Effects of clopidogrel resistence and CYP2C19 genotype on the clinical prognosis of patients with acute coronary syndrome undergoing percutaneous coronary intervention / 中华心血管病杂志

Objective: To investigate the effects of clopidogrel resistence and CYP2C19 genotype on the clinical prognosis of acute coronary syndrome(ACS) patients undergoing percutaneous coronary intervention(PCI). Methods: This study was a retrospective cohort study. ACS patients who underwent PCI in Beijing Anzhen Hospital from October 2015 to January 2017 were recruited. The inhibition rate of adenosine diphosphate(ADP) was monitored by thromboelastography. All of these patients were divided into clopidogrel resistance and non-resistance group according to the monitoring results. CYP2C19 genotype was detected by TaqMan probe-based real-time quantitative PCR. Patients were divided into slow, medium and fast metabolic group, according to the CYP2C19 genotype. After 12 months of follow-up, the end points included all-cause death, cardiac death, angina, myocardial infarction, stent thrombosis, ischemic stroke and hemorrhage were collected. Combined thrombotic events were defined as a composite of angina, myocardial infarction, stent thrombosis and ischemic stroke. The differences of the incidence of clinical events between groups were compared. Cox regression was used to analyze the effects of clopidogrel resistance and CYP2C19 genotype on the combined thrombotic events, cardiac death and hemorrhage. Results: A total of 1 696 patients were included, and the age was (59.4±9.6) years, with 1 280(75.5%) males. There were 471 cases(27.8%) in clopidogrel resistance group, and 1 225 cases(72.2%) in clopidogrel non-resistance group. There were 218 patients(12.9%) were in slow metabolic group, 668(39.4%) in medium metabolic group, and 810 (47.8%) in fast metabolic group. The median follow-up time was 13.3 months, and 131 cases were lost to follow-up, with a loss follow-up rate of 7.7%. Compared with the clopidogrel non-resistance group, the clopidogrel resistance group had a higher incidence of myocardial infarction(7.6%(36/471) vs. 5.1%(62/1 225), P=0.041), a lower incidence of hemorrhage (13.2%(62/471) vs. 17.9%(219/1 225), P=0.020) and minor hemorrhage(11.5%(54/471) vs. 15.8% (194/1 225), P=0.022). There were no statistically significant difference in all-cause death, cardiac death, angina, stent thrombosis, ischemic stroke and severe bleeding between clopidogrel resistance and non-resistance group(all P>0.05). There was no statistically significant difference in the incidence of endpoint events among different CYP2C19 genotypes (all P>0.05). Cox regression analysis showed that clopidogrel resistance was an independent factor of combined thrombotic events (OR=2.334, 95%CI 1.215-4.443, P=0.016) and bleeding events (OR=0.481, 95%CI 0.174-0.901, P=0.023). While CYP2C19 genotype was not independent factor for combined thrombotic events, cardiac death and hemorrhage (all P>0.05). Conclusion: For ACS patients after PCI, clopidogrel resistance can increase the risk of combined thrombotic events, but also reduce the risk of bleeding; while CYP2C19 genotype is not an independent factor for clinical prognosis.

Association between Serum Alkaline Phosphatase and Carotid Atherosclerosis in a Chinese Population: A Community-based Cross-sectional Study / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to investigate the relationship between alkaline phosphatase (ALP) and common carotid intima media thickness (IMT), carotid plaque, and extracranial carotid artery stenosis (ECAS).@*METHODS@#A total of 3,237 participants aged ⪖ 40 years were recruited from Jidong community in 2013-2014. Participants were divided into five quintile groups based on their serum ALP levels. Carotid atherosclerosis was assessed using ultrasound. Abnormal IMT, carotid plaque, and ECAS were defined as IMT > 0.9 mm, IMT > 1.5 mm, and ⪖ 50% stenosis in at least one extracranial carotid artery, respectively.@*RESULTS@#Common carotid IMT values and the prevalence of carotid plaque increased across serum ALP quintiles. Higher ALP quintiles were correlated with an increased risk of abnormal IMT [fourth quintile: odds ratio (OR) 1.78, 95% confidence interval (CI) 1.13-2.82, P = 0.0135; fifth quintile: OR = 1.82, 95% CI: 1.15-2.87, P = 0.0110] and ECAS compared to the lowest quintile (fifth quintile: OR = 1.47, 95% CI: 1.09-1.97, P = 0.0106). The association between ALP and prevalence of carotid plaque became insignificant after adjustment for confounders.@*CONCLUSION@#Serum ALP levels were independently associated with abnormal common carotid IMT and ECAS. These conclusions need to be further corroborated in future prospective cohort studies.

Perioperative Changes of Serum Biochemical Markers in Patients with PCI / 现代检验医学杂志

Objective To evaluate the perioperative changes of h-FABP,IMA,IL-2R,IL-6,IL-8,TNF-α and MPO in patients with PCI.Methods The serial serum samples from 34 patients were collected from November of 2011 to February of 2012 in coronary care unit of Peking Union Hospital on separately 2,4,8 and 24 hours after PCI,then IL2R,IL6,IL8,TNF-α,h-FABP,IMA and MPO were measured.Results MPO,h-FABP and CKMB increased dramatically at 2 hours after PCI(Z value were separately-3.621,-5.123 and-2.789 compared with the level at 2 h and 24 h,all P＜ 0.05),and h-FABP within 24 hours fell into the normal range.MPO dropped quickly after 4 hours of surgery and CKMB peaked at 4 hours,then decreased.The concentration of CK and cTnⅠ rose up at 4h (Z value were separately-2.803 and-2.31 compared with the level at 2h and 24 h,all P＜0.05) and declined with a climax at 8h after PCI.The correlation coefficient of CKMB and CK with cTnⅠ were higher than 0.6.Conclusion This study provided an overview of the change of multi-biomarkers following PCI,which gave a valuable information for clinical treatment.

Relationship between Neutrophil-to-Lymphocyte Ratio and Pulse Wave Velocity in Young Patients with Systemic Lupus Erythematosus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The incidence of atherosclerosis-related myocardial infarction can be as much as 50-fold greater in young patients with systemic lupus erythematosus (SLE) than in age-matched controls. There are several explanations for this phenomenon, all of which result in a chronic state of low-grade inflammation. Recently, the neutrophil-to-lymphocyte ratio (NLR) has been proposed as a useful biomarker of inflammation. Pulse wave velocity (PWV) is a reliable indicator of vascular damage and atherosclerosis. There is a paucity of data concerning the relationship between NLR and atherosclerosis as measured by PWV in patients with SLE. This study aimed to verify whether there is a positive correlation between NLR and PWV and to explore factors that influence PWV in young SLE patients.</p><p><b>METHODS</b>A total of 90 female patients with SLE were enrolled in this cross-sectional investigation. Traditional and nontraditional cardiovascular risk factors were assessed on the same day that brachial-ankle PWV (baPWV) was examined. The patients were divided into three groups according to their mean baPWV values: patients whose mean baPWV value was lower than the first tertile were placed in Group 1; patients whose mean baPWV value was between the first tertile and the second tertile were placed in Group 2; and patients whose mean baPWV value was higher than the second tertile were placed in Group 3. SPSS 20.0 was used to perform all statistical analyses in this study. Both univariate linear regression and multivariate regression models were utilized to analyze the association between NLR and arterial stiffness.</p><p><b>RESULTS</b>Systolic blood pressure, diastolic blood pressure (DBP), and triglycerides were all significantly different among Groups 1, 2, and 3 (111.90 ± 12.85 mmHg vs. 114.60 ± 12.88 mmHg vs. 129.43 ± 16.21 mmHg, P < 0.001; 68.77 ± 8.63 mmHg vs. 71.87 ± 9.77 mmHg vs. 82.57 ± 14.89 mmHg, P < 0.001; and 1.44 [0.91-2.47] mmol/L vs. 0.98 [0.78-1.26] mmol/L vs. 2.20 [0.94-3.66] mmol/L, P = 0.030; respectively), as were creatinine (57.50 [52.00-69.00] μmol/L vs. 55.50 [49.00-64.00] μmol/L vs. 64.00 [56.00-86.00] μmol/L, P = 0.045) and blood urea nitrogen (4.27 [3.79-6.22] mmol/L vs. 4.16 [3.47-4.84] mmol/L vs. 5.88 [4.04-8.19] mmol/L, P = 0.011). NLRs were significantly different among Groups 1, 2, and 3 (2.16 [1.56-3.42] vs. 3.12 [1.91-4.19] vs. 5.29 [2.63-7.25], P = 0.001). NLR, together with DBP and the SLE disease activity index, independently predicts PWV.</p><p><b>CONCLUSIONS</b>This study demonstrated that there was a positive correlation between NLR and PWV. Moreover, we found that disease activity and DBP were also positively correlated with PWV.</p>

Use of atorvastatin in lipid disorders and cardiovascular disease in Chinese patients / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>Statins are still underused for the prevention of cardiovascular disease (CVD) in China. Hence, we conducted a systemic review on the pharmacology, clinical efficacy, and adverse events of atorvastatin, as well as on patient adherence.</p><p><b>DATA SOURCES</b>We conducted a systemic search in PubMed with the following keywords: "atorvastatin" (Supplementary concept) or "atorvastatin" (All field) and ("China" [AD] or "China" [all field] or "Chinese" [All field]).</p><p><b>STUDY SELECTION</b>Clinical or basic research articles on atorvastatin were included.</p><p><b>RESULTS</b>Atorvastatin is a reversible and competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, decreasing the de novo cholesterol synthesis. The pharmacokinetics of atorvastatin among Chinese is similar to those in Caucasians, and several gene polymorphisms have proved to be associated with the metabolism of atorvastatin in the Chinese population. Several international multiple-center randomized control trials have demonstrated the benefit of atorvastatin for primary and secondary prevention of CVD. None of them, however, included the Chinese, and current evidence in the population is still inadequate, due to the small sample size, low study quality, short study duration, and the use of surrogate endpoints instead of clinical endpoints. The overall incidence of adverse events observed with atorvastatin did not increase in the 10-80 mg dose range, and was similar to that observed with placebo and in patients treated with other statins, which makes atorvastatin well-tolerated in the Chinese population. Moreover, high patient adherence was observed in clinical studies.</p><p><b>CONCLUSIONS</b>Based on the current available evidence, there is no significant difference between Chinese and non-Chinese population in term of pharmacology and clinical efficacy/safety. High-quality evidence is still needed to support the use of atorvastatin in high-risk Chinese population.</p>

Premature atherosclerosis in patients with acquired immunodeficiency syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Increased risk of atherosclerosis has been reported in patients with human immunodeficiency virus (HIV) infection since highly active antiretroviral therapy (HAART) has come into use. However, there is no clear evidence of premature atherosclerosis in Chinese HIV-infected patients. Our study was designed to determine the relationship between HIV infection and atherosclerosis in Chinese HIV-infected patients.</p><p><b>METHODS</b>One hundred and forty-five patients were enrolled in this study. These included 82 HIV-infected patients (41 HAART-treated and 41 antiretroviral therapy (ART) naïve patients) and 43 HIV-negative control subjects. Data on traditional cardiovascular risk factors, HIV infection parameters, and treatment regimens were collected. Pulse wave velocity (PWV) was determined using a pulse pressure analyzer to evaluate the function of the arterial wall as an indicator of atherosclerotic vascular damage.</p><p><b>RESULTS</b>A higher PWV ((1358.3 ± 117.8) cm/s vs. (1270.2 ± 189.2) cm/s, P = 0.010) was found in ART naïve HIV-infected patients compared with control subjects. However, HAART treated patients had lower PWV compared to ART naïve patients ((1283.8 ± 181.4) cm/s vs. (1358.0 ± 117.8) cm/s, P = 0.033). Multiple regression analysis revealed that age (B = 5.218, 95% confidence interval (CI) 1.420 - 9.016, P = 0.008), current smoking (B = -74.671, 95%CI -147.003 to -2.339, P = 0.043) and HAART (92.7% patients on a protease inhibitor-free regimen) (B = -169.169, 95%CI -272.508 to -65.831, P = 0.010) were associated with reduced PWV in HIV-infected patients.</p><p><b>CONCLUSIONS</b>Reduced PWV in HIV-infected Chinese patients indicates that they are more likely to develop arterial wall stiffness, possibly by atherosclerosis. A protease inhibitor-free regime may be protective for arterial wall of HIV infected patients.</p>

Cardiac manifestations in Sjogren syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the cardiac manifestations of patients with primary and secondary Sjogren syndrome.</p><p><b>METHODS</b>Clinical data (clinical manifestations, serologic measurements, echocardiogram) of 396 patients with Sjogren syndrome who admitted to our hospital from 2004--2007 were retrospectively analyzed. Patients with congenital, rheumatic and coronary heart diseases, hypertension and diabetes (n = 221) and patients with incomplete clinic data (n = 51) were excluded.</p><p><b>RESULTS</b>A total of 124 cases were included in this analysis (mean age 47.4 years old; 5 males; average disease duration 85.5 months). Cardiac involvement in Sjogren syndrome is usually asymptomatic. Pericardial effusion (PE) were evidenced in 20.2%, left ventricular diastolic dysfunction (LVDD) in 13.7%, pulmonary artery hypertension (PAH) in 12.9%, left atrium enlargement/in 7.3%, mitral insufficiency in 4.8%, aortic dilation in 5.6%, tricuspid insufficiency in 3.2%, left ventricular enlargement in 2.4% and left ventricular systolic dysfunction in 0.8% patients by echocardiography examinations. Patients with PE had significantly lower CH50, C3, C4 levels and significantly higher C reactive protein level (CRP) and SSA positive rate than patients without PE (all P < 0.05). The serum level of CRP was significantly associated with PE (OR 0.976, 95% CI 0.956 - 0.997, P < 0.05). Age is positively correlated to LVDD (OR 0.884, 95% CI 0.811 - 0.964, P < 0.005). The gammaglobulin level is significantly higher in the PAH group than that in the non-PAH group (P < 0.05).</p><p><b>CONCLUSIONS</b>Cardiac involvement is not rare in patients with Sjogren syndrome. PE, LVDD and PAH are usual cardiac manifestations in these patients. The serum level of CRP is positively related to PE in these patients with Sjogren syndrome.</p>