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Sepsis-induced myocardial dysfunction (SIMD) is ubiquitous in septic shock patients and is associated with high morbidity and mortality rates. Heat shock protein 22 (Hsp22), which belongs to the small HSP family of proteins, is involved in several biological functions. However, the function of Hsp22 in lipopolysaccharide (LPS)-induced myocardial injury is not yet established. This study was aimed at investigating the underlying mechanistic aspects of Hsp22 in myocardial injury induced by LPS. In this study, following the random assignment of male C57BL/6 mice into control, LPS-treated, and LPS + Hsp22 treated groups, relevant echocardiograms and staining were performed to scrutinize the cardiac pathology. Plausible mechanisms were proposed based on the findings of the enzyme-linked immunosorbent assay and Western blotting assay. A protective role of Hsp22 against LPS-induced myocardial injury emerged, as evidenced from decreased levels of creatinine kinase-MB (CK-MB), lactate dehydrogenase (LDH), and enhanced cardiac function. The post-LPS administration-caused spike in inflammatory cytokines (IL-1β, IL-6, TNF-α and NLRP3) was attenuated by the Hsp22 pre-treatment. In addition, superoxide dismutase (SOD) activity and B-cell lymphoma-2 (Bcl2) levels were augmented by Hsp22 treatment resulting in lowering of LPS-induced oxidative stress and cardiomyocyte apoptosis. In summary, the suppression of LPS-induced myocardial injury by Hsp22 overexpression via targeting of inflammation, oxidative stress, and apoptosis in cardiomyocytes paves the way for this protein to be employed in the therapy of SIMD.

Background. The association between triglyceride-rich lipoprotein cholesterol (TRL-C) and diabetes mellitus (DM) remains unclear because of limited research and data. The aim of this study was to explore the independent association between TRL-C and DM in hypertensive patients and to examine whether a healthy lifestyle would have an impact on this relationship. Methods. In this study, data from 13,721 hypertensive patients who were not treated with lipid-lowering drugs were analyzed. TRL-C was calculated from total cholesterol (TC) minus [LDL cholesterol + HDL cholesterol]. DM was defined as fasting plasma glucose of ≥7.0 mmol/L and/or self-reported history of hypoglycemic drug use. Results. After adjusting for potential confounding factors, the TRL-C was significantly positively associated with elevated DM (odds ratio (OR): 1.73 and 95% confidence interval (CI): 1.54–1.94). In subgroup analysis, a healthy lifestyle (HL) failed to modify the positive association between TRL-C and DM (HL: OR 1.93, 95%CI 1.58–2.36; non-HL: OR 1.72, 95%CI 1.50–1.98; P for interaction = 0.38). Conclusion. The results showed a positive association between TRL-C and DM in hypertensive patients. A healthy lifestyle failed to diminish the relationship between TRL-C and DM. The novel findings indicate that TRL-C might be a reliable marker of DM and may provide a new strategy for the prevention and treatment of DM.

Background The relationship between obesity indices and arterial stiffness (AS) has not been fully discovered nor has it been studied in depth in large hypertensive patient populations. The aim of this study was to explore the association between body mass index (BMI) and waist-hip ratio (WHR) levels and AS based on brachial-ankle pulse wave velocity (baPWV) in Chinese rural adults with hypertension. Methods This cross-sectional study analyzed 5049 Chinese rural adults with essential hypertension. BMI was calculated as the body weight in kilograms divided by the square of the height in meters (kg/m2). Central obesity was defined as WHR ≥ 0.9 for males and ≥ 0.85 for females. Measurement of arterial stiffness was carried out via brachial-ankle pulse wave velocity (baPWV). Results The prevalence of overweight, general obesity, central obesity and increased AS were 26.88%, 3.39%, 63.85% and 44.01%, respectively. Multivariate logistic regression analysis indicated that BMI levels were negatively associated with the prevalence of increased AS (adjusted-OR per SD increase: 0.74, 95% CI 0.67–0.81, P SD increase: 1.25, 95% CI 1.14–1.36, P CI 1.28–1.81, P β per SD increase: − 0.57, 95% CI − 0.68 to − 0.46, P β per SD increase: 4.46, 95% CI 3.04–5.88, P Conclusion There was an inverse relationship between BMI levels and increased AS or baPWV levels, whereas WHR levels and central obesity were positively associated with increased AS or baPWV levels in Chinese rural adults with hypertension.

Background Diabetic nephropathy is a major complication of diabetes. We explore the protective effect of TRPM2 knockdown on the progression of diabetic nephropathy. Methods A type 2 diabetes animal model was established in C57BL/6N mice by long-term high-fat diet (HFD) feeding combined with a single injection of 100 mg/kg streptozotocin (STZ). Genetic knockdown of TRPM2 in mouse kidneys was accomplished by the intravenous injection via the tail vein of adeno-associated virus type 2 carrying TRPM2 shRNA. Results Mice with HFD/STZ-induced diabetes exhibited kidney dysfunction, as demonstrated by increased blood creatinine and urea nitrogen levels, accompanied by glomerulus derangement, tubule damage and extracellular matrix deposition in the interstitium. The protein expression of TRPM2, transforming growth factor-β1 (TGF-β1), connective tissue growth factor, α-smooth muscles actin, fibronectin, collagen I and collagen III, and the mRNA expression and contents of inflammatory factors, including interleukin-1β, interleukin-6, interferon-α, tumour necrosis factor -α and monocyte chemotactic protein -1, were significantly elevated in the renal tissues of the HFD/STZ-induced diabetes group compared to those of the two control groups. Furthermore, fluorescent staining of TRPM2 was markedly increased in the renal tubular epithelial cells from diabetic mice. Knockdown of TRPM2 significantly attenuated HFD/STZ-induced renal inflammatory responses and fibrosis, which was accompanied by activation of TGF-β1-activated c-Jun N-terminal protein kinase-1 (JNK1) signalling. JNK1 inactivation reversed hyperglycaemia-induced fibrosis and inflammation in HK-2 cells. Conclusion TRPM2 silencing significantly attenuated fibrosis and inflammation in the kidneys of mice with HFD/STZ-induced diabetes, which was largely achieved via the inhibition of TGF-β1-activated JNK1 activation.

Little information is available on the association between brachial-ankle pulse wave velocity (baPWV) and the risk of stroke in Chinese H-type hypertension patients. Therefore, our study aimed to assess this association between baseline baPWV and short-term risk of first stroke and to propose a cutoff value of baPWV that could predict near cerebrovascular events. A total of 9787 hypertension patients without preexisting stroke who underwent baPWV measurement were included. The primary end points were first symptomatic stroke. Secondary end points were first ischemic stroke and first hemorrhagic stroke. During a median follow-up of 20.8 months, there was a total of 138 first strokes including 123 first ischemic strokes and 15 first hemorrhagic strokes. When baPWV was categorized in quartiles, the higher risks of first stroke (HR = 1.52; 95% CI: 1.05-2.21) and first ischemic stroke (HR = 1.53; 95% CI: 1.03-2.26) were found in participants in quartile 4 (≥21.31 m/s), compared with those in quartile 1-3 (

The current study aimed to explore the association between carotid intima-media thickness (CIMT) and cognitive function assessed by the Mini-Mental State Examination (MMSE) and to examine possible effect modifiers in hypertensive patients. A total of 14,322 hypertensive participants (mean age 64.2 ± 7.4 years; 40.9% male) from the China Stroke Primary Prevention Trial (CSPPT) were included in the final analysis. CIMT was measured by ultrasound, and data were collected at the last follow-up visit; MMSE was used to evaluate cognitive function. Nonparametric smoothing plots, multivariate linear regression analysis, subgroup analyses and interaction testing were performed to examine the relationship between the CIMI and cognitive function and effect modification. The mean CIMT was 0.74 ± 0.11 mm, and the mean MMSE score was 23.5 ± 4.8. There was a significant interaction (P interaction < 0.05) in both male and female populations stratified by age (

Objective Data on the association between homocysteine (Hcy) and the risk of chronic kidney disease (CKD) in patients with H-type hypertension were limited. This study aimed to examine the relation of Hcy with the prevalence of CKD and estimated glomerular filtration rate (eGFR) among Chinese adults with H-type hypertension. Methods A total of 12,873 Chinese adults with H-type hypertension aged 27-75 years were enrolled in the final analysis. Hcy concentrations were divided into 11 groups at 2 μmol/L interval. The outcome was CKD, defined as eGFR Results The prevalence of CKD was 7.58%, and the mean Hcy was 17.58 ± 10.96 μmol/L. The smoothing curve indicated that with the increase of Hcy, the prevalence of CKD increases first and then flattens, eGFR decreases first and then flattens, which supports the L-shaped association of Hcy with the prevalence of CKD and eGFR. Moreover, we further found the inflection point of Hcy was 22 μmol/L. OR (95% CI) of risk of CKD was 1.31 (1.28, 1.35) on the left side of an inflection point and 1.00 (0.99, 1.01) on the right of an inflection point, β (95% CI) of eGFR was −1.58 (−1.65, −1.50) on the left side of an inflection point and 0.00 (−0.03, 0.03) on the right of an inflection point, respectively. Similar results were found in various subgroups. Conclusions Our study suggested saturation effects of Hcy on the prevalence of CKD and eGFR among Chinese patients with H-type hypertension.

Background: Inflammatory immunity theory has raised considerable concern in the pathogenesis of atherosclerosis. Proviral integration site of murine 2 (Pim-2) kinases functions in apoptosis pathways and the anti-inflammatory response. Here, we investigated whether Pim-2 kinase inhibits atherosclerotic inflammation by suppressing the mTORC1 pathway. Methods: An atherosclerosis animal model was established by feeding ApoE -/- mice a high-fat diet. THP-1-derived macrophages were subjected to ox-LDL (50 μg/ml, 24h) conditions in vitro to mimic the in vivo conditions. Result: The protein expression of Pim-2 was upregulated in ox-LDL-treated THP-1-derived macrophages and an atherosclerotic mouse model. Additionally, ox-LDL upregulated the protein expression of p-mTOR, p-S6K1 and p-4EBP1, intracellular lipid droplets, free cholesterol and cholesterylester and the mRNA expression of inflammatory cytokines, including IL-6, MCP-1, TLR-4 and TNF-α, in THP-1-derived macrophages. Functionally, overexpressed Pim-2 (Pim-2 OE) attenuated atherosclerotic inflammation associated with the mTORC1 signaling pathway in vitro and in vivo, whereas knocked down Pim-2 (Pim-2 KD) markedly promoted atherosclerotic inflammation associated with upregulation of the mTORC1 signaling pathway. The plaque areas and lesions in the whole aorta and aortic root sections were alleviated in ApoE -/- mice with Pim-2 OE, but aggravated by Pim-2 KD. Additionally, an mTOR agonist (MHY1485) counteracted the anti-inflammatory effect of Pim-2 in ox-LDL-treated THP-1-derived macrophages after Pim-2 OE, whereas rapamycin rescued atherosclerotic inflammation in ox-LDL-treated THP-1-derived macrophages after Pim-2 KD. Furthermore, si-mTOR and si-Raptor alleviated the atherosclerotic proinflammatory effect in ox-LDL-treated THP-1-derived macrophages in a the background of Pim-2 KD. Conclusions:These results indicated that Pim-2 kinase inhibits atherosclerotic inflammation by suppressing the mTORC1 pathway.

Folate may be involved in the detoxification of heavy metals. This has been demonstrated in animal studies, in in vivo and in vitro studies, and clinical evaluations. However, knowledge regarding the associations between serum folate and blood concentrations of cadmium and lead is limited. We aimed to investigate the relationship between serum folate levels and blood concentrations of cadmium and lead in US adults. Data on 15,501 adults were obtained from the 1999–2006 National Health and Nutrition Examination Survey (NHANES) and used for the analysis. Information on serum folate concentrations and blood levels of lead and cadmium was derived from laboratory measurements in the NHANES. Multivariable linear regression was used to examine the relationship between serum folate levels and blood concentrations of cadmium and lead in US adults, controlling for confounders. The serum folate concentration was negatively correlated with blood levels of cadmium and lead (P-trends 60 mL/min/1.73 m2), the association between serum folate concentrations and blood levels of cadmium and lead was found to be more stable in adults with eGFR > 60 mL/min/1.73 m2, both in males and females. These findings warrant future studies to explore the mechanisms responsible for the beneficial role of folate in regulating cadmium and lead concentrations in the blood.

While the received traditional predictors are still the mainstay in the diagnosis and prognosis of CVD events, increasing studies have focused on exploring the ancillary effect of biomarkers for the aspiring of precision. Under which circumstances, soluble ST2 (sST2), lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), and procalcitonin (PCT) have recently emerged as promising markers in the field of both acute and chronic cardiovascular diseases. Existent clinical studies have demonstrated the significant associations between these markers with various CVD outcomes, which further verified the potentiality of markers in helping risk stratification and diagnostic and therapeutic work-up of patients. The current review article is aimed at illuminating the applicability of these four novels and often neglected cardiac biomarkers in common clinical scenarios, including acute myocardial infarction, acute heart failure, and chronic heart failure, especially in the emergency department. By thorough classification, combination, and discussion of biomarkers with clinical and instrumental evaluation, we hope the current study can provide insights into biomarkers and draw more attention to their importance.

Junpei Li,1 Shichao Yu,2 Wei Zhou,1,3 Linjuan Zhu,1,3 Tao Wang,1,3 Huihui Bao,1,3 Xiao Huang,1 Xiaoshu Cheng1,3 1Department of Cardiovascular, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, People’s Republic of China; 2Qinghua Health Center, Wuyuan, People’s Republic of China; 3Center for Prevention and Treatment of Cardiovascular Diseases, the Second Affiliated Hospital of Nanchang University, Nanchang of Jiangxi, People’s Republic of ChinaCorrespondence: Xiao Huang Email drxiaohuang@163.comXiaoshu Cheng Email xiaoshumenfan@126.comBackground: High body mass index (BMI) is a well-recognized risk factor for cardiovascular diseases. But its role in peripheral artery disease (PAD) remains perplexing. Our study aims to evaluate the association of BMI with PAD in the Chinese hypertensive population.Methods: This is a cross-sectional study with enrollment data from the Chinese H-type Hypertension Registry.10896 hypertensive patients aged ≥ 18 years were included in the final analysis.Results: The prevalence of PAD diagnosed by ABI in this study was 3.2% (n=351). A U-shaped association between BMI and PAD was found. Per SD increment (3.6 kg/m2) on the left side of the BMI threshold (BMI < 25.7 kg/m2) was associated with a 27% decrease in the adjusted risk of PAD [OR, 0.73; 95% confidence interval (CI) 0.60, 0.89; P=0.002]; BMI was significantly positively associated with the risk of PAD (OR, 1.52; 95% CI 1.52, 1.93; P=0.001) in those with BMI ≥ 25.7 kg/m2.Conclusion: In summary, a U-shaped association between BMI and the risk of PAD in the Chinese hypertensive population was found. BMI with the lowest risk of PAD was estimated to be 25.7 kg/m2.Keywords: peripheral arterial disease, body mass index, hypertension

Data regarding the association of the waist-to-height ratio (WHtR) with hypertension (HTN) are conflicting. Moreover, little information is available on the association between WHtR and HTN subtypes. Therefore, we aimed to investigate the associations between WHtR and the prevalence of HTN and its subtypes in a Chinese population. In the cross-sectional analysis, 13,947 adults from the China Hypertension Survey study were analysed. We examined the relationship between WHtR and the prevalence of HTN and its subtypes (isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systodiastolic hypertension (SDH)) using multivariate logistic regression analysis. A generalized additive model (GAM) and smooth curve fitting (penalized spline method) were also used. Overall, the mean WHtR was 0.50. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for HTN, ISH, IDH and SDH for each standard deviation (SD) increase in WHtR were 1.53 (1.45-1.61), 1.36 (1.28-1.44), 1.41 (1.20-1.65) and 1.47 (1.36-1.59), respectively. The fully adjusted smooth curve fitting revealed a linear association between WHtR and HTN, ISH, IDH, and SDH. Moreover, the positive associations between WHtR and HTN and its subtypes were more strong among younger adults (

Yue Zhang,1 Jingyi Li,2 Chengzhang Liu,3 Hongxiang Yu,1 Chen Chen,1 Chonglei Bi,4 Chongqian Fang,4 Hai Ma,5 Aimin Li,6 Qing Dong,7 Lishun Liu,8 Binyan Wang,3 Xiao Huang,9 Xiaoshu Cheng,9 Pierre Zalloua,10 Xiping Xu,11 Yong Huo,12 Gang Li1 1Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, People’s Republic of China; 3Shenzhen Evergreen Medical Institute, Guangzhou, People’s Republic of China; 4People’s Hospital of Rongcheng, Rongcheng, Shandong, People’s Republic of China; 5Health and Family Planning Commission, Rongcheng, Shandong, People’s Republic of China; 6Department of Neurosurgery, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, People’s Republic of China; 7Lianyungang Health Committee, Lianyungang, Jiangsu, People’s Republic of China; 8Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, People’s Republic of China; 9Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 10School of Medicine, Lebanese American University, Beirut, Lebanon; 11Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangzhou, People’s Republic of China; 12Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of ChinaCorrespondence: Gang Li 1800 Yuntai Road, Shanghai, 200123, People’s Republic of ChinaTel +86-21-38804518-22107Fax +86-21-58798999Email ligang@tongji.edu.cnBackground and Purpose: Elevated high-density lipoprotein cholesterol (HDL-C) levels have displayed protection against cardiovascular disease. However, the association between specific lipoprotein classes and first ischemic stroke (IS) has not been well defined, particularly in higher-risk hypertensive populations. Our study evaluated the associations of HDL-C with first IS in a Chinese hypertensive population.Methods: The study population was obtained from a community-based cohort study of hypertension in Lianyungang and Rongcheng, China. A nested case-control design was used that included 2463 identified first IS cases and 2463 controls matched by age ± 1 year, sex, and region.Results: After adjusting for potential confounders, HDL-C was inversely associated with first IS (adjusted odds ratio [aOR]: 0.91; 95% confidence interval [CI]: 0.85– 0.98). HDL-C levels of at least 65.4 mg/dL displayed a significant protective effect for first IS (aOR: 0.82; 95% CI: 0.69– 0.98). Conversely, adverse effects of first IS were observed for low-density lipoprotein cholesterol (LDL-C) levels ≥ 138.1 mg/dL (aOR: 1.20; 95% CI: 1.02– 1.42) and triglyceride (TG) levels ≥ 140.8 mg/dL (aOR: 1.27; 95% CI: 1.09– 1.49). The risk associations of LDL-C and TG with first IS were attenuated in the presence of high HDL-C (≥ 53.0 mg/dL); an increased risk of first IS was only found in the presence of low HDL-C (< 53.0 mg/dL) when LDL-C (aOR: 1.66; 95% CI: 1.19– 2.31) and TG (aOR: 1.47; 95% CI: 1.17– 1.84) were combined with HDL-C for analysis.Conclusion: In this community-based Chinese hypertensive population, higher HDL-C was a significant protective factor of first IS. These data add to the evidence describing the relationship between lipids and IS and suggest that HDL-C maybe is a marker of IS risk in Chinses hypertensive population.Keywords: high-density lipoprotein cholesterol, lipids, ischemic stroke, epidemiology

Background The atherogenic index of plasma (AIP) always remains in a potential association with arterial stiffness, however, this association has not been fully discovered and needs to be studied in depth in large hypertensive patient populations. The present analysis thus sought to further explore the association that exists between AIP and arterial stiffness in Chinese patients diagnosed with arterial hypertension. Methods This cross-sectional study analyzed 4744 Chinese individuals with essential hypertension. AIP was defined as the base 10 logarithm of the ratio of plasma of triglycerides to high-density lipoprotein cholesterol levels indicated in molar concentrations. Measurement of arterial stiffness was carried out via brachial-ankle pulse wave velocity (baPWV). Results Data were adjusted for potential confounding variables, and multivariate linear regression analysis revealed AIP to be positively correlated with baPWV (β = 1.34, 95% CI: 0.96 to 1.72, P 2 (P for interaction Conclusion AIP and arterial stiffness were positively correlated in essential hypertension patients in China, especially in those with a BMI 2. Clinical trial registration ChiCTR1800017274.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organs. However, the underlying etiology and mechanisms remain unclear. This study was performed to identify potential therapeutic targets for SLE using bioinformatics methods. First, 584 differentially expressed genes were identified based on the GSE61635 dataset. Tissue-specific analyses, enrichment analyses, and Protein–Protein interaction network were successively conducted. Furthermore, ELISA was performed to confirm the expression levels of key genes in the control and SLE blood samples. The findings revealed that tissue-specific expression of markers of the hematological system (25.5%, 28/110) varied significantly. CCL2, MMP9, and RSAD2 expression was markedly increased in the SLE samples compared with controls. In conclusion, the identified key genes (CCL2, MMP9, and RSAD2) may act as possible therapeutic targets for the treatment of SLE., GRAPHICAL ABSTRACT

We aimed to evaluate the relation of the ankle–brachial index (ABI) with the prevalence of stroke and to examine any possible effect modifiers among hypertensive patients without atrial fibrillation. A total of 10 750 subjects with hypertension aged 27‐96 years were included in the current study. The outcome was a stroke. Odds ratios of stroke concerning ABI were calculated using multivariate logistic regression models. Among 10 750 hypertensive participants, 690 (6.42%) had a stroke. Multivariate logistic analyses showed that ABI was negatively correlated with the prevalence of stroke (per SD increment; adjusted OR, 0.88; 95% CI, 0.82‐0.94). Compared with participants in Q 1, the odds ratios (95% CI) for those in the Q2 (1.05 to 1.10), Q3 (1.10 to 1.15), and Q4 (≥1.15) were 0.71 (0.56, 0.90), 0.87 (0.70, 1.08), and 0.81 (0.65, 1.01), respectively. However, compared with higher ABI value, lower ABI value (

BackgroundThe low-density lipoprotein cholesterol/high-density lipoprotein- cholesterol (LDL-C/HDL-C) ratio is an excellent predictor of cardiovascular disease (CVD). However, previous studies linking the LDL-C/HDL-C ratio to mortality have yielded inconsistent results and been limited by short follow-up periods. Therefore, the aim of the present study was to determine whether the LDL-C/HDL-C ratio could be an effective predictor of all-cause mortality in elderly hypertensive patients.MethodsA total of 6941 hypertensive patients aged 65 years or older who were not treated with lipid-lowering drugs were selected from the Chinese Hypertension Registry for analysis. The endpoint of the study was all-cause mortality. The relationship between the LDL-C/HDL-C ratio and all-cause mortality was determined using multivariate Cox proportional hazards regression, smoothing curve fitting (penalized spline method), subgroup analysis and Kaplan–Meier survival curve analysis.ResultsDuring a median follow-up of 1.72 years, 157 all-cause deaths occurred. A U-shaped association was found between the LDL-C/HDL-C ratio and all-cause mortality. Patients were divided according to the quintiles of the LDL-C/HDL-C ratio. Compared to the reference group (Q3: 1.67–2.10), patients with both lower (Q1 and Q2) and higher (Q4 and Q5) LDL-C/HDL-C ratios had higher all-cause mortality (P = 0.038).ConclusionsThe results suggest that there is a U-shaped association between the LDL-C/HDL-C ratio and all-cause mortality. Both lower and higher LDL-C/HDL-C ratios were associated with increased all-cause mortality in elderly hypertensive patients.

Arterial stiffness may affect antihypertensive response to antihypertensive treatment. However, sufficient clinical evidence is lacking. This longitudinal study aimed to evaluate the effect of baseline arterial stiffness measured by the brachial-ankle pulse wave velocity (baPWV) on response to short-term and long-term enalapril-based treatment in 3310 hypertensive adults from the China Stroke Primary Prevention Trial (CSPPT).Blood pressure (BP) measured at three months (short-term) in 2780 subjects, and the time-average on-treatment BP in 3310 subjects during a median of 4.5-year follow-ups (long-term) were analyzed in the study. After short-term antihypertensive treatment, every 1 m/s increase in baPWV denoted a 7% and 6% decreased chance of achieving systolic BP (SBP) control (odds ratio (OR), 0.93; 95% CI 0.90, 0.96; P 0.001) and BP control (OR, 0.94; 95% CI 0.91, 0.97; P 0.001), respectively, after adjustment for age, gender and other variables. After long-term treatment, every 1 m/s increase in baPWV posed an 7% and 6% greater risk of failing to attain SBP control (OR, 0.93; 95% CI 0.90, 0.95; P 0.001) and BP control (OR, 0.94; 95% CI, 0.92, 0.96; P 0.001), respectively, not regarding for DBP control after both short- and long-term treatment. Higher baseline baPWV significantly decreased SBP reduction both after three months and the median 4.5-year treatment, while increased DBP reduction after the median 4.5-year treatment.Elevated baseline baPWV significantly decreased BP response to short-and long-term treatment in adults with primary hypertensive. Arterial stiffness improvement may be an essential target to achieve adequate BP control.

Introduction The worldwide prevalence of diabetes has been increasing for decades; diabetes can lead to serious health problems and even death, but the effects of maintaining low fasting blood glucose (FBG) remain controversial. The purpose of this study was to investigate the relationship between FBG levels and all-cause mortality in a long-term follow-up cohort and to find a relatively safe range of FBG levels. Methods This study included 17,902 adults from a community-based cohort study in rural China who were prospectively followed from 2003 to 2018. Generalized estimating equations were used to evaluate the association between FBG and all-cause mortality, adjusting for pertinent covariates and auto-correlations among siblings. Results A total of 1053 (5.9%) deaths occurred during 15 years of follow-up. There was a significant U-shaped association between all-cause mortality and FBG. Compared with the reference group (FBG of 5.6 –

Objective Recent studies have reported that neutrophil-to-lymphocyte ratio (NLR) is associated with cardiovascular disease. The aim of the present study was to investigate the prognostic value of NLR in aortic disease. Methods We systematically searched electronic databases (Cochrane, PubMed, Elsevier, Medline, and Embase) from their inception to March 2020. Observational studies that evaluated the relationship between NLR and aortic disease were eligible for critical appraisal. Data were extracted from applicable articles, risk ratio (RR), weighted mean differences (MD) and 95% confidence intervals (CI) were calculated by RevMan 5.3, and statistical heterogeneity was assessed by the I2 statistic. Results Fourteen studies enrolling 4066 individuals were included in the meta-analysis. Compared with the control group, NLR was significantly higher in the aortic disease group (MD 3.44, 95%CI: 0.81–6.07, P = 0.01, I2 = 99%). The NLR was also significantly higher in non-survivors with aortic disease, compared to the survivors (MD 4.62, 95%CI: 2.75–6.50, P 2 = 60%). Compared with the aortic disease patients with a low NLR, mortality was significantly higher in those with a high NLR (RR 2.63, 95%CI: 1.79–3.86, P 2 = 67%). Conclusion Based on current evidence, an elevated NLR was associated with aortic disease and in-hospital mortality. Raised NLR also demonstrated a significantly increased the risk of mortality after surgical repair in aortic disease patients. NLR may be a good prognostic biomarker in aortic disease and deserve further research in this area.

The association between sleep conditions and arterial stiffness remains inconclusive. We aimed to investigate the relationship of sleep duration and quality with brachial-ankle pulse-wave velocity (baPWV) in hypertensive patients. A total of 14,485 hypertensive adults were included in this cross-sectional analysis. Information about sleep duration and quality was obtained via questionnaire. A baPWV level ≥1800 cm/s was defined as indicative of arterial stiffness. Compared with participants with a sleep duration β = 13.7 cm/s; 95% CI: 3.9, 23.5) and a nonsignificantly higher prevalence of arterial stiffness (39.7% vs. 33.0%; OR, 1.08; 95% CI: 0.99–1.19). Similarly, compared with participants with good or medium sleep quality, participants with poor sleep quality had a significantly higher baPWV level (β = 16.3 cm/s; 95% CI: 0.1, 32.6) and a nonsignificantly greater prevalence of arterial stiffness (36.6% vs. 35.3%; OR, 1.13; 95% CI: 0.97–1.32). When sleep duration and quality were examined jointly, participants with a sleep duration ≥8 h and/or poor sleep quality had a significantly higher baPWV level (β = 14.4 cm/s; 95% CI: 5.3, 23.4) and a greater prevalence of arterial stiffness (38.8% vs. 32.7%; OR, 1.10; 95% CI: 1.01–1.20) than those with a sleep duration

Both high-density lipoprotein cholesterol (HDL-C) and body mass index (BMI) have an impact on the prevalence of stroke. However, it is unclear whether BMI can modify the relationship between HDL-C and stroke. Therefore, we aimed to assess the effect of the BMI on the association between HDL-C and stroke in a hypertensive population without atrial fibrillation (AF). We analyzed data of 10,925 hypertensive patients without AF from the Chinese Hypertension Registry Study. BMI was categorized as

Background: Despite improvements in diagnostic and therapeutic interventions to combat cardiovascular disease (CVD) in recent decades, there are significant ongoing access gaps and sex disparities in prevention that have not been adequately quantified in China. Methods: A representative, cross-sectional, community-based survey of adults (aged ≥45 years) was conducted in 7 geographic regions of China between 2014 and 2016. Logistic regression models were used to determine sex differences in primary and secondary CVD prevention, and any interaction by age, education level, and area of residence. Data are presented as adjusted odds ratios (ORs) and 95% CIs. Results: Of 47 841 participants (61.3% women), 5454 (57.2% women) had established CVD and 9532 (70.5% women) had a high estimated 10-year CVD risk (≥10%). Only 48.5% and 48.6% of women and 39.3% and 59.8% of men were on any kind of blood pressure (BP)–lowering medication, lipid-lowering medication, or antiplatelet therapy for primary and secondary prevention, respectively. Women with established CVD were significantly less likely than men to receive BP-lowering medications (OR, 0.79 [95% CI, 0.65–0.95]), lipid-lowering medications (OR, 0.69 [95% CI, 0.56–0.84]), antiplatelets (OR, 0.53 [95% CI, 0.45–0.62]), or any CVD prevention medication (OR, 0.62 [95% CI, 0.52–0.73]). Women with established CVD, however, had better BP control (OR, 1.31 [95% CI, 1.14–1.50]) but less well-controlled low-density lipoprotein cholesterol (OR, 0.66 [95% CI, 0.57–0.76]), and were less likely to smoke (OR, 13.89 [95% CI, 11.24–17.15]) and achieve physical activity targets (OR, 1.92 [95% CI, 1.61–2.29]). Conversely, women with high CVD risk were less likely than men to have their BP, low-density lipoprotein cholesterol, and bodyweight controlled (OR, 0.46 [95% CI, 0.38–0.55]; OR, 0.60 [95% CI, 0.52–0.69]; OR, 0.55 [95% CI, 0.48–0.63], respectively), despite a higher use of BP-lowering medications (OR, 1.21 [95% CI, 1.01–1.45]). Younger patients ( Conclusions: Large and variable gaps in primary and secondary CVD prevention exist in China, particularly for women. Effective CVD prevention requires an improved overall nationwide strategy and a special emphasis on women with established CVD, who have the greatest disparity and the most to benefit.

Feng Hu,1 Feng Lu,2 Xiao Huang,1 Xiaoshu Cheng1 1The Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 2The Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of ChinaCorrespondence: Xiao Huang; Xiaoshu ChengDepartment of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, People’s Republic of ChinaTel +8613607089128Fax +86-791-86262262Email drxiaohuang@163.com; xiaoshumenfan126@163.comObjective: To explore the relationship between the plasma total homocysteine (tHcy) levels and slow coronary flow (SCF) measured by mean corrected TIMI frame count (CTFC) in patients with acute myocardial infarction (AMI).Methods: Ninety-one patients with primary myocardial infarction were enrolled in this study. The quantitative measurement of coronary blood flow was performed using the mean CTFC method. Plasma tHcy levels were determined using enzymatic assay from venous blood samples. Multivariable linear regression models indicated were used to estimate the effect size (β) of plasma tHcy levels on mean CTFC levels.Results: Compared with patients with the mean CTFC ≤ 23.61 frames per second (FPS) group, there were increased plasma tHcy levels in patients of the second, third and highest mean CTFC quartiles (P < 0.001). Linear regression models indicated that plasma tHcy levels were positively associated with mean CTFC levels (adjusted-β per SD increase: 1.96, 95% CI 1.20 to 2.73, P < 0.001). Compared to the tHcy ≤ 12.30 μmol/L group, the third and highest tHcy-quartile groups had higher mean CTFC levels (adjusted-β: 2.52, 95% CI 0.39 to 4.65, P = 0.023; adjusted-β: 5.07, 95% CI 2.98 to 7.16, P < 0.001, respectively; P for trend < 0.001). Moreover, this positive relationship was modified by diabetes mellitus (P-value for interaction was 0.046).Conclusion: We found a positive relationship between plasma tHcy levels and mean CTFC levels in patients with AMI. Moreover, diabetes mellitus played an interactive role in this positive association between the plasma tHcy levels and mean CTFC levels.Keywords: hyperhomocysteinemia, mean corrected TIMI frame count, acute myocardial infarction, slow coronary flow, coronary microcirculation dysfunction

Background Hyperhomocysteinemia (HHcy) and metabolic syndrome (MS) are established cardiovascular risk factors of stroke and are frequently associated with hypertension. However, studies on the association between HHcy combined with MS and stroke risk in hypertensive patients were absent. Material/Methods In 14 059 selected participants with elevated blood pressure, we assessed the prevalence of the MS and stroke. We defined HHcy as plasma total homocysteine >15 μmol/L. MS was defined according to the Chinese Diabetes Society (CDS) criterion. Multivariable analysis was used to examine the association of HHcy or (and) MS with stroke risk in different models. Results The prevalence rates of HHcy and MS were 49.96% and 42.21%, respectively. Patients with stroke had higher plasma total homocysteine levels and a higher prevalence of MS (P

Background Stroke is the leading cause of death in China, and the stroke burden is especially high in rural areas. Risk prediction is essential for primary prevention of stroke. However, uncertainty remains about the optimal methodology for analyzing stroke risk. In this study, we aim to determine the most effective stroke prediction method in a targeted population and establish a general framework and pipeline for future analysis. Purpose 1) to determine the most effective stroke prediction method in a targeted population and 2) to establish a general framework and pipeline for future analysis. Methods Data were obtained from the China Stroke Primary Prevention Trial (CSPPT), a randomized, double-blind, multi-center clinical trial. 20,702 hypertensive patients without prior history of stroke were included in the study. The primary outcome was new nonfatal and fatal stroke (ischemic or hemorrhagic) occurring between baseline and follow-up (a median of 4.2 years). All suspected stroke cases were collected and further validated by the event adjudication committee. We compared two regression models (logistic regression and step wise logistic regression) and two machine learning methods (extreme gradient boosting and random forest). All models were trained using questionnaire data with and without laboratory data, then analyzed and compared. The primary outcome was defined as first stroke. Accuracy, sensitivity, specificity and AUCs (area under receiver operating characteristic curve) were used to assess each model. AUCs were used to evaluate the performance of each analysis method. Results In our data set with 20,702 samples and 127 variables, the highest AUCs (0.775 (0.725–0.826)) were observed with RUS (random under sampling) applied to RF (random forest). Before applying data balancing techniques, all analysis methods showed very low sensitivity (around 0.01), very high accuracy (around 0.97), and very high specificity (around 1.00). The mean AUCs were 0.741 (0.678–0.803). After data balancing techniques were applied, we observed an increase in sensitivity and decreases in accuracy and specificity. Different data balancing techniques had different effects on analysis methods. No significant effect on AUCs was observed; the range of increase and decrease was around 0.01. Similar overall patterns were observed when training with laboratory test data added. The mean AUCs were 0.739 (0.679–0.799) and 0.734 (0.674–9.795) for all models using data with and without laboratory test respectively. The 10 most important variables as determined by the model were selected as stroke risk predictors for all analysis models. Conclusion The most effective stroke prediction method in this Chinese rural hypertensive population is RUS applied to RF. The optimal analysis method and variable selection depends on data-specific features. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Key R&D Projects, Jiangxi [20203BBGL73173] National Key Research and Development Program [2016YFE0205400]

Background Limited information is available on arterial stiffness risk among hypertensive patients with metabolically abnormal but normal weight. Visceral adiposity index (VAI) is a novel indicator for visceral fat mass and metabolism, however, whether can be used to assessed arterial stiffness in a normal-weight population remains unclear. The goal of this study was to examine the independent association of VAI with arterial stiffness in normal-weight hypertensive patients. Methods 3258 participants recruited from the China H-type Hypertension Registry Study. VAI value was calculated using sex-specific equations. High arterial stiffness was defined as baPWV ≥ 18 m/s. Multivariable regression analysis was used to identify the association of VAI with baPWV and high arterial stiffness. Results Of participants, 50.5% (1644) were males, the mean age was 65.5 (SD, 9.1) years. Mean VAI and baPWV were 2.0 (SD, 2.3) and 18.2 (SD, 3.9) m/s, respectively. For each unit increase of lg VAI in multivariable regression analysis, there was a 1.05 m/s increase in baPWV (95% CI 0.67, 1.43) and a 2.13-fold increase in the risk of high arterial stiffness (95% CI 1.59, 2.86). In all models, the VAI was consistently and significantly associated with baPWV after adjustment for different confounders. High VAI levels were stably associated with baPWV in all subgroups. Conclusions We found positive association of VAI with baPWV and high arterial stiffness in normal-weight adults with hypertension. The establishment of this association could help the arterial stiffness risk stratification in normal-weight hypertensive populations, who are frequently overlooked in preventing cardiovascular disease.

Background: The relation of LAP index with baPWV have been evaluated in several previous studies and yield inconsistent results. The aim of the study was to investigate the association between the lipid accumulation product (LAP) index and arterial stiffness in the Chinese population with hypertension.Methods: We conducted a cross-sectional analysis in 4926 participants chinese population with hypertension (aged 64.42 ± 9.44years). The LAP was developed from population-based frequency plots of adult waist circumferences and circulating triglyceride concentrations. Arterial stifness was determined by measuring brachial-ankle pulse wave velocity (baPWV).Results: Multivariate linear regression analyses showed that LAP index was independently and positively associated with baPWV (β, 25.06 cm/s (95% confdence interval [CI]: 10.91, 39.22 cm/s). Consistently, Multiple logistic analyses showed a positive association between LAP index risk of elevated baPWV (>75th percentile) (odds ratio [OR], 1.24; 95% CI 1.09, 1.40). A restricted cubic spline showed that the significant linear association existed between LAP index and baPWV. Similar results were found in various subgroups.Conclusion: LAP is a signifcant positive associated with with baPWV and elevated baPWV in Chinese hypertensive adults.

Digital, Background Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. Objectives In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. Methods ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was 13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43. Conclusions In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402), Ciencias Médicas y de la Salud

Background Several ECG criteria have been widely used for diagnosis of left ventricular hypertrophy (LVH) in clinical practice. However, their performance in a general Chinese population is limited. Methods and results A multi‐stage, stratified cluster sampling across China was performed and 7415 representative Chinese adults aged 18–85 years were analyzed. ECG was collected by using GE MAC 5500 machine. The association between five ECG‐LVH criteria (i.e., Peguero–Lo Presti, Cornell, Cornell product, Sokolow–Lyon and Sokolow–Lyon product) and echocardiographic LVH (Echo‐LVH) was assessed by Pearson's correlation, diagnostic statistics like predictive values, and receiver operating characteristics (ROC) curve. We found that the prevalence of the Echo‐LVH was 11% while ECG‐LVH ranged from 3% to 27%. All ECG‐LVH criteria had high negative predictive value (NPV) (89%) and specificity (73–96%) but low positive predictive value (PPV) (12–24%) and sensitivity (4–29%). The newly Peguero–Lo Presti criteria had higher sensitivity (29%) but lower specificity (73%) and accuracy (68%) compared with other criteria. Cornell product had the best diagnostic performance (AUC: 0.59), as well as the highest specificity (96%) and accuracy (86%) but lowest sensitivity (4%). Among single‐lead components of ECG criteria, RaVL voltage and QRS duration performed relatively better than others. Hypertensive and older individuals had higher sensitivity but lower specificity and accuracy than their counterparts. Conclusion ECG‐LVH criteria had high NPV to detect Echo‐LVH. Though with higher sensitivity, Peguero–Lo Presti criteria did not have better diagnostic performance to detect Echo‐LVH. RaVL and QRS duration had stronger association with Echo‐LVH among all single‐lead components.

Background In addition to the controversy regarding the association of hyperuricemia with mortality, uncertainty also remains regarding the association between low serum uric acid (SUA) and mortality. We aimed to assess the relationship between SUA and all-cause and cause-specific mortality. Methods This cohort study included 9118 US adults from the National Health and Nutrition Examination Survey (1999-2002). Multivariable Cox proportional hazards models were used to evaluate the relationship between SUA and mortality. Our analysis included the use of a generalized additive model and smooth curve fitting (penalized spline method), and 2-piecewise Cox proportional hazards models, to address the nonlinearity between SUA and mortality. Results During a median follow-up of 5.83 years, 448 all-cause deaths occurred, with 100 cardiovascular disease (CVD) deaths, 118 cancer deaths, and 37 respiratory disease deaths. Compared with the reference group, there was an increased risk of all-cause, CVD, cancer, and respiratory disease mortality for participants in the first and third tertiles of SUA. We further found a nonlinear and U-shaped association between SUA and mortality. The inflection point for the curve was found at a SUA level of 5.7 mg/dL. The hazard ratios (95% confidence intervals) for all-cause mortality were 0.80 (0.65-0.97) and 1.24 (1.10-1.40) to the left and right of the inflection point, respectively. This U-shaped association was observed in both sexes; the inflection point for SUA was 6 mg/dL in males and 4 mg/dL in females. Conclusion Both low and high SUA levels were associated with increased all-cause and cause-specific mortality, supporting a U-shaped association between SUA and mortality.

Recently, the potential role of gut microbiome (GM) in cardiovascular diseases has been revealed. Heart failure (HF) is one of the most prevalent cardiovascular diseases worldwide; however, whether GM dysbiosis participates in the development of HF remains largely unknown. This study aimed to investigate the specific changes in GM composition and function in isoproterenol (ISO)-induced HF in rats.The rats were divided into C (control), 4w-HF (ISO, 2.5 mg/kg/day for 4 weeks, intraperitoneally), and 2w-HF (ISO, 2.5 mg/kg/day for 2 weeks, intraperitoneally) groups. The cardiac structure and function in rats were assessed, and metagenomic analyses were then performed. Compared with the healthy control group, we found that the Shannon diversity index and microbial gene count in the 4w-HF and 2w-HF groups was drastically decreased. High-throughput sequencing showed that the three groups differed in intestinal bacterial community composition. Overgrowth of bacteria, such as Prevotella, was observed in the 4w-HF group, with reduced growth of bacteria, such as Roseburia, Lactobacillus, and Butyrivibrio, associated with healthy status compared with the C group on the genus level. Concomitant with the alteration of GM composition, underrepresentation of health-linked microbial function was observed in both the 4w-HF and 2w-HF groups compared with the C group.Iso-induced HF rats showed a significant decrease in the diversity and richness of the intestinal microbiome, with a downregulation of the key intestinal bacterial groups and overgrowth of bacteria considered to be involved in inflammatory responses as well as a decrease in health-linked microbial function. Our data indicated that altered GM may be a potential player in the pathogenesis and progression of HF.

High fibroblast growth factor 23 (FGF23) concentrations are a strong predictor of atrial fibrillation (AF), but researchers have not clearly determined the mechanism by which FGF23 causes atrial fibrosis in patients with AF. This study aims to elucidate the mechanism by which FGF23 induces atrial fibrosis in patients with AF. Immunohistochemistry was used to study the expression of FGF23, FGFR4, and fibrotic factors in patients with a normal sinus rhythm (SR) and patients with AF. Cardiac fibroblasts (CFs) were cocultured with different concentrations of the recombinant FGF23 protein. Compared with the SR group, the levels of FGF23, FGFR4, α-smooth muscle actin (α-SMA), and collagen-1 were significantly increased in the AF group. Exposure to high concentrations of the recombinant FGF23 protein increased the accumulation of reactive oxygen species (ROS) and activated α-SMA, collagen-1, signal transducer and activator of transcription 3 (STAT3) and SMAD3 signaling in cultured CFs. The levels of fibrotic proteins in CFs stimulated with high concentrations of the recombinant FGF23 protein were reversed by N-acetylcysteine (NAC, a ROS inhibitor), ship information system 3 (a SMAD3 inhibitor), and Stattic (a STAT3 inhibitor). Furthermore, compared to untreated CFs, CFs treated with the recombinant FGF23 protein were characterized by an increased interaction between STAT3 and SMAD3. Based on these results, FGF23 induces atrial fibrosis in patients with AF by increasing ROS production and subsequently activating STAT3 and SMAD3 signaling.

Oral anticoagulation therapy (OAT) is a mainstay for stroke prevention in atrial fibrillation (AF) patients. However, whether the risks of stroke/systemic embolic events (SEE) and bleeding events are affected by the type, duration, and frequency of AF in patients receiving OAT has been previously debated. We aimed to determine the risk of stroke/SEE and bleeding events associated with paroxysmal AF compared to persistent or permanent AF among patients who received OAT. Comprehensive literature searches of the Cochrane Library, PubMed/MEDLINE, and EMBASE databases were conducted from inception to July 2018. In total, 495 records were retrieved, of which 6 phase III randomized controlled trials (RCTs) focusing on the efficacy and safety of OAT in AF patients were ultimately evaluated and included. Among 70,447 AF patients, 15,028 (21.3%) patients had paroxysmal and 55,419 (78.7%) had persistent or permanent AF. Compared to persistent or permanent AF, the incidence of stroke/SEE was lower in paroxysmal AF patients (risk ratio [RR] 0.79, 95% confidence interval [CI] 0.71 to 0.88, P

The relationship between electrocardiographic-left ventricular hypertrophy (ECG-LVH) and stroke has been well established in the Western population with limited information in the Chinese population. This study evaluated the association between ECG-LVH and stroke outcome. A total of 19,815 (95.7%) subjects from the China Stroke Primary Prevention Trial (CSPPT) with baseline ECG were included. ECG-LVH by sex-unspecific Sokolow-Lyon criteria was detected in 1599 participants (8.1%) at baseline. After a mean follow-up of 4.5 years, 605 (3.1%) subjects were detected with new-onset stroke over the total population, baseline ECG-LVH was present in 72 (4.5%) of them during follow-up. After adjusting for various cofounders, ECG-LVH remained as an independent risk factor for stroke events in the total population (HR = 1.43; 95% CI, 1.10-1.84; P = 0.007) and male population (HR = 1.47; 95% CI, 1.07-2.03; P = 0.019). Subgroup analysis showed that baseline ECG-LVH was a risk factor for stroke in individuals younger than 65 years of age(HR = 1.80, 95% CI, 1.31-2.47 vs. HR = 1.02, 95% CI, 0.66-1.59, P value for interaction = 0.047). In summary, LVH diagnosed by ECG is associated with an excess risk for stroke in Chinese hypertensive population, especially in the age group of younger than 65 years.

Background To date, there is no clearly defined association between plasma selenium levels and first stroke. We aimed to investigate the association between baseline plasma selenium and first stroke risk in a community-based Chinese population. Methods Using a nested case-control study design, a total of 1255 first stroke cases and 1255 matched controls were analyzed. Participant plasma selenium concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS), and the association of plasma selenium with first stroke risk was estimated by conditional logistic regression models. Results Overall, a non-linear negative association between plasma selenium and first total stroke and first ischemic stroke risks was found in males but not in females. Compared with participants with lower selenium levels (tertile 1–2, < 94.1 ng/mL), participants with higher selenium levels (tertile 3, ≥ 94.1 ng/mL) had significantly lower risks of first total stroke (OR 0.63; 95% CI 0.48, 0.83) and first ischemic stroke (OR 0.61; 95% CI 0.45, 0.83) in males but not in females with first total stroke (OR 0.92; 95% CI 0.69, 1.22) and first ischemic stroke (OR 0.89; 95% CI 0.65, 1.22). Furthermore, a stronger association between plasma selenium and first total stroke was found in males with higher vitamin E levels (≥ 13.5 μg/mL vs. < 13.5 μg/mL P-interaction = 0.007). No significant association was observed between plasma selenium and first hemorrhagic stroke risk in either males or females. Conclusion Our study indicated a significant, non-linear, negative association between plasma selenium and first stroke in males but not in females. Trial registration ChiCTR1800017274.

Background: Magnesium supplementation may extend the life span; however, the biological mechanism is still unknown. Leukocyte telomere length (LTL) is a marker of cell aging and biological health in humans. Data concerning whether magnesium supplementation can maintain telomere length, thus prolonging life are limited.Purpose: To investigate the association between dietary magnesium intake and LTL in US middle-aged and elderly adults. Methods: A total of 4039 US adults aged ≥45 years from National Health and Nutrition Examination Survey (NHANES, 1999-2002). Dietary magnesium intake was collected by a trained interviewer using 24-hour dietary recall method and LTL was obtained using the quantitative polymerase chain reaction (PCR) method. Multivariate linear regression analysis was performed to evaluate the the crude and adjusted association of dietary magnesium intake with LTL. Results: The overall mean (SD) of LTL was 5.6 (0.6) kp. After adjusting potential confounders, every 1 mg increase in log-transformed dietary magnesium intake was associated with 0.20 kp [95% confidence intervals (CI): 0.05-0.34] longer LTL. Participants with the highest tertile (≥ 299 mg) of dietary magnesium intake had statistically significant longer LTL (β = 0.07, P=0.038) compared with the lowest tertile (< 198 mg), with significant linear trends across tertiles. Moreover, the association between dietary magnesium intake and LTL was significantly stronger in participants with higher levels of education (≥ high school compared with < high school, P for interaction = 0.002). E-value analysis suggested robustness to unmeasured confounding.Conclusions: Our findings suggested that increased dietary magnesium intake was associated with longer LTL. Theses warrant additional investigation.

Previous studies reported that the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) was a risk factor in cardiovascular disease. Peripheral artery disease (PAD) is an important risk factor for cardiovascular death. However, only a few studies investigated the correlations between the AST/ALT ratio and PAD. We analyzed data from 10 900 patients with hypertension from the Chinese Hypertension Registry Study; 350 patients had PAD (prevalence 3.2%). After adjusting for potential confounders, the AST/ALT ratio was independently and positively associated with risk of PAD (OR: 1.31, 95% CI, 1.13-1.59), and a significant increased risk of PAD for the third AST/ALT ratio tertile (T3) compared with the first tertile (T1; OR: 1.49, 95% CI, 1.09-2.04, Ptrend = .005) was found. Moreover, when we combined T1 and T2 into one group and used it as a reference group, the risk of PAD increased with the increase in AST/ALT; the risk ratio was 1.52 (95% CI, 1.20-1.95). A higher AST/ALT ratio (≥1.65) was associated with PAD risk in Chinese adults with hypertension. Our results suggest that the AST/ALT ratio may help identify patients at high risk of vascular end points and might be a convenient, economical, and effective tool for evaluating the risk of atherosclerosis.

Background and aims The relationship between the body fat percentage (BFP) and hyperuricemia is still unknown in different gender subjects. The purpose of this study was to determine the magnitude of the association between the BFP and the presence of hyperuricemia in the sex-specific group among hypertensive patients. Methods and results We conducted a cross-sectional study enrolling 14,234 hypertensive participates from the Chinese Hypertension Registry Study. Body fat percentage (BFP) was calculated by simple anthropometric parameters. Hyperuricemia was defined as serum uric acid (SUA) level 420 umol/L in men and 360 umol/L in women. The mean BFP was 24.5% in men and 37.1% in women. Multiple logistic analyses showed that the relationship between BFP with the risk of hyperuricemia in a dose-dependent manner among both men (odds ratio [OR] 1.07, 95% CI 1.06, 1.09) and women (OR 1.08, 95% CI 1.06, 1.09) in the fully adjusted model. Subgroup analyses showed the positive association between BFP and the risk of hyperuricemia was consistent in all stratification subgroups (all P for interaction >0.05). Conclusion For patients with hypertension, BFP was positively associated with an increased risk of hyperuricemia among both men and women.