Leiming Luo

Association of serum lipids with arterial stiffness in a population-based study in Beijing

Eur J Clin Invest 2011; 41 (9): 929–936

Type 2 Diabetes Is Associated With Increased Pulse Wave Velocity Measured at Different Sites of the Arterial System but Not Augmentation Index in a Chinese Population

Patients with type 2 diabetes have increased stiffness of central elastic arteries. However, whether peripheral muscular artery stiffness is equally affected by the disease remains sparsely examined. Moreover, the association between pulse wave velocity (PWV) and augmentation index (AIx) in diabetes is poorly understood.

Association of risk factors for cardiovascular disease and glomerular filtration rate: a community-based study of 4925 adults in Beijing

BACKGROUND Several large prospective studies have reported that a low estimated glomerular filtration rate (eGFR) or chronic kidney disease (CKD) is independently associated with cardiovascular disease (CVD) events and all-cause mortality in high-risk populations. However, findings from community-based population studies are scarce and inconsistent. We investigated the level of eGFR and the relationship between CVD risk factors and eGFR or CKD in the population of Beijing, China. METHODS This is a community-based observational survey in residents from three communities in Beijing for a routine health status checkup. Out of 5100 individuals who were eligible for inclusion, 4925 (96.57%) had complete data and were investigated the level of eGFR and the associated factors of reduced renal function. 2085 individuals with albuminuria values were included in the analyses on the associated factors of CKD. A questionnaire was used for risk factors of CVD. Anthropometry and blood pressure were measured. Serum creatinine, total cholesterol, triglyceride (TG), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and serum glucose were detected. The urine albumin-creatinine ratio (ACR) was used as an expression for albumin excretion. The oral glucose tolerance test was performed for the participants with no history of diabetes to diagnose diabetes. eGFR was evaluated by the Chinese modified Modification of Diet in Renal Disease equation. Reduced renal function was defined as normal renal function: eGFR ≥90 mL/min/1.73 m(2); mild reduced renal function: eGFR 89-60 mL/min/1.73 m(2); moderate to severe reduced renal function: eGFR <60 mL/min/1.73 m(2). CKD was diagnosed as eGFR <60 mL/min/1.73 m(2) or albuminuria was present. RESULTS The prevalence of mild reduced renal function (eGFR 89-60 mL/min/1.73 m(2)), moderate to severe reduced renal function (eGFR <60 mL/min/1.73 m(2)) and CKD was 41.12% (2025/4925), 1.89% (93/4925) and 18.90% (394/2085) in the present study, respectively. The proportion of risk factors was higher in the low level of eGFR. Risk factors that exposed to reduced renal function were slightly different between male and female. The results of multivariate logistic regression analysis showed older age [increased by 10 years; odds ratios (OR) = 1.22], male gender (OR = 1.38), diabetes (OR = 1.67), hypertension (OR = 1.84) and hypertriglyceridaemia (≥1.7 mmol/L; OR = 1.68) were independently associated with CKD. CONCLUSIONS In the general population in Beijing, China, multiple CVD risk factors increased with a decline in eGFR and older age, hypertension, diabetes and elevated TG were independently associated with CKD.

Association between serum homocysteine and arterial stiffness in elderly: a community-based study.

Background Arterial stiffness and homocysteine are both powerful predictors of cardiovascular disease, especially in older populations. Previous studies have investigated the association of homocysteine with arterial stiffness in human subjects, while the relationship between homocysteine and arterial stiffness in the elderly is still indefinite. The current study examined the association of homocysteine with arterial stiffness in Chinese community-based elderly persons. Methods We related serum levels of homocysteine to two measures of arterial stiffness (carotid-femoral pulse wave velocity (PWV) and carotid-radial PWV) in 780 participants (46.3% men, mean age 71.9 years (ranging 65–96 years old)) from two communities of Beijing, China. Arterial stiffness was measured within two days of the time of biomarker measurement. Results In multiple-adjusted models, homocysteine levels were strongly associated with the carotid-femoral PWV (standardized β = 0.13, P < 0.001), even after adjustment for classical risk factors of cardiovascular disease. The association is also stronger when the carotid-femoral PWV is elevated above normal, whereas no significant association with homocysteine was observed for carotid-radial PWV. Conclusions In Chinese elderly persons, serum homocysteine levels are associated with alterations of aortic stiffness.

Association between blood glucose levels and high-sensitivity cardiac troponin T in an overt cardiovascular disease-free community-based study

AIM To investigate the relationship between blood glucose levels and high-sensitivity cardiac troponin T (hs-cTnT) in an overt cardiovascular disease-free community-based study. METHODS Cardiac troponin T levels were measured using a highly sensitive assay in 1365 individuals, aged 45 years or older, without overt cardiovascular disease in a community-based, cross-sectional study, in Beijing, China. All participants underwent anthropometric measurements, biochemical analysis and an oral glucose tolerance test. RESULTS Both the prevalence of detectable hs-cTnT (≥3.0 pg/mL) and elevated hs-cTnT (≥13.3 pg/mL) were significantly higher in patients with diabetes mellitus (DM) than in patients with normal glucose tolerance (NGT), and those with impaired glucose regulation (IGR). After adjustment for multiple factors, the prevalence of detectable hs-cTnT (adjusted OR=1.22) and elevated hs-cTnT (adjusted OR=1.29) in the DM group were still significantly higher than in the NGT group. hs-cTnT was related to multiple risk factors for cardiovascular events, and fasting blood glucose level was an independent predictor of hs-cTnT. CONCLUSIONS hs-cTnT showed a varied distribution in a community-based population with different blood glucose levels. Both the prevalence of detectable hs-cTnT and elevated hs-cTnT were increased significantly in the diabetic population. hs-cTnT was related to multiple risk factors for cardiovascular events, and fasting blood glucose level was an independent predictor of hs-cTnT.

Plasma Homocysteine Is Associated with Aortic Arterial Stiffness but not Wave Reflection in Chinese Hypertensive Subjects

Objective Elevated plasma total homocysteine (tHcy) acts synergistically with hypertension to exert a multiplicative effect on cardiovascular diseases risk. The aim of this study was to determine the relationship between tHcy concentration and blood pressure, and to evaluate the role of plasma tHcy in arterial stiffness and wave reflection in hypertension. Methods In this cross-sectional study, a community-based sample of 1680 subjects (mean age 61.6 years) was classified into four groups according to tHcy level (<21.6 vs. ≥21.6 µmol/l) and blood pressure (hypertensive vs. normotensive). Levels of plasma tHcy and other biochemical parameters (e.g., lipids, glucose) were determined. Central arterial blood pressure, reflected pressure wave, and carotid-femoral pulse wave velocity (cf-PWV) were assessed by tonometry within 2 days of obtaining the blood specimen. Results Neither peripheral nor central blood pressure differed according to tHcy levels in normotensive and hypertensive subjects. Differences in cf-PWV according to tHcy were observed only in hypertensive subjects; differences in cf-PWV in normotensive subjects were not significant after adjusting for confounding factors. Central augmentation index did not differ according to tHcy level in either normotensive or hypertensive subjects. Results of univariate analysis revealed significant correlations between blood pressure parameters and tHcy concentration only among normotensive subjects; however, these correlations were not significant in a partial correlation analysis. Results of multiple regression analysis showed that plasma tHcy levels were independently correlated with cf-PWV in hypertensive subjects (β = 0.713, P = 0.004). The independent relationship between tHcy and central augmentation index was not significant by further multiple analyses in normotensive or hypertensive individuals. Conclusions Plasma tHcy level is strongly and independently correlated with arterial stiffness measured as cf-PWV only in hypertensive subjects. Thus, hypertension is a major link between tHcy and aortic arterial stiffness.

Arterial stiffness is associated with minimally elevated high-sensitivity cardiac, troponin T levels in a community-dwelling population.

OBJECTIVES Arterial stiffness predicts an increased risk of future cardiovascular events, possibly via myocardial damage. Minimally elevated levels of plasma cardiac troponin T (TnT), a marker of cardiomyocyte injury, can be detected by the high-sensitivity TnT (hsTnT) assay. The current study investigated the relationship between plasma hsTnT levels and alterations in arterial stiffness in a community-based population. METHODS We related levels of plasma hsTnT to measures of arterial stiffness (carotid-femoral pulse wave velocity [PWV], office pulse pressure [PP] and carotid-radial PWV) in 1479 participants (mean age, 62.3 years; 619 men, 860 women) from a community-based population in Beijing, China. RESULTS In multiple logistic regression models, carotid-femoral PWV (OR: 1.84; 95% CI: 1.06-3.17; P=0.028) and office PP (OR: 2.02; 95% CI: 1.31-3.11; P=0.002) were associated with a higher likelihood of detectable hsTnT. In addition, carotid-femoral PWV (OR: 2.34; 95% CI: 1.03-5.30; P=0.042) and office PP (OR: 2.30; 95% CI: 1.13-4.66; P=0.022) were significantly related to elevated hsTnT levels. A subsequent subgroup analysis found that, in subjects aged 60 years and older, the associations between carotid-femoral PWV and office PP and hsTnT levels were strengthened. The associations between hsTnT with any of the arterial stiffness measures were not present in the younger subgroup (<60 years old). CONCLUSIONS Carotid-femoral PWV and office PP are associated with minimally elevated hsTnT levels in the elderly, indicating a relationship between central artery stiffness and subclinical myocardial damage.

Association of High-Density Lipoprotein Cholesterol with the Estimated Glomerular Filtration Rate in a Community-Based Population

Background Reduced kidney function is independently associated with low high-density lipoprotein cholesterol (HDL-C) levels in patients with end-stage renal disease (ESRD), those on hemodialysis, and those with stage 3–5 chronic kidney disease (CKD). However, epidemiological data investigating the relationship between HDL-C levels and kidney function in the general population with roughly normal kidney function are limited, and the results are also inconsistent. The aim of this study was to evaluate the relationship between HDL-C levels and the estimated glomerular filtration rate (eGFR) in a community-based population in China. Methods This was a community-based cross-sectional survey. In total, 4925 participants (age range, 18–96 years; mean, 51.30±11.98 years) were recruited during routine health status examinations. A questionnaire was used to ascertain age, smoking status, and the history of hypertension and diabetes mellitus for each participant. We measured the body mass index, waist circumference, systolic and diastolic blood pressure, and fasting glucose, total cholesterol, triglyceride, HDL-C, low-density lipoprotein cholesterol, uric acid, and serum creatinine level of each participant. eGFR was evaluated using the Chinese modified Modification of Diet in Renal Disease equation. Results The HDL-C level was higher in the first quartile (lowest quartile) of eGFR than in the fourth quartile (the highest quartile). Additionally, HDL-C levels decreased as eGFR decreased. Pearson’s correlation analysis revealed that HDL-C levels were associated with eGFR (r=0.16). After adjustment for some confounders, HDL-C was independently associated with all quartiles of eGFR in the participants. Conclusions HDL-C was independently associated with kidney function in a community-dwelling general population. The association between low HDL-C levels and a decreased eGFR gradually strengthened as eGFR declined.

Association of glomerular filtration rate with high-sensitivity cardiac troponin T in a community-based population study in Beijing

Background Reduced renal function is an independent risk factor for cardiovascular disease mortality, and persistently elevated cardiac troponin T (cTnT) is frequently observed in patients with end-stage renal disease. In the general population the relationship between renal function and cTnT levels may not be clear because of the low sensitivity of the assay. In this study, we investigated the level of cTnT using a highly sensitive assay (hs-cTnT) and evaluated the association of estimated glomerular filtration rate (eGFR) with detectable hs-cTnT levels in a community-based population. Methods The serum hs-cTnT levels were measured in 1365 community dwelling population aged ≥45 years in Beijing, China. eGFR was determined by the Chinese modifying modification of diet in renal disease (C-MDRD) equation. Results With the highly sensitive assay, cTnT levels were detectable (≥3pg/mL) in 744 subjects (54.5%). The result showed that eGFR was associated with Log hs-cTnT (r = −0.14, P<0.001). After adjustment for the high predicted Framingham Coronary Heart Disease (CHD) risk (10-year risk >20%) and other prognostic indicators, moderate to severe reduced eGFR was independently associated with detectable hs-cTnT, whereas normal to mildly reduced eGFR was not independently associated with detectable hs-cTnT. In addition, after adjustment for other risk factors, the high predicted Framingham CHD risk was associated with detectable hs-cTnT in the subjects with different quartile levels of eGFR. Conclusion The levels of hs-cTnT are detectable in a community-based Chinese population and low eGFR is associated with detectable hs-cTnT. Moreover, eGFR and high predicted Framingham CHD risk are associated with detectable hs-cTnT in subjects with moderate-to-severe reduced renal function.

Overall and abdominal obesity indicators had different association with central arterial stiffness and hemodynamics independent of age, sex, blood pressure, glucose, and lipids in Chinese community-dwelling adults.

Objective Limited large sample studies have specially compared overall and abdominal obesity in relation to central arterial stiffness and hemodynamics in community-dwelling adults, especially in the People’s Republic of China. This study aimed to compare the relationship between an overall obesity indicator (body mass index [BMI]), an abdominal obesity index (waist circumference [WC]), and central arterial stiffness and hemodynamics, independent of age, sex, blood pressure, glucose, and lipids, in Chinese community-dwelling adults. Methods For 2,624 adults in this study, anthropometric indices, such as BMI and WC, were measured. Central arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Central hemodynamics was represented by central pulse pressure (cPP). Results Both overall and abdominally obese adults were older, with significantly higher cfPWV, cPP, peripheral pulse pressure (pPP), fasting blood glucose (FBG), and low-density lipoprotein-cholesterol (LDL-C), and significantly lower high-density lipoprotein-cholesterol (HDL-C). After adjusting for age and sex, both the overall and abdominally obese individuals had independently higher pPP, FBG, and LDL-C levels, and lower HDL-C level. The overall obese individuals had independently higher cPP, but not cfPWV, after adjusting for age and sex, while the abdominally obese individuals had independently higher cfPWV, but not cPP. After adjusting for age, sex, pPP, FBG, LDL-C, and HDL-C, WC, but not BMI, was independently correlated with cfPWV, and BMI, but not WC, was independently associated with cPP. Age, sex, pPP, FBG, and HDL-C levels have independent association with cfPWV. Age, sex, pPP, but not FBG and HDL-C levels, have independent association with cPP. Conclusion The abdominal obesity index (WC), rather than the overall obesity indicator (BMI), was related to central arterial stiffness, independent of age, sex, blood pressure, glucose and lipids, while the overall obesity indicator (BMI), rather than the abdominal obesity indicator (WC), was independently correlated with central hemodynamics. Age, sex, and blood pressure were independently associated with central arterial stiffness and hemodynamics, but blood glucose and lipids were independently associated with central arterial stiffness, rather than hemodynamics.