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Objective To investigate the correlation of vitamin D with essential hypertension and its target organ damages in the elderly.Methods In the retrospective study,365 elderly participants aged ≥ 60 years hospitalized in our department during January 2013 to February 2014 were involved,including 247 patients with confirmed essential hypertension(HT)and 118 patients without HT.Serum 25-hydroxy vitamin D[25(OH)D]levels were measured and compared between HT and non-HT group,and binary regression analysis was used to discuss potential influencing factors of HT.The damage index of vitamin D target organ was compared between vitamin D deficiency group(n=198)and vitamin D non deficiency group(n=49).Results The median serum 25(OH)D level of participants is 35.3 nmol/L,77.5%(283 cases)were in the insufficient vitamin D status.The level of 25(OH)D was significantly lower in HT group than in non-HT group(34.0 vs.38.7 nmol/L,P0.05)in albumin/creatinine ratio,serum creatinine,estimated glomerular filtration rate,ankle-brachial index,pulse wave velocity,intima media thickness of carotid artery,Sokolow-Lyon index,cornell index and left ventricular mass index.The serum 25(OH)D level was significantly lower in CHD plus HT group than non-CHD(P<0.05).The 25(OH)D level was negatively correlated with coronary heart disease(B=-0.021,P=0.019).The serum 25(OH)D level was significantly lower in groups with double-and triple-vessel coronary artery disease than in non-CHD group(P<0.01).Conclusions Vitamin D insufficiency is common in the elderly.The serum 25(OH)D level is significantly lower in old patients with HT especially with stage 3 HT than in non-HT ones.The 25(OH)D level is lower in HT patients with comorbid CHD,and more obvious in HT patients with multi-vessel coronary artery disease.An insufficient vitamin D status is not correlated with hypertensive target organ damages including kidney,peripheral vascular and left ventricular cardiac structure.
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Objective:To assess the consequences of switching aspirin dosage from 100 mg/d to 40 mg/d on cardiovascular benefit,bleeding risk and platelet aggregation in very elderly patients. Methods:Arachidonic acid induced platelet aggregation(AA-Ag)was measured in 537 patients aged 80 or older treated with aspirin (100 mg/d).In the study,100 patients with low on-treatment platelet ag-gregation and at high risk of bleeding and low risk of cardiovascular events,were switched to aspirin (40 mg/d)and their platelet aggregation was measured again 7 days later.Their bleeding and upper gastroin-testinal symptoms were also recorded in following 3 months.Results:The study observed a heterogeneous distributed aspirin 100 mg/d AA-Ag (range:0.42% to 28.78%)in the 537 very elderly patients.Aspi-rin 100 mg/d AA-Ag before the switch in aspirin 40 mg/d group was 5.00% ±2.32% and the rate of the patients with low on-treatment platelet aggregation was 71.00%.The rates of melena or occult blood positive,other minimal bleeding,upper gastrointestinal symptoms and a history of gastrointestinal bleeding in 40 mg/d group were higher than those in 100 mg/d group.On a regimen of aspirin 40 mg/d,AA-Ag increased to 11.21% ±4.95%(range:2.12% to 28.84%)with 95.00%of the patients with AA-Ag<20%and the rate of the patients with low on-treatment platelet aggregation was 15.00%.Multiple vari-able analysis revealed that aspirin 40 mg/d AA-Ag was significantly influenced by aspirin 100 mg/d AA-Ag,BMI and platelet counts.The rate of gastrointestinal bleeding decreased from 12.00% to 5.00%, and upper gastrointestinal symptoms decreased from 59.00% to 21.00% after the switch in 40 mg/d group.Conclusion:Switching aspirin dosage from 100 mg/d to 40 mg/d reduces the bleeding events and improves upper gastrointestinal symptoms,thus inhibiting platelet aggregation effectively in very elderly patients.
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Objective:To elucidate the correlation between urinary 11-dehydro-thromboxane B2 ( 11 dhTxB2 ) and clinical efficacy of aspirin treatment in patients with type 2 diabete and coronary artery disease ( CAD) . Methods:In this prospective cohort study, 169 aged patients with type 2 diabete accom-panying CAD in Peking University First Hospital were enrolled. The level of urinary 11dhTxB2 was detec-ted using enzyme-linked immuno-sorbent assay. Low aspirin response or high on aspirin platelet reactivity (HAPR) was defined as urinary 11dhTxB2>1 500 ng/g. All the included patients were divided into two groups based on the results, HAPR group and No-HAPR group. Results:Baseline urinary 11dhTxB2 of the patients with type 2 diabete accompanying CAD was ( 3 687 ± 3 052 ) ng/g, while the urinary 11dhTxB2 was (1 954 ± 859) ng/g in patients after 100 mg/d aspirin treatment (P<0. 001). Preva-lence of HAPR in patients with type 2 diabete accompanying CAD were 32 . 5%. Within a mean follow-up time of 12 months, the outcomes occurred more frequently in HAPR group than in No-HAPR group ( P<0 . 05 ) . Conclusion:Urinary 11 dhTxB2 can be recognized as an effective indicator in evaluating aspirin clinical efficacy of patients with type 2 diabete accompanying CAD.
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Objective: To elucidate the correlation between the single nucleotide polymorphism of CKLF-like MARVEL transmembrane member 5 ( CMTM5 ) gene rs723840 and the occurrence of high on aspirin platelet reactivity ( HAPR) . Methods:The present study is a case-control study. A total of 210 hospitalized patients in Peking University First Hospital were enrolled. Aspirin response was assessed by 0. 5 g/L arachidonic acid (AA)-induced platelet aggregation ratio (PR), and ≥3/4 quartile of PR of the population was defined as HAPR. Accordingly all the enrolled 210 coronary artery diseases ( CAD) patients were divided into HAPR group and No-HAPR group. The genotypes were determined by poly-merase chain reaction ( PCR) and sequencing analysis for rs723840 of CMTM5 gene. Results:The geno-type frequencies in rs723840 C>T of CMTM5 gene conformed well to the Hardy-Weinberg equilibrium in both HAPR group and No-HAPR group. Between the two groups, the genotypes frequencies in HAPR and No-HAPR groups were 48 . 4%, 51 . 6%, 0 . 0% and 73 . 7%, 22 . 9%, 0 . 034%, respectively ( P=0. 004). The C, T allele frequencies were significantly different in the two groups (P =0. 031,OR =0 . 501 , 95%CI:0 . 264-0 . 947 ) . Conclusion:Our study finds a significant correlation between CMTM5 gene rs723840 polymorphism and high on aspirin platelet reactivity.
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<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of rosuvastatin in Chinese patients with carotid atherosclerosis.</p><p><b>METHOD</b>A systematic search of Pubmed, EMBase, CENTRAL, CBMdisc, CNKI and WANFANG databases up to January 2013 was performed to identify studies comparing rosuvastatin with a placebo or other statins on carotid intima-medial thickness (IMT) with a minimum follow-up of 6 months in Chinese patients. Meta-analysis was performed by using RevMan 5.0 software after the strict evaluation of the methodological quality of the included studies independently by two reviewers.</p><p><b>RESULTS</b>Twenty-eight studies involving 1 392 individuals were included in this review. The pooled weighted mean difference (WMD) between rosuvastatin and placebo or control on IMT was 0.28 mm (95%CI 0.14-0.42, P < 0.01), with 0.31 mm (95%CI 0.14-0.49, P < 0.01) on 6-8 months and 0.16 mm (95%CI 0.05-0.27, P = 0.005) on 12 months, respectively. Analysis on studies in core journals showed the WMD between rosuvastatin and placebo or control on IMT was 0.18 mm (95%CI 0.09-0.27, P < 0.01). The WMD between rosuvastatin and other statins on IMT was 0.06 mm (95%CI 0.04-0.08, P < 0.01). The WMD between rosuvastatin and placebo or control on plaque score was 0.89 (95%CI 0.78-0.99, P < 0.01). The WMD between rosuvastatin and placebo or control on plaque area was 1.46 (95%CI 0.67-2.25, P < 0.01).Reports of adverse effect were elevated liver enzyme (2.30%, 19/825), elevated muscle enzyme (0.73%, 6/825), muscle aches (0.61%, 5/825).</p><p><b>CONCLUSIONS</b>Rosuvastatin therapy is effective and safe to decrease IMT in Chinese patients with carotid atherosclerosis.</p>
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Female , Humans , Male , Carotid Artery Diseases , Diagnostic Imaging , Drug Therapy , Carotid Intima-Media Thickness , Fluorobenzenes , Therapeutic Uses , Pyrimidines , Therapeutic Uses , Rosuvastatin Calcium , Sulfonamides , Therapeutic UsesABSTRACT
<p><b>OBJECTIVE</b>To compare the value between CHADS2 score and CHA2DS2-VASc score on assessing the risk of ischemic stroke in patients with nonvalvular atrial fibrillation.</p><p><b>METHODS</b>In this retrospective study, nonvalvular atrial fibrillation patients with acute ischemic stroke hospitalized from January 2004 to March 2013 in our department were included. CHADS2 score (range, 0-6) and CHA2DS2-VASc score (range, 0-9) before acute ischemic stroke was calculated. For both schemes, patients were also classified with scores of 0, 1 and ≥ 2 in low-risk, intermediated-risk and high-risk categories, respectively, the difference between the two risk stratification schemes was evaluated by each category.</p><p><b>RESULTS</b>A total of 599 patients [320 men, mean age (75.4 ± 9.1) years] were collected. According to CHADS2 score, 30 (5.0%), 132 (22.0%) and 437 (73.0%) patients were classified in the low-risk, intermediated-risk and high-risk categories, respectively. The corresponding classification by CHA2DS2-VASc score was 6(1.0%), 25(4.2%) and 568 (94.8%) cases. The number of low-risk category patients (5.0% vs. 1.0%, χ(2) = 22.04, P < 0.001) and in intermediate-risk category patients (22.0% vs. 4.2%, χ(2) = 84.81, P < 0.001, Kappa = 0.075) was significantly higher in CHADS2 score group than in CHA2DS2-VASc score group, and the consistence between the two scores was poor (Kappa = 0.322). There were less patients classified in the high-risk group by CHADS2 score compared to CHA2DS2-VASc score (73.0% vs. 94.8%,χ(2) = 131.00, P < 0.001, Kappa = 0.257).</p><p><b>CONCLUSION</b>Compared with CHADS2 score, CHA2DS2-VASc score is more valuable in predicting ischemic stroke for patients with nonvalvular atrial fibrillation.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Atrial Fibrillation , Risk Assessment , StrokeABSTRACT
Objective To deepen the understanding about Heyde's syndrome by investigating the clinical characteristics and prognosis of the patients with aortic valve stenosis complicating with gastrointestinal bleeding.Methods Patients with aortic valve stenosis and gastrointestinal bleeding coincidently admitted to our hospital from 2001 to 2011 were retrieved and analyzed.Results In all the 443 157 in-patients,474 patients were diagnosed with aortic valve stenosis (0.11％,474/443 157) and 14 patients (9 males and 5 females,aged 53-87 years old) with gastrointestinal bleeding coincidently (2.95 ％,14/474).Among the 14 patients,3 were moderate aortic valve stenosis,11 severe aortic valve stenosis.The aortic valve peak flow velocity was 324-709 (480.54 ± 188.25) cm/s and the mean aortic valve pressure gradient was 21.04-91.56 (56.93 ± 29.90) mm Hg (1 mm Hg =0.133 kPa).Heavy gastrointestinal bleeding was manifested in all the 14 patients with 1 of haematemesis and 13 of hematochezia.Hemoglobin (Hb) and red blood cell (RBC) count were significantly lower than the normal range [(69 ±28) g/L and (2.71 ±2.04) × 1012/L,P ＜0.05].Their mean corpuscular volume(MCV),mean corpuscular hemoglobin (MCH),mean corpuscular hemoglobin concentration (MCHC),platelet (PLT) count,prothrombin time (PT) and international normalized ratio (INR) were in normal range [(90.21 ± 2.94) r,(29.39 ± 1.99) pg,(327.57 ± 14.82) g/L,(185.13 ±22.55) × 109/L,(11.4 ± 1.04) s and 1.22 ±0.44,respectively].Among all the 14 patients,13 were over 65 years old and they all accepted gastrointestinal imaging (13/14).Vascular malformation of intestine was found in 6 patients with 4 lesions located in descending colon and 2 located in sigmoid colon.Hemorrhage foci were found in 2 patients with one of colon cancer,and another of duodenal ulcer,while no definite hemorrhage foci were found in the other 11 patients.A total of 6 patients with severe aortic valve stenosis underwent aortic valve replacement (AVR) successfully (6/11) and no recurrent gastrointestinal bleeding was ever found.Conservative treatment was performed in the other 5 patients with severe aortic valve stenosis (5/11) and resulted in sudden death in 2 patients (2/5).Conclusions Prompt echocardiography and gastrointestinal endoscopy should be performed in the elderly patients with obscure gastrointestinal bleeding to facilitate the early diagnosis and treatment of Heyde's syndrome.AVR is a fundamental procedure to improve the prognosis of Heyde's syndrome.
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Objective:To analyze the relationship between plasma level of cortistatin(CST) and coronary heart disease(CHD) and the factors that influence the level of CST.Methods: Plasma levels of CST were measured using ELISA method.The clinical data and the levels of CST of 40 healthy subjects and 39 CHD patients before and 1 d after percutaneous coronary intervention(PCI) were compared.And the factors that influenced the CST level were analyzed.Results: The CST levels of CHD group before or 1 d after PCI were significantly higher than those of the control group(1.97?1.12 and 2.01?0.77 vs 1.21?0.27,P0.05);There was no correlation between CST levels and fasting blood glucose(FBG),high sensitivity C-reactive protein(hsCRP),left ventricular ejection fraction(LVEF),severity of lesions of coronary arteries or history of hypertension;The levels of triglyceride(TG) and total cholesterol(TCHOL) negatively correlated with CST levels(?=-2.594,P
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Objective: To assess the influence of different doses of CKLF1 plasmid on the dynamics and magnitude of the mobilization of the mobilization bone of marrow stem cells in a rat AMI model.Methods: Different doses of plasmid DNA encoding CKLF1 gene,empty plasmid or saline were injected into male SD rats intramuscularly with in vivo electroporation.Rats were subjected to left coronary artery ligation 6 days after gene transfer.Peripheral blood samples were drawn and CD34~+ cells were assayed by FACS calibur flow-cytometer.The changes in absolute number of CD34~+ cells were evaluated.Results: Expressions of CKLF1 mRNA and protein were detected in the injection site 7 days after gene transfer.Five days after gene transfer,the CD34~+ cells numbers in CKLF1 groups were significantly higher than those in empty plasmid group,especially in CKLF1 100?g group(16.63?10~6/L vs 4.98?10~6/L,P