Background Although previous studies have suggested that left ventricular ejection fraction (LVEF) adjusted by left ventricular mass (LVM) might improve prognostic risk stratification of cardiac events, few prospective cohort studies have examined its clinical implications. We assessed the predictive ability of LVEF indexed to LVM, body surface area (BSA), and body mass index for the cardiac event risk. Methods We conducted a 5.52‐year cohort study on the association between LVEF indexed to LVM and cardiac events among 4266 participants with mildly reduced or preserved LVEF. Multivariable Cox regression analysis incorporating restricted cubic spline functions evaluated the predictive ability of LVEF, LVEF/LVM, and other indexed measures. Results After multivariable Cox regression adjustment, LVEF/LVM, LVEF/LVM/BSA, and LVEF/LVM/body mass index remained significantly associated with cardiac events (all P<0.05), whereas LVEF alone was not (P=0.569). Restricted cubic spline analysis identified a nonlinear approximately U‐shaped relationship for both LVEF/LVM and LVEF/LVM/BSA (both P for nonlinearity<0.001). Compared with the middle reference group, participants in the low LVEF/LVM (hazard ratio [HR], 2.00 [95% CI, 1.08–3.71]) and low LVEF/LVM/BSA (HR, 2.13 [95% CI, 1.11–4.07]) groups had significantly higher risks. While the high groups showed nonsignificant differences (LVEF/LVM: HR, 1.41 [95% CI, 0.68–2.95]; LVEF/LVM/BSA: HR, 1.39 [95% CI, 0.65–2.99]), the observed risk pattern indicated that values outside the ranges of 4.72 to 5.53/kg (LVEF/LVM) and 19.7 to 24.3 m2/kg2 (LVEF/LVM/BSA) suggested a higher cardiac event risk. Conclusions LVEF indexed to LVM provides better cardiac event risk stratification than LVEF alone in individuals with mildly reduced or preserved ejection fraction.

Abstract: BACKGROUND: To assess the effectiveness of incorporating simple carotid ultrasound markers into modifiable conventional vascular risk factors (C-VRFs) on identifying the high-risk stroke population. METHODS: A community-based cohort study involving 3,506 participants (mean [standard deviation] age: 61.3 [12.8] years; 41.8% male), all of whom were free of stroke and atrial fibrillation at baseline, underwent carotid ultrasound assessment. The asymptomatic carotid atherosclerosis (ACS) was assessed by detecting increased carotid intima–media thickness and plaques with or without stenosis. The new stroke events occurring during a 5.5-year follow-up were recorded. Nomograms for stroke probability by adding ACS to C-VRFs constructed models were developed and validated. RESULTS: Integrating ACS into C-VRF models further improved the models’ performance for stroke prediction. Neither additive nor multiple interactions of ACS and C-VRFs existed. While comparing with group of none/mild ACS and C-VRFs < 3, the risk of total stroke in the group with plaque and C-VRFs ≥ 3 increased by 2.6 times (hazard ratios [HRs]: 2.55, 95% confidence interval [CI]: 1.62–4.00) after adjusting for age and gender. The elevated stroke risk in the group of plaques with C-VRFs < 3 (HR: 1.88, 95% CI: 1.17–3.01) was equivalent to that with none/mild ACS and C-VRFs ≥ 3 (HR: 1.85, 95% CI: 1.12–3.00). In the group with C-VRFs < 3, 42.5% subjects had plaques, and 84% of those plaque-positive subjects were ≥ 60 years old. Moreover, the prevalence of nonstenosis and intermediate stenosis plaques was the highest, with the largest new stroke event occurring during the follow-up period. CONCLUSION: Adding ACS to multiple C-VRFs may improve high-risk stroke individual identification in the general population. While this modality may overlook the high-risk stroke population having plaques with C-VRFs < 3, in older adults.

The Beijing Healthy Aging Cohort Study (BHACS) was established to supplement the limited data of a large representative cohort of older people based on the general population and was designed to evaluate the prevalence, incidence, and natural history of cognitive decline, functional disability, and conventional vascular risk factors. The aim was to determine the evolution of these conditions by estimating the rates and determinants of progression and regression to adverse outcomes, including dementia, cardiovascular events, cancer, and all-cause death. It can therefore provide evidence to help policy makers develop better policies to promote healthy aging in China. BHACS consisted of three cohorts (BLSA, CCHS-Beijing, and BECHCS) in Beijing with a total population of 11 235 (6281 in urban and 4954 in rural areas) and an age range of 55 years or older (55–101 years) with a mean age of 70.35 ± 7.71 years (70.69 ± 7.62 years in urban and 69.92 ± 7.80 years in rural areas). BHACS-BLSA conducted the baseline survey in 2009 with a multistage stratification-random clustering procedure for people aged 55 years or older; BHACS-CCHS-Beijing conducted the baseline survey in 2013–2015 with a stratified multistage cluster random sampling method for people aged 55 years or older; and BHACS-BECHCS conducted the baseline survey in 2010–2014 with two-stage cluster random sampling method for people aged 60 years or older. Data were collected through questionnaires, physical measurements, and laboratory analyses. Topics covered by BHACS include a wide range of physical and mental health indicators, lifestyles and personal, family, and socio-economic determinants of health. There are no immediate plans to make the cohort data freely available to the public, but specific proposals for further collaboration are welcome. For further information and collaboration, please contact the corresponding author Yao He (e-mail: yhe301@x263.net).

Abstract Background Research on potentially inappropriate medications (PIM) and medication-related problems (MRP) among the Chinese population with chronic diseases and polypharmacy is insufficient. Objectives This study aimed to investigate the prevalence of PIM and MRP among older Chinese hospitalized patients with chronic diseases and polypharmacy and analyze the associated factors. Methods A retrospective cross-sectional study was conducted in five tertiary hospitals in Beijing. Patients aged ≥ 65 years with at least one chronic disease and taking at least five or more medications were included. Data were extracted from the hospitals’ electronic medical record systems. PIM was evaluated according to the 2015 Beers criteria and the 2014 Screening Tool of Older Persons’ Prescriptions (STOPP) criteria. MRPs were assessed and classified according to the Helper-Strand classification system. The prevalence of PIM and MRP and related factors were analyzed. Results A total of 852 cases were included. The prevalence of PIM was 85.3% and 59.7% based on the Beers criteria and the STOPP criteria. A total of 456 MRPs occurred in 247 patients. The most prevalent MRP categories were dosages that were too low and unnecessary medication therapies. Hyperpolypharmacy (taking ≥ 10 drugs) (odds ratio OR 3.736, 95% confidence interval CI 1.541–9.058, P = 0.004) and suffering from coronary heart disease (OR 2.620, 95%CI 1.090–6.297, P = 0.031) were the influencing factors of inappropriate prescribing (the presence of either PIM or MRP in a patient). Conclusion PIM and MRP were prevalent in older patients with chronic disease and polypharmacy in Chinese hospitals. More interventions are urgently needed to reduce PIM use and improve the quality of drug therapies.

Objective: To investigate the frailty, as estimated by accumulated health deficits, in association with the symp-tomatic carotid atherosclerosis and in relation to five-year cardiovascular (CVD) outcomes. Methods: This is a five-year prospective cohort study. Secondary analysis of data from the Beijing Longitudinal Study on Aging. Community-dwelling people aged 55+ years (n = 1257) have been followed between 2009 and 2014, and having carotid ultrasonography examinations with no CVD events at baseline. Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 37 health deficits assessed at baseline. The association between the degree of frailty and carotid atherosclerosis was examined using odds ratios (OR) with multivariate logistic regression analyses. Effects of frailty on the probability of five-year cardiovascular events and mortality were evaluated using Cox proportional hazard ratios (HR). The analyses were adjusted for demographics, baseline carotid atherosclerosis status, and CVD risk factors. Results: The FI showed characteristic properties and was independently associated with the major carotid atherosclerosis symptoms, including carotid artery intima-media thickening (the most frail vs. the least frail: OR = 4.39: 1.98-7.82), carotid plaque (OR = 3.41: 1.28-6.54), and carotid plaque stability (OR = 1.19, 95 % CI: 1.01-3.59). Compared with the least frail, the most frail individuals were more likely to develop a cardiovascular event in five years, including myocardial infarction (HR = 3.38, 95 % CI = 1.84-6.19), stroke (HR = 1.26, 95 % CI = 1.00-5.87), CVD death (HR = 6.33, 95 % CI = 1.69-11.02), and all-cause death (HR = 5.95, 95 % CI = 2.74-8.95). Conclusion: Deficit accumulation was closely associated with carotid atherosclerosis risks and strongly predicted five-year CVD events. The frailty index can be used to help identify older adults at high risks of CVD for improved preventive healthcare.

The prevalence and risk factors of intracranial atherosclerotic stenosis (ICAS) located in the anterior circulation (AC) and posterior circulation (PC) has been scarcely noted in the general population. We aimed to determine ICAS prevalence and risk factor profile of AC and PC in a representative population. Data were from the China Hypertension Survey of Beijing. In total, 4800 people aged 35 years or older were enrolled in this subsurvey for ICAS, and 3954 participants were eligible for analysis. ICAS was assessed by transcranial Doppler. The prevalence of ICAS in AC was much greater than that in PC (11.9% vs. 4.2%), and subjects with ICAS in PC were 3.9 years older than those with ICAS in AC. Multivariable logistics regression showed that the odds of hypertension and diabetes increased by 79% (OR: 1.79, 95% CI: 1.40–2.27) and 35% (OR: 1.35, 95% CI: 1.04–1.75) in those with AC vascular lesions and by 3.35 times (OR: 3.35, 95% CI: 2.49–4.50) and 71% (OR: 1.71, 95% CI: 1.19–2.46) in those with PC vascular lesions compared with those without vascular lesions. Most modifiable vascular risk factors for ICAS appeared to exert similar magnitudes of risk for PC to AC lesions.

目的 探讨北京市老年住院慢性疾病(简称慢病)患者多重用药的发生情况及其影响因素.方法 抽取北京市5家三级甲等医院4个科室(神经内科、老年科、心内科、内分泌科)中年龄不小于65岁,至少患高血压、高脂血症、冠状动脉粥样硬化性心脏病(简称冠心病)、脑梗死、2型糖尿病中的1种,并于2017年3月、6月、9月、12月首周出院患者的临床基本信息.统计住院期间使用5种及以上药物患者的临床基本信息,计算多重用药发生率,并分析其影响因素.结果 共纳入912例患者,其中男455例,女457例;中位年龄74岁;中位用药品种数为9种.多重用药发生率为93.42％.单因素分析结果表明,年龄、出院诊断疾病数、查尔森合并症指数(CCI)评分、高血压、2型糖尿病、冠心病、高脂血症是多重用药的影响因素;多因素Logistic回归分析结果表明,出院诊断疾病数、2型糖尿病、冠心病是多重用药的独立影响因素.结论 多病共存、患有2型糖尿病或冠心病的老年慢病住院患者更易发生多重用药,临床应重点关注相关人群,减少过度治疗,提高用药的合理性.

Abstract The associations of blood pressure components with cardiovascular risks and death remain unclear, and the definition of wide pulse pressure (PP) is still controversial. Using data from 1257 participants without a history of cardiovascular disease, who were followed for 4.84 years, we performed multivariable Cox regression analyses to assess how systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP contribute to risks of cardiovascular events and all‐cause death. Among all participants, SBP and PP were significantly associated with the risks of cardiovascular events and all‐cause death (all p < .05). DBP was not significantly associated with the risk of all‐cause death; rather, it was only associated with a marginally significant 1% increased risk for cardiovascular events (p = 0.051). In participants aged < 65 years, DBP was significantly associated with a 3% increased risk for cardiovascular events (hazard ratio [HR]: 1.03, 95% confidence interval [95% CI]: 1.01–1.06). The association between PP and cardiovascular events appeared to be J‐shaped in comparison to participants with the lowest‐risk PP (50–60 mmHg), with adjusted HRs of 1.71 (95% CI: 1.03–2.85), 1.63 (95% CI: 1.00–2.68), and 2.13 (95% CI: 1.32–3.43) in the <50, 60.0–72.5, and ≥72.5 mmHg subgroups, respectively. The optimal cutoff points of a wide PP for predicting the risks of cardiovascular events and all‐cause death were 70.25 and 76.25 mmHg, respectively. SBP and PP had a greater effect on cardiovascular risk, whereas DBP independently influenced cardiovascular events in middle‐aged participants. Considerable PP alterations should be avoided in antihypertensive treatment.

Abstract Background Frailty can be operationalized based on the accumulation of deficits using a frailty index (FI) and is associated with an increased risk of adverse health outcomes. Here, we aim to compare validity of a FI from laboratory data with that of the common clinical FI for prediction of mortality in adults aged 55 + years, also examine whether combined FI could improve identification of adults aged 55 + years at increased risk of death. Methods Data for this analysis were obtained from the Beijing Longitudinal Study of Aging that involved 1,257 community-dwelling Chinese people, aged 55 + years at baseline. The main outcome measure was 5-year mortality. An FI-self-report based on 30 self-reported health-related data was constructed. An FI-lab was developed using laboratory data, in addition to pulse, systolic and diastolic blood pressure, pulse pressure, body mass index (BMI) and waist. A combined FI comprised all items from each FI. Kaplan–Meier survival curve and Cox proportional hazards models were performed to evaluate the risk of each FI on death. The area under receiver operating characteristic(ROC) curves were used to compare the discriminative performance of each FI. Results Of 1257 participants, 155 died and 156 lost at the end of the 5-year follow-up. The mean FI-self-report score was 0.11 ± 0.10, the FI-lab score was 0.33 ± 0.14 and FI-combined score was 0.19 ± 0.09. Higher frailty level defined by each FI was associated with higher risk of death. After adjustment for age and sex, Cox proportional hazards models showed that the higher scores of frailty were associated with a higher risk of mortality for each FI, the hazard ratios for the FI-self-report and FI-lab and FI-combined were 1.04 (1.03 to 1.05) and 1.02 (1.01 to 1.03) and 1.05 (1.04 to 1.07), respectively. The areas under the ROC curve were 0.79 (0.77–0.82) for the FI-self-report, 0.77(0.75–0.80) for the FI-lab and 0.81(0.78–0.82) for FI-combined. Conclusions A FI from laboratory data can stratify older adults at increased risk of death alone and in combination with FI based on self-report data. Assessment in clinical settings of creating an FI using routine collected laboratory data needs to be further developed.

Background ApoE gene polymorphism and serum total homocysteine (tHcy) has been reportedly associated with cognition. In this study, we assessed the association of combined ApoE gene polymorphism and tHcy with cognition in Chinese elder adults. Methods A cross- sectional study was carried out by recruiting 1458 community-dwelling people aged 55+ and above in Beijing in 2009. All participants were interviewed using a standard questionnaire and underwent a physical examination. The mini-mental scale examination (MMSE) score was used in assessing cognitive function. Fasting venous blood samples were taken for ApoE rs429358, rs7412 genotyping, tHcy and other serum lipid measurements. Results Participants with high serum tHcy level showed a relatively lower orientation, attention abilities as well as the total MMSE score than the group with normal tHcy after adjusting confounding factors. ApoE rs429358 and rs7412 variants were observed to have the highest serum TC and TG level in the subjects with high serum tHcy level ( p < 0.05). Cognition of the subjects was found to be significantly associated with high serum tHcy level and ApoE genetic polymorphism ( p < 0.05). Independent of age, BMI, education levels, smoking and alcohol drinking, the worst cognitive ability were detected in the high serum tHcy level subjects with ApoE rs429358C/T and rs7412 C/T as compare with other groups, especially orientation function, memory and delayed recall ability and attention ability. Conclusion High serum tHcy level in combination with ApoE rs429358 and rs7412 variants might be linked with serum lipid levels and cognition, particularly for orientation function and memory and delayed recall ability in old Chinese adults.

BACKGROUNDIncreased homocysteine levels are associated with the risk of cardiovascular disease (CVD) and death. However, their prevention has not been effective in decreasing CVD risk. This study investigated the individual and combined associations of hyperhomocysteinemia and hypertension with incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.METHODSThis prospective study was conducted among 1,257 elderly participants (mean age: 69 years). A questionnaire survey, physical examinations, and laboratory tests were conducted to collect baseline data. Hyperhomocysteinemia was defined as homocysteine level ≥ 15 µmol/L. H-type hypertension was defined as concomitant hypertension and hyperhomocysteinemia. Multivariate Cox regression analysis was used to evaluate individual and combined associations of hyperhomocysteinemia and hypertension with the risks of incident CVD events and all-cause death.RESULTSOver a median of 4.84-year follow-up, hyperhomocysteinemia was independently associated with incident CVD events and all-cause death. The hazard ratios (HRs) were 1.45 (95% CI: 1.01−2.08) for incident CVD events and 1.55 (95% CI: 1.04−2.30) for all-cause death. After adjustment for confounding factors, H-type hypertension had the highest HRs for incident CVD events and all-cause death. The fully adjusted HRs were 2.44 for incident CVD events (95% CI: 1.28−4.65), 2.07 for stroke events (95% CI: 1.01−4.29), 8.33 for coronary events (95% CI: 1.10−63.11), and 2.31 for all-cause death (95% CI: 1.15−4.62).CONCLUSIONSHyperhomocysteinemia was an independent risk factor, and when accompanied by hypertension, it contributed to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.

Objective: To explore the association of depression, as well as untreated hypertension or diabetes with all-cause death in community-based postmenopausal women in Beijing.Methods: A cohort of 863 community-based postmenopausal women with no history of cardiovascular heart disease (CHD), stroke, cancer, or dementia was investigated on 20 July-28 September 2009 at baseline. Depression was diagnosed using the 30-item Center for Epidemiologic Studies Depression (CES-D) scale with CES-D >= 11. Meanwhile, data on health behavior, physical comorbidity, and social support at baseline were collected. These individuals were followed up from 20 July to 30 August 2014. All-cause mortality and cause of death were surveyed.Results: After a median follow-up of 4.97 years, 120 subjects died of all-cause. Twenty-four died of stroke, 19 died of myocardial infarction, 21 died of cancer. The others died of aging, infection, and accident. Depression and untreated HP were significantly associated with all-cause mortality in Cox models after full adjustment for all of the potential confounders (Depression HR: 2.16, 95%CI: 1.35-3.46; Untreated hypertension HR: 1.84, 95%CI: 1.12-3.02). However, negative correlation of untreated diabetes on all-cause mortality was observed in this population (HR: 1.36, 95%CI: 0.75-2.49). When depression was co-existing with hypertension/diabetes, the HR for mortality elevated significantly (Depression co-existing with hypertension HR = 3.87, 95% CI: 2.07-7.23; Depression co-existing with diabetes HR = 5.02, 95% CI: 1.5-16.79).Conclusions: It is suggested we should take sufficient care of postmenopausal females with depression and control blood pressure and glucose more effectively.

Objective:To explore the diagnostic value of the serial position effect combined with delayed recall of auditory verbal learning test in diagnosing the elderly patients with different levels of cognitive impairment.Methods:A total of 310 subjects were enrolled and divided into three groups: the normal control group(NC group, n=128), the mild cognitive impairment group(MCI group, n=133)and the mild Alzheimer's disease group(mild AD group, n=149)matched for gender, age and education level.Comprehensive neuro-psychological tests were performed on all subjects, and the Auditory Verbal Learning Test-Huashan version(AVLT-H)was used to analyze the serial position effect.Results:There were significant differences in the primacy effect of the second and third time of immediate recall, short-term and long-term delayed recall among the three groups( P<0.05), but no difference was found in the recency effect between the MCI and mild AD groups( P>0.05). The long-term delayed primacy effect combined with the short-term delayed recall showed a better validity to distinguish those elderly subjects with different levels of cognitive impairment than other memorial indexes, and the correlative sensitivity and specificity were 83.21% and 71.43%(NC group vs.MCI group), 85.71% and 92.86%(NC group vs.mild AD group), 66.67% and 75.57%(MCI group vs.mild AD group), respectively. Conclusions:The long-term delayed primacy effect combined with the short-term delayed recall can assist in distinguishing elderly patients with different levels of cognitive impairment.

OBJECTIVE To evaluate metabolic parameters of primary lesions examined by 18F-FDG PET/CT (18Fluorodeoxyglucose Positron Emission Tomography /Computed Tomography), including maximum standard uptake value (SUVmax), metabolic volume (MTV), and total lesion glycolysis (TLG). PATIENTS AND METHODS 79 patients with endometrial cancer were selected as the subjects. They were diagnosed by histopathology in our hospital for the first time from January 2016 to December 2018. All the patients were examined by 18F-FDG PET/CT. Retrospective statistical analysis was carried out to evaluate different expression of metabolic parameters examined by 18F-FDG PET/CT of different clinicopathologic factors in endometrial cancer. Spearman correlation analysis was also used. RESULTS SUVmax, TLG and MTV were correlated with FIGO staging, tissue grading, depth of myometrial invasion, and lymph node metastasis. SUVmax, TLG and MTV in lymph node metastasis group had high clinical staging, low differentiation and myometrial invasion depth >1/2, which were significantly higher than those in no lymph node metastasis group (low clinical staging, high differentiation and myometrial invasion depth ≤1/2). TLG had the greatest difference(p<0.001). TLG and MTV were correlated with histopathological classification (p<0.05). The expression levels of SUVmax, MTV and TLG of primary lesions were negatively correlated with the positive expression of ER and PR in tumor tissues (p<0.05), and significantly positively correlated with positive expression of HER -2 and Ki-67 (p<0.01). The expression of ER, PR, HER-2 and KI-67 in tumor tissues was correlated with tissue grading, clinical staging, depth of muscular layer infiltration, cervical tissue involvement and lymph node metastasis (p<0.05). CONCLUSIONS Metabolic parameters of primary lesions examined by 18F-FDG PET/CT has a good correlation with its clinicopathological features. They can provide reference for the preoperative formulation of treatment plan for endometrial cancer, so as to reduce the risk of surgery and improve the prognosis of patients.

Objective China has the largest population of patients with epilepsy worldwide, which imposes a heavy burden on the public and health care systems. Several epidemiological surveys on epilepsy have been performed in China. Although these surveys grossly describe the prevalence and gap in treatment of epilepsy, the status of epilepsy centers is unclear. The number of epilepsy centers has increased substantially in recent decades. Therefore, a nationwide investigation of the scale and distribution, personnel, equipment, and epilepsy care capacity of each epilepsy center is of great value. Methods In 2017-2018, a multicenter cross-sectional survey was performed by the Commission on Standardized Development of Epilepsy Centers, China Association Against Epilepsy in 31 provinces, autonomous regions, and municipalities. The survey consisted of 74 questions divided into four sections: (1) overview, (2) personnel, (3) essential equipment and facilities, and (4) epilepsy care service capacity. The questions ranged from January 1, 2016 to December 31, 2016. The data were analyzed using descriptive statistics. Results There were 358 epilepsy centers for the 1.38 billion national population in 2016. Three quarters were in the eastern and western regions, and >90% were in tertiary hospitals. There were 9688 doctors engaged in epilepsy care, and 4.8% of doctors and electrophysiological physicians/technicians passed the national test for electroencephalography technical accreditation. A total of 9667 patients underwent resective surgeries in 2016. There were 888 vagus nerve stimulation procedures and 275 deep brain stimulation procedures. Significance This study is the first unique survey of epilepsy centers in China. Despite their rapid development, epilepsy centers cannot meet patients' needs at this stage. The results provide data-based evidence for the formulation of policies related to epilepsy service planning.

As an atherosclerotic disease, peripheral artery disease (PAD) is highly prevalent in the elderly population. This has been aggravated by aging populations in recent years, so its prevalence is increasingly rapid. We have searched related literature on peripheral artery disease worldwide, and reviewed and summarized studies about detection methods, diagnostic criteria and global prevalence of this disease. This provides evidence for research and prevention of PAD in populations.

目的 探讨北京市年龄≥35岁人群高血压与外周动脉疾病(PAD)的关系.方法 2013年7月至2014年12月采用分层多阶段随机抽样的方法对北京四个区县年龄≥35岁居民进行上臂血压及踝臂血压测量,共检测5 126人.结果 高血压组PAD的患病率明显高于无高血压组(6.5％比3.1％,P＜0.05).Logistic回归分析结果显示,在校正年龄、性别、体质量指数(BMI)、吸烟、糖尿病、血脂代谢异常以及降压药物的使用后,与正常血压人群相比,正常高值、1级高血压、2级高血压、3级高血压其患PAD的OR(95％ CI)分别为1.38(0.87～2.19)、1.68(1.04～2.73)、2.10(1.18～3.73)、5.08(2.57～10.08).将收缩压设定为连续变量分析,结果显示收缩压每升高10 mm Hg,PAD患病风险增加19％ (OR=1.19,95％CI 1.09～1.30);收缩压为120～139、140～159、≥160 mm Hg组患PAD的风险分别为收缩压＜120 mm Hg组的1.29(95％ CI 0.83～2.01)、1.61(95％ CI 1.01～2.60)、2.75(95％ CI 1.65～4.60);趋势检验P＜0.001;而PAD患病风险与舒张压则关系不明显.在高血压患者中,高血压未治疗组、治疗后未达标组、治疗达标组的PAD患病风险分别为无高血压组的1.45(0.98～2.14)、1.93(1.34～2.78)、1.23(0.83～1.82).结论 高血压可增加PAD患病风险,收缩压升高为PAD的独立危险因素;控制高血压患者升高的血压可以控制PAD患病的风险.

The frailty index can be predictive of multiple adverse outcomes in older adults, including mortality, hospitalisation, falls, dementia, cardiovascular events, and fractures.1Clegg A Young J Iliffe S Rikkert MO Rockwood K Frailty in elderly people.Lancet. 2013; 381: 752-762Summary Full Text Full Text PDF PubMed Scopus (4647) Google Scholar, 2Rockwood K Howlett SE Age-related deficit accumulation and the diseases of ageing.Mech Ageing Dev. 2019; 180: 107-116Crossref PubMed Scopus (85) Google Scholar Age-related health deficits might begin to accumulate in early adulthood, and the usefulness of the frailty index might not be confined to older adults.1Clegg A Young J Iliffe S Rikkert MO Rockwood K Frailty in elderly people.Lancet. 2013; 381: 752-762Summary Full Text Full Text PDF PubMed Scopus (4647) Google Scholar However, whether the frailty index predicts poor health outcomes in adults younger than 50 years remains uncertain. Calibrating the frailty index to populations of younger adults is challenging given that the prevalence of frailty and adverse outcomes are generally low in these populations. Therefore, cohort studies with large populations and long-term follow-up are required. Using data from the China Kadoorie Biobank, Junning Fan and colleagues3Fan J Yu C Guo Y et al.Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study.Lancet Public Health. 2020; 5: e650-e660Summary Full Text Full Text PDF PubMed Scopus (63) Google Scholar constructed a frailty index and assessed its predictive value for mortality in Chinese adults. The authors found that the frailty index was an independent predictor for all-cause mortality and cause-specific mortality from cancer, ischaemic heart disease, cerebrovascular disease, respiratory disease, infectious disease, and other causes of death. These findings suggest that the frailty index could be a surrogate measure of biological age and predict health and mortality risk. The results might help public health and primary care practices to identify frail individuals and develop proactive interventions. These findings are particularly important for China, which has a large and ageing population. However, several aspects of the study deserve attention. First, although the frailty index was more strongly predictive of mortality in younger adults (<50 years) than in older adults (≥50 years), this finding does not mean that the frailty index is not predictive in older people.3Fan J Yu C Guo Y et al.Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study.Lancet Public Health. 2020; 5: e650-e660Summary Full Text Full Text PDF PubMed Scopus (63) Google Scholar Importantly, the deficits related to cognition and functional ability, the essential elements for health assessments in older adults, were not included in the study. Second, for several diseases, such as chronic kidney disease or vertebral fracture, diagnosis was self-reported. Third, the frailty index constructed by Fan and colleagues3Fan J Yu C Guo Y et al.Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study.Lancet Public Health. 2020; 5: e650-e660Summary Full Text Full Text PDF PubMed Scopus (63) Google Scholar had 28 items, whereas most studies incorporate more than 30 items into their frailty index.4Mitnitski A Rockwood K Aging as a process of deficit accumulation: its utility and origin.Interdiscip Top Gerontol. 2015; 40: 85-98Crossref PubMed Scopus (32) Google Scholar Finally, the primary endpoints in Fan and colleagues' study were all-cause mortality and cause-specific mortality from selected common diseases. Although some of the included diseases are major public health concerns in both younger and older adult populations, other adverse outcomes, like functional disability, cognitive impairment, fracture, falls, hospitalisations, quality of life, loneliness, and nursing home admission, are also important in older populations and of concern for health-care cost and for public health and geriatrics.5Hoogendijk EO Afilalo J Ensrud KE Kowal P Onder G Fried LP Frailty: implications for clinical practice and public health.Lancet. 2019; 394: 1365-1375Summary Full Text Full Text PDF PubMed Scopus (758) Google Scholar The frailty index covers comprehensive domains that can reflect impairments in muscle strength, mobility, cognition, vision, and functional ability, and people with frailty are characterised by reduced biological reserves and increased susceptibility to a broad range of internal and external stressors, physically, psychologically, and socially. Because frailty can be modifiable, identifying individuals with frailty has implications for public health and clinical practice, as recognised by WHO.6WHOIntegrated care for older people. Guidelines on community-level interventions to manage declines in intrinsic capacity.www.who.int/ageing/health-systems/icopeDate: 2017Date accessed: November 7, 2020Google Scholar However, translating the concept of frailty from research to public health and clinical practice has still a long way to go in China. First, the concept of frailty is not broadly acknowledged by health professionals. Second, the burden of frailty remains unclear, but evidence suggests that the burden varies with socioeconomic circumstance. Third, the ageing population generally have complex health problems and the manifestations of frailty can be heterogeneous within this population. Frail individuals are not necessarily recognised by their general practitioners, who tend to focus on specific medical diseases, and assessing frailty in a primary clinic or in the community could be seen as expensive and time consuming. Finally, care for individuals with frailty should be individualised, which could prove difficult when health-care resources are inadequate. All these issues challenge the social and health-care system in China. Future research must evaluate the burden of frailty and develop accessible instruments, such as an electronic frailty index, to identify the frail population. More general practitioners must be trained to care for older people with frailty, and policy and strategy must be tailored towards frailty prevention in younger adults and slowing frailty progression in older adults to reduce the morbidity and public health consequences of frailty. We declare no competing interests. Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort studyThe frailty index is associated with all-cause and cause-specific mortality independent of chronological age in younger and older Chinese adults. The identification of younger adults with accelerated ageing by use of surrogate measures could be useful for the prevention of premature death and the extension of healthy active life expectancy. Full-Text PDF Open Access

The association between blood pressure and intracranial artery stenosis (ICAS) in different age groups has not been elucidated. Using data from the "China Hypertension Survey," we conducted a cross-sectional analysis of the association between blood pressure parameters and ICAS. In this study, participants older than 35 years were selected by stratified, multistage random sampling. Blood pressure was measured repeatedly at rest, and ICAS was assessed by transcranial doppler ultrasound. Binary logistic regression analysis was used to demonstrate the association between different blood pressure indicators and ICAS. Of the 3640 participants included (mean age 63 +/- 13 years old, 57.8% female), systolic blood pressure (SBP) and pulse pressure (PP) were associated with ICAS in the general population; the multivariable adjusted odds ratio (OR) and corresponding 95% confidence interval (95% CI) of ICAS and multivessel stenosis were 1.32 (1.21, 1.45) and 1.29 (1.14, 1.46) per standard deviation (SD) increase in SBP and 1.44 (1.30, 1.59) and 1.52 (1.33, 1.74) for PP, respectively. Further analysis of this association in different age groups revealed inconsistent results between SBP and ICAS. Prehypertension (120 <= SBP < 140) could predict ICAS in the older group but not in the younger group, and the positive association between SBP and multivessel stenosis disappeared in the younger age group (P > .05 in all SBP subgroups). In conclusion, SBP and PP could not only identify ICAS in the middle-aged and elderly population but could also provide some information about ICAS burden; however, these associations need to be interpreted differentially based on age subgroup.

Background/objectives: Functional disability (FD) is common after stroke and associated with the occurrence of future adverse events; however, whether FD is as strong a risk factor as comorbid vascular risk factors for cardiovascular events and death is unclear. Methods: Consecutive patients 3-6 months after index ischemic stroke were assessed at baseline and followed up for documented new cardiovascular events (recurrent stroke, acute myocardial infarction, and sudden death) and death within 5 years. Comorbidity of vascular risk factors was stratified as low or intermediate-to-high risk according to the Stroke Prognostic Instrument II. Four mutually exclusive cohorts were identified (1) intermediate-to-high risk only, n = 505, (2) FD only, n = 78, (3) both intermediate-to-high risk and FD, n = 264, and (4) low risk and no FD, n = 240. Results: The incidence of cardiovascular events was lowest in patients free of FD with low risk, followed by patients with FD alone, intermediate-to-high risk alone, and both. Compared with intermediate-to-high risk only, patients free of FD with low risk had a significantly lower adjusted hazard ratio (HR) (HR: 0.56, 95% confidence interval [CI]: 0.33-0.94), patients with FD only had a similar HR (HR: 0.47, 95% CI: 0.19 -1.18), and patients with both FD and intermediate-to-high risk had a significantly higher HR (HR: 2.13, 95% CI: 1.53-2.98) of cardiovascular events. A similar trend but a larger HR was noted for all-cause death. Conclusion: FD 3-6 months after ischemic stroke is a risk equivalent to comorbidity of conventional vascular risk factors for the incidence of cardiovascular events and mortality of all-cause death.