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Diabetes is the most important comorbidity of cardiovascular disease, and cardiovascular disease is the main cause of mortality and disability of patients with type 2 diabetes. In order to standardize the diagnosis and treatment of patients with diabetes and cardiovascular disease, the National Health Commission Capacity Building and Continuing Education Center organized the experts from the field of cardiology and endocrinology systematically reviewing the research progresses and expert experiences of relevant disciplines from home and abroad, and formulated this consensus. This consensus covers the diagnosis, drug treatment, and risk factor management for patients with diabetes and cardiovascular disease (including atherosclerotic cardiovascular disease and heart failure) from the perspective of cardiovascular disease and diabetes management aiming to strengthen the comprehensive management of patients and ultimately to improve the prognosis of patients. The management of cardiovascular diseases mainly includes the management of blood pressure, blood lipids, anti-thrombosis, anti-myocardial ischemia, anti-ventricular remodeling and so on. Diabetes management mainly includes lifestyle intervention (including diet, exercise, weight loss, etc.), anti-hyperglycemia therapy (including drugs and insulin), blood glucose monitoring, and hypoglycemic prevention. In addition, specific clinical recommendations are given to patients with special health care needs such as diabetic nephropathy, elderly (>75 years), and cardiovascular critical illness.
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Objective To study the value of endothelin-1 (ET-1) in predicting the outcome of stable coronary artery disease (SCAD) patients.Methods A total of 3154 SCAD patients who were followed up for 24 months were divided into cardiocerebral vascular events group (n=189) and cardiocerebral vascular events-free group (n =2965).Their serum ET-1 level was measured by ELISA.The patients were further divided into ET-1 ＜0.3 pmol/L group (n=1588) and ET-1≥0.3 pmol/L group (n=1566).The value of ET-1 in predicting the end events was assessed by Cox regression analysis.The survival curve was plotted by Kaplan-Meier analysis.Results The serum ET-1 level was signify-cantly higher in cardiocerebral vascular events group than in cardiocerebral vascular events-free group (0.33 pmol/L vs 0.30 pmol/L,P=0.004).The incidence of clinical end events was significantly lower in ET-1 ≥0.3 pmol/L group than in ET-1 ＜0.3 pmol/L group (7.02％ vs 4.97％,P=0.015).Multivariable Cox regression analysis showed that ET-1 was a predictor of clinical end events (HR=1.656,95％CI:1.099-2.496,P=0.016).Kaplan-Meier analysis showed that the events-free survival rate was lower in patients with a higher serum ET-1 level than in those with a lower serum ET-1 level (P=0.016).Conclusion ET-1 is an important risk factor for the outcome of SCAD patients.Further studies are needed to confirm its long-term value in predicting the outcome of SCAD patients.
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Objective To study the relationship of different ABO blood types with the risk of cardiovascular events and the severity of CHD.Methods A total of coronary arteriography-confirmed 3823 Chinese Han CHD patients were divided into O blood type group (n=1140) and non-O blood type group (n=2683).A total of 3654 patients who were followed up by telephone for a median period of 24.6 months were divided into cardiovascular events group (n=348) and cardiovascular events-free group (n =3306).The risk of cardiovascular events in CHD patients with different ABO blood types was assessed according to the Cox proportional hazards model.Results The incidence of left main branch lesion or 3-branch lesions was significantly higher in cardiovascular events group than in cardiovascular events-free group (15.2％ vs 8.1％,47.7％ vs 30.5％,P＜0.01).The Gensini score was significantly higher in non-O blood type group than in O blood type group (20 vs 18,P＜0.05).The incidence of cardiovascular events was higher in non-O blood type group than in O blood type group (10.3％ vs 7.8％,P=0.019).Cox proportional hazards model showed that non-O blood type was an risk factor for cardiovascular events (HR =1.318,95 ％CI:1.030-1.685).The risk of cardiovascular events was still higher in non-O blood type group than in O blood type group after adjustment for confounders (HR=1.291,95％CI:1.008-1.657,P=0.046).Conclusion Non-O blood type is closely related with cardiovascular events in Chinese Han CHD patients.
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Objective@#To analyze the prevalence and clinical features of familial hypercholesterolemia (FH) in Chinese patients with myocardial infarction (MI).@*Method@#This retrospective study recruited a total of 2 119 consecutive patients (age (56.7±10.9) years old) undergoing coronary angiography with first MI from April 2011 to December 2016. Patients were divided into 2 groups: premature MI (male<55 years old, female<60 years old) and non-premature MI. The diagnosis of FH was established according to Dutch Lipid Clinic Network (DLCN) diagnostic criteria and referred as definite/probable FH in our study. The prevalence and clinical features of FH, including lipid level, MI characteristics and stain therapy, were explored. Multivariable logistic regression analysis was used to assess the predictive value of FH for the presence of premature MI.@*Results@#The prevalence of definite/probable FH was 3.68% (78/2 119) in MI patients and 7.28% (68/934) in premature MI patients. Onset of MI occurred 10 years earlier in patients with definite/probable FH than those without FH ((47.9±9.4) years vs. (58.8±10.7) years, P<0.01). Additionally, we found that the risk of premature MI was significantly and independently increased in definite/probable FH patients (OR=5.32, 95%CI 2.77-10.22, P<0.01). None of FH patients reached the target of LDL-C<1.8 mmol/L under statin therapy.@*Conclusions@#The prevalence of FH in Chinese patients with MI is not rare. Clinically, FH is linked with the early onset of MI.
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Objectives@#To investigate the prevalence rate and clinical characteristics of familial hypercholesterolemia (FH) in Chinese patients undergoing coronary angiography due to angina-like chest pain.@*Methods@#From March 2011 to December 2016, a total of 9 908 consecutive patients undergoing coronary angiography in Fuwai Hospital due to angina-like chest pain were enrolled. The age of enrolled patients was (56.6±11.1) years old, and 6 782 cases (68.4%) were male. The patients were divided into two groups: FH group (n=271) and non-FH group (n=9 637) according to the Dutch Lipid Clinic Network diagnostic criteria. A retrospective analyze was performed on the baseline features between the two groups including lipids levels, coronary artery disease (CAD) characteristics, and lipids-lowering treatments.@*Results@#In the total cohort, the prevalence of definite/probable FH was 2.7% (271/9 908). The incidence of premature coronary artery disease (PCAD) (women < 60 years old, or men < 55 years old) was higher in patients with FH than that in patients without FH (70.2%(201/271) vs. 44.5% (4 287/9 637); χ2=93.738, P<0.001). Patients with FH had higher level of TC and LDL-C when compared with patients without FH ((6.74±2.48) mmol/L vs. (4.15±1.10) mmol/L; (4.53±2.39) mmol/L vs. (2.52±0.97) mmol/L; t=19.403, 22.233, P<0.001, respectively). Additionally, 84.9% (230/271) of FH patients were treated with statin at different intensities, but none of them achieved the LDL-C<2.6 mmol/L.@*Conclusions@#Chinese patients with familial hypercholesterolemia not only showed a high presence of PCAD and higher lipids levels, but also exhibited a low rate of achievement of low-density lipoprotein cholesterol targets despite statin therapy. Our results thus highlight the importance of early diagnosis and intensive treatment of FH patients.
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Atherosclerotic cardiovascular disease (ASCVD) is a chronic and complex disease with multiple risk factors.Among these risk factors, only dyslipidemia is a ＂pathogenicity＂risk factor.In this article, we will discuss the following hot spots and controversies about dyslipidemia and ASCVD .Are lipid parameters just risk factors or targets of therapy ? Which of the cholesterol concentration and lipoprotein particle number has more clinical values ? Should non-fasting or fasting lipid profiles be preferred?
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Objective: To study the relationship between ABO blood type and spontaneous re-canalization (SR) in patients with acute myocardial infarction (AMI). Methods: A total of 1209 consecutive AMI patients were enrolled. Based on TIMI grade, the patients were divided into 2 groups: Non-SR group, the patients with TIMI grade 0-1,n=442 and SR group, the patients with TIMI grade 2-3,n=767. The relationship between ABO blood type and SR was investigated. Results: Compared with Non-SR group, SR group had more patients with blood type O (32.3% vs 24.7%) and less blood type A (31.7% vs 24.9%). Meanwhile, we found that a lower cholesterol level was related to patients with O blood type and SR occurrence, bothP<0.05. Multi regression analysis indicated that with adjusted age, gender, BMI, hypertension, diabetes, smoking, LDL-C and C-reactive protein, ESR, fibrinogen, D-dimmer, endothelial cardiac function, blood type O may independently predict SR occurrence in AMI patients (OR=1.49, 95% CI 1.10-2.05), while blood type A may have disadvantage for SR (OR=0.65, 95% CI 0.48-0.80). Conclusion: ABO blood type has been related to SR in AMI patients, blood type O is in favor of SR, while blood type A has disadvantage for SR occurrence.
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Objective To explore the feasibility of the application of non fasting blood lipid in the hospitalized population.Methods Self-control study was used.608 patients(aged 20~86 years old) were enrolled from April 2015 to October 2016 in lipid center of FuWai hospital.Fasting sample and non-fasting sample(1~4 h after breakfast) were collected from every patient and lipid profile including TG (triglyceride), TC (total cholesterol), HDL-C (high density lipoprotein cholesterol) and LDL-C (low density lipoprotein cholesterol) were measured in clinical laboratory.The results of two tests were compared using the Wilcoxon signed-rank test.Results The differences between non-fasting and fasting lipid test were +0.47 mmol/l (+30%) for TG,-0.03 mmol/l (-2.8%) for HDL-C,-0.09 mmol/l (-3%) for LDL-C and-0.24 mmol/l (-8.7%) for calculated LDL-C (P 4.5 mmol/L and the whole (0.07 vs.0.09),but the level of non-fasting LDL-C using formula method wassignificantly different between TG> 4.5 mmol/L and the whole (0.66 Vs.0.24),andthe drops were 34.9% vs.8.7%.Conclusion Non-fasting lipid test could be an effective routine method for lipid evaluation in the hospitalized population.
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Objective: To preliminarily explore the clinical characteristics and gender difference of patients with variant angina (VA) in China. Methods: A total of 312 patients with spontaneous attack of VA admitted in our hospital from 2003-01 to 2009-12 without stimulation test were retrospectively studied. The clinical features were compared between male and female patients to reveal the similarities and differences of VA by genders. Results: The predilection of VA was in male gender (274/312, 87.8%), the common risk factors including smoking, hypertension and hyperlipidemia; 55/312 (17.6%) patients had allergy history. There were 59/312 (18.9%) patients combining arrhythmia while VA attack; coronary angiography (CAG) found that 155/283 (54.8%) patients were with ifxed coronary stenosis and 22/312 (7.1%) combining coronary myocardial bridge. Nitrates, calcium antagonist and stent implantation may effectively control VA attack. Compared with male, female patients had the lower ratio of smokers (10.5% vs 78.8%),P<0.01, higher ratios of family history of coronary artery disease (CAD) (31.6% vs 11.3%),P<0.01, ventricular tachycardia (13.2% vs 3.6%)P<0.05 and ventricular ifbrillation (7.9% vs 1.8%),P<0.05. Conclusion: VA is a cardiac ischemia caused by coronary artery spasm with high incidence for combining arrhythmia, without in time treatment it may incur myocardial infarction even sudden death. VA patients should receive routine CAG and stent implantation according to the severity of stenosis. Female patients were with less smokers while higher ratios in family history of CAD, ventricular tachycardia and ventricular ifbrillation.
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Objective:To evaluate the clinical correlation between the CardioChek PA analyzer (CCPA)and a clinical laboratory reference method to use for screening program purposes.Methods:Fasting blood samples were collected on 325 patients (age:23 -86 years).One venous sample was col-lected using a serum tube for the evaluation on a Beckman reference analyzer.A second venous sample was collected in a lithium heparin tube and was evaluated on the CCPA analyzer.Linear regression analy-ses and Bland-Altman method were performed for each measured analyte:total cholesterol (TC),high density lipoprotein-cholesterol (HDL-C),triglycerides (TG)and low density lipoprotein-cholesterol (LDL-C).Results:Our results demonstrated a good clinical agreement for TC,HDL-C,TG and LDL-C (97.0%,92.9%,92.4% and 83.7%)in comparison with the CCPA to the reference analyzer.The correlation coefficients were 0.875,0.81 3,0.91 0,0.864,respectively.P values all <0.001 .There was no significant difference in the detection rate of hyperlipidemia in TC,HDL-C and LDL-C.Conclu-sion:We have identified the pre-analytic phase as an important step to guarantee the quality of results and indicated that the CCPA is a reliable lipid point-of-care testing system that can be used for the appli-cation of clinical screening anywhere.
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Objective: To explore the safety and efficacy of lipoprotein apheresis (LA) in treating the patients with familial hypercholesterolemia (FH). Methods: A total of 12 FH patients treated in our hospital from 2015-02 to 2016-10 were retrospectively studied. Based on intensive cholesterol lowering therapy with rosuvastatin (10-20) mg Qd and Ezetimibe 10 mg Qd, the patients received LA by double ifltration plasma pheresis (DFPP) via bilateral elbow central vein or femoral vein. The changes of lipid level were compared at before and after LA treatment. Results: For pre- and immediately after LA treatment, the average total cholesterol (TC) was (9.42±3.65) mmol/L vs (2.84±0.83) mmol/L, low density lipoprotein cholesterol (LDL-C) was (7.31±3.46) mmol/L vs (1.95±0.82) mmol/L; at 1, 3, 7 and 30 days after treatment, TC and LDL-C levels showed increasing trend, while they were still lower than they were before treatment, allP Conclusion: LA therapy may decrease blood levels of TC and LDL-C at short term in FH patients with good tolerance;even TC and LDL-C could slowly increase after treatment, while combining with lipid lowering therapy, it has been a safe and effective method for treating relevant patients.
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<p><b>UNLABELLED</b>Backround N-terminal pro-brain natriuretic peptide (NT-proBNP) is a reliable predictor in acute coronary artery disease (CAD). Little is known about patients with stable CAD, especially Chinese patients with CAD. The aim of the present study was to investigate the association of NT-proBNP levels with the severity of CAD in patients with normal left ventricular ejection fraction.</p><p><b>METHODS</b>A total of 658 consecutive patients were divided into two groups based on angiograms: CAD group (n = 484) and angiographic normal control group (n = 174). The severity of CAD was evaluated by modified Gensini score, and its relationship with NT-proBNP was analyzed.</p><p><b>RESULTS</b>The prevalence of risk factors such as age, male gender, diabetes mellitus (DM), dyslipidemia, smoking, and family history of CAD in the CAD group were higher than that in the control group. In multivariate regression model analysis, age, gender, and DM were determinants of the presence of CAD. NT-pro BNP was found to be an independent predictor for CAD (OR:1.66 (95% CI: 1.06-2.61), P < 0.05). In a receiver operating characteristic (ROC) curve analysis, an NT-proBNP value of 641.15 pmol/L was identified as a cut-off value in the diagnosis or exclusion of CAD (area under curve (AUC) = 0.56, 95% CI: 0.51-0.61). Furthermore, NT-proBNP was positively correlated with Gensini score (r = 0.14, P < 0.001) in patients with CAD.</p><p><b>CONCLUSION</b>NT-proBNP was an independent predictor for Chinese patients with CAD, suggesting that the NT-proBNP level might be associated with the presence and the severity of CAD.</p>
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Female , Humans , Male , Middle Aged , Coronary Disease , Blood , Natriuretic Peptide, Brain , Blood , Peptide Fragments , Blood , Prospective Studies , Risk Factors , Severity of Illness Index , Stroke VolumeABSTRACT
<p><b>BACKGROUND</b>Several studies investigating the prognostic utility of interleukin-10 (IL-10) in patients with acute coronary syndrome (ACS) have provided conflicting findings. The aim of the study was to assess the existing evidence regarding association between serum IL-10 levels and adverse events.</p><p><b>METHODS</b>Literature search was performed in PubMed, EMBASE, and Cochrane Trials Register databases from their inception to September 30, 2012. In addition, reference lists of the included articles and their related citations in PubMed were also reviewed for additional pertinent studies.</p><p><b>RESULTS</b>A total of 12 eligible studies comprising a total of 5882 patients were identified. The pooled relative risks for both studies reporting the risk estimates by IL-10 categories and studies reporting the risk estimates by unit IL-10 indicated an association between high IL-10 levels and adverse events. Sensitivity and subgroup analysis indicated that the results obtained in IL-10 categories were not stable.</p><p><b>CONCLUSIONS</b>Data from our meta-analysis supported the existence of a relationship between high serum IL-10 levels and adverse events in patients with ACS. Large study with longer follow-up is needed to confirm the findings.</p>
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Humans , Acute Coronary Syndrome , Blood , Interleukin-10 , BloodABSTRACT
Objective To investigate the incidence, imaging and clinical characteristics in elderly patients with coronary artery ectasia (CAE). Methods A retrospective analysis was conducted on patients with CAE who underwent coronary angiography between January 2006 and December 2012. According to age, the enrolled patients were divided into two groups (elderly group, age≥ 65 years; non-elderly group, age < 65 years). The clinical feature, imaging characteristics and the 5-year survival rate of the two groups were compared.Results The preva-lence of CAE in elderly patients was 0.33%. Patients in elderly group were found to have significantly higher proportion of female (30.1%vs. 10.1%,P< 0.001), three-vessel disease (60.5%vs. 45.2%,P = 0.003) and localized ectasia (55.0%vs. 40.2%,P = 0.003). In addition, body mass index (20.90 ± 2.71 kg/m2vs. 22.31 ± 2.98 kg/m2,P < 0.001) and percentage of current smokers (45.0%vs. 64.6%,P < 0.001) were significantly lower in elderly group. Cumulative survival curves demonstrated reduced 5-year cumulative survival at the follow-up in the elderly group compared with the non-elderly group (88.0%vs. 96.0%,P = 0.002). But the 5-year event free survival rate failed to show a significant difference between the two groups (31.0%vs. 35.0%,P= 0.311).ConclusionThe prevalence of CAE in elderly patients was 0.33%, which was about 1/3 of the entire numbers of CAE patients. There were significant differences between the elderly and the non-elderly patients with CAE in terms of coronary artery disease risk factors and coronary artery ectatic characteristics. CAE might be asso-ciated with increased mortality risk in the elderly.