Hua Cui

Impact of beta2-agonists, beta-blockers, and their combination on cardiac function in elderly male patients with chronic obstructive pulmonary disease

Purpose This study was undertaken to determine the association between cardiac function and therapy with beta2-adrenoceptor agonists (β2-agonists), β-blockers, or β-blocker–β-agonist combination therapy in elderly male patients with chronic obstructive pulmonary disease (COPD). Patients and methods This was a retrospective cohort study of 220 elderly male COPD patients (mean age 84.1 ± 6.9 years). The patients were divided into four groups on the basis of the use of β-blockers and β2-agonists. N-terminal fragment pro-B-type natriuretic peptide (NT pro-BNP), left ventricular ejection fraction (LVEF), and other relevant parameters were measured and recorded. At follow-up, the primary end point was all-cause mortality. Results Multiple linear regression analysis revealed no significant associations between NT pro-BNP and the use of β2-agonists (β = 35.502, P = 0.905), β-blockers (β = 3.533, P = 0.989), or combination therapy (β = 298.635, P = 0.325). LVEF was not significantly associated with the use of β2-agonists (β = −0.360, P = 0.475), β-blockers (β = −0.411, P = 0.284), or combination therapy (β = −0.397, P = 0.435). Over the follow-up period, 52 patients died, but there was no significant difference in mortality among the four groups (P = 0.357). Kaplan–Meier analysis showed no significant difference among the study groups (log-rank test, P = 0.362). After further multivariate adjustment, use of β2-agonists (hazard ratio [HR] 0.711, 95% confidence interval [CI] 0.287–1.759; P = 0.460), β-blockers (HR 0.962, 95% CI 0.405–2.285; P = 0.930), or combination therapy (HR 0.638, 95% CI 0.241–1.689; P < 0.366) were likewise not correlated with mortality. Conclusion There was no association between the use of β2-agonists, β-blockers, or β-blocker-β2-agonist combination therapy with cardiac function and all-cause mortality in elderly male COPD patients, which indicated that they may be used safely in this population.

Resveratrol attenuates left ventricular remodeling in old rats with COPD induced by cigarette smoke exposure and LPS instillation

The objective of this study was to investigate left cardiac damage and the cardioprotective effects of resveratrol in old rats with COPD. Rats 22 months old were divided into three groups: control (CTL), smoking and lipopolysaccharides (SM/LPS), and SM/LPS plus resveratrol (SM/LPS-Res). Cardiac function, pathology, oxidative stress, and apoptosis index were measured. Expression of myocardial SIRT1 was studied by real-time quantitative polymerase chain reaction (PCR) and Western blot detection. The heart weight-body weight ratio (LVW/BW) increased in the SM/LPS group compared with the CTL group. Both the LVW/BW and the area of fibrosis in the SM/LPS-Res group decreased compared with those in the SM/LPS group. 8-OHdG expression increased in cardiac tissue of rats in the SM/LPS group, which could be inhibited by resveratrol. Resveratrol significantly increased the activity of superoxide dismutase (SOD) and reduced the cardiac malonyldialdehyde (MDA) level in the SM/LPS-Res group. There was a significant decrease in the extent of cardiomyocyte apoptosis in the SM/LPS-Res group compared with the SM/LPS group. SIRT1 mRNA increased in the SM/LPS-Res group compared with the SM/LPS group. In conclusion, resveratrol attenuated cardiac oxidative damage and left ventricular remodeling and enhanced the decreased expression of SIRT1 in hearts of old rats with emphysema and thus might be a therapeutic modality for cardiac injury complicated in chronic obstructive pulmonary disease (COPD).

Clinical value of mean platelet volume for impaired cardiopulmonary function in very old male patients with chronic obstructive pulmonary disease

High mean platelet volume (MPV) is a marker of platelet activation. The present study was designed to test if high MPV is associated with impaired cardiopulmonary function in patients with COPD. One hundred and sixteen male outpatients (mean age, 86.03±4.29 years) with COPD were recruited. Blood samples were collected for measurements of MPV and other laboratory data. Lung function and cardiac function were also assessed. Multiple linear regression analyses revealed that MPV was negatively correlated with left ventricular ejection fraction (β=-0.252, p=0.008) and the predicted value of forced expiratory volume in one second (FEV(1)% predicted) (β=-0.384, p=0.0001), whereas MPV was positively correlated with right pulmonary arterial diameter (β=0.311, p=0.005). The present study showed an association between high MPV, a marker of platelet activation, and impaired cardiopulmonary function in elderly COPD male patients. High MPV may be regarded as an early predictive marker of impaired cardiopulmonary function in COPD.

Association factors of target organ damage: analysis of 17682 older hypertensive patients in China

Background Hypertensive target organ damage (TOD) is the main reason for mortality or disability in older hypertensive patients. The studies on hypertensive TOD in Asia, especially in Chinese older hypertensive patients, are very limited. The aim of our study was to evaluate the prevalence and correlative factors of TOD in Chinese older hypertensive inpatients. Methods This is a retrospective survey and data were collected from the computerised medical files of hypertensive inpatients from January of 1993 to December of 2008. The analysis was done on 17682 inpatients, aged 60 years or older, with the diagnosis of essential hypertension (EH). The evidences of hypertensive TOD and associated factors with TOD were collected. Results The prevalence of any hypertensive target organ involvement among these subjects was high. In multivariable logistic regressions adjusted for potentially confounding factors, older age, male gender, diabetes, EH grade 3, SBP, LDL-C, were independently associated with coronary artery disease. Age, duration of EH, EH grade 3, SBP, PP and Hcy were independently associated with cerebrovascular disease. Age, diabetes, duration of EH, EH grade 3, SBP, PP and eGFR were independently associated with chronic kidney disease. Male gender, EH grade 3 and SBP was independently associated with aortic dissection. Conclusion The prevalence of hypertensive TOD is high in Chinese older hypertensive inpatients. Various cardiovascular risk factors are associated with hypertensive TOD. The level of SBP and severe hypertension (grade 3 hypertension) are common independent risk factors of TOD.

Chronic kidney disease — Is it a true risk factor of reduced clopidogrel efficacy in elderly patients with stable coronary artery disease?

BACKGROUND Chronic kidney disease (CKD) is an established predictor of recurrent ischemic events in patients with coronary artery disease (CAD). This association has been partially ascribed to high post-treatment platelet reactivity (HPPR) according to platelet function testing. However, the influencing factors of HPPR are assay-dependent, and the relevant data of elderly patients with stable CAD are absent. PATIENTS AND METHODS 310 elderly patients (>80years of age) with stable CAD taking prolonged maintenance clopidogrel (75mg/day) were studied. Maximal platelet aggregation rate (MPA%) with light transmittance aggregometry and Platelet Reactive Units (PRU) with VerifyNow (VN) P2Y12 system were obtained. Markers of platelet activation, including PAC-1 and CD62P, were also determined. RESULTS Patients on different stages of CKD presented similar MPA% and expression of PAC-1 and CD62P. Although severe CKD patients were more likely to present HPPR identified by VNP2Y12 (odds ratio: 1.85, p=0.038), multiple logistic regression diminished this effect (adjusted odds ratio: 1.19, p=0.642), and revealed anemia as a possible predictor of HPPR (adjusted odds ratio: 5.92, p=0.001). However, in a parallel way, hemoglobin correlated with baseline PRU values as well as with post-treatment values (r=-0.624 and r=-0.463, respectively, p<0.001). Association between hemoglobin and PRU inhibition rate was not found. Moreover, hemoglobin exerted no influence on MPA% at all. CONCLUSION CKD is not necessarily associated with reduced antiplatelet effects of clopidogrel in elderly patients with stable CAD taking prolonged maintenance clopidogrel, and the seemingly influence of CKD on HPPR assessed by VNP2Y12 assay may be due to the artifactual effect of hemoglobin on VNP2Y12.

Association of cardiac and renal function with extreme N-terminal fragment Pro-B-type natriuretic peptide levels in elderly patients

BackgroundThe data are inconsistent regarding whether extreme N-terminal fragment pro-B-type natriuretic peptide (NT pro-BNP) levels are associated with impaired renal function. Furthermore, the relationship between extreme NT pro-BNP levels and cardiac and renal function in elderly patients has not been reported. The aim of the present study was to examine a hypothesis that extreme NT pro-BNP levels may be associated with impaired cardiac and renal function in elderly patients.MethodsWe retrospectively analyzed the data of demographic, clinical, and echocardiographic features on 152 consecutive elderly patients aged more than 80 years old (average age, 83.65 ± 3.58 years) with NT pro-BNP levels ≥ 3000 pg/ml. The participants were divided into two categories according to their NT pro-BNP levels: (1) 3000–10000 pg/mL and (2) >10000 pg /mL.ResultsThe number of patients with impaired renal function (P = 0.019) and the mortality (P < 0.001) in the period of inpatient was higher in the group with NT pro-BNP > 10000 pg /mL. The levels of serum creatinine and creatine kinase MB (CK-MB) in the group of NT pro-BNP > 10000 pg / mL were higher than those in the group of NT pro-BNP = 3000-10000 pg/mL (P = 0.001 and P = 0.023, respectively). Furthermore, no significant difference in the distribution by NYHA class in different NT pro-BNP levels was observed. Multiple linear regression analyses demonstrated that with NT pro-BNP levels as the dependent variable, NT pro-BNP levels were positively correlated with CK-MB (β = 0.182, P = 0.024) and creatinine levels (β = 0.281, P = 0.001). The area under the receiver-operating characteristic (ROC) curve of NT pro-BNP levels and clinical diagnosis of impaired renal function was 0.596 and reached significant difference (95%CI:0.503-0.688, P = 0.044).ConclusionThese data suggest that the extreme elevation of NT pro-BNP levels (≥3000 pg/ml) is mainly determined by impaired renal function in elderly patients above 80 years. Extreme NT pro-BNP levels may be useful for assessing the severity of impaired renal function.

The Relationship Between Serum Resistin Level and the Components of Metabolic Syndrome in Elderly Chinese Men

This study provides new insight into factors that identify frailty phenotypes in community-dwelling persons with PD and suggests a relationship between QoL and frailty in persons with PD. Frailty identification in PD should be a priority issue for prehabilitative geriatric services, especially with decreasing availability of neurologist care. Understanding complex interactions between frailty and PD will enable earlier identification of frailty. Knowledge gained can be used to inform management strategies that effectively target concomitant symptoms, preserving functional independence and improving QoL in persons with PD.

Association of serum resistin with cystatin C and urinary albumin-to-creatinine ratio in elderly Chinese men with essential hypertension

Purpose of the study Resistin, a recently discovered proinflammatory cytokine, has been strongly linked to kidney dysfunction. The aim of this study was to determine the relationship of serum resistin with serum cystatin C (sCysC) and albuminuria, two sensitive endogenous markers of renal function, in elderly male patients with essential hypertension (EH). Study design This was a cross-sectional study enrolling 296 Chinese men (age ≥60 years, mean age 81.42 years) diagnosed with EH between January 2008 and May 2011. Renal function was assessed by measurement of sCysC levels and albuminuria (calculated as the urine albumin-to-creatinine ratio (uACR)). Serum resistin and selected metabolic and cardiovascular markers were determined by serological testing. Relationships between serum resistin levels and sCysC levels and uACR were analysed using multiple regression analysis. Results Multiple linear regression analyses revealed that the serum resistin level was positively associated with the sCysC level and uACR (βuACR=0.132, puACR=0.002; βsCysC=0.015, psCysC=0.008). Conclusions Our findings demonstrated that a raised serum resistin level is a potential indicator of renal dysfunction in elderly patients with EH. Resistin may be explored as a potential biomarker in addition to sCysC and uACR to provide a more accurate diagnosis of renal damage in elderly men with EH.

A 15 years study of the causes of death among elderly hypertensive patients in a hospital-based sample of China

We aim to retrospectively analyze the causes of death in elderly inpatients with hypertension in a hospital-based population in China. During the study period of over 15 years, a total of 2314 cases of death in 19,996 hospitalized hypertensive patients with the age of 60 years or older were documented. The three leading causes of death were disease of heart (45.2%), cerebrovascular disease (34.3%) and renal failure (11.9%), accounting for more than 90% of death from all causes. Gender, age, stage of hypertension and risk stratification is associated with the constituent ratios of the causes of death.

Irbesartan Does Not Influence the Antiplatelet Effect of Aspirin in Spontaneously Hypertensive Rats

Because of the hemodynamic variation and endothelium impairment, hypertension is by far the most potent risk factor for stroke [1]. Considerable trials have demonstrated that early intervention with the measures of platelet aggregation and blood pressure control can effectively decrease the incidence of stroke [2]. Angiotensin receptor blockers (ARBs) and platelet aggregation inhibitor, such as aspirin, are the most commonly prescribed medications to prevent stroke in hypertensive patients. Recently, some data showed that ARBs could activate NF-jB pathway and increase proinflammatory gene expression associated with atherosclerosis and platelet aggregation through overstimulation of AT2 [3]. Long-term administration of ARBs also results in a several-fold increase in plasma AngIV, a N-terminal angiotensin degradation product, which could participate in thrombus formation through upregulating plasminogen activator inhibitor-1 expression [4]. These findings suggest that ARBs could participate in the pathogenesis of stroke and could increase platelet aggregation. So in this study, we used irbesartan, one of the ARBs, to investigate whether ARBs affect the platelet aggregation in spontaneously hypertensive rats (SHR) administered aspirin. Forty male SHR aged 14 weeks (250–300 g) were treated with aspirin (30 mg/kg/day), irbesartan (30 mg/kg/day), and their combination, and control animals with vehicle for 6 weeks. All animals received humane care and experimental procedures in compliance with institutional animal care guidelines. The platelet aggregation was determined by the light turbidimetric method. Blood for platelet aggregation studies was collected by abdominal aorta puncture from the SHR anesthetized with sodium pentobarbital (45 mg/kg i.p.). Whole blood was mixed with 3.8% trisodium citrate buffer (9:1 v/v) and then centrifuged at 114 g for 20 min at 4°C to obtain platelet-rich plasma (PRP). Platelet-poor plasma was prepared by centrifuging blood at 2682 g for 10 min and was used for adjusting the platelet concentration of PRP to 200,000–300,000 cells/mL and calibrating the aggregometer at maximal light transmittance. The maximum platelet aggregation of PRP was monitored at 37°C with platelet aggregation analysis system (IDXS-800i, Japan). Data were expressed as mean ± SD and analyzed using unpaired Student’s t-test. Statistical significance was set at P < 0.05. From the results (Figures 1 and 2), it can be found that the platelet aggregation induced with arachidonic acid (AA) and collagen in SHR fed with aspirin or combination of aspirin and irbesartan was significantly lower than in control group or irbesartan group (P < 0.001). There was no significant difference between aspirin group and combination of aspirin and irbesartan group. In the same way, there was also no significant difference between irbesartan group and control group. Large population studies have shown that aspirin reduces the incidence of both primary and secondary cerebrovascular disease by approximately 25% [5]. However, aspirin fails to prevent stroke in a large proportion of people because of insufficiently suppressed platelet aggregation named “aspirin resistance”. Some studies suggested that the activation of COX-2 induced by inflammatory factors could attenuate the antiplatelet aggregation from aspirin and thus promote platelet aggregation. We investigated whether irbesartan could play a counter-regulatory role against aspirin in SHR. The results showed that aspirin can effectively decrease the platelet aggregation in those fed with irbesartan or not, and there was also no reverse effect on platelet aggregation from irbesartan. Inflammatory mediator and oxidative stress are the major pathogenic molecular mechanisms underlying cerebral ischemic