Outcomes of catheter-directed thrombolysis versus systemic thrombolysis in the treatment of pulmonary embolism: a meta-analysis / 老年心脏病学杂志（英文版）

OBJECTIVE@#To evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) versus systemic thrombolysis (ST) in the treatment of pulmonary embolism (PE).@*METHODS@#The Cochrane Library, PubMed, and Embase databases were searched to collect the literature on the comparison of the results of CDT and ST in the treatment of PE from the beginning of their records to May 2020, and meta-analysis was performed by STATA software (version 15.1). Using standardized data-collection forms, the authors screened the studies and independently extracted data, and assessed the quality of the studies using the Newcastle-Ottawa Scale for cohort studies. Cohort studies that examined the following results were included in the current study: in-hospital mortality, all-cause bleeding rate, gastrointestinal bleeding rate, intracranial hemorrhage rate, the incidence of shock, and hospital length of stay.@*RESULTS@#A total of eight articles, with 13,242 participants, involving 3962 participants in the CDT group and 9280 participants in the ST group were included. CDT compared with ST in the treatment of PE can significantly affect in-hospital mortality rate [odds ratio (OR) = 0.41, 95% CI: 0.30-0.56, P < 0.05], all-cause bleeding rate (OR = 1.20, 95% CI: 1.04-1.39, P = 0.012), gastrointestinal bleeding rate (OR = 1.43, 95% CI: 1.13-1.81, P = 0.003), the incidence of shock (OR = 0.46, 95% CI: 0.37-0.57, P < 0.05), and hospital length of stay [standard mean difference (SMD) = 0.16, 95% CI: 0.07-0.25, P < 0.05]. However, there was no significant effect on intracranial hemorrhage rate in patients with PE (OR = 0.70, 95% CI: 0.47-1.03, P = 0.070).@*CONCLUSIONS@#CDT is a viable alternative to ST in the treatment of PE, as it can significantly reduce in-hospital mortality rate, all-cause bleeding rate, gastrointestinal bleeding rate, and incidence of shock. However, CDT may prolong hospital length of stay to a certain extent. Further research is needed to evaluate the safety and efficacy of CDT and ST in the treatment of acute PE and other clinical outcomes.

Clinical characteristics and prognosis of young (<35 years) patients with acute ST-segment elevation myocardial infarction / 中华心血管病杂志

Objective: To analyze the risk factors and clinical characteristics as well as long-term prognosis of young patients (aged 18-35 years) with acute ST-segment elevation myocardial infarction (STEMI). Methods: In this retrospective study, from January 2007 to December 2017, STEMI patients who were hospitalized in Beijing Anzhen Hospital, Capital Medical University and younger than 45 years old were collected. Patients were divided to the 18-35 years old group and 36-44 years old group. The basic information of patients, clinical laboratory results, surgical information and discharge diagnosis of enrolled patients were extracted from the electronic medical record system. Subgroup analysis on STEMI patients aged 18 to 35 years was performed to compare the clinical features and outcome of patients with normal coronary angiography or stenotic coronary angiography. Results: 496 patients (20.3%) were between 18 and 35 years old, 480 cases (96.8%) were men, and 371 cases (74.8%) were smokers. The proportion of hypertension and diabetes was lower, but percent of obese (122 cases (43.3%)), level of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), uric acid and homocysteine ​​(Hcy) were significantly higher in patients aged 18 to 35 years compared with STEMI patients aged 36 to 44 years (all P<0.05). In the 18-35 years old group, there were 53 patients (10.7%) with normal coronary angiography and 443 patients (89.3%) with stenosis. The age, proportion of hypertension and diabetes, TC, LDL-C, and triglyceride (TG) levels were lower in the normal coronary angiography group than those in the coronary artery stenosis group (all P<0.05). The main coronary artery lesions were single vessel lesions (263 cases (59.4%)), and the main culprit vessels were left anterior descending artery lesions (238 cases (53.7%)). The follow-up time was 7.0 (4.0, 10.0) years, cardiovascular events were reported in 62 patients (18.9%), of which 14 patients (3.2%) died. The survival rate of patients without cardiovascular events in normal coronary angiography group was higher than that in stenosis group (P=0.029). Multivariate Cox regression analysis showed that diabetes (HR=2.713, 95%CI 1.479-4.976, P=0.001) and dyslipidemia (HR=2.819, 95%CI 1.564-5.079, P=0.001) were independent risk factors for recurrence of cardiovascular events in adult STEMI patients aged 18 to 35 years. Conclusions: STEMI patients aged 18 to 35 years were featured by male sex, obese and smokers. The proportion of hypertension and diabetes was low, while the levels of LDL-C, uric acid and Hcy were high in these patients. Coronary artery stenosis was common, and the stenosis was more likely to occur in the left anterior descending branch. Patients with normal coronary angiography had a better prognosis than those with stenosis. Diabetes and hyperlipidemia increased the risk of recurrent cardiovascular events.

Difference on prevalence and trends of conventional risk factors for ASCVD between young Chinese and American adults with first acute myocardial infarction / 中华心血管病杂志

Objective: This study aimed to compare the prevalence and trends of conventional risk factors for atherosclerotic cardiovascular disease(ASCVD) between young Chinese and American adults with first acute myocardial infarction. Methods: This was a retrospective cohort analysis. Hospitalized yang adults (aged from 18 to 44 years old) with first acute myocardial infarction(AMI) from January 2007 through December 2017 were identified from Beijing Anzhen hospital medical record system. Prevalence and trends of hypertension, diabetes mellitus, obesity, smoking, and dyslipidemia were analyzed and compared with young American adults, whose data were reported by Yandrapalli et al, and the hospitalizations for a first AMI in young adults aged 18 to 44 years were identified from national inpatient sample from January 2005 through September 2015. Results: Chinese cohort included 2 866 young adults with a first AMI (male, n=2 739, female, n=127), the mean age was (39±5) years. Presentation of AMI was more frequently ST-segment elevation myocardial infarction (77.3%, 2 214/2 866). American cohort included 280 875 subjects (male, n=203 700, female, n=77 175), the mean age was 39±5 years. Presentation of AMI was more frequently non-ST-segment elevation myocardial infarction (53.6%, 150 549/280 875). In China, dyslipidemia 2 254 (78.6%), smoking 2 084(72.7%), and hypertension 1 170 (40.8%) were most prevalent, and 96.0% (2 752/2 866) of patients had at least 1 risk factor; in the United States, smoking 159 537(56.8%), dyslipidemia 145 212 (51.7%), and hypertension 139 876 (49.8%) were most prevalent, and 90.3% (253 630/280 875) of patients had at least 1 risk factor. Women had a prevalence of diabetes was higher in women, and prevalence of dyslipidemia and smoking was higher in men in China (all P<0.05);prevalence of obesity, diabetes and hypertension was higher in Women, and prevalence of dyslipidemia and smoking was higher in man in the United States (all P<0.001). Prevalence of dyslipidemia and smoking was higher Chinese men (79.3% vs. 54.6%, 75.5% vs. 58.1%,all P<0.001), and prevalence of obesity, diabetes and hypertension was lower (13.1% vs. 18.6%, 14.9% vs. 19.9%, 40.6% vs. 49.3%, all P<0.001)in Chinses cohort than those in the United States cohort. Prevalence of smoking and obesity was lower (12.6% vs. 53.4%, 10.2% vs. 26.9%, all P<0.001) and prevalence of dyslipidemia was higher (63.8% vs. 44.1% P<0.001) in Chinese women than those in the United States women. Patients presenting with non-ST-segment elevation myocardial infarction had a higher prevalence of obesity, diabetes and hypertension than patients presenting with ST-segment elevation myocardial infarction in China (20.1% vs.10.9%, 17.6% vs. 14.5%, 47.4% vs. 38.9%, all P<0.05). The prevalence of the three risk factors also was higher in patients presenting with non-ST-segment elevation myocardial infarction in the US (24.0% vs.17.0%, 25.0% vs. 20.0%, 54.6% vs. 44.2%, all P<0.001), prevalence of smoking and dyslipidemia was lower in these patients (53.5% vs. 60.5%,51.4% vs. 52.1%, all P<0.001). The prevalence of hypertension and obesity increased and the rate of smoking reduced in China from 2007 through 2017 (all trend P<0.001). The prevalence of all these five conventional risk factors increased temporally in the United States from 2005 to 2015 (all trend P<0.001). The prevalence of hypertension increased by 15.6% in China and 14.5% in the United States, respectively, accounting the largest increase. Conclusions: Smoking, dyslipidemia, and hypertension are most prevalent in China and United State. Significant sex and AMI subtype difference are observed for individual risk factors. The prevalence of hypertension and obesity increased significantly over time in China and all these five conventional risk factors increased significantly in the United States.

Risk factor distribution features and trends of young adults with first acute coronary syndrome / 中华心血管病杂志

Objective: To observe the characteristics and trends during the last 11 years of risk factors of young adults with first acute coronary syndrome (ACS). Methods: It was a cross-sectional study. We included young adults (18 to 44 years old) hospitalized for acute coronary syndrome in Beijing Anzhen Hospital for a first time from January 2007 to December 2017. Acute coronary syndromes include ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). The general information, medical history and laboratory test were recorded. Risk factors of ACS were smoking, dyslipidemia, overweight/obesity, hypertension and diabetes. Results: Data from 7 106 patients were analyzed, mean age was (39.8±4.2) years old and 6 593(92.8%)were men, including 2 254 (31.7%) STEMI, 704 (9.9%) NSTEMI and 4 148 (58.4%) UA. Most patients were male (6 593(92.8%)). Dyslipidemia (85.8%(6 094/7 106)), overweight/obesity (82.3%(5 850/7 106)), and smoking (63.9%(4 545/7 106)) were most prevalent. 98.3% (6 885/7 106) patients had at least 1 risk factor. The prevalence of hypertension, diabetes and overweight/obesity increased from 2007 to 2017. Rates of hypertension increased from 37.1%(111/299) to 48.1%(498/1 035) (Ptrend<0.01), diabetes from 12.0%(36/299) to 19.4%(201/1 035) (Ptrend<0.01), overweight/obesity from 74.2%(222/299) to 83.9%(868/1 035) (Ptrend<0.05), respectively. Conclusions: Dyslipidemia, overweight/obesity and smoking are most prevalent risk factors in young adults with a first ACS and most patients have at least 1 risk factor for ACS. Rates of hypertension, diabetes and overweight/obesity progressively increases over time in this patient cohort.

Relations between smoking,alcohol intake,physical activity,sleeping hours and the metabolic syndrome in Chinese male aged 18-45 years old / 中华流行病学杂志

Objective To analyze the relationship between prevalence of metabolic syndrome (MS) and behavior habits such as smoking,alcohol intake,physical activity,sleeping hours.Methods A multi-stage stratified cluster sampling was conducted in 31 provinces,autonomous regions,and municipalities in China according to the program of National Nutrition and Health Survey.Questionnaire survey,interview,physical examination,measurement of biochemical indices,and dietary investigation were done.In total,4937 men aged 18 to 45 years old were selected.Results The MS prevalence was 6.9%(329/4937).The rate of drinking was 49.4% and smoking rate was 54.4%.The percentage of sleeping was hours from 7 to 8 was 70.5%.The percentage of spending time on physical activity over 420 minutes/week was as high as 41.9%.Data from single logistic regression showed volume of smoking more than 600 packs and alcohol intake were associated with high risk of MS and no significantly associations were found between MS and the duration of physical activity and the sleeping time.Multivariate logistic regression showed that the risk of MS in smokers with the volume more than 600 packs age increased significantly as compared to nonsmokers with the odds ratio as 1.443 (95%CI:1.044-1.993 ) and 1.765 (95%CI:1.150-2.708) in smokers with volume from 600 to 899 packs age,and more than 900 packs age respectively.Compared to the nondrinkers,the odds ratios were 1.525 (95%CI:1.135-2.048),2.322(95%CI:1.671-3.255) and 2.033 (95%CI:1.478-2.796) in subjects volume of alcohol dranking as 1 to 2 times per week,3 to 4 times per week and more than 5 times per week respectively.Conclusion Tobacco and alcohol were associated with high risks of MS.

Relationship between duration of low to moderate intensity physical activity and the prevalence of metabolic syndrome / 中华预防医学杂志

<p><b>OBJECTIVE</b>To analyze the relationship between low to moderate physical activity and the prevalence of metabolic syndrome (MS).</p><p><b>METHODS</b>A multi-stage stratified cluster sampling was conducted in 31 provinces, autonomous regions, and municipalities in the interior of China according to the program of the National Nutrition and Health Survey in 2002. Questionnaire survey, interview, physical examination, measurement of biochemical indices and dietary investigation were done. In total, the physical activity of 26 477 persons aged 18 or above were investigated. The duration of low to moderate physical activity was divided into five grades: 0-min/week, 90-min/week, 151-min/week, 301-min/week, over 420 min/week, and the MS prevalence were investigated respectively. The relationship between MS and age (including four age groups 18-, 35-, 45-, 60 or above) or the duration of physical time were investigated.</p><p><b>RESULTS</b>The MS prevalence among persons aged 18 or above was 9.4% (2490/26 477). And the prevalence was 10.3% (1191/11 516) in man and 8.7%(1299/14 961) in women, respectively (χ(2) = 21.035, P = 0.000). The MS prevalence was 2.1% (127/6070) in 18-years old group and 15.0% (1012/6734) in over 60 years old group. The MS prevalence increased with increasing age (χ(2) = 776.768, P = 0.000). 81.2% (21 499/26 477) of subjects engaged in low to moderate intensity physical activity. The percentage of spending time on physical activity over 420 min/week was dominant and as high as 43.7% (11 561/26 477). The MS prevalence was 13.8% (166/1203) for 0-min grade, 13.2% (64/485) for 90-min grade, 11.8% (153/1298) for 151-min grade, 10.1% (124/1225) for 301-min grade and 12.5% (512/4090) for over 420 min grade (χ(2) = 9.58, P = 0.047). Logistic regression analysis results showed, the MS risk of subjects spending 301-min per week on low to moderate intensity physical activity was significantly low than the MS prevalence among subjects of 90-min grade, OR = 0.844 (95%CI: 0.675 - 0.968), and no statistical difference was found in people spending over 420 min per week OR = 0.936(95%CI: 0.769 - 1.136).</p><p><b>CONCLUSION</b>Most of people aged 18 or above engaged in low to moderate intensity physical activity. MS prevalence may be decreased by low to moderate intensity physical activity for 301-min per week, but the decrease was not significant while the duration of time was longer than 420 min per week.</p>

Analysis on the level of exposure and the cluster of risk factors to stroke for patients with non valvular atrial fibrillation / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the level of exposure and cluster of risk factors to stroke for patients with non valvular atrial fibrillation.</p><p><b>METHODS</b>A questionnaire survey was conducted among 583 patients with non valvular atrial fibrillation, randomly selected from 8 general hospitals and 7 community health service centers located in the 8 districts in Beijing city in 2006.</p><p><b>RESULTS</b>133 patients attacked stroke and the prevalence of stroke in the total 583 patients was 22.8%. 78 patients attacked stroke after being diagnosed as atrial fibrillation with the prevalence related to atrial fibrillation as 14.3%. The levels of exposure related to age, duration of atrial fibrillation, histories of hypertension, diabetes and dyslipidemia were significantly different between stroke and non-stroke patients (P < 0.05). Data from multiple variables logistic regression analysis showed that age, duration of atrial fibrillation, history of dyslipidemia and history of diabetes increased the risk of stroke with odds ratio as 1.06, 2.08, 1.82, 1.79 respectively (95%CI was not including 1). The risk of stroke among those having 3 or 4 risk factors was 4.36 and 4.51 times of those without risk factor after adjusting for age, sex and duration of atrial fibrillation.</p><p><b>CONCLUSION</b>Age, duration of atrial fibrillation, history of dyslipidemia and history of diabetes were the main risk factors related to stroke and the clustering of risk factors would further increase the risk. It is important to control blood pressure, blood surge and lipid besides therapy of anticoagulation or antiplatelet for patients with nonvalvular atrial fibrillation.</p>

Analysis on hypertension control and follow up among elderly patients with hypertension in communities / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study hypertension control, follow up and the factors associated with the rate of hypertension control.</p><p><b>METHODS</b>Through a community-based study, the routine data were collected through a community hypertension managing software for one year.</p><p><b>RESULTS</b>There were 3375 hypertension patients above 60 years old recruited in the information system. In the baseline, the rate of blood pressure control was 63.5%, and arranging intervals up to 6 months was 66.9%. Hypertension control rate for the baseline, the third month and the sixth month was 61.8%, 62.4% and 61.6%, respectively (chi2 = 0.16, P = 0.69). Among hypertensives whose blood pressure was stabilized in baseline, hypertension control rates for the third month and the sixth month was 72.9.8% and 72.1%, respectively (chi2 = 0.26, P = 0.61). Blood pressure stabilized over 6 months in comparing with others, and the proportion for regular taking medication was 96.2% and 97.7% (chi2 = 3.58, P = 0.06). The proportion for physical activity, less salt intake, weight control was significantly higher in the patients whose blood pressure control well over 6 month.</p><p><b>CONCLUSION</b>Rate of blood pressure control among elderly patient with hypertension who frequently consults the doctor in the community is high. Ineffectiveness in systolic and diabetes control is the important factor, which decreases the rate of blood pressure. Physical activity, less salt intake, and weight control are of help to hypertension control. For those, the blood pressure are stabilized, a follow up with 3 to 6 months interval is appropriate.</p>

Analysis of outpatient hypertension treatment among different grade hospitals in Beijing / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the therapy of hypertensive outpatients among different grade hospitals in Beijing.</p><p><b>METHODS</b>Thirty-nine hospitals including 4 third grade hospitals, 4 second grade hospitals and 31 first grade hospitals in Beijing were selected randomly (by stratified randomization). The grade was accredited according to the hospital accreditation standard issued by Ministry of Health of the People's Republic of China.</p><p><b>RESULTS</b>The average hypertension control rate (< 140/90 mm Hg, 1 mm Hg = 0.133 kPa) in outpatients was 32.3%. The hypertension control rate in the third grade, second grade, first grade hospitals were 37.7%, 36.9%, and 31.2% respectively. There was no difference in the control rate among the three different grade hospitals (P > 0.05). The frequency to use anti-hypertension drugs including long-acting calcium antagonism, ACEI, beta-receptor blocker in the third grade hospitals was significantly higher than those of the first and second grade hospitals. The rate of examination using ultrasonic cardiogram, CT, Holter and ambulatory blood pressure monitoring were significantly higher in the third grade hospitals than that of the first and second grade hospitals. There were significant differences in annual cost of hypertension treatment among three different grade hospitals (P < 0.01), being the highest (1567.5 yuan) in the third grade hospitals, medium (845.4 yuan) in the second grade hospitals, the lowest (651.8 yuan) in the first grade hospitals.</p><p><b>CONCLUSIONS</b>Significant difference in the cost of hypertensive treatment among three different grade hospitals exists in Beijing. However, there was no difference in the control rate among them. The overall hypertension control rate is 32.3%, leaving 67.7% uncontrolled. Efforts to increase the hypertension control rate should be made in all hospitals. How to guide and arrange the hypertension patients to consult a suitable hospital is important for rational and economical use of health cost.</p>

Relationship between the patients' knowledge on hypertension prevention and control and the rate on blood pressure control / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the relationship between blood pressure control status and patients' knowledge on hypertension prevention and control among hypertensive patients.</p><p><b>METHODS</b>A total of 726 hypertensives were selected from four community health service centers (2 urban and 2 rural) in Beijing. All subjects were investigated by questionnaires and their blood pressures were measured at the same time.</p><p><b>RESULTS</b>The rate for blood pressure under control (< 140/90 mm Hg, 1 mm Hg = 0.133 kPa) in the rural and urban patients were 46.4% and 23.9% respectively. The control rate increased with the increase of patients' knowledge on prevention and control of hypertension in both urban and rural patients. The cumulative effect of knowledge on hypertension control status could contribute 30.0% to the difference in hypertension control rate between rural and urban patients.</p><p><b>CONCLUSION</b>Patients' knowledge on hypertension control was significantly related to the rate on hypertension control. Health education should be helpful to improve the rate on hypertension control.</p>