[Current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in China].

Objective: To investigate the current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in 21 provinces of China. Methods: In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients aged 60 years or over were recruited from 165 hospitals in 21 provinces across China from April to July 2011. Current status and influence factors of ACEI/ARB application among 1 789 cases with diabetes mellitus were investigated in the survey. Results: Totally, 1 069 patients used ACEI/ARB drugs (59.8%); proportion of ACEI (544 cases, 30.4%) drugs were the same as ARB drugs (533 cases, 29.8%) in terms of usage of drug types, and combination of the two drugs were taken by 28 cases (1.6%) at the same time. ACEI/ARB usage decreased with the increasing of age, and the rate of drug usage in male patients was slightly higher than that in female, however there was no statistical difference (both P>0.05); the rate of usage of ACEI/ARB drugs gradually decreased with increasing of coronary heart disease or diabetes duration (P<0.05); the rates of usage of ACEI/ARB drugs in hypertension, dyslipidemia, myocardial infarction, renal insufficiency patients and patients received revascularization therapy were significantly higher (all P<0.05). Multivariable logistic regression analysis showed that hypertension (OR=3.016, 95%CI: 1.376-4.887), dyslipidemia (OR=1.489, 95%CI: 1.114-2.031), revascularization (OR=2.291, 95%CI: 1.276-3.277), myocardial infarction (OR=2.561, 95%CI: 1.571-4.545), renal insufficiency (OR=1.337, 95%CI: 1.145-2.013), and insulin treatment (OR=1.584, 95%CI: 1.084-2.511) were positively correlated with ACEI/ARB usage (P<0.05); and coronary heart disease duration was negatively correlated with ACEI/ARB drugs usage (duration 5-10 years: OR=0.621, 95%CI: 0.416-0.823; duration >10 years, OR=0.664, 95%CI: 0.471-0.840). Conclusions: The rate of usage of ACEI/ARB drugs in elderly coronary heart disease outpatients complicated with diabetes mellitus is still low, however, patients with hypertension, dyslipidemia, myocardial infarction, renal insufficiency and patients received revascularization therapy and insulin treatment are more likely to use ACEI/ARB drugs.

[Effects of body mass index on blood pressure control rate in elderly coronary heart disease outpatients with hypertension].

Objective: To explore the influences of body mass index (BMI) on blood pressure control rate in elderly coronary heart disease (CHD) outpatients with hypertension. Methods: In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients with hypertension aged 60 years or over were recruited from 165 hospitals in 21 provinces or cities across China from April to July 2011, and 5 140 cases of elderly CHD patients with hypertension were finally included into the study. The cases were divided into low BMI group (n=130 cases), normal body mass index (BMI) group (n=1 390 cases), overweight (n=2 418 cases), obesity group (n=662 cases) according to the different levels of BMI. Clinical data and blood pressure control rate were compared among the groups, and relationships of different BMI levels with blood pressure control rate were analyzed by the binary classification unconditioned Logistic regression equation. Results: There was a statistically significant difference in blood pressure control rate of general population, men and women patients among low BMI group, normal BMI group, overweight and obesity group (χ2=66.346, 58.995, 26.044, respectively, P<0.001), blood pressure failure rate in obesity group (73.7%) was higher than that in overweight group (65.8%) and normal BMI group (57.5%) (P<0.05), and overweight group was also higher than normal BMI group (P<0.05); blood pressure failure rate in obesity men was higher than that in normal BMI and low BMI group (P<0.05), overweight group was higher than normal BMI group (P<0.05); blood pressure failure rate in obesity women was higher than that in normal BMI and low BMI group (P<0.05). There was a statistically significant difference in blood pressure control rate of different age groups (60-70, 71-80, >80 years old) among low BMI group, normal BMI group, overweight and obesity group (χ2=37.729, 20.007, 15.538, respectively, P<0.001). Blood pressure failure rate in obesity patients with 60-70 years old was higher than that in overweight and normal BMI group (P<0.05), blood pressure failure rates in obesity and overweight patients with 71-80 and > 80 years old were also higher than those in normal BMI group (P<0.05). Multivariable Logistic regression equation showed that overweight in overall population (OR=1.313, 95%CI 1.170-1.731, P<0.05), obesity (OR=2.295, 95%CI 2.295-1.496, P<0.05) were independent risk factors for blood pressure failure rate, in addition, obesity was also risk factor for blood pressure failure rate in men and women patients. Conclusions: Increased BMI has an adverse effect on blood pressure control rate in elderly CHD outpatients with hypertension, and may be the independent risk for blood pressure failure rate in those patients. Much more attention should be given to control BMI level so as to increase the blood pressure success rate and improve the patients' prognosis.

[Changes in plasma concentration of interleukin-6 in elderly patients with coronary artery disease complicated with heart failure].

OBJECTIVE: The aim of this study was to observe the concentrations of plasma interleukin-6(IL-6) in elderly patients with coronary artery disease(CAD). METHODS: Forty-eight CAD patients with heart failure, 15 CAD patients without heart failure, and 30 normal subjects were studied. The plasma concentration of interleukin-6(IL-6) was measured by enzyme-linked immunosorbent assay. RESULTS: The plasma concentration of IL-6 in CAD patients with heart failure was significantly higher than that without heart failure and normal subjects, respectively (P < 0.05). There was no significant difference between CAD patients without heart failure and normal subjects in the plasma levels of IL-6. There was a negative correlation between the concentration of IL-6 and left ventricular ejection fraction(LVEF) (r = -0.60, P < 0.01). The plasma concentration of IL-6 of the group with re-hospitalization because of severe heart failure was significantly higher than that of the group without hospital readmission (P < 0.01). CONCLUSION: The plasma concentration of IL-6 in CAD patients with heart failure may provide the important information for the severity of the disease and for the prognostic prediction in the disease.

Regulation of superoxide anion generation in bovine alveolar macrophages by bacterial lipopolysaccharide, serum proteins, and modulators of signal transduction.

The respiratory burst of phagocytes in an important leukocyte function which results in generation of oxygen species that are both microbicidal and potentially damaging to host tissues. We investigated regulation of the respiratory burst of alveolar macrophages in response to lipopolysaccharide (LPS) derived from gram-negative bacteria, serum proteins, and several modulators of signal transduction. When employed as a single stimulus, LPS (E. coli 055:B5, 10 ng/ml-1 microgram/ml) was a weak stimulus for generation of superoxide anion (O2-) as compared to the potent effect of the protein kinase C activator, phorbol 12-myristate 13-acetate (PMA; 500 ng/ml). However, when LPS was combined with fetal bovine serum (FBS; 0.4-1.0% vol/vol, equivalent to 128-320 micrograms protein/ml), O2- generation was enhanced approximately two-fold over LPS alone. A chromatographically-derived bovine serum fraction which contained bovine lipopolysaccharide-binding protein (bLBP; 0.25-1.0 microgram/ml) was an effective substitute for FBS at a much lower protein concentration than whole FBS, and a similar synergistic effect with LPS on O2- generation was observed. Stimulation of macrophages for generation of O2- either with LPS alone or with LPS plus serum/serum fraction was suppressed by the protein tyrosine kinase inhibitor heribimycin A (0.2 ng/ml), and the calcium chelator BAPTA (12 microM), but not by modulators of G-proteins, including pertussis toxin (10 ng/ml) and cholera toxin (5 micrograms/ml protein). Essentially complete inhibition of O2- synthesis by herbimycin A and BAPTA occurred in the presence of LPS and the bLBP-containing serum fraction (1 microgram/ml protein), but only partial inhibition (46.7% and 64.1%, respectively) was observed in the presence of LPS plus FBS (256 micrograms/ml protein). These results indicate that when LPS is used as a sole stimulus it induces modest respiratory burst activity. However, when LPS is combined with appropriate serum components, it stimulates alveolar macrophages to generate larger amounts of O2-. Cellular signaling pathways important in stimulation of macrophages by LPS and serum components are protein tyrosine kinase- and Ca(++)-dependent, but do not relay on G-protein-mediated signaling.

Interleukin-6 secretion by bacterial lipopolysaccharide-stimulated bovine alveolar macrophages in vitro.

Interleukin-6 (IL-6) is a pluripotent cytokine that may play a role in pulmonary defense against bacterial pathogens. We have quantitated the response of bovine alveolar macrophages (bAM) to bacterial lipopolysaccharide (LPS; E. coli 055: B5) in vitro using the IL-6 sensitive 7TD1 cell line. Bacteria LPS in the absence of serum induced IL-6 secretion from bAM (1 x 10(6) ml-1) over a range of LPS concentrations from 10 ng ml-1 to 10 micrograms ml-1. This resulted in IL-6 levels ranging from approximately 5 to over 200 U ml-1.IL-6 secretion by from approximately 5 to over 200 U ml-1.IL-6 secretion by LPS-stimulated bAM was increased by 24 h poststimulation, and continued to increase up to 72 h after stimulation. Fetal bovine serum (FBS, 1% vol/vol; 320 micrograms ml-1) enhanced IL-6 secretion from macrophages in the presence of LPS by approximately 10-fold compared with LPS alone. A bovine serum fraction (1 microgram ml-1 protein) prepared using ion-exchange chromatography also markedly enhanced IL-6 secretion versus LPS alone. The stimulatory effect of IL-6-like activity in the bAM supernatants was neutralized by an anti-human IL-6 polyclonal antibody. Northern blot analysis revealed increased IL-6 mRNA at 2 h poststimulation with LPS + FBS, peak levels at 4 h, and levels were decreased by 6 h poststimulation. Results suggest that IL-6 is secreted by bovine alveolar macrophages, and that bacterial LPS and serum components synergize to produce this response.