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Xiaoyu Wang,1 Xiaoli Chen,1 Yanfang Wang,1 Sheng Peng,2 Jingjiang Pi,3 Jinnan Yue,1 Qingshu Meng,1 Jie Liu,1 Liang Zheng,1,4 Paul Chan,5 Brian Tomlinson,6 Zhongmin Liu,1 Yuzhen Zhang1 1Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China; 2Department of Trauma, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, People’s Republic of China; 3Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 4Jian hospital, Shanghai East Hospital, Tongji University School of Medicine, Jian, 343006, People’s Republic of China; 5Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 6Faculty of Medicine, Macau University of Science and Technology, Macau, People’s Republic of ChinaCorrespondence: Yuzhen Zhang; Zhongmin Liu, Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, 150 Jimo Road, Pudong 15New District, Shanghai, 200092, People’s Republic of China, Tel +86-21-61569673, Email yzzhang-tj@tongji.edu.cn; liu.zhongmin@tongji.edu.cnObjective: The association of lipoprotein(a) [Lp(a)] with atherosclerotic cardiovascular disease (ASCVD) risk can be modified by chronic systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) is a reliable and easily available marker of immune response to various infectious and non-infectious stimuli. The purpose of this study was to assess the combined effects of Lp(a) and NLR in predicting the ASCVD risk and coronary artery plaque traits.Methods: This study included 1618 patients who had coronary computed tomography angiography (CTA) with risk assessment of ASCVD. CTA was used to evaluate the traits of coronary atherosclerotic plaques, and the association of ASCVD with Lp(a) and NLR was assessed by multivariate logistic regression models.Results: Plasma Lp(a) and NLR were significantly increased in patients having plaques. High Lp(a) was defined as the plasma Lp(a) level > 75 nmol/L and high NLR as NLR > 1.686. The patients were grouped into four categories according to normal or high NLR and plasma Lp(a) as nLp(a)/NLR-, hLp(a)/NLR-, nLp(a)/NLR+ and hLp(a)/NLR+. The patients in the latter three groups had higher risk of ASCVD compared to the reference group nLp(a)/NLR-, with the highest ASCVD risk in the hLp(a)/NLR+ group (OR = 2.39, 95% CI = 1.49– 3.83, P = 0.000). The occurrence of unstable plaques was 29.94% in the hLp(a)/NLR+ group, which was significantly higher than groups nLp(a)/NLR+, hLp(a)/NLR- and nLp(a)/NLR- with 20.83%, 26.54% and 22.58%, respectively, and there was a significantly increased risk of unstable plaque in the hLp(a)/NLR+ group compared to the nLp(a)/NLR- group (OR = 1.67, 95% CI = 1.04– 2.68, P = 0.035). The risk of stable plaque was not significantly increased in the hLp(a)/NLR+ group compared to the nLp(a)/NLR- group (OR = 1.73, 95% CI = 0.96– 3.10, P = 0.066).Conclusion: The concomitant presence of elevated Lp(a) and higher NLR is associated with increased unstable coronary artery plaques in patients with ASCVD.Keywords: lipoprotein(a), neutrophil to lymphocyte ratio, ASCVD and coronary artery plaque

YingLu Wang,1,&ast; Chang Liu,1,&ast; Liping Liu,1,&ast; Xiaoli Chen,1 Lu Wei,1 Jie Liu,1 Sheng Peng,2 Jingjiang Pi,3 Qi Zhang,3 Brian Tomlinson,4 Paul Chan,5 Lin Zhang,1 Huimin Fan,1 Liang Zheng,1 Zhongmin Liu,1 Yuzhen Zhang1 1Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2Department of Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 3Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 4Faculty of Medicine, Macau University of Science and Technology, Macau, People’s Republic of China; 5Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuzhen Zhang; Zhongmin Liu, Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China, Tel +86 21-61569673, Email yzzhang-tj@tongji.edu.cn; liu.zhongmin@tongji.edu.cnPurpose: With increase of population aging, the prevalence of atherosclerotic cardiovascular disease (ASCVD) and elevated serum thyroid stimulating hormone (TSH) in elderly is increasing. High TSH level was reported to be associated with ASCVD and CVD mortality; however, few are studied in Chinese population, especially in the elderly. This study aimed to investigate the prevalence of elevated serum TSH and ASCVD in an elderly population of Chinese community and to explore the association between high serum TSH and ASCVD or CVD mortality.Patients and Methods: We conducted a study involving 3814 adults who were at least 60 years of age. Questionnaires, physical examinations, and laboratory blood samples were collected in 2014, and a 78-months follow-up for cardiovascular and all-cause mortality was performed till December of 2020. Logistics regression was used to analyze the association between TSH and ASCVD. We used Cox models to assess the hazard ratios (HRs) for all-cause and CVD mortality across changes in serum TSH.Results: In this study, the prevalence of the elevated serum TSH was 19.8%, and significantly higher in women than in men (24.5% vs 13.9%, p < 0.001). The prevalence of ASCVD was 21.7%. In logistics regression models, elevated TSH was associated with ASCVD after adjusting for the risk factors of ASCVD in people over the age of 70 years (adjusted OR 1.054, P = 0.014). After a follow-up of 6.5 years, total 441 (11.6%) all-cause death and 174 (4.6%) death of CVD were observed. In Cox regression model, no significant correlation was found between TSH and all-cause mortality or CVD mortality in the elderly population.Conclusion: In the elderly population, there is high prevalence of elevated serum TSH and ASCVD. Elevated TSH seemed to be not associated with risk of all-cause or CVD mortality.Keywords: cardiovascular disease, thyroid stimulating hormone, mortality, community-dwelling elderly

Jingqi Zhu,1,2,* Zhangwei Yang,2,* Xiaoli Chen,3,* Jie Liu,3 Liang Zheng,3 Lin Zhang,3 Jingjiang Pi,4 Gang Li,2 Tao Zhuang,3 Chang Liu,3 Yinglu Wang,3 Liping Liu,3 Lieying Fan,5 Paul Chan,6 Brian Tomlinson,7 Ying Li,4 Zhongmin Liu,3 Yuzhen Zhang3 1Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 3Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 4Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 5Department of Clinical Laboratory, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 6Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 7Faculty of Medicine, Macau University of Science and Technology, Macau, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuzhen Zhang; Zhongmin LiuKey Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Pudong New District, Shanghai, 200120, People’s Republic of ChinaTel +86-21-61569673Email yzzhang-tj@tongji.edu.cn; liu.zhongmin@tongji.edu.cnObjective: An association of atrial fibrillation (AF) with epicardial fat volume (EFV) varied in different ethnic groups. We evaluated the AF-related risk factors and its association with pericardial fat in Chinese patients.Methods: Patients referred for coronary computed tomography angiography (CCTA) in Shanghai East Hospital during 2012 to 2014 (n=2042, 43.8% women, mean age 65.0 years) had AF and cardiovascular risk assessment. Pericardial fat depots were measured from CT and the association of EFV with non-valvular AF risk factors was evaluated by multivariate logistic regression models.Results: AF was present in 8.5% of patients with 11.6% of AF patients having rheumatic heart disease (RHD) and 8.7% having other valvular diseases. With increasing age, the proportion of RHD-related AF decreased and the risk factors for non-valvular AF increased. There was a significantly higher proportion of risk factors for non-valvular AF in men than in women (p=0.008), but RHD-related AF was more prevalent in women than men (p=0.013). The patients with non-valvular AF had significantly higher BMI and EFV with more pronounced elevation of EFV (p< 0.001). Multivariate logistic regression showed a significant association of EFV with AF after adjustment for BMI and clinical risk factors, and the highest EFV quartile was associated with AF independent of left atrial size and obstructive coronary artery disease.Conclusion: The association of EFV with non-valvular AF in Chinese patients was independent of generalized adiposity and clinical risk factors especially in highest EFV quartile. These findings support the growing appreciation of the association of EFV with AF.Keywords: atrial fibrillation, epicardial fat, pericardial fat, obesity, body mass index, computed tomography, echocardiography

Elaine Chow,1,2 Emily WM Poon,2 Benny SP Fok,1 Juliana CN Chan,2 Brian Tomlinson1–3 1Phase 1 Clinical Trial Centre, The Chinese University of Hong Kong, Hong Kong; 2Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; 3Faculty of Medicine, Macau University of Science & Technology, Taipa, MacauCorrespondence: Elaine Chow Email e.chow@cuhk.edu.hkBackground: Previous studies suggest gliclazide is metabolised primarily by CYP2C19 rather than CYP2C9, unlike other sulphonylureas. CYP2C19 *2 and *3 polymorphisms are more common in Asians.Methods: We investigated the effect of CYP2C19 polymorphisms on gliclazide pharmacokinetics in 15 healthy male Chinese subjects after a single 80mg oral dose.Results: In CYP2C19 poor metabolisers (*2/*2, n=4), plasma area-under-the-curve was higher by nearly two-fold compared with intermediate metabolisers (*2 and *3 heterozygotes, n=7) and extensive metabolisers (*1/*1, n=4) (p

Miao Hu, Brian Tomlinson Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong Abstract: Rosuvastatin is one of the most potent statins available for reducing circulating low-density lipoprotein cholesterol (LDL-C) levels, which enables more high-risk patients to achieve their lipid goals. Its favorable balance of effects on atherogenic and protective lipoproteins and its pleiotropic effects, including anti-inflammatory and antioxidant effects and improvement in endothelial dysfunction, are associated with slowing of progression of atherosclerosis within the artery wall and have been translated into clinical benefits for cardiovascular outcomes. This review provides an update on the safety and the efficacy of rosuvastatin in recent large clinical trials. It appears that rosuvastatin has a beneficial effect on the progression of atherosclerosis across the clinical dosage range of 2.5–40 mg. It reduced cardiovascular events in relatively low-risk subjects with elevated high-sensitivity C-reactive protein and normal low-density lipoprotein cholesterol. As with other statins, rosuvastatin did not show overall benefit in terms of survival in patients with heart failure, but certain clinical or biochemical markers reflecting underlying disease characteristics may help to identify subgroups of patients that benefit from statin therapy. In patients with end-stage renal disease undergoing chronic hemodialysis, rosuvastatin had no effect on reducing cardiovascular events. Although there is a slightly increased risk of incident diabetes with this class of agents, the absolute benefits of statin therapy on cardiovascular events overweigh the risk in patients with moderate or high cardiovascular risk or with documented cardiovascular disease. As with other statins, rosuvastatin is an appropriate therapy in addition to antihypertensive treatment to reduce cardiovascular risk in hypertensive patients. Keywords: atherosclerosis, cardiovascular disease, lipids, rosuvastatin

What happens if efforts to achieve sustainability fail? Research in many fields argues that contemporary global industrial civilization will not persist indefinitely in its current form, and may, like many past human societies, eventually collapse. Arguments in environmental studies, anthropology, and other fields indicate that this transformation could begin within the next half-century. While imminent collapse is far from certain, it is prudent to consider now how to develop sociotechnical systems for use in these scenarios. We introduce the notion of collapse informatics-the study, design, and development of sociotechnical systems in the abundant present for use in a future of scarcity. We sketch the design space of collapse informatics and a variety of example projects. We ask how notions of practice-theorized as collective activity in the "here and now"-can shift to the future since collapse has yet to occur. © 2013 ACM.

How did Asian states and peoples try to achieve better lives across the twentieth century, and how far did they succeed? Modern discussions of development concentrate on the importance of enhancing personal capabilities and human development, rather than on simple economic growth. The comparative history of colonial Asian countries, both before and after political independence, shows the range of economic, political, social, and environmental conditions necessary for such improvements. Increases in life expectancy across the range of countries are a useful metric to compare public health and the supply of basic needs. Countering endemic disease – especially malaria – has played an important part here. One key to success in the fight against malaria has been the ability of states, local authorities, and communities to provide support-based security to those who require it. Some colonial Asian countries have been better at this than others and have prospered accordingly. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Although observational studies suggest that soy foods or isoflavones are cardio-protective, clinical trials on whole soy or isoflavone daidzein (one major isoflavone and the precursor of equol) on blood pressure (BP) and endothelial function (EF) are few and have not been specifically conducted among equol producers, a population most likely to benefit from soy treatment. SUBJECTS/METHODS: We performed a 6-month double-blind, randomized, placebo-controlled trial to examine the effect of whole soy (soy flour) or purified daidzein on BP and EF in prehypertensive or untreated hypertensive postmenopausal women verified to be equol producers. A total of 270 eligible women were recruited and randomized to either one of the three treatment groups, 40 g soy flour (whole soy group), 40 g low-fat milk powder+63 mg daidzein (daidzein group) or 40 g low-fat milk powder (active control group) daily, each given as a solid beverage powder for 6 months. The primary outcome measures were 24 h ambulatory BP (ABP) and EF assessed by flow-mediated dilation using brachial artery ultrasound. RESULTS: A total of 253 subjects completed the study according to protocol. Urinary isoflavones indicated good compliance with the interventions. Intention to treat and per-protocol analysis indicated that there was no significant difference in the 6-month changes or % changes in parameters of ABP and brachial flow-mediated dilation among the three treatment groups. A further subgroup analysis among hypertensive women (n = 138) did not alter the conclusions. CONCLUSIONS: Whole soy and purified daidzein had no significant effect on BP and vascular function among equol- producing postmenopausal women with prehypertension or untreated hypertension. European Journal of Clinical Nutrition (2015) 69, 1161-1168; doi:10.1038/ejcn.2015.24; published online 18 March 2015, INTRODUCTION Elevated blood pressure (BP) is an independent risk factor for cardiovascular diseases (CVD) and renal impairment. (1) High BP remains a major reversible cardiovascular risk factor. (2) A metaanalysis [...]