2023 China Guidelines for Lipid Management / 老年心脏病学杂志（英文版）

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death among urban and rural residents in China, and elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for ASCVD. Considering the increasing burden of ASCVD, lipid management is of the utmost importance. In recent years, research on blood lipids has made breakthroughs around the world, hence a revision of China guidelines for lipid management is imperative, especially since the target lipid levels in the general population vary in respect to the risk of ASCVD. The level of LDL-C, which can be regarded as appropriate in a population without frisk factors, can be considered abnormal in people at high risk of developing ASCVD. As a result, the "Guidelines for the prevention and treatment of dyslipidemia" were adapted into the "China Guidelines for Lipid Management" (henceforth referred to as the new guidelines) by an Experts' committee after careful deliberation. The new guidelines still recommend LDL-C as the primary target for lipid control, with CVD risk stratification to determine its target value. These guidelines recommend that moderate intensity statin therapy in adjunct with a heart-healthy lifestyle, be used as an initial line of treatment, followed by cholesterol absorption inhibitors or/and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, as necessary. The new guidelines provide guidance for lipid management across various age groups, from children to the elderly. The aim of these guidelines is to comprehensively improve the management of lipids and promote the prevention and treatment of ASCVD by guiding clinical practice.

Short-term impact of modified blood-lipid reports on physicians' lipid lowering drug prescribing behavior and knowledge improvement on dyslipidemia / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the physicians' lipid lowering drug prescribing behavior and knowledge on dyslipidemia before and at 8 months after new-issued blood-lipid reports in our hospital.</p><p><b>METHOD</b>Blood-lipid reports in our hospital is newly modified in that the classification of dyslipidemia and lipid-lowering guideline and target lipid level are listed on the back of lipid report besides the normal lipid value listed immediately after the measured lipid levels. Physicians' lipid lowering drug prescribing behavior and knowledge on dyslipidemia before and at 8 months after new-issued blood-lipid reports were examined in 143 doctors from various departments before and at 8 months after new-issued lipid reports.</p><p><b>RESULTS</b>At 8 months after the new issued lipid reports, doctors' cognition rate about the guideline was significantly increased [83.9% (120/143) vs. 67.1% (96/143), P < 0.001] and the guideline was considered more helpful on daily practice [75.3% (58/77) vs. 55.8% (43/77), P = 0.005] compared to baseline. However, the prescription rate of dyslipidemia therapy did not change significantly (69.2% vs. 63.2%, P = 0.117) at 8 months after the new issued lipid reports.</p><p><b>CONCLUSIONS</b>The modification of the blood-lipid reports improved doctors' knowledge on dyslipidemia and on the "Chinese guidelines on prevention and treatment of dyslipidemia in adults". However, the lipid lowering drug prescribing behavior remained unchanged at 8 months after the modification of the lipid reports. Further investigation is warranted to see if the lipid lowering drug prescribing behavior could be changed in the long-term.</p>

Polymorphisms in the apolipoprotein A5 gene and apolipoprotein C3 gene in patients with coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the association between the -1131T/C and 56C/G polymorphism in the APOA5 gene as well as the -482C/T in the APOC3 gene and susceptibility to coronary artery disease (CAD) in a Chinese Han population.</p><p><b>METHODS</b>Using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and polyacrylamide gel electrophoresis (PAGE) methods, we analyzed the genotypes in 312 CAD patients diagnosed by angiography and 317 healthy controls. The levels of serum lipid profiles were also studied by biochemical methods.</p><p><b>RESULTS</b>The frequency of the APOA5 -1131 C allele in CAD patients was significantly higher than that of the control group (39.9% vs. 33.3%, P = 0.02). Compared with the wild type TT, CC homozygotes had a significantly increased CAD risk (OR = 1.93 and OR = 1.80 using unadjusted and adjusted logistic regression models, respectively). This association still existed after adjustment for the APOC3-482 variant. The APOA5-1131C allele also showed a correlation with increasing plasma TG levels (P < 0.01).</p><p><b>CONCLUSIONS</b>The APOA5-1131T/C polymorphism but not APOC3-482C/T might contribute to an increased risk of CAD among Chinese accompanied by an elevation of serum TG levels; this effect was found to be independent of the APOC3-482C/T variant.</p>

Analysis of the levels of serum total calcium and inorganic phosphate of 2,342 children in Beijing / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the changes of serum total calcium (Ca) and inorganic phosphate (P) levels during children growth and related factors.</p><p><b>METHODS</b>Using a stratified-multi-steps-cluster sampling method, we selected 2,342 healthy children aged 10-18 years from urban and suburban areas of Beijing from September 2001 to December 2001 to test the levels of serum Ca and P. Their meal status was also surveyed to analyse the correlation of the leves of serum Ca and P with sex, age, height, weight, and diet on statistic basis.</p><p><b>RESULTS</b>The Ca levels of Beijing children were (2.39 +/- 0.12) mmol/L, which had a positive correlation with age, height, and weight (P < 0.01). The Ca levels of female children were somewhat higher than those of male [male, (2.38 +/- 0.12) mmol/L; female, (2.39 +/- 0.12) mmol/L; P < 0.05]. The Ca levels of urban children were significantly higher than those of suburban children [urban, (2.40 +/- 0.13) mmol/L; suburban, (2.37 +/- 0.10) mmol/L; P < 0.001]. The P levels of Beijing children were (1.39 +/- 0.18) mmol/L, which had a negative correlation with age, height, and weight (P < 0.01). The P levels of male children were significantly higher than those of female [male, (1.43 +/- 0.18) mmol/L; female, (1.36 +/- 0.17) mmol/L; P < 0.001]. The P levels of urban children were significant higher than those of suburban children [urban, (1.41 +/- 0.19) mmol/L; suburban, (1.38 +/- 0.16) mmol/L; P < 0.001]. The Ca levels of Beijing children had a negative correlation with P levels (r=-0.141, P < 0.01). [Ca] x [P] (mmol/L) of Beijing children were 3.32 +/- 0.44. The value of [Ca] x [P] reached peak by 3.45 +/- 0.46 when Beijing children were of 13-14 years old, and then the value declined with increasing age.</p><p><b>CONCLUSION</b>The levels of serum Ca and P correlates with sex, age, growth, and diet. The level of serum Ca goes up while P goes down during the children growth.</p>

Study on the relationship between smoking, alcohol intake and hyperlipidemia in fishermen / 中华流行病学杂志

<p><b>OBJECTIVE</b>To identify the relationship between smoking, alcohol intake and hyperlipidemia in fishermen.</p><p><b>METHODS</b>115 fishermen were randomly recruited and divided into case and control groups according to the result of blood lipoprotein. A questionnaire was used to record general information and the history of smoking and alcohol intake. Statistics were gathered to compare the difference of lipoprotein and apolipoprotein level between exposure and control groups and to calculate the OR value of smoking and alcohol intake.</p><p><b>RESULTS</b>The OR of smoking was 3.417 (95% CI: 1.132 - 10.308), with significant dosage-effect relationship between smoking index and hyperlipidemia. The serum low density lipoprotein-cholesterol (LDL-C) and apolipoprotein (apo) B levels in smoking group was higher than that of control group. The OR value of alcohol intake at early age (early than 20) were 3.275 (95% CI: 1.249 - 8.580) and 4.016 (95% CI: 1.475 - 10.952) respectively. The LDL-C, apoB, the serum total cholesterol (TC)/high density lipoprotein-cholesterol (HDL-C) levels in alcohol abuse group were higher than that of control group.</p><p><b>CONCLUSION</b>Smoking and alcohol abuse were important risk factors of hyperlipidemia, through changing the level of LDL-C and apoB. There was synergistic action between smoking and alcohol abuse in the development of hyperlipidemia.</p>

Evaluation of enzymatic method for determination of serum beta-hydroxybutyrate and its clinical application / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate an enzymatic method for determining serum beta-hydroxybutyrate (beta-HB) with the National Committee for Clinical Laboratory Standards (NCCLS) projects, and to discuss its clinical values in diabetic ketoacidosis (DKA).</p><p><b>METHODS</b>The precision, accuracy, specificity, linearity and interference of the enzymatic method were analyzed. This method was used to determine serum beta-HB in 60 cases of normals, 50 cases of diabetes, and 34 cases of DKA by autochemistry analyzer.</p><p><b>RESULTS</b>Enzymatic beta-HB assay was precise (within-run CV, day-to-day CV, and total CV < 5%). The linearity studies showed the method was linear up to 4 mmol/L. Recovery rate was 98.5%-104.1%. Hemolysis (Hemoglobin up to 18.2 g/L), icteric samples with total bilirubin up to 224 mumol/L, and lipemia up to triglyceride concentration of 2.28 mmol/L did not interfere with the beta-HB results in this method. Serum beta-HB levels were significantly elevated in DKA patients compared with DM patients and controls (P < 0.01). Positive rate of serum beta-HB in DKA patients was significantly higher than that of urinary ketone (P < 0.05).</p><p><b>CONCLUSIONS</b>Enzymatic method is convenient and reliable, allows full automation, and is rapid enough to be used for both routine and urgent determinations of serum beta-HB. It can be used in diagnosing and monitoring treatment of DKA.</p>

Hyperhomocysteinemia and deep-vein thrombosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the relationship between plasma homocysteine (Hcy) level and deep-vein thrombosis (DVT), and analyze the interaction of Hcy, folate and methylenetetrahydrofolate reductase (MTHFR) gene polymorphism in patients with DVT.</p><p><b>METHODS</b>Totally 69 patients with DVT and 111 healthy controls were included in our case-control study. We determined the MTHFR C677T genotypes by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP), measured the serum folate and vitamin B12 by radioimmunoassay (RIA), and measured the plasma homocysteine level by fluorescence polarization immunoassay (FPIA).</p><p><b>RESULTS</b>The frequency of the MTHFR C677T TT genotype had no significant difference between DVT group and control group (P > 0.05). The plasma Hcy level was significantly higher in DVT group than in control group (13.03 +/- 8.74 mumol/L vs 10.14 +/- 4.30 mumol/L, P < 0.05). Both serum folate and VitB12 of patients with DVT were not significantly different from those of controls. The odds radios (OR) of hyperhomocysteinemia for DVT was 2.53 (95% CI 1.08-5.92). The interaction of low folate level and TT genotype increased the risk of DVT (OR = 3.12, 95% CI 1.17-8.38).</p><p><b>CONCLUSION</b>Hyperhomocysteinemia may be an independent risk factor for DVT in Han nationality, while serum folate level and MTHRF C677T genotype are not. An interaction between serum folate level and MTHFR genotype that affect the Hcy level is an important risk factor for DVT.</p>

Clinical evaluation of two kinds homogenous assays for determination of high-density lipoprotein cholesterol / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of two kinds homogenous assays for direct determination of high-density lipoprotein cholesterol (HDL-C) based on the principle of polyanion polymer/detergent (PPD method) and polyethylene glycol-modified enzyme (PEGME) method.</p><p><b>METHODS</b>The two homogenous methods were compared with the precipitation method (PTA-Mg2+ method), their precision, accuracy, specificity and interference were also analyzed.</p><p><b>RESULTS</b>Both homogenous HDL-C assays were precise, having a within-run CV < 3%, day-to-day CV < 3% and total CV < 4%. The HDL-C values measured by the two homogenous methods correlated well with those by PTA-Mg2+ method (X): Y = 0.9316 X + 0.1063, r = 0.9762 for PPD method (Y); and Y = 0.9106 X + 0.1368, r = 0.9894 for PEGME method (Y). The linearity studies showed the two homogenous methods to be linear up to 4.14 mmol/L. The lowest detectable concentration of the two methods was apparently 0.08 mmol/L. Recoveries of the two methods were 94.1%-106.2%. Hemoglobin did not interfere with the HDL-C results in the two homogenous methods, whereas icteric samples with total bilirubin > 200 mg/L showed discrepancies. Lipemia up to triglyceride concentration of 17.0 mmol/L did not interfere with the two homogenous HDL-C assays.</p><p><b>CONCLUSIONS</b>The two new homogenous HDL-C assays meet the requirements for accuracy, precision, ease of handling with massive sample, allow full automation, and are clinically useful.</p>

Acute phase high sensitivity C-reactive protein affects the prognosis of ischemic stroke / 中华神经科杂志

3 mg/L was significantly worse than in those with hs-CRP≤3 mg/L (18.18%,5.45%;P=0.044,log-rank test). Higher hs-CRP concentration was an independent predictor of death or new vascular event(OR 3.609;95% CI 0.869—14.992;P=0.047).Conclusion Higher hs-CRP concentration in acute phase after ischemic stroke is an independent predictor of death or new vascular event in a year.