[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.

Relationship of arterial stiffness and early mild diastolic heart failure in general middle and aged population.

AIMS: The brachial-ankle pulse wave velocity (baPWV) has been recognized as a marker that reflects arterial stiffness. We conducted an investigation to evaluate whether baPWV is independently associated with early mild diastolic heart failure (DHF) in a general middle and aged population. METHODS AND RESULTS: From 1 July 2009 until 31 August 2009, we investigated 2095 subjects for the relevant factors of heart failure in the Lujiazui Community, Shanghai. The baPWV, echocardiography, and blood sampling were performed in the morning after a 12 h overnight fast. A total of 1929 subjects had the complete data, including questionnaire, age, gender, baPWV, brain natriuretic peptide, and E/A ratio. Early mild DHF was defined as a left ventricular ejection fraction >50%, E/A ratio <0.8, and E/E' ≤ 8; finally, 482 subjects with early mild DHF and 1282 subjects with non-DHF entered into analysis. Among 1764 subjects, 31.6% of the subjects were male (average age was 58.0 ± 12.3), 35.8% of the subjects had hypertension, the average body mass index (BMI) was 24.2 ± 3.3 kg/m(2), baPWV was 1513.0 (1329.1, 1763.5) cm/s, and the baPWV was significantly correlated with the E/A ratio (r = -0.39, P < 0.01). There was a difference of the baPWV [1456.0 (1295.3, 1698.3) vs. 1670.5 (1465.6, 1910.8) cm/s] between the non-DHF group and the early mild DHF group (P < 0.01). Multiple logistic-regression analyses demonstrated that age, male gender, BMI, baPWV, posterior left ventricular wall thickness (PVWT), interventricular septal thickness (IVST), E/E' ratio, left ventricular mass index (LVMI), systolic blood pressure (≥140 mmHg), and diastolic blood pressure (≥90 mmHg) were independently correlated with early mild DHF. CONCLUSIONS: The increased arterial stiffness is associated with early mild DHF in a general middle and aged population independently of age, male gender, BMI, PVWT, IVST, E/E' ratio, LVMI, and high blood pressure. The non-invasive techniques described may allow serial measurements to be made over time to monitor baPWV changes in arteries provided the introduction of anti-arteriosclerosis therapy.