Objective: To investigate the associations between 24-hour urinary sodium excretion (24hUNaE) and all-cause mortality in adult Northern Chinese population. Methods: Data from this study were derived from the prospective urban and rural epidemiology (PURE) study in north China. Baseline information of all participants were obtained by face to face interview through trained research staffs based on questionnaires, and morning fasting urine samples of participants were collected to estimate 24hUNaE and 24-hour potassium excretion (24hUKE). Multivariable frailty Cox regression models were used to explore the association between 24hUNaE (<3.00, 3.00-3.99, 4.00-4.99, 5.00-5.99 and ≥6 g/d) and all-cause death. Results: A total of 27 310 participants were included in this study. The mean 24hUNaE was (5.84±1.73) g/d. After a median follow-up of 8.8 years, 1 024 participants died (3.7%), including 390 cardiovascular related deaths and 591 non-cardiovascular related deaths. The cause of death of the remaining patients could not be determined. Using 24hUNaE level of 4.00-4.99 g/d as the reference group, after fully adjustment, 24hUNaE ≥6.00 g/d was associated with an increased risk of all-cause death (HR=1.24, 95%CI: 1.02-1.49) and cardiovascular related death (HR=1.39, 95%CI: 1.02-1.88). 24hUNaE<3.00 g/d was associated with increased risk of all-cause mortality (HR=1.38, 95%CI: 0.96-1.99). There was no significant association between 24hUNaE and non-cardiovascular related death. Furthermore, using the combination of 24hUNaE 4.00-4.99 g/d and 24hUKE≥2.11 g/d as the reference group, the highest risk occurred in participants with the combination of low sodium (<3.00 g/d) and low potassium (<2.11 g/d). Conclusion: 24hUNaE equal or higher than 6 g/d or lower than 3 g/d is associated with increased risk of all-cause mortality and cardiovascular related death in Northern Chinese population. Besides, moderate sodium intake in combination with increased potassium intake might reduce the risk of all-cause death.
Humans ; Adult ; Sodium/urine* ; Prospective Studies ; Potassium/urine* ; China/epidemiology* ; Proportional Hazards Models ; Cardiovascular Diseases/epidemiology*

OBJECTIVETo determine the value of the urinary microalbumin/creatinine ratio (UACR) and the relationship between UACR and traditional cardiovascular risk factors among elderly community subjects.

METHODSA representative population in Shanghai rural district aged more than 65 years who participated in the heart health survey of the key projects in the national science and technology pillar program in the eleventh five-year plan period of China were sampled via a clustered complex sampling method. A midstream collection from the first morning void collected was used to measure the urinary microalbumin, the urinary creatinine and the UACR. Baseline information including traditional cardiovascular risk factors were obtained by standard questionaire to analyze the distribution status of UACR in the population with or without the risk factors.

RESULTS(1) There were 1718 subjects (721 males) of (73.3 ± 5.5) years included in this study. (2) The prevalence of with at least one cardiovascular risk factor was 78.00% in this cohort, the top there risk factors were dyslipidemia (61.06%), hypertension (44.59%) and diabetes (13.80%). (3) The median (the lower quartile-the upper quartile) of the UACR of the population without cardiovascular diseases and risk factors was 13.81 (6.03 - 26.51) µg/mg. The level of UACR was significantly higher in females than that in males [17.12 (7.28 - 33.28) µg/mg vs. 5.49 (2.92 - 9.76) µg/mg, P < 0.01]. (4) The level of UACR in population with hypertension, diabetes or dyslipidemia was 16.27 (6.65 - 42.00) µg/mg, 26.27 (10.92 - 76.65) µg/mg and 16.39 (6.98 - 41.03) µg/mg respectively, all exceeding that of the healthy group (P < 0.05 or P < 0.01). (5) The levels of UACR increased in proportion to the increase of cardiovascular risk factor numbers, the UACR of the population with 0, 1, 2, 3 and 4 cardiovascular risk factors were 13.81 (6.03 - 26.51) µg/mg, 15.76 (6.79 - 36.44) µg/mg, 13.82 (5.68 - 34.43) µg/mg, 16.47 (6.07 - 50.56) µg/mg and 18.63 (11.26 - 83.09) µg/mg, respectively. The population with 4 cluster of cardiovascular risk factors posed the higher level of UACR than that of population with 0 cardiovascular risk factors (P < 0.05).

CONCLUSIONSThe three most common risk factors of cardiovascular diseases among the elderly community subjects aged more than 65 years are dyslipidemia, hypertension and diabetes, all of which are related to the elevation of UACR.

Aged ; Albuminuria ; epidemiology ; Cardiovascular Diseases ; epidemiology ; urine ; Cohort Studies ; Creatinine ; urine ; Cross-Sectional Studies ; Female ; Humans ; Male ; Risk Factors

There has been a long-known association between high dietary sodium intake and hypertension, as well as the increased risk of cardiovascular disease. Reduction of sodium intake is a major challenge for public health. Recently, there have been several controversial large population-based studies regarding the current recommendation for dietary sodium intake. Although these studies were performed in a large population, they aroused controversies because they had a flaw in the study design and methods. In addition, knowledge of the advantages and disadvantages of the methods is essential in order to obtain an accurate estimation of sodium intake. I have reviewed the current literatures on the association between sodium intake and cardiovascular events, as well as the methods for the estimation of sodium intake.
Cardiovascular Diseases ; Hypertension ; Public Health ; Sodium* ; Sodium, Dietary ; Urine Specimen Collection

BACKGROUND: Epidemiological evidence has shown that serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations, a diagnostic biomarker for heart failure, are positively associated with cardiovascular risk. Since NT-proBNP in serum is excreted in urine, it is hypothesized that urinary NT-proBNP concentrations are correlated with serum concentrations and linked with cardiovascular risk in the general population. METHODS: A total of 3060 community-dwelling residents aged ≥ 40 years without history of cardiovascular disease (CVD) were followed up for a median of 8.3 years (2007-2015). Serum and urinary concentrations of NT-proBNP at baseline were compared. The hazard ratios (HRs) and their 95% confidence intervals (CIs) for the association between NT-proBNP concentrations and the risk of developing CVD were computed using the Cox proportional hazards model. RESULTS: The median values (interquartile ranges) of serum and urinary NT-proBNP concentrations at baseline were 56 (32-104) pg/mL and 20 (18-25) pg/mL, respectively. There was a strong quadratic correlation between the serum and urinary concentrations of NT-proBNP (coefficient of determination [R CONCLUSIONS The present study demonstrated that urinary NT-proBNP concentrations were well-correlated with serum concentrations and were positively associated with cardiovascular risk. Given that urine sampling is noninvasive and does not require specially trained personnel, urinary NT-proBNP concentrations have the potential to be an easy and useful biomarker for detecting people at higher cardiovascular risk.
Adult ; Aged ; Aged, 80 and over ; Biomarkers/urine* ; Cardiovascular Diseases/urine* ; Female ; Heart Failure/diagnosis* ; Humans ; Incidence ; Japan/epidemiology* ; Male ; Middle Aged ; Natriuretic Peptide, Brain/urine* ; Peptide Fragments/urine* ; Prospective Studies ; Risk Assessment

OBJECTIVETo explore the association between urinary microalbumin-to-creatinine ratio (ACR) and brachial-ankle pulse wave velocity (baPWV) in hypertensive patients.

METHODSA total of 877 primary hypertension patients were enrolled in this trial from September 2009 to December 2012, and were randomly recruited and patients were divided into normal ACR group (ACR < 30 mg/g, n = 723), micro-albuminuria group (30 mg/g ≤ ACR < 300 mg/g, n = 136) and macro-albuminuria group (ACR ≥ 300 mg/g, n = 18). baPWV was measure by automatic pulse wave velocity measuring system.

RESULTSThe baPWV values in patients of micro-albuminuria group and macro-albuminuria group were significantly higher than in the normal ACR group (all P < 0.05). The baPWV value of macro-albuminuria group was significantly higher than in the micro-albuminuria group (P < 0.05). Linear correlation analysis revealed that ACR was positively correlated with baPWV (r = 0.413, P < 0.01). Multiple linear regression analysis showed that ACR independently correlated with baPWV in patients with primary hypertension (β = 0.29, R(2) = 0.112, P < 0.01) after adjusting for age, sex, body mass index, systolic blood pressure, diastolic blood pressure, blood glucose, total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride. Using ACR < 30 mg/g and ACR ≥ 30 mg/g as dichotomous variable, binary logistic regression analysis showed that ACR ≥ 30 mg/g was also a risk factor of the ascending baPWV in primary hypertension patients (OR: 1.73, 95% CI: 1.62-2.98) after adjusting the traditional cardiovascular risk factors.

CONCLUSIONACR is positively correlated to baPWV in primary hypertension patients, and the ascending baPWV is a risk factor of early renal dysfunction in primary hypertension patients.

Albuminuria ; Ankle ; Ankle Brachial Index ; Blood Flow Velocity ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Creatinine ; urine ; Essential Hypertension ; Humans ; Hypertension ; physiopathology ; urine ; Pulsatile Flow ; Pulse Wave Analysis ; Regression Analysis ; Risk Factors

Arsenic is a unique element with distinct physical characteristics and toxicity whose importance in public health is well recognized. The toxicity of arsenic varies across its different forms. While the carcinogenicity of arsenic has been confirmed, the mechanisms behind the diseases occurring after acute or chronic exposure to arsenic are not well understood. Inorganic arsenic has been confirmed as a human carcinogen that can induce skin, lung, and bladder cancer. There are also reports of its significant association to liver, prostate, and bladder cancer. Recent studies have also suggested a relationship with diabetes, neurological effects, cardiac disorders, and reproductive organs, but further studies are required to confirm these associations. The majority of research to date has examined cancer incidence after a high exposure to high concentrations of arsenic. However, numerous studies have reported various health effects caused by chronic exposure to low concentrations of arsenic. An assessment of the health effects to arsenic exposure has never been performed in the South Korean population; thus, objective estimates of exposure levels are needed. Data should be collected on the biological exposure level for the total arsenic concentration, and individual arsenic concentration by species. In South Korea, we believe that biological exposure assessment should be the first step, followed by regular health effect assessments.
Arsenic/*toxicity/urine ; Cardiovascular Diseases/chemically induced ; *Environmental Exposure ; Environmental Pollutants/*toxicity ; Female ; Humans ; Male ; Neoplasms/chemically induced ; Reproduction/drug effects

Arsenic is a unique element with distinct physical characteristics and toxicity whose importance in public health is well recognized. The toxicity of arsenic varies across its different forms. While the carcinogenicity of arsenic has been confirmed, the mechanisms behind the diseases occurring after acute or chronic exposure to arsenic are not well understood. Inorganic arsenic has been confirmed as a human carcinogen that can induce skin, lung, and bladder cancer. There are also reports of its significant association to liver, prostate, and bladder cancer. Recent studies have also suggested a relationship with diabetes, neurological effects, cardiac disorders, and reproductive organs, but further studies are required to confirm these associations. The majority of research to date has examined cancer incidence after a high exposure to high concentrations of arsenic. However, numerous studies have reported various health effects caused by chronic exposure to low concentrations of arsenic. An assessment of the health effects to arsenic exposure has never been performed in the South Korean population; thus, objective estimates of exposure levels are needed. Data should be collected on the biological exposure level for the total arsenic concentration, and individual arsenic concentration by species. In South Korea, we believe that biological exposure assessment should be the first step, followed by regular health effect assessments.
Arsenic/*toxicity/urine ; Cardiovascular Diseases/chemically induced ; *Environmental Exposure ; Environmental Pollutants/*toxicity ; Female ; Humans ; Male ; Neoplasms/chemically induced ; Reproduction/drug effects

The relationship between salt intake and adequate blood pressure control is not well investigated in Korea populations, especially in patients with cardiovascular disease. This cross-sectional study enrolled 19,083 subjects who participated in the Korea National Health and Nutrition Examination Survey conducted from 2009-2011. The amount of salt intake was estimated using the Tanaka equations based on spot urine samples. Comparing patients with and without cardiovascular disease, systolic blood pressure (129.1+/-18.1 mmHg vs. 120.0+/-18.1 mmHg, P<0.001) and the amount of urinary sodium excretion (149.4+/-37.5 mM/day vs. 144.1+/-36.2 mM/day, P<0.001) were higher in patients with cardiovascular diseases. Among patients with cardiovascular disease, the high blood pressure group showed an increased amount of urinary sodium excretion compared to the normal blood pressure group (155.5+/-38.2 vs. 146.6+/-36.9 mM/day, P<0.001). The odds ratio (OR) of high blood pressure was higher (OR, 1.825; 95% CI, 1.187-2.807; P-for-trend 0.003, highest quartile of urinary sodium excretion vs. lowest quartile) in patients with cardiovascular disease. A higher amount of urinary sodium excretion was associated with a lower rate of adequate blood pressure control in Korean population, especially with cardiovascular disease.
Adult ; Aged ; Algorithms ; Blood Pressure/*physiology ; Cardiovascular Diseases/complications/*pathology ; Cross-Sectional Studies ; Demography ; Female ; Humans ; Hypertension/complications ; Male ; Middle Aged ; Nutrition Surveys ; Odds Ratio ; Sodium, Dietary/*urine

Primary gout is a metabolic disease that has its basis in an inborn error in the intermediary metabolism of purines and related compounds. It is characterized by hyperuricemia, recurrent attacks of acute arthritis, deposition of monosodium urate crystals in and around the joints of the extremities, urolithiasis, renal and cardiovascular disease. Thirty-eight patients with gout managed at the department of orthopaedic surgery, Dong-A University Hospital, from April, 1990 to November 1993, had been reviewed retrospectively and the following results were obtained. 1. Most of cases were male(95%) and the mean age was 55.4 years old. 2. The case of first attack was 8 cases(21%), the most common age of first attack was fifth decade and mean duration of disease was 7.4 years. 3. The most common precipitating factor was overindulgence in food and alcohol. 4. The avarage uric acid level of serum and that 24-hour urine collection in acute attacks were 11.2 mg/dl and 24.5mg/D. Respectively all of the cases except four revealed increased ESR (average 43 mm/hr). 5. When the acute attack was developed, the most common involved joint was the first M-P joint (83%) of the foot, but as the acute gout was progressed to the chronic form, multiple joints were affected. 6, The punched out lesion in the radiograph was found in 7 cases(25 joints), among them 6 cases had suffered from the disease for longer than 3 years. 7. The most common complication was nephropathy(18 cases). 8. In case of acute gouty attack, we administered colchicine in the 22 cases. The therapeutic method of colchicine usually consisted of oral administration of 2 tablets(1.3mg) initially, followed by 1 tablet(0.65mg) every hour untill the relief of joint pain or the development of gastointestinal symptoms. We rocomended 6-8 tablets of colchicine for the management of acute gouty attack with safety. 9. Colchicine in small daily dose(0.65mg qd or bid) could be effective to prevent the recurrent attacks of high risk gouty arthritis.
Administration, Oral ; Arthralgia ; Arthritis ; Arthritis, Gouty ; Cardiovascular Diseases ; Clinical Study ; Colchicine ; Extremities ; Foot ; Gout ; Humans ; Hyperuricemia ; Joints ; Metabolic Diseases ; Metabolism ; Methods ; Precipitating Factors ; Purines ; Retrospective Studies ; Tablets ; Uric Acid ; Urine Specimen Collection ; Urolithiasis

Rheumatoid arthritis (RA) is associated with significant cardiovascular (CV) morbidity and mortality. Increased urinary albumin excretion is a marker of CV risk. There are only few data on urinary albumin excretion in RA patients. Aim of the present study was to investigate urinary albumin excretion in RA patients and analyze, whether there is an association between urinary albumin excretion and vascular function as measured by the augmentation index (AIx). In a total of 341 participants (215 with RA, 126 without RA) urinary albumin-creatinine ratio (ACR) was determined and the AIx was measured. The Kolmogorov-Smirnov-test was used to cluster patient groups whose distributions of ACR can be considered to be equal. A crude analysis showed a median ACR of 6.6 mg/g in the RA group and 5.7 mg/g in patients without RA (P > 0.05). In order to account for diabetes (DM) we formed 4 distinct patient groups. Group 1: RA-/DM- (n = 74); group 2: RA+/DM- (n = 195); group 3: RA-/DM+ (n = 52); group 4: RA+/DM+ (n = 20). Clustering of these groups revealed two distinct patient groups: those without RA and DM, and those with either RA or DM or both. The latter group showed statistically significant higher ACR (median 8.1 mg/g) as the former (median 4.5 mg/g). We found no significant correlation between AIx and ACR. Urinary albumin excretion in patients with RA or DM or both is higher than in subjects without RA and DM. This can be seen as a sign of vascular alteration and increased CV risk in these patients.
Aged ; Albumins/analysis ; Albuminuria/*complications ; Arthritis, Rheumatoid/complications/*diagnosis ; Cardiovascular Diseases/etiology ; Cluster Analysis ; Creatinine/urine ; Diabetes Mellitus, Type 2/complications ; Female ; Humans ; Male ; Middle Aged ; Pulse Wave Analysis ; Risk Factors ; Vascular Stiffness/*physiology