刘岗
中国医学科学院阜外医院 特需医疗中心12病区
Previous studies have identified high on treatment platelet reactivity (HTPR) as a potent factor predicting ischemic events for patients with coronary heart disease. We assessed the efficacy and safety of ticagrelor (90 mg twice-daily) and double-dose of clopidogrel (150 mg once-daily) among Chinese patients for elective percutaneous coronary intervention. We enrolled 40 patients with HTPR from among 317 patients with non-ST-segment elevation acute coronary syndromes after a successful elective percutaneous coronary intervention (PCI). Platelet reactivity was measured by VerifyNow P2Y12 assay. Platelet reactivity was significantly lower for both groups when compared with baseline platelet reactivity after medication adjustment (all P < 0.001). The mean platelet reactivity units (PRU) was significantly lower for the ticagrelor group compared with that of the clopidogrel group over time (all P < 0.001). The differences in the rate of sustained HTPR at different time points between the two groups were significant (2 hours: 0% versus 60%; 8 hours: 5.6% versus 50%; 24 hours: 5.9% versus 43.8%, all P < 0.05). Genetic variation of CYP2C19*2 had no impact on PRU means or rate of HTPR in the ticagrelor group (P > 0.05). During the 30-day follow-up, no MACE occurred in any patient, and the overall risk of bleeding showed no difference between the two groups (35% versus 21%, P = 0.48). Our results suggest that ticagrelor may achieve a more rapid and greater platelet inhibition than double-dose clopidogrel. Further studies are still needed to assess the differences in efficacy and safety between ticagrelor and double-dose clopidogrel administration for Chinese patients post elective PCI.
International heart journal 2017
BACKGROUND:Green tea has been shown to improve cholesterol metabolism in animal studies, but the molecular mechanisms underlying this function have not been fully understood. Long non-coding RNAs (lncRNAs) have recently emerged as a major class of regulatory molecules involved in a broad range of biological processes and complex diseases. Our aim was to identify important lncRNAs that might play an important role in contributing to the benefits of epigallocatechin-3-gallate (EGCG) on cholesterol metabolism.METHODS:Microarrays was used to reveal the lncRNA and mRNA profiles in green tea polyphenol(-)-epigallocatechin gallate in cultured human liver (HepG2) hepatocytes treated with EGCG and bioinformatic analyses of the predicted target genes were performed to identify lncRNA-mRNA targeting relationships. RNA interference was used to investigate the role of lncRNAs in cholesterol metabolism.RESULTS:The expression levels of 15 genes related to cholesterol metabolism and 285 lncRNAs were changed by EGCG treatment. Bioinformatic analysis found five matched lncRNA-mRNA pairs for five differentially expressed lncRNAs and four differentially expressed mRNA. In particular, the lncRNA AT102202 and its potential targets mRNA-3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) were identified. Using a real-time polymerase chain reaction technique, we confirmed that EGCG down-regulated mRNA expression level of the HMGCR and up-regulated expression of AT102202. After AT102202 knockdown in HepG2, we observed that the level of HMGCR expression was significantly increased relative to the scrambled small interfering RNA control (P < 0.05).CONCLUSIONS:Our results indicated that EGCG improved cholesterol metabolism and meanwhile changed the lncRNAs expression profile in HepG2 cells. LncRNAs may play an important role in the cholesterol metabolism.
Chinese medical journal 2015
There is currently limited data on which drug should be used to improve blood pressure (BP) control in patients with resistant hypertension (RH). We performed a systematic review and meta-analysis of published studies evaluating the anti-hypertensive benefit of aldosterone antagonists (AA) as an add-on therapy in patients with RH. A systematic literature search for eligible studies was conducted until June 2014, using literature databases and hand search. Studies were stratified according to controlled vs uncontrolled design and analyzed using random-effect models. We identified 13 eligible studies involving a total of 2640 patients, consisting of 3 randomized controlled trials, and 10 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic BP of -16.5 (95% confidence interval (CI), -30.0 to -3.0) and -4.1 (95% CI, -7.8 to -0.32) mm Hg, respectively, compared with control. In uncontrolled studies, there was a reduction in mean systolic and diastolic BP of -19.7 (95% CI, -23.2 to -16.2) and -9.1 (95% CI, -10.3 to -7.8) mm Hg, respectively, compared with pre-AA therapy. Subgroup analysis showed that the systolic BP change was more pronounced in patients with baseline systolic BP >150 mm Hg (weighted mean difference (WMD), -23.1 mm Hg) than in patients with ⩽150 mm Hg (WMD, -15.4 mm Hg) (between groups P<0.001), suggesting that the baseline systolic BP was a predictor of the BP response to AA treatment. Furthermore, AA demonstrated a mild increase in serum potassium and creatinine (for both, P<0.001). The findings suggest that AA as an add-on therapy was effective for lowering systolic and diastolic BP in patients with RH.
Journal of human hypertension 2015
Primary aldosteronism (PA) has been associated with increased target organ damage (TOD), most likely through mineralocorticoid receptor-dependent endothelial dysfunction, in comparison with essential hypertension (EH). The aim of this study was to evaluate the level of biomarkers of endothelial dysfunction in PA and the relationship with left ventricular hypertrophy (LVH) and microalbuminuria (MAU). A total of 50 PA patients and 51 patients with EH individually matched for age, sex, blood pressure and duration of hypertension participated in this study. Biomarkers of endothelial dysfunction, including von Willebrand factor (vWF), intercellular adhesion molecule 1 (ICAM-1) and oxidized low-density lipoprotein (ox-LDL), were measured. Plasma aldosterone concentration (PAC), MAU and echocardiography were also evaluated. In PA patients, vWF, ICAM-1, ox-LDL, LVH and MAU were all significantly higher than in EH patients (all P<0.05). Furthermore, LVH was positively correlated with PAC (P=0.002), vWF (P=0.013) and ox-LDL (P=0.020). MAU was positively correlated with PAC (P<0.001), vWF (P=0.013) and ICAM-1 (P=0.001). Multiple regression analysis indicated that vWF, ICAM-1 and PAC independently predicted MAU (all P<0.05). Likewise, PAC, vWF and ox-LDL were significant predictors of LVH (all P<0.05). Taken together, our results suggest that endothelial dysfunction may contribute to TOD in PA patients.
Journal of human hypertension 2014
The effect of tea intake on blood pressure (BP) is controversial. We performed a meta-analysis of randomised controlled trials to determine the changes in systolic and diastolic BP due to the intake of black and green tea. A systematic search was conducted in MEDLINE, EMBASE and the Cochrane Controlled Trials Register up to May 2014. The weighted mean difference was calculated for net changes in systolic and diastolic BP using fixed-effects or random-effects models. Previously defined subgroup analyses were performed to explore the influence of study characteristics. A total of twenty-five eligible studies with 1476 subjects were selected. The acute intake of tea had no effects on systolic and diastolic BP. However, after long-term tea intake, the pooled mean systolic and diastolic BP were lower by - 1·8 (95 % CI - 2·4, - 1·1) and - 1·4 (95 % CI - 2·2, - 0·6) mmHg, respectively. When stratified by type of tea, green tea significantly reduced systolic BP by 2·1 (95 % CI - 2·9, - 1·2) mmHg and decreased diastolic BP by 1·7 (95 % CI - 2·9, - 0·5) mmHg, and black tea showed a reduction in systolic BP of 1·4 (95 % CI - 2·4, - 0·4) mmHg and a decrease in diastolic BP of 1·1 (95 % CI - 1·9, - 0·2) mmHg. The subgroup analyses showed that the BP-lowering effect was apparent in subjects who consumed tea more than 12 weeks (systolic BP - 2·6 (95 % CI - 3·5, - 1·7) mmHg and diastolic BP - 2·2 (95 % CI - 3·0, - 1·3) mmHg, both P< 0·001). The present findings suggest that long-term ( ≥ 12 weeks) ingestion of tea could result in a significant reduction in systolic and diastolic BP.
The British journal of nutrition 2014
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. The goal of the present study was to quantify the association between use of nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of AF incidence. MEDLINE and EMBASE were searched for studies that reported risk of AF associated with nonaspirin NSAID use. Combined relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using the random-effects model. Stratified meta-analyses were used to discern which patients were at the highest risk of AF due to NSAID use. Five studies were identified that met the inclusion criteria, 3 of which additionally reported specifically on the association between selective NSAIDs and risk of AF. Overall, NSAID use was associated with a 12% increased risk for AF incidence (RR 1.12, 95% CI 1.06 to 1.18). The association was found to be apparent among new users (RR 1.53, 95% CI 1.37 to 1.70). The increased risk of AF might be explained by the occurrence of chronic heart failure and kidney disease. In addition, use of selective NSAIDs was still related to an increased risk of AF (RR 1.24, 95% CI 1.18 to 1.30). Sensitivity analyses found results to be robust. In conclusion, use of nonaspirin NSAIDs was associated with an increased risk of incident AF. The association was found to be apparent for new users, with a 53% increase in risk. These findings suggest that AF needs to be added to the cardiovascular risks to be considered when prescribing NSAIDs.
The American journal of cardiology 2014
No therapy has been shown to improve survival rate in heart failure with preserved ejection fraction (HFPEF). Recent observational studies of the association between statin use and the risk of mortality in HFPEF have shown mixed results. The goal of the present study was to systematically review all published observational studies evaluating the effect of statins on the risk of mortality in HFPEF. A literature search in the PubMed and EMBASE databases was undertaken through December of 2013. Combined relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using the random-effects model. Subgroup analyses, sensitivity analysis, and cumulative meta-analysis were also performed. A total of 11 eligible studies with 17,985 patients with HFPEF were included in the analysis. Statin use was associated with a 40% lower risk of mortality (RR 0.60, 95% CI 0.49 to 0.74, p<0.001). Stratification of studies by controlled or uncontrolled confounding factors affected the final estimate (confounder-controlled RR 0.63, 95% CI 0.51 to 0.77, p<0.001 and confounder-uncontrolled RR 0.49, 95% CI 0.24 to 1.01, p=0.053). Furthermore, sensitivity analysis confirmed the stability of the results. Cumulative meta-analysis showed an obvious trend of reduction in mortality rates in statin users from 2005 to 2013. In conclusion, our meta-analysis supports the hypothesis that statin therapy may be associated with improved survival rates in patients with HFPEF. Nevertheless, randomized controlled trials are needed to confirm the efficacy of statins in HFPEF.
The American journal of cardiology 2014
BACKGROUND:The effects of lipophilic statins in heart failure (HF) were controversial. The goal of the present study was to systematically review all randomised controlled trials evaluating the effects of lipophilic statins in patients with HF.METHODS:We performed a comprehensive literature search to identify eligible trials that prospectively randomised patients with HF to lipophilic statins or control. Primary end points were all-cause mortality, cardiovascular mortality, hospitalisation for worsening HF, left ventricular ejection fraction (LVEF), and low-density lipoprotein cholesterol. Risk ratios (RRs) and Weighted mean differences (WMDs) were calculated using fixed-effects models or random-effects models.RESULTS:A total of 13 randomised trials with 1,532 subjects were included in this analysis. Ten trials randomised patients to atorvastatin, two to simvastatin, and one to pitavastatin. Overall, lipophilic statins significantly decreased all-cause mortality (RR 0.53, P<0.001), cardiovascular mortality (RR 0.66, P=0.04), and hospitalisation for worsening HF (RR 0.60, P<0.001). Subgroup analyses showed that the effects of lipophilic statins in HF were not modified by age, baseline LVEF, and cause of HF. In addition, patients randomised to lipophilic statins had a significant increase in LVEF (WMD 3.91%, P<0.001) and decrease in low-density lipoprotein cholesterol (WMD 0.90 mmol/L, P<0.001).CONCLUSIONS:It appears that further studies are needed to determine if lipophilic statins are beneficial for HF patients.
Heart, lung & circulation 2014
