doi.org/10.1038/s41371-021-00566-9DOI Listing
June 2021

Sex difference in the association between plasma selenium and first stroke: a community-based nested case-control study.

Biol Sex Differ 2021 May 29;12(1):39. Epub 2021 May 29.

Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi Province, China.

Background: To date, there is no clearly defined association between plasma selenium levels and first stroke. We aimed to investigate the association between baseline plasma selenium and first stroke risk in a community-based Chinese population.

Methods: Using a nested case-control study design, a total of 1255 first stroke cases and 1255 matched controls were analyzed. Participant plasma selenium concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS), and the association of plasma selenium with first stroke risk was estimated by conditional logistic regression models.

Results: Overall, a non-linear negative association between plasma selenium and first total stroke and first ischemic stroke risks was found in males but not in females. Compared with participants with lower selenium levels (tertile 1-2, < 94.1 ng/mL), participants with higher selenium levels (tertile 3, ≥ 94.1 ng/mL) had significantly lower risks of first total stroke (OR 0.63; 95% CI 0.48, 0.83) and first ischemic stroke (OR 0.61; 95% CI 0.45, 0.83) in males but not in females with first total stroke (OR 0.92; 95% CI 0.69, 1.22) and first ischemic stroke (OR 0.89; 95% CI 0.65, 1.22). Furthermore, a stronger association between plasma selenium and first total stroke was found in males with higher vitamin E levels (≥ 13.5 μg/mL vs. < 13.5 μg/mL P-interaction = 0.007). No significant association was observed between plasma selenium and first hemorrhagic stroke risk in either males or females.

Conclusion: Our study indicated a significant, non-linear, negative association between plasma selenium and first stroke in males but not in females.

Trial Registration: ChiCTR1800017274 .
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http://dx.doi.org/10.1186/s13293-021-00383-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164764PMC
May 2021

High-Density Lipoprotein Cholesterol and the Risk of First Ischemic Stroke in a Chinese Hypertensive Population.

Clin Interv Aging 2021 14;16:801-810. Epub 2021 May 14.

Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.

Background And Purpose: Elevated high-density lipoprotein cholesterol (HDL-C) levels have displayed protection against cardiovascular disease. However, the association between specific lipoprotein classes and first ischemic stroke (IS) has not been well defined, particularly in higher-risk hypertensive populations. Our study evaluated the associations of HDL-C with first IS in a Chinese hypertensive population.

Methods: The study population was obtained from a community-based cohort study of hypertension in Lianyungang and Rongcheng, China. A nested case-control design was used that included 2463 identified first IS cases and 2463 controls matched by age ± 1 year, sex, and region.

Results: After adjusting for potential confounders, HDL-C was inversely associated with first IS (adjusted odds ratio [aOR]: 0.91; 95% confidence interval [CI]: 0.85-0.98). HDL-C levels of at least 65.4 mg/dL displayed a significant protective effect for first IS (aOR: 0.82; 95% CI: 0.69-0.98). Conversely, adverse effects of first IS were observed for low-density lipoprotein cholesterol (LDL-C) levels ≥138.1 mg/dL (aOR: 1.20; 95% CI: 1.02-1.42) and triglyceride (TG) levels ≥140.8 mg/dL (aOR: 1.27; 95% CI: 1.09-1.49). The risk associations of LDL-C and TG with first IS were attenuated in the presence of high HDL-C (≥53.0 mg/dL); an increased risk of first IS was only found in the presence of low HDL-C (<53.0 mg/dL) when LDL-C (aOR: 1.66; 95% CI: 1.19-2.31) and TG (aOR: 1.47; 95% CI: 1.17-1.84) were combined with HDL-C for analysis.

Conclusion: In this community-based Chinese hypertensive population, higher HDL-C was a significant protective factor of first IS. These data add to the evidence describing the relationship between lipids and IS and suggest that HDL-C maybe is a marker of IS risk in Chinses hypertensive population.
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http://dx.doi.org/10.2147/CIA.S295252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132192PMC
June 2021

The relationship between the atherogenic index of plasma and arterial stiffness in essential hypertensive patients from China: a cross-sectional study.

BMC Cardiovasc Disord 2021 May 19;21(1):245. Epub 2021 May 19.

Department of Cardiology, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China.

Background: The atherogenic index of plasma (AIP) always remains in a potential association with arterial stiffness, however, this association has not been fully discovered and needs to be studied in depth in large hypertensive patient populations. The present analysis thus sought to further explore the association that exists between AIP and arterial stiffness in Chinese patients diagnosed with arterial hypertension.

Methods: This cross-sectional study analyzed 4744 Chinese individuals with essential hypertension. AIP was defined as the base 10 logarithm of the ratio of plasma of triglycerides to high-density lipoprotein cholesterol levels indicated in molar concentrations. Measurement of arterial stiffness was carried out via brachial-ankle pulse wave velocity (baPWV).

Results: Data were adjusted for potential confounding variables, and multivariate linear regression analysis revealed AIP to be positively correlated with baPWV (β = 1.34, 95% CI: 0.96 to 1.72, P < 0.001). When AIP was instead treated as a categorical variable divided into quartiles, the same relationship was observed (P for trend < 0.001). We additionally found AIP and baPWV had a stronger positive association in individuals with a body mass index (BMI) < 24 kg/m (P for interaction < 0.05).

Conclusion: AIP and arterial stiffness were positively correlated in essential hypertension patients in China, especially in those with a BMI < 24 kg/m. Clinical trial registration ChiCTR1800017274.
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http://dx.doi.org/10.1186/s12872-021-02049-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136204PMC
May 2021

Cross-sectional association of meal skipping with lipid profiles and blood glucose in Chinese adults.

Nutrition 2021 Mar 17;90:111245. Epub 2021 Mar 17.

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China. Electronic address:

Objectives: There is an increasing trend of skipping meals, especially breakfast and dinner, in China. Previous studies on the association of meal skipping with lipid profiles and blood glucose have yielded inconsistent results.

Methods: A national representative survey of 47 841 adults (age ≥ 45 y) was conducted in China. Frequency of breakfast, lunch, and dinner consumption were assessed with a questionnaire. Blood triacylglycerols, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting blood glucose were measured using standard methods. Generalized linear models were used to estimate relative concentrations and 95% confidence intervals (CIs).

Results: Of 37 355 participants included in the analysis, the prevalence of skipping breakfast, lunch, and dinner was 9.06%, 0.67%, and 0.67%, respectively. Breakfast skippers are more likely to reside in rural areas, while lunch and dinner skippers tend to be urban residents. Compared with regular breakfast consumption, skipping breakfast was associated with 10.6% (95% CI, 8.3-12.9%) higher concentrations of triacylglycerols, 5.5% (95% CI, 4.7-6.3%) higher total cholesterol, 7.7% (95% CI, 6.5-8.9%) higher low-density lipoprotein cholesterol, 2.4% (95% CI, 1.5-3.4%) lower high-density lipoprotein cholesterol, and 1.6% (95% CI, 1.0-2.1%) lower fasting blood glucose. Significant linear trends were observed for days of skipping breakfast per week and biomarker concentrations. No association was found for lunch or dinner skipping. The higher triacylglycerols and lower high-density lipoprotein cholesterol associated with skipping breakfast were more evident in participants who were overweight or obese, and those who were physically inactive.

Conclusions: Our findings suggest a worse lipid profile of breakfast skippers. Not skipping breakfast might benefit cardiovascular disease prevention in Chinese adults.
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http://dx.doi.org/10.1016/j.nut.2021.111245DOI Listing
March 2021

Plasma exosomes induce inflammatory immune response in patients with acute myocardial infarction.

Arch Physiol Biochem 2021 May 5:1-9. Epub 2021 May 5.

Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China.

Exosomes are a kind of nanoscale extracellular vesicles with diameters of 30-100 nm and act as intracellular communication vehicles to influence cellular activities. Emerging pieces of evidence have indicated that exosomes play important roles in inflammation. However, the biological roles of plasma exosomes in acute myocardial infarction (AMI) patients have remained largely unexplored. In the current study, we found the plasma exosome levels were notably increased in patients with AMI in comparison with healthy controls (HCs), and AMI exosomes could induce endothelial cell injury. Furthermore, our data demonstrated that AMI exosomes triggered a pro-inflammatory immune response, at least partly depending on the activation of the NF-ĸB signalling. Together, AMI exosomes have pro-inflammatory properties and play a significant role in inflammation in AMI patients.
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http://dx.doi.org/10.1080/13813455.2021.1912102DOI Listing
May 2021

AST/ALT Ratio and Peripheral Artery Disease in a Chinese Hypertensive Population: A Cross-Sectional Study.

Angiology 2021 Mar 29:33197211004410. Epub 2021 Mar 29.

Center for Prevention and Treatment of Cardiovascular Diseases, 196534The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.

Previous studies reported that the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) was a risk factor in cardiovascular disease. Peripheral artery disease (PAD) is an important risk factor for cardiovascular death. However, only a few studies investigated the correlations between the AST/ALT ratio and PAD. We analyzed data from 10 900 patients with hypertension from the Chinese Hypertension Registry Study; 350 patients had PAD (prevalence 3.2%). After adjusting for potential confounders, the AST/ALT ratio was independently and positively associated with risk of PAD (OR: 1.31, 95% CI, 1.13-1.59), and a significant increased risk of PAD for the third AST/ALT ratio tertile (T3) compared with the first tertile (T1; OR: 1.49, 95% CI, 1.09-2.04, = .005) was found. Moreover, when we combined T1 and T2 into one group and used it as a reference group, the risk of PAD increased with the increase in AST/ALT; the risk ratio was 1.52 (95% CI, 1.20-1.95). A higher AST/ALT ratio (≥1.65) was associated with PAD risk in Chinese adults with hypertension. Our results suggest that the AST/ALT ratio may help identify patients at high risk of vascular end points and might be a convenient, economical, and effective tool for evaluating the risk of atherosclerosis.
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http://dx.doi.org/10.1177/00033197211004410DOI Listing
March 2021

Prevalence and factors associated with depressive and anxiety symptoms in a Chinese population with and without cardiovascular diseases.

J Affect Disord 2021 05 10;286:241-247. Epub 2021 Mar 10.

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; National Clinical Research Center for Cardiovascular Diseases, Beijing, China. Electronic address:

Background: Few data have reported the prevalence of depressive and anxiety symptoms in patients with cardiovascular disease (CVD) in China. Our study aimed to estimate the prevalence and related risk factors of these mental health symptoms.

Methods: A total of 47841 participants from seven regions of China were enrolled by a two-stage, stratified, community-based, clustering sampling strategy between 2014 and 2016. Data of sociodemographic status and medical history were collected through a standard questionnaire. The Center for Epidemiologic Studies Depression Scale and Zung's self-rating anxiety scale were used to screen depressive and anxiety symptoms.

Results: Among 47588 individuals who completed the self-report questionnaires, the weighted prevalence of depressive symptom was 2.9% and that of anxiety symptom was 1.5%. In females with heart failure (HF) and stroke, prevalence of either depressive and anxiety symptoms were 15.1% and 13.8%, respectively; while 9.4% and 8.4% for the male counterparts. Among patients with ≥ any 3 specific CVDs, the prevalence of having either depressive or anxiety symptoms were 13.1% and 6.8% for females and males, respectively. Younger age, female, unmarried, lower income, and disease history of atrial fibrillation, HF and stroke tend to link with higher risks of mental health symptoms.

Limitations: Cross-sectional study.

Conclusion: A high proportion of patients with CVD had depressive and anxiety symptoms. Screening for mental health symptoms is more important in higher-risk populations who are at younger age, being female, unmarried, with low income, and with diagnoses of atrial fibrillation, HF, and stroke.
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http://dx.doi.org/10.1016/j.jad.2021.02.006DOI Listing
May 2021

Visceral Adiposity Index Is Inversely Associated with Renal Function in Normal-Weight Adults with Hypertension: The China H-Type Hypertension Registry Study.

J Nutr 2021 Jun;151(6):1394-1400

Department of Cardiovascular Medicine, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China.

Background: Risk of chronic kidney disease (CKD) is higher in normal-weight metabolically unhealthy people, especially when combined with hypertension. In this context, whether the visceral adiposity index (VAI), which reflects body fat distribution and metabolism, can be used to identify the risk of CKD among normal-weight hypertensive patients is unclear.

Objectives: This study aimed to evaluate the association between VAI and renal function in normal-weight hypertensive patients.

Methods: In this cross-sectional study, 8591 hypertensive patients with normal BMI from the China H-type Hypertension Registry Study were analyzed. The VAI was calculated with serum triglycerides, serum HDL cholesterol, waist circumference, and BMI. VAI was ln-transformed for analysis on account of the skewed distribution. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epidemiology Collaboration equation. CKD was defined as an eGFR <60 mL · min-1 · 1.73 m-2. Multivariable linear and multivariable logistic regression analyses were performed to evaluate the association of VAI with eGFR and CKD.

Results: The prevalence rate of CKD was 10.1%. Multivariable linear regression analyses showed that an elevated lnVAI reduced eGFR by 2.63 mL · min-1 · 1.73 m-2 (95% CI: -3.54, -1.72 mL · min-1 · 1.73 m-2). Multivariable logistic regression analysis showed that an elevated lnVAI was independently associated with the prevalence of CKD (OR: 1.59; 95% CI: 1.31, 1.93). As possible confounding factors were removed the association became greater. The higher the VAI was, the greater the decrease in eGFR and the higher the risk of CKD. No significant interactions were found in any of the subgroups (age, sex, physical activity, current smoking, current drinking, fasting glucose, LDL cholesterol, blood pressure, and antihypertensive drugs).

Conclusions: VAI, as a simple surrogate measure of visceral fat accumulation, is independently and inversely associated with renal function in normal-weight Chinese hypertensive adults.This trial was registered at chictr.org.cn as ChiCTR1800017274.
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http://dx.doi.org/10.1093/jn/nxab022DOI Listing
June 2021

Association between plasma copper levels and first stroke: a community-based nested case-control study.

Nutr Neurosci 2021 Feb 3:1-10. Epub 2021 Feb 3.

Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, People's Republic of China.

Background And Aims: Uncertainty remains regarding the association between the risk of stroke and plasma copper levels in population with copper mostly in normal range due to limited data. We examined the association between baseline plasma copper and risk of first stroke in Chinese community-dwelling population.

Methods: We conducted a nested case control study from 'H-type Hypertension and Stroke Prevention and Control Project'. A total of 1255 first stroke cases and 1255 controls matched for age, sex and study site were included in the analysis. Conditional logistic regression analyses were performed to evaluate the association between plasma copper and first stroke.

Results: The overall mean of copper was 15.90 (2.66) μmol/L. In total, 94.26% participants' copper concentration was in the normal range by Mayo Clinic laboratory reference values. Smoothing curve showed that the associations of plasma copper with first stroke and its subtypes were linear. Each standard deviation (SD) increment of plasma copper was independently and positively associated with risk of first stroke [odds ratio (OR): 1.17, 95% confidence interval (CI): 1.07-1.28]. The multivariable ORs with 95% CIs for total stroke, ischemic stroke and hemorrhagic stroke in the highest versus the lowest quartile of plasma copper were 1.49 (1.16-1.90; -trend = 0.001), 1.46 (1.12-1.92; -trend = 0.004) and 2.05 (0.95-4.38; -trend = 0.050), respectively.

Conclusions: Baseline plasma copper was positively associated with risk of first ischemic stroke in an approximately linear fashion among Chinese community population (80.32% hypertensives), although their copper levels were mostly within the normal range according to current reference values. Our findings warrant additional investigation.
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http://dx.doi.org/10.1080/1028415X.2021.1875299DOI Listing
February 2021

Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China.

Heart 2021 Jan 28. Epub 2021 Jan 28.

Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China

Objective: To determine AF prevalence and gaps in atrial fibrillation (AF) awareness and management in China.

Methods: We conducted a community-based survey of 47 841 adults (age ≥45 years) in seven geographic regions of China between 2014 and 2016. Participants underwent a structured questionnaire, a standard 12-lead ECG, physical examination and blood sampling. AF prevalence, defined by either ECG detection or self-report, was estimated according to sampling weights, non-response and age and sex distribution of the population. We used multivariable logistic regression to estimate associations among sociodemographic, clinical and geographic factors with the AF prevalence, awareness and treatment.

Results: The weighted AF prevalence was 1.8% (95% CI 1.7% to 1.9%), but varied from 0.9% to 2.4% across geographical regions and equates to being present in an estimated 7.9 (95% CI 7.4 to 8.4) million people in China. Among men and women, the AF prevalence increased from 0.8% and 0.6% in the age group 45-54 years to 5.4% and 4.9% in the age group ≥75 years, respectively. Proportions of people who were aware of having AF decreased overall from 65.3% in 45-54 year-olds to 53.9% in ≥75 year-olds and varied between sex (men 58.5%, women 68.8%) and residency status (urban 78.3%, rural 35.3%). Only 6.0% of patients with high-risk AF received anticoagulation therapy.

Conclusions: AF prevalence is higher than previously reported in China, with low awareness and large treatment gaps. Large-scale efforts are urgently needed to reduce AF adverse consequences.
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http://dx.doi.org/10.1136/heartjnl-2020-317915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958113PMC
January 2021

Role of TRPM7 in cardiac fibrosis: A potential therapeutic target (Review).

Exp Ther Med 2021 Feb 27;21(2):173. Epub 2020 Dec 27.

Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China.

Cardiac fibrosis is a hallmark of cardiac remodeling associated with nearly all forms of heart disease. Clinically, no effective therapeutic drugs aim to inhibit cardiac fibrosis, owing to the complex etiological heterogeneity and pathogenesis of this disease. A two-in-one protein structure, a ubiquitous expression profile and unique biophysical characteristics enable the involvement of transient receptor potential melastatin-subfamily member 7 (TRPM7) in the pathogenesis and development of fibrosis-related cardiac diseases, such as heart failure (HF), cardiomyopathies, arrhythmia and hyperaldosteronism. In response to a variety of stimuli, multiple bioactive molecules can activate TRPM7 and related signaling pathways, leading to fibroblast proliferation, differentiation and extracellular matrix production in cardiac fibroblasts. TRPM7-mediated Ca signaling and TGF-β1 signaling pathways are critical for the formation of fibrosis. Accumulating evidence has demonstrated that TRPM7 is a potential pharmacological target for halting the development of fibrotic cardiac diseases. Reliable drug-like molecules for further development of high-affinity drugs targeting TRPM7 are urgently needed. The present review discusses the widespread and significant role of TRPM7 in cardiac fibrosis and focuses on its potential as a therapeutic target for alleviating heart fibrogenesis.
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http://dx.doi.org/10.3892/etm.2020.9604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792474PMC
February 2021

Association between platelet count and the risk of bleeding among patients with nonvalvular atrial fibrillation taking dabigatran after radiofrequency ablation: a cohort study.

Cardiovasc Diagn Ther 2020 Oct;10(5):1175-1183

Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, China.

Background: A reduction in platelet count or function can be a risk factor for bleeding in anticoagulated patients. However, the association between platelet count and the risk of bleeding among nonvalvular atrial fibrillation (NVAF) patients taking dabigatran remains unclear. The aim of this study was to investigate the relationship between platelet count and the risk of bleeding among patients with NVAF taking dabigatran after radiofrequency ablation.

Methods: In this multicenter, prospective and observational study, a total of 576 NVAF patients treated with dabigatran (110 mg bid) after radiofrequency ablation were recruited from 12 centers in China from February 2015 to December 2017. All patients were followed for 3 months. The association between platelet count and the risk of bleeding was evaluated by Cox proportional hazards regression analysis. To explore the nonlinearity between platelet count and bleeding, we used a Cox proportional hazards regression model with cubic spline functions and smooth curve fitting and a two-piecewise Cox proportional hazards model.

Results: During a median follow-up duration of 87 days, 50 patients experienced bleeding events. Overall, there was an inverse relationship between the risk of bleeding and platelet count. Low platelet count (<100×10/L) were associated with an increased risk of bleeding [hazard ratio (HR), 4.05; 95% confidence interval (CI): 1.32-12.46] compared to normal counts. The adjusted smooth curve showed a nonlinear relationship between platelet count and bleeding events. The inflection point of the platelet count was 105×10/L. For platelet counts <105×10/L, the HR (95% CI) was 0.89 (0.84-0.95), and for platelet counts ≥105×10/L, the HR (95% CI) was 1.01 (0.95-1.08).

Conclusions: Low platelet counts were associated with an increased risk for bleeding among patients with NVAF taking dabigatran after catheter ablation.
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http://dx.doi.org/10.21037/cdt-20-645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666943PMC
October 2020

The ankle-brachial index and risk of incident stroke in Chinese hypertensive population without atrial fibrillation: A cross-sectional study.

J Clin Hypertens (Greenwich) 2021 01 17;23(1):114-121. Epub 2020 Nov 17.

Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

We aimed to evaluate the relation of the ankle-brachial index (ABI) with the prevalence of stroke and to examine any possible effect modifiers among hypertensive patients without atrial fibrillation. A total of 10 750 subjects with hypertension aged 27-96 years were included in the current study. The outcome was a stroke. Odds ratios of stroke concerning ABI were calculated using multivariate logistic regression models. Among 10 750 hypertensive participants, 690 (6.42%) had a stroke. Multivariate logistic analyses showed that ABI was negatively correlated with the prevalence of stroke (per SD increment; adjusted OR, 0.88; 95% CI, 0.82-0.94). Compared with participants in Q 1, the odds ratios (95% CI) for those in the Q2 (1.05 to 1.10), Q3 (1.10 to 1.15), and Q4 (≥1.15) were 0.71 (0.56, 0.90), 0.87 (0.70, 1.08), and 0.81 (0.65, 1.01), respectively. However, compared with higher ABI value, lower ABI value (<1.05) would significantly increase the odds of stroke (OR: 1.26, 95% CI [1.05-1.50]), especially in the elderly over 65 years old. A generalized additive model and a smooth curve fitting showed that there existed an L-shaped association between ABI and the prevalence of stroke. Our results suggest that an L-shaped association between ABI and the prevalence of stroke was found in general hypertensive patients, with a turning point at about 1.05. Compared with higher ABI value, lower ABI value (<1.05) would significantly increase the prevalence of stroke (OR: 1.26, 95% CI [1.05-1.50]), especially in the elderly over 65 years old.
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http://dx.doi.org/10.1111/jch.14102DOI Listing
January 2021

A U-shaped association between the LDL-cholesterol to HDL-cholesterol ratio and all-cause mortality in elderly hypertensive patients: a prospective cohort study.

Lipids Health Dis 2020 Nov 12;19(1):238. Epub 2020 Nov 12.

Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China.

Background: The low-density lipoprotein cholesterol/high-density lipoprotein- cholesterol (LDL-C/HDL-C) ratio is an excellent predictor of cardiovascular disease (CVD). However, previous studies linking the LDL-C/HDL-C ratio to mortality have yielded inconsistent results and been limited by short follow-up periods. Therefore, the aim of the present study was to determine whether the LDL-C/HDL-C ratio could be an effective predictor of all-cause mortality in elderly hypertensive patients.

Methods: A total of 6941 hypertensive patients aged 65 years or older who were not treated with lipid-lowering drugs were selected from the Chinese Hypertension Registry for analysis. The endpoint of the study was all-cause mortality. The relationship between the LDL-C/HDL-C ratio and all-cause mortality was determined using multivariate Cox proportional hazards regression, smoothing curve fitting (penalized spline method), subgroup analysis and Kaplan-Meier survival curve analysis.

Results: During a median follow-up of 1.72 years, 157 all-cause deaths occurred. A U-shaped association was found between the LDL-C/HDL-C ratio and all-cause mortality. Patients were divided according to the quintiles of the LDL-C/HDL-C ratio. Compared to the reference group (Q3: 1.67-2.10), patients with both lower (Q1 and Q2) and higher (Q4 and Q5) LDL-C/HDL-C ratios had higher all-cause mortality (< 1.67: HR 1.81, 95% CI: 1.08-3.03; ≥2.10: HR 2.00, 95% CI: 1.18-3.39). Compared with the lower and higher LDL-C/HDL-C ratio groups, patients with LDL-C/HDL-C ratios of 1.67-2.10 had a significantly higher survival probability (log-rank P = 0.038).

Conclusions: The results suggest that there is a U-shaped association between the LDL-C/HDL-C ratio and all-cause mortality. Both lower and higher LDL-C/HDL-C ratios were associated with increased all-cause mortality in elderly hypertensive patients.
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http://dx.doi.org/10.1186/s12944-020-01413-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659118PMC
November 2020

Association between nontraditional lipid profiles and peripheral arterial disease in Chinese adults with hypertension.

Lipids Health Dis 2020 Nov 3;19(1):231. Epub 2020 Nov 3.

Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi Province, China.

Background: Data on the relationship between nontraditional lipid profiles [total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratio, triglyceride (TG)/HDL-C ratio, low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio, non-high-density lipoprotein cholesterol (non-HDL-C)] and the risk of peripheral artery disease (PAD) are limited. The present study investigated the relationship of nontraditional lipid indices with PAD in hypertensive patients.

Methods: This cross-sectional study was performed among 10,900 adults with hypertension. Participants were diagnosed with PAD when their ankle-brachial index (ABI) was < 0.9. The association between nontraditional lipid profiles and PAD was examined using multivariate logistic regression analysis and the restricted cubic spline.

Results: All nontraditional lipid indices were independently and positively associated with PAD in a dose-response fashion. After multivariable adjustment, the per SD increments of the TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C were all significantly associated with 37, 14, 40, and 24% higher risk for PAD, respectively. The adjusted ORs (95% CI) for PAD were 1.77 (1.31, 2.40), 1.71 (1.25, 2.34), 2.03 (1.50, 2.74), and 1.70 (1.25, 2.31) when comparing the highest tertile to the lowest tertile of the TC/HDL-C, TG/HDL-C, LDL-C/HDL-C ratios and non-HDL-C, respectively.

Conclusions: Among Chinese hypertensive adults, all nontraditional lipid indices were positively associated with PAD, and the LDL-C/HDL-C and TC/HDL-C ratios were better than the other nontraditional lipid indices for predicting PAD. These findings may improve the risk stratification of cardiovascular disease and dyslipidemia management.

Trial Registration: CHiCTR, ChiCTR1800017274 . Registered 20 July 2018.
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http://dx.doi.org/10.1186/s12944-020-01407-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640397PMC
November 2020

Saturation Effects of Plasma Homocysteine on Chronic Kidney Disease in Chinese Adults With H-type Hypertension: A Cross-sectional Study.

J Ren Nutr 2020 Oct 29. Epub 2020 Oct 29.

Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China; Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China. Electronic address:

Objective: Data on the association between homocysteine (Hcy) and the risk of chronic kidney disease (CKD) in patients with H-type hypertension were limited. This study aimed to examine the relation of Hcy with the prevalence of CKD and estimated glomerular filtration rate (eGFR) among Chinese adults with H-type hypertension.

Methods: A total of 12,873 Chinese adults with H-type hypertension aged 27-75 years were enrolled in the final analysis. Hcy concentrations were divided into 11 groups at 2 μmol/L interval. The outcome was CKD, defined as eGFR <60 mL/min/1.73 m.

Results: The prevalence of CKD was 7.58%, and the mean Hcy was 17.58 ± 10.96 μmol/L. The smoothing curve indicated that with the increase of Hcy, the prevalence of CKD increases first and then flattens, eGFR decreases first and then flattens, which supports the L-shaped association of Hcy with the prevalence of CKD and eGFR. Moreover, we further found the inflection point of Hcy was 22 μmol/L. OR (95% CI) of risk of CKD was 1.31 (1.28, 1.35) on the left side of an inflection point and 1.00 (0.99, 1.01) on the right of an inflection point, β (95% CI) of eGFR was -1.58 (-1.65, -1.50) on the left side of an inflection point and 0.00 (-0.03, 0.03) on the right of an inflection point, respectively. Similar results were found in various subgroups.

Conclusions: Our study suggested saturation effects of Hcy on the prevalence of CKD and eGFR among Chinese patients with H-type hypertension.
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http://dx.doi.org/10.1053/j.jrn.2020.09.002DOI Listing
October 2020

Nonlinear association between blood lead and hyperhomocysteinemia among adults in the United States.

Sci Rep 2020 10 13;10(1):17166. Epub 2020 Oct 13.

Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China.

Evidence regarding the association between blood lead levels (BLL) and hyperhomocysteinemia (HHcy) in US adults was limited. We aimed to investigate the association of BLL with the risk of HHcy, and to examine possible effect modifiers using US National Health and Nutrition Examination Survey (NHANES) database. We performed a cross-sectional study using data from up to 9,331 participants aged ≥ 20 years of NHANES from 2001 to 2006. BLL was measured by atomic absorption spectrometry. HHcy was defined as plasma homocysteine level > 15 µmol/L. The weighted prevalence of HHcy was 6.87%. The overall mean BLL was 1.9 μg/dL. Overall, there was a nonlinear positive association between Ln-transformed BLL (LnBLL) and the risk of HHcy. The Odds ratios (95% CI) for participants in the second (0.04-0.49 μg/dL), third (0.5-0.95 μg/dL) and fourth quartiles (> 0.95 μg/dL) were 1.12 (95% CI: 0.71, 1.76), 1.13 (95% CI: 0.73, 1.77), and 1.67 (95% CI: 1.07, 2.61), respectively, compared with those in quartile 1. Consistently, a significantly higher risk of HHcy (OR: 1.49; 95% CI: 1.19, 1.88) was found in participants in quartile 4 compared with those in quartiles 1-3. Furthermore, a strongly positive association between LnBLL and HHcy was observed in participants with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m. Our results suggested that a higher level of BLL (LnBLL > 0.95 μg/dL) was associated with increased risk of HHcy compared with a lower level of BLL (LnBLL ≤ 0.95 μg/dL) among U.S. adults, and the association was modified by the eGFR.
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http://dx.doi.org/10.1038/s41598-020-74268-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553908PMC
October 2020

Association between serum albumin and peripheral arterial disease in hypertensive patients.

J Clin Hypertens (Greenwich) 2020 12 9;22(12):2250-2257. Epub 2020 Oct 9.

Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

The authors aimed to evaluate the relationship of serum albumin with peripheral arterial disease (PAD) and investigate any possible effect modifiers in hypertensive patients. In the cross-sectional study, a total of 10,900 Chinese hypertensive patients aged ≥18 years were enrolled. The outcome was PAD, defined as an ankle-brachial index (ABI) <0.90 in either leg. The overall mean (SD) serum albumin was 46.8 (4.2) g/L. There were significant inverse associations of serum albumin with PAD (per SD increment; OR: 0.83; 95% CI: 0.72, 0.94). Compared with the lowest tertile (<45.1 g/L), the multivariate-adjusted ORs (95% CI) for participants in the middle tertile (45.1-48.2 g/L) and highest tertile (≥48.2 g/L) of serum albumin were 0.89 (95% CI: 0.67, 1.16) and 0.65 (95% CI: 0.47, 0.90), respectively. Conversely, lower albumin (<48.2 g/L) concentrations were associated with increased odds of PAD (OR: 1.45; 95% CI: 1.08-1.96) compared with higher concentrations. Furthermore, the albumin-PAD association was significantly stronger in males (OR: 2.08; 95% CI: 1.31, 3.30) than in females (OR: 1.06; 95% CI: 0.70, 1.58; p interaction = .024). In conclusion, among Chinese hypertensive adults, lower serum albumin was associated with the prevalence of PAD only in males but not in females.
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http://dx.doi.org/10.1111/jch.14071DOI Listing
December 2020

Is There a Nonlinear Relationship between Serum Uric Acid and Lipids in a Hypertensive Population with eGFR ≥30 ml/min/1.73 m? Findings from the China Hypertension Registry Study.

Int J Endocrinol 2020 18;2020:9725979. Epub 2020 Sep 18.

Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

Background: Evidence regarding the nonlinear relationship between serum uric acid (SUA) and blood lipids in Chinese population with hypertension is limited. Therefore, the present study aimed to investigate whether there is a nonlinear association between SUA and lipids in Chinese hypertensive population with an estimated glomerular filtration rate (eGFR) ≥30 ml/min/1.73 m.

Methods: A total of 13,355 hypertensive participants with eGFR ≥30 ml/min/1.73 m were selected from the Chinese Hypertension Registry Study. Multivariate linear regression was used to examine the linear relationship between SUA and lipids. Smooth curve fitting (penalized spline method) and threshold saturation effects were used to analyze the nonlinear association between SUA and lipids.

Results: In the fully adjusted model, the results showed a positive correlation between SUA and TG ( = 0.15; 95% CI: 0.14, 0.16) and LDL-C ( = 0.06; 95% CI: 0.05, 0.07), respectively. However, the relationship between SUA and HDL-C was nonlinear. The inflection point of SUA was 7.24 mg/dL. On the left side of the inflection point (<7.24 mg/dL), SUA was negatively associated with HDL-C ( = -0.02; 95% CI -0.02, -0.01). On the right side of the inflection point (≥7.24 mg/dL), SUA was not related to HDL-C ( = 0.01; 95% CI -0.01, 0.02).

Conclusion: After adjusting for all covariates, SUA was positively associated with TG and LDL-C. The relationship between SUA and HDL-C was nonlinear. The negative correlation between SUA and HDL-C only existed when the SUA was less than 7.24 mg/dL in a hypertensive population with eGFR ≥30 ml/min/1.73 m.
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http://dx.doi.org/10.1155/2020/9725979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519986PMC
September 2020

Diastolic blood pressure achieved at target systolic blood pressure (120-140 mm Hg) and dabigatran-related bleeding in patients with nonvalvular atrial fibrillation: A real-world study.

Anatol J Cardiol 2020 10;24(4):267-273

Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University; Jiangxi-China.

Objective: Elevated systolic blood pressure (SBP) can significantly increase the bleeding risk in patients with atrial fibrillation (AF). However, it is unclear whether elevated diastolic blood pressure (DBP), in the presence of well-controlled SBP is also associated with bleeding. Therefore, we aimed to examine the specific relationship between DBP and bleeding in patients with AF treated with anticoagulants and had well-controlled SBP.

Methods: We analyzed data from 542 of 929 patients with nonvalvular AF (NVAF) treated with dabigatran from the Monitor System for the Safety of Dabigatran Treatment study (MISSION-AF) who had a SBP of 120-140 mm Hg at the time of enrollment. The association between DBP and bleeding was analyzed using multivariate logistic regression and smooth curve fitting (penalized spline method). Threshold saturation effect analysis was used to show the nonlinear relationship between DBP and bleeding.

Results: After 3 months of follow-up, 49 bleeding events occurred. Compared with participants with DBP <80 mm Hg, those with DBP ≥80 mm Hg had a 118% higher bleeding risk [hazard ratio (HR): 2.18; 95% confidence interval (CI): 1.19, 3.98; p<0.05]. The smooth curve showed a nonlinear relationship between DBP and bleeding risk, and the inflection point of DBP was 80 mm Hg. When DBP was ≥80 mm Hg, the bleeding risk increased by 59% (HR: 1.59; 95% CI: 1.16, 2.19; p<0.05) for every 5 mm Hg increase in DBP.

Conclusion: Upon achieving an optimal SBP (120-140 mm Hg), a higher DBP might be associated with a higher bleeding risk in patients with NVAF treated with dabigatran.
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http://dx.doi.org/10.14744/AnatolJCardiol.2020.11823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585965PMC
October 2020

Association Between Fasting Blood Glucose and All-Cause Mortality in a Rural Chinese Population: 15-Year Follow-Up Cohort Study.

Diabetes Ther 2020 Nov 25;11(11):2691-2701. Epub 2020 Sep 25.

Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.

Introduction: The worldwide prevalence of diabetes has been increasing for decades; diabetes can lead to serious health problems and even death, but the effects of maintaining low fasting blood glucose (FBG) remain controversial. The purpose of this study was to investigate the relationship between FBG levels and all-cause mortality in a long-term follow-up cohort and to find a relatively safe range of FBG levels.

Methods: This study included 17,902 adults from a community-based cohort study in rural China who were prospectively followed from 2003 to 2018. Generalized estimating equations were used to evaluate the association between FBG and all-cause mortality, adjusting for pertinent covariates and auto-correlations among siblings.

Results: A total of 1053 (5.9%) deaths occurred during 15 years of follow-up. There was a significant U-shaped association between all-cause mortality and FBG. Compared with the reference group (FBG of 5.6 - < 6.1 mmol/l), the risk of death among individuals with FBG levels < 5.6 mmol/l significantly increased by 38% (OR 1.34; 95% CI 1.13-1.59), while the risk of death among individuals with FBG ≥ 6.1 mmol/l or participants with a self-reported history of diabetes significantly increased by 51% (OR 1.49; 95% CI 1.20-1.85). Additionally, the U-shaped association remained steady in any stratification of risk factors.

Conclusion: Our study showed a significant U-shaped relationship between FBG levels and risk of all-cause mortality in this rural Chinese population. When FBG was within the range of 5.6 - < 6.1 mmol/l, the risk of all-cause mortality was the lowest.
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http://dx.doi.org/10.1007/s13300-020-00927-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547918PMC
November 2020

Positive association between triglyceride glucose index and arterial stiffness in hypertensive patients: the China H-type Hypertension Registry Study.

Cardiovasc Diabetol 2020 09 18;19(1):139. Epub 2020 Sep 18.

Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China.

Background: Data are limited on whether TyG index is an independent predictor of arterial stiffness in hypertensive patients. The purpose of this study was to assess the association between the TyG index and arterial stiffness, and examined whether there were effect modifiers, in hypertensive patients.

Methods: This study included 4718 hypertensive adults, a subset of the China H-type Hypertension Registry Study. The TyG index was calculated as ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Arterial stiffness was determined by measuring brachial-ankle pulse wave velocity (baPWV).

Results: The overall mean TyG index was 8.84. Multivariate linear regression analyses showed that TyG index was independently and positively associated with baPWV (β, 1.02; 95% confidence interval [CI] 0.83, 1.20). Consistently, Multiple logistic analyses showed a positive association between TyG index risk of elevated baPWV (> 75th percentile) (odds ratio [OR], 2.12; 95% CI 1.80, 2.50). Analyses using restricted cubic spline confirmed that the associations of TyG index with baPWV and elevated baPWV were linear. Subgroup analyses showed that stronger associations between TyG index and baPWV were detected in men (all P for interaction < 0.05).

Conclusion: TyG index was independently and positively associated with baPWV and elevated baPWV among hypertensive patients, especially in men. The data suggest that TyG index may serve as a simple and effective tool for arterial stiffness risk assessment in daily clinical practice.
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http://dx.doi.org/10.1186/s12933-020-01124-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501677PMC
September 2020

Serum folate modified the association between low-density lipoprotein cholesterol and carotid intima-media thickness in Chinese hypertensive adults.

Nutr Metab Cardiovasc Dis 2020 11 24;30(12):2303-2311. Epub 2020 Jul 24.

Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, China. Electronic address:

Background And Aims: While folate is known for its importance in cardiovascular health, it is unknown whether folate status can modify the association between low-density lipoprotein cholesterol (LDL-C) and carotid intima-media thickness (CIMT). We aimed to investigate this question in a Chinese hypertensive population, who are at high-risk of low folate and atherosclerosis.

Methods And Results: This report included 14,970 hypertensive adults (mean age 64.5 years; 40.3% male) from the China Stroke Primary Prevention Trial (CSPPT) and analyzed the fasting serum LDL-C and folate, and CIMT data obtained at the last follow-up visit. LDL-C was calculated using the Friedewald equation. Serum folate levels were measured by chemiluminescent immunoassay. CIMT was measured by ultrasound. Non-parametric smoothing plots, multivariate linear regression analysis, subgroup analyses and interaction testing were performed to examine the LDL-C-CIMI relationship and effect modification by folate. Consistent with graphic plots, multivariate linear regression showed that LDL-C levels were independently and positively associated with CIMT (β = 7.69, 95%CI: 5.76-9.62). More importantly, the relationship between LDL-C and CIMT was significantly attenuated with increasing serum folate levels (1st tertile: β = 10.06, 95%CI: 6.67-13.46; 2nd tertile: β = 6.81, 95%CI: 3.55-10.07; 3rd tertile: β = 5.96, 95%CI: 2.55-9.36; P-interaction = 0.045). Subgroup analyses showed the association between LDL-C and CIMT across serum folate tertiles was robust among various strata (all P-interaction >0.05).

Conclusions: Among Chinese hypertensive adults, the serum folate levels could modify the association between LDL-C and CIMT. Our findings, if further confirmed, have important clinical implications.
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http://dx.doi.org/10.1016/j.numecd.2020.07.021DOI Listing
November 2020

Prognostic role of neutrophil-to-lymphocyte ratio in aortic disease: a meta-analysis of observational studies.

J Cardiothorac Surg 2020 Aug 10;15(1):215. Epub 2020 Aug 10.

Department of Cardiovascular Medicine, Institute of Cardiovascular disease, Second Affiliated Hospital of Nanchang University, Nan Chang, Jiang Xi, 330006, PR China.

Objective: Recent studies have reported that neutrophil-to-lymphocyte ratio (NLR) is associated with cardiovascular disease. The aim of the present study was to investigate the prognostic value of NLR in aortic disease.

Methods: We systematically searched electronic databases (Cochrane, PubMed, Elsevier, Medline, and Embase) from their inception to March 2020. Observational studies that evaluated the relationship between NLR and aortic disease were eligible for critical appraisal. Data were extracted from applicable articles, risk ratio (RR), weighted mean differences (MD) and 95% confidence intervals (CI) were calculated by RevMan 5.3, and statistical heterogeneity was assessed by the I statistic.

Results: Fourteen studies enrolling 4066 individuals were included in the meta-analysis. Compared with the control group, NLR was significantly higher in the aortic disease group (MD 3.44, 95%CI: 0.81-6.07, P = 0.01, I = 99%). The NLR was also significantly higher in non-survivors with aortic disease, compared to the survivors (MD 4.62, 95%CI: 2.75-6.50, P < 0.00001, I = 60%). Compared with the aortic disease patients with a low NLR, mortality was significantly higher in those with a high NLR (RR 2.63, 95%CI: 1.79-3.86, P < 0.00001, I = 67%).

Conclusion: Based on current evidence, an elevated NLR was associated with aortic disease and in-hospital mortality. Raised NLR also demonstrated a significantly increased the risk of mortality after surgical repair in aortic disease patients. NLR may be a good prognostic biomarker in aortic disease and deserve further research in this area.
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http://dx.doi.org/10.1186/s13019-020-01263-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419193PMC
August 2020

Relationship Between Platelet to Lymphocyte Ratio and Stable Coronary Artery Disease: Meta-Analysis of Observational Studies.

Angiology 2020 11 28;71(10):909-915. Epub 2020 Jul 28.

Department of Cardiovascular Medicine, 47861Second Affiliated Hospital of Nanchang University, Institute of Cardiovascular Disease, Nanchang, Jiangxi, People's Republic of China.

Recent studies have reported a relationship between the platelet to lymphocyte ratio (PLR) and acute coronary syndromes. The aim of the present study was to investigate the association between PLR and stable coronary artery disease (CAD). A systematic search was conducted based on electronic databases (Cochrane, PubMed, Elsevier, Medline, and Embase). A total of 14 studies (n = 4,871) were included in the meta-analysis. Compared with the non-CAD group, PLR was significantly higher in CAD group ( = .002). After further classification according to the Gensini score, the cases with atherosclerosis demonstrated a higher PLR than those without atherosclerosis ( < .001). Platelet to lymphocyte ratio was higher in the severe atherosclerosis group compared with the mild atherosclerosis group ( < .001). Compared with the poor coronary collateral circulation (CCC) group, PLR was significantly lower in the good CCC group ( < .001). The PLR was significantly higher in patients with coronary slow flow (CSF) than those with normal coronary flow ( = .01). On the basis of current evidence, an elevated PLR was associated with stable CAD, and it might be useful for predicting CAD severe stenosis, collateral circulation, and CSF. Future studies are needed to clarify the relationship between PLR and stable CAD.
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http://dx.doi.org/10.1177/0003319720943810DOI Listing
November 2020

Hyaluronic acid-based antibacterial hydrogels constructed by a hybrid crosslinking strategy for pacemaker pocket infection prevention.

Carbohydr Polym 2020 Oct 2;245:116525. Epub 2020 Jun 2.

Optogenetics & Synthetic Biology Interdisciplinary Research Center, State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, No.130 Meilong Road, Shanghai 200237, PR China. Electronic address:

In this study, we developed an injectable antibacterial hydrogel based on hyaluronic acid (HA) and chlorhexidine (CHX) for cardiovascular implantable electronic device (CIED) infection treatment. To balance stability and moldability, the HA scaffold was pre-crosslinked by 1,4-butanediol diglycidyl ether (BDDE) and then ground to form an HA microgel (CHA). Then, the antibacterial agent CHX was further crosslinked in the CHA microgel through electrostatic interactions between CHA and CHX to obtain hybrid crosslinked hydrogels (CHA/CHX). These hydrogels exhibited shear-thinning/self-recovery behavior, allowing easy injection into the CIED pocket and good matching with the pocket shape without extra space requirements, which represents an improvement on previously reported methods. In vitro and in vivo antibacterial tests showed that the CHA/CHX hydrogels had both good biocompatibility and very effective antibacterial action. The above results indicated that the CHA/CHX hydrogels would be an excellent candidate for CIED pocket infection treatment.
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http://dx.doi.org/10.1016/j.carbpol.2020.116525DOI Listing
October 2020

Interleukin-35 pretreatment attenuates lipopolysaccharide-induced heart injury by inhibition of inflammation, apoptosis and fibrotic reactions.

Int Immunopharmacol 2020 Sep 14;86:106725. Epub 2020 Jul 14.

Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China. Electronic address:

Previous studies have demonstrated that targeting inflammation is a promising strategy for treating lipopolysaccharide (LPS)-induced sepsis and related heart injury. Interleukin-35 (IL-35), which consists of two subunits, Epstein-Barr virus-induced gene 3 (EBI3) and p35, is an immunosuppressive cytokine of the IL-12 family and exhibits strong anti-inflammatory activity. However, the role of IL-35 in LPS-induced heart injury reains obscure. In this study, we explored the role of IL-35 in heart injury induced by LPS and its potential mechanisms. Mice were treated with a plasmid encoding IL-35 (pIL-35) and then injected intraperitoneally (ip) with LPS (10 mg/kg). Cardiac function was assessed by echocardiography 12 h later. LPS apparently decreased the expression of EBI3 and p35 and caused cardiac dysfunction and pathological changes, which were significantly improved by pIL-35 pretreatment. Moreover, pIL-35 pretreatment significantly decreased the levels of cardiac proinflammatory cytokines including TNF-α, IL-6, and IL-1β, and the NLRP3 inflammasome. Furthermore, decreased number of apoptotic myocardial cells, increased BCL-2 levels and decreased BAX levels inhibited apoptosis, and LPS-induced upregulation of the expression of cardiac pro-fibrotic genes (MMP2 and MMP9) and fibrotic factor (Collagen type I) was inhibited. Further investigation indicated that pIL-35 pretreatment might suppressed the activation of the cardiac NF-κBp65 and TGF-β1/Smad2/3 signaling pathways in LPS-treated mice. Similar cardioprotective effects of IL-35 pretreatment were observed in mouse myocardial fibroblasts challenged with LPS in vitro. In summary, IL-35 pretreatment can attenuate cardiac inflammation, apoptosis, and fibrotic reactions induced by LPS, implicating IL-35 as a promising therapeutic target in sepsis-related cardiac injury.
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http://dx.doi.org/10.1016/j.intimp.2020.106725DOI Listing
September 2020

Association of self-reported sleep duration and quality with BaPWV levels in hypertensive patients.

Hypertens Res 2020 12 16;43(12):1392-1402. Epub 2020 Jul 16.

Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China.

The association between sleep conditions and arterial stiffness remains inconclusive. We aimed to investigate the relationship of sleep duration and quality with brachial-ankle pulse-wave velocity (baPWV) in hypertensive patients. A total of 14,485 hypertensive adults were included in this cross-sectional analysis. Information about sleep duration and quality was obtained via questionnaire. A baPWV level ≥1800 cm/s was defined as indicative of arterial stiffness. Compared with participants with a sleep duration <8 h per day, participants with a sleep duration ≥8 h per day had a significantly higher baPWV level (β = 13.7 cm/s; 95% CI: 3.9, 23.5) and a nonsignificantly higher prevalence of arterial stiffness (39.7% vs. 33.0%; OR, 1.08; 95% CI: 0.99-1.19). Similarly, compared with participants with good or medium sleep quality, participants with poor sleep quality had a significantly higher baPWV level (β = 16.3 cm/s; 95% CI: 0.1, 32.6) and a nonsignificantly greater prevalence of arterial stiffness (36.6% vs. 35.3%; OR, 1.13; 95% CI: 0.97-1.32). When sleep duration and quality were examined jointly, participants with a sleep duration ≥8 h and/or poor sleep quality had a significantly higher baPWV level (β = 14.4 cm/s; 95% CI: 5.3, 23.4) and a greater prevalence of arterial stiffness (38.8% vs. 32.7%; OR, 1.10; 95% CI: 1.01-1.20) than those with a sleep duration <8 h and good/medium sleep quality. In summary, among hypertensive patients, a longer sleep duration (≥8 h per day) and poor sleep quality were associated with higher baPWV levels and a higher prevalence of arterial stiffness.
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http://dx.doi.org/10.1038/s41440-020-0509-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671938PMC
December 2020

Achieving blood pressure control targets in hypertensive patients of rural China - a pilot randomized trial.

Trials 2020 Jun 11;21(1):515. Epub 2020 Jun 11.

Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

Background: This study aimed to test the feasibility and titration methods used to achieve specific blood pressure (BP) control targets in hypertensive patients of rural China.

Methods: A randomized, controlled, open-label trial was conducted in Rongcheng, China. We enrolled 105 hypertensive participants aged over 60 years, and who had no history of stroke or cardiovascular disease. The patients were randomly assigned to one of three systolic-BP target groups: standard: 140 to < 150 mmHg; moderately intensive: 130 to < 140 mmHg; and intensive: < 130 mmHg. The patients were followed for 6 months.

Discussion: The optimal target for systolic blood pressure (SBP) lowering is still uncertain worldwide and such information is critically needed, especially in China. However, in China the rates of awareness, treatment and control are only 46.9%, 40.7%, and 15.3%, respectively. It is challenging to achieve BP control in the real world and it is very important to develop population-specific BP-control protocols that fully consider the population's characteristics, such as age, sex, socio-economic status, compliance with medication, education level, and lifestyle. This randomized trial showed the feasibility and safety of the titration protocol to achieve desirable SBP targets (< 150, < 140, and < 130 mmHg) in a sample of rural, Chinese hypertensive patients. The three BP target groups had similar baseline characteristics. After 6 months of treatment, the mean SBP measured at an office visit was 137.2 mmHg, 131.1 mmHg, and 124.2 mmHg, respectively, in the three groups. Home BP and central aortic BP measurements were also obtained. At 6 months, home BP measurements (2 h after drug administration) showed a mean SBP of 130.9 mmHg in the standard group, 124.9 mmHg in the moderately intensive group, and 119.7 mmHg in the intensive group. No serious adverse events were recorded over the 6-month study period. Rates of adverse events, including dry cough, palpitations, and arthralgia, were low and showed no significant differences between the three groups. This trial provided real-world experience and laid the foundation for a future, large-scale, BP target study.

Trial Registration: Feasibility Study of the Intensive Systolic Blood Pressure Control; ClinicalTrials.gov, ID: NCT02817503. Registered retrospectively on 29 June 2016.
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http://dx.doi.org/10.1186/s13063-020-04368-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291427PMC
June 2020