Objective: To explore associations between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risk of cardiovascular events in a Chinese population, with a long-term follow-up. Methods: A random sample of 2,031 participants (73.6% males, mean age = 60.4 years) was derived from the Asymptomatic Polyvascular Abnormalities Community study (APAC) from 2010 to 2011. Serum Lp-PLA2 levels were determined by enzyme-linked immunosorbent assay (ELISA). The composite endpoint was a combination of first-ever stroke, myocardial infarction (MI) or all-cause death. Lp-PLA2 associations with outcomes were assessed using Cox models. Results: The median Lp-PLA2 level was 141.0 ng/mL. Over a median follow-up of 9.1 years, we identified 389 events (19.2%), including 137 stroke incidents, 43 MIs, and 244 all-cause deaths. Using multivariate Cox regression, when compared with the lowest Lp-PLA2 quartile, the hazard ratios with 95% confidence intervals for developing composite endpoints, stroke, major adverse cardiovascular events, and all-cause death were 1.77 (1.24-2.54), 1.92 (1.03-3.60), 1.69 (1.003-2.84), and 1.94 (1.18-3.18) in the highest quartile, respectively. Composite endpoints in 145 (28.6%) patients occurred in the highest quartile where Lp-PLA2 (159.0 ng/mL) was much lower than the American Association of Clinical Endocrinologists recommended cut-off point, 200 ng/mL. Conclusion Higher Lp-PLA2 levels were associated with an increased risk of cardiovascular event/death in a middle-aged Chinese population. The Lp-PLA2 cut-off point may be lower in the Chinese population when predicting cardiovascular events.
1-Alkyl-2-acetylglycerophosphocholine Esterase/blood* ; Asians ; Cardiovascular Diseases/diagnosis* ; China/epidemiology* ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Mortality ; Myocardial Infarction/blood* ; Predictive Value of Tests ; Risk Factors ; Stroke/blood*

In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive blood pressure (BP) lowering was associated with significant reduction in composite cardiovascular (CV) outcomes in hypertension. Subsequently, several meta-analyses have corroborated the findings from SPRINT and these benefits were more prominent in subjects with higher cardiovascular risk at baseline. As such, the recent American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guideline and the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guideline recommended the lowering of target BP to less than 130/80 mmHg in most hypertensive subjects. However, one should keep in mind the potential harm of too much BP lowering. Post hoc analysis of clinical trials have demonstrated increased cardiovascular mortality and events with too much BP lowering. Therefore, although intensive BP lowering may be beneficial in further reducing CV outcomes, too much reduction below 120/70 mmHg may actually harmful. In conclusion, although intensive BP lowering to achieve target BP below 130/80 mmHg is beneficial in reducing CV outcomes, one should do so cautiously as to avoid adverse events. As such, the first target of anti-hypertensive treatment should be to achieve BP lowering below 140/90 mmHg. Once that target is achieved, one could target BP below 130/80 mmHg keeping in mind to avoid signs of organ hypoperfusion such as orthostatic hypotension, orthostatic dizziness, weakness and serum creatinine elevation.
Blood Pressure ; Cardiology ; Cardiovascular Diseases ; Creatinine ; Dizziness ; Heart ; Hypertension ; Hypotension, Orthostatic ; Mortality

Hypertension affects the majority of patients with chronic kidney disease (CKD) and increases the risk of cardiovascular disease, end-stage renal disease and mortality. Previously, many hypertension guidelines have suggested blood pressure targets in patients with CKD. Recently, the American College of Cardiology/American Heart Association 2017 Guideline for Hypertension suggests a new definition for hypertension and therapeutic targets, which were equally applicated to patients with CKD. These changes reflect the results of the Systolic Blood Pressure Intervention Trial (SPRINT) study, but the renal outcome of intensive blood pressure control was not good. Furthermore, the majority of hypertension guidelines including those of the Korean Society of Hypertension and the European Society of Hypertension have retained the traditional definition. Herein, we intend to analyze in detail the effect of intensive blood pressure control on kidney through the post-hoc analyses of the SPRINT study.
Blood Pressure ; Cardiovascular Diseases ; Diagnosis ; Heart ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Mortality ; Renal Insufficiency, Chronic

Mortalities from cardiovascular disease in Korea have decreased markedly over the past three decades. The major cardiovascular and metabolic risk factors, however, remain prevalent, and their burden on health is large. The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) planned a cohort study in order to identify novel risk factors and to develop evidence-based prevention strategies of cardiovascular and metabolic diseases. The CMERC deliberately designed two prospective cohorts, a community-based general population cohort (the CMERC cohort) and its sister cohort (a hospital-based high-risk patient cohort), covering a broad spectrum of cardiovascular and metabolic diseases. This paper describes the CMERC cohort study of community-dwelling adults aged 30 to 64 years. A total of 8097 adults completed baseline measurement between 2013 and 2018. Baseline measurements assessed socio-demographic factors, medical history, health-related behaviors, psychological health, social network and support, anthropometry, body composition, and resting blood pressure and comprised electrocardiography, carotid artery ultrasonography, fasting blood analysis, and urinalysis. Both active follow-up through an annual telephone survey and a 5-year on-site health examination survey and passive follow-up through secondary data linkage with national databases, such as national death records, have been applied. Researchers interested in collaborative research may contact the corresponding author.
Adult ; Anthropometry ; Blood Pressure ; Body Composition ; Cardiovascular Diseases ; Carotid Arteries ; Cohort Studies ; Death Certificates ; Electrocardiography ; Fasting ; Follow-Up Studies ; Humans ; Information Storage and Retrieval ; Korea ; Metabolic Diseases ; Mortality ; Prospective Studies ; Republic of Korea ; Risk Factors ; Siblings ; Telephone ; Ultrasonography ; Urinalysis

BACKGROUND: Microalbuminuria (MA) is a predictor for diabetic nephropathy and mortality of cardiovascular disease. Diabetic nephropathy can be prevented by blood glucose and blood pressure control. Koreans have been found to have a significantly higher risk of type 2 diabetes than Caucasians, despite having normal weights. It is necessary to consider obesity status in the prevention of type 2 diabetes. This study aimed to determine the relationship between MA and hypertension according to obesity status in prediabetes.METHODS: This study was retrospectively conducted in 1,183 prediabetes, aged 30-70 years with fasting blood glucose levels of 100-125 mg/dL or hemoglobin A1c levels of 5.7–6.4% who health examinees at 16 health promotion centers from 2015 to 2016. Study subjects were classified according to obesity and hypertension. Obesity is defined as body mass index of ≥25 kg/m². Blood pressure was categorized as follows: normal blood pressure, <120/80 mmHg; prehypertension, 120–139/80–89 mmHg; and hypertension, ≥140/90 mmHg. We analyzed the relationship between MA and hypertension according to obesity using multivariable logistic regression analysis.RESULTS: While both prehypertensive and hypertensive subgroups were significantly associated with MA in the nonobese, the hypertensive subgroup was only associated with MA in the obese. In the combined effects of obesity and hypertension, prediabetes with normal weight and hypertension had the highest risk of MA (adjusted odds ratio, 6.39; 95% confidence interval, 2.90–14.10) compared to those with nonobese and normal blood pressure.CONCLUSIONS: Our findings suggest that nonobese prediabetes with hypertension would need to be more concerned about MA than do obese prediabetes with hypertension.
Albuminuria ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Diabetic Nephropathies ; Fasting ; Health Promotion ; Hypertension ; Logistic Models ; Mortality ; Obesity ; Odds Ratio ; Prediabetic State ; Prehypertension ; Retrospective Studies ; Weights and Measures

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Early detection of subclinical atherosclerosis is important for reduction of cardiovascular risk. However, the current diagnostic strategy, which focuses on traditional risk factors or the use of risk scoring, is unsatisfactory. Arterial walls thicken and stiffen with age, a process known as arteriosclerosis. There is a close interaction between arterial stiffness and atherosclerosis. Increased luminal pressure and shear stress caused by arterial stiffening result in endothelial dysfunction, accelerate the formation of atheromas, and stimulate excessive collagen production and deposition in the arterial wall. Carotid intima-media thickness (CIMT) has been shown to predict cardiovascular risk in many large studies. However, there is controversy regarding the value of CIMT for prediction of cardiovascular risk because of differences in study design, specifically with respect to CIMT measurements. Pulse wave velocity (PWV) is the most widely used measure of arterial stiffness; measurement of PWV is simple, non-invasive, and reproducible. Many clinical studies and meta-analyses have shown that PWV has predictive value in cardiovascular disease beyond traditional risk factors, both in the general population and in patients with various diseases. Brachial pressure has been a poor surrogate for aortic pressure for more than 50 years. However, recent studies have shown a closer relationship between central blood pressure and intermediate cardiovascular phenotypes or cardiovascular target organ damage, compared to the respective relationships with brachial blood pressure. Considering the non-invasiveness and ability to collect multiple types of clinical data, measurement of CIMT, PWV, and central blood pressure may be useful to identify patients at high risk for development of cardiovascular disease.
Arterial Pressure ; Arteriosclerosis ; Atherosclerosis ; Blood Pressure ; Cardiovascular Diseases ; Carotid Intima-Media Thickness ; Collagen ; Humans ; Mortality ; Phenobarbital ; Phenotype ; Plaque, Atherosclerotic ; Pulse Wave Analysis ; Risk Factors ; Vascular Stiffness

Acute myocardial infarction (AMI) is a fatal cardiovascular disease, and mortality is relatively high; therefore, integrated assessment is necessary for its management. There are several risk predictive models, but treatment trends have changed due to newly introduced medications and the universal use of percutaneous coronary intervention (PCI). The author aimed to find out predictive factors of in-hospital mortality in Korean patients with AMI. A group of 13,104 patients with AMI enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) registry were divided into two groups. One was a derivation group for evaluating mortality prediction; the other was a validation group for the application of risk prediction. In-hospital mortality was 4.2% (n=552). With hierarchical and stepwise multivariate analyses, nine factors were shown to predict in-hospital mortality for Korean patients with AMI. These were 1) being over 65 years of age, 2) high Killip class over II, 3) hyperglycemia over 180 mg/dl, 4) tachycardia over 100/min, 5) serum creatinine over 1.5 mg/dl, 6) atypical chest pain, 7) low systolic blood pressure under 90 mmHg, 8) low Thrombolysis In Myocardial Infarction (TIMI) flow (TIMI 0-II) before PCI and 9) low TIMI flow (TIMI 0-II) after PCI. The validation group showed a predictive power of 88.3%. Old age, high Killip class, hyperglycemia, tachycardia, renal dysfunction, atypical chest pain, low systolic blood pressure, and low TIMI flow are important risk factors of in-hospital mortality in Korean patients with AMI.
Blood Pressure ; Cardiovascular Diseases ; Chest Pain ; Creatinine ; Hospital Mortality* ; Humans ; Hyperglycemia ; Korea ; Mortality ; Multivariate Analysis ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Prognosis ; Risk Factors ; Tachycardia

BACKGROUND: Admission blood glucose (BG) level is a predictor of mortality in critically ill patients with various conditions. However, limited data are available regarding this relationship in critically ill patients with cardiovascular diseases according to diabetic status. METHODS: A total of 1,780 patients (595 with diabetes) who were admitted to cardiac intensive care unit (CICU) were enrolled from a single center registry. Admission BG level was defined as maximal serum glucose level within 24 hours of admission. Patients were divided by admission BG level: group 1 (< 7.8 mmol/L), group 2 (7.8–10.9 mmol/L), group 3 (11.0–16.5 mmol/L), and group 4 (≥ 16.6 mmol/L). RESULTS: A total of 105 patients died in CICU (62 non-diabetic patients [5.2%] and 43 diabetic patients [7.9%]; P = 0.105). The CICU mortality rate increased with admission BG level (1.7%, 4.8%, 10.3%, and 18.8% from group 1 to group 4, respectively; P < 0.001). On multivariable analysis, hypertension, mechanical ventilator, continuous renal replacement therapy, acute physiology and chronic health evaluation II (APACHE II) score, and admission BG level significantly influenced CICU mortality in non-diabetic patients (group 1 vs. group 3: hazard ratio [HR], 3.31; 95% confidence interval [CI], 1.47–7.44; P = 0.004; group 1 vs. group 4: HR, 6.56; 95% CI, 2.76–15.58; P < 0.001). However, in diabetic patients, continuous renal replacement therapy and APACHE II score influenced CICU mortality but not admission BG level. CONCLUSION: Admission BG level was associated with increased CICU mortality in critically ill, non-diabetic patients admitted to CICU but not in diabetic patients.
APACHE ; Blood Glucose ; Cardiovascular Diseases ; Critical Care ; Critical Illness ; Diabetes Mellitus ; Humans ; Hypertension ; Intensive Care Units ; Mortality ; Prognosis ; Renal Replacement Therapy ; Ventilators, Mechanical

The recently published 2017 American College of Cardiology (ACC)/American Heart Association (AHA)/American Academy of Physician Assistants/Association of Black Cardiologists/American College of Preventive Medicine/American Geriatrics Society/American Pharmacists Association/American Society of Hypertension (ASH)/American Society for Preventive Cardiology/National Medical Association/Preventive Cardiovascular Nurses Association (2017 ACC/AHA/ASH guideline for short) lowered the threshold for diagnosis of hypertension from 140/90 mm Hg to 130/80 mm Hg. Also, the revised guideline recommends pharmacological treatment for all hypertensive patients with either previous cardiovascular disease or 10-year atherosclerotic cardiovascular disease (ASCVD) risk greater than 10%. Since most diabetic hypertensive patients have ASCVD risk greater than 10%, the guideline recommends that all diabetics with blood pressure (BP) above 130/80 mm Hg be treated both pharmacologically and with active lifestyle modification. Although the evidence suggests that intensive lowering of BP may be beneficial in diabetic patients, there is lack of evidence that pharmacologic treatment in subjects with baseline BP below 140 mm Hg is beneficial, with some studies suggesting actual potential for harm. Also, there are data to suggest a potential risk of increased risk of cardiovascular events and mortality in subjects whose diastolic BP (DBP) was lowered to below 60 mm Hg. As such, strict BP lowering may be beneficial if the target BP could be achieved without side effects such as orthostatic hypotension and decreased renal function. Also, lowering of DBP below 60 mm Hg should be avoided. Lastly, treatment should be started in subjects with baseline BP above 140/90 mm Hg until further evidence suggests otherwise.
Blood Pressure* ; Cardiology ; Cardiovascular Diseases ; Diagnosis ; Geriatrics ; Heart ; Humans ; Hypertension ; Hypotension, Orthostatic ; Life Style ; Mortality ; Pharmacists

Objective: To quantify the burden of cardiovascular disease (CVD) deaths that attributed to metabolic disorders in population aged ≥25 years in Jiangsu province. Methods: The data we used were from the following three sources: 1) 2015 Jiangsu Chronic Disease Risk Factor and Nutrition Survey, 2) death surveillance, 3) results of the 2016 Global Burden of Disease Study, based on population attributable fractions (PAF), to analyze related parameters as mortality, years of life lost (YLL), life expectancy (LE) and premature mortality. Results: Most people died from ischemic stroke (IS) showed the standard mortality as 87.48/100 000. High SBP appeared as the major cause on CVD deaths. PAF with high cholesterol and high BMI decreased along with the increase of age while high fasting plasma glucose increased. Deaths due to ischemic heart diseases, IS or hemorrhagic stroke that attributed to metabolism disorders would reduce the LE by 1.08, 1.07 or 0.55 years, respectively. Males appeared to have higher YLL than females and were more likely to die from premature CVD, as the consequence of having metabolism disorders. Conclusions: Blood pressure control should be considered an important approach to reduce the burden of CVD. According to the characteristics of gender-related risks and the distinct impact of age-related metabolism disorders on different CVD diseases, stratified strategies should be strengthened for comprehensive prevention and control of CVD, in Jiangsu province.
Adult ; Blood Pressure ; Cardiovascular Diseases/epidemiology* ; Chronic Disease ; Cost of Illness ; Female ; Humans ; Life Expectancy ; Male ; Metabolic Diseases/epidemiology* ; Mortality/trends* ; Mortality, Premature ; Risk Factors