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This study aims to evaluate the age- and sex-specific associations of comorbidities with stroke and MI and further calculate the population-attributable fractions (PAFs) of five comorbid diseases for stroke and myocardial infarction (MI) by age and sex. This is a prospective cohort study. This study leveraged data from a sub-cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project. Participants aged 35–75 years without a prevalent stroke and MI were enrolled from January 2016 to December 2020, with follow-up through December 2021. Five common comorbidities were collected at baseline, and the study outcome was hospitalization for stroke and MI identified from the Inpatients Registry. Of 100,873 participants, the mean age was 54.2 (±10.2) years, 34.2% were ≥60 years old, and 60.8% were women. After a median follow-up of 3.52 years, 4156 participants had stroke/MI. The strengths of the associations between hypertension, diabetes, and obesity with stroke/MI were higher in younger individuals than in seniors, and obesity had a more hazardous impact on stroke/MI in men than in women. The five comorbidities collectively explained a higher population attributable fraction (PAF) for stroke/MI in the young group (51.5[46.9, 55.7] %) than in the senior group (41.3[37.0, 45.4] %), in men (45.6[40.9, 49.9] %) than in women (41.1[36.1, 45.7] %). Most of the common comorbidities were significantly associated with stroke and MI. Several age and sex differences in the impacts of comorbidities on stroke/MI were observed, highlighting the importance of age- and sex-specific preventive strategies to reduce premature stroke and MI. [Display omitted] [ABSTRACT FROM AUTHOR]

Existing evidence suggested that short-term exposure to fine particulate matter (PM 2.5) may increase the risk of death from myocardial infarction (MI), while PM 2.5 constituents responsible for this association has not been determined. We collected 12,927 MI deaths from 32 counties in southern China during 2011–2013. County-level exposures of ambient PM 2.5 and its 5 constituents (i.e., elemental carbon (EC), organic carbon (OC), sulfate (SO 4 2-), ammonium (NH 4 +), and nitrate (NO 3 -)) were aggregated from gridded datasets predicted by Community Multiscale Air Quality Modeling System. We employed a space-time-stratified case-crossover design and conditional logistic regression models to quantify the association of MI mortality with short-term exposure to PM 2.5 and its constituents across various lag days. Over the study period, the daily mean PM 2.5 mass concentration was 77.8 (standard deviation (SD) = 72.7) µg/m3. We estimated an odds ratio of 1.038 (95% confidence interval (CI): 1.003–1.074), 1.038 (1.013–1.063) and 1.057 (1.023–1.097) for MI mortality associated with per interquartile range (IQR) increase in the 3-day moving-average exposure to PM 2.5 (IQR = 76.3 µg/m3), EC (4.1 µg/m3) and OC (9.1 µg/m3), respectively. We did not identify significant association between MI death and exposure to water-soluble ions (SO 4 2-, NH 4 + and NO 3 -). Likelihood ratio tests supported no evident violations of linear assumptions for constituents-MI associations. Subgroup analyses showed stronger associations between MI death and EC/OC exposure in the elderly, males and cold months. Short-term exposure to PM 2.5 constituents, particularly those carbonaceous aerosols, was associated with increased risks of MI mortality. [Display omitted] [ABSTRACT FROM AUTHOR]

We aimed to assess the feasibility and superiority of machine learning (ML) methods to predict the risk of Major Adverse Cardiovascular Events (MACEs) in chest pain patients with NSTE-ACS. Enrolled chest pain patients were from two centers, Beijing Anzhen Emergency Chest Pain Center Beijing Bo'ai Hospital, China Rehabilitation Research Center. Five classifiers were used to develop ML models. Accuracy, Precision, Recall, F-Measure and AUC were used to assess the model performance and prediction effect compared with HEART risk scoring system. Ultimately, ML model constructed by Naïve Bayes was employed to predict the occurrence of MACEs. According to learning metrics, ML models constructed by different classifiers were superior over HEART (History, ECG, Age, Risk factors, & Troponin) scoring system when predicting acute myocardial infarction (AMI) and all-cause death. However, according to ROC curves and AUC, ML model constructed by different classifiers performed better than HEART scoring system only in prediction for AMI. Among the five ML algorithms, Linear support vector machine (SVC), Naïve Bayes and Logistic regression classifiers stood out with all Accuracy, Precision, Recall and F-Measure from 0.8 to 1.0 for predicting any event, AMI, revascularization and all-cause death (vs. HEART ≤ 0.78), with AUC from 0.88 to 0.98 for predicting any event, AMI and revascularization (vs. HEART ≤ 0.85). ML model developed by Naïve Bayes predicted that suspected acute coronary syndrome (ACS), abnormal electrocardiogram (ECG), elevated hs-cTn I, sex and smoking were risk factors of MACEs. Compared with HEART risk scoring system, the superiority of ML method was demonstrated when employing Linear SVC classifier, Naïve Bayes and Logistic. ML method could be a promising method to predict MACEs in chest pain patients with NSTE-ACS. [ABSTRACT FROM AUTHOR]

Cardiovascular health level according to the American Heart Association's Life's Essential 8 (LE8) in China and its effectiveness on the 10-year and lifetime risk of atherosclerotic cardiovascular diseases is unclear. This prospective study included 88,665 participants in the China-PAR cohort (data from 1998 to 2020) and 88,995 in the Kailuan cohort (data from 2006 to 2019). Analyses were conducted by November 2022. LE8 was measured according to the American Heart Association's LE8 algorithm, and a high cardiovascular health status was defined as a LE8 score ≥80 points. Participants were followed for the primary composite outcomes, including fatal and nonfatal acute myocardial infarction, ischemic stroke, and hemorrhagic stroke. The lifetime risk was estimated from the cumulative risk of atherosclerotic cardiovascular diseases through ages 20−85 years, the association of LE8 and LE8 change with atherosclerotic cardiovascular diseases was assessed with the Cox proportional-hazards model, and partial population-attributable risks evaluated the proportion of atherosclerotic cardiovascular diseases that could be averted. The mean LE8 score was 70.0 in the China-PAR cohort and 64.6 in the Kailuan cohort, with 23.3% and 8.0% of participants having a high cardiovascular health status, respectively. Participants in the highest quintile had about 60% lower 10-year and lifetime risk of atherosclerotic cardiovascular diseases in the China-PAR and Kailuan cohorts than participants with the lowest quintile LE8 score. If everyone maintained the highest quintile of LE8 score, approximately half of the atherosclerotic cardiovascular diseases could be prevented. The participant with LE8 score that increased from the lowest to the highest tertile during 2006−2012 had a 44% (hazard ratio=0.56; 95% CI=0.45, 0.69) lower observed risk and a 43% (hazard ratio=0.57; 95% CI=0.46, 0.70) lower lifetime risk of atherosclerotic cardiovascular diseases than those remaining in the lowest tertile in the Kailuan cohort. The LE8 score was below optimal levels in Chinese adults. A high baseline LE8 score and an improving LE8 score were associated with decreased 10-year and lifetime risk of atherosclerotic cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Deferred revascularization of mildly stenotic coronary vessels based exclusively on physiological evaluation is associated with up to 5% residual incidence of future adverse events at 1 year. We aimed to evaluate the incremental value of angiography-derived radial wall strain (RWS) in risk stratification of non–flow-limiting mild coronary narrowings. This is a post hoc analysis of 824 non–flow-limiting vessels in 751 patients from the FAVOR III China (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) trial. Each individual vessel had ≥1 mildly stenotic lesion. The primary outcome was vessel-oriented composite endpoint (VOCE), defined as the composite of vessel-related cardiac death, vessel-related myocardial infarction (nonprocedural), and ischemia-driven target vessel revascularization at 1-year follow-up. During 1-year follow-up, VOCE occurred in 46 of 824 vessels, with a cumulative incidence of 5.6%. Maximum RWS (RWS max) was predictive of 1-year VOCE with an area under the curve of 0.68 (95% CI: 0.58-0.77; P < 0.001). The incidence of VOCE was 14.3% in vessels with RWS max >12% vs 2.9% in those with RWS max ≤12%. In the multivariable Cox regression model, RWS max >12% was a strong independent predictor of 1-year VOCE in deferred non–flow-limiting vessels (adjusted HR: 4.44; 95% CI: 2.43-8.14; P < 0.001). The risk of deferred revascularization based on combined normal RWS max and Murray–law-based quantitative flow ratio (μQFR) was significantly reduced compared with μQFR alone (adjusted HR: 0.52; 95% CI: 0.30-0.90; P = 0.019). Among vessels with preserved coronary flow, angiography-derived RWS analysis has the potential to further discriminate vessels at risk of 1-year VOCE. (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease [FAVOR III China Study]; NCT03656848) [Display omitted] [ABSTRACT FROM AUTHOR]

Bioresorbable scaffolds (BRS) emerged as an alternative to conventional stents with a fundamental idea, to avoid a permanent metallic cage with all its harmful effects on the vessel. The Absorb BVS was the first widely studied device with the promising concept of performing a percutaneous coronary intervention, giving the necessary initial support to maintain vessel integrity and avoid acute vessel thrombosis. After a period, complete resorption of the device without leaving in the vessel any metallic structure would theoretically offer several benefits as the reduction of the inflammatory response and recovering normal vasomotor function, recovering access of jailed side-branches and segments for surgical revascularization, and the reduction of very late stent thrombosis derived from late acquired malapposition. However, cumulative evidence from the different absorb randomized trials (ABSORB II, ABSORB III, ABSORB China, ABSORB Japan) raised significant concerns, due to an elevated rate of scaffold thrombosis, target lesion failure and target vessel failure, when compared to contemporary everolimus drug-eluting stents. Several mechanisms arose explaining scaffold failure; some were strictly related to the device itself, and others related to the operator and the lesion itself. Newer generation BRS are under development targeting the main limitations of the ABSORB BVS, mainly focusing on reducing strut thickness, improving the mechanical structure with faster resorption times, and a better crossing profile. The story of BRS is not over yet, with ongoing refinements in the quest for the ideal stent. • The ideal device to be used for PCI should relief the coronary obstruction with virtually no side effects. • BRS provided the possibility of restoring vessel integrity without leaving in the vessel any metallic structure. • Evidences of an higher-than expected rate of target vessel failure, mainly driven by an high rate of ScT and ScR has reduced the initial enthusiasm. [ABSTRACT FROM AUTHOR]

The incidence and mortality rate of myocardial infarction are increasing per year in China. The polarization of macrophages towards the classically activated macrophages (M1) phenotype is of utmost importance in the progression of inflammatory stress subsequent to myocardial infarction. Poly (ADP-ribose) polymerase 1(PARP1) is the ubiquitous and best characterized member of the PARP family, which has been reported to support macrophage polarization towards the pro-inflammatory phenotype. Yet, the role of PARP1 in myocardial ischemic injury remains to be elucidated. Here, we demonstrated that a myocardial infarction mouse model induced cardiac damage characterized by cardiac dysfunction and increased PARP1 expression in cardiac macrophages. Inhibition of PARP1 by the PJ34 inhibitors could effectively alleviate M1 macrophage polarization, reduce infarction size, decrease inflammation and rescue the cardiac function post-MI in mice. Mechanistically, the suppression of PARP1 increase NLRC5 gene expression, and thus inhibits the NF-κB pathway, thereby decreasing the production of inflammatory cytokines such as IL-1β and TNF-α. Inhibition of NLRC5 promote infection by effectively abolishing the influence of this mechanism discussed above. Interestingly, inhibition of NLRC5 promotes cardiac macrophage polarization toward an M1 phenotype but without having major effects on M2 macrophages. Our results demonstrate that inhibition of PARP1 increased NLRC5 gene expression, thereby suppressing M1 polarization, improving cardiac function, decreasing infarct area and attenuating inflammatory injury. The aforementioned findings provide new insights into the proinflammatory mechanisms that drive macrophage polarization following myocardial infarction, thereby introducing novel potential targets for future therapeutic interventions in individuals affected by myocardial infarction. Inhibition of PARP1 increased NLRC5 expression, and repressed NF-κB signaling with decreasing the production of inflammatory cytokines such as IL-1β, TNF-α, thereby suppressing M1 polarization, improving cardiac function, decreasing infarct area and attenuating inflammatory injury. [Display omitted] • PJ34 treatment post-MI enhances NLRC5, improving cardiac function and inflammation outcomes. • NLRC5 inhibition leans cardiac macrophages towards M1, affecting M2 minimally. • PARP1 inhibition via PJ34 ups NLRC5, curbs NF-κB, and improves heart recovery after MI. [ABSTRACT FROM AUTHOR]

The impact of fibrinolysis-first strategy on outcomes of patients with ST-segment-elevation myocardial infarction (STEMI) during the COVID-19 pandemic was unknown. Data from STEMI patients presenting to Fuwai Hospital from January 23 to April 30, 2020 were compared with those during the equivalent period in 2019. The primary end-point was net adverse clinical events (NACE; a composite of death, non-fatal myocardial reinfarction, stroke, emergency revascularization, and bleeding over BARC type 3). The secondary outcome was a composite of recurrent ischaemia, cardiogenic shock, and exacerbated heart failure. The final analysis included 164 acute STEMI patients from 2020 and 240 from 2019. Eighteen patients (20.2% of those with indications) received fibrinolysis therapy in 2020 with a median door-to-needle time of 60.0 (43.5, 92.0) minutes. Patients in 2020 underwent primary PCI less frequently than their counterparts (14 [14.2%] vs. 144 [86.8%] in 2019, P < 0.001), and had a longer median door-to-balloon time (175 [121,213] minutes vs. 115 [83, 160] minutes in 2019, P = 0.009). Patients were more likely to undergo elective PCI (86 [52.4%] vs. 28 [11.6%] in 2019, P < 0.001). The in-hospital NACE was similar between 2020 and 2019 (14 [8.5%] vs. 25 [10.4%], P = 0.530), while more patients developed a secondary outcome in 2020 (20 [12.2%] vs. 12 [5.0%] in 2019, P = 0.009). The fibrinolysis-first strategy during the COVID-19 pandemic was associated with a lower rate of timely coronary reperfusion and increased rates of recurrent ischaemia, cardiogenic shock, and exacerbated heart failure. However, the in-hospital NACE remained similar to that in 2019. • Fibrinolysis-first strategy for STEMI was used in China during the COVID-19 pandemic. • Delayed primary PCI and the index elective PCI are integral parts of the strategy. • This strategy decreased the rate of timely coronary reperfusion. • Rates of recurrent ischaemia, cardiogenic shock, and heart failure increased overall. • The strategy didn't increase the rate of in-hospital net adverse clinical events. [ABSTRACT FROM AUTHOR]

This study aimed to determine the association of hyperlipidemia with clinical endpoints among hospitalized patients with COVID-19, especially those with pre-existing cardiovascular diseases (CVDs) and diabetes. This multicenter retrospective cohort study included all patients who were hospitalized due to COVID-19 from 21 hospitals in Hubei province, China between December 31, 2019 and April 21, 2020. Patients who were aged < 18 or ≥ 85 years old, in pregnancy, with acute lethal organ injury (e.g., acute myocardial infarction, severe acute pancreatitis, acute stroke), hypothyroidism, malignant diseases, severe malnutrition, and those with normal lipid profile under lipid-lowering medicines (e.g., statin, niacin, fenofibrate, gemfibrozil, and ezetimibe) were excluded. Propensity score matching (PSM) analysis at 1:1 ratio was performed to minimize baseline differences between patient groups of hyperlipidemia and non-hyperlipidemia. PSM analyses with the same strategies were further conducted for the parameters of hyperlipidemia in patients with increased triglyceride (TG), increased low-density lipoprotein cholesterol (LDL-C), and decreased high-density lipoprotein cholesterol (HDL-C). Mixed-effect Cox model analysis was performed to investigate the associations of the 28-days all-cause deaths of COVID-19 patients with hyperlipidemia and the abnormalities of lipid parameters. The results were verified in male, female patients, and in patients with pre-existing CVDs and type 2 diabetes. Of 10 945 inpatients confirmed as COVID-19, there were 9 822 inpatients included in the study, comprising 3513 (35.8%) cases without hyperlipidemia and 6309 (64.2%) cases with hyperlipidemia. Based on a mixed-effect Cox model after PSM at 1:1 ratio, hyperlipidemia was not associated with increased or decreased 28-day all-cause death [adjusted hazard ratio (HR), 1.17 (95% CI, 0.95-1.44), P =0.151]. We found that the parameters of hyperlipidemia were not associated with the risk of 28-day all-cause mortality [adjusted HR, 1.23 (95% CI, 0.98-1.55), P = 0.075 in TG increase group; 0.78 (95% CI, 0.57-1.07), P = 0.123 in LDL-C increase group; and 1.12 (95% CI, 0.9-1.39), P = 0.299 in HDL-C decrease group, respectively]. Hyperlipidemia was also not significantly associated with the increased mortality of COVID-19 in patients accompanied with CVDs or type 2 diabetes, and in both male and female cohorts. Our study support that the imbalanced lipid profile is not significantly associated with the 28-day all-cause mortality of COVID-19 patients, even in those accompanied with CVDs or diabetes. Similar results were also obtained in subgroup analyses of abnormal lipid parameters. Therefore, hyperlipidemia might be not a major causative factor for poor outcome of COVID-19, which provides guidance for the intervention of inpatients during the epidemic of COVID-19. [ABSTRACT FROM AUTHOR]

Background: The pandemic of COVID-19 has created a crisis in healthcare systems across the globe. This situation would affect the diagnosis and treatment of patients with STEMI. The outbreak was under improved control in the mainland of China. We here describe the impact of this pandemic on STEMI patient's management.Methods: Information of STEMI patient management was collected from the CPC data reporting platform. We compared these with data of patients from the same period in 2018 and 2019. Also we made an analysis of those characteristics in each month in 2020.Results: There was 51.4% decrease of STEMI patients admitted to hospital during the peak period of COVID-19 epidemic. The ratio of no reperfusion of STEMI patients is more than 10% higher in 2020 than 2018, 2019. The percentage of STEMI patients received fibrinolysis in 2020 was 2 to 3 times higher than that in 2018, 2019, while the volume of PPCI dropped by more than half. The mortality rate of whole cohort and perioperative was the highest in February 2020.Conclusions: COVID-19 pandemic dramatically reduced the number of STEMI patients attending hospital and delay the time to treatment and consequently, a higher in-hospital mortality. The benefits of thrombolysis during the pandemic remain to be proven. [ABSTRACT FROM AUTHOR]

Graphical abstract This review article mainly focuses on the mechanism of action (MoA) of Dantonic® for the treatment of chronic stable angina, which includes the promotion of coronary microcirculation, the optimization of myocardial energy metabolism and the inhibition of platelet aggregation. Highlights • Dantonic® is a currently used medicine for chronic stable angina (CSA) in China. • The mechanism of action (MoA) of Dantonic® for CSA mainly includes three aspects. • The MoA of Dantonic® for CSA includes promoting coronary microcirculation. • The MoA of Dantonic® for CSA includes optimizing myocardial energy metabolism. • The MoA of Dantonic® for CSA includes inhibiting platelet aggregation. Abstract Chronic stable angina (CSA) presents as a complication of coronary heart disease, leading to a high incidence and mortality rate worldwide. Dantonic® or Compound Danshen Dripping Pills (CDDP) is a well-known traditional Chinese medicine used for the treatment of myocardial ischemic diseases, such as angina pectoris (AP), myocardial infarction, and sudden death. Dantonic® has been extensively utilized in clinical practice in China for more than 14 years and has proved to be an effective therapy for the treatment of many myocardial ischemic diseases since its approval by CFDA in 1994. Clinical studies in China have shown that Dantonic® is an effective and safe drug for the treatment of angina pectoris manifested with ameliorating anginal symptoms and showing few adverse effects. Nevertheless, the mechanism of Dantonic® for the treatment of angina has been underestimated. Therefore, in this review, we mainly focus on discussing the pharmacological mechanism of action (MoA) of Dantonic® for the treatment of CSA, including the promotion of coronary microcirculation, the optimization of myocardial energy metabolism, and the inhibition of platelet aggregation. [ABSTRACT FROM AUTHOR]

Background Acute myocardial infarction (AMI) has sharply increased and become a major cause of hospitalization and mortality in China over the past few decades, with the rapid economic development and substantial life-style changes. Methods We compared the characteristics, risk factors, and in-hospital outcomes among 1314 patients with AMI from Beijing Collaborative Group data in 1972 and 1973, and 2200 patients in Beijing from China AMI registry in 2013 and 2014. Results The proportions of patients with <30 and >70 years old in 2010s were significantly higher than those in 1970s (1970s vs 2010s: 0.2% vs 0.9% and 15.8% vs 25.6%, respectively, p  < 0.05). The proportion of male patients was higher in 2010s (75.6%) than that (68.3%) in 1970s ( p  < 0.001). Rural population with AMI markedly increased (1970s vs 2010s: 6.5% vs 14.5%, p  < 0.001). Patients with AMI in 2010s were more likely to have a history of diabetes mellitus (DM), prior stroke and myocardial infarction (MI) than those in 1970s (1970s vs 2010s: DM 6.2% vs 27.6%; prior stroke 6.2% vs 10.5%; prior MI 9.5% vs 11.9%; all p  < 0.05). The in-hospital mortality was significantly lower in 2010s (2.6%) than that in 1970s (24%; p  < 0.05). Conclusions Age, gender, rural population, diabetes, prior stroke and MI history as well as in-hospital mortality were significantly different among patients with AMI in Beijing over 40 years. The patterns most likely reflect big lifestyle changes, improved socioeconomic status, less targeted heart disease prevention programs, and advance in medical therapies. [ABSTRACT FROM AUTHOR]

Monitoring data on fine particulate matter (PM 2.5 ) level in China's major cities were available since 2013. We conducted a time-stratified case-crossover study to evaluate the association between short-term exposure to PM 2.5 and hospital admissions for acute myocardial infarction (AMI), as well as subsequent cardiac and AMI readmissions among AMI survivors. Hospital admissions for ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI) from 1 January 2014 through 31 December 2015 were identified from electronic Hospitalization Summary Reports. Conditional logistic regression was used to explore the relation between PM 2.5 and hospital admissions for AMI. Individuals discharged alive following STEMI in 2014 were followed up for subsequent readmissions through 31 December 2015. We used the Cox proportional hazards model to evaluate the effect of PM 2.5 pollution on subsequent cardiac and STEMI readmissions. Hospital admissions for STEMI (n = 106,467) and NSTEMI (n = 12,719) were examined separately. Exposure to an interquartile range (IQR) increase in PM 2.5 concentration (47.5 μg/m 3 ) at lags 2, 3, 4 and 0–5 days corresponded with 0.6% (95% CI, 0.1%–1.1%), 0.8 (95% CI, 0.3%–1.3%), 0.6% (95% CI, 0.1%–1.1%) and 0.9% (95% CI, 0–1.8%) increases in STEMI admissions, respectively. For NSTEMI, no significant association was observed with PM 2.5 . We also observed significant associations of PM 2.5 concentration with both subsequent cardiac and STEMI readmissions among STEMI survivors. In conclusion, short-term elevations in PM 2.5 concentration may increase the risk of STEMI but not NSTEMI, and the association appeared to be more evident among STEMI survivors. [ABSTRACT FROM AUTHOR]

Background: Zinc is one of the most important microelements in the body and zinc homeostasis plays a critical role in maintaining cellular structure and function. Zinc dyshomeostasis can lead to many diseases, such as cardiovascular disease. Our aim was to investigate whether there is a relationship between zinc and cardiac markers, and the risk of acute myocardial infarction (AMI) by zinc quartiles.Methods: We enrolled a total of 529 patients and measured their serum zinc levels and cardiac markers. We performed further studies after dividing subjects into four groups according to their concentrations of zinc by quartile to clarify the relationship between zinc levels and risk of increased acute myocardial infarction prevalence rate.Results: We observed that there was a significant inverse linear relationship between zinc and Lg(creatine kinase) (p=0.011), Lg(creatine kinase-MB) (p=0.002) and Lg(cardiac troponin T) (p=0.045). In addition, the acute myocardial infarction prevalence rates were 28.8%, 24.8%, 20.5%, and 18.2% by patients with zinc quartiles, respectively. Multivariate logistic regression analysis showed that the odds ratio between the lowest and highest zinc quartile groups was 1.92 (1.019-3.604) (p<0.05).Conclusions: The present study revealed a relationship between serum zinc levels in that zinc levels were significantly inversely correlated with serum creatine kinase (CK), creatine kinase-MB (CKMB) and cardiac troponin T (cTnT) levels. Furthermore, we found that the prevalence rate of acute myocardial infarction decreased with increasing zinc quartiles. [ABSTRACT FROM AUTHOR]

Incidence rate of cardiovascular disease (CVD) has significant seasonal trend, being higher in winter. However, the extent to which the seasonal variation of CVD deaths was caused by temperature remains unclear. We obtained daily data on temperature and CVD and myocardial infarction (MI) mortality from nine Chinese mega-cities during 2007-2013. Distributed lag non-linear models were applied to assess the city-specific temperature-related daily excess deaths across lag 0-21 days, using the minimum-mortality temperature as reference. Then, estimates of excess deaths in four seasons were separately aggregated from the daily series, and its ratio to the corresponding total deaths produced seasonal attributable fraction (AF). In total, 1,079,622 CVD and 201,897 MI deaths were recorded in the nine Chinese cities. Significant and non-linear associations between temperature and mortality were observed, with a total of 195,516 CVD and 50,658 MI deaths attributable to non-optimum temperatures. 103,439 (95% empirical CI: 54,475-141,537) CVD and 24,613 (5891-36,279) MI deaths related to non-optimum temperature occurred in winter, compared with 15,923 (1436-28,853) and 4946 (-325-9016) in summer. Temperature-related AFs were higher among MI than CVD, with AFs of 42% (9-62%) and 35% (19-48%) in winter, and 13% (-1-23%) and 8% (1-14%) in summer, respectively. This study may have important implications for developing effective targeted intervention measures on CVD events. [ABSTRACT FROM AUTHOR]

Background In contrast with most developed countries, mortality from acute myocardial infarction (AMI) continues to rise in China. We examined secular trends and age, period, and cohort effects in mortality from AMI in China from 1987 to 2014. Methods Data on deaths from AMI between 1987 and 2014 were obtained from the Chinese Health Statistics Annual Report (1987–2001) and the Chinese Health Statistics Yearbook (2003–2015). We then conducted an age-period-cohort analysis using the intrinsic estimator approach. Results There was an upward trend in AMI mortality in both urban and rural populations that accelerated from 2004 onwards. AMI mortality increased 5.6-fold from 1987 to 2014. The net age effect on AMI mortality increased exponentially. AMI mortality risk in the 80–84 years of age bracket was 220.15 and 190.70 times higher than in the 15–19 years of age bracket in urban and rural populations, respectively. There was a V-shaped trend in the net period effect between 1999 and 2009. Meanwhile, although there was a global reduction in the cohort effect in urban and rural AMI mortality, we found a modest increase among urban populations born between 1975 and 1989 and rural populations born between 1990 and 1999. Conclusion The changes in exposure to lifestyle-related risk factors and triggers such as air pollution have contributed to the increase in AMI mortality in China over recent decades. The sharp increase in AMI mortality since 2004 is primarily attributable to population aging and the rise in AMI deaths among younger generations. [ABSTRACT FROM AUTHOR]

To investigate the risk factors of dapagliflozin-associated diabetic ketosis/ketoacidosis (DK/DKA) in patients with type 2 diabetes mellitus (T2DM). A case-control study was conducted in a general hospital in China from 2018 to 2021. T2DM patients who developed DK/DKA after dapagliflozin treatment were identified. Each patient in the DA/DKA group was matched with a patient in the non-DK/DKA group in terms of the baseline characteristics. Receiver operating characteristic (ROC) curve analysis and logistic regressions were performed. Out of 1,684 hospitalized patients taking dapagliflozin, 170 were diagnosed with dapagliflozin-associated DK/DKA. A total of 137 cases were matched with 137 controls. The mean time-to-onset (TTO) of DK/DKA was 28.59 days. Logistic regression showed that current drinking (OR = 7.656, p < 0.001), T2DM duration ≥ 7.625 years (OR = 2.399, p = 0.017), acute ST-elevations myocardial infarction (STEMI) (OR = 12.770, p = 0.028), acute infection (OR = 2.862, p = 0.043), insulin dose reduction/cessation before dapagliflozin exposure (OR = 6.751, p < 0.001), and a major plus or major operation (OR = 2.652, p = 0.022) were risk factors for dapagliflozin-associated DK/DKA. Furthermore, T2DM duration ≥ 7.625 years (p = 0.046) and acute STEMI (p < 0.001) were independently associated with more severe DK/DKA. Current drinking, long T2DM duration, STEMI, acute infection, insulin deficiency, and major operation are the risk factors associated with DK/DKA in T2DM patients. Furthermore, long T2DM duration and STEMI were associated with more severe DK/DKA situations. [ABSTRACT FROM AUTHOR]

Background Familial hypercholesterolemia (FH) is marked by an elevated plasma cholesterol and risk of premature cardiovascular disease. An increased burden of FH is being realized. Objective To provide data on FH in Chinese patients with myocardial infarction (MI) and its potential contribution to early MI. Methods A total of 1843 consecutive patients undergoing coronary angiography with their first MI were recruited. The clinical FH was diagnosed using the Dutch Lipid Clinic Network criteria. The prevalence and clinical features of FH and the relationship of FH to risk of early MI were investigated. Results Of the 1843 patients, 48.2% were detected as premature MI (pMI, the onset age ≤55 years for men, ≤60 years for women). The prevalence of definite/probable FH reached 3.9% (7.1% in pMI and 0.9% in non-pMI). Furthermore, we found that the risk of pMI was significantly elevated in both definite/probable FH (vs. unlikely FH, odds ratio, 5.05 [1.10–23.23]) and possible FH (vs unlikely FH, odds ratio, 2.65 [1.22–5.77]), independently from classical risk factors and medications. Additionally, patients with definite/probable FH occurred 10 years younger than those with unlikely FH in the onset age of MI (48.63 ± 1.20 vs 58.35 ± 0.30 years, P < .001). When considered in subgroup of pMI or non-pMI, an early onset of MI was also observed in definite/probable FH (pMI, 45.83 ± 0.89 vs 47.87 ± 0.34 years; non-pMI, 60.75 ± 1.96 vs 65.07 ± 0.22 years; both P < .05). Conclusion The prevalence of FH among Chinese patients with MI appeared common, particularly among those with pMI. The phenotypic FH might significantly promote the early onset of MI. [ABSTRACT FROM AUTHOR]

We adopted a difference-in-difference (DID) design to evaluate the impact of a case-based payment pilot in Tianjin, China on hospital admission, utilization of varied therapeutic regimes, and the associated costs. We used claim data of all admissions of angina and acute myocardial infarction during July 2015 to June 2018, 18 months before and after the program. Our analyses were supported by convincing common trends tests and a couple of sensitivity analyses. As intended, for patients who received percutaneous coronary stenting (PCS) and were counted in the case-based payment system, we showed that the program decreased length-of-stay, per-admission spending, and out-of-pocket spending by 20.8%, 14.2%, and 95.5%, respectively, but did not increase readmissions. However, when considering all patients who suffered from the two types of coronary heart diseases, we found that the program otherwise increased per-admission spending by nearly 11%. As a result, the program took a perverse effect in increasing monthly spending for the health insurance scheme and the society by 1005.6 thousand USD (47·5%) and 1095·7 thousand USD (34·7%), respectively. Increases in hospital admissions, and proportion of performing PCS accounted for 66·7% and 39·2% of the rise, respectively. In addition, our analysis provided evidence of health providers' cream-skimming behaviors, including selecting younger patients with lower CCI in the case-based system, up-coding complications, and keeping higher cost patients in the fee-for-service payment system. We draw lessons that case-based payment may make an unintended impact that increases healthcare costs when incentives are not properly designed. • The case-based payment pilot decreased per-admission costs for case-mixes included. • For the specific diseases, the program however increased per-admission spending. • Admissions receiving high cost therapeutic regimes accounted for the rise. • The program decreased LOS and OOP costs but did not increase readmissions. • Patient selection and up-coding were profound. [ABSTRACT FROM AUTHOR]

Objective: Although sleep is one of the most important health-related factors, the association of sleep duration with incidence of myocardial infarction or all-cause death has not been fully understood, especially in the general Chinese population. The objective of this study was to explore the relationship between sleep duration and risk of myocardial infarction and all-cause death in China.Methods: Out of the 101,510 participants who were originally included into the Kailuan prospective cohort study and followed up for an average of 3.98 years, 95,903 participants were actually sampled to evaluate the impacts of sleep duration on myocardial infarction and all-cause death. Sleep duration was categorized as ≤5, 6, 7, and 8 hours/night, and ≥9 hours per night. Cox proportional hazards models were used to analyze the association of sleep duration with the incidence of myocardial infarction and all-cause death.Results: After a mean follow-up period of 3.98 years, 423 participants developed myocardial infarction and 1793 participants died. A U-shape association between sleep duration and all-cause death was found. The age- and gender-adjusted hazard ratios (95% confidence interval [CI]) of all-cause death (with seven hours of daily sleep being considered for the reference group) for individuals reporting ≤5, 6, and 8 hours, and ≥9 hours were 1.29 (1.08-1.55), 0.97 (0.82-1.14), 1.11 (0.97-1.27), and 1.77 (1.31-2.38), respectively, with a p ≤ 0.01. However, no significant association was seen between sleep duration and myocardial infarction.Conclusion: Both short and long duration of sleep might be potential predictors/markers for all-cause death, but not for myocardial infarction. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance As folk medicines used in China since 1950s, Dioscorea nipponica Makino (DN), D. panthaica Prain et Burkill (DP), and D. zingiberensis C.H. Wright (DZ) are regarded as having more or less the same traditional therapeutic actions, such as activating blood, relieving pain, and dispersing swelling. It is noteworthy that, of the 49 species of the genus Dioscorea distributed in China, based on such traditional efficacies, only these three have been further developed as effective single-herb medicines for treating cardiovascular diseases by the modern pharmaceutical industry. In our previous study, it was found that the chemical compositions of DN and DP were similar, and both were distinct from that of DZ. Hence, whether their different chemical profiles support their anti-IHD (ischemic heart disease) activity in common still needs to be answered. So far it is still unknown whether the efficacies of these three herbs act via similar mechanism and whether they possess comparable therapeutic efficacy for experimental myocardial ischemia (MI). Aim of the study The present study aimed to further investigate the underlying mechanisms with respect to antioxidative stress activity by which these Dioscorea spp. attenuate MI, and to compare the therapeutic effect of total saponins from these three species on myocardial antioxidant levels and myocardial histology. Material and methods The serum levels of creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), total superoxide dismutases (SOD), catalase (CAT), glutathione peroxidase (GPx), the total antioxidant capacity (T-AOC), and malondialdehyde (MDA), as well as myocardial histology, were compared among rat groups administered with total saponins (TS) of DN, DP or DZ (abbreviated as DNTS, DPTS and DZTS, respectively). The rats experienced myocardial ischemia induced by isoprenaline (ISO) injection; the test solutions (DNTS, DPTS, DZTS) were administered either after the ISO injection, or both before and after. Results Compared with the model group (ISO injection only), TS groups exhibited significantly reduced activities of CK, LDH and AST, lowered level of MDA, and increased activities of SOD, CAT, GPx and T-AOC; heart tissues from TS groups revealed less severe histological damage. The cardioprotective efficacy of these three Dioscorea TS for rat MI was closely comparable based on the above observations. Conclusion The findings of the present study provide evidence that the anti-MI effect of DNTS, DPTS and DZTS can be attributed to the increase of myocardial antioxidant levels and decrease of lipid peroxidation formation, and the closely comparable results observed from these three Dioscorea saponins thereby explains the similarity in their clinical efficacy as anti-MI drugs. [ABSTRACT FROM AUTHOR]

Background Major adverse cardiac events (MACEs) are important causes of perioperative morbidity and mortality for elderly patients undergoing non-cardiac surgery. Treatment and control rates for coronary artery disease (CAD) in Chinese patients are poorer than rates in western countries. However, no previous prospective study has focused on perioperative MACE in this population. Our aim was to ascertain the incidence and risk factors associated with MACEs in Chinese patients. Methods Consecutive CAD patients, aged ≥60 years, who underwent non-cardiac surgery at five medical centers in China, were prospectively enrolled. Clinical variables, including electrocardiogram and troponin I levels, were evaluated to estimate MACEs. The main outcome was occurrence of at least one perioperative MACE from admittance to 30 days after surgery, defined as any of the following complications: cardiac death, nonfatal cardiac arrest, acute myocardial infarction (MI), congestive heart failure (CHF), and angina. MACE independent risk factors were based on the Andersen–Gill multiplicative intensity model. Results Of the 1422 patients recruited, 129 (9.1%) developed at least one MACE, and cardiac death occurred in 11 patients (0.8%). The independent risk factors contributing to postoperative MACE included age ≥75 years, female gender, history of MI, history of hypertension, high-risk surgery, intraoperative hypotension, and intraoperative hypoxemia. Conclusions The incidence of MACE in Chinese elderly patients with CAD who underwent non-cardiac surgery was 9.1%. Seven independent risk factors for a perioperative MACE were identified. Preventing intraoperative hypoxemia and hypotension may reduce the occurrence of MACE in these high risk patients. [ABSTRACT FROM AUTHOR]

Objective Both the Global Registry of Acute Coronary Events (GRACE) risk score and neutrophil count could predict clinical outcomes in patients with acute coronary syndromes. However, the ability of them to identify high risk patients leaves room for improvement. The purpose of the present study was to evaluate whether the combination of them could have a better performance in predicting clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Methods A total of 1287 consecutive STEMI patients were recruited at two centers in China. Neutrophil count was measured and the GRACE risk score was calculated. Results During a median period of 37 months (IQR, 29–47), 135 (10.9%) patients had major adverse cardiovascular events (MACE), including 116 all-cause death. Neutrophil count and the GRACE risk score were higher in patients with MACE. Both neutrophil count and the GRACE score were significant and independent predictors for MACE [HR: 1.260 (1.203–1.319), P < 0.001; HR: 1.007 (1.002–1.011), P < 0.001; respectively). Combination of them increased the area under the ROC (0.698 vs. 0.796, P < 0.001). The addition of neutrophil count to GRACE model enhanced net reclassification improvement (0.637, P = 0.020) and integrated discrimination improvement (0.180, P < 0.001), suggesting effective discrimination and reclassification. Conclusion Both neutrophil count and the GRACE risk score are independent predictors for MACE in patients with STEMI. A combination of them could derive a more accurate prediction for clinical outcomes in these patients. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the prevalence of atrial fibrillation (AF) in physical laborers in rural China and identify contributing risk factors. Methods A cross-sectional study of 11,956 permanent residents of Liaoning Province in rural China ⩾35 y of age (primarily physical laborers) was conducted between January and August 2013 (response rate 85.3%). All participants completed a questionnaire and underwent a physical exam, echocardiography and electrocardiography. Blood samples were drawn for laboratory analyses, and AF was diagnosed on the basis of history and electrocardiograph findings. Risk factors for AF were evaluated with a stepwise logistic regression analysis. Results The prevalence of AF was 1.2% overall, but rose steeply with age (0.1% in those 35-44 y of age, and 4.6% in those ⩾75 y); there was no significant gender difference at any age. Independent risk factors for AF were age (odds ratio [OR] 1.89; P < 0.001), diabetes (OR 2.07; P = 0.001), history of myocardial infarction (OR 5.91;P < 0.001), low left ventricular ejection fraction (OR 1.85; P = 0.005), and low physical activity (OR 1.72;P = 0.003), whereas obesity, hypertension, cholesterol and triglyceride levels, current smoking and drinking, left ventricular hypertrophy, and family history of AF were not significant contributors. Conclusions Although the prevalence of AF in physical labors in rural China is low, age, diabetes, history of myocardial infarction, low left ventricular ejection fraction, and low physical activity are independent risk factors. [ABSTRACT FROM AUTHOR]

Background It was not understood whether age- and sex-related differences were apparent in lipid profiles among acute myocardial infarction (AMI) patients in China. Objectives To investigate lipid abnormalities in such AMI patients. Methods A retrospective analysis of 1213 patients hospitalized with a first AMI between May 2007 and July 2011. Results Our data indicated that, compared with the elderly, the nonelderly tended to have higher low-density lipoprotein cholesterol (LDL), total cholesterol (TC), and non–high-density lipoprotein cholesterol (N-HDL) for both males and females. There was significant difference in LDL among various age groups ( P < .001): LDL levels in the 50–59 and 60–69 year age groups were higher than those in 70–79 and 80–89 year age groups. Compared with males, females tended to have higher LDL in both the 50–59 and 60–69 year age groups. There was no difference in HDL among various age groups for female AMI patients, but there was significance for males. Compared with males, females had higher HDL in 40–49, 50–59, 60–69, and 70–79 year age groups, respectively. Among various age groups, there was significant difference in triglycerides (TG) for male AMI patients, but no difference in TG for females. The levels of TG were higher in 40–49, 50–59, and 60–69 year age groups than those in 70–79, 80–89, and ≥90 year age groups, respectively, for males. Isolated low HDL (low HDL + normal LDL + normal TG) was the most common type of combined dyslipidemia for male elderly (31.4%), male nonelderly (22.9%), and female elderly (19.2%) patients. Conclusion We concluded that there was age- and sex-related difference in lipid profiles among AMI patients, with more prevalent dyslipidemia in the nonelderly than the elderly. Perimenopausal women were prone to higher LDL, and low HDL was prevalent among AMI patients in East China. [ABSTRACT FROM AUTHOR]

Background: Lifestyle modification is an integral component of cardiac secondary prevention, while it has been confirmed that myocardial infarction (MI) patients' health-related behaviors are heavily influenced by their illness perception. Objectives: To evaluate the effect of a telephone follow-up intervention for improving MI patients' illness perception and lifestyle. Design: A randomized controlled trial, longitudinal research design was employed. Settings: Cardiac care units in four major general hospitals in Guangzhou, China. Participants: Inclusion criteria were being diagnosed with an initial acute MI, being able to communicate orally in Mandarin or Cantonese and read in Chinese, and living in Guangzhou. Exclusion criteria were with continuing uncontrolled arrhythmias or heart failure, being illiteracy, or with a history of major psychiatric illness, exercise-induced asthma, uncontrolled diabetes, or evidence of dementia. Method: 124 patients admitted with the first acute MI were randomized to receive either routine care or routine care plus a telephone follow-up intervention, which consist of a pre-discharge education and three telephone follow-up instructions. Data were collected before discharge, at the 6th and the 12th week after discharge from hospital, respectively. Results: At the 6th and the 12th week after discharge, patients in the intervention group had significantly positive perceptions about symptoms of MI (mean difference 3.27, 95% confidence interval 2.48-4.07, p < .001; mean difference 2.12, 95% confidence interval 1.34-2.89, p < .001 respectively) and how long their illness would last (mean difference -0.69, 95% confidence interval -0.91 to -0.47, p < .001; mean difference -0.74, 95% confidence interval -0.96 to -0.51, p < .001 respectively) compared with the control group. The intervention group also had more positive beliefs about the controllability (F = 4.23, p = .04) and more improved beliefs about the causes of MI than the control group. Moreover, the intervention improved the patients' nutrition (F = 5.16, p = .03) and physical activity at the 12-week follow-up (mean difference 0.37, 95% confidence interval 0.17-0.58, p < .001). [ABSTRACT FROM AUTHOR]

Abstract: Background: Current guidelines recommend intensive low-density lipoprotein (LDL) cholesterol lowering with statins, with a target of 70mg/dL (1.81mmol/L) LDL cholesterol for those with a very high risk of coronary artery events. However, there is no multicenter study assessing the effect of intensive lipid-lowering therapy with statins on acute coronary syndrome (ACS) in a Chinese population with low baseline LDL cholesterol levels. Methods and results: Patients (n =1355) with ACS were treated with a moderate dose of statin (atorvastatin 10 mg/d, or equivalent dose of other statins, n =675) or with an intensive dose of statin (atorvastatin, 20 or 40mg/d, or equivalent dose of other statins, n =680) for 2 years. The primary end points were cardiac death, non-fatal acute myocardial infarction (MI), revascularization, ischemic stroke and documented unstable angina or severe heart failure requiring emergency hospitalization. Baseline lipid levels were nearly identical in both groups with a mean LDL cholesterol level of 2.7mmol/L (103mg/dL). At 3 months, LDL cholesterol levels declined 20.2% in the moderate dose statin group and 26.6% in the intensive statin group, respectively (P <0.001). In a 2-year follow-up, a primary end point event occurred in 20 patients in the moderate dose statin group and in 28 patients in the intensive statin group. There was no significant between-group difference in the primary outcome (hazard ratio, 1.39; 95% confidence interval [CI], 0.78–2.46; P =0.245). Conclusions: For ACS patients with a relatively low baseline LDL cholesterol level who received optimized current medication and interventional therapy, the incremental LDL cholesterol reduction of 6.4% achieved by double-dose statin did not bring significant clinical effectiveness. [Copyright &y& Elsevier]

Abstract: Ethnopharmacological relevance: Carthamus tinctorius L. (Compositae), a widely used traditional Chinese medicine, was known as Hong hua (Chinese: ▪), safflower. Safflower with a wide spectrum of pharmacological effects has been used to treat dysmenorrhea, amenorrhea, postpartum abdominal pain and mass, trauma and pain of joints, etc. The present paper reviews the advancements in investigation of botany and ethnopharmacology, phytochemistry, pharmacology and toxicology of safflower. Finally, the possible tendency and perspective for future investigation of this plant are discussed, too. Materials and methods: The information on safflower was collected via piles of resources including classic books about Chinese herbal medicine, and scientific databases including Pubmed, Google Scholar, ACS, Web of science, CNKI and others. Results: Over 104 compounds from this plant have been isolated and identified, and quinochalcones and flavonoids are considered as the characteristic and active constituents of safflower. Safflower with its active compounds possesses wide-reaching biological activities, including dilating coronary artery, improving myocardial ischemia, modulating immune system, anticoagulation and antithrombosis, antioxidation, antiaging, antihypoxia, antifatigue, antiinflammation, anti-hepatic fibrosis, antitumor, analgesia, etc. Conclusions: As an important traditional Chinese medicine, it is important to investigate the pharmacological effects and molecular mechanisms of this plant based on modern realization of diseases' pathophysiology. More bioactive components should be identified using bioactivity-guided isolation strategies, and the possible mechanism of action as well as potential synergistic or antagonistic effects of multi-component mixtures derived from safflower need to be evaluated integrating pharmacological, pharmacokinetic, bioavailability-centered and physiological approaches. Further studies on safflower can lead to the development of new drugs and therapeutics for various diseases, and how to utilize it better should be paid more attention to. [ABSTRACT FROM AUTHOR]

Abstract: Background: China has become the world's second-largest economy after the United States since 2010. The cardiovascular diseases in have deteriorated significantly in resent 20years. There is few published report about collaboration in Chinese Cardiology and Cardiovasology (C&C) field so far. The current study reveals the status of the collaboration activities in Chinese C&C field. Methods: Articles published in 5 journals related to C&C from 2000 to 2010 were retrieved from China National Knowledge Infrastructure (CNKI) and VIP Journal Integration Platform(VJIP). Methods such as co-authorship, co-word analysis, centrality, k-core, m-slice were used in this study. Results: Although the percentage of co-authored papers and the average number of authors per paper in Chinese C&C field were generally increasing, the geographic distribution of the research collaboration activitities was extremely uneven. There were 87 authors and 5 institutions ranking in top 1% of all the three centralities but 92.8% authors belonged to 10-Core and below. 90.93% authors are among 1-slice, 2-slice and 3-slice. We found 63 cohesive research groups in the focuses of research collaboration for Coronary artery disease and myocardial infarction, etc. Conclusion: The government should provide important role in supporting or encouraging the research collaboration among different regional areas. Based on the author ranking in the centralities, we will be able to select academic leaders more easily. The research studies in the field of collaboration network will provide important role to assist researchers to master the forefront research subjects, and to help research scientists to apply for scientific project funding. [Copyright &y& Elsevier]

Abstract: Objective: Uncontrolled hypertension (HTN) results in strokes, myocardial infarction (MI), and other complications, which are the leading cause of disability, death, and severe economic consequence. We conducted an economic evaluation to determine the costs and quality-adjusted life-years (QALYs) associated with amlodipine (Norvasc) and the angiotensin II receptor blockers (ARBs) in preventing stroke and MI among Chinese HTN patients. Methods: A cost-utility analysis was conducted from the third-party payer perspective. A Markov model was constructed to estimate 5-year costs and health consequences of amlodipine and valsartan. Effectiveness data were based on a published meta-analysis. Utility data were retrieved from the published literature. Costs of MI were retrieved from China Health Statistics Yearbook. Costs of stroke were obtained from retrospective chart review and follow-up interviews in Chinese tertiary hospitals. Costs included costs of drugs, direct medical costs of HTN management, stroke/MI treatment, and follow-up management. Discounting rate used for costs and QALYs was 3%. Results: Total direct medical and drug costs of amlodipine and valsartan (ARB) users were ¥111,731,716 and ¥132,058,611, respectively; total QALYs of amlodipine and valsartan users were 30,648.5 and 30,520.8, respectively. Amlodipine is dominant with lower costs and higher QALYs. This demonstrated that compared with valsartan, amlodipine is a cost-saving therapy with better QALY outcome. When irbesartan data were used in the comparison, the magnitude of cost saving changed but the overall conclusion remained the same. Conclusion: Amlodipine is a cost-saving therapy compared with ARBs in preventing stroke and MI for Chinese HTN patients. [Copyright &y& Elsevier]

Background: Administration of a loading dose of atorvastatin 80 mg/d has been shown to be beneficial in patients with stable coronary artery disease and acute coronary syndromes. However, little is known about the impact and mechanism behind the beneficial effects of loading-dose atorvastatin treatment before percutaneous coronary intervention (PCI), especially for those patients experiencing cardiovascular inflammation in ST-segment elevation myocardial infarction (STEMI). Objective: The goal of this randomized clinical study was to investigate whether, before emergency PCI, administration of loading-dose atorvastatin therapy in STEMI patients inhibits inflammation and improves cardiac function during 24 weeks of follow-up. Methods: A total of 102 STEMI patients were enrolled into 3 groups: group A (n = 32) received 80 mg of atorvastatin before emergency PCI, post-PCI follow- up atorvastatin 40 mg for 4 weeks, and atorvastatin 20 mg for 20 weeks; group B (n = 32) received no pre-PCI loading dose of atorvastatin but did receive atorvastatin 40 mg for 4 weeks and then atorvastatin 20 mg for 20 weeks; and group C (n = 38) received only post-PCI atorvastatin 20 mg for 24 weeks. Results: No differences were found in baseline demographic and angiographic characteristics among the 3 groups. Patients in group A had the lowest plasma levels of high-sensitivity C-reactive protein (hs-CRP), B-type natriuretic peptide (BNP), and matrix metalloproteinase type 9 (MMP-9) (P = 0.05). Patients in group A also showed improvement in heart performance, with significant increases in their left ventricular ejection fraction. To a lesser extent, group B displayed reductions in the plasma levels of hs-CRP, BNP, and MMP-9 at later time points (P = 0.05). Compared with those in group C, patients in group B also exhibited significant improvement in left ventricular ejection fraction (P = 0.05). Conclusions: Loading-dose atorvastatin therapy before emergency PCI reduced the inflammatory response and myocardial dysfunction in these STEMI patients by lowering hs-CRP, BNP, and MMP-9. Pre-PCI loading-dose atorvastatin treatment may help prevent inflammatory response and improve cardiac function in patients with acute coronary syndromes undergoing emergency PCI. ClinicalTrials. gov identifier: NCT01334671. [ABSTRACT FROM AUTHOR]

Objective: To explore illness perception (IP) and its predictors among Chinese patients with myocardial infarction (MI). Methods: The revised Illness Perception Questionnaire (IPQ-R) was used in the present study. A cross-sectional, descriptive design was employed. The study was conducted in four major hospitals in Guangzhou (China) with a sample of 193 MI patients. Pearson''s and Spearman''s correlation, t test, one-way ANOVA, factor analysis and multiple linear regression were used. Results: Among the 12 common symptoms of MI, on average only 3.37 were recognized by the subjects. Among the six factors of the cause dimension, “immune factors” received the highest score, followed by “gene and chance”, “behavioral factors”, “psychological factors”, “environmental factors”, and “physical factors”. Subjects perceived MI as a chronic, cyclic illness with serious consequences that could be controlled through treatment, and believed that they had a negative affective response to MI. Furthermore, the dimensions of patients’ IP were correlated, and illness-related factors and socio-demographic factors acted as predictors of IP. Conclusion: The IP of Chinese patients with MI needs to be improved. Practice implications: Based on our findings, effective interventions can be designed to promote MI patients’ IP to facilitate their coping strategies after an episode of MI. [Copyright &y& Elsevier]

Abstract: Objective: In this study, we examine the association of single nucleotide polymorphisms (SNPs) of the human ATP binding cassette transporter G1 (ABCG1) gene with atherosclerotic coronary artery disease (CAD) in a Chinese Han population. Methods: 1021 patients with CAD and 1013 unaffected control subjects were enrolled. PCR-based ligation detection reaction (PCR-LDR) method was used to genotype four SNPs of ABCG1, three (rs2234714, rs2234715 and rs57137919) in the promoter region and one (rs1044317) in the 3′-untranslated region (UTR). Results: The human ABCG1 −367G>A polymorphism (rs57137919) showed a significantly decreased risk for CAD and myocardial infarction (MI) in a dominant model (adjusted OR=0.73, p =0.033 for CAD, and adjusted OR=0.65, p =0.014 for MI, respectively). The rs57137919 also showed an association with angiographic severity of CAD (multi-vessel vs. single-vessel CAD, adjusted OR=0.40, p =0.005). The findings were further supported by luciferase reporter assay, in which the polymorphism impaired reporter gene expression. The ABCG1 −768G>A polymorphism (rs2234714) showed an association with CAD in a recessive model (adjusted OR=0.64, p =0.015), but did not demonstrate a functional influence on reporter gene expression in the luciferase reporter assay. Conclusions: The SNP rs57137919 in the ABCG1 promoter region is functionally associated with a reduced risk of CAD in a Chinese Han population. [Copyright &y& Elsevier]

Abstract: The effect of Cyclovirobuxine D, an active ingredient from Buxus microphylla, was investigated in the potential prevention of cardiac dysfunction in rats with congestive heart failure. Heart failure was induced by left coronary artery occlusion and verified using echocardiography. Cyclovirobuxine D was administered for 30days (0.5, 1.0 and 2.0mg/kg, ig) and mortality, cardiac function, hemodynamics, microcirculation, histology and ultrastructure assessments were observed. Results from the present study suggest that Cyclovirobuxine D is beneficial for heart failure induced by myocardial infarction and supports the potential for Cyclovirobuxine D as a new therapy for heart failure. [Copyright &y& Elsevier]

Abstract: Ethnopharmacological relevance: Salvianolic acid (SAL) and tanshinone (TAN) are major hydrophilic and lipophilic compounds, respectively, from one herbal medicine, Danshen, which has been widely and successfully used for treating cardiovascular diseases in Asian countries. Because few studies have reported different molecular mechanisms between the different compounds in same herb, we investigate if separate molecular pathways are involved in cardioprotective effect by different active components of Danshen. Materials and methods: We used an acute myocardial infarction (MI) model to compare the cardioprotective effects of SAL and TAN in rats. Both infarct size and echocardiographic response were evaluated at 3, 7, 14 and 28 days after surgery. Genes involved in ischemic injury and in responses to SAL or TAN treatment in ischemic hearts were identified by microarray analysis and verified by quantitative real-time RT-PCR. Results: Results showed that both SAL and TAN delay the development of ischemia by decreasing infarct size and improving systolic function post MI. Gene ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis indicated different kinetics and gene expression profiles by SAL and TAN. SAL acts in a later period after ischemia, and its effect is probably mediated by downregulation of genes involved in oxidative stress, certain G-protein coupled receptor activities and apoptosis. On the other hand, TAN acts relatively early after ischemic injury and its effect is at least in part mediated by inhibition of intracellular calcium, cell adhesion and alternative complement pathway. Strikingly, we found that TAN, a recently identified member of selective estrogen receptor modifier (SERM), indeed regulates genes known to be involved in estrogen metabolism post MI. Conclusions: Although both SAL and TAN contribute to the cardioprotective effect of Danshen, there are significant mechanistic and temporal differences between the two: TAN acts at an early stage after ischemic injury mainly by inhibition of intracellular calcium and cell adhesion pathways whereas SAL acts mainly by down-regulating apoptosis. [Copyright &y& Elsevier]

Objective: To determine the level of awareness of the hazards of tobacco smoking and secondhand smoke inhalation among adults in China. Methods: Household surveys were conducted with a total of 13 354 respondents aged 15 years or over from 100 counties of 28 Chinese provinces using a stratified multi-stage geographically clustered sample design. Results: The findings revealed that 81.8% of the population was aware that smoking causes serious diseases, and 27.2% and 38.7% were aware that smoking causes stroke and heart attack, respectively. Only 64.3% of respondents were aware that secondhand smoke can cause serious diseases, and 27.5%, 51.0%, and 52.6% were aware that secondhand smoke causes heart disease in adults, lung disease in children and lung cancer in adults, respectively. Awareness regarding smoking-related hazards across all participants was significantly associated with several factors, including gender, smoking status, urban/rural residency, education level and exposure to tobacco control publicity in the last 30 days. Awareness regarding tobacco-related hazards in smokers was significantly associated with urban/rural residency, education level, exposure to tobacco control publicity in the last 30 days, and physician''s advice. Awareness relating to the hazards of inhaling secondhand smoke was associated with smoking status, urban/rural residency, age, education level, and exposure to tobacco control publicity in the last 30 days. Medical professionals were found to know more about the health hazards of tobacco compared with people in other types of employment. Conclusions: Overall awareness of the health hazards of tobacco has improved in the last 15 years in China, but is still relatively poor. Improved means of communicating information and more effective warning labels on cigarette packaging are necessary for increasing public awareness of tobacco hazards, particularly among rural residents and people with less education. [Copyright &y& Elsevier]

Shuanglong Formula (SLF) is a classic formula for treating heart disease in traditional Chinese medicine (TCM). And it has been reported that the combinational treatment of SLF with autologous mesenchymal stem cells (MSCs) transplantation could be of benefit to people with acute myocardial infarction. However, their underlying mechanisms are not clear. Aim of the study: The effects of whole formula and its herbal main ingredients on rat MSCs differentiation towards cardiomyocytes were investigated and the distinct protein expression profile in MSC-derived cardiomyocytes studied. Materials and methods: The protein expression profiles of rat MSCs and cardiomyocyte-like cells were determined with two-dimensional gel electrophoresis (2-DE). Results: Our data demonstrated that SLF can induce MSCs into cardiomyocyte-like cells and around 36 proteins mainly involved in cytoskeleton, cell tissue energy metabolism and signal transduction have been shown to be regulated distinctly by SLF treatment. Conclusions: Data presented in this study suggest that large rearrangement of the proteome occur during the differentiation process of the MSCs to terminally differentiated cardiomyocyte-like cells and offer the possibility for further characterization of specific targets driving the stem cell differentiation. [Copyright &y& Elsevier]

Objective: Total cholesterol (TC) is an important risk factor for myocardial infarction (MI), but the effect of TC on MI in Chinese male hypertension population has not been well documented. We conducted a prospective cohort study to determine the incidence and relative risk for MI across a wide range of TC levels in Chinese male hypertension population. Methods: A cohort of 5 298 male employees aged 18-74 years recruited from Capital Steel and Iron Company in Beijing of China in 1974-1980 was followed up for an average of 20.84 years. A total of 122 incident MI cases were identified during the period of follow-up. Results: The incidence of MI among participants with elevated TC and those with desirable TC in male non-hypertension population was 137.20 and 63.81 per 100 000 person-years, respectively; and the corresponding incidence in male hypertension population was 279.80 and 130.96 per 100 000 person-years, respectively. After adjustment for important covariables, 10.38%, 16.71%, and 23.80% of MI cases were attributable to hypertension, elevated TC, and hypertension plus elevated TC, respectively. In male hypertension population, the multivariate adjusted hazard ratios of MI were 1.21, 2.39, 3.38, and 3.95 for participants with TC level of 5.17-5.68, 5.69-6.20, 6.21-6.71, and ≥6.72 mmol/L, compared with those with TC<5.17 mmol/L. The corresponding population attributable risks were 2.92%, 9.20%, 8.87%, and 9.84%, respectively. Conclusion: Elevated TC is an important independent risk factor of MI both in male non-hypertension and hypertension populations. There is a linear association between TC level and MI incidence in Chinese male hypertension population. [Copyright &y& Elsevier]

Abstract: Introduction: Tumor necrosis factor alpha (TNF-alpha) is a primary pro-inflammatory cytokines and has been implicated in cardiovascular disease pathogenesis. Relationship between polymorphisms in TNF-alpha gene and coronary heart disease (CHD) has been reported, but remains a controversial one. Materials and Methods: A single nucleotide polymorphism (SNP) discovery in a total of 4739 base pairs in the promoter region, exon region and exon/intron boarding region of TNF-alpha gene in randomly selected 48 patients by direct sequencing was conducted. Four SNPs (-806C>T, -308G>A, -238G>A, and +467G>A) out of seven polymorphisms identified were further investigated for associations in 804 CHD patients (of which 504 patients with Myocardial infarction (MI)) and 905 age- and gender-matched controls. Results: No main effects of loci and haplotypes reached statistical significance in the total sample. However, a significant gene-smoking interaction was observed. In nonsmokers, compared with individuals of G/G genotype, individuals carrying the A allele of the -238G>A polymorphism showed a lower risk of developing CHD (odds ratio 0.48, 95%CI 0.24-0.94, P=0.033), and an even lower risk of developing MI (odds ratio 0.36, 95%CI 0.15-0.88, P=0.026). Haplotype analysis confirmed the results of individual polymorphism analyses. In addition, the -806C>T polymorphism was found to be associated with MI in smokers (P=0.039). Conclusions: This study identified a significant interaction between TNF-alpha gene and smoking status. Both single locus and haplotype analyses indicated that A allele of the -238G>A polymorphism decreased the risk of CHD among nonsmokers in Chinese Han population. [Copyright &y& Elsevier]

Abstract: Objective: To perform a psychometric evaluation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS) in Chinese patients with coronary heart disease. Design and setting: Patients with angina (n =162), MI (n =124) or heart failure (n =95) were recruited from a regional university-affiliated hospital. The Chinese version of the MIDAS (C-MIDAS), the Hospital Anxiety and Depression Scale (HADS) and the Short-Form 36 Health Survey (SF-36) were administered to all patients at baseline and the C-MIDAS was also administered seven day (n =92) and three months (n =363) later. Results: The C-MIDAS conforms to the 7-factor structure as proposed in the original version. It is reliable with Cronbach''s alphas from 0.73 to 0.94 and test–retest reliabilities from 0.76 to 0.92. Four of its subscales (physical activity, insecurity, emotional reaction and dependency) correlated significantly with the SF-36 and the HADS in each diagnostic group and had good discriminative properties in terms of gender, emotional disturbance and perceived health deterioration, with responsiveness supported by medium-high effect sizes (0.43–0.83) and standardize response means (0.46–0.82). The other three subscales measuring treatment-related impacts added little to the validity and responsiveness of the C-MIDAS. Conclusion: To render the C-MIDAS a core health-related quality of life measure for Chinese-speaking patients with coronary heart disease, further studies need to clarify the content adequacy and cultural relevancy of those subscales measuring treatment-related impact. [Copyright &y& Elsevier]

Objective To examine the relationship between apolipoprotein E (Apo E) gene polymorphism and risk of coronary artery disease (CAD), analyzing association of polymorphism with classical risk factors. Methods A total of 124 patients (including 84 Han population and 40 Uygur population) with angiographically verified CAD or myocardial infarction were prospectively evaluated. Data referring to hypertension, diabetes, and tobacco consumption were recorded. The levels of total cholesterol (TC), high density lipoprotein (HDL) cholesterol, Apo A1 and B, and triglycerides (TU) were determined. DNA was obtained from 124 patients and 70 controls. In order to determine Apo E genotypes, DNA was PCR amplified and digested with HhaI. The genetic polymorphism of Apo E is due to three common alleles, epsilon (∊)2, ∊3, &epsi4, at a single autosomal gene locus. These alleles determine the six phenotypes E2/2, E3/3, E4/4, E4/2, E4/3, and E3/2. Results In Uygur population, the frequency of the &epsi2, &epsi3, and &epsi4 was 0.155, 0.648, and 0.197 respectively. In Han population, the frequency of the ∊2, ∊3, and ∊4 was 0.08 1, 0.772, and 0.146 respectively. In the patient group, the frequency of the ∊2, ∊3, and ∊4 was 0.060,0.758, and 0.182 respectively. In the control group, the frequency of the ∊2, ∊3, and ∊4 was 0.193, 0.671, and 0.136 respectively. ∊2 frequency of Uygur' patients and controls was 0.050 and 0.290 respectively. Serum low density lipoprotein (LDL) cholesterol, TC, and TG values tended to decrease from the Apo E-2 phenotypes to Apo E-2 phenotype. When deletion polymorphism of ∊2 was compared with the common risk factors for CAD, its risk ratio (RR) is 4.38. Conclusions These studies confirm and find that Apo E phenotype distribution in Uygur population differs significantly from that in Han population in Xinjiang. CAD patients have significantly lower ∊2 allele and slightly higher ∊3 or ∊4 allele frequency than controls, especially in Uygur population. It shows protective effects of ∊2 on CAD. [ABSTRACT FROM AUTHOR]

Aims: To investigate the association of severe hypoglycemia (SH) with all-cause mortality and complication risks among Chinese patients with type 2 diabetes mellitus (T2DM).Methods: Cohort study and nested case-control studies were conducted based on medical insurance database 2008-2015. The incidence of outcomes or the exposure of previous SH was compared among matched patients, respectively. The association between SH and outcomes was investigated and validated by different models.Results: Among cohort study participants (mean age of 59.0 ± 11.2 years), SH was associated with higher risk of all-cause mortality (HR = 1.80, P < 0.001) and transient ischemic attacks (TIA, HR = 1.51, P < 0.001), while no association was observed between SH and complications including myocardial infarction (MI), angina, arrhythmia and stroke. Similarly, SH was associated with about doubled all-cause mortality (OR = 1.76, P < 0.001) and TIA (OR = 2.00, P < 0.001), but not associated with risk of MI or stroke in nested case-control studies.Conclusions: In Chinese patients with T2DM, SH is associated with increased risk of all-cause mortality and TIA, but no significant differences were found regard to the other examined complication risks, which need to be further explored in future studies. [ABSTRACT FROM AUTHOR]

The procurance of gold nanoparticles in the plant extracts is an excellent way to attain nanomaterials natural and eco-friendly nanomaterials. The Dehydrated roots of Chinese Euphorbia fischeriana flowering plant are called "Lang-Du". In this study, the retrieving of gold nanoparticles from Euphorbia fischeriana root was amalgamated by standard procedure. Fabricated gold nanoparticles were portrayed through the investigations of ultraviolet and visible spectrophotometry (UV–Vis), Fourier transform infrared spectroscopy (FTIR), High resolution transmission electron microscopy (HRTEM) and X-ray diffraction (XRD). The UV–Vis and FTIR results explicated the obtained particles were sphere-shaped and the terpenoids of Euphorbia fischeriana had strong communications with gold surface. The HRTEM and XRD images exposed the produced gold nanoparticles had an extreme composition of crystal arrangement and excellent uniformed size of particles. In our study, the Isoprenaline induced myocardial damage established the elevation in TBARS, LOOH of heart tissues and notable decline in antioxidant enzymes SOD, CAT, GPx, and GSH. This biochemical result was additionally proved by histopathological assessment. Remarkably, the pretreatment with EF-AuNps(50 mg/kg b.w) illustrated stabilized levels of serum creatine and cardiotropins in myocardial infarcted animals. And further we understood the essential function of NF-ƙB, TNF-α, IL-6 signaling molecules and its way progression in the development of vascular tenderness. • Myocardial infarction (MI), the well-known heart sickness with high transience speed, in China • Ultrastructure and morphological examination further confirms the effect of EF-AuNps on isoprenaline induced animals • Further the inflammatory marker studies eventually corroborate the effect of EF-AuNps in molecular level [ABSTRACT FROM AUTHOR]

In 2012, China's first diagnosis-related group (DRG) payment system was piloted in Beijing. This study explored whether this payment pilot improved quality and reduced costs of acute myocardial infarction (AMI) care in hospitals implementing DRG payment as compared to control hospitals. A difference-in-difference study design was used with regression and considered several quality indicators including aspirin at arrival, aspirin at discharge, β-blocker at arrival, β-blocker at discharge, statin at discharge, in-hospital mortality, and 30-day readmission rates. DRG payment mechanisms without specific mechanisms to promote care quality did not improve quality of AMI care. Future studies should study the impact of cost control mechanisms together with quality improvement efforts to assess how quality of care may be improved within the Chinese healthcare system. These lessons would be helpful to share with lower-middle-income countries undergoing rapid development that are transitioning to a significantly higher burden of non-communicable diseases. • Reforming fee-for-service payment systems to DRG payment may slow quality gains. • Process quality indicators instead of outcome quality indicators are affected by DRG payment. • In addition to changing payment methods, reforms should include building a system supporting quality improvement and incorporate process quality indicators as evaluation metrics. [ABSTRACT FROM AUTHOR]

Few studies have evaluated the morbidity burden of cardiovascular diseases (CVDs) due to coarse particulate matter (PM C , particles with an aerodynamic diameter between 2.5 and 10 μm) pollution, especially in a multi-city setting. This study aimed to investigate the short-term impacts of PM C on hospital admissions (HAs) for total and cause-specific CVDs in 18 cities of Sichuan Province, Southwestern China during 2015–2016, and calculate the corresponding attributable risks. First, generalized additive model (GAM) was employed to estimate the city-specific associations of PM C with CVDs hospitalizations, and then combined the results from the single cities to obtain the pooled effects at the regional level. Age-, sex- and season-specific analyses were also performed. We further estimated the burden of HAs for CVDs attributable to PM C exposure. A total of 621,835 HAs for CVDs were collected during the study period. We found that PM C was significantly associated with elevated risks of CVDs hospitalizations. Per 10 μg/m3 increase in PM C corresponded to an increase of 1.18% (95% CI: 0.67%–1.68%) in daily HAs for CVDs. For specific subtypes of CVDs, significant associations of PM C with acute myocardial infarction, heart failure and ischemic stroke were observed. The effect estimates of PM C remained robust after adjusting for PM 2.5 (particles with an aerodynamic diameter ≤ 2.5 μm) and gaseous pollutants in co-pollutant models. The pernicious effects were found to be stronger in the elderly and in the warm season. Overall, about 1.26% (95% CI: 0.73%–1.79%) of HAs for CVDs could be attributable to PM C exposure, corresponding to 7863 (95% CI: 4554–11110) attributable CVDs HAs. Our findings suggest that PM C might result in increased risk of HAs for CVDs in Sichuan Province, Southwestern China, and should be considered in the prevention and control of CVDs. Image 1 • Increased risk of HAs for CVDs was associated with elevated levels of PM C. • Significant associations of PM C with AMI, HF and IS were observed. • Associations of PM C were stronger in the elderly and in the warm season. • Overall, 1.26% of HAs for CVDs were attributed to PM C exposure. [ABSTRACT FROM AUTHOR]