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Background and Purpose— It is still inconclusive whether high plasma lipoprotein(a) [Lp(a)] level is a risk factor for stroke. Small sample size and different ethnic groups and methodologies might be contributors to the conflicts in study results. The purpose of the present study was to investigate the association between plasma Lp(a) levels, pentanucleotide TTTTA repeat (PNTR) polymorphism of the apolipoprotein(a) [apo(a)] gene, and Chinese stroke in a case-control study. Methods— We recruited 1825 cases with stroke (44.3% cerebral atherothrombosis, 28.3% lacunar infarction, and 27.3% intracerebral hemorrhage) and 1817 controls from 7 centers in China. Lp(a) concentrations were quantified by enzyme-linked immunosorbent assay. The PNTR polymorphism of the apo(a) gene was determined by polymerase chain reaction–polyacrylamide gel electrophoresis. Conditional multivariate logistic regression analysis was used to identify independent risk factors for stroke and its subtypes. Results— Lp(a) levels were significantly higher in cases than in controls (median, 28.5 versus 23.1 mg/dL; P Conclusions— Our results indicate for the first time that low numbers of apo(a) PNTR and plasma Lp(a) levels are independently associated with both ischemic and hemorrhagic stroke in Chinese.

To explore the correlation between computed tomographic (CT) vascular convergence sign and enhancement value in patients with pulmonary nodules.A total of 708 consecutive patients with pulmonary nodule received dual-source CT scan from January 2010 to January 2012. They were divided into vascular convergence sign group (including 4 subgroups) and non-vascular convergence sign group. Then the correlation between CT vascular convergence sign and enhancement values was analyzed.The enhancement values in vascular convergence sign group were significantly higher than those in non-vascular convergence sign group ((27.6 ± 10.5) vs (3.2 ± 2.8) HU, P = 0.000). The CT enhancement values in lesions tended to increase with the number of connecting blood vessels. However, no significant differences existed among the subgroups (P0.05). The accuracy of vascular convergence sign for detection of pulmonary malignant nodules was 84.9%, 70.6% and 60.3% according to the standards of CT enhancement values ≥ 15, 20, 25 HU respectively. The sensibility, specificity and accuracy of determining pulmonary malignant nodules were 97.2%, 68.8% and 93.7% according to the standard of vascular convergence sign. The accuracy of determining pulmonary nodules' CT enhancement values ≥ 15 HU was 88.1% according to the standard of vascular convergence sign.Vascular convergence sign may be used to indicate the enhancement of pulmonary nodules when CT enhancement images are not available.

To explore the characteristics and related risk factors of arterial elasticity in persons with prehypertension, high-normal blood lipid and(or) impaired glucose regulation(impaired fasting glucose and(or) impaired glucose tolerance).After receiving physical and biochemical examinations, a total of 1238 persons were enrolled. Among them, the etiologies were prehypertension (n = 65), high-normal blood lipid (n = 156), impaired glucose regulation (n = 159), prehypertension and high-normal blood lipid (n = 85), prehypertension and impaired glucose regulation (n = 77), high-normal blood lipid and impaired glucose regulation (n = 55) and prehypertension, high-normal blood lipid and impaired glucose regulation (n = 9). Also 332 healthy subjects, 113 hypertensive patients, 150 hyperlipidemics and 37 diabetics were enrolled as controls. Systemic vascular compliance (SVC), systemic vascular resistance (SVR), brachial artery distensibility (BAD) were measured with Dynapulse 200 M (Pulse Metric, Inc., USA).In persons with prehypertension, SVC was lower than healty group ((1.14 ± 0.20) ml vs (1.26 ± 0.23) ml, P0.01)and higher than hypertensive group ((1.11 ± 0.18) ml, P = 0.011), SVR higher than healty group (157 ± 29) kPa×s×L(-1) vs (148 ± 25) kPa×s×L(-1), P = 0.012) and lower than hypertensive group ((166 ± 36) kPa×s×L(-1), P0.01)and BAD lower than healty group(5.93% ± 1.14% vs 6.50% ± 1.30%, P0.01). Among different groups with prehypertension, high-normal blood lipid and(or) impaired glucose regulation, SVC, SVR and BAD had significant differences. As indicated by multiple linear regression analysis, blood pressure was an independent risk factor of arterial elasticity.Vascular function becomes damaged in prehypertensive stage. As an independent risk factor, blood pressure had more potent effect than lipid and blood glucose. Multiple cardiovascular risk factors with high-normal value may affect vascular function more strongly.

Objective: Tissue kallikrein (TK) cleaves kininogen to produce the potent bioactive compounds kinin and bradykinin, which lower blood pressure and protect the heart, kidneys, and blood vessels. Reduction in TK levels is associated with cardiovascular disease and diabetes in animal models. In this study, we investigated the association of TK levels with event-free survival over 5 years in Chinese first-ever stroke patients. Methods: We conducted a case–control study with 1,268 stroke patients (941 cerebral infarction, 327 cerebral hemorrhage) and 1,210 controls. Plasma TK levels were measured with an enzyme-linked immunosorbent assay. We used logistic regression and Cox proportional hazards models to assess the relationship between TK levels and risk of first-time or recurrent stroke. Results: Plasma TK levels were significantly lower in stroke patients (0.163 ± 0.064mg/l vs 0.252 ± 0.093mg/l, p < 0.001), especially those with ischemic stroke. After adjustment for traditional risk factors, plasma TK levels were negatively associated with the risk of first-ever stroke (odds ratio [OR], 0.344; 95% confidence interval [CI], 0.30–0.389; p < 0.001) and stroke recurrence and positively associated with event-free survival during 5 years of follow-up (relative risk, 0.82; 95% CI, 0.74–0.90; p < 0.001). Compared with the first quartile of plasma TK levels, the ORs for first-ever stroke patients were as follows: second quartile, 0.77 (95% CI, 0.56–1.07); third quartile, 0.23 (95% CI, 0.17–0.32); fourth quartile, 0.04 (95% CI, 0.03–0.06). Interpretation: Lower plasma TK levels are independently associated with first-ever stroke and are an independent predictor of recurrence after an initial stroke. ANN NEUROL 2011

Plasma homocysteine concentrations have been associated with the risk of stroke, but its relevance to secondary vascular events and mortality after stroke remains unclear because of inconsistent results from clinical trials. The aim of the present study was to investigate whether plasma homocysteine levels and the MTHFR (methylenetetrahydrofolate reductase) variant C677T contributed to the risk of stroke recurrence and all-cause mortality in a large prospective cohort of stroke patients in a Chinese population. A total of 1823 stroke patients (age, 35–74 years) were recruited during 2000–2001 and prospectively followed-up for a median of 4.5 years. During the follow-up, 347 recurrent strokes and 323 deaths from all-causes were documented. After adjustment for age, gender and other cardiovascular risk factors, a high homocysteine concentration was associated with an increased risk of 1.74-fold for stroke recurrence {RR (relative risk), 1.74 [95% CI (confidence interval), 1.3–2.3]; P

To compare the values of measurements of obesity, including body mass index(BMI), waist circumference (WC), waist-to-hip ratio (WHR), bioelectrical impedance analyzer(BIA) (fat mass and FAT%), ultrasonography (US) (subcutaneous fat distance and intraabdominal fat distance), and computed tomography (CT) in predicting the quantification of visceral adipose in abdominal obesity, and to evaluate the best cut-off point, sensitivity and specificity of these methods.4,301 inpatients with hypertension, 2,155 males and 2,146 females, aged (56.4 +/- 13.8) (11 - 89), all with at least 1 risk factor of cardiovascular diseases, underwent simple body fat measurement. 3458 received BIA, 2,553 received B mode ultrasonography, 1039 underwent CT examination, and 659 received all kinds of examination. Abdominal visceral adipose area (VA) measured with CTor= 100 cm(2) was the diagnostic criteria of visceral fat obesity (VFO). Receiver operating characteristic (ROC) curve was used to analyze the body fat indexes to determine the best cut-off point.(1) It was accurate for WC, fat mass, BMI, intraabdominal fat distance, FAT%, and WHR were all accurate in diagnosis of VFO with the values of area under ROC of 0.730 - 0.867. WC was the most effective measurement. (2) The best cut-off points of these methods in predicting abdominal visceral obesity in males and females were as follows: WC: 89.5 cm and 85.5 cm for WC. 25 kg/m(2) and 26 kg/m(2) for BMI, 0.97 and 0.95 for WHR, 29% and 38% for fat composition, 18.6 kg, and 20.4 kg for fat mass, and 38.5 mm and 34.7 mm for intraabdominal fat distance.WC, fat mass, BMI, intraabdominal fat distance, simple fat parameters, and WHR all can predict visceral adipose in abdominal obesity, in which WC is the best. For a given WC, the type of obesity can be determined by BIA and US.

To explore the relationship of different types of abdominal obesity to risk of metabolic syndrome (MS).Visceral fat area (VA) and substantial fat area (SA) were assessed by CT in 846 patients, 470 males and 376 females, aged 55 +/- 12, who suffered from at least one cardiometabolic risk factor and divided into 4 groups according to their VA and waist circumference (WC): non-obesity, masked visceral fat obesity (VFO), pseudo-VFO, and VFO groups. Blood pressure, fasting blood glucose, fasting serum insulin, and lipid profile were also measured. The MS risks of different types of abdominal obesity were compared.The prevalence rate of masked VFO of males was 10.9% (51/470), significantly higher than that of female (4.8%, 18/376). The prevalence rate of MS of the male patients with masked VFO was 43.1%, significantly higher than that of those in non-obesity group (25.0%), and lower than those of the males in the pseudo-VFO group (78.7%) and in the VFO group (88.6%), whereas the MS prevalence rate of the males in the pseudo-VFO group was significantly higher than those in the non-obesity and masked VFO groups. On the other hand, the MS prevalence rate of the female patients with masked VFO was 33.3%, not significantly different from that of the female patients in the non-obesity group (31.2%), but significantly lower than those of the pseudo-VFO and VFO groups (78.7% and 90.9% respectively). The MS prevalence rate of the female pseudo-VFO patients was also significantly higher than those in the non-obesity and masked VFO groups. Logistic regression analysis showed that WC and VA were independent risk factors for MS [OR (95% CI) = 1.13 (1.10-1.17), 1.01 (1.01-1.02), respectively, P0.01).Different types of abdominal obesity have important impacts on the risk of metabolic syndrome. Masked VFO, even though with normal WC, and pseudo-VFO have considerably higher cardiometabolic risks.

To contrastive analyze the population characteristics and individual variations of enhancement modes of normal pancreas and aorta at intravenous injection rates of 3 mL/s and 2 mL/s.Sixty-seven patients with normal pancreas were selected, and were divided randomly into 2 groups with different intravenous injection rates (3 mL/s for 35 patients in Group A and 2 mL/s for 32 patients in Group B). Single-level serial dynamic CT scan was performed at the level where the pancreas was best demonstrated. The enhancement values of pancreas and aorta for each time point of each patient were calculated, and the time-density curves of enhancement of pancreas and aorta of each patient were obtained. The peak enhancement and the time to reach the peak enhancement of pancreas and aorta of each individual patient were evaluated, and the 2 groups were compared. The individual variations of the enhancement modes of pancreas and aorta in each group were analyzed.The peak enhancement of pancreas was (75.7+/-17.0) Hu at (43.9+/-6.6) s for Group A, and (66.5+/-16.0) Hu at (55.2+/-5.0) s for Group B; the peak enhancement of aorta was (226.2+/-35.2) Hu at (35.4+/-4.5) s for Group A, (182.8+/-32.8) Hu at (48.0+/-3.7) s for Group B. There were significant differences in both the peak enhancement and the time to reach the peak enhancement of pancreas and aorta between the 2 groups. The coefficients of variation of time to reach the peak enhancement for pancreas and aorta were 15.0% and 12.7% in Group A, and 9.2% and 7.7% in Group B, respectively. The temporal windows of the optimal enhancement of pancreas were (9.7+/-4.5)s and (13.7+/-3.6)s in Group A and B, respectively.Better enhancement of pancreas and aorta is obtained at 3 mL/s than 2 mL/s, the time to reach the peak enhancement of pancreas and aorta is comparatively earlier at 3 mL/s than 2 mL/s, and the temporal windows of optimal enhancement of pancreas and aorta are comparatively shorter at 3 mL/s than 2 mL/s.

To observe the relationship between abdominal obesity and left ventricular weight/function.A total of 495 patients [265 males, mean age (55 +/- 12) years] with hypertension (139), diabetes (65), metabolic syndrome (285), diabetes complicated with hypertension (11) were enrolled in this study. Visceral adipose area (VA), the subcutaneous adipose (SA), the total abdominal adipose (TA) were measured by computerized tomography (CT) and left ventricular weight and function were obtained by echocardiography. Patients were divided into three groups according to the VA (I. VA75 cm(2), n=173, II. VA75 and110 cm(2), n=153, III. VAor= 110 cm(2), n=169).Left ventricular mass (LVM) and LVM index (LVMI) increased and LVEF and E/A decreased in proportion to increasing VA. Left ventricular hypertrophy (LVH) rate was significantly higher in group II and III compared to group I and LVEF was significantly reduced in group III compared to group I and II. There are significant correlation between LVMI and VA, SA, TA as well as between LVEF and VA after adjusting gender, age and blood pressure. Logistic regression analysis showed that VA is an independent predictor for LVH.The abdominal adipose accumulation is closely related to the left ventricular weight and function.

To investigate the regulation of calcium sensitive signal substance calpain in signal transduction of myocardial remodeling in patients with congestive heart failure.All 39 congestive heart failure (CHF) patients with rheumatic mitral valve stenosis disease were selected and 38 cases of healthy persons were included as controls. Cardiac function parameters were measured by echocardiography. The concentration of angiotension II (AngII) in plasma and myocardial tissues was determined by radio immunoassay (RIA). Western blot was used to assay the protein expression of calpain, cain/cabin 1, cain/cabin 1Delta, and calcineurin (CaN) phosphorylation.The AngII concentrations in the plasma and myocardial tissues in patients with CHF were higher than those in the control group. Meanwhile the AngII concentrations positively correlated to the parameters of the cardiac dilation respectively but negatively correlated to the parameters of cardiac function. Pathological changes of myocardial tissues in CHF with valvular heart disease showed typical myocardial remodeling. The hypertrophy was dominant at early stage of CHF, while at the end stage the characteristics include disordered alignment of the myocytes, the discontinuity and dissolving of cardiomyofibrills, destroyed subcellular organs, and the hyperplasia of interstitial tissue. Compared to the control group, u-calpain, m-calpain, and cain/cabin 1Delta protein expression, CaN phosphorylation in myocardial tissues in CHF groups were highly expressed and their expressions were positively correlated to the severity of CHF. The expression of cain/cabin1 deceased and its expression was negatively correlated to the severity of CHF.The degradation of cain/cabin 1 by calpain may play an important role by causing the activation of CaN signal pathway in myocardial remodeling mediated by renin angiotension system in CHF.

To assess the relationship between PPAR gamma C161-T polymorphism and Carotid Atherosclerosis in metabolic Syndrome (MS).Polymerase chain reaction-restricted fragments length polymorphism was used to study the distribution of the PPAR gamma C161-T polymorphism in 248 metabolism syndrome, 163 essential hypertension (EH) and 115 type 2 diabetes mellitus (DM) patients and 121 normal controls. Fasting insulin (FINS), fasting blood glucose (FBG), uric Acid (UA), plasma lipids and ultrasonography for carotid artery were examined.Waistline and BMI were significantly higher in MS compared with those in control, EH and DM (P0.01). systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were markedly higher in MS and EH compared with those in DM and control (P0.01). The frequencies of the CC, CT and TT were 74.6%, 21.8% and 3.6% in MS respectively, The frequencies of the CC was significantly higher in MS compared with that in control, but T allele carrier (CT + TT) was significantly lower compared with control, DM and EH (P0.05 or P0.01). In MS, CC genotype had significantly increased the intima-media thickness (IMT) of common carotid artery and plaque index compared with CT + TT (IMT: 0.84 mm +/- 0.3 mm vs 0.66 mm +/- 0.19 mm; plaque index: 2.19 +/- 1.21 vs 1.66 +/- 1.36, P0.05), CC genotype had significantly increased plaque index compared with CT + TT in EH and DM (plaque index: EH: 1.55 +/- 1.23 vs 1.29 +/- 0.92; DM: 1.57 +/- 1.2 vs 1.18 +/- 0.85, P0.05); CC genotype had significantly higher SBP compared with CT + TT in EH (P0.05), CC genotype had significantly increased plaque index in MS than that in DM and EH (P0.01), CC genotype had significantly increased IMT in MS compared with DM. CC genotype had significantly higher SBP and PP compared with CT + TT in MS (SBP: 155 mm Hg +/- 23 mm Hg vs 145 mm Hg +/- 21 mm Hg; PP: 69 mm Hg +/- 8 mm Hg vs 58 mm Hg +/- 8 mm Hg, 1 mm Hg = 0.133 kPa, P0.05).In MS, CC genotype was prone to lesion of carotid artery, but CT + TT may reduce lesion of carotid artery, which implicates that PPAR gamma C161-T may play a important role in carotid artery arteriosclerosis.

To assess the association of the metabolic syndrome with stroke in Chinese using the definition of ATP III, and revised definition according to Chinese criteria for abdominal obesity.Multi-center case control study, 1934 first-ever-stroke patients (Atherothrombosis, lacunar infarction, and intracerebral hemorrhage) aged 30 to 74 years were sequentially recruited. And 1839 age, gender and geographically matched subjects were included as controls.The prevalence of metabolic syndrome defined by either ATP III or Chinese criteria was significantly increasing in patients with lacunar infarction, cerebral atherosclerosis, or intracerebral hemorrhage than control subjects. After age- and sex-adjusted and further adjusted age, sex, total cholesterol, smoking, drinking, and education levels, the metabolic syndrome defined by ATP III criteria was associated with a 2.7 to 4.3 fold and 2.5 to 4.0 fold higher risk of the three stroke subtypes, respectively.the metabolic syndrome defined by ATP III and revised according to Chinese criteria of abdominal obesity was positively associated with the risk of stroke in our case control study. This study underscores the need for well-designed prospective study in Chinese to give further evidence to the link between metabolic syndrome and stroke.

To explore the relationship between genetic anomaly and risk factors in hypertension, a polymorphism at position G894T of the gene encoding the endothelial nitric oxide synthase (eNOS) together with hypertension related risk factors were observed in patients with essential hypertension (EH) in Chongqing city.Two hundred and twenty-six patients with EH and matched controls were selected. Genotypes of polymorphisms were determined by polymerase chain reaction (PCR), while PCR products were digested by restriction endonuclease (BanII). Questionnaire referred to life style, dietary, smoking, alcohol consumption, psychological and mental state, waist-to-hip ratio (WHR), etc was administered.There was no significant difference noticed in genotype distribution for the eNOS gene G894T genotype between hypertensive groups and controls, but difference was found among certain related risk factors, such as salt intake, snoring and WHR, etc. Logistic regression analysis showed no association between 894T allele and hypertension.Although the polymorphism of eNOS gene G894T did not seem to play an important and direct role in the pathogenesis of EH it might have indirect effects through certain risk factors.

To explore the association between alpha-adducin (ADD1) G/W460 and intracerebral hemorrhage (ICH) in Chinese.Samples of peripheral blood were collected from 456 patients with ICH diagnosed by CT or MRI from 7 clinical centers in China and 454 age, sex, and geographically matched subjects as controls. The ADD1 G/W460 polymorphism was detected by PCR. Information about prior exposure to various potential risk factors was collected by questionnaire survey.The distribution of ADD1gene G460W polymorphisms in the ICH patients and controls were in agreement with the Hardy-Weinberg proportion. The prevalence of 460W allele among ICH cases was 82.2%, higher than that in the controls (76.0%, crude odds ratio, 1.46; 95% CI, 1.05 to 2.05). The ADD1 460W allele was still significantly associated with ICH after adjustment for hypertension and other ICH putative risk factors (adjusted odds ratio, 1.38; 95% CI, 1.01 to 1.88).Alpha-adducin gene G/W 460 polymorphism is significantly associated with the risk of ICH. This association does not appear to be mediated by established ICH risk factors, specifically hypertension status.

To study the structure and function of the carotid artery in the metabolic syndrome (MS).171 patients were divided into three groups: metabolic syndrome (MS), diabetes mellitus (DM), and essential hypertension (EH). Plasma lipids and ultrasonography for carotid artery were examined.Levels of TG, LDL, ApoB were significantly higher in MS as compared with those EH (P0.01, 0.05, 0.01). Levels of TG were higher in MS as compared with those in DM (P0.01). The carotid resistance index and the intima-media thickness (IMT) of common carotid artery were significantly higher in MS as compared with those in DM or EH (P0.05). The occurrence rate of carotid plaque and plaque index was higher in patients with MS than that in patients with EH or DM (P0.01, 0.01).Clustering of multiple cardiovascular risk factors can cause more severe atherosclerosis of carotid artery in MS.