BACKGROUNDCoronary heart disease is the main complication of type 2 diabetes mellitus; its incidence is closely related to microalbuminuria. The aim of this study was to investigate the correlation between the urinary albumin excretion rate and the incidence and severity of coronary heart disease in elderly type 2 diabetes mellitus patients.

METHODSA total of 612 hospitalized type 2 diabetes mellitus patients aged 60 years or older, who were given coronary angiography for diagnosis of possible coronary heart disease, participated. Their urinary albumin excretion rate was measured, and the severity of coronary artery stenosis was quantified with the Gensini scoring system to analyze the incidence of coronary heart disease and the severity of coronary artery stenosis. The optimal urinary albumin excretion rate predictive value for coronary heart disease incidence in elderly type 2 diabetes mellitus patients was determined.

RESULTSThe incidence of coronary heart disease, the number of patients with coronary vascular disease and the Gensini scores were significantly different between the microalbuminuria group and the normal albuminuria group (P < 0.05). The urinary albumin excretion rate was independently correlated with the occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients (odds ratio (OR) = 1.058, P < 0.0001, 95% confidence interval (CI): 1.036 - 1.080). Urinary albumin excretion rate and the Gensini score were independently correlated in elderly type 2 diabetes mellitus patients (β = 0.476, P < 0.0001). The best predictive value of urinary albumin excretion rate was 10.45 µg/min for elderly type 2 diabetes mellitus patients. The area under the curve was 0.764, with a sensitivity and specificity of 70.0% and 72.2%, respectively.

CONCLUSIONSThe occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients with microalbuminuria was higher than that in patients with normal albuminuria, and the severity of the disease also increased in patients with microalbuminuria. In elderly type 2 diabetes mellitus patients, urinary albumin excretion rate was positively correlated with the incidence and severity of coronary heart disease and was also an independent factor contributing to coronary heart disease.

Aged ; Albuminuria ; epidemiology ; physiopathology ; urine ; Coronary Artery Disease ; epidemiology ; physiopathology ; urine ; Diabetes Mellitus, Type 2 ; epidemiology ; physiopathology ; urine ; Female ; Humans ; Male ; Middle Aged ; Risk Factors

OBJECTIVETo assess the clinical significance of ankle-brachial index(ABI) in aged Chinese hypertensive men and to determine the association of ABI with clinical coronary heart disease, stroke.

METHODSAnkle-brachial index (ABI) was measured by means of peripheral vascular lab in aged hypertensive men from 301 Hospital and Anzhen Hospital while the clinical characteristics of the study population were investigated and collected. ABI < or = 0.9 was defined as peripheral arterial disease (PAD), 1.01 - 1.30 as borderline PAD.

RESULTSThere were 244 aged Chinese hypertensive men with antihypertensive treatment and with mean age 76.47 +/- 9.75 enrolled in this study, in whom 15 men with missing data except general information and ABI measurement. The mean ABI was 0.941 +/- 0.258 with the highest frequency 1.01 - 1.30. Eighty five men were diagnosed as PAD, 22 as borderline PAD, 135 normal ABI and 2 with ABI > 1.3. ABI and rate of hypertension control in PAD and borderline PAD men were significantly lower than those with normal ABI. In both PAD and borderline PAD patients, the hypertension duration (except in borderline PAD), creatinine level, neutrophil count (except in borderline PAD), percentage of alcohol drinking, prevalence of diabetes mellitus (except in borderline PAD), coronary artery disease, stroke and dyslipidemia (except in borderline PAD) were significantly higher than those with normal ABI patients. The prevalences of PAD, borderline PAD, coronary artery disease and stroke in this study population were 35.1%, 9.1%, 64.0%, 40.5%, respectively. The prevalences of PAD, borderline PAD, coronary artery disease and stroke increased significantly with increasing age. Logistic regression analysis showed that lower ABI was inversely associated with clinical coronary artery disease and stroke after adjustment for age, body mass index, hypertension duration, rate of hypertension control, systolic blood pressure, diastolic blood pressure, status of smoking, alcohol drinking, diabetes mellitus, dyslipidemia. The fully-adjusted odds ratios (ORs) for PAD and borderline PAD group compared with normal ABI group for the prevalence of coronary artery disease, and stroke demonstrated that these conditions were conversely related to ABI.

CONCLUSIONAged hypertensive men have high prevalence of PAD. Low ABI level was independently associated with coronary artery disease and stroke.

Aged ; Aged, 80 and over ; Ankle Brachial Index ; China ; epidemiology ; Coronary Disease ; epidemiology ; etiology ; physiopathology ; Humans ; Hypertension ; complications ; physiopathology ; Male ; Middle Aged ; Prevalence ; Stroke ; epidemiology ; etiology ; physiopathology

OBJECTIVETo understand the prevalence of sleep disordered breathing (SDB) in elderly patients with coronary artery disease (CAD) and explore the relations between SDB and CAD.

METHODSSixty-two elderly patients with and 18 without CAD identified by coronary angiography underwent examinations by polysomnography (PSG). Left ventricular ejection fraction (LVEF) was measured by 99Tc equilibrium radionuclide angiography.

RESULTSIn the 62 elderly patients with CAD, 53.2% had SDB, a rate significantly higher that (22.2%) in the 18 non-CAD patients. The CAD patients with SDB had higher respiratory disturbance index (RDI) and body mass index (BMI) and lower arterial saturation of oxygen (SaO2) during sleep, with longer duration of low SPO2 (less that 90%). The incidence of hypertension was higher in CAD patients with SDB than in those without SDB. No significant correlation was found between the severity of coronary artery disease and RDI (r=-0.16, P>0.05).

CONCLUSIONThe elderly patients with CAD have higher incidence of SDB, and appropriate interventions should be administered in those with severe SDB.

Aged ; Aged, 80 and over ; China ; epidemiology ; Coronary Angiography ; Coronary Artery Disease ; complications ; diagnostic imaging ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Prevalence ; Sleep Apnea Syndromes ; complications ; epidemiology ; physiopathology

BACKGROUNDThe incidence of diabetic nephropathy (DN) increases year by year. However, clinical characteristics of DN patients on maintenance hemodialysis (MHD) were rarely reported in China. The purpose of this study was to examine the clinical characteristics of the DN patients on MHD in Anhui Province, Eastern China.

METHODSThe clinical data of MHD patients in the hemodialysis centers of 26 hospitals in Anhui Province from January 1, 2014, to March 31, 2014, were examined. The differences between DN patients and non-DN patients were compared regarding vascular access, nutritional status, mineral and bone disorder, and other indexes.

RESULTSAmong the selected 2768 adult MHD patients, 427 had DN. The incidence of hypertension, coronary heart disease, and cerebral thrombus in DN patients was 94.1%, 21.5%, and 15.0%, respectively, which were higher than those in non-DN patients (P < 0.001). Category of vascular access for hemodialysis in DN patients was arteriovenous fistula (AVF) (87.4% [373/427]) and tunneled cuffed catheter (TCC) (11.2% [48/427]). The percentage of AVF was significantly lower than that of non-DN patients (P < 0.001), and percentage of TCC was significantly higher than that of non-DN patients (P < 0.001). Hemoglobin achievement rate in DN patients was 32.0%. The incidence of hypoalbuminemia was 24.7%, significantly higher than that in non-DN patients (P < 0.001). The achievement rate of the target range in mineral values was 55.9% in corrected serum calcium level, 30.1% in serum phosphorus level, and 49.3% in intact parathyroid hormone (iPTH) level in DN patients. Compared with non-DN patients, the achievement rate of serum phosphorus was significantly higher in DN patients.

CONCLUSIONSDN patients on MHD in Anhui province exhibited different clinical characteristics compared to non-DN hemodialysis patients. They presented higher percentage in TCC use and cardiovascular complication, lower serum albumin and iPTH levels than those in non-DN patients.

Aged ; Calcium ; blood ; China ; Coronary Disease ; blood ; epidemiology ; physiopathology ; Cross-Sectional Studies ; Diabetic Nephropathies ; blood ; epidemiology ; physiopathology ; Female ; Humans ; Hypertension ; blood ; epidemiology ; physiopathology ; Intracranial Thrombosis ; blood ; epidemiology ; physiopathology ; Male ; Middle Aged ; Parathyroid Hormone ; blood ; Phosphorus ; blood ; Renal Dialysis

OBJECTIVETo observe the incidence of ischemic J wave before and post percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD).

METHODSCHD patients (n = 117) underwent percutaneous coronary intervention (PCI) in Shanxi cardiovascular hospital were included in this study. The 12-lead ECGs were recorded within 24 hours before and after PCI. The ischemic J waves of five lead-groups (II, III, aVF group: V(1), V(2) group; V(3), V(4) group; V(5), V(6) group;I, aVL group) were analyzed and the number of lead-groups with J waves (0 - 5) were obtained in each patient. According to time course or wave amplitude, J waves were classified into three grades: small (time course between 0.02 - 0.03 s or wave amplitude between 0.05 - 0.09 mV), large (time course between 0.04 - 0.06 s or wave amplitude between 0.10 - 0.20 mV) and enormous (time course > 0.06 s or wave amplitude > 0.20 mV) J waves.

RESULTSThe number of lead-groups with ischemic J waves (0 - 5) in each patient was similar between pre and post PCI in the 117 patients (χ(2) = 6.23, P = 0.285). The numbers of small, large and enormous J waves were 157, 36 and 9 respectively before PCI and 163, 20 and 5 after PCI. The incidence of small J waves increased (77.72% vs. 86.70%) while large and enormous J waves decreased (17.82%, 4.46% vs. 10.64%, 2.66%) post PCI (χ(2) = 5.28, P < 0.05).

CONCLUSIONSThe numbers of lead-groups with ischemic J waves were similar before and post PCI. However, the amplitude of ischemic J waves decreased after PCI suggesting PCI could improve ischemic J waves in CHD patients.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Coronary Artery Disease ; complications ; physiopathology ; therapy ; Electrocardiography ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Ischemia ; epidemiology ; physiopathology ; Treatment Outcome

OBJECTIVETo analyze the current use of reperfusion strategies and the outcomes of patients with ST elevation acute coronary syndromes (ACS) in China.

METHODSA total of 518 consecutive patients (371 male and 147 females, mean age 65 +/- 11) with ST elevation ACS or newly discovered left bundle branch block were registered from 20 hospitals from 5 regions (ranging from large regional centre hospitals to small county hospitals) in China. Patient general characteristics, reperfusion patterns and outcomes were analyzed. Patients were followed up for 3 months.

RESULTSThe median time from pain onset to presentation at the hospital was 4 hours. Pre-hospital delay > 12 hours was found in 20% patients. Fifty-six percent patients (292/518) underwent reperfusion therapy (134 with primary percutaneous coronary intervention and 158 with fibrinolysis). The median time from admission to reperfusion (door-to-needle) was 65 min in fibrinolysis group and 110 min (door-to-cath) in primary PCI group respectively. Urokinase was used in 67% (106/158) patients underwent fibrinolysis. Multivariate logistic regression analysis showed that age >/= 75 years (P < 0.01), previous myocardial infarction (P < 0.01) and history of congestive heart failure (P < 0.05) were associated with no reperfusion therapy. Mortality and congestive heart failure rates were significantly higher in patients with no reperfusion therapy not only at discharge (P < 0.01) but also at 3 months (P < 0.01) compared to patients underwent reperfusion. The incidence of combined outcomes (death or MI, and death, MI or Strobe) was also higher in patients without reperfusion therapy at 3 months (all P < 0.01) compared to patients underwent reperfusion. There were no differences on combined outcomes between fibrinolysis and primary PCI subgroups.

CONCLUSIONReperfusion therapy was the primary treatment of choice to improve the outcomes of patients with ST elevation ACS. Strategies to increase reperfusion therapy rate for ST elevation ACS are urgently needed in China.

Aged ; Causality ; China ; epidemiology ; Coronary Disease ; epidemiology ; physiopathology ; therapy ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Reperfusion ; Registries ; Treatment Outcome

BACKGROUNDArterial stiffness is well known as an important risk factor for coronary artery disease. In this study, we aimed to investigate the association between carotid-ankle pulse wave velocity (caPWV) and risk of coronary artery disease (CAD), and the interaction between pulse wave velocity (PWV) and other potential risk factors of CAD.

METHODSA community-based cross-sectional study was conducted for subjects living in Beijing, China. We collected 213 subjects with coronary artery disease and 1 266 subjects without CAD between September 2007 and January 2009 in a community center of Beijing. A multivariate Logistic regression analysis was carried out to assess the odds ratios of factors related to CAD.

RESULTSWe found CAD subjects were more likely to have a higher body massindex (BMI), fasting glucose, uric acid, low-density lipoprotein (LDL) cholesterol, high-sensitivity Creactive protein (hs-CRP), carotic-femoral pulse wave velocity (cfPWV) and caPWV (P < 0.05), and CAD subjects had a significantly lower HDL cholesterol levels (P < 0.05). Moreover, the proportion of hypertension in CAD subjects was significantly higher than non-CAD subjects. The multiple Logistic regression analysis showed that hypertension, higher uric acid, hs-CRP, cfPWV and caPWV levels significantly increased the risk of CAD, with ORs (CI) of 1.47 (1.25-1.74), 1.17 (1.01-1.26), 1.35 (1.10-1.67), 1.15 (1.09-1.19) and 1.07 (1.01-1.15), respectively. Higher HDL cholesterol was significantly associated with reduced risk of CAD, with ORs (CI) of 0.58 (0.40-0.83). In addition, cfPWV had significant association with age, hypertension, LDL cholesterol, with Pearson's coefficients of 0.166, 0.074, and 0.030, respectively.

CONCLUSIONScfPWV and caPWV are independently associated with significant CAD, and cfPWV has significant correlation with age and hypertension. cfPWV and caPWV may be used as a practical tool for predicting the risk of CAD.

Adult ; Aged ; Aged, 80 and over ; Coronary Artery Disease ; epidemiology ; physiopathology ; Cross-Sectional Studies ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Risk Factors ; Vascular Stiffness ; physiology ; Young Adult

BACKGROUNDPeople with metabolic syndrome are at higher risk for developing coronary artery disease (CAD). The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in hospital and long term prognosis of CAD with metabolic syndrome and to determine the factors influencing the prognosis of the disease.

METHODSThe DESIRE registry contains data of 3696 patients with CAD between 2001 and 2004. Mean long term followup was (829 +/- 373) days. Diagnosis of metabolic syndrome was based on modified International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome, using body mass index (BMI) instead of waist circumference.

RESULTSOf 2596 patients with complete records of height, weight, and so on, 1280 (49.3%) were identified with metabolic syndrome. The patients with metabolic syndrome had higher level of body mass index, systolic blood pressure, diastolic blood pressure, fasting glucose and disordered blood lipid (all P < 0.0001), with higher creatinine [(10.5 +/- 4.3) mg/L vs (9.9 +/- 2.9) mg/L, P < 0.0001] and the number of white blood cells [(7.49 +/- 2.86) x 10(9)/L vs (7.19 +/- 2.62) x 10(9)/L, P = 0.008) compared with those without metabolic syndrome. The patients with metabolic syndrome showed severer coronary angiographic alterations (left main artery and/or > or = 2-vessel) (73.6% vs 69.6%, P = 0.031). There were no significant differences of major adverse cardiac and cerebral events (MACCE) or mortality in hospital between the two groups. During followup, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (11.8% vs 10.0%, P = 0.044). Fasting blood glucose (> or = 1000 mg/L) and triglyceride (TG, > or = 1500 mg/L) were responsible for most of the increased risk associated with the metabolic syndrome (adjusted OR 1.465, 95% CI 1.037 - 1.874, P = 0.032; OR 1.378, 95% CI 1.014 - 1.768, P = 0.044).

CONCLUSIONSThe prevalence of metabolic syndrome was very high in CAD patients. The metabolic syndrome confers a higher risk of long term MACCE in patients with CAD, and dysglycaemia and hypertriglycaemia appear to be responsible for most of the associated risk.

Adult ; Aged ; Blood Glucose ; analysis ; Coronary Artery Disease ; complications ; physiopathology ; therapy ; Female ; Humans ; Lipids ; blood ; Male ; Metabolic Syndrome ; complications ; epidemiology ; Middle Aged ; Myocardial Revascularization ; Prognosis

BACKGROUND: Several reports have documented that Asians have a strong tendency to develop insulin resistance. The aims of this study were to evaluate the relative effects of insulin resistance and obesity on the risk factors for coronary heart disease (CHD) and to clarify whether insulin resistance accentuates these effects in apparently healthy men. METHODS: We conducted a cross sectional survey on 4, 067 apparently healthy Korean men, aged between 20 and 83 years, with body mass indices (BMI) ranging from 15.19 to 40.29 kg/m2. The presence of insulin resistance was defined as a homeostasis model assessment (HOMA-IR) value > 2.23, which is the cutoff for the highest decile in the normal BMI group (BMI < 23 kg/m2; 1, 438 subjects). RESULTS: The prevalence of insulin resistance was 24.7% in the overweight subjects (23< or=BMI< 25 kg/m2; 1, 259 subjects) and 43.9% in the obese subjects (BMI> or=25 kg/m2; 1, 370 subjects). The BMI was identified as the major determinant for total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), and waist circumference (WC) as the most important for apolipoprotein B (Apo B), systolic and diastolic blood pressures and C-reactive protein (CRP), and HOMA-IR as the most important for fasting blood sugar, triglyceride (TG), low high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I (Apo A-I) and TC/HDL ratio. The presence of insulin resistance was found to accentuate the risk factors for CHD, with the exception of LDL-C and Apo A-I in the obese. CONCLUSION: WC and HOMA-IR were found to be closely associated with non-traditional markers for CHD, such as high Apo B, hypertriglyceridaemia and the TC/HDL-C ratio, which are predictors for the presence of small, dense LDL particles. The insulin resistance among obese men was more prevalent than expected, and the presence of insulin resistance accentuates the effect of obesity in terms of the risk of CHD.
Adult ; Aged ; Aged, 80 and over ; Apolipoprotein A-I/blood ; Blood Glucose/metabolism ; Blood Pressure ; Body Mass Index ; Cholesterol, HDL/blood ; Cholesterol, LDL/blood ; Coronary Disease/epidemiology/*physiopathology ; Cross-Sectional Studies ; Humans ; *Insulin Resistance ; Korea/epidemiology ; Male ; Middle Aged ; Obesity/epidemiology/*physiopathology ; Predictive Value of Tests ; Risk Factors

OBJECTIVEThe study was designed to investigate the clinical characteristics and the effects of therapeutic proposal on Kawasaki disease (KD).

METHODSClinical features, diagnosis and treatment for totally 942 patients with KD hospitalized during Jan, 2000 to Dec, 2004 were reviewed. Clinical features of typical and incomplete KD were compared. Also, influential factors for KD resistant to intravenous immune globulin (IVIG) therapy were analyzed. Five hundred and ten cases were followed up for analyzing the prognosis of coronary artery lesion (CAL).

RESULTS(1) 774 cases were diagnosed as typical KD, and 168 cases as incomplete KD. The incidence of infants with incomplete KD was higher than that of infants with typical KD (18.5% vs. 10.1%, P < 0.01). As compared with typical KD, the cases of incomplete KD had a long duration of fever before final diagnosis [(7.7 +/- 2.9) d vs. (7.0 +/- 2.4) d, P < 0.01], high hemoglobin level [Hb, (106.6 +/- 13.4) g/L vs. (103.5 +/- 12.3) g/L, P < 0.01], high hematocrit [Hct, (32.0 +/- 4.3)% vs. (31.0 +/- 4.0)%, P < 0.01], and high prevalence of CAL (23.8% vs. 16.8%, P < 0.05), respectively. The occurrence rate and emerging time of clinical manifestations in incomplete KD and in typical KD were presented, respectively: non-exudative conjunctivitis [occurrence rate, 64.9% vs. 93.5%; emerging time, (4.4 +/- 1.4) d vs. (4.0 +/- 1.6) d, respectively (P < 0.05 or P < 0.01)], erythema and cracking of lips [occurrence rate, 50.6% vs. 94.8%; emerging time, (4.9 +/- 1.4) d vs. (4.5 +/- 1.6) d, respectively (P < 0.05 or P < 0.01)], rash [occurrence rate, 35.1% vs. 87.7%; emerging time, (3.9 +/- 1.9) d vs. (3.4 +/- 1.7) d, respectively (P < 0.05 or P < 0.01)], erythema and edema of extremity [occurrence rate, 26.8% vs. 71.4%; emerging time, (6.7 +/- 1.5) d vs. (5.3 +/- 1.7) d, respectively (P < 0.01)], cervical lymphadenopathy [occurrence rate, 34.5% vs. 68.0%; emerging time, (4.3 +/- 2.5) d vs. (3.6 +/- 2.2) d, respectively (P < 0.05 or P < 0.01)], strawberry tongue [occurrence rate, 31.0% vs. 59.8%; emerging time, (5.6 +/- 2.2) d vs. (4.9 +/- 1.8) d, respectively (P < 0.05 or P < 0.01)], membranous desquamation of fingertips [occurrence rate, 34.5% vs. 56.3%; emerging time, (11.7 +/- 3.3) d vs. (10.3 +/- 2.7) d, respectively (P < 0.01)], and desquamation peri-anus [occurrence rate, 42.9% vs. 50.0%; emerging time, (6.7 +/- 2.7) d vs. (6.9 +/- 2.5) d, respectively (P > 0.05)]. Except for peri-anus desquamation, other clinical manifestations in incomplete KD were sporadical as compared to typical KD. (2) Six per cent (51/857) of cases were resistant to the IVIG therapy. As compared to the group responding to IVIG therapy, high prevalence of CAL (31.4% vs. 17.1%, P < 0.05), long fever duration [(10.6 +/- 3.9) d vs. (7.5 +/- 2.3) d, P < 0.01], low Hb level [(99.9 +/- 14.1) g/L vs. (104.3 +/- 12.4) g/L, P < 0.01], low Hct [(30.1 +/- 4.5)% vs. (31.2 +/- 4.0)%, P < 0.05], low platelet [PLT, (256.9 +/- 142.4) x 10(9)/L vs. (309.7 +/- 131.5) x 10(9)/L, P < 0.05], and low albumin level [ALB, (27.8 +/- 8.4) g/L vs. (33.5 +/- 6.7) g/L, P < 0.01] were found in the group resistant to IVIG therapy, respectively. (3) In patients who received IVIG 1 g/kg and 2 g/kg, the recovery rates from CAL were 83.1% and 89.7% (P > 0.05), respectively. The prevalence of CAL in those without CAL in acute and subacute stages was 0.9% and 3.5% (P > 0.05), respectively, during 2 year-follow-up period.

CONCLUSION(1) Infants appeared to have more chances to suffer from incomplete KD. Incomplete KD had high prevalence of CAL. The peri-anus desquamation might be an important clue for early diagnosis of incomplete KD. (2) In acute stage, the influential factors for KD resistance to IVIG therapy included prolonged fever, non-elevated PLT, and persistent decrease in Hb, Hct and ALB levels. (3) Children receiving IVIG 1 g/kg and 2 g/kg had the similar effects on recovery and prevention from CAL within the first two years after KD onset.

Adolescent ; Blood Platelets ; drug effects ; Child ; Child, Preschool ; China ; Coronary Aneurysm ; drug therapy ; epidemiology ; etiology ; prevention & control ; Coronary Artery Disease ; complications ; diagnosis ; drug therapy ; physiopathology ; Dose-Response Relationship, Drug ; Female ; Fever ; drug therapy ; physiopathology ; Follow-Up Studies ; Humans ; Immunoglobulins, Intravenous ; administration & dosage ; therapeutic use ; Immunologic Factors ; Infant ; Infant, Newborn ; Male ; Prognosis ; Retrospective Studies ; Risk Factors ; Treatment Outcome