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Background/AimsThere were two methods used for measuring skeletal muscle mass index (SMI); one is SMM (%) = skeletal muscle mass(kg) /body weight mass (kg)×100%, and the other is SMH (kg/m2) = skeletal muscle mass(kg)/ height (m)2. The aim of this study was to compare on the distribution of the two algorithms of SMI.MethodsThis study included 141,451 participants who accepted physical examination. Body mass index (BMI), and body fat percentage (BFP) were estimated using a bioelectrical impedance analyzer. SMI was calculated by the two algorithms.ResultsLevels of BMI, BFP, SMM and SMH differed significantly among the sexes. BMI and BFP were significantly positively correlated with age, while SMM was significantly negatively correlated with age (β = -0.23, P P P P P

BackgroundThe current outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses an unprecedented health crisis. The most common chronic illness among patients infected with SARS-CoV-2 is hypertension. Immune dysregulation plays an important role in SARS-CoV-2 infection and in the development of hypertension; however, the dynamic immunological characteristics of COVID-19 patients with hypertension remain largely unclear.MethodsIn total, 258 hypertensive patients infected with SARS-CoV-2 were included in this study. CD38+HLA-DR+ and CD38+PD-1+ CD8+ T cells, IFNγ+CD4+ and IFNγ+CD8+ T cells, the titers of IgG, IgM, and IgA against SARS-CoV-2 spike protein, and SARS-CoV-2 throat viral loads were measured weekly over 4 weeks after the onset of symptoms. Clinical outcomes were also monitored.FindingsCD4+ T lymphopenia was observed in 100% of the severe and critical cases. Compared with the surviving patients, the patients with fatal outcomes exhibited high and prolonged expression of CD38+HLA-DR+ and CD38+PD-1+ on CD8+ T cells, low expression of SARS-CoV-2-specific IFNγ+CD4+ and IFNγ+CD8+ T cells, low titers of IgG, IgM, and IgA against SARS-CoV-2 spike protein, and high SARS-CoV-2 viral load during the illness. In the surviving patients, the viral load was significantly inversely correlated with SARS-CoV-2-specific IFNγ+CD8+and IFNγ+CD4+ T cells, IgG, IgM, and IgA.InterpretationT lymphopenia is common in critical or severe COVID-19 cases with hypertension. Prolonged activation and exhaustion of CD8+ T cells were associated with severe disease. The delayed SARS-CoV-2-specific antibody responses may be insufficient for overcoming severe SARS-CoV-2 infection in the absence of SARS-CoV-2-specific cellular responses.

Knowledge of the dynamic immunological characteristics of patients with coronavirus disease 2019 (COVID-19) is essential for clinicians to understand the progression of the disease. Our data showed that the immune system and function gradually remodeled and declined with age, starting from age 16 until age 91 in 25,239 healthy controls. An analysis of the relationship between the number of lymphocytes and age revealed that the lymphocyte and subset counts tended to decline with age significantly. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunity declined with age and was associated with survival time in fatal cases. Loss in the expansion of SARS-CoV-2-specific immunity could be expanded in vitro. The concurrent decline in SARS-CoV-2-specific cellular and humoral immunities and prolonged SARS-CoV-2 exposure predicted fatal outcomes. Our findings provide a basis for further analysis of SARS-CoV-2-specific immunity and understanding of the pathogenesis of fatal COVID-19 cases.HighlightsThe immune system and function gradually remodeled and declined with age.SARS-CoV-2-specific immunity declined with age in fatal cases.SARS-CoV-2-specific immunity was associated with survival time in fatal cases.Loss in the expansion of SARS-CoV-2-specific immunity could be expanded in vitro.A concurrent decline in SARS-CoV-2-specific cellular and humoral immunities and prolonged SARS-CoV-2 exposure predicted fatal outcomes.

In December 2019, novel coronavirus (SARS-CoV-2) infected pneumonia occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of SARS-CoV-2 pneumonia compared to normal controls in Chinese Han population is limited. Our objective is to describe the clinical characteristics of SARS-CoV-2 pneumonia compared to normal controls in the Chinese Han population. In this case series of 752 patients, the full spectrum of cases is described. Fever was present in 86-90% of the patients. The second most common symptom was cough (49.1-51.0%), fatigue (25.2-27.1%), sputum (20.0-23.1%), and headache (9.8-11.1%). the mortality rate is 4.6% in Wuhan, 1.9% in Beijing, and 0.9% in Shanghai. Our findings showed that the levels of lymphocytes were 0.8(IQR, 0.6-1.1)109/L in Wuhan, 1.0(IQR, 0.7-1.4)109/L in Beijing, and 1.1 (IQR, 0.8-1.5) 109/L in Shanghai before admission to hospitals, respectively, indicating that cellular immune function might relate to the mortality. Based on the reference ranges of normal Chinese Han population and the data of the critically ill patients we have observed, it is recommended that reference ranges of people at high risk of COVID-19 infection are CD3+ lymphocytes below 900 cells/mm3, CD4+ lymphocytes below 500 cells/mm3, and CD8+ lymphocytes below 300 cells/mm3.

BackgroundIn December 2019, novel coronavirus (SARS-CoV-2) infected pneumonia occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of SARS-CoV-2 pneumonia without comorbidities compared to normal controls in Chinese Han population is limited. Our objective is to describe the epidemiological and clinical characteristics of SARS-CoV-2 pneumonia without comorbidities compared to normal controls in the Chinese Han population.MethodsRetrospective, multi-center case series of the 69 consecutive hospitalized patients with confirmed SARS-CoV-2 pneumonia, from February 7 to February 28, 2020; final date of follow-up was February 29, 2020.ResultsThe study population included 69 hospitalized patients with confirmed SARS-CoV-2 pneumonia without comorbidities and 14,117 normal controls. 50.7% patients were male and 49.3% were female; 1.5% patients were asymptomatic cases, 63.8% patients were mild cases, and 36.2% patients were severe or critical cases. Compared with mild patients (n=44), severe or critical patients (n=25) were significantly older (median age, 67 years [IQR, 58-79] vs. 49 years [IQR, 36-60]; p28 pg/mL) and 4.4% patients were diagnosed fungal infections or shock. 4.3% patients have been discharged; 1.5% patient had died; 1.5% patient had recovery.ConclusionsIn this multicenter case series of 69 patients without comorbidities, the full spectrum of asymptomatic, mild, severe, and critical cases is described. 50.7% patients were male and 49.3% were female; 1.5% patients were asymptomatic cases, 63.8% patients were mild cases, and 36.2% patients were severe or critical cases. 4.3% patients have been discharged; 1.5% patient had died; 1.5% patient had recovery. Among the 25 patients with severe or critical disease, 12.0% patients were underwent non-invasive mechanical ventilation, 8.0% patients underwent invasive mechanical ventilation, and 4.0% patients died.

It is recommended that patients with coronary heart disease (CHD) pursue a normal body weight, while the effects of body weight and weight change on prognosis are still controversial. The present study was to assess these effects using a large-scale population with CHD in China.A total of 5276 patients with CHD were included from Jan 2000 to Dec 2014. Baseline and endpoint weights were measured. Outcomes including mortality and cardiovascular events were obtained.Relative to patients with normal weight, risks for adverse outcomes were lowest in overweight patients and similar in obese patients. Hazard ratios (HRs) and 95% confidence interval (95% CI) for all-cause death were 1.42 (1.06, 1.91) if overweight turned into normal weight and were 2.01 (1.28, 3.16) or 5.33 (2.81, 10.1) if obese turned into overweight or normal weight. Death risk increased with the extent of weight loss and moderate or large weight gain (p0.05 for all). Similar results were found when risks for cardiovascular mortality and events were considered. Furthermore, these results remained significant when the patients were stratified by several covariates and even when several definitions of weight change were considered.Obesity did not increase adverse outcome risks in patients with CHD. Both weight loss and weight gain increased adverse outcome risks regardless of baseline body weight. The findings suggest that maintaining a stable weight may be a better strategy for the reduction of risks for cardiovascular outcomes and all-cause death in patients with CHD.

Obesity induces dyslipidemia, hypertension, glucose intolerance, and inflammatory state, which results in atherogenic processes, diabetes, and cardiovascular disease. We usually use body composition indices, such as body mass index (BMI), body fat percentage (BFP), waist circumference-height ratio (WHtR), and waist-hip ratio (WHR) to reflect the obesity. The aim of this large population-based cross-sectional study was to investigate the associations between body composition indices and metabolic parameters in Chinese adults.A total of 12,018 Chinese adults were included. Body composition indices, such as BMI, BFP, WHtR, and WHR, and metabolic parameters, such as systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), fasting blood glucose (FBG), 2 h postprandial blood glucose (2h PBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), insulin resistance index (HOMA-IR), high-sensitivity C-reactive protein (hs-CRP), and white blood cell count (WBC), were measured and analyzed. All analyses were stratified by gender.All body composition indices and metabolic parameters except 2h PBG differed significantly between males and females (all P0.001). BMI was positively associated with SBP, DBP, LDL-C, TC, TG, FBG, 2h PBG, HbA1c, FINS, HOMA-IR, hs-CRP, and WBC, and inversely associated with HDL-C; similar relationships were identified between the metabolic parameters and BFP, WHtR, and WHR. In the multivariate analysis, the odds of impaired glucose regulation, dyslipidemia, insulin resistance, and increased hs-CRP were 1.36, 1.92, 3.44, and 1.27 times greater in the overweight group than those in the normal weight group, respectively, and 1.66, 3.26, 7.53, and 1.70 times greater in the obese group than those in the normal weight group, respectively. The odds of dyslipidemia and hs-CRP were 1.29 and 1.38 times greater in the BFP ≥28.0% group than in the BFP28.0% group, respectively. The odds of dyslipidemia, HOMA-IR, and hs-CRP were 1.55, 1.26, and 1.48 times greater in the WHtR ≥0.96 group than in the WHtR0.96 group, respectively. Among males, the odds of HOMA-IR were 1.46 times greater in the WHR ≥0.54 group than in the WHR0.54 group. Similar results were observed in females.This study identified positive associations between all evaluated body composition indices and metabolic parameters in Chinese adults. Among the body composition indices, BMI predicted four of the five evaluated metabolic disorders in both gender groups.中国成人身体成分指标和代谢参数之间的关系:横断面研究 摘要 背景: 肥胖可导致血脂异常, 血压升高, 糖代谢异常, 炎症状态, 由此引发动脉粥样硬化, 糖尿病, 心血管疾病。 我们通常用身体成分指标, 如身体质量指数 (BMI), 体脂百分比 (BFP), 腰高比 (WHtR) 和腰臀比 (WHR) 反映肥胖程度。 本文通过对中国成人的横断面研究揭示身体成分指标和代谢参数之间的关系。 方法: 研究对象包括12018中国成年人. 身体成分指标包括: BMI, BFP, WHtR, WHR。 代谢参数包括: 收缩压 (SBP), 舒张压 (DBP), 总胆固醇 (TC), 甘油三酯 (TG), 低密度脂蛋白胆固醇 (LDL-C), 高密度脂蛋白胆固醇 (HDL-C), 空腹血糖 (FBG), 餐后2 h血糖 (2h PBG), 糖化血红蛋白 (HbA1c), 空腹胰岛素 (FINS), 胰岛素抵抗指数 (HOMA-IR), 高敏c反应蛋白 (hs-CRP), 和白细胞计数 (WBC)。 所有分析都按性别分层。 结果: 中国成年男性和女性相比, 除了2h PBG外, 所有身体成分指标及代谢参数之间存在显著统计学差异 (

Objectives To assess the effect of baseline body mass index (BMI) status and weight change on mortality in older men with impaired glucose regulation (IGR). Methods Eight hundred eighty-five men with IGR aged 60 to 90 were included. Baseline and endpoint weight were measured. All-cause and cardiovascular mortality were observed during a median follow-up period of 10 years. Multivariate Cox regressions were used to estimate associations between BMI, weight change and mortality. Results Relative to normal weight, overweight was associated with lower all-cause mortality (hazard ratios, HRs [95% confidence interval, 95% CI]: 0.57 [0.41, 0.78]) and cardiovascular mortality (0.52 [0.29, 0.93]), whereas obesity did not significantly decrease or increase the mortality risk. Furthermore, compared to weight stability, all types of weight change led to increased mortality risk, except small weight gain. Specifically, after adjustment for covariates and the initial weight, the HRs (95% CI) of large weight loss were 1.64 (1.15, 2.34) for all-cause mortality and 1.85 (1.10, 3.14) for cardiovascular mortality, and the HRs (95% CI) of large weight gain were 1.55 (1.01, 2.40) for all-cause mortality and 2.11 (1.04, 4.30) for cardiovascular mortality. Similar associations were observed when weight change was redefined in sensitivity analyses. Conclusions Both BMI at baseline and weight change have independent U-shaped associations with all-cause and cardiovascular mortality among older men with IGR. The present study suggests that older men with IGR may ensure their best survival by being overweight at baseline or by maintaining their weight regardless of their baseline weight status.

Background: A combination of genetic and environmental factors contributes to the development of hypertension. Polymorphisms of the gene encoding methylenetetrahydrofolate reductase (MTHFR) have been shown to associate with increased risk of hypertension. However, very few studies concentrated on the age of hypertension onset. This cross-sectional study sought to investigate the interaction between MTHFR polymorphisms and lifestyle factors on age of onset of hypertension in the Chinese Han population. Methods: Totally 5,760 hypertension patients and 14,753 normotensive controls were enrolled during an annual health examination at a single center. Lifestyle factors and disease history were collected through a questionnaire. Findings We confirmed the MTHFR TT genotype is a risk factor for hypertension (OR=1.15, 95% CI=1.14-1.27), as are age (OR=1.07, 95% CI=1.07-1.08), BMI (OR=1.05, 95% CI=1.047-1.054), hyperhomocysteinemia (OR=1.015, 95% CI=1.008-1.021), and male gender (OR=1.69, 95% CI=1.54-1.87). The age of onset of hypertension in patients harboring the MTHFR 677CT and TT genotypes was 2.03 and 2.07 years earlier, respectively, than individuals with the CC genotype. Family history, overdrinking, male gender, and high BMI were associated with earlier age of onset of hypertension and the risk was cumulative being3.9, 6.5, and 8.4 years earlier in individuals with 1, 2, and 3 risk factors, respectively. Healthy lifestyle factors delayed the age of onset of hypertension including those individuals carrying the MTHFR genetic risk factor. Interpretation: The MTHFR C677T and TT polymorphisms predispose to earlier age of onset of hypertension. Favorable lifestyle factors substantially delayed the onset of hypertension including in those individuals carrying the MTHFR genetic risk factor. Genetic predisposition to hypertension responded to favorable lifestyle changes eliminating the myth that genetic risk cannot be prevented. Funding: The State Science and Technology Support Program, the Chinese National Natural Science Fund and the Military Healthcare Programs. Declaration of Interest: We declare no competing interests. Ethical Approval: The study was approved by the Ethical Committee of PLA general hospital, Beijing, China. All participants gave informed consent before participation.

To investigate associations of novel cardiovascular markers with obesity in a general population.A total of 9361 individuals without diabetes or cardiovascular disease were studied between 2009 and 2012 in China. High-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), brachial-ankle pulse wave velocity (baPWV), pulse pressure, and central systolic blood pressure (cSBP) were assessed according to body mass index (BMI) levels and different BMI/metabolic syndrome (MetS) combinations.'Levels of hs-cTnT, baPWV, pulse pressure, and cSBP increased across BMI levels. Obesity was positively associated with these markers in multivariate models (P0.05 for all). When stratified by MetS, these associations remained significant in the non-MetS group, and compared with normal weight participants, the obese participants had 1.87 (95% confidence interval: 1.48, 2.36), 1.27 (1.02, 1.57), 1.89 (1.39, 2.57), and 2.71 (2.11, 3.47) fold risks for having elevated hs-cTnT, baPWV, pulse pressure, and cSBP, respectively, and had 1.61 (1.26, 2.05), 1.75 (1.27, 2.42), 2.45 (1.46, 4.11), and 3.14 (2.13, 4.62) fold risks for having 1, 2, 3, and 4 elevated cardiovascular markers, respectively; while no relationship was observed between obesity and these novel markers in the MetS group, after multivariate adjustment. These results were unchanged when using a waist-hip ratio, body fat per cent, and visceral adiposity index to redefine obesity.Obesity was positively associated with novel cardiovascular markers (except NT-proBNP) in participants without MetS rather than in participants with MetS. Obese participants without MetS also had higher odds of having more number of elevated cardiovascular markers.

Objective To evaluate the effect of obesity on long-term prognosis in patients with acute coronary syndrome (ACS) but without diabetes. Methods A total of 571 patients with ACS but without diabetes were included in a retrospective study. The patients were categorized as normal, overweight, and obese groups based on body mass index (BMI) levels. The mean follow-up time was 3 years. The ultimate events were major adverse cardiovascular events (MACE), including primary ultimate events (sudden cardiac death and non-fatal myocardial infarction) and rehospitalization with unstable angina. Results The incidence of long-term MACE was 33.6%, and it decreased with the increase in BMI levels (P trend=0.031). Obese patients had a lower risk of MACE than their normal weight counterparts (HR=0.58; 95% CI, 0.37-0.91; P=0.016). After multivariable adjustment, the lower risk of MACE in obese patients remained significant (HR=0.60; 95% CI, 0.39-0.94; P=0.027). Conclusions In a population with ACS but without diabetes, obese patients had a decreased risk of cardiovascular events compared with normal weight patients. In concordance with the data in patients with diabetes or coronary heart disease, the present study has further suggested that obesity may play a protective effect on long-term prognosis in patients with ACS but without diabetes. DOI: 10.11855/j.issn.0577-7402.2014.11.07

Background Very few studies have evaluated the potential of using B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) as surrogate markers to guide clinical interventional or conservative therapy decisions. Aim The aim of the current study was to evaluate the potential of using BNP and NT-proBNP as surrogate markers to guide clinical interventional or conservative therapy decisions. Methods We identified randomized controlled trials that randomized patients with acute coronary syndrome (ACs) of unstable angina and myocardial infarction without sT-segment elevation ACs to early invasive therapy versus a more conservative approach by systematic search of articles and databases. Results Five randomized controlled trials with a total of 8125 patients and with a mean duration of 11.2months were included in the meta-analysis. At a mean follow-up of 11.2months, the incidence of all-cause mortality was 5.9% in the early invasive group, compared with 6.8% in the conservative group (risk ratio=0.74; 95% confidence interval, 0.59-0.86; P = 0.001). Conclusions in summary, BNP/NT-proBNP-guided management of ACs is significantly improved by early invasive therapy by improving long-term survival and reducing nonfatal myocardial infarction for unstable angina. However, there does not seem to be a clear benefit of using such a strategy over existing clinical recommendations.

The American Heart Association's 2020 Strategic Goals define a new concept of cardiovascular health. However, the prevalence of ideal cardiovascular health outside of the United States is unclear, and its relationship with psychological status has not been reported.We included 9962 participants (mean age 47.1 years; 44.2% women) from the survey of the Disease Risk Evaluation and Health Management study from October 2009 to Feb 2012. The prevalence of poor, intermediate, and ideal cardiovascular health levels were calculated, and psychological status was assessed using the 21-item Depression Anxiety Stress Scales.After adjusting for sex and age, only 0.5% of the participants met ideal levels of all 7 cardiovascular health metrics, and 26.9% presented with 5 to 7 ideal health metrics. Fasting plasma glucose was the most prevalent ideal metric (71.2%), whereas physical activity was the least prevalent (18.1%). Women had a significantly higher proportion of 5 to 7 ideal health metrics compared with men (40.4% versus 13.4% after adjusting for age), and the proportion of participants who had 5 to 7 ideal health metrics significantly decreased with age (P0.001 for trend). Furthermore, the scores for depression, anxiety, and stress showed a negative correlation with the number of ideal health metrics, with regression coefficients of -0.07, -0.07, and -0.11, respectively (P0.05).Few adults met ideal levels of cardiovascular health. Individuals, communities, and health-care providers in China should be better integrated to pay closer attention to primordial prevention of unhealthy lifestyles and psychological problems.

Background Most biomarkers lack clinical sensitivity and specificity for predicting adverse outcomes in patients with acute coronary syndromes (ACS). We identified potential predictors through proteomic analysis. Methods Serum proteomic analysis was performed by surface-enhanced laser desorption/ionization protein chip technology in 409 patients with ACS. The primary endpoints were 30-day and 3-year occurrence of major adverse cardiovascular events (cardiac death, non-fatal myocardial infarction and target lesion revascularization). Results A m/z 4174.39 peak was associated with an increased incidence of 3-year events. In multivariate analysis, the m/z 4174.39 peak showed an independent correlation with 3-year (over 30-day) events (hazard ratio, 2.33; 95% confidence interval (CI), 1.23 to 4.39; P = 0.009 for the fourth versus first quartile), while the creatine kinase MB fraction (CK-MB) and troponin T levels were associated with 30-day events ((ln CK-MB: hazard ratio, 1.36; 95% CI, 1.07 to 1.73; P = 0.013); (ln troponin T: hazard ratio, 1.36; 95% CI, 1.12 to 1.64; P = 0.002)). Conclusions The m/z 4174.39 peak is a strong marker for predicting the long-term outcomes, and may correspond to a new biomarker, such as a member of the CXC chemokine family, and provide additional prognostic value in ACS.

Both glycated albumin (GA) and glycated hemoglobin (HbA1c) reflect the mean glucose levels. This study was conducted to investigate the relationships among GA, HbA1c, and arterial stiffness in the general population.A total of 11,014 participants were included. Serum GA; HbA1c; and arterial stiffness indices, including brachial-ankle pulse wave velocity (baPWV) and central systolic blood pressure (cSBP), were measured. Single-factor and multivariate regression analyses were performed. Receiver operating characteristic (ROC) analysis was performed to compare the predictive value of GA, HbA1c, and their combination for arterial stiffness. All analyses were stratified by sex.Men had a lower GA level than women. GA, HbA1c, and plasma glucose levels were correlated. The levels of baPWV and cSBP increased across sex-specific quartiles of GA and HbA1c (P for trend0.001 for all). Both GA and HbA1c were positively related to elevated baPWV and cSBP after adjusting for conventional factors (P0.05 for all). These relationships remained significant when participants were divided into groups with normal glucose tolerance, prediabetes, or diabetes. Regarding screening for elevated baPWV and cSBP, the values of the area under the ROC curve (AUC) for GA were similar to those for HbA1c in men but were lower than those for HbA1c in women. The combination of GA and HbA1c did not improve the AUC compared with HbA1c alone.Both GA and HbA1c were associated with arterial stiffness. The predictive value of GA for arterial stiffness was similar in men but lower in women compared with that of HbA1c.

The objective of the present study was to evaluate the predictive values of percent body fat (PBF) and body mass index (BMI) for cardiovascular risk factors, especially when PBF and BMI are conflicting. BMI was calculated by the standard formula and PBF was determined by bioelectrical impedance analysis. A total of 3859 ambulatory adult Han Chinese subjects (2173 males and 1686 females, age range: 18-85 years) without a history of cardiovascular diseases were recruited from February to September 2009. Based on BMI and PBF, they were classified into group 1 (normal BMI and PBF, N = 1961), group 2 (normal BMI, but abnormal PBF, N = 381), group 3 (abnormal BMI, but normal PBF, N = 681), and group 4 (abnormal BMI and PBF, N = 836). When age, gender, lifestyle, and family history of obesity were adjusted, PBF, but not BMI, was correlated with blood glucose and lipid levels. The odds ratio (OR) and 95% confidence interval (CI) for cardiovascular risk factors in groups 2 and 4 were 1.88 (1.45-2.45) and 2.06 (1.26-3.35) times those in group 1, respectively, but remained unchanged in group 3 (OR = 1.32, 95%CI = 0.92-1.89). Logistic regression models also demonstrated that PBF, rather than BMI, was independently associated with cardiovascular risk factors. In conclusion, PBF, and not BMI, is independently associated with cardiovascular risk factors, indicating that PBF is a better predictor.

Obesity is associated with an increased cardiovascular events in the general population. However, recent studies have shown a paradoxic relation between obesity and adverse outcomes in patients with type 2 diabetes, coronary artery disease, heart failure, or hypertension. However, whether this

OBJECTIVE The present study was conducted to compare the clinical outcomes and investigate prognostic factors of acute coronary syndrome (ACS) in patients with normal coronary angiography. METHODS The study was a retrospective cohort of 736 adult patients admitted with ACS between April 2007 and March 2008. After 3 years of follow-up, data regarding the following endpoints were obtained: death (cardiac and noncardiac), nonfatal myocardial infarction, and recurrent angina leading to repeated coronary angiography. The analysis focused on patients with a culprit lesion (n=678) and on those without a culprit lesion (n=51). RESULTS Major adverse cardiac events (MACEs) were significantly more frequent in the group with culprit lesions than in the group without culprit lesions (P

BACKGROUND: The presence of food-specific IgG antibodies in human serum may be useful for diagnosis of adverse food reactions. However, the clinical utility of testing for such antibodies remains very controversial. The aim of this study was to evaluate the serum levels and population distribution of food-specific IgGs and their association with chronic symptoms in a large-scale Chinese population. METHODOLOGY/PRINCIPAL FINDINGS: A total of 21305 adult participants from different regions of China had 14 type of food-specific serum IgG antibodies that were measured by enzyme-linked immunosorbent assay. Among these, 5,394 participants were randomly chosen to complete follow-up questionnaire surveys on their dietary characteristics and chronic symptoms. The concentrations of food-specific IgGs against 14 foods ranged from a median (interquartile range) of 7.3 (3.8, 12.6) U/mL of pork-specific IgG to 42.3 (28.8, 60.2) U/mL of crab-specific IgG. The concentration of food-specific IgGs was closely related to gender; after adjustment for region and age, women had higher concentrations of food-specific IgGs against all of the 14 foods except chicken (regression coefficient (95% CI): 0.01 (-0.003, 0.023); P = 0.129) and corn (0.002 (-0.013, 0.016); P = 0.825). Similar results were also found in the relationship of geographic region to the food-specific IgG concentrations for the 14 foods. Chronic symptoms were negatively associated with the concentrations of a few food-specific IgGs, and were positively associated with the concentrations of other food-specific IgGs. CONCLUSIONS: The levels of food-specific IgGs were variable both in healthy and in symptomatic Chinese adults. These findings raise awareness that demographic factors, the type of food and specific chronic symptoms should be considered before food elimination treatment based on IgG testing in patients with chronic symptoms is used in clinical practice.

To the Editor: Dr Carnethon and colleagues reported higher total and noncardiovascular mortality in adults with diabetes who were normal weight vs overweight or obese. Close examination of the data suggests that there is a potential limitation in the analysis that might have affected the conclusions. The absence of association between weight status and cardiovascular mortality was attributed to the small number of observed cardiovascular events. However, participants who had comorbid hypertension at the time of incident diabetes were not excluded from the analysis. The prevalence of hypertension was higher in overweight and obese participants than in the cohort with normal weight, leading to higher risk of cardiovascular events in the former. Also, systolic blood pressure rather than hypertension was adjusted for in the multivariable models, which may have attenuated the association of weight status with cardiovascular mortality. In addition, obesity is an independent risk factor for the development of cardiovascular diseases. Although this study excluded patients who had preexisting cardiovascular disease at baseline, the morbidity of cardiovascular disease might be higher in overweight and obese patients than in patients with normal weight during follow-up of the study. This may have attenuated the obesity paradox that patients with normal weight had higher cardiovascular mortality than overweight and obese patients. Previous studies found the obesity paradox between body mass index and cardiovascular mortality because patients who had preexisting cardiovascular disease were not excluded.