Huihui Bao

Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China

Background This study aimed to describe the prevalence and risk factors of prehypertension and hypertension in Jiangxi Province, China. Individuals with prehypertension frequently progress into hypertension and are at high risk of developing cardiovascular disease and stroke. Methods A cross-sectional survey of 15,296 participants (15 years or older) was conducted in Jiangxi Province, China, in 2013, using questionnaire forms and physical measurements. Results The prevalence of prehypertension and hypertension was 32.3% (39.2% in men and 27.6% in women) and 29.0% (30.1% in men and 28.2% in women), respectively. The awareness, treatment, and control rates among all hypertensive participants were 64.8%, 27.1%, and 12.6%, respectively. The prevalence of prehypertension in males declined with age, but the prevalence of hypertension increased in different genders. The prevalence of prehypertension and hypertension increased with increasing body mass index (BMI). The prevalence of prehypertension decreased, in parallel to an increase in the prevalence of hypertension, with increasing waist circumference (WC). A combination of WC and BMI was superior to individual indices in identifying hypertension. A multivariate logistic regression analysis indicated that increasing age, high BMI, high visceral adipose index, and high heart rate were risk factors for prehypertension and hypertension. The high body fat percentage was significantly associated with prehypertension. Living in an urban area, male sex, abdominal obesity, and menopause were correlated with hypertension. Conclusions Prehypertension and hypertension are epidemic in southern China. Further studies are needed to explore an indicator that can represent the visceral fat accurately and has a close relationship with cardiovascular disease.

Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China.

Objectives The purpose of this study is to assess the prevalence of overweight/obesity, abdominal obesity and obesity-related risk factors in southern China. Methods A cross-sectional survey of 15,364 participants aged 15 years and older was conducted from November 2013 to August 2014 in Jiangxi Province, China, using questionnaire forms and physical measurements. The physical measurements included body height, weight, waist circumference (WC), body fat percentage (BFP) and visceral adipose index (VAI). Multivariate logistic regression analysis was performed to evaluate the risk factors for overweight/obesity and abdominal obesity. Results The prevalence of overweight was 25.8% (25.9% in males and 25.7% in females), while that of obesity was 7.9% (8.4% in males and 7.6% in females). The prevalence of abdominal obesity was 10.2% (8.6% in males and 11.3% in females). The prevalence of overweight/obesity was 37.1% in urban residents and 30.2% in rural residents, and this difference was significant (P < 0.001). Urban residents had a significantly higher prevalence of abdominal obesity than rural residents (11.6% vs 8.7%, P < 0.001). Among the participants with an underweight/normal body mass index (BMI), 1.3% still had abdominal obesity, 16.1% had a high BFP and 1.0% had a high VAI. Moreover, among obese participants, 9.7% had a low /normal WC, 0.8% had a normal BFP and 15.9% had a normal VAI. Meanwhile, the partial correlation analysis indicated that the correlation coefficients between VAI and BMI, VAI and WC, and BMI and WC were 0.700, 0.666, and 0.721, respectively. A multivariate logistic regression analysis indicated that being female and having a high BFP and a high VAI were significantly associated with an increased risk of overweight/obesity and abdominal obesity. In addition, living in an urban area and older age correlated with overweight/obesity. Conclusion This study revealed that obesity and abdominal obesity, which differed by gender and age, are epidemic in southern China. Moreover, there was a very high, significant, positive correlation between WC, BMI and VAI. However, further studies are needed to explore which indicator of body fat could be used as the best marker to indirectly reflect cardiometabolic risk.

The role of fQRS in coronary artery disease

BackgroundExperimental and clinical studies have suggested that the presence of fragmented QRS complex (fQRS) is associated with various cardiovascular diseases. fQRS may predict major adverse cardiovascular events (MACE). The current meta-analysis was performed using clinical outcome studies to evaluate the role of fQRS in coronary artery disease (CAD).MethodsA systematic search of electronic databases (Cochrane, Medline, Embase and Pubmed) from their inception to April 2014 was performed. Data were extracted from applicable articles to evaluate the prognostic value of fQRS in CAD.ResultsA total of 16 observational studies about fQRS and CAD (n = 3,997 patients) were identified. Compared with the non-fQRS group, MACE and mortality were significantly higher in the fQRS group —odds ratios (OR) 3.19, 95 % confidence interval (95 % CI) [2.3, 4.42], p < 0.00001; OR 2.24, 95 % CI [1.71, 2.94], p < 0.0001. Patients developed Q waves, anterior-wall myocardial infarction (MI), and low left ventricular ejection fraction (LVEF) more frequently in the fQRS group than in the non-fQRS group—OR 2.59, 95 % CI [1.76, 3.81], p < 0.00001; OR 2.43, 95 % CI [1.07, 5.52], p = 0.03; OR − 6.43, 95 % CI [− 9.11, − 3.74], p < 0.00001.ConclusionBased on current evidence, fQRS was associated with increased MACE, mortality, Q waves, anterior-wall MI, and decreased LVEF in CAD. These findings show that fQRS is a reliable marker in CAD.ZusammenfassungHintergrundExperimentelle und klinische Studien liefern Hinweise, dass das Vorliegen eines fragmentierten QRS-Komplexes (fQRS) mit verschiedenen kardiovaskulären Erkrankungen in Zusammenhang steht. Ein fQRS prognostiziert möglicherweise schwere unerwünschte kardiovaskuläre Ereignisse („major adverse cardiovascular events“, MACE). Die vorliegende Metaanalyse wurde anhand klinischer Outcome-Studien durchgeführt, um die Rolle des fQRS bei der koronaren Herzkrankheit (KHK) zu untersuchen. MethodenIn elektronischen Datenbanken (Cochrane, Medline, Embase und Pubmed) erfolgte von ihrem Beginn bis zum April 2014 eine systematische Suche. Aus geeigneten Artikeln wurden Daten extrahiert, um den prognostischen Wert des fQRS bei KHK zu ermitteln.ErgebnisseInsgesamt wurden 16 Beobachtungsstudien zu fQRS und CAD (n = 3997 Patienten) gefunden. Gegenüber der Gruppe ohne fQRS waren MACE und Mortalität in der fQRS-Gruppe signifikant höher (Odds Ratio, OR: 3,19; 95%-Konfidenzintervall, 95%-KI: 2,3–4,42; p < 0,00001; OR: 2,24; 95%-KI: 1,71–2,94; p < 0,0001). Bei den Patienten in der fQRS-Gruppe traten häufiger Q-Wellen, ein Herzinfarkt mit Lokalisierung an der Vorderwand und eine niedrigere linksventrikuläre Ejektionsfraktion (LVEF) auf als in der Gruppe ohne fQRS (OR: 2,59; 95%-KI: 1,76–3,81; p < 0,00001; OR: 2,43; 95%-KI: 1,07–5,52; p = 0,03; OR: − 6,43; 95%-KI: − 9,11; − 3,74; p < 0,00001).SchlussfolgerungGemäß der aktuellen Datenlage stand eine fQRS mit einer erhöhten Rate von MACE, Mortalität, Q-Wellen und Herzinfarkten mit Lokalisation an der Vorderwand sowie mit einer niedrigeren LVEF bei KHK in Zusammenhang. Diese Ergebnisse zeigen, dass ein fQRS ein verlässlicher Marker bei KHK ist.

The role of fQRS in coronary artery disease. A meta-analysis of observational studies.

BackgroundExperimental and clinical studies have suggested that the presence of fragmented QRS complex (fQRS) is associated with various cardiovascular diseases. fQRS may predict major adverse cardiovascular events (MACE). The current meta-analysis was performed using clinical outcome studies to evaluate the role of fQRS in coronary artery disease (CAD).MethodsA systematic search of electronic databases (Cochrane, Medline, Embase and Pubmed) from their inception to April 2014 was performed. Data were extracted from applicable articles to evaluate the prognostic value of fQRS in CAD.ResultsA total of 16 observational studies about fQRS and CAD (n = 3,997 patients) were identified. Compared with the non-fQRS group, MACE and mortality were significantly higher in the fQRS group —odds ratios (OR) 3.19, 95 % confidence interval (95 % CI) [2.3, 4.42], p < 0.00001; OR 2.24, 95 % CI [1.71, 2.94], p < 0.0001. Patients developed Q waves, anterior-wall myocardial infarction (MI), and low left ventricular ejection fraction (LVEF) more frequently in the fQRS group than in the non-fQRS group—OR 2.59, 95 % CI [1.76, 3.81], p < 0.00001; OR 2.43, 95 % CI [1.07, 5.52], p = 0.03; OR − 6.43, 95 % CI [− 9.11, − 3.74], p < 0.00001.ConclusionBased on current evidence, fQRS was associated with increased MACE, mortality, Q waves, anterior-wall MI, and decreased LVEF in CAD. These findings show that fQRS is a reliable marker in CAD.ZusammenfassungHintergrundExperimentelle und klinische Studien liefern Hinweise, dass das Vorliegen eines fragmentierten QRS-Komplexes (fQRS) mit verschiedenen kardiovaskulären Erkrankungen in Zusammenhang steht. Ein fQRS prognostiziert möglicherweise schwere unerwünschte kardiovaskuläre Ereignisse („major adverse cardiovascular events“, MACE). Die vorliegende Metaanalyse wurde anhand klinischer Outcome-Studien durchgeführt, um die Rolle des fQRS bei der koronaren Herzkrankheit (KHK) zu untersuchen. MethodenIn elektronischen Datenbanken (Cochrane, Medline, Embase und Pubmed) erfolgte von ihrem Beginn bis zum April 2014 eine systematische Suche. Aus geeigneten Artikeln wurden Daten extrahiert, um den prognostischen Wert des fQRS bei KHK zu ermitteln.ErgebnisseInsgesamt wurden 16 Beobachtungsstudien zu fQRS und CAD (n = 3997 Patienten) gefunden. Gegenüber der Gruppe ohne fQRS waren MACE und Mortalität in der fQRS-Gruppe signifikant höher (Odds Ratio, OR: 3,19; 95%-Konfidenzintervall, 95%-KI: 2,3–4,42; p < 0,00001; OR: 2,24; 95%-KI: 1,71–2,94; p < 0,0001). Bei den Patienten in der fQRS-Gruppe traten häufiger Q-Wellen, ein Herzinfarkt mit Lokalisierung an der Vorderwand und eine niedrigere linksventrikuläre Ejektionsfraktion (LVEF) auf als in der Gruppe ohne fQRS (OR: 2,59; 95%-KI: 1,76–3,81; p < 0,00001; OR: 2,43; 95%-KI: 1,07–5,52; p = 0,03; OR: − 6,43; 95%-KI: − 9,11; − 3,74; p < 0,00001).SchlussfolgerungGemäß der aktuellen Datenlage stand eine fQRS mit einer erhöhten Rate von MACE, Mortalität, Q-Wellen und Herzinfarkten mit Lokalisation an der Vorderwand sowie mit einer niedrigeren LVEF bei KHK in Zusammenhang. Diese Ergebnisse zeigen, dass ein fQRS ein verlässlicher Marker bei KHK ist.

Effect of Nicorandil Administration on Preventing Contrast-Induced Nephropathy: A Meta-Analysis

Several studies have investigated the effect of nicorandil on contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). However, the final results of these trials are not identical. This meta-analysis evaluated the role of nicorandil administration on CIN prevention. We searched databases to find randomized controlled trial (RCT) comparing nicorandil with hydration versus conventional hydration therapy on preventing CIN. Finally, 5 articles (805 patients) were included in our meta-analysis; the data showed that nicorandil was related to significant reduction in the risk of CIN (risk ratio = 0.37, 95% confidence interval [CI]: 0.22-0.61, P = .0001). We found not only the cystatin C level after operation was nonsignificant between 2 groups at the first 24 hours (P = .65, 95% CI = −0.06 to 0.04) and 48 hours (P = .19, 95% CI = −0.11 to 0.02) but also the serum creatinine level was nonsignificantly elevated, at 24 hours (P = .46, 95% CI = −5.19 to 1.88) and 72 hours (P = .49, 95% CI = −0.49 to 0.34). Our analysis suggested that the nicorandil treatment compared with conventional hydration can significantly reduce the risk of CIN.

A mutation in the CACNA1C gene leads to early repolarization syndrome with incomplete penetrance: A Chinese family study

Background Early repolarization syndrome (ERS) may be a near-Mendelian or an oligogenic disease; however, no direct evidence has been provided to support this theory. Methods and results We described a large Chinese family with nocturnal sudden cardiac death induced by ERS in most of the young male adults. One missense mutation (p.Q1916R) was found in the major subunit of the L-type calcium channel gene CACNA1C by the direct sequencing of candidate genes. A concomitant gain-of-function variant in the sodium channel gene SCN5A (p.R1193Q) was found to rescue the phenotype of the female CACNA1C-Q1916R mutation carriers, which led to the incomplete penetrance. The functional studies, via the exogenous expression approach, revealed that the CACNA1C-Q1916R mutation led to a decreasing L-type calcium current and the protein expression defect. The decreased calcium current produced by the mutant channel was improved by isoproterenol but exacerbated by testosterone. The effects of CACNA1C-Q1916R mutation and testosterone on cellular electrophysiology were further confirmed by the human ventricular action potential simulation. Conclusions Our results demonstrated that the loss-of-function CACNA1C-Q1916R mutation contributed to ERS-related sudden cardiac death, and the phenotypic incomplete penetrance was modified by the SCN5A-R1193Q variant and sex. These findings suggest that phenotypes of ERS are modified by multiple genetic factors, which supports the theory that ERS may be an oligogenic disease.

SERUM HOMOCYSTEINE LOWERING BY LONG-TERM LOW-DOSE FOLIC ACID: NEW INSIGHT ON MTHFR GENE-FOLATE INTERACTION FROM CHINA STROKE PRIMARY PREVENTION TRIAL

Background: Hypertension accompanied by elevated blood homocysteine (Hcy) can synergistically increase the risk of stroke. Folic acid (FA) can lower Hcy, but genetic effect modification has not been evaluated in large randomized trial. This post-hoc analysis of the China Stroke Primary Prevention

Pim-2 protects H9c2 cardiomyocytes from hypoxia/reoxygenation-induced apoptosis via downregulation of Bim expression.

We know that silencing Bim, a pro-apoptosis protein, significantly attenuates glucose and oxygen-deprived induced apoptosis in cardiomyocytes. However, the mechanisms underlying the regulation of the Bim activation in the heart have remained unknown. Pim-2 is one of three Pim serine/threonine kinase family members thought to be involved in cell survival and proliferation. H9c2 cardiomyocytes were subjected to a hypoxia/reoxygenation (H/R) condition in vitro, mimicking ischemic/reperfusion injury in vivo. H/R augmented the expression of Bim, Cyt C, and Pim-2 and induced H9c2 cell apoptosis. Overexpression of Pim-2 attenuated apoptosis which induced by H/R in H9c2 cells, via downregulation of Bim and Cyt C expression. Silencing of Pim-2 promoted H/R-induced apoptosis via upregulation of Bim and Cyt C expression. Co-IP revealed the interaction between Pim-2 and Bim protein, with Bim Ser65 phosphorylated by Pim-2. Furthermore, blocking proteasome activity by MG132 prevented Bim degradation, and Bim S65A mutation could reverse the anti-apoptotic role of Pim-2 which induced by H/R. These data demonstrated that Pim-2 is a novel Bim-interacting protein, which negatively regulates Bim degradation and protects H9c2 cardiomyocytes from H/R-induced apoptosis.

The Presence of Giant Epsilon Waves in a Patient with Arrhythmogenic Right Ventricular Cardiomyopathy

Epsilon wave, which is a major diagnosis criterion for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVD/C), is defined as small amplitude potentials. The present case is a 49‐year‐old man with a history of syncope and palpitations for 6 months. The ECG documented ventricular tachycardia (VT) when the patient has palpitations. However, there has been a giant epsilon wave in sinus rhythm. Electroanatomic mapping also has a prominent double potential identified on ABL catheter. The amplitude of epsilon wave reached 0.9 mV, which might be the maximum epsilon wave until now.

Relationship of sleep duration on workdays and non-workdays with blood pressure components in Chinese hypertensive patients

ABSTRACT Objectives: This study aimed to assess the relationship of sleep duration on workdays and non-workdays with BP components [systolic BP (SBP), diastolic (DBP), pulse pressure (PP), and mean arterial pressure (MAP)] among Chinese hypertensive adults. Methods: The study included 3,376 hypertensive patients without antihypertensive treatment. Self-reported sleep durations on workdays and non-workdays were measured by the questionnaire. Multiple linear regression analyses were performed to evaluate the association of sleep duration with BP components. Results: Overall, compared with a sleep duration of 5–9 h, individuals who slept ≥10 h on both workdays and non-workdays were positively correlated with SBP [β (95% CIs) = 3.99 (1.06, 6.93) and 4.33 (1.79, 6.87)] and PP [β (95% CIs) = 3.25 (0.71, 5.79) and 3.05 (0.85, 5.25)], but not with DBP. Moreover, individuals who slept ≥10 h only on non-workdays had higher MAP [β (95% CIs) = 2.30 (0.63, 3.97)]. The stratified analyses showed that subjects with a BMI ≥24 kg/m2 in the longer sleep duration group (≥10 h) only on workdays compared to the reference group had higher SBP, DBP and MAP (all P for interaction <0.05). The effect of longer sleep duration on BP components showed no difference in the following subgroups: sex, age, smoking and drinking (all P for interaction >0.05). Conclusion: Compared with a sleep duration of 5–9 h, longer sleep duration (≥10 h) on workdays and non-workdays was associated with high SBP and PP among Chinese hypertensive adults without antihypertensive treatment.