Publications by authors named "Yong Huo"

398 Publications

Self-perceived psychological stress and risk of first stroke in treated hypertensive patients.

Psychosom Med 2021 Oct 12. Epub 2021 Oct 12.

Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory; Guangdong Provincial Clinical Research Center for Kidney Disease; Guangzhou 510515, China Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China Institute of Biomedicine, Anhui Medical University, Hefei 230032, China Shenzhen Evergreen Medical Institute, Shenzhen 518057, China Department of Cardiology, Peking University First Hospital, Beijing 100034, China Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, E4132, Baltimore, MD 21205-2179, USA.

Objective: We aimed to investigate the prospective association between self-perceived psychological stress and first stroke, and examine possible effect modifiers among adults with hypertension.

Methods: A total of 20,688 hypertensive adults with information on self-perceived psychological stress at baseline were included from the China Stroke Primary Prevention Trial (CSPPT). Participants were randomly assigned to a double-blind treatment of receiving a single tablet daily with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. Follow up visits occurred every 3 months after randomization. Psychological stress was measured with a one-item 3-point rating scale. The primary outcome was first stroke (fatal or nonfatal).

Results: The median treatment period was 4.5 years. Compared with participants with low levels of psychological stress, those with high psychological stress had a significantly higher risk of first stroke (adjusted HR, 1.40; 95%CI: 1.01, 1.94) or first ischemic stroke (adjusted HR, 1.45; 95%CI: 1.01, 2.09). Moreover, a stronger positive relationship between psychological stress and first stroke was found in participants with time-averaged mean arterial pressure (MAP) <101 mmHg (median) (P-interaction = 0.004) during the treatment period. However, our study did not find a significant association between psychological stress and first hemorrhagic stroke.

Conclusions: Higher psychological stress was associated with an increased risk of first stroke among treated hypertensive patients, especially in those with lower MAP during the treatment period.
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http://dx.doi.org/10.1097/PSY.0000000000001030DOI Listing
October 2021

Lipid goal attainment in post-acute coronary syndrome patients in China: Results from the 6-month real-world dyslipidemia international study II.

Clin Cardiol 2021 Oct 15. Epub 2021 Oct 15.

Global Medical and Scientific Affairs (GMSA), MSD China, Shanghai, China.

Background: Dyslipidemia International Study II (DYSIS II)-China was conducted to determine the low-density lipoprotein cholesterol (LDL-C) goal (<1.8 mmol/L) attainment rate in patients with post-acute coronary syndrome (ACS).

Hypothesis: Compliance with treatment guideline recommendations improves the LDL-C goal attainment rate in post-ACS patients.

Methods: This multicenter prospective observational study conducted at 28 tertiary hospitals determined the LDL-C goal attainment rates at admission and 6-month follow-up in patients on lipid-lowering treatment (LLT) for ≥3 months and those not on LLT (LLT-naive or off LLT for ≥3 months) at admission. Predictors of goal attainment at 6 months were identified using multivariate logistic regression.

Results: The LDL-C goal attainment rate at admission in 1102/1103 enrolled patients was 17.1%; it was 41.2% among 752 patients with available lipid results at 6 months. The distance to goal was 0.7 mmol/L at 6 months. Statin monotherapy was the most prescribed LLT. Only 7.7% of patients were receiving statin + ezetimibe and 8.4% of patients were receiving an atorvastatin-equivalent dose of ≥40 mg/day at 6 months. Being male (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.6) and undergoing percutaneous coronary intervention during index hospitalization (OR 1.5, 95% CI 1.1 to 2.1) were the independent predictors for LDL-C goal attainment.

Conclusions: This real-world DYSIS II study in China reports a low LDL-C goal attainment rate in post-ACS patients even after 6 months of LLT. Lack of intensification of statin therapy and underutilization of combinations suggest gaps between real-world treatment practices and guideline recommendations.
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http://dx.doi.org/10.1002/clc.23725DOI Listing
October 2021

Urinary albumin-to-creatinine ratio and the risk of first stroke in Chinese hypertensive patients treated with angiotensin-converting enzyme inhibitors.

Hypertens Res 2021 Oct 13. Epub 2021 Oct 13.

Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510515, China.

We aimed to evaluate the relationship of the albumin-to-creatinine ratio (ACR) with the risk of first stroke and examine possible effect modifiers in hypertensive patients. A total of 11,632 hypertensive participants with urinary ACR measurements and without a history of stroke from the China Stroke Primary Prevention Trial (CSPPT) were included in this analysis. The primary outcome was first stroke. Over a median follow-up of 4.4 years, 728 first strokes were identified, of which 633 were ischemic, 89 were hemorrhagic, and 6 were uncertain types. Overall, there was a significant positive association between natural log-transformed ACR and the risk of first stroke (HR, 1.11; 95% CI: 1.03-1.20) and first ischemic stroke (HR, 1.12; 95% CI: 1.03-1.22). Consistently, participants with ACR ≥ 10 mg/g had a significantly higher risk of first stroke (HR, 1.26; 95% CI: 1.06-1.50) and first ischemic stroke (HR, 1.33; 95% CI: 1.10-1.59) than those with ACR < 10 mg/g. Moreover, the association of ACR with first stroke was significantly stronger in participants with higher total homocysteine (tHcy) levels (<10 versus ≥ 10 μmol/L; P for interaction = 0.044). However, there was no significant association between ACR and first hemorrhagic stroke (per natural log [ACR] increment: HR, 1.02; 95% CI: 0.82-1.27). In summary, hypertensive patients with ACR ≥ 10 mg/g had a significantly increased risk of first stroke or first ischemic stroke. This positive association was more pronounced among participants with higher tHcy levels.
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http://dx.doi.org/10.1038/s41440-021-00780-5DOI Listing
October 2021

Joint Associations Between Plasma 25-Hydroxyvitamin D, Glycemic Status and First Stroke in General Hypertensive Adults: Results From the China Stroke Primary Prevention Trial (CSPPT).

J Nutr 2021 Sep 24. Epub 2021 Sep 24.

Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing, China.

Background: Associations between vitamin D and stroke remain inconsistent. One major risk factor for stroke is high blood glucose, but the role it plays in this association is not well-studied.

Objectives: We aimed to evaluate the individual association between plasma 25-hydroxyvitamin D (25(OH)D) and risk of first stroke stratified by fasting blood glucose (FBG), and the joint associations between plasma 25(OH)D, glycemic status and first stroke in hypertensive adults.

Methods: This study was a nested, case-control design utilizing data from the China Stroke Primary Prevention Trial (CSPPT). This analysis included 591 first stroke cases (of which 475 were ischemic stroke, 114 were hemorrhagic stroke, and 2 were uncertain type) and 591 matched controls. The age range of the study population was 45-75 years. The normal FBG (NFG) group had FBG < 5.6 mmol/L,  and the impaired FBG (IFG) group had FBG ≥ 5.6 mmol/L and < 7.0 mmol/L. Diabetes was defined as participants with FBG ≥ 7 mmol/L or who were receiving treatment with hypoglycemic agents. Odds ratios (ORs) (95% confidence intervals) were calculated using unconditional logistic regression models.

Results: Multivariable adjusted models revealed an inverse association between quartiles of 25(OH) D and risk of first stroke among participants with NFG, but the opposite trend was observed for those with IFG or diabetes. The largest odds ratios (>2) were observed among patients with diabetes, compared to the reference group of NFG and high 25(OH)D. Those with NFG and low 25(OH)D (OR = 1.73, 95%CI = 1.22 to 2.44) or those with IFG and high 25(OH)D (OR = 1.74, 95%CI = 1.14 to 2.67) both had higher risk of total stroke. There was a significant interaction between 25(OH)D and a combined group of IFG and diabetes (P = 0.001). Similar results were observed for ischemic stroke.

Conclusions: In a hypertensive population, the relation between plasma 25(OH)D and risk of first stroke was significantly modified by fasting blood glucose.Registration-URL: https://www.clinicaltrials.gov. Unique identifier: NCT00794885.
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http://dx.doi.org/10.1093/jn/nxab339DOI Listing
September 2021

Treatment of Chinese Patients with Hypertriglyceridemia with a Pharmaceutical-Grade Preparation of Highly Purified Omega-3 Polyunsaturated Fatty Acid Ethyl Esters: Main Results of a Randomized, Double-Blind, Controlled Trial.

Vasc Health Risk Manag 2021 15;17:571-580. Epub 2021 Sep 15.

Peking University First Hospital, Beijing, 100034, People's Republic of China.

Introduction: The lipid-modifying potential of omega-3 polyunsaturated fatty acids in Chinese patients is under-researched. We conducted a multicenter, randomized, placebo-controlled, double-blind, parallel-group study of twice-daily treatment with OMACOR (OM3EE), a prescription-only formulation of highly purified ethyl esters of omega-3 polyunsaturated fatty acids in Chinese adult patients (≥18 years) who had elevated baseline fasting serum triglycerides (TG).

Methods: Patients were stratified according to the severity of their hypertriglyceridemia (severe HTG, with baseline TG ≥500 and <1000 mg/dL or moderate HTG, with baseline TG >200 and <500 mg/dL) or use of statins. Patients randomized to OM3EE therapy received 2 g/day for 4 weeks, then 4 g/day for 8 weeks. The primary efficacy endpoint was the percentage change in fasting serum TG between baseline and the end of treatment in patients with severe HTG. The study was concluded after a planned interim analysis demonstrated a significant TG-lowering effect of OM3EE in that contingent (=0.0019).

Results: The mean TG end-of-treatment effect of OM3EE was -29.46% (standard deviation 40.60%) in the severe HTG contingent compared with +0.26% (standard deviation 54.68%) in the placebo group. Corresponding changes were -12.12% and -23.25% in the moderate HTG and combination cohorts (vs +55.45% and +6.24% in relevant placebo groups). A dose-dependent reduction in TG was evident in all patient contingents. Safety and tolerability of OM3EE were in line with previous experience.

Discussion: These data indicate that OMACOR therapy at a dose of 2-4 g/day is an effective treatment for Chinese patients with raised TG levels and is well tolerated.
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http://dx.doi.org/10.2147/VHRM.S325217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450163PMC
September 2021

Plasma selenium and the risk of first stroke in adults with hypertension: a secondary analysis of the China Stroke Primary Prevention Trial.

Am J Clin Nutr 2021 Sep 21. Epub 2021 Sep 21.

Key Laboratory of Precision Nutrition and Food Quality, Ministry of Education, Department of Nutrition and Health, College of Food Sciences and Nutritional Engineering, China Agricultural University, Beijing 100083, China.

Background: Previous studies indicated that selenium (Se) may play an important role in cardio-cerebrovascular disease. However, the relationship between circulating selenium and risk of first stroke remains inconclusive.

Objective: We conducted a secondary analysis of the China Stroke Primary Prevention Trial (CSPPT), using a nested case-control design, and aimed to investigate the correlation between Se concentration and first stroke risk in adults with hypertension and examine the potential effect modifiers.

Methods: In the CSPPT, a total of 20,702 adults with hypertension were randomly assigned to a double-blind, daily treatment with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. A total of 618 first stroke cases and 618 controls matched for age, sex, treatment group, and study site were included in this study.

Results: During a median follow-up duration of 4.5 years (IQR, 4.2-4.6 y), there was a significant inverse association between plasma Se and the risk of first stroke (per SD increment; adjusted OR: 0.81; 95% CI: 0.68, 0.96) and ischemic stroke (per SD increment; adjusted OR: 0.76; 95% CI: 0.62, 0.93). Furthermore, a stronger inverse association between plasma Se and first stroke was observed in participants with higher folate concentrations at baseline (≥ 7.7 (median), adjusted OR: 0.67; 95% CI: 0.54, 0.85, versus <7.7 ng/mL adjusted OR: 0.98; 95% CI: 0.80, 1.21; P for interaction = 0.008), and those with higher time-averaged systolic blood pressure (SBP) over the treatment period (≥ 140, adjusted OR: 0.71; 95% CI: 0.58, 0.86, versus <140 mmHg, adjusted OR: 0.96; 95% CI: 0.77, 1.20; P for interaction = 0.023).

Conclusions: In summary, there was a significant inverse association between plasma Se and risk of first stroke in Chinese adults with hypertension, especially among those with higher baseline folate concentrations and those with higher time-averaged SBP over the treatment period.Trial registration number: NCT00794885URL of registration: https://www.clinicaltrials.gov/ct2/show/NCT00794885?term=NCT00794885&draw=2&r.
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http://dx.doi.org/10.1093/ajcn/nqab320DOI Listing
September 2021

Hydration for prevention of kidney injury after primary coronary intervention for acute myocardial infarction: a randomised clinical trial.

Heart 2021 Sep 11. Epub 2021 Sep 11.

Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, The Affiliated Guangdong Provincial People's Hospital of South China University of Technology, Guangzhou, Guangdong, China

Objective: To evaluate the efficacy of aggressive hydration compared with general hydration for contrast-induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).

Methods: The Aggressive hydraTion in patients with STEMI undergoing pPCI to prevenT Contrast-Induced Acute Kidney Injury study is an open-label, randomised controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 min, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/hour for 6 hours after randomisation. The primary end point is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48-72 hours after primary angioplasty. The safety end point is acute heart failure.

Results: From July 2014 to May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs 31.1%; risk ratio (RR) 0.70, 95% CI 0.52 to 0.96). Acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (8.1% vs 6.4%, RR 1.13, 95% CI 0.66 to 2.44). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants.

Conclusions: Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI.
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http://dx.doi.org/10.1136/heartjnl-2021-319716DOI Listing
September 2021

Effect of age stratification on the association between carotid intima-media thickness and cognitive impairment in Chinese hypertensive patients: new insight from the secondary analysis of the China Stroke Primary Prevention Trial (CSPPT).

Hypertens Res 2021 Sep 7. Epub 2021 Sep 7.

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

The current study aimed to explore the association between carotid intima-media thickness (CIMT) and cognitive function assessed by the Mini-Mental State Examination (MMSE) and to examine possible effect modifiers in hypertensive patients. A total of 14,322 hypertensive participants (mean age 64.2 ± 7.4 years; 40.9% male) from the China Stroke Primary Prevention Trial (CSPPT) were included in the final analysis. CIMT was measured by ultrasound, and data were collected at the last follow-up visit; MMSE was used to evaluate cognitive function. Nonparametric smoothing plots, multivariate linear regression analysis, subgroup analyses and interaction testing were performed to examine the relationship between the CIMI and cognitive function and effect modification. The mean CIMT was 0.74 ± 0.11 mm, and the mean MMSE score was 23.5 ± 4.8. There was a significant interaction (P interaction < 0.05) in both male and female populations stratified by age (<60 vs. ≥60 years), and higher CIMT was significantly associated with decreased MMSE scores only in participants aged ≥60 years (male: β = -2.29, 95% CI -3.23 to -1.36; female: β = -1.96, 95% CI -2.97 to -0.95). Males with abnormal HDL-C showed a stronger negative association (β = -3.16, 95% CI -4.85 to -1.47) than those with normal HDL-C (normal vs. abnormal, P for interaction = 0.004). We observed that increased CIMT was significantly associated with cognitive impairment in the hypertensive population, especially among individuals with an age greater than 60 years and HDL-C deficiency. Overall, upon diagnosis of hypertension, treatment should start at the earliest opportunity to prevent end-organ damage and cognitive decline.
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http://dx.doi.org/10.1038/s41440-021-00743-wDOI Listing
September 2021

Safety and efficacy of a platelet glycoprotein Ib inhibitor for patients with non-ST segment elevation myocardial infarction: A phase Ib/IIa study.

Pharmacotherapy 2021 Oct 21;41(10):828-836. Epub 2021 Sep 21.

Department of Cardiology, Peking University First Hospital, Beijing, China.

Study Objective: This study aimed to determine the safety and efficacy of a novel GP Ib receptor inhibitor in patients with non-ST segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI).

Design And Setting: Multicenter, randomized, double-blind, placebo-controlled, dose-escalating, phase Ib-IIa clinical trial. Eligible patients were randomly assigned to the low-dose (n=20, 2 IU/60 kg), moderate-dose (n=20, 3 IU/60 kg), or high-dose anfibatide group (n=20, 5 IU/60 kg), or the placebo group (n=30). Anfibatide was administered for up to 48 hours along with standard aspirin and clopidogrel therapy.

Patients: Ninety patients with NSTEMI who underwent PCI at six academic hospitals in China.

Measurements And Main Results: All three doses of anfibatide showed dose-dependent antiplatelet activity as measured by ex vivo platelet aggregation at 5 minutes, 24 hours, and 48 hours during infusion, and 4 hours post-infusion compared with placebo. Higher inhibition of platelet aggregation occurred in all anfibatide groups compared with the placebo group. The post-procedural TIMI grade flow, myocardial blush grade, and corrected TIMI frame count were not significantly different among the four groups. Thirty-day mortality, non-fatal myocardial infarction, and major bleeding were rare and comparable between patients who received anfibatide and placebo. There was no significant difference in the platelet count among the groups during follow-up.

Conclusions: This study shows that intravenous administration of the platelet receptor GP Ib antagonist anfibatide is feasible and safe to inhibit platelet aggregation without increasing the risk of bleeding and thrombocytopenia in patients with NSTEMI undergoing PCI.
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http://dx.doi.org/10.1002/phar.2620DOI Listing
October 2021

LDL cholesterol levels and in-hospital bleeding in patients on high-intensity antithrombotic therapy: findings from the CCC-ACS project.

Eur Heart J 2021 08;42(33):3175-3186

Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China.

Aims: Emerging evidence has linked cholesterol metabolism with platelet responsiveness. We sought to examine the dose-response relationship between low-density lipoprotein cholesterol (LDL-C) and major in-hospital bleeds in acute coronary syndrome (ACS) patients.

Methods And Results: Among 42 378 ACS patients treated with percutaneous coronary intervention (PCI) enrolled in 240 hospitals in the Improving Care for Cardiovascular Disease in China-ACS project from 2014 to 2019, a total of 615 major bleeds, 218 ischaemic events, and 337 deaths were recorded. After controlling for baseline variables, a non-linear relationship was observed for major bleeds, with the higher risk at lower LDL-C levels. No dose-response relationship was identified for ischaemic events and mortality. A threshold value of LDL-C <70 mg/dL was associated with an increased risk for major bleeds (adjusted odds ratio: 1.49; 95% confidence interval: 1.21-1.84) in multivariable-adjusted logistic regression models and in propensity score-matched cohorts. The results were consistent in multiple sensitivity analyses. Among ticagrelor-treated patients, the LDL-C threshold for increased bleeding risk was observed at <88 mg/dL, whereas for clopidogrel-treated patients, the threshold was <54 mg/dL. Across a full spectrum of LDL-C levels, the treatment effect size associated with ticagrelor vs. clopidogrel on major bleeds favoured clopidogrel at lower LDL-C levels, but no difference at higher LDL-C levels.

Conclusions: In a nationwide ACS registry, a non-linear association was identified between LDL-C levels and major in-hospital bleeds following PCI, with the higher risk at lower levels. As the potential for confounding may exist, further studies are warranted.

Trial Registration: ClinicalTrials.gov Identifier: NCT02306616.
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http://dx.doi.org/10.1093/eurheartj/ehab418DOI Listing
August 2021

Eutrophication increases deterministic processes and heterogeneity of co-occurrence networks of bacterioplankton metacommunity assembly at a regional scale in tropical coastal reservoirs.

Water Res 2021 Sep 26;202:117460. Epub 2021 Jul 26.

Department of Ecology and Institute of Hydrobiology, Jinan University, Guangzhou, China. Electronic address:

Understanding microbial metacommunity assembly and the underlying methanisms are fundamental objectives of aquatic ecology. However, little is known about how eutrophication, the primary water quality issue of aquatic ecosystems, regulates bacterioplankton metacommunity assembly at a regional scale in reservoirs. In this study, we applied a metacommunity framework to study bacterioplankton communities in 210 samples collected from 42 tropical coastal reservoirs in the wet summer season. We found that the spatial pattern of bacterioplankton community compositions (BCCs) at a regional scale was shaped mainly by species sorting. The reservoir trophic state index (TSI) was the key determinant of bacterioplankton metacommunity assembly. BCC turnover increased significantly with the TSI differences between sites (∆TSI) when ∆TSI was < 20, but remained at a level of about 80% when ∆TSI was > 20. Compared to oligo-mesotrophic and mesotrophic reservoirs, increased heterogeneity of co-occurrence bacterioplankton networks and bacterioplankton β-diversity were observed across eutrophic reservoirs. We propose that larger variation in phytoplankton community assembly may play directly or indirectly deterministic processes in controlling the bacterioplankton metacommunity assembly and became the potential mechanisms behind the observed higher BCC heterogeneity across the eutrophic reservoirs. Our research contributes to a broader understanding of the ecological effects of eutrophication on reservoir ecosystems and provides clues to the management of the tropical coastal reservoirs.
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http://dx.doi.org/10.1016/j.watres.2021.117460DOI Listing
September 2021

Elevated Interarm Systolic Blood Pressure Difference Is Positively Associated with Increased Likelihood of Coronary Artery Disease.

Int J Hypertens 2021 21;2021:5577957. Epub 2021 Jul 21.

Department of Cardiology, Peking University First Hospital, Beijing, China.

Background: Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We investigated the relationship between interarm systolic blood pressure difference and coronary artery disease.

Methods: We retrospectively analyzed data for patients undergoing coronary angiography and brachial-ankle pulse wave velocity examination during hospitalization from 2013 to 2018. Patients underwent simultaneous upper arm blood pressure measurement. Interarm systolic blood pressure difference (IASBPD) was defined as the absolute value of the difference between the right and left upper limb systolic blood pressure. Patients with IASBPD ≥10 mmHg constituted the high group, and those with IASBPD <10 mmHg constituted the normal group. We also recorded data for cardiovascular risk factors. Coronary artery disease was defined as ≥50% vessel stenosis or having undergone interventional therapy according to coronary angiography results.

Results: Compared with the normal group, the number of patients with coronary artery disease was higher in the high group (86.1% vs. 74.6%, =0.029). Multiple logistic regression showed that IASBPD ≥10 mmHg were positively correlated with coronary artery disease (odds ratio, 2.313; 95% confidence interval, 1.086-4.509; =0.029), and as the IASBPD value increased, the correlation also gradually increased.

Conclusions: IASBPD ≥10 mmHg was positively related to coronary artery disease and increased IASBPD values were correlated with coronary artery disease severity.
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http://dx.doi.org/10.1155/2021/5577957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321749PMC
July 2021

Hypertensive Retinopathy and the Risk of Stroke Among Hypertensive Adults in China.

Invest Ophthalmol Vis Sci 2021 07;62(9):28

Department of Ophthalmology, Peking University First Hospital, Beijing, China.

Purpose: This study aimed to investigate the association between hypertensive retinopathy and the risk of first stroke, examine possible effect modifiers in hypertensive patients, and test the appropriateness of the Keith-Wagener-Barker (KWB) classification for predicting stroke risk.

Methods: In total, 9793 hypertensive participants (3727 males and 6066 females) without stroke history from the China Stroke Primary Prevention Trial were included in this study. The primary outcome was first stroke.

Results: Over a median follow-up of 4.4 years, 592 participants experienced their first stroke (509 ischemic, 77 hemorrhagic, and six unclassifiable strokes). In total, 5590 participants were diagnosed with grade 1 retinopathy (57.08%), 1466 with grade 2 retinopathy (14.97%), 231 with grade 3 retinopathy (2.36%), and three with grade 4 retinopathy (0.03%). Grades 1 and 2 were merged and classified as mild retinopathy, and grades 3 and 4 were merged and classified as severe retinopathy. There was a significant positive association between hypertensive retinopathy and the risk of first stroke and first ischemic stroke, and no effect modifiers were found. The hazard ratios (HRs) for first stroke were as follows: mild versus no retinopathy, 1.26 (95% confidence interval [CI], 1.01-1.58, P = 0.040), and severe versus no retinopathy, 2.40 (95% CI, 1.49-3.84, P < 0.001). The HRs for ischemic stroke were as follows: severe versus no retinopathy, 2.35 (95% CI, 1.41-3.90, P = 0.001), and nonsignificantly increased HRs for mild versus no retinopathy, 1.26 (95% CI, 0.99-1.60, P = 0.057).

Conclusions: There was a significant positive association between hypertensive retinopathy and the risk of first stroke in patients with hypertension, indicating that hypertensive retinopathy may be a predictor of the risk of stroke. A simplified two-grade classification system based on the KWB classification is recommended for predicting stroke risk.
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http://dx.doi.org/10.1167/iovs.62.9.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300046PMC
July 2021

Sex differences in mortality after an acute coronary syndrome increase with lower country wealth and higher income inequality.

Rev Esp Cardiol (Engl Ed) 2021 Jun 23. Epub 2021 Jun 23.

Departamento de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Grupo de Investigación Cardiovascular Traslacional Multidisciplinaria, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain. Electronic address:

Introduction And Objectives: Although several factors associated with sex differences in the management and outcomes after acute coronary syndrome (ACS) have been reported, little is known about the influence of socioeconomic factors on sex disparities. Our aim was to evaluate the influence of country wealth and income inequality on national sex differences in mortality after ACS.

Methods: Sex differences in 2-year postdischarge mortality were evaluated in 23 489 ACS patients from the EPICOR and EPICOR Asia registries. Adjusted Cox regression models by country-based terciles of gross national income per capita and income inequality were used.

Results: Women (24.3%) were older than men (65.5 vs 59.4 years, P <.001), had more comorbidities, were less often revascularized (63.6% vs 75.6%, P <.001) and received fewer guideline recommended therapies at discharge. Compared with men, a higher percentage of women died during follow-up (6.4% vs 4.9%, P <.001). The association between sex and mortality changed direction from hazard ratio (HR) 1.32 (95%CI, 1.17-1.49) in the univariate assessment to HR 0.76 (95%CI, 0.67-0.87) after adjustment for confounders. These differences were more evident with increasing country wealth (HR = 0.85; 95%CI, 0.72-1.00; HR = 0.66; 95%CI, 0.50-0.87; HR = 0.60; 95%CI, 0.40-0.90; trend test P = .115) and with decreasing income inequality (HR = 0.54; 95%CI, 0.36-0.81; HR = 0.66; 95%CI, 0.50-0.88; HR = 0.87; 95%CI, 0.74-1.03; trend test P = .031).

Conclusions: Women with ACS living in high socioeconomic countries showed a lower postdischarge mortality risk compared with men. This risk was attenuated in countries with poorer socioeconomic background, where adjusted mortality rates were similar between women and men.
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http://dx.doi.org/10.1016/j.rec.2021.05.006DOI Listing
June 2021

Associations between remnant lipoprotein cholesterol and central systolic blood pressure in a Chinese community-based population: a cross-sectional study.

Lipids Health Dis 2021 Jun 26;20(1):60. Epub 2021 Jun 26.

Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.

Background: The lipid profile is reportedly related to peripheral blood pressure or pulse wave velocity. However, no studies have investigated the associations between lipid parameters, especially remnant lipoprotein cholesterol (RLP-C), and central systolic blood pressure (cSBP).

Methods: This study used baseline data of a community-based cohort in Beijing, China. Participants who had been treated with anti-hypertensive or lipid-lowering agents were excluded. RLP-C is equal to total cholesterol (TC) minus the sum of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). An Omron HEM-9000AI device was used to measure non-invasive cSBP. The associations between blood lipid profile and non-invasive cSBP were evaluated using multivariable regression models.

Results: The 5173 included participants were 55.0 ± 8.5 years old; 35.7% (1845) of participants were men. Increased cSBP was significantly associated with increased TC, LDL-C, non-high-density lipoprotein cholesterol (non-HDL-C), triglyceride (TG), and RLP-C but with decreased HDL-C, even after adjusting for possible covariates. When simultaneously entering individual pairs of RLP-C and other blood lipid parameters into the multivariable regression model, RLP-C remained significantly associated with cSBP, even after adjusting for other lipids. Compared with participants who had RLP-C levels in the first quartile (Q1), cSBP for those with RLP-C in Q4 was increased to 4.57 (95% confidence interval [CI]: 3.08-6.06) mmHg after adjusting for LDL-C, 4.50 (95%CI: 2.98-6.02) mmHg after adjusting for TC, 3.91 (95%CI: 1.92-5.89) mmHg after adjusting for TG, 5.15 (95%CI: 3.67-6.63) mmHg after adjusting for HDL-C, and 4.10 (95%CI: 2.36-5.84) mmHg after adjusting for non-HDL-C.

Conclusions: Increased blood RLP-C level was significantly associated with higher cSBP in a Chinese population, independently of other lipids, which indicates its importance in individual cardiovascular risk assessment.
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http://dx.doi.org/10.1186/s12944-021-01490-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235613PMC
June 2021

Intra-aortic balloon pump on in-hospital outcomes of cardiogenic shock: findings from a nationwide registry, China.

ESC Heart Fail 2021 Aug 21;8(4):3286-3294. Epub 2021 Jun 21.

Peking University First Hospital, Beijing, China.

Aims: The real-world usage of intra-aortic balloon pump (IABP) in various cardiogenic shocks (CS) and the association with outcomes are lacking. We aimed to investigate IABP adoption in CS in a nationwide registry in China.

Methods And Results: We retrospectively retrieved data of 30 106 CS patients (age 67.1 ± 14.6 years, 37.6% female patients) in the Hospital Quality Monitoring System registry from 2013 to 2016. Ischaemic heart disease was the leading cause of CS (73.9%). Hypertension, cardiomyopathy, myocarditis, valvular, and congenital heart disease were seen in 36.0%, 7.5%, 2.6%, 7.3%, and 2.4% of the population. IABP was employed in 2320 (7.7%) subjects. The association between IABP usage and primary outcome of in-hospital mortality and secondary outcomes of expenses and lengths of stay were investigated. The patients with IABP support had similar in-hospital mortality to those without IABP (39.6% vs. 38.3%, P = 0.226), but longer hospital-stay [8.0 (2.0-16.0) vs. 6.0 (2.0-13.0) days, P < 0.001] and higher expenses [7.1(4.4-11.1) vs. 2.3 (0.8-5.5) 10 000RMB, P < 0.001]. IABP support was not associated with reduced mortality in the overall CS population in multivariate regression analysis [odds ratio (OR) 1.05, 95% confidence interval (CI) 0.95-1.17], except for subgroups with myocarditis (OR 0.61, 95% CI 0.39-0.95, P for interaction = 0.010) and those who did not receive the early percutaneous coronary intervention (PCI) (OR 0.86, 95% CI 0.75-0.97, P for interaction < 0.001). Similar results were further confirmed in the propensity-score-matched population.

Conclusions: In this nationwide registry of CS patients, IABP was not noted with improved survival but increased healthcare consumption. However, IABP appears protective in those with myocarditis or who failed to receive early PCI.
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http://dx.doi.org/10.1002/ehf2.13479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318473PMC
August 2021

Relationship Between Different Risk Factor Patterns and Follow-Up Outcomes in Patients With ST-Segment Elevation Myocardial Infarction.

Front Cardiovasc Med 2021 25;8:633992. Epub 2021 May 25.

Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.

Few studies have been concerned with the combined influences of the presence of multiple risk factors on follow-up outcomes in AMI patients. Our study aimed to identify risk factor patterns that may be associated with 1-year survival in male patients with ST-segment elevation myocardial infarction (STEMI). Data were from the China STEMI Care Project Phase 2 (CSCAP-2) collected between 2015 and 2018. A total of 15,675 male STEMI patients were enrolled in this study. Risk factor patterns were characterized using latent class analysis (LCA) according to seven risk factors. Associations between risk factor patterns and follow-up outcomes, including the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause death, were investigated by Cox proportional hazard regression analysis. We obtained four risk factor patterns as "young and middle-aged with low levels of multimorbidity," "middle-aged with overweight," "middle-aged and elderly with normal weight," and "elderly with high multimorbidity." Four patterns had significant differences in event-free survival ( < 0.001). As compared with the patients of "young and middle-aged with low levels of multimorbidity" pattern, the risk of incidence of MACCE and all-cause death were increased in patients of "middle-aged with overweight" pattern (All-cause death: = 1.70, 95% CI:1.29~2.23; MACCE: = 1.49, 95% CI1.29~1.72), "middle-aged and elderly with normal weight" pattern (All-cause death: = 3.04, 95% CI: 2.33~3.98; MACCE: = 1.82, 95% CI: 1.56~2.12), and "elderly with high multimorbidity" pattern (All-cause death: = 5.78, 95% CI: 4.49~7.42; MACCE: = 2.67, 95% CI 2.31~3.10). By adopting a Latent Class Analysis Approach, STEMI patients can be characterized into four risk factor patterns with significantly different prognosis. The data is useful for the improvement of community health management in each specific subgroup of patients, which indicates a particular risk factor pattern.
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http://dx.doi.org/10.3389/fcvm.2021.633992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185218PMC
May 2021

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

Biol Sex Differ 2021 05 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

Association of epicardial fat thickness with left ventricular diastolic function parameters in a community population.

BMC Cardiovasc Disord 2021 05 28;21(1):262. Epub 2021 May 28.

Department of Cardiovascular Disease, Peking University First Hospital, Beijing, China.

Background: We examined the relationship between epicardial fat thickness (EFT) measured by echocardiography and left ventricular diastolic function parameters in a Beijing community population.

Methods: We included 1004 participants in this study. Echocardiographic parameters including E and A peak velocity, the early diastolic velocities (e') of the septal and lateral mitral annulus using tissue doppler imaging, E/e', and EFT were measured. EFT1 was measured perpendicularly on the right ventricular free wall at end diastole in the extension line of the aortic root. EFT2 was the maximum thickness measured perpendicularly on the right ventricular free wall at end diastole. Multivariable linear regression was used to analyze the relationship between EFT and the mean e' and E/e'.

Results: The mean age of the participants was 63.91 ± 9.02 years, and 51.4% were men. EFT1 and EFT2 were negatively correlated with lateral e', septal e', and mean e' (p < 0.05), and the correlation coefficient for EFT1 and EFT2 and mean e' was - 0.138 and - 0.180, respectively. EFT1 and EFT2 were positively correlated with lateral E/e', septal E/e', and mean E/e' (p < 0.05), and the correlation coefficient for EFT1 and EFT2 and mean e' was 0.100 and 0.090, respectively. Multivariable egression analysis showed that EFT2 was independently and negatively associated with e' mean (β = - 0.078 [95% confidence interval = - 0.143, - 0.012, p = 0.020]). There were no interactions between EFT2 and any covariates, including age or heart groups, sex, BMI, or presence of hypertension, diabetes, or coronary heart disease, in relation to left ventricular diastolic dysfunction.

Conclusions: EFT2 was negatively and independently associated with e' mean, which suggests that more attention to this type of adipose fat is required for cardiovascular disease therapy.
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http://dx.doi.org/10.1186/s12872-021-02071-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162010PMC
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

Trends in cause-related comorbidities in hospitalized patients with secondary hypertension in China from 2013 to 2016: a retrospective analysis of hospital quality monitoring system data.

J Hypertens 2021 10;39(10):2015-2021

Department of Cardiology, Peking University First Hospital, Beijing.

Background: Secondary hypertension has emerged as a major public health problem in China. Early diagnosis and treatment can significantly improve the clinical outcomes. However, data on the current cause composition in China are seldom reported.

Objective: To describe the trends in cause-related comorbidities in hospitalized patients with secondary hypertension in China from 2013 to 2016.

Methods: This was a retrospective analysis based on the national Hospital Quality Monitoring System (HQMS) database, which collects information from the front pages of in-hospital medical records. Hospitalized patients with secondary hypertension from 746 tertiary hospitals that consistently uploaded data to the HQMS from 2013 to 2016 were enrolled. All diagnoses were identified using International Classification of Diseases version 10 (ICD-10) diagnostic codes. Descriptive analyses were used to determine the proportions of secondary hypertension causes and changing trends over 4 years.

Result: The study collected data on 402 371 hospitalized patients with secondary hypertension from the HQMS during 2013-2016. Secondary hypertension caused by renal parenchymal disease ranked first and accounted for more than 50%. Obstructive sleep apnea syndrome (OSAS) followed closely with a rate of approximately 25%. Primary aldosteronism presented the highest proportion among all causes of endocrine hypertension. Regarding longitudinal changes over time, the rates of renal hypertension showed a significant downward trend from 2013 to 2016 (P < 0.001). In contrast, OSAS, endocrine hypertension, renal vascular disease, and aorta diseases maintained a significant upward trend from 2013 to 2016 (P < 0.001). The rates of these diseases in women with common secondary hypertension was higher than that of men, except in patients with OSAS (P < 0.001). In addition, renal parenchymal diseases and renal vascular diseases gradually decreased with age, whereas OSAS and aortic diseases gradually increased with age. The proportion of endocrine hypertension in the middle-aged group was higher than the other two age groups.

Conclusion: The study provides important information on the changing trends of cause rate of secondary hypertension modified by age and sex in China during 2013-2016. Renal parenchymal disease is still the most common cause of secondary hypertension with a decreasing trend, followed by OSAS with an increasing trend.
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http://dx.doi.org/10.1097/HJH.0000000000002891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452322PMC
October 2021

Egg consumption associated with all-cause mortality in rural China: a 14-year follow-up study.

Eur J Public Health 2021 07;31(3):613-618

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

Background: Dietary recommendations regarding egg intake remain controversial topic for public health. We hypothesized that there was a positive association between egg consumption and all-cause mortality.

Methods: To test this hypothesis, we enrolled 9885 adults from a community-based cohort in Anhui Province, China during 2003-05. Egg consumption was assessed by food questionnaire. Stratified analyses were performed for age, sex, body mass index (BMI), blood pressure, smoking, drinking and laboratory tests.

Results: After an average follow-up of 14.1 years, 9444 participants were included for analysis. A total of 814 deaths were recorded. Participants' BMI and lipid profile had no significantly difference between three egg consumption groups. BMI was 21.6±2.7 of the whole population, especially BMI>24 was only 17.3%. A bivariate association of egg consumption >6/week with increased all-cause mortality was observed compared with ≤6/week (RR: 1.35, 95% CI: 1.05, 1.73, P = 0.018). A significant interaction was observed for BMI ≥ 21.2 kg/m2 vs. BMI<21.2 kg/m2 (P for interaction: 0.001). No other significant interactions were found.

Conclusions: In this study, consuming >6 eggs/week increased risk of all-cause mortality, even among lean participants, especially who with BMI ≥ 21.2 kg/m2. Eggs are an easily accessible and constitute an affordable food source in underdeveloped regions. Consuming <6 eggs/week may be the most suitable intake mode.
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http://dx.doi.org/10.1093/eurpub/ckaa250DOI Listing
July 2021

Prospective association between baseline plasma zinc concentration and development of proteinuria in Chinese hypertensive patients.

J Trace Elem Med Biol 2021 Jul 2;66:126755. Epub 2021 Apr 2.

Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510515, China. Electronic address:

Objective: We aimed to evaluate the association between baseline plasma zinc and the development of proteinuria as well as possible effect modifiers in hypertensive patients.

Methods: This is a subset of the China Stroke Primary Prevention Trial (CSPPT) Renal Sub-Study. In the CSPPT, participants were randomized to receive a daily oral dose of 1 tablet containing 10 mg enalapril and 0.8 mg folic acid or 1 tablet containing 10 mg enalapril only. A total of 783 participants with plasma zinc measurements and without proteinuria at baseline were included in the current study. The study outcome was the development of proteinuria during the follow-up, defined as a urine dipstick reading of trace or ≥1+ at the exit visit.

Results: During a median follow-up duration of 4.4 years, the development of proteinuria occurred in 93 (11.9 %) participants. There was an inverse relation of baseline plasma zinc with the development of proteinuria (per SD increment; OR, 0.74, 95 % CI: 0.55-0.99), p for trend of quartiles = 0.005.

Conclusions: In Chinese hypertensive patients, there was a significant inverse association between baseline plasma zinc and the development of proteinuria, although plasma zinc remained in the reference range.
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http://dx.doi.org/10.1016/j.jtemb.2021.126755DOI Listing
July 2021

Heart Rate Predicts the Risk of New-Onset Peripheral Arterial Disease in a Community-Based Population in China.

Ther Clin Risk Manag 2021 26;17:267-274. Epub 2021 Mar 26.

Department of Cardiology, Peking University First Hospital, Beijing, People's Republic of China.

Introduction: Elevated heart rate is linked with poor prognosis and has been shown to accelerate the progress of atherosclerosis. However, the association between heart rate and new-onset PAD is unknown.

Methods: A total of 3463 participants without PAD at baseline from a community-based cohort in Beijing were included and followed up for 2.3 years. PAD was defined as ankle-brachial index (ABI) ≤0.9. We used multivariate logistic regression models to investigate the association of heart rate and the risk of new-onset PAD.

Results: Participants were 56.67 ± 8.54 years old, and 36.12% were men. The baseline ABI was 1.11 ± 0.08, and the incidence of new-onset PAD was 2.97%. Multivariate regression models, adjusted for sex, age, risk factor of atherosclerosis, medications, and baseline ABI, showed that heart rate was significantly associated with incidence of PAD (odds ratio [OR] = 1.22, 95% confidence interval [CI]: 1.03-1.43, = 0.020); every increase of 10 heart beats per minute (bpm) was associated with a 22% increase in the odds of developing new-onset PAD. Respondents in the higher-heart rate group (≥80 bpm) had an increased risk of new-onset PAD, compared with those in the lower-heart rate group (<80 bpm) (OR = 1.73, 95% CI: 1.14-2.63, = 0.010). Subgroup analyses revealed no significant heterogeneity among the analyzed subgroups.

Conclusion: Elevated heart rate was independently associated with the risk of new-onset PAD in a community-based population in Beijing. Heart rate management should be considered for the purpose of PAD prevention.
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http://dx.doi.org/10.2147/TCRM.S304491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009540PMC
March 2021

Relation between Blood Pressure Variability within a Single Visit and Stroke.

Int J Hypertens 2021 2;2021:2920140. Epub 2021 Mar 2.

Division of Cardiology, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing 100034, China.

Blood pressure variability (BPV) has been identified as an important risk factor for cardiovascular events. The white coat effect (WCE), which is measured as the first systolic blood pressure (SBP) measurement minus the mean of the second and third measurements, is a BPV indicator within a single visit. In total, 2,972 participants who had three measurements of BP within a single visit were included. The participants were divided into three groups based on their WCE percentiles: Group 1 (WCE, 2.5-97.5th percentiles of WCE), Group 2 (WCE, 0-2.4th percentiles of WCE), and Group 3 (WCE, 97.6-100th percentiles of WCE). A multiple logistic regression model was used to analyze the relationship between WCE and stroke after adjusting for cardiovascular disease risk factors. Compared with the WCE group, the OR for stroke in the WCE group was 2.78 (95% CI: 1.22, 6.36, =0.015). After adjusting for cardiovascular factors, OR increased to 3.12 (95% CI: 1.22, 7.96, =0.017). The OR of WCE for stroke was 0.93 (95%CI: 0.87, 0.99, =0.036). BPV within a single visit is associated with stroke. The value and direction of the change may be important as well.
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http://dx.doi.org/10.1155/2021/2920140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943313PMC
March 2021

An Asian-specific MPL genetic variant alters JAK-STAT signaling and influences platelet count in the population.

Hum Mol Genet 2021 May;30(9):836-842

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA.

Genomic discovery efforts for hematological traits have been successfully conducted through genome-wide association study on samples of predominantly European ancestry. We sought to conduct unbiased genetic discovery for coding variants that influence hematological traits in a Han Chinese population. A total of 5257 Han Chinese subjects from Beijing, China were included in the discovery cohort and analyzed by an Illumina ExomeChip array. Replication analyses were conducted in 3827 independent Chinese subjects. We analyzed 12 hematological traits and identified 22 exome-wide significant single-nucleotide polymorphisms (SNP)-trait associations with 15 independent SNPs. Our study provides replication for two associations previously reported but not replicated. Further, one association was identified and replicated in the current study, of a coding variant in the myeloproliferative leukemia (MPL) gene, c.793C > T, p.Leu265Phe (L265F) with increased platelet count (β = 20.6 109 cells/l, Pmeta-analysis = 2.6 × 10-13). This variant is observed at ~2% population frequency in East Asians, whereas it has not been reported in gnomAD European or African populations. Functional analysis demonstrated that expression of MPL L265F in Ba/F3 cells resulted in enhanced phosphorylation of Stat3 and ERK1/2 as compared with the reference MPL allele, supporting altered activation of the JAK-STAT signal transduction pathway as the mechanism underlying the novel association between MPL L265F and platelet count.
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http://dx.doi.org/10.1093/hmg/ddab062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161516PMC
May 2021

Coronary angiography-derived contrast fractional flow reserve.

Catheter Cardiovasc Interv 2021 Feb 15. Epub 2021 Feb 15.

Department of Cardiology, Peking University First Hospital, Beijing, China.

Background: Based on coronary angiography and mean aortic pressure, a specially designed computational flow dynamics (CFD) method is proposed to determine contrast fractional flow reserve (cFFR) without using invasive pressure wire. This substudy assessed diagnostic performance of coronary angiography-derived cFFR in catheterization laboratory, based on a previous multicenter trial for online assessment of coronary angiography-derived FFR (caFFR).

Methods: Patients with diagnosis of stable angina pectoris or unstable angina pectoris were enrolled in six centers. Wire-based FFR was measured in coronary arteries with 30-90% diameter stenosis. Offline angiography-derived cFFR was computed in blinded fashion against the wire-based FFR and caFFR at an independent core laboratory.

Results: A total of 330 patients were enrolled to fulfill inclusion/exclusion criteria from June 26 to December 18, 2018. Offline angiography-derived cFFR and wire-based FFR results were compared in 328 interrogated vessels. The statistical analysis showed the highest diagnostic accuracy of 89.0 and 86.6% for angiography-derived cFFR with a cutoff value of 0.94 and 0.93 against the wire-based FFR with a cutoff value of 0.80 and 0.75, respectively. The corresponding sensitivity and specificity were 92.2 and 87.3% for the cutoff value of 0.94 and 80.0 and 88.4% for the cutoff value of 0.93, which are similar to those against the caFFR. The receiver-operating curve has area under the curve of 0.951 and 0.972 for the wire-based FFR with the cutoff value of 0.80 and 0.75, respectively.

Conclusions: Coronary angiography-derived cFFR showed higher accuracy, sensitivity, and specificity against wired-based FFR and caFFR. Hence, angiography-derived cFFR could enhance the hemodynamic assessment of coronary lesions.
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http://dx.doi.org/10.1002/ccd.29558DOI Listing
February 2021

Neutrophil counts and the risk of first stroke in general hypertensive adults.

Hypertens Res 2021 07 9;44(7):830-839. Epub 2021 Feb 9.

National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.

We aimed to investigate the association between neutrophil counts and first stroke and examine possible effect modifiers among treated hypertensive adults. This is a post hoc analysis of the China Stroke Primary Prevention Trial (CSPPT). A total of 11,878 hypertensive adults with data on neutrophil counts at baseline were included in the current study. The primary outcome was first stroke. During a median follow-up of 4.5 years, 414 (3.5%) participants experienced a first stroke, including 358 with ischemic stroke, 55 with hemorrhagic stroke and one with uncertain type of stroke. Compared with participants in quartile 1 (<2.9 × 10/L) of neutrophil counts, those in the upper quartiles (quartile 2-4 [≥2.9 × 10/L]) had a significantly higher risk of first stroke (HR, 1.35; 95% CI: 1.02, 1.78) or first ischemic stroke (HR, 1.38; 95% CI: 1.02, 1.86). Moreover, a strong positive association between neutrophil counts and first ischemic stroke was found in participants with total homocysteine (tHcy) levels <15 μmol/L (HR, 1.74; 95% CI: 1.17, 2.58; vs. ≥15 μmol/L; HR, 0.91; 95% CI: 0.57, 1.46, P interaction = 0.042) at baseline or time-averaged mean arterial pressure (MAP) ≥102 mmHg (median) (HR, 1.92; 95% CI: 1.27, 2.89; vs. <102 mmHg; HR, 0.89; 95% CI: 0.57, 1.41, P interaction = 0.015) during the treatment period. However, no such association between neutrophil counts and first hemorrhagic stroke was found. In summary, high baseline neutrophil counts were associated with an increased risk of first ischemic stroke among hypertensive patients, especially in those with low tHcy at baseline or high time-averaged MAP during the treatment period.
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http://dx.doi.org/10.1038/s41440-021-00625-1DOI Listing
July 2021

Survey on uric acid in Chinese subjects with essential hypertension (SUCCESS): a nationwide cross-sectional study.

Ann Transl Med 2021 Jan;9(1):27

Department of Cardiology, Peking University First Hospital, Beijing, Chin.

Background: Hyperuricemia (HUA) is associated with hypertension and increased cardiovascular risk. Current data regarding the prevalence of HUA in Chinese hypertensive patients are lacking. Our study aims to explore the prevalence and determinants of HUA in Chinese hypertensive adults.

Methods: Treatment-naive hypertensive adults or those taking single antihypertensive agent were included in a nationwide cross-sectional study. Basic demographics, antihypertensive medications, serum uric acid (UA), and other parameters were documented.

Results: The overall prevalence rate of HUA was 38.7% among 33,785 valid cases, 35.1% for males (UA >420 µmol/L), and 45.2% for females (UA >360 µmol/L). A multiple logistic regression analysis, adjusted for demographic and clinical factors (model 1), revealed that female sex [odds ratio (OR), 95% CI, 1.43, 1.36-1.51], age of ≥65 years (1.12, 1.05-1.19), low evaluated glomerular filtration rate [eGFR; 2.06, 1.91-2.23, the lowest [Q1] the highest quartile (Q4)], unmarried (1.58, 1.10-2.27), Western China residency (3.21, 3.33-3.91), longer hypertension duration (1.97, 1.78-2.12, Q4 Q1) and aspirin use (1.21, 1.14-1.29) were associated with HUA. In a multiple logistic regression analysis adjusted for clinical and metabolic parameters (model 2), female sex (OR, 95% CI, 1.34, 1.27-1.41), age of ≥65 years (1.09, 1.03-1.16), low eGFR (2.35, 2.19-2.52, Q1 Q4), new-onset hypertension (2.01, 1.73-2.33), higher quartile of fasting blood glucose (FBG), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) levels, and body mass index (BMI) were associated with higher risk of HUA (1.89, 1.76-2.03; 2.15, 1.99-2.31; 2.86, 2.67-3.06; 1.27, 1.27-1.36, respectively, Q4 Q1). Losartan, valsartan, and nifedipine were associated with lower risk of HUA (OR, 95% CI, 0.77, 0.67-0.88, 0.68, 0.60-0.77; 0.87, 0.77-0.99, 0.79, 0.70-0.89 and 0.80, 0.70-0.91, 0.82, 0.72-0.92), respectively, in models 1 and 2.

Conclusions: The prevalence rate of HUA in Chinese hypertensive patients was 38.7%. Female sex, aging (≥65 years), and low eGFR were independent predictors of HUA. HUA was lower among the patients who were taking losartan, valsartan, and nifedipine. Western region residents, new-onset hypertension, longer hypertension duration, aspirin use, higher FBG, TG, LDL-C levels and BMI were potential risk factors for HUA.
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http://dx.doi.org/10.21037/atm-20-3458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859747PMC
January 2021
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