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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

残余胆固醇与心血管、癌症死亡率的相关性:一项全国性队列研究

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Science Bulletin 2024年第4期69卷 526-534页

作者：田原武依戚敏杰宋莉娟陈伯望王椿淇路甲鹏杨阳张小艳崔建兰许巍杨皓贺文彦张岩郑昕张海波郭远林李希 National Clinical Research center of cardiovascular diseases State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Henan Provincial center for Disease Control and Prevention Zhengzhou 450000China Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Shenzhen Center for Cardiovascular Diseases Fuwai Hospital Chinese Academy of Medical SciencesShenzhen 501800China Central China Sub-center of the National center for cardiovascular diseases Zhengzhou 450000China

The health significance of triglyceride-rich lipoproteins,also known as remnant cholesterol,has been increasingly recognized.However,evidence of their associations with cause-specific mortality in the general population was previously insufficient.To explore these associations and their heterogeneities across subgroups,a prospective cohort study was conducted including 3,403,414 community-based participants from China HEART,an ongoing government-funded public health program throughout China,from November 2014 through December 2022.The study assessed mortality risk of all-cause mortality,cardiovascular disease(CVD)mortality(including mortality from ischemic heart diseases(IHD),ischemic stroke(IS),and hemorrhagic stroke(HS),separately),and cancer mortality(including lung cancer,stomach cancer,and liver cancer,separately).During the 4-year follow-up,23,646 individuals died from CVD(including 8807 from IHD,3067 from IS,and 5190 from HS),and 20,318 from cancer(including 6208 from lung cancer,3013 from liver cancer,and 2174 from stomach cancer).Compared with individuals with remnant cholesterolcardiovascular disease mortality,as well as a reduced risk of mortality for certain types of cancer.

关键词： Remnant cholesterol Mortality cardiovascular disease Cancer

Association of acute glycemic parameters at admission with cardiovascular mortality in the oldest old with acute myocardial infarction

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Journal of Geriatric Cardiology 2024年第3期21卷 349-358页

作者： Hui-Hui LIU Meng ZHANG Yuan-Lin GUO Cheng-Gang ZHU Na-Qiong WU Ying GAO Rui-Xia XU Jie QIAN Ke-Fei DOU Jian-Jun LI Cardiometabolic center State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

OBJECTIVES Stress-related glycemic indicators,including admission blood glucose(ABG),stress-hyperglycemia ratio(SHR),and glycemic gap(GG),have been associated with worse outcomes after acute myocardial infarction(AMI).However,data regarding their prognostic value in the oldest old with AMI are unavailable.Therefore,this study aimed to investigate the association of stress-related glycemic indicators with short-and long-term cardiovascular mortality(CVM)in the oldest old(≥80 years)with AMI.METHODS In this prospective study,a total of 933 consecutive old patients with AMI admitted to FuWai hospital(Beijing,China)were enrolled.On admission,ABG,SHR,and GG were assessed and all participants were classified according to their quartiles.Kaplan-Meier,restricted cubic splines(RCS),and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.RESULTS During an average of 1954 patient-years of follow-up,a total of 250 cardiovascular deaths were recorded.Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG.After adjusting for potential covariates,patients in quartile 4 of ABG,SHR,and GG had a respective 1.67-fold(95%CI:1.03-2.69;P=0.036),1.80-fold(95%CI:1.16-2.79;P=0.009),and 1.78-fold(95%CI:1.14-2.79;P=0.011)higher risk of long-term CVM risk compared to those in the reference groups(quartile 1 of ABG and quartile 2 of SHR and GG).Furthermore,RCS suggested a J-shaped relationship of ABG and a Ushaped association of SHR and GG with long-term CVM.Additionally,we observed similar associations of these acute glycemic parameters with 30-day CVM.CONCLUSIONS Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and longterm CVM among the oldest old with AMI,suggesting that they may be useful for risk stratification in this special population.

关键词： admitted infarction shaped

Development and validation of a model integrating clinical and coronary lesion-based functional assessment for longterm risk prediction in PCI patients

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Journal of Geriatric Cardiology 2024年第1期21卷 44-63页

作者： Shao-Yu WU Rui ZHANG Sheng YUAN Zhong-Xing CAI Chang-Dong GUAN Tong-Qiang ZOU Li-Hua XIE Ke-Fei DOU State Key Laboratory of cardiovascular Disease BeijingChina Cardiometabolic Medicine center Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Catheterization Laboratories Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Department of Cardiology Fu Wai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

OBJECTIVES To establish a scoring system combining the ACEF score and the quantitative blood flow ratio(QFR) to improve the long-term risk prediction of patients undergoing percutaneous coronary intervention(PCI).METHODS In this population-based cohort study, a total of 46 features, including patient clinical and coronary lesion characteristics, were assessed for analysis through machine learning models. The ACEF-QFR scoring system was developed using 1263consecutive cases of CAD patients after PCI in PANDA Ⅲ trial database. The newly developed score was then validated on the other remaining 542 patients in the cohort.RESULTS In both the Random Forest Model and the Deep Surv Model, age, renal function(creatinine), cardiac function(LVEF)and post-PCI coronary physiological index(QFR) were identified and confirmed to be significant predictive factors for 2-year adverse cardiac events. The ACEF-QFR score was constructed based on the developmental dataset and computed as age(years)/EF(%) + 1(if creatinine ≥ 2.0 mg/d L) + 1(if post-PCI QFR ≤ 0.92). The performance of the ACEF-QFR scoring system was preliminarily evaluated in the developmental dataset, and then further explored in the validation dataset. The ACEF-QFR score showed superior discrimination(C-statistic = 0.651;95% CI: 0.611-0.691, P < 0.05 versus post-PCI physiological index and other commonly used risk scores) and excellent calibration(Hosmer–Lemeshow χ^(2)= 7.070;P = 0.529) for predicting 2-year patient-oriented composite endpoint(POCE). The good prognostic value of the ACEF-QFR score was further validated by multivariable Cox regression and Kaplan–Meier analysis(adjusted HR = 1.89;95% CI: 1.18–3.04;log-rank P < 0.01) after stratified the patients into high-risk group and low-risk group.CONCLUSIONS An improved scoring system combining clinical and coronary lesion-based functional variables(ACEF-QFR)was developed, and its ability for prognostic prediction in patients with PCI was further validated to be significantly better than the post-PCI physiological

关键词： patients coronary prediction

Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High cardiovascular Risk in China

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Cardiology Discovery 2024年第1期4卷 15-22页

作者： Jiaying Li Aoxi Tian Jiamin Liu Jinzhuo Ge Yue Peng Xiaoming Su Jing Li National Clinical Research center for cardiovascular diseases National Health Commission Key Laboratory of Clinical Research for Cardiovascular MedicationsState Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeNational Center for Cardiovascular DiseasesBeijing 100037China

Objective:Home blood pressure monitoring(HBPM)is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension.However,evidence remains scarce about the effectiveness of HBPM use in the real world.This study aimed to examine the associations of HBPM use with blood pressure(BP)control and medication adherence.Methods:This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged≥50 years.At baseline,information about types of BP monitor,frequency of HBPM,perception of anti-hypertensive treatment,and measured office BP were collected.During the 1-year follow-up(visits at 1,2,3,6,and 12 months),information on medication adherence was collected at each visit.The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up.A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes,stratified by the perceptions of anti-hypertensive treatment.Results:A total of 5,363 hypertensive patients were included in the analysis.The age was(64.6±7.2)years,and 41.2%(2,208)were female.Of the total patients,85.9%(4,606)had a home BP monitor and 47.8%(2,564)had an incorrect perception of anti-hypertensive treatment.Overall,24.2%(1,299)of patients monitored their BP daily,37.6%(2,015)weekly,17.3%(926)monthly,and 20.9%(1,123)less than monthly.At baseline,the systolic BP and diastolic BP were(146.6±10.8)mmHg and(81.9±10.6)mmHg,respectively,and 28.5%(1,527)of patients had their BP controlled.Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment,there is no significant association between HBPM frequency and BP control at baseline.During the 1-year follow-up,23.9%(1,280)of patients had non-adherence to medications at least once.In patients with an incorrect perception of anti-hypertensive treatment,those monitoring BP most frequently(daily)had the highest non-adherence rate(29.9%,175/585).Compared with those monitoring their

关键词： Hypertension Home blood pressure monitoring Blood pressure control Medication adherence

Diagnostic performance of intravascular ultrasound-based fractional flow reserve in evaluating of intermediate left main stenosis

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Journal of Geriatric Cardiology 2024年第1期21卷 34-43页

作者： Yong-Gang SUI Cheng YANG Chang-Dong GUAN Yan-Lu XU Na-Qiong WU Wei-Xian YANG Yong-Jian WU Ke-Fei DOU Yue-Jin YANG Shu-Bin QIAO Wei YU Bo XU Sheng-Xian TU Jie QIAN Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Catheterization Laboratories Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Biomedical Instrument Institute School of Biomedical EngineeringShanghai Jiao Tong UniversityShanghaiChina National Clinical Research center for cardiovascular diseases BeijingChina

BACKGROUND The recently introduced ultrasonic flow ratio(UFR),is a novel fast computational method to derive fractional flow reserve(FFR)from intravascular ultrasound(IVUS)images.In the present study,we evaluate the diagnostic performance of UFR in patients with intermediate left main(LM)stenosis.METHODS This is a prospective,single center study enrolling consecutive patients with presence of intermediated LM lesions(diameter stenosis of 30%-80%by visual estimation)underwent IVUS and FFR measurement.An independent core laboratory assessed offline UFR and IVUS-derived minimal lumen area(MLA)in a blinded fashion.RESULTS Both UFR and FFR were successfully achieved in 41 LM patients(mean age,62.0±9.9 years,46.3%diabetes).An acceptable correlation between UFR and FFR was identified(r=0.688,P50%(AUC=0.66,Pdiseases,UFR was proved to be associated with acceptable correlation and high accuracy with pressure wire-based FFR as standard reference.The present study supports the use of UFR for functional evaluation of intermediate LM stenosis.

关键词： stenosis flow fractional

Top Five Stories of the Cellular Landscape and Therapies of Atherosclerosis:Current Knowledge and Future Perspectives

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Current Medical Science 2024年第1期44卷 1-27页

作者： Qi PAN Cheng CHEN Yue-jin YANG State Key Laboratory of cardiovascular Disease Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100037China

Atherosclerosis(AS)is characterized by impairment and apoptosis of endothelial cells,continuous systemic and focal inflammation and dysfunction of vascular smooth muscle cells,which is documented as the traditional cellular paradigm.However,the mechanisms appear much more complicated than we thought since a bulk of studies on efferocytosis,transdifferentiation and novel cell death forms such as ferroptosis,pyroptosis,and extracellular trap were reported.Discovery of novel pathological cellular landscapes provides a large number of therapeutic targets.On the other side,the unsatisfactory therapeutic effects of current treatment with lipid-lowering drugs as the cornerstone also restricts the efforts to reduce global AS burden.Stem cell-or nanoparticle-based strategies spurred a lot of attention due to the attractive therapeutic effects and minimized adverse effects.Given the complexity of pathological changes of AS,attempts to develop an almighty medicine based on single mechanisms could be theoretically challenging.In this review,the top stories in the cellular landscapes during the initiation and progression of AS and the therapies were summarized in an integrated perspective to facilitate efforts to develop a multi-targets strategy and fill the gap between mechanism research and clinical translation.The future challenges and improvements were also discussed.

关键词： atherosclerosis transdifferentiation extracellular traps efferocytosis stem cell nanoparticles

Genetically predicted waist circumference and risk of atrial fibrillation

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Chinese Medical Journal 2024年第1期137卷 82-86页

作者： Wenting Wang Jiang-shan Tan Jingyang Wang Wei Xu Liting Bai Yu Jin Peng Gao Peiyao Zhang Yixuan Li Yanmin Yang Jinping Liu Department of Cardiopulmonary Bypass State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Anaesthesiology Second Affiliated HospitalHainan Medical CollegeHaikouHainan 570311China State Key Laboratory of cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

Introduction:Observational studies have revealed an association between waist circumference(WC)and atrial fibrillation(AF).However,it is difficult to infer a causal relationship from observational studies because the observed associations could be confounded by unknown risk factors.Therefore,the causal role of WC in AF is unclear.This study was designed to investigate the causal association between WC and AF using a two-sample Mendelian randomization(MR)analysis.Methods:In our two-sample MR analysis,the genetic variation used as an instrumental variable for MR was acquired from a genome-wide association study(GWAS)of WC(42 single nucleotide polymorphisms with a genetic significance of P<5×10^(-8)).The data of WC(from the Genetic Investigation of ANthropometric Traits consortium,containing 232,101 participants)and the data of AF(from the European Bioinformatics Institute database,containing 55,114 AF cases and 482,295 controls)were used to assess the causal role of WC on AF.Three different approaches(inverse variance weighted[IVW],MR-Egger,and weighted median regression)were used to ensure that our results more reliable.Results:All three MR analyses provided evidence of a positive causal association between high WC and AF.High WC was suggested to increase the risk of AF based on the IVW method(odds ratio[OR]=1.43,95%confidence interval[CI],1.30-1.58,P=2.51×10^(-13)).The results of MR-Egger and weighted median regression exhibited similar trends(MR-Egger OR=1.40[95%CI,1.08-1.81],P=1.61×10^(-2);weighted median OR=1.39[95%CI,1.21-1.61],P=1.62×10^(-6)).MR-Egger intercepts and funnel plots showed no directional pleiotropic effects between high WC and AF.Conclusions:Our findings suggest that greater WC is associated with an increased risk of AF.Taking measures to reduce WC may help prevent the occurrence of AF.

关键词： Genetically predicted Waist circumference Atrial fibrillation Mendelian randomization

LDL-C rebound after long-term evolocumab treatment and intravascular imaging evidence in a familial hypercholesterolemia patient with early-onset myocardial infarction

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Chronic diseases and Translational Medicine 2024年第1期10卷 69-74页

作者： Zhifan Li Shuang Zhang Zheng Yin Wenjia Zhang Yonggang Sui Jianjun Li Kefei Dou Jie Qian Naqiong Wu Cardiometabolic center National Center for Cardiovascular DiseasesFuwai HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina

Patients with familial hypercholesterolemia(FH)have elevated low-density lipoprotein cholesterol(LDL-C)levels and are at high risk of premature cardiovascular disease.1 Heterozygous FH(HeFH)is one of the commonest genetic disorders,and is more frequent among those with ischemic heart disease(IHD),atherosclerotic cardiovascular disease(ASCVD)and premature IHD.

关键词： cardiovascular familial elevated