BACKGROUND:Circulating insulin-like growth factor binding protein 2 (IGFBP-2) is associated with metabolic changes in both physiological and pathological conditions. The aim of this study was to investigate the correlation between IGFBP-2 related immunoreactivity in serum and arterial stiffness in a healthy Chinese population. METHODS:In this cross-sectional study, 360 healthy participants aged 37-87 years were recruited from 1500 and were divided into three groups according to serum IGFBP-2 related immunoreactivity (Tertile I, 25.437 ng/ml-120.870 ng/ml; Tertile II, 120.871 ng/ml-161.914 ng/ml; Tertile III, 161.915 ng/ml-321.636 ng/ml). Arterial stiffness was evaluated by measuring the brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI), and carotid intima-media thickness (cIMT). The association between IGFBP-2 related immunoreactivity and arterial stiffness was estimated by multiple stepwise regression. RESULTS:Compared with the other two groups population, the individuals in Tertile I had significantly older age (62.66 ± 13.30 years, P < 0.01), lower level of triglyceride (1.08 ± 0.70 mmol/l, P < 0.01) and E/A (peak velocity of early filling and preak velocity of atrial filling ratio) (0.90 ± 0.33, P < 0.05). IGFBP-2 related immunoreactivity was inversely related with baPWV in the total population (r = -0.171, P < 0.01) and in Tertile I (r = -0.275, P < 0.01). After adjusting for age and the other confounders, no association was found between IGFBP-2 related immunoreactivity and baPWV in the total population. However, In Tertile I, reduced IGFBP-2 related immunoreactivity in serum was an independent risk factor of baPWV acceleration in three different adjustment models: Model 1 (no adjustment, P < 0.01), Model 2 (adjusted for age, P < 0.05), and Model 3 (adjusted for all variables, P < 0.05). CONCLUSION:IGFBP-2 related immunoreactivity in serum is inversely associated with baPWV in a healthy Chinese population. This association did not change after adjustment for conventional risk factors for cardiovascular diseases in the subjects with the lowest IGFBP-2 related immunoreactivity. Consequently, reduction of IGFBP-2 related immunoreactivity may be a predictor of arterial stiffness. IGFBP-2 seems to be a potential intervention target in early atherosclerosis.

心房颤动(atrial fibrillation,AF)是最常见的老年心律失常之一.与51～60岁人群比较,年龄≥80岁人群的AF患病率增加了6倍,其中非瓣膜性AF为主要类型.缺血性脑卒中是高龄老年AF患者主要并发症之一,80～89岁AF患者发生率为23.5％,30 d病死率高达24％[1].由于指南中CHA2DS2-VASc评分增加了年龄的权重,大多数老年心血管共病患者的CHA2DS2-VASc评分≥2分,抗凝治疗是老年AF管理的重要措施之一.然而,老年AF患者同时也为出血的高危人群,栓塞风险与出血风险的权衡及把握在老年人群中显得尤为困难.现探讨1例高龄非瓣膜性AF伴肾功能不全及反复脑卒中患者的抗凝管理,旨在丰富临床医师对老年AF患者的抗凝管理经验.

Abstract Objectives: The aim of this study was to investigate whether higher serum uric acid (SUA) levels within the physiological range were associated with changes in lumbar spine bone mineral density (LBMD) in postmenopausal women without existing lumbar spine osteoporosis after a longitudinal follow-up of 3.09 years, and to further confirm the relationship between SUA and bone mineral density (BMD) in other sites such as femoral neck, total hip, and trochanter at follow-up. Methods: A longitudinal study of 175 healthy postmenopausal women without osteoporosis was conducted in Shenyang, China. BMD of the lumbar spine, femoral neck, total hip, and trochanter were measured using dual-energy x-ray absorptiometry at each visit. Pearson's correlation analysis and regression analyses were performed to determine any associations. Results: There were positive correlations between baseline SUA and BMD of the lumbar spine (P = 0.03), total hip (P = 0.04), and trochanter (P = 0.04). Moreover, higher baseline SUA levels were independently associated with LBMD decline and the odds ratio of the baseline SUA of the third quartile group was 0.12 (95% confidence interval, 0.02-0.70, P < 0.05), with P = 0.23 for the trend in baseline SUA when compared with participants in the lowest, first quartile group after adjustment for many potential confounding variables. Conclusions: Higher SUA levels within the normal physiological range were independently associated with decreased LBMD, and SUA levels were positively related to the BMD of the lumbar spine, total hip, and trochanter in healthy Chinese postmenopausal women.

真实世界研究证实,抗栓治疗相关各种出血并发症是临床老年患者抗栓策略的最大忧患.因此规范老年慢性冠状动脉综合征抗栓治疗中的出血防治是心血管专家以及老年医学专家的共同目的[1]. 1抗栓治疗出血程度的识别及处理原则 1.1出血程度的识别 有关出血定义或分级历来存在诸多标准.为规范和便于比较,2011年欧美出血学术研究会制定了统一的出血分类标准.0型:无出血.1型:非活动性出血.2型:明显出血,但未达到3～5型,需医疗干预.3型:包括血红蛋白降低＜50 g/L,需输血(3a);心包压塞、血红蛋白降低≥50 g/L,需静脉应用血管活性物质(3b);以及颅内出血,脊髓出血,损害视力的出血(3c).4型:冠状动脉旁路移植术相关的出血.5型:可能(5a)或确定的(5b)致命性出血,以识别临床不同程度的出血并相应干预[2].抗凝药物应用时多采用国际血栓和止血大会标准定义大出血事件[3].

To the Editor: Aging is associated with kidney dysfunction and an increased risk of cardiovascular disease. The connection between the cardiovascular system and kidney function is apparent, even in the early stage of renal insufficiency. Cystatin C (CYSC), one of the cystatin superfamily that is expressed in all the nucleated cells, was considered to be one of the best indicators for evaluating renal function.[1] CYSC is a potent inhibitor of cathepsin B (CTSB), which is strictly regulated by CYSC in extracellular matrix remodeling. Imbalances between CYSC and CTSB are connected with atherosclerosis (AS), coronary heart disease, and chronic kidney disease with aging-related phenotypes. Our previous study confirmed that serum CTSB levels were associated with age and decreased cardiovascular-renal functions in healthy adults,[2] suggesting that CTSB exhibits heightened sensitivity to changes in cardiovascular and glomerular function. The present investigation, underlining the role of synthetic and degradative pathways in the aging process, emphasizes that cardio-renal interaction with aging could depend partly on differential expression of some genes leading to an imbalance of functional proteins. In this study, we analyzed the association between renal function, measured by CYSC and estimated glomerular filtration rate (eGFR), and vascular parameters in a healthy Chinese population. This community-based longitudinal study was begun with the enrollment of subjects in 2008 with follow-up conducted in 2011. In 2008, 501 healthy subjects were confirmed to be study participants out of 1500 volunteers. Following a three-year follow-up, 401 study subjects received the same examinations as were performed in 2008. In this study, we performed a cross-sectional analysis data of 401 subjects in 2011. All subjects were selected based on the results of a physician's questionnaire and clinical biochemical examination. The inclusion criteria were (1) age older than 30 years; (2) being healthy by self-evaluation; (3) self-care ability; (4) normal social interaction ability and adaptability; and (5) the ability to provide written informed consent. The exclusion criteria were subjects with cardiovascular disease, diabetes, hypertension, and nephropathy, such as nephritis, polycystic kidney, renal tuberculosis, kidney stones, hydronephrosis, and ischemic nephropathy. Those previously or currently undergoing therapy that may cause kidney injury were excluded. After excluding individuals for abnormal physical examinations or laboratory tests, a total of 401 healthy subjects (178 men and 223 women) were included in the study. This study was approved by the Medical Ethics Committee of General Hospital of People's Liberation Army, and all subjects provided written informed consent. Basic parameters, including age, sex, height, and weight, were noted. Blood pressure was measured after the subjects had rested for 10 min. Blood samples were collected at least 10 h after overnight fasting, and blood biochemistry samples, including serum creatinine (SCr), uric acid (UA), fasting blood glucose (FBG), serum triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), were tested with standard assays. The Chronic Kidney Disease Epidemiology Collaboration equation was used to estimate eGFR by using SCr levels. The subjects were placed in a supine position with a neck pillow. The distal wall of the proximal end of the common carotid artery 10 to 15 cm from the beginning of the enlargement was selected. All examinations were performed by the same ultrasonographer blinded to clinical information. The vertical distance between the boundary of lumina-intima and the boundary of intima-adventitia was measured as the intima-media thickness (IMT) of the common carotid artery, and the vertical distance from one side of the intima to the other side of intima was determined as the internal diameter (D). We used the color spectrum Doppler mode and asked the subjects to hold their breath while the blood flow spectrum was obtained. The peak systolic blood flow velocity (SPV) and end-diastolic blood flow velocity (EDV) were measured. Measurements were taken over three cardiac cycles and averaged. All data were analyzed using the SPSS 19.0 statistical software package (SPSS Inc, Chicago, IL, USA). The Kolmogorov-Smirnov method was used for normality testing. The measured data are expressed as mean ± standard deviation, with differences examined using independent-sample t-tests. Spearman correlation coefficient test was used to assess the correlation between the two variables. Multiple linear regression analysis was used to examine the effects of confounding factors. The basic characteristics of the participants were compared according to age and gender [Supplementary Table 1, https://links.lww.com/CM9/A483]. Except for diastolic blood pressure (DBP) and HDL, the differences between the other indicators were statistically significant (P < 0.05). The elderly exhibited higher SCr, CYSC, UA, IMT, D, carotid intima-medial thickness to diameter (IMT/D), pulsatile index (PI), and resistance index (RI) (P < 0.05) and lower eGFR, SPV, and EDV (P < 0.05), than young. Except for DBP, IMT/D, and SPV, there were gender differences for the other variables in the same age group. Females had significantly lower levels of SCr, CYSC, UA, IMT, D, PI, and RI and higher levels of eGFR and EDV (P < 0.05). The subjects’ parameters are expressed by tertile of eGFR in Supplementary Table 2, https://links.lww.com/CM9/A483. Age, body mass index (BMI), systolic blood pressure (SBP), FBG, SCr, CYSC, UA, TC, LDL, IMT, D, IMT/D, PI, and RI gradually decreased with the progression from low to high eGFR value (P < 0.05), whereas HDL, SPV, and EDV gradually increased (P < 0.05). The subjects were divided into three groups according to serum CYSC levels as follows: low concentration group (N = 134 [33.42%]), moderate concentration group (N = 140 [34.91%]), and high concentration group (N = 127 [31.67%]). Age, BMI, SBP, SCr, UA, IMT, D, IMT/D, PI, and RI gradually increased with the progression from low to high CYSC concentration (P < 0.05), whereas HDL, eGFR, SPV, and EDV gradually decreased (P < 0.05) [Supplementary Table 3, https://links.lww.com/CM9/A483]. Supplementary Table 4, https://links.lww.com/CM9/A483 presents the association between eGFR and clinical and laboratory variables. In all participants, eGFR was correlated with age, SBP, SCr, CYSC, UA, IMT, D, IMT/D, SPV, and EDV. In males, eGFR was correlated with age, SCr, CYSC, UA, cigarette smoking, IMT, IMT/D, SPV, and EDV. In females, eGFR was correlated with age, BMI, SBP, SCr, CYSC, UA, TG, TC, LDL, IMT, D, SPV, and EDV. Overall, serum CYSC was associated with age, BMI, HDL, SCr, eGFR, UA, IMT, D, IMT/D, EDV, and SPV. In men, serum CYSC was associated with age, SCr, UA, IMT, IMT/D, SPV, and EDV. In women, serum CYSC was associated with age, BMI, SBP, TG, SCr, UA, IMT, D, SPV, and EDV [Table 1]. Table 1 - Correlation of serum CYSC levels with basic characteristics and vascular parameters using rp (Spearman correlation coefficient). Total Male Female Items r p P r p P r p P Age 0.535† <0.001 0.526† <0.001 0.653† <0.001 BMI 0.250† <0.001 0.030 0.727 0.256† <0.001 Cigarette smoking 0.126∗ 0.021 −0.029 0.741 0.041 0.568 SBP 0.139∗ 0.015 0.130 0.128 0.269† <0.001 DBP 0.038 0.509 0.026 0.765 0.101 0.153 TG 0.180† 0.002 −0.025 0.775 0.307† <0.001 TC −0.064 0.266 −0.166 0.052 0.095 0.184 HDL −0.272† <0.001 −0.175∗ 0.041 −0.151∗ 0.034 LDL 0.022 0.696 −0.100 0.242 0.146∗ 0.040 FBG −0.026 0.651 −0.150 0.078 0.045 0.533 SCr 0.571† <0.001 0.483† <0.001 0.571† <0.001 eGFR −0.739† <0.001 −0.680† <0.001 −0.757† <0.001 UA 0.428† <0.001 0.224† 0.008 0.461† <0.001 IMT 0.498† <0.001 0.481† <0.001 0.482† <0.001 D 0.413† <0.001 0.194∗ 0.025 0.470† <0.001 IMT/D 0.248† <0.001 0.393† <0.001 0.181∗ 0.016 SPV −0.279† <0.001 −0.252† 0.003 −0.346† <0.001 EDV −0.425† <0.001 −0.364† <0.001 −0.436† <0.001 PI 0.187† 0.001 0.169 0.050 0.077 0.295 RI 0.180† 0.001 0.176∗ 0.041 0.096 0.195 P values are from the ANOVA. ∗P < 0.05; †P < 0.01. ANOVA: Analysis of variance; BMI: Body mass index; CYSC: Cystatin C; D: Carotid diameter; DBP: Diastolic blood pressure; EDV: End-diastolic velocities; eGFR: Estimated glomerular filtration rate; FBG: Fasting blood glucose; HDL: High-density lipoprotein; IMT/D: Carotid intima-medial thickness to diameter; IMT: Carotid intima-media thickness; LDL: Low-density lipoprotein; PI: Pulsatile index; RI: Resistance index; SBP: Systolic blood pressure; SCr: Serum creatinine; SPV: Blood systolic peak velocities; TC: Total cholesterol; TG: Triglyceride; UA: Uric acid. The relationship between eGFR and serum CYSC and vascular markers, determined through multivariate linear stepwise regression analysis after adjustment for parameters associated with eGFR in the pairwise correlation analysis, and the traditional cardiovascular risk factors, is shown in Supplementary Table 5, https://links.lww.com/CM9/A483. Overall, eGFR levels were still significantly associated with D, EDV (P < 0.05), and PI (P < 0.01) after full adjustment. In males, eGFR exhibited significant and independent association with SPV, EDV, PI (P < 0.01), and RI (P < 0.05). Overall, CYSC remained significantly associated with IMT/D after adjusting for age and all confounding variables (P < 0.01). In females, CYSC showed significant and independent associations with IMT/D (P < 0.01) [Supplementary Table 6, https://links.lww.com/CM9/A483]. In this study, we selected subjects from a Chinese population free of cardiovascular disease, diabetes, hypertension, nephropathy, and other acute and chronic diseases, therefore excluding many potential confounders. Our results are consistent with those reported by Buscemi et al,[3] who found a significant association between renal function and subclinical carotid atherosclerotic damage in people with no known renal impairment, though important kidney function parameters, such as CYSC, were not accounted for. Compared with creatinine and urea nitrogen, CYSC is a very stable indicator of the glomerular filtration rate.[4] CYSC better reflects the changes in renal function, especially for the elderly. In fact, CYSC is not only an essential parameter of kidney function, as one of the cystatin superfamily, but imbalances between cathepsins and CYSC regulation also plays an important role in extracellular matrix remodeling, contributing to many pathological processes.[5] In this study, CYSC has been linked to aging-related cardiovascular-renal parameters in healthy adults, suggesting that CYSC exhibits heightened sensitivity to changes in cardiovascular and glomerular function. The present investigation, underlining the role of synthetic and degradative pathways in the aging process, emphasizes that cardio-renal interaction with aging could depend partly on differential expression of some genes, leading to an imbalance among functional proteins. There are several understandings of the sex-specific differences for our research. First of all, traditional risk factors in males may affect vascular stiffening more than females, which leads to a differential effect of CYSC on arterial stiffness parameters, such as IMT/D. Second, CYSC has been found to participate in the pathological processes of AS, even in the early stage. An increase in coronary artery calcification by the female hormone estrogen in women is slower than that in men, indicating that CYSC plays an important role in the development of AS. Third, it is suspected that sex-specific differences may be connected with the activity of several cytokines and hormones and the differential expression of some functional proteins. Therefore, this study also suggests that sex must be considered while interpreting CYSC levels. The underlying mechanism remains to be determined. The sex-specific effects of CYSC on blood vessels verified in this study aid in the understanding of the pathological changes in atherosclerotic vascular disease. To conclude, our study shows that in a healthy population-based cohort, eGFR, and CYSC in the normal or slightly reduced range is independently associated with age-related vascular damage. This suggests that structural arterial changes might occur early, even in the absence of overt nephropathy. Further investigation is needed to confirm and improve these findings. Funding This work was supported by grants from the the National Basic Research Program of China (973-Program, Nos. G2000057006, 2007CB507405, and 2013CB530804). Conflicts of interest None.

The relationship between transforming growth factor β superfamily members (GDF11 and BMP4) and bone metabolism remains controversial. The aim of this study was to investigate the association between serum GDF11 and BMP4 levels and lumbar spine bone mineral density (LBMD) in a cohort of postmenopausal Chinese women. This was a non-prospective cross-sectional study of 350 postmenopausal women with a mean age of 63.13 ± 8.66 years who came from Shenyang, China. LBMD was measured using dual-energy X-ray absorptiometry. Serum GDF11 and BMP4 concentrations were detected using a sandwich enzyme immunoassay kit. Pearson’s correlation analysis and regression analyses were carried out to investigate the relationships between LBMD and serum GDF11 and BMP4 levels. A linear association between LBMD and serum LgGDF11 concentration was observed after adjusting for numerous confounders (P = 0.018). In addition, the osteoporosis (OP) was inversely related to LgGDF11 and the odds ratios for postmenopausal women with lumbar OP in LgGDF11 quartile group 2, group 3, and group 4 were 0.46 (95% CI 0.23–0.90, P < 0.05), 0.41 (95% CI 0.20–0.84, P < 0.05), and 0.30 (95% CI 0.14–0.63, P < 0.01), respectively (P = 0.001 for the trend), when compared to the highest quartile of LgGDF11 after adjustments for many confounding variables in this study. This study showed that serum GDF11 levels were linearly related to LBMD, and it was also revealed that serum GDF11 levels were significantly associated with lumbar OP in postmenopausal women. However, serum BMP4 levels were not associated with LBMD and lumbar OP.

BACKGROUND:Electromechanical coupling may play a significant role in the association between abnormal myocardial mechanics and heterogeneity of repolarization. This study sought to assess the potential relationship between the left atrial volume index (LAVI), which is an important marker of cardiac diastolic function, and ventricular repolarization variables, such as the QT interval, Tpeak-to-Tend (Tpe) interval and Tpe/QT ratio, in an apparently healthy Chinese population. METHODS:This was a community-based cross-sectional study conducted in Shenyang, China. A total of 414 healthy subjects aged 35-91 years, including 186 men (44.9%), were enrolled. In addition to performing clinical and laboratory measurements, all subjects underwent comprehensive echocardiography and standard 12-lead electrocardiography. Echocardiographic and electrocardiographic results were analysed separately and in a blinded fashion. Correlation and regression analyses were applied to determine associations. RESULTS:Subjects were divided into four groups according to quartile of LAVI levels (<16.0, 16.0-18.9, 19.0-22.5 and >22.5 mL/m2). Ventricular repolarization variables, such as QT interval and QTc interval, gradually increased with the progression from low to high LAVI levels (P<0.05). LAVI was positively and significantly correlated with the QT interval, the QTc interval, and the Tpe interval (P<0.01). After adjusting for age and other possible confounders, LAVI showed significant and independent associations with the QT interval and the QTc interval (P<0.001; P=0.003). CONCLUSION:Echocardiographic LAVI is linearly associated with ventricular repolarization variables even in healthy people.

背景心血管疾病(CVD)是危害我国居民身体健康的首要疾病,是女性死亡的首要原因.女医生群体可能有更高的CVD患病风险,而针对女医生这种高危职业CVD危险因素暴露情况尚不明确.目的 分析北方地区女医生CVD危险因素暴露情况,并探究其发生高血压的影响因素,为北方地区女医生CVD防治及预警提供科学依据.方法 本研究为病例对照研究,研究时间为2016年10月—2018年1月.研究对象包括女医生和社区健康女性.其中女医生(n=681)来源于2016年中华心血管病学会女性健康学组公益项目"女医生心血管病危险因素队列研究"中的北方地区女医生亚组人群,社区健康女性(n=334)来源于本研究团队前期进行的国家重点基础研究发展项目课题"心肾交互作用影响老年内脏多器官功能减退的机制及干预研究(2013CB530804)"中的健康女性亚组人群.先总体比较女医生与社区健康女性年龄、学历、心脑血管病家族史、生活方式、绝经状态、激素服用史、实验室检查指标.再依据年龄将研究对象分为35～45岁年龄段、46～55岁年龄段、56～65岁年龄段,比较不同年龄段女医生与社区健康女性上述观察指标,最后分析女医生患高血压的影响因素.结果 女医生年龄小于社区健康女性,研究生以上学历、心脑血管病家族史、运动缺乏、饮茶史、饮咖啡史、睡眠缺乏占比高于社区健康女性,超重/肥胖占比、已绝经占比、血糖、总胆固醇、低密度脂蛋白低于社区健康女性(P<0.05).35～45岁,女医生研究生以上学历占比、心脑血管病家族史占比、饮茶史占比、饮咖啡史占比、睡眠缺乏占比、三酰甘油高于社区健康女性,血糖低于社区健康女性(P<0.05);46～55岁,女医生研究生以上学历占比、心脑血管病家族史占比、运动缺乏占比、饮茶史占比、饮咖啡史占比、睡眠缺乏占比、激素服用史占比、总胆固醇、低密度脂蛋白高于社区健康女性,已绝经占比低于社区健康女性(P<0.05);56～65岁,女医生研究生以上学历占比、心脑血管病家族史占比、运动缺乏占比、饮茶史占比、饮咖啡史占比、饮酒史占比、睡眠缺乏占比、血糖、总胆固醇、低密度脂蛋白高于社区健康女性(P<0.05).46～55岁女医生研究生以上学历占比、运动缺乏占比、饮咖啡史占比、高密度脂蛋白低于35～45岁,心脑血管病家族史占比、已绝经占比、激素服用史占比、血糖、三酰甘油、总胆固醇、低密度脂蛋白高于35～45岁(P<0.05);56～65岁女医生研究生以上学历占比低于35～45岁、46～55岁,超重/肥胖占比、已绝经占比、血糖、三酰甘油、总胆固醇、低密度脂蛋白高于35～45岁、46～55岁(P<0.05);56～65岁女医生运动缺乏占比低于35～45岁(P<0.05).多因素Logistic回归分析结果显示,年龄〔OR=1.110,95％CI(1.063,1.158)〕、睡眠缺乏〔OR=2.273,95％CI(1.085,4.762)〕、肥胖/超重〔OR=5.491,95％CI(2.995,10.067)〕、低密度脂蛋白增高〔OR=2.975,95％CI(1.371,6.457)〕是女医生患高血压的影响因素(P<0.05).结论 北方地区女医生应注意的CVD危险因素主要为生活方式,包括运动缺乏、饮茶史、饮咖啡史、睡眠缺乏.女医生患高血压的危险因素包括年龄、睡眠缺乏、肥胖/超重、低密度脂蛋白增高,应重视上述早期预警指标,做好CVD的一级预防.

Background Systematic investigation and analysis of cardiovascular health status (CVHS) of Chinese women is rare. This study aimed to assess CVHS and atherosclerotic cardiovascular disease (ASCVD) burden in the Chinese women physicians (CWP) and community-based non-physician cohort (NPC). Methods In this prospective, multicenter, observational study, CVHS using the American Heart Association (AHA) defined 7 metrics (such as smoking and fasting glucose) and ASCVD risk factors including hypertension, hyperlipidemia and type-2 diabetes were evaluated in CWP compared with NPC. Results Of 5832 CWP with a mean age of 44 ± 7 years, only 1.2% achieved the ideal CVHS and 90.1% showed at least 1 of the 7 AHA CVHS metrics at a poor level. Total CVHS score was significantly decreased and ASCVD risk burden was increased in postmenopausal subjects in CWP although ideal CVHS was not significantly influenced by menopause. Compared to 2596 NPC, fewer CWP had ≥ 2 risk factors (8% vs. 27%, P < 0.001); CWP scored significantly higher on healthy factors, a composite of total cholesterol, blood pressure, fasting glucose ( P < 0.001), but, poorly on healthy behaviors ( P < 0.001), specifically in the physical activity component; CWP also showed significantly higher levels of awareness and rates of treatment for hypertension and hyperlipidemia, but, not for type-2 diabetes. Conclusion Chinese women’s cardiovascular health is far from ideal and risk intervention is sub-optimal. Women physicians had lower ASCVD burden, scored higher in healthy factors, but, took part in less physical activity than the non-physician cohort. These results call for population-specific early and improved risk intervention.

Background: Cathepsin B (CTSB) and cystatin C (CYSC) are new biomarkers for several physiological and pathological processes as their activities increase with age. The aim of this study was to explore population-level associations between serum CTSB and CYSC with an age-related pulmonary subclinical state. Methods: We examined 401 healthy participants (aged 36–87 years, of which 44.3% were male) in northern Chinese cities. We used a standard spirometer to determine lung function. Serum CTSB and CYSC levels were measured by enzyme-linked immunosorbent assay (ELISA). Results: For all participants, serum CTSB was related to maximum vital capacity (VC MAX), forced vital capacity (FVC), forced expiratory volume in 1 s, peak expiratory flow, forced expiratory flow at 25% of FVC, forced expiratory volume in 3 s (FEV3), and inspiratory vital capacity (VC IN). These associations were lost after full adjustment. CYSC remained significantly associated with inspiratory capacity (IC), breath frequency (BF; p < 0.001), minute ventilation (MV), the ratio of FEV3 and FVC (FEV3%FVC), and expiratory reserve volume ( p < 0.05) after adjusting for all other possible confounders. In males, serum CYSC levels exhibited significant and independent associations with FVC, FEV3 ( p < 0.05), and IC ( p < 0.001) and serum CTSB levels exhibited significant and independent associations with BF ( p < 0.05). Conclusions: Our results confirmed serum CYSC concentration associations with an age-related lung function in healthy people. However, the association between serum CTSB and lung function was not well confirmed. Serum measurements of CYSC may provide valuable predictors of pulmonary function in healthy people, especially healthy elderly adults. The reviews of this paper are available via the supplemental material section.

缺血性心脏病(IHD)已成为最重要的心血管疾病之一.其发生、发展、治疗和预后存在性别差异.与男性相比,女性非阻塞性冠心病、冠状动脉微血管功能障碍(CMD)和射血分数保留性心力衰竭(HFpEF)的患病率更高,其机制可能与性激素对自主神经、内皮/血管张力、肾素-血管紧张素-醛固酮系统(RAAS)等的调节有关.目前尚缺乏针对女性CMD的前瞻性随机临床试验证据和诊治指南.本文就女性IHD的特点,以及CMD的流行病学、危险因素、临床评估和治疗的性别差异进行综述.

BACKGROUND:Diastolic electromechanical couple, a well-described phenomenon in symptomatic heart failure, has not been well studied in healthy people. We hypothesized that ventricular repolarization variables, such as the QT interval, Tpeak-to-Tend (Tpe) interval and Tpe/QT ratio, are associated with cardiac diastolic function in the healthy Chinese population. AIM:To assess the relationship between ventricular repolarization variables and cardiac diastolic function in apparently healthy Chinese individuals. METHODS:This was a community-based cross-sectional study conducted in Shenyang, China. A total of 414 healthy subjects aged 35-91 years were enrolled. All subjects underwent standard 12-lead electrocardiography (ECG) and comprehensive echocardiography. ECG enabled the measurement of QT and Tpe intervals and Tpe/QT ratio. echocardiographic parameters, such as the ratio of mitral early diastolic inflow velocity (E) and late diastolic inflow velocity (A), E-wave deceleration time, left atrial volume (LAV) and LAV index, were measured to assess diastolic function. E/A < 0.75 was considered to indicate reduced diastolic function. ECG and echocardiography results were analyzed separately and in a blinded fashion. Correlation and regression analyses were applied to determine associations. RESULTS:Ventricular repolarization variables, such as the QTc interval (393.59 ± 26.74 vs 403.86 ± 33.56; P < 0.001), Tpe interval (72.68 ± 12.41 vs 77.26 ± 17.86; P < 0.01), Tpec interval (76.36 ± 13.53 vs 83.32 ± 21.25; P < 0.001) and Tpe/QT ratio (0.19 ± 0.03 vs 0.20 ± 0.04; P < 0.01), were significantly different between the normal diastolic function group and the reduced diastolic function group. Significant associations were found between repolarization variables and diastolic function. After adjusting for all other possible confounders, the QTc and Tpec intervals were significantly associated with the E/A ratio (P = 0.008; P = 0.010). In men, the QTc interval was associated with abnormal diastolic function, and compared to the third QTc tertile, in the second QTc tertile, the odds ratio was 0.257 (95%CI: 0.102-0.649; P = 0.004). CONCLUSION:Repolarization variables are associated with cardiac diastolic function even in healthy people. Moderate levels of the QTc interval exert a protective effect on diastolic dysfunction in men.

Objectives: Changes in serum protein levels of fibroblast growth factor 23 (FGF23) and Klotho resulting from bone metabolism are still controversial. The purpose of this study was to observe the relationship between FGF23 and Klotho serum proteins and lumbar spine bone mineral density (LBMD) in northern Chinese postmenopausal women. Methods: This was a community-based cross-sectional study carried out in Shenyang, a northern Chinese city. The study included 355 postmenopausal women with an average age of 62.92 ± 8.78 years. FGF23 and Klotho serum proteins were measured using a sandwich enzyme immunoassay. LBMD was examined using dual-energy X-ray absorptiometry. Pearson's correlation and regression analyses were performed to investigate the associations among them. Results: The LgKlotho was positively correlated with LBMD (r = 0.105). There was a linear relationship between LgKlotho serum levels and LBMD (P = 0.007) after adjusting for BMI, and the relationship still existed after adjustments for many confounding variables (P = 0.045), including age, BMI, systolic blood pressure, diastolic blood pressure, total protein, total bilirubin, high-density lipoprotein cholesterol, fasting blood glucose, serum calcium, estimated glomerular filtration rate, serum uric acid, estradiol, cigarette smoking, alcohol consumption, milk intake, calcium and vitamin D supplements, physical exercise, and fracture history in postmenopausal women. FGF23 serum levels were, however, not significantly associated with LBMD. Conclusions: Klotho was positively correlated with LBMD, and there was a linear relationship between Klotho serum protein levels and LBMD; however, the levels of serum Klotho were not independently associated with reduced LBMD in northern Chinese postmenopausal women. Moreover, serum FGF23 levels were not significantly related to LBMD in this sample population.

Biomarkers of aging are a biological parameter that can predict the functional status of an individual in the absence of disease and can be used to better predict morbidity and mortality, compared to using the chronological age alone. Most of aging biomarkers were gene, molecules, and protein, which were found in basic scientific researches, such as telomeres, proteomics, cytokines, etc. However, it is almost impossible for single biomarkers to fully reveal the mechanism of aging. Because of the complexity of aging process, the biomarkers of aging may need to be composed of multiple genes, proteins, and metabolites. The biological age is based on the setting of biological markers, which is a parameter for evaluating the functional status of the individual. Aging is not only dependent on the process of time. The chronological age is only the evaluation indicators of time scale in the aging process. Therefore, biological age can be more representative of the true degree of aging than chronological age, which provides a quantitative standard for individualized aging. According to the factor score, we established biological age score (BAS) = 0.248 (CA) + 0.195 (IMT) - 0.196 (EDV) - 0.167 (E/A) - 0.166 (MVEL) + 0.188 (PP) + 0.182(FIB) + 0.193 (CYSC) through 7 aging biomarkers selected from 108 variables. The study found the rate of aging was gradually increased before the age of 75 years old and afterward entered a stable plateau. In the future, the new approach may be needed to investigate the mechanisms and evaluation of aging.

OBJECTIVES:The relationship between the decline of renal function and bone mineral density (BMD) in healthy populations is not well-researched. The aim of this study was to investigate the association between the age-related decline in renal function and lumbar spine BMD (LBMD) in a community-based cross-sectional study of 390 healthy postmenopausal women (mean age 62.97 ± 8.79 years) from Shenyang, China.METHODS:Dual-energy x-ray absorptiometry was used to measure LBMD. Estimated glomerular filtration rate (eGFR) was calculated using a modified Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for Asians and the CKD-EPI serum creatinine-cystatin c equation. Pearson's correlation analysis and binary logistic regression were used to evaluate associations.RESULTS:The eGFR-ASIA and eGFR-Scys were positively correlated with LBMD (r = 0.120 and r = 0.108, respectively). After adjustments for numerous potential confounders, the odds ratio for participants with LBMD decline in eGFR-ASIA quartile 3 group and 4 group were 2.45 (95% confidence interval [CI] 1.12-5.38, P < 0.05) and 3.89 (95% CI 1.55-9.76, P < 0.01), respectively, with P = 0.003 for the trend in eGFR-ASIA compared with the lowest quartile 1 group of eGFR-ASIA, where the odds ratio of eGFR-Scys for the quartile of 3 and 4 groups were 2.47 (95% CI 1.09-5.62, P < 0.05) and 2.63 (95% CI 1.10-6.29, P < 0.05), respectively, with P = 0.016 for the trend in eGFR-Scys compared with the lowest quartile 1 group of eGFR-Scys.CONCLUSIONS:The renal function decline was independently associated with decreased LBMD, and it was possible that the age-related decline in kidney function was an independent risk factor for decreased LBMD in healthy Chinese postmenopausal women.

BACKGROUND:Studies have suggested that Helicobacter pylori (Hp) infection is associated with atherosclerotic process, while the relationship between pepsinogens, gastrin and atherosclerosis is unknown. AIM:The aim of the study was to observe association of Hp infection on atherosclerotic parameters and blood pressure, and explore the relationship between atherosclerotic parameters, blood pressure and gastric biomarkers in a healthy population. METHODS:395 subjects were chosen and received physical examinations, carotid artery ultrasound, peripheral atherosclerosis measurement, and testing of serum pepsinogen (PG) I and II, Hp antibody, and gastrin-17 (G-17) levels. Analyses were conducted by Student's t-test, ANOVA, Pearson correlation, multiple linear regression and binary logistic regression. RESULTS:In Hp-infected subjects, right carotid intima media thickness (R-CIMT) were higher (P = 0.027) and left ankle brachial index were higher in 45-64 years compared to 35-44 years group (P = 0.039, P = 0.016). Hp-IgG, PGI and G-17 respectively positively correlated with CIMT, pulse wave velocity and systolic blood pressure (P = 0.044, P = 0.013, P = 0.021). The unadjusted OR in subjects with elevated CIMT for quartile IV of PGI was 3.542 (95% CI, 1.491-8.411), the adjusted OR was 2.916 (95% CI, 1.035-8.216). The unadjusted OR in subjects with elevated CIMT for quartile III of G-17 was 4.351 (95% CI, 1.670-11.336) and for quartile IV was 3.108 (95% CI, 1.149-8.406), the adjusted OR for quartile III was 4.962 (95% CI, 1.515-16.258). CONCLUSIONS:Hp infection, higher levels of PGI and G-17 may contribute to atherosclerotic process by influencing atherosclerotic parameters and blood pressure in a healthy population, the influence on CIMT was most significant.

目的 探讨老年心血管疾病患者心脏结构和功能的影响因素及性别差异.方法 收集203例老年心血管疾病患者,记录年龄、疾病史、用药史;测量血压;检测血脂、肝功、血肌酐(Scr)、胱抑素(Cys)C、同型半胱氨酸(Hcy)、游离脂肪酸(FFAs)和B型利钠肽(BNP)水平,MDRD公式计算估算肾小球滤过率(eGFR);彩色超声诊断仪分析心脏结构和功能.结果 多元逐步回归分析发现,在男性组,左室质量指数(LVMI)与舒张压(DBP)呈正相关(B=0.877,P<0.05);左室射血分数(LVEF)与钙离子拮抗剂(CCB)呈正相关(B=2.739,P<0.05),与B型利钠肽(BNP)呈负相关(B=-0.012,P<0.05);左室舒张早期二尖瓣流速峰值与左室舒张晚期二尖瓣流速峰值比值(E/A)与eGFR呈正相关(B=0.003,P<0.05),与FFAs呈负相关(B=-0.154,P<0.05).在女性组,LVMI与收缩压(SBP)呈正相关(B=0.359,P<0.05);LVEF与CCB呈负相关(B=-0.257,P<0.05);E/A与高血压负相关(B=-0.149,P<0.05).结论 老年心血管疾病患者心脏结构和功能的影响因素存在性别差异,女性高血压及SBP水平是左室重构及舒张功能下降的主要危险因素.男性DBP和肾脏功能对LVMI和舒张功能的影响更大.