党爱民
中国医学科学院阜外医院
Obesity, birth weight and lifestyle factors have been found associated with the risk of frailty in observational studies, but whether these associations are causal is uncertain. We conducted a two-sample Mendelian randomization study to investigate the associations. Genetic instruments associated with the exposures at the genome-wide significance level (p < 5 × 10-8) were selected from corresponding genome-wide association studies (n = 143,677 to 703,901 individuals). Summary-level data for the frailty index were obtained from the UK Biobank (n = 164,610) and Swedish TwinGene (n = 10,616). The β of the frailty index was 0.15 (p = 3.88 × 10-9) for 1 standard deviation increase in the prevalence of smoking initiation, 0.19 (p = 3.54 × 10-15) for leisure screen time, 0.13 (p = 5.26 × 10-7) for body mass index and 0.13 (p = 1.80 × 10-4) for waist circumference. There was a suggestive association between genetically predicted higher birth weight and moderate-to-vigorous intensity physical activity with the decreased risk of the frailty index. We observed no causal association between genetically predicted age of smoking initiation and alcoholic drinks per week with the frailty index. This study supports the causal roles of smoking initiation, leisure screen time, overall obesity, and abdominal obesity in frailty. The possible association between higher birth weight, proper physical activity and a decreased risk of frailty needs further confirmation.
Aging 2023
Background:The aim of this study is to investigate the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in assessing the poor outcomes of adult patients with acute myocarditis.Methods:A total of 170 adult patients with available NT-proBNP information were included in the study. They were grouped according to quartiles of NT-proBNP concentrations at admission. Baseline and follow-up information was collected. Thirty-day major adverse cardiac events (MACE) were death and heart transplantation. Long-term MACE included all-cause death, heart transplantation, re-hospitalization due to heart failure, sustained ventricular arrhythmia, and myocarditis relapse.Results:During a median follow-up of 3.8 years, patients in the highest NT-proBNP quartile suffered from the highest risk both of 30-day and long-term MACE (P < 0.001 by log-rank test). Multivariate analysis showed that apart from left ventricular ejection fraction (LVEF), an increased baseline NT-proBNP > 3,549 pg/mL (hazard ratio 3.535, 95% CI 1.316-9.499, P = 0.012) and NT-proBNP > 7,204 pg/mL (hazard ratio 22.261, 95% CI 1.976-250.723, P = 0.012) was independent predictor of long-term and 30-day MACE, respectively.Conclusions:Higher baseline NT-proBNP level was an independent predictor of poor outcomes in adult patients with acute myocarditis. Therefore, NT-proBNP may serve as a useful biomarker for risk stratification in acute myocarditis patients.
Frontiers in cardiovascular medicine 2022
PURPOSE:Antihypertensive treatment is the most important method to reduce the risk of cardiovascular events in hypertensive patients. However, there is scant evidence of the benefits of levoamlodipine maleate for antihypertensive treatment using a head-to-head comparison in the real-world. This study aims to examine the effectiveness of levoamlodipine maleate used to treat outpatients with primary hypertension compared with amlodipine besylate in a real-world setting.METHODS:This was a pragmatic comparative effectiveness study carried out at 110 centers across China in outpatients with primary hypertension treated with levoamlodipine maleate or amlodipine besylate, with 24 months of follow-up. The primary outcomes used for evaluating the effectiveness were composite major cardiovascular and cerebrovascular events (MACCE), adverse reactions, and cost-effectiveness.RESULTS:Among the included 10,031 patients, there were 482 MACCE, 223 (4.4%) in the levoamlodipine maleate group (n = 5018) and 259 (5.2%) in the amlodipine besylate group (n = 5013) (adjusted hazard ratio = 0.90, 95%CI: 0.75-1.08, P = 0.252). The levoamlodipine maleate group had lower overall incidences of any adverse reactions (6.0% vs. 8.4%, P < 0.001), lower extremity edema (1.1% vs. 3.0%, P < 0.001) and headache (0.7% vs. 1.1%, P = 0.045). There was a nearly 100% chance of the levoamlodipine maleate being cost-effective at a willingness to pay threshold of 150,000 Yuan per quality-adjusted life years (QALYs) gained, resulting in more QALYs (incremental QALYs: 0.00392) and cost savings (saving 2725 Yuan or 28.8% reduction in overall costs) per patient.CONCLUSION:In conclusion, levoamlodipine maleate could reduce cost by 29% with a similar MACCE incidence rate and lower occurrence of adverse reactions (especially edema and headache) compared with amlodipine besylate.TRIAL REGISTRATION:Clinicaltrials.gov NCT01844570 registered at May 1, 2013.
Cardiovascular drugs and therapy 2021
BACKGROUND:Lipoprotein(a) has been suggested as an independent risk factor for cardiovascular events in patients with coronary heart disease (CHD).OBJECTIVE:This study aimed to investigate the association of lipoprotein(a) with long-term poor prognosis following acute coronary syndromes (ACS) in advanced-age patients.METHODS:We enrolled 536 patients aged ≥80 years hospitalized for ACS and plasma lipoprotein(a) concentrations were measured at admission. The primary outcomes were hard CHD events (a composite of fatal or non-fatal myocardial infarction, and CHD death). The secondary outcomes included major adverse cardiovascular events (MACEs), all-cause death and cardiac death.RESULTS:During a median 66-month follow-up, 89 hard CHD events occurred. The optimal cutoff points of lipoprotein(a) levels were obtained from ROC curve analyses. Kaplan-Meier curves showed a significantly higher cumulative incidence of hard CHD events, MACEs, all-cause death and cardiac death in high lipoprotein(a) group than that in low lipoprotein(a) group. Multivariate Cox proportional hazards analyses revealed that elevated lipoprotein(a) levels were independently associated with an increased risk of hard CHD events [hazard ratio (HR): 1.714, 95% confidence interval (95%CI): 1.114-2.638], MACEs (HR 1.354, 95%CI: 1.024-1.790), all-cause death (HR 1.804, 95%CI: 1.286-2.532) and cardiac death (HR 1.891, 95%CI: 1.112-3.217). Furthermore, adding lipoprotein(a) to the prognostic model for hard CHD events improved the C-statistic value (P < 0.05).CONCLUSION:Elevated lipoprotein(a) levels were associated with an increased risk of hard CHD events, MACEs, all-cause death and cardiac death in the advanced-age patients with ACS, which indicated that routine screening for lipoprotein(a) might aid prognosis and risk assessment.
Journal of clinical lipidology 2021
Arterial stiffness has been suggested as an independent cardiovascular risk factor. This systematic review and meta-analysis aimed to quantify the association between brachial-ankle pulse wave velocity (baPWV) and prognosis in atherosclerotic cardiovascular disease (ASCVD) patients. The PubMed, EMBASE, and Cochrane Library databases were searched for cohort studies examining the association of high baPWV with prognosis in ASCVD patients. High baPWV was defined by the cutoffs provided by each study. The outcomes of interest were cardiovascular events, cardiovascular mortality, and all-cause mortality. Hazard ratios (HRs) and 95% confidence intervals (CIs) were combined using the random-effects model with inverse variance weighting. We identified 15 studies that were eligible for inclusion in the meta-analysis. The overall HRs and 95% CIs of cardiovascular events, cardiovascular mortality, and all-cause mortality for high baPWV were 2.55 (1.61-4.03), 2.66 (1.88-3.76), and 1.77 (1.09-2.87), respectively. The association between baPWV and cardiovascular events remained significant, irrespective of determination methods for cutoffs of baPWV, classification of ASCVD, outcome definitions, Newcastle-Ottawa Scale score and average age, independent of age and hypertension. Significantly higher HRs were observed in the subgroups of >3 years follow-up duration (p for interaction: 0.04), cutoff points by ROC curves (p for interaction: 0.04) and an average age of <65 years (p for interaction: 0.01). A 1 standard deviation increase in baPWV was associated with a 1.41-fold (1.24-1.60) increase in the risk of cardiovascular events. High baPWV is independently associated with an increased risk of cardiovascular events, cardiovascular mortality, and all-cause mortality in ASCVD patients.
Hypertension research : official journal of the Japanese Society of Hypertension 2021
OBJECTIVE:This study was performed to explore the clinical manifestations and longterm prognosis in patients with Takayasu arteritis (TA) with pulmonary artery involvement (PAI).METHODS:The medical records of 194 patients with TA who underwent traditional catheter angiography or computed tomography of pulmonary artery from 2009 to 2016 were retrospectively reviewed. The clinical manifestations, angiographic features, and mortality of 128 patients with TA with PAI were further analyzed.RESULTS:Patients with TA with PAI had a higher risk of pulmonary hypertension (PH) than patients with TA alone (61.7% vs 7.6%, p < 0.001). Patients with PAI and PH more frequently developed dyspnea, hemoptysis, and lower limbs edema (all p < 0.05) than those without PH. Patients with PH also had a higher incidence of bilateral PAI (84.8% vs 34.7%, p < 0.001) and a higher pulmonary artery obstruction index [23 (interquartile range 20-27) vs 10 (6-15), p < 0.001]. Left heart disease was presented in 39 (30.5%) patients with TA with PAI. During the median followup of 38 (21-58) months, 19 and 2 deaths occurred among patients with and without PH, respectively. Among patients with PAI, the mortality rate was 7 times higher in patients with than without PH (p = 0.009). Independent predictors of mortality were the disease duration (p = 0.047), New York Heart Association class III/IV (p = 0.019), right ventricular systolic dysfunction (p = 0.019), and respiratory failure (p = 0.007).CONCLUSION:Patients with TA with PAI have a higher risk of developing PH than patients with TA alone. The presence of PH in patients with PAI increases the risk of early mortality.
The Journal of rheumatology 2020
AIM:Takayasu arteritis (TAK) is a rare inflammatory large-vessel vasculitis with increased cardiovascular morbidity and mortality. Brachial-ankle pulse wave velocity (ba-PWV) is a widely used measure of arterial stiffness and serves as an indicator of either cardiovascular risk or severity of vascular damage. However, the studies about the relationship between TAK and ba-PWV are limited. This study aimed to investigate the use of ba-PWV in the patients with TAK.METHODS:Sixty-seven patients with TAK and 67 age and sex matched healthy controls were recruited. Patients with TAK were grouped according to disease activity. The routine hematological parameters and ba-PWV were summarized.RESULTS:Ba-PWV was significantly higher in the patients with TAK than in the healthy controls (P＜0.001). Ba-PWV was significantly higher in the patients with active TAK than in the patients with inactive TAK (P= 0.04). Multiple liner regression analysis indicated that TAK (β=363.97, P=0.013), and mean arterial pressure (MAP) (β=8.52, P=0.012) were independently related to ba-PWV. Ba-PWV did not correlate with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in overall patients with TAK (both P＞0.05). In patients with TAK without immunosuppressive therapy, ba-PWV significantly correlated with CRP (r=0.419, P=0.008) but not ESR (P＞0.05). Multiple logistic regression analysis indicated that ba-PWV was an independent predictor of active TAK in overall patients with TAK (OR=1.003, 95% CI=1.000-1.007; P=0.040) and patients with TAK without immunosuppressive therapy (OR=1.006, 95% CI=1.001-1.012; P=0.031).CONCLUSIONS:Being significantly increased in patients with TAK, ba-PWV is significantly associated with TAK disease activity, and it probably correlates with systematic inflammation.
Journal of atherosclerosis and thrombosis 2020
INTRODUCTION/OBJECTIVES:Fibroblast growth factor (FGF23) is an endocrine hormone that can be induced by inflammation and plays a role in the pathogenesis of cardiac abnormalities. Few studies have reported plasma FGF23 levels in patients with Takayasu arteritis (TAK). We hypothesized that the production of FGF23 in TAK is associated with abnormal cardiac mass.METHOD:Forty-seven patients diagnosed with TAK and 52 age- and gender-matched healthy controls were included in this observational study. Plasma FGF23 was detected by human enzyme-linked immunosorbent assay. Multivariable linear regression analyses were performed to examine the association between FGF23 and left ventricular mass index (LVMI).RESULTS:Patients with TAK had higher plasma FGF23 than healthy controls [121.8 (84.5-168.8) vs. 86.7 (70.5-101.1) RU/ml, P < 0.001]. Patients with higher FGF23 concentrations were more likely to be females (100.0% vs. 75.0%, P = 0.01), angiographic type V (69.6% vs. 33.3%, P = 0.013), heart failure (43.5% vs. 12.5%, P = 0.018), and have higher LVMI [126.3 (81.1-177.7) vs. 85.9 (69.7-114.3) g/m2, P = 0.041]. Plasma FGF23 was significantly associated with LVMI in TAK patients [β = 0.402, 95% confidence interval (CI) 0.032-0.301, P = 0.016], after adjusting for age, gender, disease duration, angiographic type (angiographic type V vs. non-angiographic type V), the presence of cardiovascular events and hypertension, and serum N-terminal pro-B-type natriuretic peptide in the multivariate linear regression. Age (β = - 0.399, P = 0.016) and the presence of angiographic type V (β = 0.376, P = 0.018) were identified to be significant determinants of plasma FGF23 in patients with TAK.CONCLUSIONS:Plasma FGF23 was elevated in patients with TAK and was associated with LVMI. FGF23 may participate in the development of abnormal cardiac mass in patients with TAK.Key Points• Plasma FGF23 was elevated in patients with TAK.• FGF23 was significantly associated with LVMI in TAK.• Age and the presence of angiographic type V were determinants of plasma FGF23 in patients with TAK.
Clinical rheumatology 2020
AIM:This study was designed to analyze microparticles (MPs) from endothelial cells (EMPs) and immune cells from healthy individuals and paitents with Takayasu arteritis (TA), and any possible relationships between MPs and TA acitivity.METHODS:MPs derived from the plasma of 51 subjects were analyzed, including 32 patients with TA and 19 healthy individuals. Flow cytometry was performed with Annexin (Anx)-V and antibodies against surface markers of endothelial cells (CD144), T cells (CD3), B cells (CD19), and monocytes (CD14).RESULTS:The concentrations of total EMPs, AnxV＋ EMPs and AnxV- EMPs were significantly increased when comparing patients with TA and healthy controls (54×103 vs. 32×103 MPs /ml, P=0.0004; 22×103 vs. 12×103 MPs /ml, P=0.0006; and 31×103 vs. 19×103 MPs /ml, P=0.0005), and comparing active TA patients with remission ones (85×103 vs. 45×103 MPs /ml, P=0.016; 39×103 vs. 14×103 MPs /ml, P=0.0092; and 47×103 vs.29×103 MPs /ml, P=0.0371). In addition, the concentrations of total EMPs (odds ratio [OR]=1.024, 95% confidence interval [CI]: 1.001 to 1.048, P=0.037), AnxV＋(OR=1.089, 95%CI: 1.011 to 1.172, P=0.024), and AnxV- EMPs (OR=1.029, 95% CI: 1.002 to 1.056, P=0.034) were positively related to TA activity. With multiple linear regression analysis, platelet was associated with both total and AnxV- EMP concentrations independently, while erythrocyte sedimentation rate was independently correlated with AnxV＋EMPs.CONCLUSION:Concentrations of endothelial microparticles are correlated with inflammation in Takayasu arteritis and may be useful markers to assess disease activity.
Journal of atherosclerosis and thrombosis 2019
OBJECTIVES:This study aims to investigate the association between arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) and cardiovascular events (CVEs) in patients with Takayasu's arteritis (TAK).METHODS:A total of 240 TAK patients, who underwent baPWV measurement, were included in the study. The primary outcome was CVEs, which was defined as presently or previously diagnosed with myocardial infarction, unstable angina, congestive heart failure, aortic aneurysm/dissection, cerebral infarction/transient ischaemic attack (TIA), or cerebral haemorrhage.RESULTS:A total of 74 (30.8%) patients with CVEs were included in the present cohort. Compared with the patients without CVEs, those with CVEs had a higher prevalence of hyperlipidaemia (HL), smoking history, active stage, angiographic type V, renal dysfunction (RDF), higher baPWV and high sensitive C-reactive protein (hs-CRP) level (all, p<0.05). The multivariate logistic regression analysis showed that HL (OR: 2.465, 95%CI: 1.308-4.648, p=0.005), smoking history (OR: 4.764, 95%CI: 1.623-13.985, p=0.004), baPWV (OR: 1.132, 95%CI: 1.063-1.204, p<0.001), and hs-CRP (OR: 1.111, 95%CI: 1.040-1.188, p=0.002) were independently associated with the presence of CVEs. The multiple linear regression analysis revealed that age (β=0.100, p=0.002), mean blood pressure (β=0.071, p<0.001), angiographic type V (β=3.681, p<0.001) and RDF (β=1.800, p=0.048) were independently correlated with baPWV.CONCLUSIONS:Increased baPWV was independently associated with CVEs in patients with TAK. Age, angiographic type V, mean blood pressure and RDF were the strongest determinants for baPWV in TAK. BaPWV may be a potential maker to predict CVEs in patients with TAK.
Clinical and experimental rheumatology 2019
