Homocysteine, hypertension, and risks of cardiovascular events and all-cause death in the Chinese elderly population: a prospective study

BACKGROUND Increased 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.METHODS This 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≥15μmol/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.RESULTS Over 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).CONCLUSIONS Hyperhomocysteinemia was an independent risk factor,and when accompanied by hypertension,it contrib-uted to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.

Listeria monocytogenes bacteremia in a centenarian and pathogen traceability:A case report

BACKGROUND Early diagnosis and appropriate antibiotic treatment are important to survival of Listeria monocytogenes(L.monocytogenes)bacteremia.Penicillin tends to be the most commonly used antibiotic.However,there are limited data on antibiotic use in elderly patients with serious complications.We describe the clinical presentation,antibiotic therapy,and traceability of L.monocytogenes in a centenarian with a history of eating frozen food.CASE SUMMARY A 102-year-old man suffered from high fever with chill after hematochezia.Tentative diagnoses were lower gastrointestinal hemorrhage and localized peritonitis.Meropenem and ornidazole were the empirical therapy.The patient did not respond and developed multiple system dysfunction even after teicoplanin was added to the therapy.L.monocytogenes was identified from blood cultures on day 5 of admission.The patient had a history of consuming frozen dumplings.Meropenem/ornidazole/teicoplanin were replaced with meropenem/linezolid.The patient gradually became afebrile.He received meropenem/linezolid for 10 d,and piperacillin/tazobactam was applied as step-down treatment for 2 wk with good clinical results.There was no sign of relapse during follow-up after discharge.L.monocytogenes isolates from the patient and frozen dumplings belonged to different serotypes and sequence types(STs):1/2b and ST5 from the patient and 1/2c and ST9 from the dumplings.CONCLUSION More awareness of listeriosis should be raised.Linezolid might be an option for listeriosis in elderly people with serious complications.