[A cross-sectional study on the treatment goals of blood pressure, serum lipids and blood glucose in elderly patients with coronary heart disease].

OBJECTIVE: To investigate the current status of treatment goals for blood pressure, serum lipids and blood glucose in the elderly patients (> 65 years old) with coronary heart disease (CHD) in China and to identify their associated factors. METHODS: In this cross-sectional survey, the CHD subjects aged > 65 years old were recruited from 66 hospitals in Beijing, Shanghai, Tianjin, Guangdong, Zhejiang and Xinjiang from June 2006 to January 2007. RESULTS: A total of 2420 participants, including 1441 males and 979 females. Their mean age was (73 ± 6) years. The targeted blood pressure was systolic blood pressure < 130 mm Hg (1 mm Hg = 0.133 kPa) and diastolic blood pressure < 80 mm Hg. And the success rate was 24.8% (559/2420). The blood pressure achievement rate among the females was 21.8% (213/979). And it was lower than 26.8%(386/1441) among the males (P < 0.01). The serum lipids goal of achievement was LDL-C (low density lipoprotein-cholesterol) < 2.6 mmol/L for the high-risk patients and LDL-C < 2.07 mmol/L especially for the super-high-risk patients. The success rate for achieving the target LDL-C level was 36.5%(884 cases). The LDL-C achievement rate among the females was 28.7% (281 cases). And it was obviously lower than 41.8%(603 cases) among the males (P < 0.01). The success rate for achieving the target LDL-C level increased with aging (P < 0.05). The blood glucose goal of achievement was FPG (fasting plasma glucose) > 4.4 mmol/L and FPG < 6.1 mmol/L. The success rate for achieving the target blood glucose level was 61.0% (1476/2420). Binary logistic regression analysis indicated that the independent risk factors of achieving the blood pressure target for the elderly CHD patients were female, history of hypertension, diuretics and nifedipine. The odds ratio (OR) of these risk factors were 1.245 [95% confidence interval (CI): 1.016 - 1.527], 2.889 (95%CI: 2.319 - 3.599), 0.689 (95%CI: 0.538 - 0.883), 0.405 (95%CI: 0.170 - 0.964) respectively. The independent risk factors of achieving the serum lipids target for the elderly CHD patients were female, the duration of hypertension of 10 - 20 years, the duration of hypertension of 20 - 30 years, diabetic history or dyslipidemia and therapeutic lifestyle change (TLC). The OR of these risk factors were 1.750 (95%CI: 1.252 - 2.445), 3.988 (95%CI: 1.951 - 8.152), 2.158 (95%CI: 1.075 - 4.333), 3.026 (95%CI: 1.986 - 4.610), 2.166 (95%CI: 1.549 - 3.030) and 0.493 (95%CI: 0.302 - 0.805) respectively. The independent risk factors of achieving the blood glucose target for the elderly CHD patients were diabetic history, TLC, diuretics, calcium channel blocker (CCB) and hypoglycemic drugs. The OR of these risk factors were 3.191 (95%CI: 2.259 - 4.507), 0.690 (95%CI: 0.528 - 0.902), 1.507 (95%CI: 1.150 - 1.975), 0.718 (95%CI: 0.579 - 0.890) and 0.477 (95%CI: 0.235 - 0.969) respectively. CONCLUSION: In the present survey, the achievement rates of blood pressure, serum lipids and blood glucose are low in the elderly CHD patients, especially in females. There has been a huge gap between the treatment guidelines and clinical practices in China. We should carry out different strategies according to different conditions to enhance the health and life quality for the elderly CHD patients.

The prevalence and related risk factors of anxiety and depression symptoms among Chinese pregnant women in Shanghai.

OBJECTIVE: To investigate the prevalence of anxiety and depression of the pregnant women during the prenatal period, and provide information for further epidemiological study. METHODS: With ethics committee approval, a total of 527 recruited pregnant women from the Department of Obstetrics and Gynecology, Tongji University Medical School were selected at four hospitals that affiliated to the University. By applying a self-designed questionnaire for hospital anxiety and depression (HAD) scale, we evaluated anxious and depressive symptoms in these women. RESULTS: The prevalence rates of anxiety and depression in these Chinese pregnant women during prenatal period were 6.8% and 4.8%, respectively, whereas the co-prevalence rate of both anxiety and depression was 3.4%, and anxiety and/or depression 15.0%. The relationship between the prevalence rate of anxiety/depression and the age distribution was proven negatively correlated (chi2 = 1.478, P = 0.016) by the trend chi-squared test. Among all three groups, the prevalence rate of anxiety and depression was highest in the group of below 20 years old, lowest in the group of over 30 years old, and in-between in the group of 20 to 30 years old. Logistic regression analysis showed that lower age was a risk factor (odds ratio (OR) = 10.094, 95% confidence interval (CI): 1.418-71.838). Meanwhile, poor educational background (OR = 1.929, 95% CI: 1.101-3.379) was a relevant risk factor as well. CONCLUSIONS: We suggest that introduction of psychological health instruction programs for pregnant women, especially the younger ones, should be strengthened. Besides, the essential intervention measures may be applied if necessary.

[Value of measuring ankle brachial index for diagnosing peripheral arterial disease in Chinese patients with high cardiovascular risk].

OBJECTIVE: To evaluate the value of measuring ankle brachial index (ABI) for diagnosing peripheral arterial disease(PAD) compared with conventional digital subtraction angiography (DSA) as the reference standard. METHODS: A total of 383 consecutive inpatients (245 male, mean age 64.1 +/- 11.7 years) underwent both conventional DSA and ABI measurements. RESULTS: The rate of statin intervention was 90.9%, ACEI 69.2%, antiplatelet 96.6% and beta-blockers 67.9%. The intravascular stenosis was classified into six degrees: normal, < 30%, 30% - 49%, 50% - 69%, 70% - 89% and > or = 90%. Compared to the traditional gold standard (DSA) in diagnosis PDA, the ABI value decreased in proportion to the severity of PAD (the ABI value was 1.08 +/- 0.11, 1.05 +/- 0.16, 0.99 +/- 0.17, 0.66 +/- 0.24, 0.55 +/- 0.28 and 0.54 +/- 0.00 respectively in the six ranks). There was a significant correlation between DSA and ABI in diagnosis PAD. CONCLUSION: ABI measurement is an accurate and reliable non-invasive alternative to conventional DSA in the assessment of lower extremity arteries in patients with peripheral arterial disease.