Abdominal Obesity and Its Attribution to All-cause Mortality in the General Population with 14 Years Follow-up: Findings from Shanxi Cohort in China

Objective This study aimed to assess the association of waist circumference(WC) with all-cause mortality among Chinese adults.Methods The baseline data were from Shanxi Province of 2002 China Nutrition and Health Survey. The death investigation and follow-up visit were conducted from December 2015 to March 2016. The visits covered up to 5,360 of 7,007 participants, representing a response rate of 76.5%. The Cox regression model and floating absolute risk were used to estimate hazard ratio and 95% floating CI of death by gender and age groups(≥ 60 and 60 years old). Sensitivity analysis was performed by excluding current smokers; participants with stroke, hypertension, and diabetes; participants who accidentally died; and participants who died during the first 2 years of follow-up.Results This study followed 67,129 person-years for 12.5 years on average, including 615 deaths. The mortality density was 916 per 100,000 person-years. Low WC was associated with all-cause mortality among men. Multifactor-adjusted hazard ratios(HR) were 1.60(1.35–1.90) for WC 75.0 cm and 1.40(1.11–1.76) for WC ranging from 75.0 cm to 79.9 cm. Low WC( 70.0 cm and 70.0–74.9 cm) and high WC(≥ 95.0 cm) groups had a high risk of mortality among women. The adjusted HRs of death were 1.43(1.11–1.83), 1.39(1.05–1.84), and 1.91(1.13–3.22).Conclusion WC was an important predictor of death independent of body mass index(BMI). WC should be used as a simple rapid screening and predictive indicator of the risk of death.     

The utility of coagulation activity for prediction of risk of mortality and cardiovascular events in guideline-treated myocardial infarction patients

Background: Despite improved treatment of myocardial infarction (MI), real-world patients still suffer substantial risk for subsequent cardiovascular events. Little is known about coagulation activity shortly after MI and whether coagulation activity markers may identify patients at increased risk despite contemporary treatment.

Objective: To evaluate D-dimer concentration and thrombin generation potential shortly after discharge after MI and evaluate if these markers could predict the risk of future cardiovascular and bleeding events.

Methods: Unselected MI patients (n?=?421) were included in the observational REBUS study (NCT01102933) and followed for two years. D-dimer concentrations, thrombin peak, and endogenous thrombin potential (ETP) were analyzed at inclusion (3–5 days after MI) and at early follow-up (after 2–3 weeks).

Results: Seventy-five patients (17.8%) experienced the composite endpoint (all-cause death, MI, congestive heart failure, or all-cause stroke), and 31 patients (7.4%) experienced a clinically relevant bleeding event. D-dimer concentrations at early follow-up were associated with the composite endpoint (HR [per SD increase] 1.51 [95% CI 1.22–1.87]) and with clinically relevant bleeding (HR [per SD increase] 1.80 [95% CI 1.32–2.44]). Thrombin generation potential was not significantly associated with either the composite endpoint or with clinically relevant bleeding. Higher thrombin peak and ETP at early follow-up were both inversely associated with stroke (HR [per SD increase] 0.50 [95% CI 0.30–0.81] and 0.43 [95% CI 0.22–0.83], respectively).

Conclusion: In unselected MI patients treated according to contemporary guidelines, D-dimer measurements may identify patients at increased risk of new cardiovascular and bleeding events. The inverse association of thrombin generation potential and risk of stroke has to be further investigated.     

Prediction of Abdominal Visceral Obesity From Body Mass Index, Waist Circumference and Waist-hip Ratio in Chinese Adults： Receiver Operating Characteristic Curves Analysis

Objective To evaluate the sensitivity and specificity of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) measurements in diagnosing abdominal visceral obesity. Methods BMI, WC, and WHR were assessed in 690 Chinese adults (305 men and 385 women) and compared with magnetic resonance imaging (MRI) measurements of abdominal visceral adipose tissue (VA). Receiver operating characteristic (ROC) curves were generated and used to determine the threshold point for each anthropometric parameter. Results 1) MRI showed that 61.7% of overweight/obese individuals (BMI≥25 kg/m2) and 14.2% of normal weight (BMI<25 kg/m2) individuals had abdominal visceral obesity (VA≥100 cm2). 2) VA was positively correlated with each anthropometric variable, of which WC showed the highest correlation (r=0.73-0.77, P<0.001). 3) The best cut-off points for assessing abdominal visceral obesity were as followed: BMI of 26 kg/m2, WC of 90 cm, and WHR of 0.93, with WC being the most sensitive and specific fact     

BMI,WC, WHtR,VFI and BFI: Which Indictor is the Most Efficient Screening Index on Type 2 Diabetes in Chinese Community Population

ObjectiveObesity is a major risk factor for type 2 diabetes, many indexes can be used to describes obesity and predict diabetes. This research attempts to identify the best indicator of obesity to screening diabetes in Chinese population.MethodsA cross-sectional data of 8121 subjects aged 35–60 years were included in this research belongs to the Diabetes Appropriate Technology Intervention Study. Anthropometric indicators including body weight, height, waist circumferences (WC), body fat index (BFI) and visceral fat index (VFI) and blood biochemical indicators after an overnight fast [fasting blood glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, and triacylglycerol] were measured. BMI (body mass index) and Weight to Height Ratio was calculated.ResultsSubjects with obesity had a higher risk of physician diagnosed diabetes (OR=2.50, 95% CI 1.83–3.43), new diagnosed diabetes (OR=4.23, 95% CI 2.91–6.15) and pre-diabetes (OR=1.75, 95% CI 1.31–2.34) compared to those with normal Body mass index (BMI). There was a significant trend of increased risk of all diabetes status with increased waist circumference (WC). The waist-to-height ratio (WHtR) yielded the most significant association with new diagnosed diabetes and physician diagnosed diabetes than other indices.ConclusionCentral obesity is significantly correlated with diabetes. VFI was most correlated with pre-diabetes while WHtR is an efficient screening index than BMI and WC in Chinese community diabetes screening.     

Growth differentiation factor 15 in a community-based sample: age-dependent reference limits and prognostic impact

Background: Despite the growing body of evidence on growth differentiation factor 15 (GDF-15) reference values for patients with existing cardiovascular disease, limited investigation has been dedicated to characterizing the distribution and prognostic impact of GDF-15 in predominantly healthy populations. Furthermore, current cutoff values for GDF-15 fail to account for the well-documented age-dependence of circulating GDF-15.

Methods: From 810 community-dwelling older adults, we selected a group of apparently healthy participants (n?=?268). From this sample, circulating GDF-15 was modeled using the generalized additive models for location scale and shape (GAMLSS) to develop age-dependent centile values. Unadjusted and adjusted Cox proportional hazards models were used to assess the association between the derived GDF-15 reference values (expressed as centiles) and all-cause mortality.

Results: Smoothed centile curves showed increasing GDF-15 with age in the apparently healthy participants. An approximately three-fold difference was observed between the 95th and 5th GDF-15 centiles across ages. In a median 8.0 years of follow-up, 97 all-cause deaths were observed in 806 participants with eligible values. In unadjusted Cox regression analyses, the hazard ratio (95% CI) for all-cause mortality per 25-unit increase in GDF-15 centile was 1.80 (1.48–2.20) and dichotomized at the 95th centile, ≥95th versus <95th, was 3.04 (1.99–4.65). Age-dependent GDF-15 centiles remained a significant predictor of all-cause mortality in all subsequent adjusted models.

Conclusions: Age-dependent GDF-15 centile values developed from a population of apparently healthy older adults are independently predictive of all-cause mortality. Therefore, GDF-15 reference values could be a useful tool for risk-stratification in a clinical setting.

ClinicalTrials.gov Identifier: NCT01452178.     

BMI and BMI Changes to All-cause Mortality among the Elderly in Beijing: a 20-year Cohort Study

Objective To explore the association between body mass index (BMI) and all-cause mortality among the elderly in Beijing. Methods This analysis was based on the Beijing multidimensional longitudinal study of aging (BLSA), which included 2,090 subjects over 55 years old and was followed-up from 1992 to 2012. BMI-mortality curves were drawn to find the optimal BMI range with the lowest mortality. Cox proportional hazard models were used to obtain the hazard ratios (HRs) for BMI and BMI changes in the overall population and in specific stratified populations. Results During follow-up, 1,164 deaths were recorded; BMI-mortality curve was U-shaped, with the lowest mortality at a BMI of approximately 25 kg/m2. After adjusting for gender, age, smoking, drinking and some pre-existing diseases, HRs for underweight, overweight and obesity compared with normal weight were 1.372 (95% CI: 1.154-1.631), 0.767 (95% CI: 0.666-0.884) and 0.871 (95% CI: 0.830-1.246), respectively. HR for BMI drop was 3.245 (95% CI: 0.824-12.772) in the underweight group and 1.892 (95% CI: 0.830-1.246) in the normal weight group, HR for BMI rise was 1.795 (95% CI: 1.243-2.591) in normal weight group and 1.962 (95% CI: 1.202-3.203) in the overweight group. Conclusion Keeping BMI in an overweight status and stable is related to a reduced mortality.     

Positive association between hypertension and urinary bladder cancer: epidemiologic evidence involving 79,236 propensity score-matched individuals

Introduction: We hypothesized that hypertensive patients harbor a higher risk of urinary bladder (UB) cancer.

Material and methods: We performed a population-based cohort study on adults using a National Health Insurance Research Database (NHIRD) dataset. Hypertension and comparison non-hypertensive (COMP) groups comprising 39,618 patients each were propensity score-matched by age, sex, index date, and medical comorbidities. The outcome was incident UB cancer validated using procedure codes. We constructed multivariable Cox models to derive adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Cumulative incidence was compared using a log-rank test.

Results: During a total follow-up duration of 380,525 and 372,020 person-years in the hypertension and COMP groups, 248 and 186 patients developed UB cancer, respectively, representing a 32% increase in the risk (aHR, 1.32; 95% CI, 1.09–1.60). Hypertensive women harbored a significantly increased risk of UB cancer (aHR, 1.55; 95% CI, 1.12–2.13) compared with non-hypertensive women, whereas men with hypertension had a statistically non-significant increased risk (aHR, 1.22; 95% CI, 0.96–1.55). The sensitivity analysis demonstrated that the increased risk was sustained throughout different follow-up durations for the entire cohort; a statistical increase in the risk was also noted among hypertensive men.

Conclusion: This nationwide population-based propensity score-matched cohort study supports a positive association between hypertension and subsequent UB cancer development.     

Atrial fibrillation in patients undergoing coronary artery surgery is associated with adverse outcome

Abstract

Background: The aim was to determine the association between atrial fibrillation (AF) and outcome in patients undergoing coronary artery bypass grafting (CABG).

Methods: All patients undergoing CABG between January 2010 and June 2013 were identified in the Swedish Heart Surgery Registry. Outcomes studied were all-cause mortality, cardiovascular mortality, myocardial infarction, congestive heart failure, ischemic stroke, and recurrent AF. Patients with history of AF prior to surgery (preoperative AF) and patients without history of AF but with AF episodes post-surgery (postoperative AF) were compared to patients with no AF using adjusted Cox regression models.

Results: Among 9,107 identified patients, 8.1% (n?=?737) had preoperative AF, and 25.1% (n?=?2,290) had postoperative AF. Median follow-up was 2.2?years. Compared to no AF, preoperative AF was associated with higher risk of all-cause mortality, adjusted hazard ratio with 95% confidence interval (HR) 1.76 (1.33–2.33); cardiovascular mortality, HR 2.43 (1.68–3.50); and congestive heart failure, HR 2.21 (1.72–2.84). Postoperative AF was associated with risk of all-cause mortality, HR 1.27 (1.01–1.60); cardiovascular mortality, HR 1.52 (1.10–2.11); congestive heart failure, HR 1.47 (1.18–1.83); and recurrent AF, HR 4.38 (2.46–7.78). No significant association was observed between pre- or postoperative AF and risk for myocardial infarction and ischemic stroke.

Conclusions: Approximately 1 in 3 patients undergoing CABG had pre- or postoperative AF. Patients with pre- or postoperative AF were at higher risk of all-cause mortality, cardiovascular mortality, and congestive heart failure, but not of myocardial infarction or ischemic stroke. Postoperative AF was associated with higher risk of recurrent AF.     

药物洗脱支架与金属裸支架置入术后对糖尿病患者远期死亡、心肌梗死和支架血栓发生情况的影响

目的本研究通过比较糖尿病患者置入金属裸支架(bare metal stents,BMS)vs药物洗脱支架(drug eluting stents,DES)后发生死亡、心肌梗死(myocardial infarction,MI)、再次血运重建和支架血栓的情况,以评价糖尿病患者置入DES后的远期安全性和有效性。方法本研究于2003年7月～2005年12月连续入选了834例因冠心病合并糖尿病在首都医科大学附属北京安贞医院心内科行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的患者,按置入支架类型将患者分为DES组(n=583)和BMS组(n=251)。主要终点事件为24个月时全因病死率;次要终点事件为24个月时非致死性MI、再次血运重建以及主要不良心血管事件(major adverse cardiac events,MACE)的发生率。结果本研究结果经多因素回归分析显示,DES组明显降低了24个月时死亡[3.2%vs 5.1%,危险比(hazard ratio,HR)0.34,95%可信区间(confidential interval,CI)0.12～0.94,P=0.038]和心性死亡的风险(2.2%vs 4.4%,HR=0.29,95%CI:0.13～0.87,P=0.027),非致死性MI和心性死亡与非致死性MI复合终点发生风险比较差异无统计学意义;明确和可能的支架血栓的发生风险比较差异也没有统计学意义(1.9%vs 2.0%,HR=0.96,95%CI:0.51～2.17,P=0.351)。DES明显降低了再次血运重建的风险(10.5%vs 20.7%,HR=0.24,95%CI:0.11～0.78,P<0.001)和靶血管再次血运重建的风险(8.9%vs 17.1%,HR=0.33,95%CI:0.16～0.87,P<0.001);与BMS组比较DES组的MACE的风险也明显降低,差异有统计学意义(15.8%vs 27.9%,HR=0.19,95%CI:0.09～0.85,P<0.001);其主要与DES组患者的死亡和靶血管再次血运重建的风险降低有关。结论与BMS相比,DES可显著降低糖尿病患者的24个月时死亡、再次血运重建和MACE的风险,而未增加非致死性MI和支架血栓的风险。置入DES后死亡风险的降低原因,主要与DES降低再狭窄后的死亡和MI风险,获得更高的完全血运重建率以及未增加支架血栓的风险相关。     

Changes of arterial pressure following relief of obstruction in adults with hydronephrosis

Abstract

Background: As much as 20% of all cases of hypertension are associated with kidney malfunctions. We have previously demonstrated in animals and in pediatric patients that hydronephrosis causes hypertension, which was attenuated by surgical relief of the ureteropelvic junction (UPJ) obstruction. This retrospective cohort study aimed to investigate: (1) the proposed link between hydronephrosis, due to UPJ obstruction, and elevated arterial pressure in adults; and (2) if elevated blood pressure in patients with hydronephrosis might be another indication for surgery.

Materials and methods: Medical records of 212 patients undergoing surgical management of hydronephrosis, due to UPJ obstruction, between 2000 and 2016 were assessed. After excluding patients with confounding conditions and treatments, paired arterial pressures (i.e. before/after surgery) were compared in 49 patients (35 years old; 95% CI 29–39). Split renal function was evaluated by using mercaptoacetyltriglycine (MAG3) renography before surgical management of the hydronephrotic kidney.

Results: Systolic (?11?mmHg; 95% CI 6–15?mmHg), diastolic (?8?mmHg; 95% CI 4–11?mmHg), and mean arterial (-9?mmHg; 95% CI 6–12) pressures were significantly reduced after relief of the obstruction (p?<?0.001). Split renal function of the hydronephrotic kidney was 39% (95% CI 37–41). No correlations were found between MAG3 and blood pressure level before surgery or between MAG3 and the reduction of blood pressure after surgical management of the UPJ obstruction.

Conclusions: In adults with hydronephrosis, blood pressure was reduced following relief of the obstruction. Our findings suggest that elevated arterial pressure should be taken into account as an indication to surgically correct hydronephrosis.     

体质量指数与急性ST段抬高型心肌梗死患者预后的相关性研究

目的 探讨体质量指数(BMI)对急性ST段抬高型心肌梗死(STEMI)患者预后的影响.方法 回顾性收集该院2014年收治的STEMI住院患者的临床资料,将患者根据BMI分为4组:低体质量组(n=31)、正常体质量组(n=139)、超重组(n=71)和肥胖组(n=26),对比分析4组患者的临床基线资料,并随访心肌梗死后7d和年内的全因死亡率.结果 BMI越高患者发病年龄越轻(P＜0.01),女性所占比例越小(P =0.001),其中肥胖组患者的清蛋白水平、血红蛋白水平均相对较高(P=0.004;P=0.006);心肌梗死后1年的全因死亡率随着BMI升高而明显降低(P=0.003),心肌梗死后7d的全因死亡率差异无统计学意义(P=0.287).结论 BMI与STEMI患者的远期预后相关,“肥胖矛盾”现象在STEMI患者中是存在的,但应结合患者年龄、性别、并发症和药物治疗等多个因素综合评估BMI对STEMI患者预后的影响.     

体质指数与血管重建的冠心病心力衰竭患者预后的关系

目的 了解体质指数(BMI)对接受血管重建治疗的冠心病心力衰竭(心衰)患者预后的影响.方法 药物洗脱支架对血运重建策略影响研究(单中心回顾性注册研究)入选2004年7月1日至2005年9月30日在北京安贞医院接受血管重建治疗的3632例患者,2006年9月1日对患者进行随访.本研究入选其中有体质指数(BMI)资料的慢性心衰患者1010例.将患者按BMI分为3组:BMI<24(正常组),BMI 24～27.9(超重组)和BMI≥28(肥胖组),比较不同组别之间的临床和预后情况.不良心脑血管事件(MACCE)包括全因死亡、非致死性心肌梗死、非致死性卒中和再次血管重建.结果 正常组295例,超重组495例,肥胖组220例.随访中位时间为542 d,超重和肥胖患者较年轻[(59.3±10.1)岁、(58.6±10.3)岁比(62.6.4±9.9)岁,P<0.01],高血压病史(61.2,66.8%比52.5%,P=0.017)和稳定型心绞痛(21.2%,23.7%比17.0%,P=0.005)比例高,甘油三酯[(1.90±1.05)mmol/L,(2.10±1.12)mmol/L比(1.48±0.92)mmol/L,P<0.01)]、空腹血糖[(6.07±2.09)mmol/L,(5.96±1.53)mmol/L比(5.67±1.92)mmol/L,P=0.021]和肌酐[(84.9±21.7)μmol/L,(90.2±30.9)μmol/L比(82.2±25.8)μmol/L]水平高(P均<0.05).与正常体重的患者相比,在调整了其他因素后,超重组的全因死亡风险(HR 0.769,95%CI 0.442～1.338)和MACCE(HR 0.998,95% CI 0.754～1.322)并未增加,而肥胖组全因死亡(HR 0.285,95%CI 0.104～0.777)和MACCE(HR 0.596,95% CI 0.401～0.885)风险降低.BMI对心性死亡无显著影响.结论 在进行血管重建的冠心病心衰患者中,尽管超重和肥胖者相对体重正常者有更多的危险因素,但是接受血管重建治疗后的预后不比体重正常者差.     

血清microRNA-155、microRNA-21、趋化素、瘦素与糖尿病肥胖患者胰岛素抵抗的相关性

目的 探讨糖尿病肥胖患者血清microRNA-155(miR-155)、microRNA-21(miR-21)、趋化素、瘦素水平与胰岛素抵抗（IR）的相关性。方法 选取2022年1月—2023年4月山东中医药大学第二附属医院收治的138例2型糖尿病（T2DM）患者为研究对象,其中肥胖患者73例（肥胖组）,非肥胖患者65例（非肥胖组）。肥胖组中有IR 45例（IR组）,无IR 28例（非IR组）。收集患者一般资料,包括性别、体质量指数（BMI）、年龄、颈围（NC）、腰围（WC）、空腹血糖（FPG）、甘油三酯（TG）、空腹胰岛素（FINS）、高密度脂蛋白胆固醇（HDL-C）、miR-155、miR-21、趋化素、瘦素、胰岛素抵抗指数（HOMA-IR）水平;通过多因素逐步Logistic回归模型分析T2DM肥胖患者发生IR的危险因素;绘制受试者工作特征（ROC）曲线,分析miR-155、miR-21、趋化素、瘦素诊断T2DM肥胖患者IR的效能;Pearson法分析miR-155、miR-21、趋化素、瘦素与HOMA-IR的相关性。结果 肥胖组miR-155相对表达量低于非肥胖组（P <...     

Combined Effect of Smoking and Obesity on Coronary Heart Disease Mortality in Male Veterans: A 30-year Cohort Study

Objective Evidence is lacking regarding the combined effects of smoking and obesity on mortality from coronary heart disease in male veterans.This study aimed to explore the combined effect of smoking and obesity on coronary heart disease mortality in male veterans in China.Methods A cohort of 1,268 male veterans from 22 veteran centers in Xi’an(Shaanxi Province,China)were followed up once every 2 years from February 1,1987 to October 30,2016.The endpoint was death from any cause.The hazard ratio(HR)of each risk factor and the 95%confidence interval(CI)were calculated using a multivariate Cox proportional hazard model.Results The total follow-up was 24394.21 person-years;each subject was followed up for a mean duration of 19.24 years.By the end of the study,of the 1,268 veterans,889 had died,363 were alive,and 16 were lost to follow-up.Cox regression analysis results revealed that current smoking(HR:1.552,95%CI:1.074–2.243),obesity(HR:1.625,95%CI:1.024–2.581),and the combined effect of the two factors(HR:2.828,95%CI:1.520–5.262)were associated with coronary heart disease mortality.Conclusion Our results suggest that obese veterans who smoke might be an important target population for coronary heart disease mortality control.     

Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China

Background:Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.Methods:We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.Results:The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56–4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84–0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17–0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33–5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01–1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48–17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83–6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27–0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.Conclusions:Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.     

Long-term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart failure in Beijing: a multicenter cohort study with a 5-year follow-up

Background:Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.Methods:This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.Results:The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023–1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958–0.983), fatigue (HR: 1.127, 95% CI: 1.009–1.258), ascites (HR: 1.190, 95% CI: 1.057–1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140–1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291–1.769), heart rate (HR: 1.003, 95% CI: 1.001–1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993–0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008–1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220–1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223–1.690), serum sodium (HR: 0.980, 95% CI: 0.972–0.988), serum albumin (HR: 0.981, 95% CI: 0.971–0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073–1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183–1.614), diabetes (HR: 1.118, 95% CI: 1.010–1.237), stroke (HR: 1.252, 95% CI: 1.121–1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626–0.814), β-blockers (HR: 0.673, 95% CI: 0.588–0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604–0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646–0.965), spironolactone (HR: 0.814, 95% CI: 0.663–0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531–0.733), nitrates (HR: 0.715, 95% CI: 0.631–0.811), and digoxin (HR: 0.579, 95% CI: 0.465–0.721).Conclusions:The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.     

阻塞性睡眠呼吸暂停与甘油三酯葡萄糖指数的相关性

目的 探讨阻塞性睡眠呼吸暂停（OSA）与甘油三酯葡萄糖（TyG）指数的相关性。方法 选取2021年1月—2022年12月中南大学湘雅二医院行睡眠呼吸监测的270例OSA患者。根据甘油三酯和空腹血糖计算TyG指数,根据TyG指数的三分位数将患者分为Q1组、Q2组、Q3组,根据睡眠呼吸暂停低通气指数（AHI）将患者分为轻度组、中度组、重度组。采用多元线性分析评估TyG指数与AHI之间的关系,有序Logistic回归分析TyG指数与OSA严重程度之间的关系。结果 TyG指数越高的患者AHI、体质量指数（BMI）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖越高,而血清高密度脂蛋白胆固醇（HDL-C）水平则越低（P <0.05）。TyG指数越高的患者肥胖和糖尿病、冠心病比例越高,男性比例越高,年龄更低（P <0.05）。随着患者AHI的增加,TyG指数、BMI增加,TG、空腹血糖上升,最低血氧饱和度下降（P <0.05）,OSA越严重的患者肥胖、高血压和冠心病比例越高（P <0.05）。Pearson相关性分析结果显示,TyG指数与AHI水平呈正相关（r =0.282,P <0.05）。多元线性回归分析结果显示,AHI（b =0.002）、BMI（b =0.017）、TG（b =0.361）、空腹血糖（b =0.109）和性别（b =0.083）是TyG的影响因素（P <0.05）。有序Logistic模型结果显示：轻度OSA［O^R=0.396（95% CI：0.207,0.757）］和中度OSA［O^R=0.281（95% CI：0.163,0.484）］患者的TyG等级较重度OSA低,说明OSA严重程度增加是TyG指数升高的影响因素。非肥胖患者［O^R=0.424（95% CI：0.253,0.710）］、不吸烟患者［O^R=0.506（95% CI：0.283,0.904）］、非糖尿病患者［O^R=0.268（95% CI：0.156,0.460）］、非冠心病患者［O^R=0.452（95% CI：0.253,0.807）］、女性［O^R=0.409（95% CI：0.221,0.760）］的TyG等级较低,故吸烟、肥胖、糖尿病、冠心病、男性是TyG指数升高的影响因素（P <0.05）。结论 TyG指数与OSA严重程度相关,可以考虑将TyG指数用于OSA患者胰岛素抵抗的观察,从而进行干预,使患者获益。     

Association between serum uric acid level and mortality in China

Background:Whether there is an association between serum uric acid (SUA) level and risk of mortality in the general population remains unclear. Based on the China National Survey of Chronic Kidney Disease linked to mortality data, a population-based cohort study was performed to investigate the association between SUA level and all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality in China.Methods:The survival status of participants in the cross-sectional survey was identified from January 1, 2006 to December 31, 2017. Only 33,268 individuals with complete SUA data among the 47,204 participants were included in the analysis. We determined the rates of all-cause mortality, CVD mortality, and cancer mortality. We used Cox proportional hazards regression models to evaluate the effect of the SUA level on mortality.Results:During a total of 297,538.4 person-years of follow-up, 1282 deaths occurred. In the Cox proportional hazards regression model, the rate of all-cause mortality, CVD mortality, and cancer mortality had a U-shaped association with SUA levels only in men, whereas no significant associations were detected in women. For all-cause mortality in men, the multivariable-adjusted hazard ratios (HRs) in the first, second, and fourth quartiles compared with the third quartile were 1.31 (95% confidence interval [CI] 1.04–1.67), 1.17 (95% CI 0.92–1.47), and 1.55 (95% CI 1.24–1.93), respectively. For CVD mortality, the corresponding HRs were 1.47 (95% CI 1.00–2.18), 1.17 (95% CI 0.79–1.75), and 1.67 (95% CI 1.16–2.43), respectively. For the cancer mortality rate, only a marginally significant association was detected in the fourth quartile compared with the third quartile with an HR of 1.43 (95% CI 0.99–2.08).Conclusions:The association between SUA and mortality differed by sex. We demonstrated a U-shaped association with SUA levels for all-cause and CVD mortalities among men in China.     

Association of Estimated Pulse Wave Velocity and the Dynamic Changes in Estimated Pulse Wave Velocity with All-Cause Mortality among Middle-Aged and Elderly Chinese

ObjectiveWe aimed to clarify the association between estimated pulse wave velocity (ePWV) and the changes in ePWV with all-cause mortality among middle-aged and elderly Chinese.MethodsData were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011–2018. The ePWV was calculated using an equation that included age and mean blood pressure (MBP). The ΔePWV was assessed as the difference in ePWV between the first two waves. Cox proportional hazard models were used to determine the association between ePWV and ΔePWV with all-cause mortality after adjustment for potential confounders.ResultsOf 13,116 participants during a median follow-up of 7.0 years, 1,356 deaths occurred. An increased ePWV was independently associated with all-cause mortality. The hazard ratio [95% confidence interval (CI)] for participants from the 1st–4th quartile groups was 1.00, 1.69 (1.31–2.18), 3.09 (2.44–3.91), and 8.54 (6.78–10.75), respectively. Each standard deviation (SD) increment of ePWV increased the risk of all-cause mortality by 132%. Furthermore, the ΔePWV was significantly associated with a 1.28-fold (95% CI, 1.18–1.38) risk of all-cause mortality per SD increment.ConclusionThis cohort study provided novel evidence from a Chinese population that an increased ePWV or progression of the ePWV was independently associated with all-cause mortality, which highlighted the importance of mitigating ePWV progression in clinical practice.