ABSTRACT
Objective:To investigate the influencing factors for major adverse cardiovascular events(MACE)in older patients with preserved ejection fraction(HFpEF)or with mid-range ejection fraction(HFmrEF)heart failure in the vulnerable phase.Methods:Data for 312 patients with preserved or mid-range ejection fraction heart failure hospitalized at the Department of Geriatrics, General Hospital of Tianjin Medical University from January 2017 to October 2019 were retrospectively collected, and 17 patients were lost to follow-up.A total of 295 elderly patients with preserved or mid-range ejection fraction heart failure were included in this study.According to whether major cardiovascular events occurred in the vulnerable phase(90 d after discharge), patients were divided into a MACE group(n=87)and anon-MACE group(n=208). Baseline data between the two groups were compared.Univariate logistic regression analysis wasused to determine risk factors for patients in the vulnerable phase, and COX regression analysis and Kaplan-Meier survival analysis were conducted to evaluate the influence of resting heart rate and hematocrit on MACE in the vulnerable phase.The predictive value of resting heart rate and hematocrit in MACE was analyzed by the ROC curve.Results:The resting heart rate at discharge in the MACE group was(78.6±6.9)bpm, higher than(71.1±8.4)bpm in the non-MACE group( t=7.30, P<0.01), whereas hematocrit was(32.3±3.6)%in the MACE group, lower than(36.6±4.9)% in the non-MACE group( t=-8.22, P<0.01). Resting heart rate and hematocrit were risk factors for MACE in elderly patients with HFpEF or HFmrEF in the vulnerable phase.Multivariate Cox regression analysis showed that HR was 1.11 for resting heart rate(95% CI: 1.07-1.14, P<0.001)and 0.91 for hematocrit(95% CI: 0.83-0.99, P=0.034). The survival times of patients with low and high resting heart rate were(86.5±1.2)d and(57.9±3.2)d, respectively.The survival rate of the high resting heart rate group(87.3%, 89/102)was lower than that of the low resting heart rate group(98.4%, 190/193)( χ2=116.30, P<0.01). The survival times of patients with high and low hematocrit values were(84.6±1.7)d and(67.0±2.4)d, respectively.The survival rate of the low hematocrit group(91.9%, 148/161)was lower than that of the high hematocrit group(97.8%, 131/134)( χ2=40.32, P<0.01). ROC curve analysis revealed that the cut-off values for resting heart rate and hematocrit were 73.5 bpm and 35.4%, respectively.The area under the ROC curve(0.919, 95% CI: 0.882-0.947, P<0.05)for the diagnosis of MACE using the combination of both parameters was significantly larger than that using resting heart rate(0.885, 95% CI: 0.843-0.919, P<0.05)or hematocrit(0.747, 95% CI: 0.694-0.796, P<0.05)alone. Conclusions:Resting heart rate and hematocrit are the main influencing factors for MACE in elderly patients with HFpEF or HFmrEF in the vulnerable phase.
ABSTRACT
Objective To study the effects of health management on blood pressure and lifestyle of hypertensive outpatients.Methods A total of 319 hypertensive outpatients were randomly assigned to the control group (n =160) or the health management group (n =159).Pharmacologic therapy was given to the control group,while in the health management group,intensive health management combined with pharmacologic therapy was conducted.Blood pressure,height,body weight (BW),total cholesterol (TC),and fasting blood glucose (FBG) of the participants were measured and compared at baseline and 12 months.Results There were no significant differences of clinical characteristics between two groups at baseline.After 12 months' intervention,more significant decrease of systolic blood pressure and diastolic blood pressure was found in the health management group (t values were 2.701 and 2.306,respectively;both P ＜ 0.05).There were statistically significant differences of body mass index (BMI) and serum TC levels between the control and the health management group (t values were 2.111 and 2.227,respectively ;P ＜ 0.05).After the intervention,two groups showed no significant difference in current cigarette smoking (x2=2.787,P ＞ 0.05).The participants in the health management group showed improved physical exercises,diet,and adherence to treatment at the end of the observation (x2 values were 59.459,52.018,6.321 and 5.392,respectively; all P ＜ 0.05).Conclusion Compared with pharmacologic therapy,health management combined with pharmacologic therapy could significantly improve clinical parameters and life style of hypertensive patients.
ABSTRACT
ObjectiveTo study the effects of health management on elderly patients with metabolic syndrome and lower extremity arterial disease.Methods A total of 118 metabolic syndrome( MS ) patients with ankle-brachial index (ABI) ＜ 0.9 and no intermittent claudication were randomly assigned to the control group( n =60,receiving pharmacologic therapy ) or health management group ( n =58,receiving intensive health management + pharmacologic therapy).Blood pressure,ABI,total cholesterol (TC),and fasting blood glucose(FBS) were tested before and 12 after the intervention.Results Clinical data were comparable between the two groups at baseline.After 12-months' intervention,systolic blood pressure(SBP) and FBS in both groups were significantly decreased,especially in the health management group[SBP:(141 ± 10)mm Hg(1 mm Hg=0.133 kPa) vs(146±11) mm Hg,t =2.581,P=0.011; FBS:(5.32 ±1.33) mmol/L vs ( 5.92 ± 1.61 ) mmol/L,t =2.231,P =0.028].TC ( 5.51 ± 0.51 ) mmol/L vs ( 5.11 ± 0.49 ) mmol/L,(t=4.307,P=0.000) and ABI(0.77 ±0.17 vs 0.84 ±0.19,t=2.091,P=0.039) of the health management group were significantly improved at 12 months.Patients in the health management group also showed higher SF-36 scores than those in the control group( physical functioning:72.2 ± 12.4 vs 65.2 ±20.1,t =2.268,P =0.025 ; emotion:73.9 ± 18.0 vs 65.6 ± 21.1,t =2.295,P =0.023 ; mental health:63.9 ± 13.3vs 58.3 ± 12.5,t =2.358,P =0.020 ).Conclusion Compared with medication,health management and pharmacologic therapy could significantly improve clinical parameters and quality of life of elderly MS patients combined with peripheral arterial disease.
ABSTRACT
Serum levels of human CXC-chemokine ligand 16,basic fibroblast growth factor,plateletderived endothelial cell growth factor,and number of endothelial progenitor cells were determined in 80 patients with type 2 diabetes mellitus and 40 normal control subjects.It was found that there were some disturbances of angiogenesis in diabetic patients.These abnormalities were more pronounced in these patients with old age,hyperglycemia,raised HbA1c,and presence of vascular diseases.
ABSTRACT
Objective To study the effects of health management on cardiovascular events in the elderly patients with hypertension. Methods A total of 182 elderly patients with hypertension were randomly assigned to the control group (n = 61 ), pharmacologic therapy group (n = 61 ) or health management group ( n = 60). Serum biomarkers, brachial-ankle pulse wave velocity ( baPWV ), and blood pressure were tested at baseline and after intervention. Results There were no differences between the 2 groups in clinical characteristics at baseline. The average following-up period was (21 ± 7 ) months. The improvement of systolic blood pressure ( t = 3.915, P = 0. 000 ), pulse pressure ( t = 3. 966, P = 0. 000), and baPWV ( t = 3. 093, P = 0. 002) in the health management group was more significant than the control group;the systolic blood pressure ( t = 2. 008, P= 0. 046 ) was bitterly improved than the pharmacologic therapy group. The accumulative survival rate of the health management group (96. 7% ) was higher than the control group (83.6%; x2 =5. 921 ,P =0. 015) ,similar to the pharmacologic therapy group (93.3%; x2 =2. 821,P=0.091 ). Decreased systolic blood pressure, diastolic blood pressure, pulse pressure and baPWV were protective factors. After adjusted by age and gender,the improvement of systolic blood pressure was found to be an independent protective factors ( RR = 0. 75, P ＜ 0. 05 ). Conclusion Health management in elderly patients with hypertension could more significantly reduce the risk of cardiovascular diseases.
ABSTRACT
Objective To measure serum ghrelin level in elderly Chinese, and investigate the relationship of the serum ghrelin level with age, obesity and other metabolic disorders. Methods A total of 109 men aged over 60 years without history of smoking and alcohol consumption from health examination were enrolled in this study. Subjects were excluded if they had serious diabetic complications, coronary artery disease and hepatic or renal dysfunction. A cross sectional study was made on ghrelin level and the correlated metabolic disorders. Results Compared with ghrelin level in subjects with normal BMI [(823. 57±410.40) ng/L], the ghrelin level was significantly decreased in overweight and obese elderly male, [(442.42 ± 171.10) ng/L and (434.64 ± 177.65) ng/L respectively]. ghrelin was significantly lower in subjects with three or more metabolic disorders (420.84±165.91) ng/L than in those with less disorder. Single factor analysis showed ghrelin was inversely associated with BMI, TG and uric acid (r=-0.359,-0.243,-0.189), but it was not associated with age, blood pressure, fasting glucose and insulin levels. Multivariate analysis revealed only BMI significantly affected the level of ghrelin (β =-0.386). Conclusions BMI is closely associated with ghrelin in elderly male,ghrelin is significantly lower with increased number of metabolic disorders.