Plasma renin and risk of cardiovascular disease and mortality: the Framingham Heart Study.

AIMS: Previous studies relating plasma renin to cardiovascular disease (CVD) and mortality yielded conflicting results. We related plasma renin to incidence of CVD and mortality in 3408 individuals (mean age 59; 53% women) and in a hypertensive subset (n = 1413). METHODS AND RESULTS: On follow-up (mean 7.1 years), 176 participants (122 hypertensives) developed CVD and 215 individuals (127 hypertensives) died. Overall, log-renin was associated with mortality [multivariable-adjusted hazards ratio (HR) per SD increment: in whole sample, 1.14, 95% confidence interval (CI) 1.00-1.30, P = 0.046; hypertensives, 1.16, 95% CI 1.00-1.35, P = 0.046], but relations varied over time (P < 0.02). Log-renin was associated with mortality at 2.5 years of follow-up (HR per SD increment: whole sample at 2.5 years, 1.23, 95% CI 1.04-1.45; hypertensives at 2 years, 1.28, 95% CI 1.06-1.54), but not during longer follow-up (HR per SD increment at 5 years: whole sample, 1.02, 95% CI 0.80-1.29; hypertensives, 0.98, 95% CI 0.74-1.30). The time-dependent relation of renin and mortality risk was maintained upon excluding participants with prevalent CVD. Renin was not associated with CVD incidence (HR per SD increment log-renin: whole sample, 0.99, 95% CI 0.85-1.14; hypertensives, 0.96, 95% CI 0.82-1.12). CONCLUSION: Higher plasma renin was associated with greater short-term mortality but not with CVD incidence in the community.     

空腹血糖受损及高血压对心脑血管病的影响

目的:探讨空腹血糖受损(IFG)以及IFG合并高血压与心脑血管疾病的关系。方法:于2016年3月至4月,采用横断面的调查方法,获取苏州市高新区非糖尿病居民8 568人,收集其人口统计学、疾病史、生活方式资料,并进行体格及实验室生化检查。采用非条件Logistic回归模型分析IFG及IFG合并高血压与心脑血管疾病的关系。结果:8 568个研究对象中,心脑血管疾病患者280例(患病率3.27%,标化患病率为2.65%),其中冠心病175例(患病率2.04%,标化患病率为1.68%),脑卒中122例(患病率1.42%,标化患病率为1.14%)。多因素调整后,分层分析结果显示,不论在高血压(OR=1.52,95%CI:1.06~2.19)还是非高血压人群(OR=2.00,95%CI:1.05~3.82)中,IFG与心脑血管疾病的关系,均差异有统计学意义;与血糖及血压均正常者相比,IFG、高血压、IFG合并高血压与心脑血管疾病经调整后分别为(OR=2.17,95%CI:1.14~4.12;OR=2.52,95%CI:1.83~3.48;OR=3.77,95%CI:2.46~5.77)。结论:IFG是心脑血管疾病的独立危险因素,IFG合并高血压能增加心脑血管疾病的患病风险。     

Apolipoprotein E genotype and cardiovascular disease in the Framingham Heart Study

Background: Apolipoprotein (apo) E is a constituent of lipoproteins with considerable variation due to cysteine-arginine exchanges. The apo E4 (Arg112-Cys) polymorphism has been associated with dementia and hypercholesterolemia. We investigated the relation of APOE genotype to cardiovascular disease (CVD) in the Framingham Offspring Study. Methods and results: DNA was isolated from 3413 study participants and APOE genotypes were determined utilizing the polymerase chain reaction and restriction isotyping. In the entire group of subjects, 20.7% had apo E4/4 or E3/4 (Group E4); 14.1% had apo E2/2 or E2/3 (Group E2) and 63.9% had the apo E3/3 genotype (Group E3). Subjects with E2/4 (1.3%) were excluded. Period prevalence of CVD between examinations 1 and 5 (1971-1994) (366 events) was related to APOE genotype. Age adjusted period prevalence of CVD in men was 18.6% for Group E4, 18.2% for Group E2 and 12.7% for Group E3 (P=0.004); while in women these rates were 9.9, 4.9, and 6.6%, respectively (P=0.037). After adjustment for non-lipid risk factors the relative odds for CVD in Group E2 men was 1.79 (P=0.0098) and in Group E4 it was 1.63 (P=0.0086) compared with the Group E3; while in Group E4 women it was 1.56 (P=0.054). After adjustment for all CVD risk factors, the relative odds in Group E2 men was 1.94 (P=0.004) and in Group E4 men it was 1.51 (P=0.0262). Conclusions: The presence of the apo E2 or apo E4 alleles in men is associated with significantly greater CVD risk. This genotypic information may help to identify individuals at increased risk for CVD events.     

Heart rate and cardiovascular mortality: the Framingham Study

The relation of resting heart rate on biennial ECG examinations to mortality rates over 30 years of follow-up of the Framingham cohort was examined based on 1876 total deaths and 894 cardiovascular deaths, evolving out of 5070 subjects free of cardiovascular disease at entry into the study. In both sexes, at all ages, all-cause, cardiovascular, and coronary mortality rates increased progressively in relation to antecedent heart rates determined biennially. A more impressive association to cardiovascular disease was observed in men than in women, which was independent of associated cardiovascular risk factors. Case fatality rates following coronary events also increased with antecedent heart rate and the fraction of coronary deaths as sudden death increased strikingly with heart rate in men 35 to 64 years of age. There was also a substantial excess of noncardiovascular deaths at high heart rates, and the proportion of all deaths resulting from cardiovascular disease did not increase with heart rate. The excess cardiovascular deaths with more rapid heart rates were also noted, excluding those with interim overt cardiovascular disease, suggesting an effect independent of preexisting cardiac damage.     

空腹血糖受损新标准对其患病率和缺血性心血管病发病危险的影响

目的评价2003年美国糖尿病协会新的空腹血糖受损标准对中国35～64岁人群空腹血糖受损率的影响以及与缺血性心血管病发病危险的关系。方法以中国多省市前瞻性队列研究的数据为基础,对30378人基线血糖水平的分布特点以及10年随访期间发生的缺血性心血管病（包括冠心病和缺血性脑卒中）事件关系进行分析。结果（1）依据新的空腹血糖受损的标准,我国35～64岁人群空腹血糖受损率从6．9％上升到21．6％,增加了2.1倍;（2）按基线血糖水平分为4个亚组,随着血糖水平的升高,其他传统心血管病危险因素的比例增加;（3）缺血性心血管病人年发病率和血糖单因素分析显示,随着血糖水平的增加男女两性缺血性心血管病发病危险增加,并达到统计学意义;（4）多因素分析显示,在调整了其他传统的心血管病危险因素后,空腹血糖受损新的标准（由6．11mmol／L降为〈5．55mmol／L）对男性缺血性心血管病有独立的影响作用（RR=1．302,95％CI=1．021～1．660）;对女性缺血性心血管病发病危险缺乏独立的影响作用（RR=1．255,95％CI=0．887～1．776）。结论依据新标准中国35～64岁人群空腹血糖受损率增加了2倍以上。随着血糖水平的增加伴有其他传统的危险因素的比例及缺血性心血管病的人年发病率增加,多因素分析后空腹血糖受损新切点增加男性缺血性心血管病发病的危险。     

我国中年人群糖尿病和空腹血糖异常对心血管病发病的预测价值

目的 采用前瞻性研究分析糖尿病在我国中年人群中是否心血管病发病的独立危险因素。方法 中国和美国心血管病和心肺疾病流行病学合作研究1983—1984年在北京和广州工农人群(35—54岁)中用国际标准化的方法进行了心血管病危险因素基线调查。对10076人的队列按照统一的方案每2年随访一轮到1997年底，根据美国糖尿病协会空腹血糖的分类标准对于基线血糖水平进行分层，用Cox回归调整年龄和调整相关因素后，计算糖尿病和空腹血糖异常对于冠心病和脑卒中发病的相对危险。结果 在除外基线时有心肌梗死和脑卒中史资料完整的9111人中，按照世界卫生组织MONICA方案的诊断标准，共计发生冠心病事件72例，脑卒中事件259例。心血管病的其他危险因素在空腹血糖异常组和糖尿病组高于正常组。经年龄调整和多因素调整后，糖尿病对冠心病和脑卒中发病的相对危险在女性(3．78和4．20)和性别合并组(3．22和2．50)显著高于血糖正常组，男性未达到统计学显著水平，空腹血糖异常组未见相对危险的增高。糖尿病对于冠心病和脑卒中发病的相对危险度仅低于高血压而高于血清总胆固醇和吸烟。结论 在我国中年人群中糖尿病是冠心病和脑卒中发病的重要危险因素之一。     

Chronic kidney disease as a predictor of cardiovascular disease (from the Framingham Heart Study)

Chronic kidney disease (CKD) is a risk factor for cardiovascular disease (CVD), although shared risk factors may mediate much of the association. CKD and CVD were related in the setting of specific CVD risk factors, and whether more advanced CKD was a CVD risk equivalent was determined. The Framingham Heart Study original cohort (n = 2,471, mean age 68 years, 58.9% women) was studied. Glomerular filtration rate was estimated (eGFR) using the simplified Modification of Diet in Renal Disease Study equation. CKD was defined as eGFR <59 (women) and <64 ml/min/1.73 m(2) (men), and stage 3b CKD was defined as eGFR of 30 to 44 (women) and 30 to 50 ml/min/1.73 m(2) (men). Cox proportional hazard models adjusting for CVD risk factors were used to relate CKD to CVD. Effect modification by CVD risk factors was tested for. Overall, 23.2% of the study sample had CKD (n = 574, mean eGFR 50 ml/min/1.73 m(2)) and 5.3% had stage 3b CKD (n = 131, mean eGFR 42 ml/min/1.73 m(2)). In multivariable models (mean follow-up 16 years), stage 3 CKD was marginally associated with CVD (hazard ratio [HR] 1.17, 95% confidence interval [CI] 0.99 to 1.38, p = 0.06), whereas stage 3b CKD was associated with CVD (HR 1.41, 95% CI 1.05 to 1.91, p = 0.02). Testing CVD risk equivalency, the risk of CVD for stage 3b CKD in subjects with previous CVD was significantly lower compared with subjects with previous CVD and no stage 3b CKD (age- and sex-adjusted HR for CVD 0.66, 95% CI 0.47 to 0.91, p = 0.01). Low high-density lipoprotein cholesterol modified the association between CKD and CVD (p = 0.004 for interaction). Stage 3b CKD was associated with CVD, but was not a CVD risk equivalent. In conclusion, CVD risk in the setting of CKD is higher in the setting of low high-density lipoprotein cholesterol.     

Impact of impaired fasting glucose and impaired glucose tolerance on arterial stiffness in an older Chinese population: the Guangzhou Biobank Cohort Study-CVD

The aim of the study was to compare the impact of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) on vascular function among older Chinese people. A random sample of 671 men and 603 women aged 50 to 85 years without known diabetes from the Guangzhou Biobank Study-CVD was examined in a cross-sectional study. Subjects with no previously confirmed or treated diabetes but with both fasting plasma glucose less than 5.6 mmol/L and 2-hour glucose from 7.8 to less than 11.0 mmol/L were classified as having isolated IGT, and those with no previously confirmed and treated diabetes but with both fasting plasma glucose from 5.6 to less than 7.0 mmol/L and 2-hour glucose less than 7.8 mmol/L were classified as having isolated IFG. A total of 11.0% of the men and 8.6% of the women had isolated IFG, and 17.7% of the men and 18.6% of the women had isolated IGT. The brachial-ankle pulse wave velocity and pulse pressure were increased in both the isolated IFG and isolated IGT subjects compared with the normoglycemia group (both Ps < .001). Compared with subjects with isolated IFG, those with isolated IGT appeared to have a higher age- and sex-adjusted brachial-ankle pulse wave velocity (1543 ± 22 vs 1566 ± 17, P = .07) and to be more insulin resistant (2-hour postload insulin: 54.2 ± 2.13 vs 26.8 ± 2.99 μU/mL, P < .001), had a worse lipid profile (apolipoprotein [apo] B: 1.07 ± 0.02 vs 0.97 ± 0.02g/L, P < .001; apo B/apo A-1 ratio: 0.80 ± 0.02 vs 0.69 ± 0.02, P < .001), but had lower glycosylated hemoglobin levels (6.03% ± 0.06% vs 5.86% ± 0.04%, P < .001) (values are mean ± SE). Subjects with isolated IGT had greater arterial stiffness, probably as a result of being more insulin resistant, with a worse lipid profile than those with isolated IFG. The sole use of fasting glucose level to identify prediabetic people would fail to identify a significant proportion of the at-risk population.     

Impaired fasting glycaemia resembles impaired glucose tolerance with regard to cardiovascular risk factors: population-based, cross-sectional study of risk factors for cardiovascular disease.

AIMS: To compare subjects with impaired glucose tolerance and impaired fasting glucose in relation to risk factors for developing cardiovascular disease. METHODS: A total of 1374 patients (678 female, 696 male) listed with a general practice clinic in Denmark were given an oral glucose tolerance test, a physical examination, and a self-administered questionnaire. Risk factors for cardiovascular disease were assessed for 90 participants (48 female, 42 male) with impaired glucose tolerance (including 12 subjects (1 female and 11 male), who also fulfilled criteria for impaired fasting glycaemia) and 51 subjects (20 female, 31 male) with impaired fasting glycaemia (World Health Organization 1999 criteria). RESULTS: There were no statistical differences with regard to known risk factors for cardiovascular disease between participants with isolated impaired fasting glycaemia and those with impaired glucose tolerance. CONCLUSIONS: We found noticeable similarities in the cardiovascular risk factor profile in subjects with impaired fasting glycaemia and in subjects with impaired glucose tolerance in our population. When planning screening initiatives, it seems relevant to take into account people with impaired fasting glycaemia as well as those with impaired glucose tolerance.     

老年空腹血糖受损62例进展研究

目的分析老年空腹血糖受损者(IFG)8年间进展情况。方法于2002年5～6月对我区离退休老干部中IFG行口服75g葡萄糖试验(OGTT),选取单纯空腹血糖受损者(I-IFG)62例,依据2003年美国糖尿病学会IFG诊断标准,将空腹血糖(FPG)为5.6～6.09mmol/L的受损者分为新增IFG组(A组),空腹血糖为6.1～6.99mmol/L的受损者分为原IFG组(B组),定期随访8年。结果基线时2组IFG者的血压、血脂、体质量指数(BMI)等临床指标差异均无统计学意义(P>0.05)。至随访结束时,A组进展为糖尿病(DM)的比率为20.59%,B组IFG进展为DM的比率为46.43%,是A组的2.25倍,差异有统计学意义(P<0.05);2组IFG逆转为糖耐量正常(NGT)、仍保持I-IFG以及进展为空腹血糖受损合并糖耐量受损(IFG/IGT)者的比率差异均无统计学意义(P>0.05)。全部IFG进展为DM的比率是32.25%,逆转为NGT的比率是14.52%,仍维持在I-IFG或IFG/IGT状态的比率是53.23%。结论 IFG诊断标准下调后,IFG患病率明显上升,但新增IFG进展为DM的风险明显低于原IFG。     

Peri-aortic fat,cardiovascular disease risk factors,and aortic calcification: The Framingham Heart Study

ObjectivePerivascular fat through the secretion of paracrine and pro-inflammatory mediators may play a role in obesity-mediated vascular disease. We sought to examine associations between adipose tissue depots immediately surrounding the thoracic aorta, metabolic risk factors, and vascular calcification.MethodsIn participants free of cardiovascular disease (CVD) from the Framingham Heart Study Offspring cohort who underwent computed tomography (n = 1067, mean age 59 years, 56.1% women), thoracic peri-aortic fat depots were quantified. Visceral abdominal tissue (VAT) and calcification of the thoracic and abdominal aorta were also measured.ResultsPeri-aortic fat depots were correlated with body mass index, waist circumference (WC), VAT (all p < 0.0001), hypertension (p = 0.007), low HDL (p < 0.0001), serum triglycerides (p < 0.0001), impaired fasting glucose (p = 0.005), and diabetes (p = 0.02). These associations generally remained significant after adjustment for BMI and WC (all p-values < 0.05), but not after VAT adjustment. Thoracic aortic fat was associated with thoracic calcification in models containing VAT (OR 1.31, 95% CI 1.01–1.71, p = 0.04), but was not significant after adjustment for CVD risk factors (OR 1.16, 95% CI 0.88–1.51, p = 0.30). Thoracic aortic fat, however, was associated with abdominal aortic calcification (OR 1.48, 95% CI 1.11–1.98, p = 0.008) and coronary artery calcification (OR 1.47, 95% CI 1.09–1.98, p = 0.001) even in models including CVD risk factors and VAT.ConclusionsThoracic peri-aortic fat is associated with measures of adiposity, metabolic risk factors, and coronary and abdominal aortic calcification.