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HMG-CoA reductase (HMGCR) is the rate-limiting enzyme in cholesterol de novo biosynthesis and its degradation may bring therapeutic benefits for the treatment of cardiovascular disease (CVD) and nonalcoholic steatohepatitis (NASH). Before, we disclosed compound HMG499 as a potent HMGCR degrader, which could be a promising agent for treating CVD, however its side-effect of promoting cholesterol accumulation in cells should be eliminated before progression. Herein, a series of novel heterocyclic ring-fused analogs of HMG499 were synthesized and investigated for their activities of stimulating HMGCR degradation using a HMGCR (TM1-8)-GFP reporting system. Among them, the most active compound 29 (QH536) showed an EC 50 of 0.22 μΜ in promoting HMGCR degradation, which was about 2 times more potent than HMG499 (EC 50  = 0.43 μM). Interestingly, 29 was different from HMG499, it had no side-effect of inducing cholesterol accumulation in cells. Mechanistic studies disclosed that 29 could significantly decrease statin-induced accumulation of HMGCR protein via ubiquitination and degradation of HMGCR through ubiquitin-proteasome pathway and inhibit the cholesterol biosynthesis in cells. Therefore, these heterocyclic ring-fused analogs could be used as promising leads for the development of new types of agents against CVD. Furthermore, 29 also lowered cholesterol levels and suppressed TGFβ1-induced proliferation of LX-2 hepatic stellate cells in a dose-dependent manner. In particular, 29 not only decreased the NASH associated fibrotic mRNA and protein expression of α-SMA, COL1A1, TIMP1 and TGFβ1 but also suppressed cholesterol levels and inflammatory genes of TNF-α, IL-6 an IL-1β in RAW264.7 macrophage cells, indicating that 29 may bring therapeutic benefit to treat NASH., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: Cardiovascular disease (CVD) is the leading cause of mortality worldwide. The effect of socioeconomic factors on cause-specific mortality and burden of CVD is rarely evaluated in low- and middle-income countries, especially in a rapidly changing society., Methods: Original data were derived from the vital registration system in Yangpu, a representative, population-stable district of urban Shanghai, China, during 1974-2015. Temporal trends for the mortality rates and burden of CVD during 1974-2015 were evaluated using Joinpoint Regression Software. The burden was evaluated using age-standardized person years of life loss per 100,000 persons (SPYLLs). Age-sex-specific CVD mortality rates were predicted by using age-period-cohort Poisson regression model., Results: A total of 101,822 CVD death occurred during 1974-2015, accounting for 36.95% of total death. Hemorrhagic stroke, ischemic heart disease, and ischemic stroke were the 3 leading causes of CVD death. The age-standardized CVD mortality decreased from 144.5/100,000 to 100.7/100,000 in the residents (average annual percentage change [AAPC] -1.0, 95% confidence interval [CI] -1.7 to - 0.2), which was mainly contributed by women (AAPC -1.3, 95% CI - 2.0 to - 0.7), not by men. Hemorrhagic stroke, the major CVD death in the mid-aged population, decreased dramatically after 1991. The crude mortality of ischemic heart disease kept increasing but its age-adjusted mortality decreased continually after 1997. SPYLLs of CVD death increased from 1974 to 1986 (AAPC 2.1, 95% CI 0.4 to 3.8) and decreased after 1986 (AAPC 1.8, 95% CI - 2.3 to - 1.3). These changes were in concert with the implementation of policies including extended medical insurance coverage, pollution control, active prophylaxis of CVD including lifestyle promotion, and national health programs. The mortality of CVD increased in those born during 1937-1945, a period of the Japanese military occupation, and during 1958-1965, a period including the Chinese Famine. Sequelae of CVD and ischemic heart disease are predicted to be the leading causes of CVD death in 2029., Conclusions: Exposure to serious malnutrition in early life might increase CVD mortality in later life. Improvements in medical services, pollution control, and lifestyle could decrease CVD death. New strategy is needed to prevent the aging-related CVD death and burden in the future.

Background: Carotid-femoral pulse-wave velocity (cf-PWV) and brachial-ankle PWV (ba-PWV) are the 2 most frequently applied PWV measurements. However, little is known about the comparison of hypertensive target organ damage (TOD) with cf-PWV and ba-PWV., Methods and Results: A total of 1599 community-dwelling elderly subjects (age >65 years) in northern Shanghai were recruited from June 2014 to August 2015. Both cf-PWV and ba-PWV were measured using SphygmoCor and VP1000 systems, respectively. Within the framework of comprehensive cardiovascular examinations, risk factors were assessed, and asymptomatic TOD, including left ventricular mass index, peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), carotid intima-media thickness, arterial plaque, creatinine clearance rate, and urinary albumin-creatinine ratio were all evaluated. Both PWVs were significantly associated with male sex, age, waist/hip circumference, fasting plasma glucose, and systolic blood pressure, and ba-PWV was also significantly related to body mass index. Both PWVs were significantly correlated with most TOD. When cf-PWV and ba-PWV were both or separately put into the stepwise linear regression model together with cardiovascular risk factors and treatment, only cf-PWV, but not ba-PWV, was significantly associated with carotid intima-media thickness and creatinine clearance rate ( P <0.05). When cf-PWV and ba-PWV were both or separately put into the same full-mode model after adjustment for confounders, only cf-PWV, but not ba-PWV, showed significant association with carotid intima-media thickness and creatinine clearance rate ( P <0.05). Similar results were observed in logistic regression analysis., Conclusions: Taken together, in the community-dwelling elderly Chinese, cf-PWV seems to be more closely associated with hypertensive TOD, especially vascular and renal TOD, as compared with ba-PWV., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02368938., (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)

Background: The purpose of this study was to investigate the impact of different blood pressure (BP) categories on risk of developing cardiovascular disease (CVD) events and mortality, and to evaluate the optimal range of BP in patients after stroke in rural areas of China., Methods: We performed a post hoc analysis of 1058 patients with a history of stroke or transient ischemic attack from the Northeast China Rural Cardiovascular Health Study. The average follow-up systolic blood pressure (SBP) and diastolic blood pressure (DBP) were categorized into 10-mm Hg increments. The primary outcome was a composite of death due to any cause, nonfatal coronary heart disease, and nonfatal stroke. The secondary outcomes were recurrent stroke, CVD events, CVD mortality, and all-cause mortality., Results: The relationship between BP (systolic and diastolic) followed a J- or U-shaped curve with primary and secondary outcomes, with increased event rates at low and high BP values, both unadjusted variables and after adjustment for baseline confounding variables. The event rates were lowest in the SBP of 110-119 and DBP of 80-89 mm Hg. Patients with a BP lower than 110/70 or 140/90 mm Hg or higher had a significantly increased risk of worse outcomes., Conclusions: For stroke survivors, a J- or U-shaped curve association exists between BP and the risk of future CVD events and mortality, with the lowest event rates in the BP range of 110-119 systolic and 80-89 diastolic. SBPs of 110-139 and DBPs of 70-89 are the appropriate range for patients after stroke in rural areas of China., (Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

The Eighth Joint National Committee (JNC-8) panel recently recommended a systolic blood pressure (BP) threshold of ≥ 150 mmHg for the initiation of drug therapy and a therapeutic target of <150/90 mmHg in patients ≥ 60 years of age. However, results from some post-hoc analysis of randomized controlled trials and observational studies did not support these recommendations. In the prospective cohort study, 5006 eligible hypertensive patients aged ≥ 60 years from rural areas of China were enrolled for the present analysis. The association between the average follow-up BP and outcomes (all-cause and cardiovascular death, incident coronary heart disease [CHD], and stroke), followed by a median of 4.8 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. The relationship between BP (systolic or diastolic) showed an increased or J-shaped curve association with adverse outcomes. Compared with the reference group of BP <140/90 mmHg, the risk of all-cause death (hazard ratio [HR]: 2.698; 95% confidence interval [CI]: 1.989-3.659), cardiovascular death (HR: 2.702; 95% CI: 1.855-3.935), incident CHD (HR: 3.263; 95% CI: 2.063-5.161), and stroke (HR: 2.334; 95% CI: 1.559-3.945) was still significantly increased in the group with BP of 140-149/<90 mmHg. Older hypertensive patients with BP of 140-149/<90 mmHg were at higher risk of developing adverse outcomes, implying that lenient BP control of 140-149/<90 mmHg, based on the JNC-8 guidelines, may not be appropriate for hypertensive patients aged ≥ 60 years in rural areas of China.

Background: The quantitative associations between prehypertension or its separate blood pressure (BP) ranges and the risk of main cardiovascular diseases (CVDs) have not been reliably documented., Methods: We performed a comprehensive search of PubMed (1966 to June 2012) and the Cochrane Library (1988 to June 2012) without language restrictions. Prospective studies were included if they reported multivariate-adjusted risk ratios (RRs) and corresponding 95 % confidence intervals (CIs) of desirable outcomes, including fatal or non-fatal incident stroke, coronary heart disease, myocardial infarction (MI) or total CVD events, with respect to prehypertension or its separate BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline with normal BP (<120/80 mmHg) as reference. Pooled RRs were estimated using a random-effects model or a fixed-effects model., Results: Twenty-nine articles met our inclusion criteria, with 1,010,858 participants. Both low-range and high-range prehypertension were associated with a greater risk of developing or dying of total CVD (low-range: RR: 1.24; 95 % CI: 1.10 to 1.39; high range: RR: 1.56; 95 % CI: 1.36 to 1.78), stroke (low-range: RR: 1.35; 95 % CI: 1.10 to 1.66; high-range: RR: 1.95; 95 % CI: 1.69 to 2.24) and myocardial infarction (MI) (low range: RR: 1.43; 95 % CI: 1.10 to 1.86; high range: RR: 1.99; 95 % CI: 1.59 to 2.50). The whole range prehypertension had a 1.44-fold (95 % CI: 1.35 to 1.53), 1.73-fold (95 % CI: 1.61 to 1.85), and 1.79-fold (95 % CI: 1.45 to 2.22) risk of total CVD, stroke, and MI, respectively. There was no evidence of publication bias., Conclusions: Prehypertensive patients have a greater risk of incident stroke, MI and total CVD events. The impact was markedly different between the low and high prehypertension ranges

Background: To investigate the predictive value of ankle-brachial index (ABI) for all-cause mortality and cardiovascular mortality in Chinese patients with chronic kidney disease (CKD)., Patients and Methods: 1563 CKD patients were enrolled in the cohort and were followed up for about 3 years in China. CKD was defined as an eGFR less than 60 ml/min/1.73m(2). 573 participants were diagnosed with PAD using ABI <= 0.90. Their average age was 73.4 ±8.2 years., Results: During a median follow-up of 38 months, there were 1353 CKD patients with complete data. A total of 313 patients (161 with and 152 without PAD) died during follow-up. 184 deaths (99 with and 85 without PAD) were caused by cardiovascular disease (CVD). All-cause and CVD mortality of CKD patients with PAD was increased 2.2-fold and 2.4-fold compared with CKD patients without PAD. The hazard ratio (HR) of PAD for all-cause and CVD mortality was 2.15 (95 % CI: 1.66 - 2.79) and 2.51 (95 % CI: 1.80 - 3.50) respectively. Mortality of CKD patients significantly increased with decreasing ABI. That of CKD patients with ABI <= 0.4 was the highest (42.9 % and 28.6 %, respectively) in different ABI categories. Relative risks of all-cause and CVD mortality of CKD patients with ABI <= 0.4 were increased 3.479-fold (95 % CI: 2.076 - 5.830) and 4.960-fold (95 % CI: 2.644 - 9.302) respectively compared with those of patients with ABI > 1.0 and <= 1.4. Special models to evaluate the predictive value of ABI to mortality of CKD patients suggested that addition of ABI significantly increased the predictive value of the model for 3-year mortality compared with a model including conventional risk factors alone., Conclusions: Low ankle-brachial index can predict increased mortality of chronic kidney disease patients. Addition of ankle-brachial index can significantly improve the prediction of 3-year mortality compared with conventional risk factors alone.

Objective: Peripheral arterial disease (PAD) is a common clinical manifestation of the systemic atherosclerotic process, and the ankle-brachial index (ABI) is an ideal tool to diagnose PAD. Currently, there have been few long-term follow-up studies focused on the associations of the ABI with all-cause mortality and cardiovascular disease (CVD) mortality in Chinese MetS patients. The aim of this study was to evaluate the usefulness of ABI to predict the prognosis of CVD in hospitalized Chinese patients with metabolic syndrome (MetS)., Methods: Participants from multi-center departments were followed up from November 2004 to January 2011. The study sample actually comprised 1,266 valid participants whose age was ≥35 years. Patients were separated into four groups, with an ABI ≤0.4, 0.41-0.7, 0.71-0.9 and 0.91-1.4. An ABI ≤0.9 was defined as PAD, and subjects with an ABI >1.4 were excluded because of the false negative rate. Factors related to all-cause and cardiovascular mortality were observed by Cox models and the log rank test. Potential confounding variables with values of p<0.10 were adjusted for the multivariate analysis., Results: An abnormal ABI value was strongly, independently, and inversely correlated with the all-cause and cardiovascular mortality. After adjusting for age and other covariates, Cox models revealed that an abnormal ABI value was still correlated with the all-cause mortality (relative risk/RR/=1.82, 95% confidence interval/CI/=1.45-2.34 p<0.01), and CVD mortality (RR=1.88, 95% CI=1.51-2.90 p<0.01)., Conclusion: An abnormal ABI value was not only a significant and independent risk factor for CVD, but also for the survival rate in Chinese MetS patients. Routine ABI evaluation could therefore be helpful for identifying high risk patients, especially MetS patients.

Background: Few studies reported the associations between decreased glomerular filtration rate (GFR) and mortality, coronary heart disease (CHD), and stroke in hypertensive patients. We aim to assess the associations between GFR and mortality, CHD, and stroke in hypertensive patients and to evaluate whether low GFR can improve the prediction of these outcomes in addition to conventional cardiovascular risk factors., Methods and Findings: This is an observational prospective study and 3,711 eligible hypertensive patients aged ≥5 years from rural areas of China were used for the present analysis. The associations between eGFR and outcomes, followed by a median of 4.9 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. Low eGFR was independently associated with risk of all-cause mortality, cardiovascular mortality, and incident stroke [multivariable adjusted hazard ratios (95% confidence intervals) for eGFR <60 ml/min/1.73 m(2) relative to eGFR ≥90 ml/min/1.73 m(2) were 1.824 (1.047-3.365), 2.371 (1.109-5.068), and 2.493 (1.193-5.212), respectively]. We found no independent association between eGFR and the risk of CHD. For 4-year all-cause and cardiovascular mortality, integrated discrimination improvement (IDI) was positive when eGFR were added to traditional risk factors (1.51%, P = 0.016, and 1.99%, P = 0.017, respectively). For stroke and CHD events, net reclassification improvements (NRI) were 5.9% (P = 0.012) and 1.8% (P = 0.083) for eGFR, respectively., Conclusions: We have established an inversely independent association between eGFR and all-cause mortality, cardiovascular mortality, and stroke in hypertensive patients in rural areas of China. Further, addition of eGFR significantly improved the prediction of 4-year mortality and stroke over and above that of conventional risk factors. We recommend that eGFR be incorporated into prognostic assessment for patients with hypertension in rural areas of China., Limitations: We did not have sufficient information on atrial fibrillation to control for the potential covariate. These associations should be further confirmed in future.

Background: The association between increased serum uric acid (SUA) levels and cardiovascular risk has been debated for decades. Several large studies have provided conflicting results regarding the clinical significance of elevated SUA levels in cardiovascular disease (CVD) or cerebrovascular disease. The aim of this study was to investigate the relationship between SUA and CVD and all-cause mortality and their potential diagnostic value., Methods: A total of 3570 in-patients ranging in age from 56 to 95 years (mean (67.36 +/- 11.36) years) were selected from 20 hospitals in Beijing and Shanghai. A carefully designed questionnaire was used to gather baseline data of each patient. All patients were divided into two main groups according to their SUA levels: high SUA and normal SUA groups. Serum indices and other important parameters were measured., Results: Compared with normal SUA group, high SUA group had significant difference in systolic blood pressure (SBP), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), body mass index (BMI), and age (P < 0.05 or P < 0.01). High SUA prevailed in female and patients with history of essential hypertension, while history of smoking and diabetes showed no significant difference between two groups. All-cause and CVD mortality occurred more frequently in high SUA group than in normal SUA group. In the accumulative survival analysis, high SUA group had lower survival rate than normal SUA group both in CVD and all-cause mortality. COX regression analysis indicated that the history of smoking, age and high SUA were independent risk factors for the development of CVD., Conclusions: These preliminary observations suggest that patients with high SUA levels would face higher risk of mortality. SUA measurement may be applied as a routine predictor for clinical assessment.

Aim: This study was conducted to investigate the role of chronic kidney disease (CKD) in 1-year all cause mortality and cardiovascular mortality among Chinese patients who were at least 50 years old and had a history of coronary artery disease (CAD), stroke, or peripheral vascular disease (PAD), or with two or more cardiovascular risks., Methods: Of 3,732 hospitalized patients enrolled, 3,423 patients (91.7%) with complete data were eligible for 1-year follow-up. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m(2)., Results: 1,166 (34.1%) were diagnosed with CKD. Most cases were unrecognized. Patients having an eGFR of <30 mL/min/1.73 m(2) were less likely to be prescribed beta-blockers, statins, or aspirin (all p<0.001). A powerful relationship was observed between the severity of renal dysfunction and all causes of death or cardiovascular death. Adjusted for other covariates, the hazard ratio (HR) for all causes of death and for cardiovascular death among patients with an eGFR of 30-45 mL/min/1.73 m(2) was 1.70 (95% CI, 1.18-2.45) and 1.85 (95% CI, 1.12-3.01) as compared with 2.93 (95% CI, 1.96-4.38) and 3.47 (95% CI, 1.91-6.31) for patients with an eGFR of <30 mL/min/1.73 m(2)., Conclusions: One third of Chinese patients at high risk for atherosclerotic events were diagnosed with CKD. Most of these cases were unrecognized and undertreated. An eGFR of <45 mL/min/1.73 m(2) was an independent predictor of all causes of death and of cardiovascular death.

Objective: Smoking is a major risk factor for peripheral arterial disease (PAD), and PAD is associated with all-cause and cardiovascular disease (CVD) mortality. The objective of this study was to determine the combined effects of smoking and PAD on all-cause and CVD mortality., Methods: A total of 1979 males 35 years of age or older were enrolled from eight university-affiliated hospitals in Beijing and Shanghai in 2004, with both smoking status and PAD diagnosis obtained, 1712 of them had complete follow-up data. Mortality data were obtained from all participants between December 2007 and February 2008. Cox proportional hazards models were used to evaluate relative risks (RRs) of all-cause mortality and CVD mortality among different groups., Results: At baseline, the average age of participants was 66.98-years-old (SD = 11.57), prevalence of PAD was 24.0% and 65.4% smoked cigarettes. During the 3-year follow-up, all-cause cumulative mortality rates were 27.9% (PAD/smoker), 26.3% (PAD/nonsmoker), 14.1% (no PAD/smoker), and 14.4% (no PAD/nonsmoker) (P < .001), and CVD cumulative mortality rates were 17.8%, 14.9%, 8.1%, and 7.3%, respectively (P < .001). Compared with the no PAD/nonsmoker subjects, adjusted RR from all-cause mortality in the groups of both PAD/smoker, PAD/nonsmoker, and no PAD/smoker were 1.88 (95% confidence interval [CI], 1.34-2.64), 1.37 (95% CI, 0.85-2.23), and 1.08 (95% CI, 0.79-1.49), respectively. The adjusted RR from CVD mortality was 2.12 (95% CI, 1.37-3.28), 1.55 (95% CI, 0.84-2.86), and 1.13 (95% CI, 0.74-1.71), respectively., Conclusion: PAD is a major determinant of mortality. Smoking did not contribute to mortality in this study. Further research is needed.

Introduction: Peripheral arterial disease (PAD) is an important manifestation of systemic atherosclerosis.The present study was to estimate the prevalence of and risk factors for PAD in Chinese hypertensive patients with and without known cardiovascular disease (CVD) which consisted of coronary heart disease, angina, stroke, and transient ischaemic attack., Material and Methods: A cross-sectional study consisting of 5,186 hypertensive patients was conducted from July to November 2004 in Beijing and Shanghai, China. PAD was defined as an ankle-brachial index < or = 0.90 in either leg., Results: The prevalence of PAD was 29.0% among hypertensive patients with known CVD, higher than in patients without known CVD (16.6%, P <0.0001). After multivariable logistic regression analysis, older age and current smoking were independently associated with prevalent PAD among all hypertensive patients.Among hypertensive patients without known CVD, higher total cholesterol (OR and 95% CI: 1.518, 1.162-1.984 in men and 1.460, 1.097-1.944 in women), was independently associated with prevalent PAD. Higher fasting glucose (OR and 95% CI: 1.027, 1.001-1.054 in men and 1.033, 1.006-1.061 in women) and higher uric acid (OR and 95% CI: 1.002, 1.001-1.003 in men and 1.003, 1.001-1.005 in women) were risk factors for PAD among hypertensive patients with known CVD. No association was found between obesity and PAD in hypertensive patients with and without known CVD., Conclusions: Prevalence of and risk actors for PAD among Chinese hypertensive patients with and without CVD were different. Cessation of smoking should be stressed to inhibit the progression of PAD in hypertensive patients.

Objective: To evaluate the risk factors for peripheral arterial disease (PAD) and the relationship of low ankle brachial index (ABI) to all-cause and cardiovascular disease (CVD) mortality in Chinese male patients with hypertension., Methods: The data of 1606 male participants with hypertension from the eight hospitals in Beijing and Shanghai were analyzed. ABI was ascertained at baseline by measuring the systolic pressures on bilateral brachial and tibial arteries. ABI < or = 0.9 was used as the diagnostic criteria for PAD identification. The follow-up survey was conducted from November 2005 to January 2006., Results: Of 1606 male participants with hypertension at baseline, 406 (25.3% ) were in low-ABI group and 1200 (74.7%) were in normal-ABI group. Older age, TC, history of diabetes, history of smoking and 2-grade hypertension were associated with low ABI in male patients with hypertension. During the (12.87 +/- 2.94) months follow-up, there were 153 deaths. Of which, 62 were attributable to CVD. Low ABI was associated with adjusted all-cause and CVD mortality risk of 1.728 (1.223-2.441) and 2.388 (1.409-4.046) respectively in Cox regression models. Rate of survival for the low-ABI group was significantly worse than for the normal-ABI group. The risk of all-cause and CVD mortality was increased with the decline of ABI., Conclusion: Low ABI is independently associated with the high risks of all-cause and CVD mortality in Chinese male patients with hypertension. The utility of ABI as a tool for predicting mortality in the patients with hypertension should be popularized.

The ankle-brachial index (ABI) is a non-invasive, reliable measurement of lower-extremity ischemia. A low ABI is associated with increased risk of coronary heart disease, stroke and death. However, the relationship between ABI and all-cause mortality or cardiovascular disease (CVD) mortality in patients with metabolic syndrome (MetS) has not been well studied. Accordingly, we here investigated the association between ABI and all-cause and CVD mortality in an elderly Chinese population with MetS. A total of 2,274 MetS patients diagnosed under the criteria proposed by the International Diabetes Federation were divided into two groups based on repeated ABI measurement over a period of 13.6 months: ABI

Background: The aim of the present study was to evaluate the risk factors for peripheral arterial disease and the relationship between the ankle - brachial index (ABI) and mortality from all-cause and cardiovascular disease (CVD) in Chinese patients with type 2 diabetes mellitus (DM)., Methods and Results: ABI was identified at baseline by measuring systolic pressure in the bilateral brachial and tibial arteries. Mortality surveillance was completed from November 2004 to January 2006. Among 1,647 participants with type 2 DM at baseline, 531 (32.2%) were in the low-ABI group. Older age, female gender, higher serum level of total cholesterol, longer duration of DM and a history of smoking were associated with low ABI. During the 13-month follow-up, there were 132 deaths, of which 47 were from CVD. Low ABI was associated with mortality from all-cause and CVD, the adjusted relative risk of which was 1.851 (95% confidence interval 1.280-2.676) and 3.211 (1.703-6.053), respectively, in Cox regression models. The survival rate was significantly lower in the low-ABI group than in the normal-ABI group., Conclusion: Low ABI was independently associated with a high risk of all-cause and CVD mortality in Chinese patients with type 2 DM. ABI should be promoted as an ideal tool for predicting mortality in diabetic patients.

Objective: To investigate the prevalence of metabolic syndrome (MS) in the patients with coronary heart disease (CHD) in China., Methods: The clinical data, including anthropometric data, case record form (CRF), clinical examination, etc. of all CHD patients hospitalized from 1 Jun 2005 to 31 Sep 2005 in the department of cardiology of 52 hospitals in 7 northern, middle, and southern cities in China. A total of 3513 CHD patients, 2341 males and 1172 females, aged 23 approximately 99, were recruited., Results: The prevalence of MS was 30.4% among the 3513 CHD patients, 27.4% among the males and 36.4% among the females. The prevalence of MS among the CHD patients in the northern cities was 36.5%, significantly higher than those in the middle and southern cites (25.% and 25.1% respectively, chi(2) = 50.252, P < 0.001), with a trend to gradually decrease from north to south. The prevalence of MS among the CHD patients receiving acute admission was 28.8%, not significantly different from that receiving scheduled admission (31.2%, P = 0.139). There was a clear age-related increase in the prevalence of MS (chi(2) = 23.625, P < 0.001). The prevalence of MS of the males aged < 60 was higher than that of the females aged < 60; and the prevalence of MS of the females aged > 60 was higher than that of the females aged > 60., Conclusion: The prevalence of MS in CHD patients is rather high in China. It is important to screen for MS in patients with high risk for new vascular incidents.

To obtain reliable data on the epidemiology, co-morbidities and risk factor profile of peripheral arterial disease (PAD), we evaluated the clinical significance of the ankle brachial index (ABI) as an indicator of PAD in Chinese patients at high cardiovascular (CV) risk. ABI was measured in 5,646 Chinese patients at high CV risk, and PAD was defined as an ABI<0.9 in either leg. Multivariable logistic regression analyses were performed to identify factors associated with PAD. A total of 5,263 patients were analyzed, 52.9% male, mean age 67.3 years, mean body mass index (BMI) 24.2 kg/m2, mean systolic/diastolic blood pressure (SBP/DBP) 139/80.7 mmHg. The prevalence of PAD in the total group of patients was 25.4%, and the prevalence was higher in females than in males (27.1% vs. 23.9%; odds ratio [OR]: 1.64). Patients with PAD were older than those without PAD (72.3+/-9.9 years vs. 65.6+/-11.7 years; OR: 1.06), and more frequently had diabetes (43.3% vs. 31.3%; OR: 2.02), coronary heart disease (CHD) (27.0% vs. 18.8%; OR: 1.67), stroke (44.4% vs. 28.3%; OR: 1.78), lipid disorders (57.2% vs. 50.7%; OR: 1.3) and a smoking habit (42.7% vs. 38.6%; OR: 1.52). The ORs for the PAD group compared with the non-PAD group demonstrated that these conditions were inversely related to ABI. Statin, angiotensin-converting enzyme-inhibitors and antiplatelet agents were only used in 40.5%, 53.6% and 69.1% of PAD patients, respectively. The data demonstrated the high prevalence and low treatment of PAD in Chinese patients at high CV risk. A lower ABI was associated with generalized atherosclerosis. Based on these findings, ABI should be a routine measurement in high risk patients. Aggressive medication was required in these patients.

Objective: Secreted frizzled related protein 5 (SFRP5) is a novel anti-inflammatory adipokine that is implicated in metabolic and cardiovascular disease (CVD). However, little is known about the relevance of SFRP5 with asymptomatic hypertensive target organ damages (TODs). We aimed to investigate the association between SFRP5 and TOD in a large population. Clinical trial registration: NCT02368938. Methods: A total of 1,745 community-dwelling elderly subjects aged over 65 years from northern Shanghai were recruited in the study. Plasma SFRP5 level was measured by an enzyme-linked immunosorbent assay. Asymptomatic TODs, including left ventricular mass index, peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity, carotid intima-media thickness (CIMT), pulse wave velocity (PWV), estimated glomerular filtration rate, and urinary albumin-creatinine ratio were evaluated. Results: Plasma SFRP5 level was negatively associated with body mass index, waist/hip ratio, and fasting blood glucose (all P<0.001). Men, compared with women, had lower plasma SFRP5 level (4.19 vs 5.13 ng/mL, P<0.001). Additionally, plasma SFRP5 level was lower in diabetics than in those without diabetes (4.30 vs 4.81 ng/mL, P<0.05). Furthermore, an inverse association was observed between SFRP5 and PWV and CIMT (both P<0.05). Lastly, the multivariate logistic regression analysis showed lower SFRP5 level was significantly associated with increased arterial stiffness in the elderly (odds ratio 0.83, 95% confidence interval 0.71 to 0.99 per 1 standard deviation increase, P<0.05). Conclusion: Plasma SFRP5 level was inversely correlated with conventional cardiovascular risk factors, and low plasma SFRP5 was also significantly associated with arterial stiffening in the elderly Chinese population. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) remains a significant cause of morbidity and mortality. Multiple trials over the past several years have examined the effects of both angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in the treatment of left ventricular dysfunction, both acutely after myocardial infarction and in chronic heart failure. Yet, there is still confusion regarding the relative efficacy of rennin-angiotensin-aldosterone system (RAAS) inhibition. Our study was conducted to assess efficacy of ACEIs and ARBs in reducing all-cause and cardiovascular mortality in heart failure patients.Methods: We included randomized clinical trials compared ACEIs and ARBs treatment (any dose or type) with placebo treatment, no treatment, or other anti-HF drugs treatment, reporting cardiovascular or total mortality with an observation period of at least 12 months. Data sources included Pubmed, EMBASE, the Cochrane Central Register of Controlled Trials. Dichotomous outcome data from individual trials were analyzed using the risk ratio measure and its 95%CI with random-effects/ fixed-effects models. We performed meta-regression analyses to identify sources of heterogeneity. All-cause mortality and CV mortality were thought to be the main outcomes.Results: A total of 47,662 subjects were included with a mean/median follow-up ranged from 12 weeks to 4.5 years. Of all 38 studies, 32 compared ACEIs with control therapy (included 13 arms that compared ACEIs with placebo, 10 arms in which the comparator was active treatment and 9 arms that compared ACEIs with ARBs), and six studies compared ARBs with placebo. ACEIs treatment in patients with HF reduced all-cause mortality to 11% (risk ratio (RR): 0.89, 95% confidence interval (CI): 0.83-0.96, p = 0.001) and the corresponding value for cardiovascular mortality was 14% (RR: 0.86, 95% CI: 0.78-0.94, p = 0.001). However, ARBs had no beneficial effect on reducing all-cause and cardiovascular mortality. In head-to-head analysis, ACEIs was not superior to ARBs for all-cause mortality and cardiovascular deaths.Conclusions: In HF patients, ACEIs, but not ARBs reduced all-cause mortality and cardiovascular deaths. Thus, ACEIs should be considered as first-line therapy to limit excess mortality and morbidity in this population. [ABSTRACT FROM AUTHOR]

Objectives: Quantitative associations between prehypertension or its two separate blood pressure (BP) ranges and cardiovascular disease (CVD) or all-cause mortality have not been reliably documented. In this study, we performed a comprehensive systematic review and meta-analysis to assess these relationships from prospective cohort studies. Methods: We conducted a comprehensive search of PubMed (1966-June 2012) and the Cochrane Library (1988-June 2012) without language restrictions. This was supplemented by review of the references in the included studies and relevant reviews identified in the search. Prospective studies were included if they reported multivariate-adjusted relative risks (RRs) and corresponding 95% confidence intervals (CIs) of CVD or all-cause mortality with respect to prehypertension or its two BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline. Pooled RRs were estimated using a random-effects model or a fixed-effects model depending on the between-study heterogeneity. Results: Thirteen studies met our inclusion criteria, with 870,678 participants. Prehypertension was not associated with an increased risk of all-cause mortality either in the whole prehypertension group (RR: 1.03; 95% CI: 0.91 to 1.15, P = 0.667) or in its two separate BP ranges (low-range: RR: 0.91; 95% CI: 0.81 to 1.02, P = 0.107; high range: RR: 1.00; 95% CI: 0.95 to 1.06, P = 0.951). Prehypertension was significantly associated with a greater risk of CVD mortality (RR: 1.32; 95% CI: 1.16 to 1.50, P<0.001). When analyzed separately by two BP ranges, only high range prehypertension was related to an increased risk of CVD mortality (low-range: RR: 1.10; 95% CI: 0.92 to 1.30, P = 0.287; high range: RR: 1.26; 95% CI: 1.13 to 1.41, P<0.001). Conclusions: From the best available prospective data, prehypertension was not associated with all-cause mortality. More high quality cohort studies stratified by BP range are needed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The prevalence of hypertension in individuals with diabetes mellitus is higher than that in individuals without diabetes mellitus. High fiber intake decreases blood glucose and lipids levels. This study investigated the effects of cereal fiber intake on systolic and diastolic blood pressures in a rat model of type 2 diabetes mellitus. Methods: Thirty male Goto Kakizaki rats were randomly assigned to one of three groups. Each group was fed a barley diet, a white rice diet, or cornstarch diet. The rats were pair fed for 16 wk. Systolic and diastolic blood pressures were measured once every 4 wk by the photoelectric oscillometric tail-cuff method without anesthesia. Results: The barley diet significantly decreased systolic blood pressure from week 12 and decreased the plasma levels of total cholesterol, triacylglycerol, and low-density lipoprotein cholesterol. There were significant positive correlations between plasma lipids levels and systolic blood pressure. Conclusions: High fiber intake has beneficial effects on systolic blood pressure and blood lipids levels and suggests that fiber intake should be increased in individuals who have diabetes mellitus to prevent complications. [Copyright &y& Elsevier]