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Association of stage 1 hypertension defined by the 2017 ACC/AHA guideline with cardiovascular events and mortality in Chinese adults

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Chinese Medical Journal 2024年第1期137卷 63-72页

作者： Qiannan Gao Liuxin Li Jingjing Bai Luyun Fan Jiangshan Tan Shouling Wu Jun Cai Hypertension Center Fuwai HospitalState Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100037China Department of cardiology Kailuan General HospitalNorth China University of Science and TechnologyTangshanHebei 063000China Emergency Center Fuwai HospitalState Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100037China

Background:The 2017 American College of cardiology/American Heart Association(ACC/AHA)blood pressure(BP)guideline lowered the threshold defining hypertension to 130/80 mmHg.However,how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear.This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population.Methods:Participants with stage 1 hypertension(n=69,509)or normal BP(n=34,142)were followed in this study from 2006/2007 to 2020.Stage 1 hypertension was defined as a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg.None were taking antihypertensive medication or had a history of myocardial infarction(MI),stroke,or cancer at baseline.The primary outcome was a composite of MI,stroke,and all-cause mortality.The secondary outcomes were individual components of the primary outcome.Cox proportional hazards models were used for the analysis.Results:During a median follow-up of 11.09 years,we observed 10,479 events(MI,n=995;stroke,n=3408;all-cause mortality,n=7094).After multivariable adjustment,the hazard ratios for stage 1 hypertension vs.normal BP were 1.20(95%confidence interval[CI],1.13-1.25)for primary outcome,1.24(95%CI,1.05-1.46)for MI,1.45(95%CI,1.33-1.59)for stroke,and 1.11(95%CI,1.04-1.17)for all-cause mortality.The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90(95%CI,0.85-0.96).Conclusions:Using the new definition,Chinese adults with untreated stage 1 hypertension are at higher risk for MI,stroke,and all-cause mortality.This finding may help to validate the new BP classification system in China.

关键词： Hypertension cardiovascular disease All-cause mortality Cox regression analysis

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Circulating biomarker-and magnetic resonance-based nomogram predicting long-term outcomes in dilated cardiomyopathy

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Chinese Medical Journal 2024年第1期137卷 73-81页

作者： Yupeng Liu Wenyao Wang Jingjing Song Jiancheng Wang Yi Fu Yida Tang Department of cardiology Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhou 510080China Guangdong cardiovascular Institute Guangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhou 510080China Department of cardiology Institute of Vascular MedicinePeking University Third HospitalBeijing 100191China Department of cardiology State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems State Key Laboratory of Natural and Biomimetic DrugsSchool of Pharmaceutical SciencesPeking UniversityBeijing 100083China Department of Physiology and Pathophysiology School of Basic Medical SciencesPeking University Health Science CenterBeijing 100083China Key Laboratory of Molecular cardiovascular Science Ministry of EducationBeijing 100191China

Background:Dilated cardiomyopathy(DCM)has a high mortality rate and is the most common indication for heart transplantation.Our study sought to develop a multiparametric nomogram to assess individualized all-cause mortality or heart transplantation(ACM/HTx)risk in DCM patients.Methods:The present study is a retrospective cohort study.The demographic,clinical,blood test,and cardiac magnetic resonance imaging(CMRI)data of DCM patients in the tertiary center(Fuwai Hospital)were collected.The primary endpoint was ACM/HTx.The least absolute shrinkage and selection operator(LASSO)Cox regression model was applied for variable selection.Multivariable Cox regression was used to develop a nomogram.The concordance index(C-index),area under the receiver operating characteristic curve(AUC),calibration curve,and decision curve analysis(DCA)were used to evaluate the performance of the nomogram.Results:A total of 218 patients were included in the present study.They were randomly divided into a training cohort and a validation cohort.The nomogram was established based on eight variables,including mid-wall late gadolinium enhancement,systolic blood pressure,diastolic blood pressure,left ventricular ejection fraction,left ventricular end-diastolic diameter,left ventricular end-diastolic volume index,free triiodothyronine,and N-terminal pro-B type natriuretic peptide.The AUCs regarding 1-year,3-year,and 5-year ACM/HTx events were 0.859,0.831,and 0.840 in the training cohort and 0.770,0.789,and 0.819 in the validation cohort,respectively.The calibration curve and DCA showed good accuracy and clinical utility of the nomogram.Conclusions:We established and validated a circulating biomarker-and CMRI-based nomogram that could provide a personalized prediction of ACM/HTx for DCM patients,which might help risk stratification and decision-making in clinical practice.

关键词： Cardiomyopathy,dilated Heart transplantation Mortality Nomograms Least absolute shrinkage and selection operator Decision curve analysis

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Targeting deubiquitinase OTUB1 protects vascular smooth muscle cells in atherosclerosis by modulating PDGFRβ

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Frontiers of Medicine 2024年第3期18卷 465-483页

作者： Fei Xu Han Chen Changyi Zhou Tongtong Zang Rui Wang Shutong Shen Chaofu Li Yue Yu Zhiqiang Pei Li Shen Juying Qian Junbo Ge Department of cardiology and Laboratory of Heart Valve Disease West China HospitalSichuan UniversityChengdu610041China Department of cardiology Zhongshan HospitalFudan UniversityResearch Unit of Cardiovascular Techniques and DevicesChinese Academy of Medical SciencesShanghai200032China Shanghai Institute of cardiovascular Diseases Shanghai200032China National Clinical Research Center for Interventional Medicine&Shanghai Clinical Research Center for Interventional Medicine(19MC1910300) Shanghai200032China

Atherosclerosis is a chronic artery disease that causes various types of cardiovascular dysfunction.Vascular smooth muscle cells(VSMCs),the main components of atherosclerotic plaque,switch from contractile to synthetic phenotypes during atherogenesis.Ubiquitylation is crucial in regulating VSMC phenotypes in atherosclerosis,and it can be reversely regulated by deubiquitinases.However,the specific effects of deubiquitinases on atherosclerosis have not been thoroughly elucidated.In this study,RNAi screening in human aortic smooth muscle cells was performed to explore the effects of OTU family deubiquitinases,which revealed that silencing OTUB1 inhibited PDGF-BB-stimulated VSMC phenotype switch.Further in vivo studies using Apoe−/−mice revealed that knockdown of OTUB1 in VSMCs alleviated atherosclerosis plaque burden in the advanced stage and led to a stable plaque phenotype.Moreover,VSMC proliferation and migration upon PDGF-BB stimulation could be inhibited by silencing OTUB1 in vitro.Unbiased RNA-sequencing data indicated that knocking down OTUB1 influenced VSMC differentiation,adhesion,and proliferation.Mass spectrometry of ubiquitinated protein confirmed that proteins related to cell growth and migration were differentially ubiquitylated.Mechanistically,we found that OTUB1 recognized the K707 residue ubiquitylation of PDGFRβwith its catalytic triad,thereby reducing the K48-linked ubiquitylation of PDGFRβ.Inhibiting OTUB1 in VSMCs could promote PDGFRβdegradation via the ubiquitin–proteasome pathway,so it was beneficial in preventing VSMCs’phenotype switch.These findings revealed that knocking down OTUB1 ameliorated VSMCs’phenotype switch and atherosclerosis progression,indicating that OTUB1 could be a valuable translational therapeutic target in the future.

关键词： atherosclerosis vascular smooth muscle cell ubiquitylation deubiquitinase OTUB1 PDGFRβ

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You had me at PELO:a"Ribosome Rescuer"induces NLR inflammasome assembly

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Cellular & Molecular Immunology 2024年第1期21卷 1-2页

作者： Zoie Magri Alexander Poltorak graduate program in Immunology Tufts Graduate School of Biomedical Sciences136 Harrison AvenueBostonMA02111USA Department of Immunology Tufts University School of MedicineBostonMA02111USA

Pyroptosis,an inflammatory form of programmed cell death,eliminates a niche where pathogens replicate,providing overall benefits to a host.When left uncontrolled,pyroptosis can lead to severe pathology.Overactive pyroptotic activation has been implicated in neuroinflammation,cardiovascular disease,acute respiratory distress syndrome(ARDS),and many other diseases[1,2,3].Because of its multiple and permanent consequences,pyroptosis is a highly regulated signaling pathway.Major regulators of pyroptosis are NLR inflammasomes,which are activated by various“danger”signals such as ATP.

关键词： inflam NLR distress

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Therapeutic advances in atrial fibrillation based on animal models

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2024年第2期25卷 135-152页

作者： Qian GONG Xuan LE Pengcheng YU Lenan ZHUANG Institute of Genetics and Reproduction College of Animal SciencesZhejiang UniversityHangzhou310058China Key Laboratory of cardiovascular Intervention and Regenerative Medicine of Zhejiang Province Department of CardiologySir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhou310016China

Atrial fibrillation(AF)is the most prevalent sustained cardiac arrhythmia among humans,with its incidence increasing significantly with age.Despite the high frequency of AF in clinical practice,its etiology and management remain elusive.To develop effective treatment strategies,it is imperative to comprehend the underlying mechanisms of AF;therefore,the establishment of animal models of AF is vital to explore its pathogenesis.While spontaneous AF is rare in most animal species,several large animal models,particularly those of pigs,dogs,and horses,have proven as invaluable in recent years in advancing our knowledge of AF pathogenesis and developing novel therapeutic options.This review aims to provide a comprehensive discussion of various animal models of AF,with an emphasis on the unique features of each model and its utility in AF research and treatment.The data summarized in this review provide valuable insights into the mechanisms of AF and can be used to evaluate the efficacy and safety of novel therapeutic interventions.

关键词： Atrial fibrillation Animal model Therapeutic

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Associations between remnant cholesterol levels and mortality in patients with diabetes

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World Journal of Diabetes 2024年第4期15卷 712-723页

作者： Deng Pan Lin Xu Li-Xiao Zhang Da-Zhuo Shi Ming Guo Department of cardiovascular Xiyuan Hospital of China Academy of Chinese Medical SciencesBeijing 100091China graduate School Beijing University of Chinese MedicineBeijing 100020China National Clinical Research Center for Chinese Medicine cardiology Xiyuan Hospital of China Academy of Chinese Medical SciencesBeijing 100091China Gynecological Department of Traditional Chinese Medicine China-Japan Friendship HospitalBeijing 100020China

BACKGROUND Dyslipidemia is frequently present in patients with diabetes.The associations of remnant cholesterol and mortality remains unclear in patients with diabetes.AIM To explore the associations of remnant cholesterol with all-cause and cardiovas-cular mortality in patients with diabetes.METHODS This prospective cohort study included 4740 patients with diabetes who par-ticipated in the National Health and Nutrition Examination Survey from 1999 through 2018.Remnant cholesterol was used as the exposure variable,and all-cause and cardiovascular mortality were considered outcome events.Outcome data were obtained from the National Death Index,and all participants were followed from the interview date until death or December 31,2019.Multivariate proportional Cox regression models were used to explore the associations between exposure and outcomes,in which remnant cholesterol was modeled as both a categorical and a continuous variable.Restricted cubic splines(RCSs)were calculated to assess the nonlinearity of associations.Subgroup(stratified by sex,age,body mass index,and duration of diabetes)and a series of sensitivity analyses were performed to evaluate the robustness of the associations.RESULTS During a median follow-up duration of 83 months,1370 all-cause deaths and 389 cardiovascular deaths were documented.Patients with remnant cholesterol levels in the third quartile had a reduced risk of all-cause mortality[hazard ratio(HR)95%confidence interval(CI):0.66(0.52-0.85)];however,when remnant cholesterol was modeled as a continuous variable,it was associated with increased risks of all-cause[HR(95%CI):1.12(1.02-1.21)per SD]and cardiovascular[HR(95%CI):1.16(1.01-1.32),per SD]mortality.The RCS demonstrated nonlinear associations of remnant cholesterol with all-cause and cardiovascular mortality.Subgroup and sensitivity analyses did not reveal significant differences from the above results.CONCLUSION In patients with diabetes,higher remnant cholesterol was associated with increased risks of all-cause and cardiovascul

关键词： Diabetes Remnant cholesterol Mortality cardiovascular National Health and Nutrition Examination Survey

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Plasma metabolites and risk of myocardial infarction:a bidirectional Mendelian randomization study

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Journal of Geriatric cardiology 2024年第2期21卷 219-231页

作者： Dong-Hua LI Qiang WU Jing-Sheng LAN Shuo CHEN You-Yi HUANG Lan-Jin WU Zhi-Qing QIN Ying HUANG Wan-Zhong HUANG Ting ZENG Xin HAO Hua-Bin SU Qiang SU Department of cardiovascular Medicine Minzu Hospital of Guangxi Zhuang Autonomous RegionGuangxiChina Senior Department of cardiology the Sixth Medical CenterChinese PLA General HospitalBeijingChina Library of graduate School Chinese PLA General HospitalBeijingChina Department of cardiology Jiangbin Hospital of Guangxi Zhuang Autonomous RegionGuangxiChina Health Management Institute the Second Medical CenterChinese PLA General HospitalBeijingChina

BACKGROUND Myocardial infarction(MI)is a critical cardiovascular event with multifaceted etiology,involving several genetic and environmental factors.It is essential to understand the function of plasma metabolites in the development of MI and unravel its complex pathogenesis.METHODS This study employed a bidirectional Mendelian randomization(MR)approach to investigate the causal relationships between plasma metabolites and MI risk.We used genetic instruments as proxies for plasma metabolites and MI and conducted MR analyses in both directions to assess the impact of metabolites on MI risk and vice versa.In addition,the large-scale genome-wide association studies datasets was used to identify genetic variants associated with plasma metabolite(1400 metabolites)and MI(20,917 individuals with MI and 440,906 individuals without MI)susceptibility.Inverse variance weighted was the primary method for estimating causal effects.MR estimates are expressed as beta coefficients or odds ratio(OR)with 95%CI.RESULTS We identified 14 plasma metabolites associated with the occurrence of MI(P<0.05),among which 8 plasma metabolites[propionylglycine levels(OR=0.922,95%CI:0.881–0.965,P<0.001),gamma-glutamylglycine levels(OR=0.903,95%CI:0.861–0.948,P<0.001),hexadecanedioate(C16-DC)levels(OR=0.941,95%CI:0.911–0.973,P<0.001),pentose acid levels(OR=0.923,95%CI:0.877–0.972,P=0.002),X-24546 levels(OR=0.936,95%CI:0.902–0.971,P<0.001),glycine levels(OR=0.936,95%CI:0.909–0.964,P<0.001),glycine to serine ratio(OR=0.930,95%CI:0.888–0.974,P=0.002),and mannose to trans-4-hydroxyproline ratio(OR=0.912,95%CI:0.869–0.958,P<0.001)]were correlated with a decreased risk of MI,whereas the remaining 6 plasma metabolites[1-palmitoyl-2-arachidonoyl-GPE(16:0/20:4)levels(OR=1.051,95%CI:1.018–1.084,P=0.002),behenoyl dihydrosphingomyelin(d18:0/22:0)levels(OR=1.076,95%CI:1.027–1.128,P=0.002),1-stearoyl-2-docosahexaenoyl-GPE(18:0/22:6)levels(OR=1.067,95%CI:1.027–1.109,P=0.001),alpha-ketobutyrate levels(OR=1.108,95%CI:1.041–1.180,P=0.001),5-acetylamino-6-formylam

关键词： infarction alterations diagnosis

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Implications of left atrial volume index in patients with three-vessel coronary disease:A 6.6-year follow-up cohort study

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Chinese Medical Journal 2024年第4期137卷 441-449页

作者： Ru Liu Lei Song Ce Zhang Lin Jiang Jian Tian Lianjun Xu Xinxing Feng Linyuan Wan Xueyan Zhao Ou Xu Chongjian Li Runlin Gao Rutai Hui Wei Zhao Jinqing Yuan Department of cardiology Fuwai HospitalChinese Academy of Medical SciencesBeijing 100037China Department of Respiratory and Pulmonary Vascular Disease Fuwai Yunnan Cardiovascular HospitalKunmingYunnan 650102China Department of Endocrinology Fuwai HospitalChinese Academy of Medical SciencesBeijing 100037China Department of Echocardiography Fuwai HospitalChinese Academy of Medical SciencesBeijing 100037China Information Center Fuwai HospitalChinese Academy of Medical SciencesBeijing 100037China

Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score II,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with TVD.Methods:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital.A total of 7818 patients with available baseline LAVI data were included in the study.Baseline,procedural,and follow-up data were collected.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and stroke.Secondary endpoints included all-cause death,cardiac death,MI,revascularization,and stroke.Long-term outcomes were evaluated among LAVI quartile groups.Results:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score II.Notably,there was a significant interaction between LAVI quartiles and treatment strategies for MACCE.CABG was associated with lower risk of MACCE than MT alone,regardless of LAVI quartiles.Among patients in the fourth quartile,PCI was associated with significantly increased risk of cardiac death compared with CABG(HR

关键词： Three-vessel coronary disease Left atrial volume index Coronary artery bypass grafting Percutaneous coronary intervention Myocardial ischemia Prognosis

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Maternal Preconception Serum Alanine Aminotransferase Levels and Risk of Preterm Birth among Reproductive-Aged Women—China,2013-2017

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China CDC weekly 2024年第10期6卷 181-188,I0001页

作者： Chuanyu Zhao Jiajing Jia Hanbin Wu Qin Xu Xinyi Lyu Meiya Liu Xuan Hu Jueming Lei Yuzhi Deng Yuan He Yuanyuan Wang Zuoqi Peng Ya Zhang Hongguang Zhang Qiaomei Wang Haiping Shen Yiping Zhang Donghai Yan Ying Yang Xu Ma National Research Institute for Family Planning BeijingChina National Human Genetic Resources Center BeijingChina graduate School of Peking Union Medical College BeijingChina Department of Epidemiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

Summary What is already known about this topic?The significance of maternal liver health concerning preterm birth(PTB)is well recognized;however,there is a gap in understanding the precise influence of preconception s... 详细信息

关键词： Serum precise concerning

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Vaccination against coronavirus disease 2019 in patients with pulmonary hypertension:A national prospective cohort study

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Chinese Medical Journal 2024年第6期137卷 669-675页

作者： Xiaohan Wu Jingyi Li Jieling Ma Qianqian Liu Lan Wang Yongjian Zhu Yue Cui Anyi Wang Cenjin Wen Luhong Qiu Yinjian Yang Dan Lu Xiqi Xu Xijie Zhu Chunyan Cheng Duolao Wang Zhicheng Jing Department of cardiology State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Echocardiography National Center for Cardiovascular DiseasesFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Pulmonary Circulation Shanghai Pulmonary HospitalTongji University School of MedicineShanghai 200433China Department of cardiology The First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenan 450052China Department of Clinical sciences Liverpool School of Tropical MedicineLiverpoolUnited Kingdom

Background:Coronavirus disease 2019(COVID-19)has potential risks for both clinically worsening pulmonary hypertension(PH)and increasing mortality.However,the data regarding the protective role of vaccination in this population are still lacking.This study aimed to assess the safety of approved vaccination for patients with PH.Methods:In this national prospective cohort study,patients diagnosed with PH(World Health Organization[WHO]groups 1 and 4)were enrolled from October 2021 to April 2022.The primary outcome was the composite of PH-related major adverse events.We used an inverse probability weighting(IPW)approach to control for possible confounding factors in the baseline characteristics of patients.Results:In total,706 patients with PH participated in this study(mean age,40.3 years;mean duration after diagnosis of PH,8.2 years).All patients received standardized treatment for PH in accordance with guidelines for the diagnosis and treatment of PH in China.Among them,278 patients did not receive vaccination,whereas 428 patients completed the vaccination series.None of the participants were infected with COVID-19 during our study period.Overall,398 patients received inactivated severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)vaccine,whereas 30 received recombinant protein subunit vaccine.After adjusting for baseline covariates using the IPW approach,the odds of any adverse events due to PH in the vaccinated group did not statistically significantly increase(27/428[6.3%]vs.24/278[8.6%],odds ratio=0.72,P=0.302).Approximately half of the vaccinated patients reported at least one post-vaccination side effects,most of which were mild,including pain at the injection site(159/428,37.1%),fever(11/428,2.6%),and fatigue(26/428,6.1%).Conclusions:COVID-19 vaccination did not significantly augment the PH-related major adverse events for patients with WHO groups 1 and 4 PH,although there were some tolerable side effects.A large-scale randomized controlled trial is warranted to confirm this finding.The final approval

关键词： Coronavirus disease COVID-19 Pulmonary hypertension Vaccination

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