Prevalence, risk factors, and survival associated with pulmonary hypertension and heart failure among patients with underlying coronary artery disease: a national prospective, multicenter registry study in China

Background: Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH.Methods: Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RHC), and other baseline clinical data were recorded. Patients were followed up and their survival was recorded.Results: One hundred and eighty-two CAD-HF patients were enrolled, including 142 with HF with a preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF];left ventricular ejection fraction [LVEF] ≥50%) and 40 with a reduced ejection fraction (heart failure with reduced ejection fraction [HFrEF];LVEF < 50%). PH was diagnosed with RHC in 77.5% of patients. Patients with PH showed worse hemodynamic parameters and higher mortality. HFrEF-PH patients had worse survival than HFpEF-PH patients. CAD-HF patients with an enlarged left ventricular end-diastolic diameter and reduced hemoglobin were at higher risk of PH. Nitrate treatment reduced the risk of PH. Elevated creatinine and mean pulmonary arterial pressure (mPAP), diastolic pressure gradient (DPG) ≥7 mmHg, and previous myocardial infarction (MI) entailed a higher risk of mortality in CAD-HF patients with PH.Conclusions: PH is common in CAD-HF and worsens the hemodynamics and survival in these patients. Left ventricle enlargement and anemia increase the risk of PH in CAD-HF. Patients may benefit from nitrate medications. Renal impairment, elevated mPAP, DPG ≥7 mmHg, and previous MI are strong predictors of mortality in CAD-HF-PH patients.Trial Registration: ClinicalTrials.gov, NCT02164526.

Ten year risk assessment of ischemic cardiovascular disease and intervention analysis among middle-aged residents with moderate risk and above in a Shanghai-based community

Objective: The exposure conditions with regard to 10-year ischemic cardiovascular disease (ICVD) risk among residents aged 45-59 years treated in Hudong Community Health Service Center were surveyed to provide an objective basis for further studies on the relation between risk factors and ICVD events. Methods: The survey was conducted from October 2013 to March 2014 with use of the princi-ple of cluster sampling. Our investigation involved questionnaire and laboratory tests. All residents were evaluated according to the table of National 10-Year Risk Assessment for ICVD to forecast the 10-year risk. The community intervention methods were medication and lifestyle intervention based on the relevant guidelines. Results: The body mass index and smoking rate were significantly higher in men than in women. The 10-year ICVD risk was 6.1% for moderate risk or above. We performed intervention in such residents for 1 year, with the result that the blood pressure and total cholesterol levels were significantly decreased (P<0.05). Conclusion: It is imperative that early prediction and intervention be conducted for the resi-dents with risk factors. After the intervention, we found that the risk declined in 79.41% of the residents with moderate risk and or above and that the 10-year ICVD risk score decreased.