The effect of fasting plasma glucose on in-hospital mortality after acute myocardial infarction in patients with and without diabetes:findings from a prospective,nationwide,and multicenter registry

OBJECTIVES To evaluate the predictive value of fasting plasma glucose(FPG)for in-hospital mortality in patients with acute myocardial infarction(AMI)with different glucose metabolism status.METHODS We selected 5,308 participants with AMI from the prospective,nationwide,multicenter CAMI registry,of which 2,081 were diabetic and 3,227 were nondiabetic.Patients were divided into high FPG and low FPG groups according to the optim-al cutoff values of FPG to predict in-hospital mortality for diabetic and nondiabetic cohorts,respectively.The primary endpoint was in-hospital mortality.RESULTS Overall,94 diabetic patients(4.5%)and 131 nondiabetic patients(4.1%)died during hospitalization,and the optimal FPG thresholds for predicting in-hospital death of the two cohorts were 13.2 mmol/L and 6.4 mmol/L,respectively.Compared with individuals who had low FPG,those with high FPG were significantly associated with higher in-hospital mortality in diabet-ic cohort(10.1%vs.2.8%;odds ratio[OR]=3.862,95%confidence interval[CI]:2.542-5.869)and nondiabetic cohort(7.4%vs.1.7%;HR=4.542,95%CI:3.041-6.782).After adjusting the potential confounders,this significant association was not changed.Further-more,FPG as a continuous variable was positively associated with in-hospital mortality in single-variable and multivariable models regardless of diabetic status.Adding FPG to the original model showed a significant improvement in C-statistic and net reclassification in diabetic and nondiabetic cohorts.CONCLUSIONS This large-scale registry indicated that there is a strong positive association between FPG and in-hospital mor-tality in AMI patients with and without diabetes.FPG might be useful to stratify patients with AMI.

The association of grip strength with cardiovascular diseases and all-cause mortality in people with hypertension:Findings from the Prospective Urban Rural Epidemiology China Study

Background:Both hypertension and grip strength(GS)are predictors of mortality and cardiovascular disease(CVD),but whether these risk factors interact to affect CVD and all-cause mortality is unknown.This study sought to investigate the associations of GS with the risk of major CVD incidence,CVD mortality,and all-cause mortality in patients with hypertension.Methods:GS was measured using a Jamar dynamometer(Sammons Preston,Bolingbrook,IL,USA)in participants aged 3570 years from 12 provinces included in the Prospective Urban Rural Epidemiology China Study.Cox frailty proportional hazards models were used to examine the associations of GS and hypertension and the outcomes of all-cause mortality and CVD incidence/mortality.Results:Among 39,862 participants included in this study,15,964 reported having hypertension,and 9095 had high GS at baseline.After a median follow-up of 8.9 years(interquartile range,6.79.9 years),1822 participants developed major CVD,and 1250 deaths occurred(388 as a result of CVD).Compared with normotensive participants with high GS,hypertensive patients with high GS had a higher risk of major CVD incidence(hazard ratio(HR)=2.39;95%confidence interval(95%CI):1.863.06;p<0.001)or CVD mortality(HR=3.11;95%CI:1.596.06;p<0.001)but did not have a significantly increased risk of all-cause mortality(HR=1.24;95%CI:0.921.68;p=0.159).These risks were further increased if hypertensive participants whose GS level was low(major CVD incidence,HR=3.31,95%CI:2.604.22,p<0.001;CVD mortality,HR=4.99,95%CI:2.649.43,p<0.001;and all-cause mortality,HR=1.93,95%CI:1.472.53,p<0.001).Conclusion:The present study demonstrates that low GS is associated with the highest risk of major CVD incidence,CVD mortality,and all-cause mortality among hypertensive patients.High levels of GS appear to mitigate long-term mortality risk among hypertensive patients.

Triglyceride glucose index predicts in-hospital mortality in patients with ST-segment elevation myocardial infarction who underwent primary angiography

OBJECTIVES To assess the correlation between triglyceride glucose(TyG)index and in-hospital mortality in patients with ST-segment elevation myocardial infarction(STEMI).METHODS A total of 2190 patients with STEMI who underwent primary angiography within 12 h from symptom onset were selected from the prospective,nationwide,multicenter CAMI registry.TyG index was calculated with the formula:Ln[fasting triglycerides(mmol/L)×fasting glucose(mmol/L)/2].Patients were divided into three groups according to the tertiles of TyG index.The primary endpoint was in-hospital mortality.RESULTS Overall,46 patients died during hospitalization,in-hospital mortality was 1.5%,2.2%,2.6%for tertile 1,tertile 2,and tertile 3,respectively.However,TyG index was not significantly correlated with in-hospital mortality in single-variable logistic regression analysis.Nonetheless,after adjusting for age and sex,TyG index was significantly associated with higher mortality when regarded as a continuous variable(adjusted OR=1.75,95%CI:1.16-2.63)or categorical variable(tertile 3 vs.tertile 1:adjus-ted OR=2.50,95%CI:1.14-5.49).Furthermore,TyG index,either as a continuous variable(adjusted OR=2.54,95%CI:1.42-4.54)or categorical variable(tertile 3 vs.tertile 1:adjusted OR=3.57,95%CI:1.24-10.29),was an independent predictor of in-hospital mortality after adjusting for multiple confounders in multivariable logistic regression analysis.In subgroup analysis,the pro-gnostic effect of high TyG index was more significant in patients with body mass index<18.5 kg/m2(P interaction=0.006).CONCLUSIONS This study showed that TyG index was positively correlated with in-hospital mortality in STEMI patients who underwent primary angiography,especially in underweight patients.

Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment:a multicenter prospective study in China

Background:Generic drugs are bioequivalent to their brand-name counterparts;however,concerns still exist regarding the effectiveness and safety of generic drugs because of small sample sizes and short follow-up time in most studies.The purpose of this study was to evaluate the long-term antihypertensive efficacy,cost-effectiveness and cardiovascular outcomes of generic drugs compared with brand-name drugs.Methods:In a multicenter,community-based study including 7955 hypertensive patients who were prospectively followed up for an average of 2.5 years,we used the propensity-score-matching method to match the patients using brand-name drugs to those using generic drugs in a ratio of 1:2,2176 patients using brand-name drugs and 4352 patients using generic drugs.Results:There were no significant differences between generic drugs and brand-name drugs in blood pressure(BP)-lowering efficacy,BP control rate,and cardiovascular outcomes including coronary heart disease and stroke.The adjusted mean(95%confidence interval[CI])of systolic BP(SBP)-lowering was-7.9 mmHg(95%CI,-9.9 to-5.9)in the brand-name drug group and-7.1 mmHg(95%CI,-9.1 to-5.1)in the generic drug group after adjusting for age,sex,body mass index,number of antihypertensive drugs and traditionally cardiovascular risk factors.Among patients aged<60 years,brand-name drugs had a higher BP control rate(47%vs.41%;P=0.02)and a greater effect in lowering SBP compared with generic drugs,with the between-group difference of 1.5 mmHg(95%CI,0.2-2.8;P=0.03).BP control rate was higher in male patients using brand-name drugs compared with those using generic drugs(46%vs.40%;P=0.01).Generic drugs treatment yielded an average annual incremental cost-effectiveness ratio of$315.4 per patient per mmHg decrease in SBP compared with brand-name drugs treatment.Conclusions:Our data suggested that generic drugs are suitable and cost-effective in improving hypertension management and facilitating public health benefits,especially in low-and middle-income areas.

Dynamic changes of renal cortical blood perfusion before and after percutaneous transluminal renal artery stenting in patients with severe atherosclerotic renal artery stenosis

Background:This study aims to observe the dynamic changes of renal artery(RA)disease and cortical blood perfusion(CBP)evaluated by contrast-enhanced ultrasound(CEUS)after percutaneous transluminal renal artery stenting(PTRAS)in patients with severe atherosclerotic renal artery stenosis(ARAS)and to analyze the relationship between CBP and prognosis.Methods:This was a single-center retrospective cohort study.A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included.According to renal glomerular filtration rate(GFR)detected by radionuclide imaging at 12 months after PTRAS,all patients were divided into the poor prognosis group(n=21,GFR decreased by≥20%compared with baseline)and the control group(n=77,GFR decreased by<20%or improved compared with baseline).Renal artery stenosis was diagnosed by digital subtraction angiography,and renal CBP was evaluated by CEUS using TomTec Imaging Systems(Germany)before PTRAS,at 6 months and 12 months after discharge.The receiver operating characteristic(ROC)curve with area under the curve(AUC)was used to analyze the predictive value of CBP parameters,including area under ascending curve(AUC1),area under the descending curve(AUC2),rising time(RT),time to peak intensity(TTP),maximum intensity(IMAX),and mean transit time(MTT)for poor prognosis.Results:Among the 98 patients,there were 52 males(53.1%),aged 55–74 years old,with an average age of 62.1±8.7 years,and an average artery stenosis of 82.3±12.9%.The poor prognosis group was associated with significantly increased incidence of diabetes(76.2%vs.41.6%),and lower levels of GFR of the stenotic kidney(21.8 mL/min vs.25.0 mL/min)and total GFR(57.6 mL/min vs.63.7 mL/min)(all P<0.05),compared with the control group(P<0.05).In addition,the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group(9.5%vs.0,χ^(2)=9.462,P=0.002).Compared with the control group,the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2,and extended duration of TTP and MTT(P<0.05).At 6 months and 12 months of follow-up,patients in the control group were associated with markedly increased AUC1,AUC2,and IMAX,and shorter duration of RT and MTT(P<0.05).The ROC curve showed that the predictive values of AUC1,AUC2,RT,TTP,IMAX,and MTT for poor prognosis were 0.812(95%CI:0.698–0.945),0.752(95%CI:0.591–0.957),0.724(95%CI:0.569–0.961),0.720(95%CI:0.522–0.993),0.693(95%CI:0.507–0.947),and 0.786(95%CI:0.631–0.979),respectively.Conclusions:Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced,and does not show significant improvement after stent treatment over the first year of follow-up.The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients.Trial Registration:ChiCTR.org.cn,ChiCTR1800016252.

Effectiveness of redcore lotion in patients with vulvovaginal candidiasis: a systematic review and Meta-analysis

OBJECTIVE:To summarize and evaluate the effectiveness and safety of Redcore lotion on treating vulvovaginal candidiasis(VVC)using a systematic review and Meta-analysis of randomized controlled trials.METHODS:A systematic literature search was performed in five English and three Chinese electronic databases up to October 2019.Randomized controlled trials in the treatment for VVC were included;only studies which compared the effectiveness and safety of Redcore lotion plus miconazole with miconazole alone were included.Relative risk(RR)and 95%confidence intervals(CI)were used in the Meta-analysis.RESULTS:Seven studies involving 768 patients suffering from VVC were identified;468 of the patients were pregnant women(60.9%).Combination group(Redcore lotion plus miconazole)was more effective in redu CIng symptomatic episodes of VVC than miconazole alone,with respect to cure rate(RR,1.31;95%CI,1.09-1.57;P=0.01),fungal culture negative rate(RR,1.21;95%CI,1.04-1.41;P=0.01),and effective rate(RR,1.18;95%CI,1.05-1.35;P=0.01).Subgroup analyses for pregnant women also showed that the combination group had superior outcomes with respect to VVC cure rate(RR,1.48;95%CI,1.16-1.88,P<0.01),fungal culture negative rate(RR,1.26;95%CI;1.09-1.47;P<0.01),and effective rate(RR,1.25;95%CI,1.10-1.42;P<0.01).Additionally,the observed risk of adverse events was lower in the combination medication group(RR,0.30;95%CI,0.14-0.65;P<0.01).CONCLUSIONS:Though overall quality of individual studies was low,Redcore lotion plus miconazole can significantly improve clinical effectiveness and safety compared with miconazole alone.

中度主动脉瓣狭窄人群的预后及左室收缩功能在其中的预测价值:一项来自China-VHD队列的研究

中度主动脉瓣狭窄(AS)患者的预后存在争议,尤其是左室收缩功能(LVEF)在该人群的应用价值仍不明确.该研究旨在探讨中度AS患者的预后及左室收缩功能对其的预测价值.研究通过全国多中心前瞻性队列研究China-VHD连续纳入了来自中国46家三甲医院的万余名严重瓣膜病患者,其中513例为中度AS,并依据LVEF界值分为三组,分别为LVEF≤40%(LVEF显著降低组),40%<LVEF<50%(LVEF轻度降低组)和LVEF≥50%(LVEF正常组).入选患者53.0%为男性,平均年龄62.0岁.2年随访期内,中度AS患者生存率显著低于年龄和性别相匹配的中国人群的预期生存率(P<0.001).Cox回归模型提示LVEF分组始终是2年全因死亡和心源性死亡的最强预测因子(LVEF显著降低组,HR4.55,P=0.001;LVEF轻度降低组,HR3.02,P=0.020;LVEF正常组为对照/参考),相对死亡风险随着LVEF的降低而呈单调增加趋势,LVEF的最佳界值为60%.研究结果提示,LVEF降低是中度AS人群预后不佳的首要危险因素,今后或可考虑将LVEF低于60%作为进一步干预的界值。