Association of acute glycemic parameters at admission with cardiovascular mortality in the oldest old with acute myocardial infarction

OBJECTIVES Stress-related glycemic indicators,including admission blood glucose(ABG),stress-hyperglycemia ratio(SHR),and glycemic gap(GG),have been associated with worse outcomes after acute myocardial infarction(AMI).However,data regarding their prognostic value in the oldest old with AMI are unavailable.Therefore,this study aimed to investigate the association of stress-related glycemic indicators with short-and long-term cardiovascular mortality(CVM)in the oldest old(≥80 years)with AMI.METHODS In this prospective study,a total of 933 consecutive old patients with AMI admitted to FuWai hospital(Beijing,China)were enrolled.On admission,ABG,SHR,and GG were assessed and all participants were classified according to their quartiles.Kaplan-Meier,restricted cubic splines(RCS),and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.RESULTS During an average of 1954 patient-years of follow-up,a total of 250 cardiovascular deaths were recorded.Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG.After adjusting for potential covariates,patients in quartile 4 of ABG,SHR,and GG had a respective 1.67-fold(95%CI:1.03-2.69;P=0.036),1.80-fold(95%CI:1.16-2.79;P=0.009),and 1.78-fold(95%CI:1.14-2.79;P=0.011)higher risk of long-term CVM risk compared to those in the reference groups(quartile 1 of ABG and quartile 2 of SHR and GG).Furthermore,RCS suggested a J-shaped relationship of ABG and a Ushaped association of SHR and GG with long-term CVM.Additionally,we observed similar associations of these acute glycemic parameters with 30-day CVM.CONCLUSIONS Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and longterm CVM among the oldest old with AMI,suggesting that they may be useful for risk stratification in this special population.

Lipoprotein(a)and Benefit of PCSK9 Inhibition in Emergency Complex Higher-risk and Indicated Patients

Objective There is a large population of patients classified as complex higher-risk and indicated patients(CHIPs)in China with a poor prognosis.The treatment of these patients is complex and challenging,especially when acute cardiac events occur,such as acute coronary syndrome(ACS)or heart failure.Pharmacotherapy and some mechanical circulatory support(MCS)therapeutic devices can provide stable hemodynamic support for CHIPs-percutaneous coronary intervention(PCI).LDL-C is an important pathogenic factor in atherosclerosis,and the target of blood lipid control.Recent studies have revealed that lipoprotein(a)[Lp(a)],which is formed when a covalent bond between apolipoprotein(a)and apolipoprotein B-100 is made,produces an LDL-like particle.This particle is an independent risk factor for the development of atherosclerosis,and is closely correlated to stent thrombosis and restenosis.Furthermore,this requires active intervention.PCSK9 inhibitors have been used in lipid-lowering treatment,and preventing atherosclerosis.The present study explores the efficacy of PCSK9 inhibitors in CHIPs-ACS,and the association between the change in Lp(a)and survival after 2 years of follow-up.Methods The present real-world,prospective control study enrolled 321 CHIPs-ACS who underwent emergency PCI from August 2019 to November 2020,and these patients were followed up for 2 years.These patients were divided into two groups:PCSK9 group(n=161)given the combined PCSK9 inhibitor(140 mg of evolocumab every 2 weeks)and statins-based therapy,and SOC group(n=160)treated with statin-based lipid-lowering therapy alone.Then,the change in lipid index was measured,and the cardiovascular(CV)event recurrence rate was evaluated after one month and 2 years.Afterwards,the contribution of serum lipid parameters,especially the Lp(a)alteration,in patients with earlier initiation of the PCSK9 inhibitor to the CV outcome was analyzed.Results The LDL-C level was significantly reduced in both groups:52.3%in the PCSK9 group and 32.3%(P<0.001)in the SOC group.It is noteworthy that the Lp(a)level decreased by 13.2%in the PCSK9 group,but increased by 30.3%in the SOC group(P<0.001).Furthermore,the number of CV events was not significantly different between the PCSK9 and SOC groups after the 2-year follow-up period.In the PCSK9 group,the Lp(a)reduction was associated with the baseline Lp(a)levels of the patients(r2=−0.315,P<0.001).Moreover,the decrease in Lp(a)contributed to the decline in CV events in patients who received ACS CHIPs-PCI,and the decrease in Lp(a)level was independent of the LDL-C level reduction.Conclusion The early initiation of PCSK9 inhibitors can significantly reduce the LDL-C and Lp(a)levels in ACS CHIPs-PCI.However,further studies are needed to confirm whether PCSK9 inhibitors can reduce the incidence of CV disease in CHIPs.

2023 China Guidelines for Lipid Management

Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of death among urban and rural residents in China,and elevated low-density lipoprotein cholesterol(LDL-C)is a risk factor for ASCVD.Considering the increasing burden of ASCVD,lipid management is of the utmost importance.In recent years,research on blood lipids has made breakthroughs around the world,hence a revision of China guidelines for lipid management is imperative,especially since the target lipid levels in the general population vary in respect to the risk of ASCVD.The level of LDL-C,which can be regarded as appropriate in a population without frisk factors,can be considered abnormal in people at high risk of developing ASCVD.As a result,the“Guidelines for the prevention and treatment of dyslipidemia”were adapted into the“China Guidelines for Lipid Management”(henceforth referred to as the new guidelines)by an Experts’committee after careful deliberation.The new guidelines still recommend LDL-C as the primary target for lipid control,with CVD risk stratification to determine its target value.These guidelines recommend that moderate intensity statin therapy in adjunct with a heart-healthy lifestyle,be used as an initial line of treatment,followed by cholesterol absorption inhibitors or/and proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitors,as necessary.The new guidelines provide guidance for lipid management across various age groups,from children to the elderly.The aim of these guidelines is to comprehensively improve the management of lipids and promote the prevention and treatment of ASCVD by guiding clinical practice.

Association of serum lipoprotein(a) level with the severity and prognosis of calcific aortic valve stenosis: a Chinese cohort study

Background There was a causal relationship between elevated lipoprotein(a)[Lp(a)]levels and increased risk of calcific aortic valve stenosis(CAVS)in whites and blacks.The present study aimed to investigate whether Lp(a)levels were associated with aortic stenosis(AS)severity and clinical events in Chinese patients.Methods Levels of serum Lp(a)were measured in 652 patients with CAVS,whom all underwent baseline echocardiographic examination.The clinical endpoint was defined as a composite of aortic valve replacement(AVR)and cardiac death.Results Patients in the tertile 3 of Lp(a)had a higher percentage of severe AS compared with those in the tertile 1 and 2 of Lp(a)(46.2%vs.33.9%,P=0.005).Moreover,the top tertile of Lp(a)was an independent predictor of severe AS(OR=1.78,95%CI:1.18-2.66,P=0.006).However,there was no significant association between tertile 3 of Lp(a)and clinical events(hazard ratio:0.73;95%CI:0.43-1.24;P=0.239)in the multivariate Cox regression analysis during a mean follow-up time of 3.16±2.74 years.Conclusions Elevated Lp(a)level was an independent predictor of severe AS by echocardiography in the Chinese population,but was not associated with the increased risk of AVR and cardiac death,suggesting that Lp(a)levels might be helpful in the risk stratification of patients with CAVS.

Relationship of lipid and lipoprotein ratios with coronary severity in patients with new on-set coronary artery disease complicated with type 2 diabetics

BackgroundDiabetes mellitus (DM ) 与冠的动脉疾病(CAD ) 被联系前进。尽管以前的研究与 CAD 表明了类脂化合物和脂蛋白比率的协会，没有数据有关在类脂化合物和脂蛋白比率和在糖尿病患者的新发作 CAD 的严厉之间的关系当前是可得到的。因此，现在的学习的目的有新发作 CAD 的 380 个连续 T2DM 病人是在与类型 2 DM (T2DM ).MethodsA 在病人预言 CAD 的严厉调查类脂化合物和脂蛋白比率的实用性全部的在现在的学习被注册。然后，他们根据 Gensini 被分类进三个组分数(GS ) tertiles。在类脂化合物和脂蛋白比率之间的关系当前使用了， GS 与到 apoA 的 apolipoprotein B 是自然转变木头的 GS ( lnGS )的 investigated.ResultsPositive 关联--我比率( apoB/apoA-I )， non-high-density 脂蛋白胆固醇到 apoA --我比率( non-HDL-C/apoA-I )，并且低密度的脂蛋白胆固醇到 apoA --我比率( LDL-C/apoA-I )被发现( r = 0.18 ， 0.13 ， 0.12 ，分别地所有 P &#x0003c ；0.05 ) 。Multivariate 逻辑分析为高 GS 作为最强壮的预言者显示了 apoB/apoA-I (或 = 5.67， 95% CI：1.45-23.92， P = 0.003 ) 。在操作 apoB/apoA-I 的典型曲线的接收装置下面的区域是 0.63 (95% CI：0.60-0.66， P = 0.001 ) 为预言高 GS。apoB/apoA-I 的最佳的截止值预言高 GS 与 61.2% 的敏感和 62.1%.ConclusionsLipid 和脂蛋白比率的特性是 0.72 可能为在 T2DM 病人预言新发作 CAD 的严厉是有用的，并且 apoB/apoA-I 在这张人口作为最重要的预言者出现。

Effects of Pitavastatin on Lipoprotein Subfractions and Oxidized Low-density Lipoprotein in Patients with Atherosclerosis

It has been demonstrated that pitavastatin can significantly reduce low-density lipoprotein(LDL)cholesterol(LDL-C),but its impact on lipoprotein subfractions and oxidized low-density lipoprotein(oxLDL)has not been determined.The aim of the present study was to investigate the potential effects of pitavastatin on subfractions of LDL and high-density lipoprotein(HDL)as well as oxLDL in untreated patients with coronary atherosclerosis(AS).Thirty-six subjects were enrolled in this study.O f them,18 patients with AS were administered pitavastatin 2 mg/day for 8 weeks and 18 healthy subjects without therapy served as controls.The plasma lipid profile,lipoprotein subfractions and circulating oxLDL were determined at baseline and 8 weeks respectively.The results showed that pitavastatin treatment indeed not only decreased LDL-C,total cholesterol(TC),triglycerides(TG)and apolipoprotein B(ApoB)levels,and increased HDL cholesterol(HDL-C),but also reduced the cholesterol concentration of all of the LDL subfractions and the percentage of intermediate and small LDL subfractions.Meanwhile,pitavastatin could decrease plasma oxLDL levels.Furthermore,a more close correlation was found between oxLDL and LDL-C as well as LDL subfractions after pitavastatin treatment.We concluded that a moderate dose of pitavastatin therapy not only decreases LDL-C and oxLDL concentrations but also improves LDL subfractions in patients with AS.

Clinical features of coronary artery ectasia in the elderly

ObjectiveTo 与冠的动脉 ectasia (CAE ) 在老病人调查发生，成像和临床的特征 .MethodsA 回顾的分析与 CAE 在病人上被进行经历了在 2006 年 1 月和 2012 年 12 月之间的冠的 angiography。根据年龄，注册病人被划分成二个组(老组，年龄 ≥；65 年；非老的组，年龄 <；65 年) 。临床的特征，成像特征和二个组的 5 年的幸存率是在老病人的 CAE 的 compared.ResultsThe 流行是 0.33% 。在老组的病人被发现有女性的显著地更高的比例(30.1% 对 10.1% ， P <；0.001 ) ，三容器的疾病(60.5% 对 45.2% ， P = 0.003 ) 并且局部性的 ectasia (55.0% 对 40.2% ， P = 0.003 ) 。另外，身体团索引(20.90 ±；2.71 kg/m 2 对 22.31 ±；2.98 kg/m 2, P <；0.001 ) 并且当前的吸烟者的百分比(45.0% 对 64.6% ， P <；0.001 ) 在老组是显著地更低的。累积幸存曲线与非老的组相比在老组在后续表明了减少的 5 年的累积幸存(88.0% 对 96.0% ， P = 0.002 ) 。但是免费幸存率没能显示出二之间的重要差别的 5 年的事件组织(31.0% 对 35.0% ， P = 0.311 ) 在老病人的 CAE 的 .ConclusionThe 流行是 0.33% ，它关于 CAE 病人的全部数字的 1/3。在之间有重要差别老并且有 CAE 的非老的病人以冠的动脉疾病冒险因素和冠的动脉 ectatic 特征。CAE 可能与增加的死亡风险被联系在老。

Free triiodothyronine in relation to coronary severity at different ages： Gensini score assessment in 4206 euthyroid patients

为了学习在正常范围以内的免费 triiodothyronine ( FT3 )是否在不同的性和年龄 groups.MethodsA 在冠的动脉疾病( CAD )的存在和严厉上有效果， 4206 个 euthyroid 病人总计连续地被注册并且把组划分了成 CAD ( n = 3306 )并且 非CAD 组( n = 900 )。所有病人经历了冠的 angiography (CAG ) 。Gensini 分数(GS ) 被用来决定冠的动脉狭窄的严厉。严重 CAD 被定义为 GS > 32 并且温和 CAD 被定义为 GS 32。逻辑回归分析和线性回归分析被进行与不同的性在病人与 CAD 决定 FT3 的协会， FT3 的 ages.ResultsConcentration 在 angiography 正常的控制组比那在有 CAD 的病人是更低的(P < 0.05 ) 。另外， FT3 的集中在温和 CAD 比那在严重 CAD 是更低的。在为传统的心血管的风险因素和潜在的 confounders 调整以后， FT3 否定地与 CAD 的存在被相关，然而并非在老病人(> 65 岁) 。Multivariable 线性回归分析证明 FT3 否定地在正常以内与稳定的 CAD 在男、年轻的病人，然而并非在旧 patients.ConclusionsLow FT3 与 GS 被联系范围否定地在年轻病人，然而并非在旧的与 CAD 的存在和严厉被联系。进一步的研究被需要证实我们的调查结果。

Novel findings in relation to multiple anti-atherosclerotic effects of XueZhiKang in humans

Background: Previous studies have clearly demonstrated that XueZhiKang (XZK), an extract of cholestin, can decrease low-density lipoprotein cholesterol (LDL-C) and cardiovascular events. However, the mechanism of the effects of XZK on athero-sclerosis (AS) in humans has been reported less frequently. In the present study, we investigated the impact of XZK on lipoprotein subfractions, oxidized LDL (oxLDL), and interleukin-6 (IL-6). Methods: From October 2015 to July 2016, 40 subjects were enrolled in this study. Of them, 20 subjects with dyslipidemia received XZK 1200 mg/day for 8 weeks (XZK group); 20 additional healthy subjects who did not receive therapy acted as controls. The plasma lipoprotein subfractions, oxLDL, and IL-6 were examined at baseline and again at 8 weeks. Results: Data showed that XZK could significantly decrease not only plasma LDL-C levels (87.26 ± 24.45 vs. 123.34 ± 23.99, P<0.001), total cholesterol (4.14 ± 0.87 vs. 5.08 ± 1.03, P<0.001), triglycerides (0.95 ± 0.38 vs. 1.55 ± 0.61, P<0.05), and apolipoprotein B (1.70 ± 0.35 vs. 1.81 ± 0.72, P<0.05), but also oxLDL (36.36 ± 5.31 vs. 49.20 ± 15.01, P<0.05) and IL-6 (8.50 ± 7.40 vs. 10.40 ± 9.49, P<0.05). At the same time, XZK reduced the concentration of small LDL-C (1.78 ± 2.17 vs. 6.33 ± 7.78, P<0.05) and the percentage of the small LDL subfraction (1.09 ± 1.12 vs. 3.07 ± 3.09, P<0.05). Conclusions: Treatment with 1200 mg/day XZK for 8 weeks significantly decreased the atherogenic small LDL subfraction and reduced oxidative stress and inflammatory markers, in addition to affecting the lipid profile, suggesting multiple beneficial effects in coronary artery disease.