Wenkai Xiao

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.

Influence of Low High‐Density Lipoprotein Cholesterol on Arterial Stiffening and Left Ventricular Diastolic Dysfunction in Essential Hypertension

J Clin Hypertens (Greenwich). 2011;13:710–715. ©2011 Wiley Periodicals, Inc.

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.

Multimarker Analysis for New Biomarkers in Relation to Central Arterial Stiffness and Hemodynamics in a Chinese Community-Dwelling Population.

Central arterial stiffness and hemodynamics independently reflect the risk of cardiovascular events. This Chinese community-based analysis was performed to evaluate the relationships of new biomarkers with central arterial stiffness and hemodynamics by a multimarker method. This analysis consisted of 1540 participants who were fully tested for the new biomarkers including N-terminal prohormone of brain natriuretic peptide, lipid accumulation product, triglyceride–high-density lipoprotein cholesterol (TG–HDL-c) ratio, uric acid, high-sensitivity C-reactive protein, and homocysteine. Carotid–femoral pulse wave velocity (cfPWV), central pulse pressure (cPP), and central augmentation index (cAIx) were measured. The median (range) age of entire cohort was 62 years (21-96 years), and 40.5% were males. The median (interquartile range) of cfPWV, cPP, and cAIx was 11.0 m/s (9.6-13.0 m/s), 42 mm Hg (35-52 mm Hg), and 28% (21%-33%), respectively. In multivariate analysis, participants with higher cfPWV had significantly higher age, peripheral pulse pressure, TG, TG–HDL-c ratio, and homocysteine levels compared with others (P < .05 for all). Multimarker analysis in a Chinese community-dwelling population reinforced the potential clinical value of plasma TG–HDL-c ratio and homocysteine levels as the biomarkers of increased arterial stiffness.

Association of glomerular filtration rate with arterial stiffness in Chinese women with normal to mildly impaired renal function

Objective Both decreased glomerular filtration rate (GFR) and arterial stiffness were considered as risk factors for atherosclerosis. Previous studies have suggested the association between central arterial stiffness and the degree of GFR loss. Whether decreased GFR contributes to peripheral artery stiffness remains controversial. Moreover, data analyzed from a cohort of Chinese women are rare. Our aim was to explore the relationship between GFR and regional arterial stiffness in Chinese women. Methods In this cross-sectional study, we randomly recruited 1131 adult women residents with GFR ≥ 60 mL/min per 1.73 m2 estimated by the Chinese Modification of Diet in Renal Disease equation from three large communities. Central and peripheral arterial stiffness were estimated simultaneously by measuring carotid-femoral pulse wave velocity (PWVcf) and carotid-radial PWV (PWVcr) using a validated automatic device. Augmentation Index at heart rate 75 beats/minutes (AIx-75) was measured by pulse wave analysis as a composite parameter reflecting both large and distal arterial properties. Results The mean estimated GFR (eGFR) of the study group was 100.05 ± 23.26 mL/minute per 1.73 m2. Subjects were grouped by tertiles of eGFR level. PWVcf and AIx-75 increased ongoing from the top to the bottom eGFR tertile, while the values of PWVcr were comparable. Both univariate Pearson correlations and multiple stepwise regression analyses showed that eGFR significantly correlated to PWVcf, but not to PWVcr and AIx-75. Conclusions In Chinese women with normal to mildly impaired renal function, decreased eGFR affected carotid-to-femoral rather than carotid-to-radial stiffening. This provides rational to conduct future prospective studies to investigate predictors of atherosclerosis in this population.