Cardiovascular Risk Factors in China

The Annual Report on Cardiovascular Health and Diseases in China(2022) intricate landscape of cardiovascular health in China. This section dissects cardiovascular risk factors in China which including hypertension, dyslipidemia, diabetes mellitus, chronic kidney disease, metabolic syndrome and air pollution. Hypertension prevalence has steadily increased in China,with efforts to control it facing challenges in achieving optimal rates, especially in rural areas. Interventions like salt substitutes and intensive blood pressure control show promise but need improvement. Abnormal lipid levels, indicative of dyslipidemia,have risen significantly, posing a risk for cardiovascular diseases. Despite efforts, many patients struggle to achieve target lipid levels, necessitating improved treatment strategies. Both type 1 and type 2 diabetes mellitus affect millions of adults in China,with long-term complications adding to the disease burden. Early intervention and effective management are crucial to mitigate its impact. Prevalent among older adults, chronic kidney disease is associated with diabetes mellitus, hypertension, and cardiovascular diseases, necessitating comprehensive management approaches. The prevalence of metabolic syndrome, characterized by a cluster of risk factors, has increased in both adults and adolescents, calling for lifestyle modifications and public health interventions. Ambient and household air pollution remain significant environmental risk factors, despite some improvements in air quality. Continued efforts to reduce emissions are essential for mitigating associated health risks. Addressing these risk factors requires a multifaceted approach, including public health initiatives, policy interventions, and individual-level strategies to promote healthy lifestyles and reduce environmental exposures. Surveillance and research efforts are crucial for monitoring trends and developing effective strategies to lessen the burden of cardiovascular diseases in China.

Influencing Factors on Cardiovascular Health in China

The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.This is the first section of the report,which dissects influential factors across diverse domains.The investigation identifies tobacco use as a paramount concern,portraying China as the global epicenter of tobacco consumption.Cigarette smoking,exacerbated by second-hand smoke exposure,emerges as a critical and preventable risk factor,contributing to a surge in attributable deaths over the past three decades.In the realm of dietary nutrition,the study discerns an overall improvement,yet discerns worrisome deviations,notably an escalating fat intake surpassing recommended guidelines.The shifting dietary structure reveals diminished consumption of cereals and vegetables juxtaposed with an uptick in animal foods,while excessive intake of cooking oil and salt persists,straying substantially from endorsed levels.The exploration of physical activity patterns unfolds a nuanced narrative.Varied trends are observed among students,with concerns arising from sedentary behaviors and inadequate adherence to recommended guidelines.The analysis spans a trajectory of declining physical activity in Chinese adults,coupled with an alarming surge in sedentary leisure time,ultimately linking these factors to heightened risks of cardiovascular diseases and increased adiposity.An examination of overweight and obesity trends uncovers a relentless upward trajectory,projecting substantial prevalence by 2030.Noteworthy prevalence rates underscore the imperative for targeted interventions to curtail this burgeoning health crisis,with the anticipated prevalence extending to nearly two-thirds of the adult population.Psychological factors,notably depression,constitute an integral facet of cardiovascular health.Prevalence rates among patients with coronary artery disease and acute myocardial infarction underscore the intricate interplay between mental health and cardiovascular outcomes.Additionally,persistent depressive symptoms are shown to significantly elevate the risk of cardiovascular diseases and mortality.This first section underscores the multifaceted challenges facing cardiovascular health in China,emphasizing the imperative for tailored interventions across tobacco control,dietary habits,physical activity,obesity management,and psychological well-being to mitigate the escalating burden of cardiovascular diseases in the population.

Heart failure in China:epidemiology and current management

The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascularhealth in China.In connection with the previous section,this sixth section of the report offers a comprehensive analysis of heart failure(HF)in China.HF is one of the most important cardiovascular disease in the 21st century.Its mortality is equivalent to that of cancer.It is an important public health problem that seriously affects the health of Chinese residents.In recent years,with the deepeningof understanding,the change of treatment principles,the innovation of treatment methods and the update of treatment guidelines,the in-hospital mortality of HF patients has declined,and the long-term prognosis is also improving.However,there are stilldifferences in the management level of HF among different hospitals in China.How to improve the standardized diagnosis andtreatment level of HF in China remains an important challenge.

Epidemiology and current management of cardiovascular disease in China

The Annual Report on Cardiovascular Health and Diseases in China(2022) intricate landscape of cardiovascular health in China. This is the fourth section of the report with a specific focus on epidemiology and current management of cardiovascular disease(CVD) in China. This section of the report highlights the epidemiological trends of CVD in China. It reveal a concerning rise in prevalence, with approximately 330 million affected individuals, including significant numbers with stroke, coronary artery disease(CAD), heart failure, and other conditions. CVD stands as the primary cause of mortality among both urban and rural populations, accounting for nearly half of all deaths in 2020. Mortality rates are notably higher in rural areas compared to urban centers since 2009. While age-standardized mortality rates have decreased, the absolute number of CVD deaths has increased, primarily due to population aging. Ischemic heart disease, hemorrhagic and ischemic strokes are the leading causes of CVD-related deaths. Notably, the burden of atherosclerotic cardiovascular disease has risen substantially, with atherosclerotic cardiovascular disease-related deaths increasing from 1990 to 2016. The incidence of ischemic stroke and ischemic heart disease has shown similar increasing trends over the past three decades. CAD mortality, particularly acute myocardial infarction, has been on the rise, with higher mortality rates observed in rural areas since 2016. The prevalence of CAD has increased significantly, with over 11 million patients identified in 2013. Studies assessing hospital performance in managing acute coronary syndrome reveal gaps in adherence to guideline-recommended strategies, with disparities in care quality across hospitals. However, initiatives like the China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Retrospective AMI Study and the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS) project aim to improve patient outcomes through enhanced care protocols. Moreover, advancements in medical technology, such as quantitative flow ratio-guided lesion selection during percutaneous coronary intervention, show promise in improving clinical outcomes for patients undergoing intervention.

Disorders of cardiac rhythm in China

The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.In connection with the previous section,this seventh section of the report offers a comprehensive analysis of dis-orders of heart rhythm in China.In 2021,China has achieved significant development and gratifying results in many aspects of the field of arrhythmia.Left bundle branch pacing(LBBP),as an emerging pacing technique originating from China,has received widespread attention.New research results have emerged on its indications,surgical procedures,clinical evaluation,and com-parison with other pacing techniques.Its feasibility,effectiveness,and safety have been basically verified,but its long-term pro-gnosis still needs further confirmation from larger samples and longer follow-up time research results.Leadless pacemakers have begun to be used in a wider range of clinical applications,and related large sample cohort studies have been reported.In addi-tion,there are also noteworthy new achievements in the fields of pacemaker remote programming,anticoagulation and radiofre-quency catheter ablation(RFCA)therapy for atrial fibrillation,and implantable cardioverter defibrillator prevention of sudden cardiac death.In terms of clinical practice,due to COVID-19 pandemic,the number of RFCA procedures and other device im-plantations in China has fluctuated,but it has gradually recovered since 2020.

Epidemiology and current management of cerebrovascular disease in China

The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.In connection with the previous section,this fifth section of the report continues the dissection on the manage-ment of cardiovascular diseases(CVD).Cerebrovascular disease is the leading cause of death and loss of healthy life among Chinese residents.Based on the results of GBD 2019,from 1990 to 2019,the years of life lost due to premature death caused by stroke showed a decreasing trend,while the years lived with disability still increased continuously.At present,national mortal-ity surveillance system can provide national and provincial representative annual death data on cerebrovascular disease,but the national representative data on some other important epidemiological indicators(such as incidence,prevalence,disability rate,and case fatality rate)are scarce in China.With the construction of large cohort population and extension of follow-up time,re-search on stroke-related risk factors is increasing,providing a basis for the prevention and control of risk factors.Due to limited large-scale population-based intervention studies,there is a lack of epidemiological evidence to transform into feasible interven-tion strategies and measures.In recent years,great progress in endovascular treatment for basilar-artery occlusion has been achieved in China,but there is still much room for improvement of guideline-based anticoagulant treatment and lipid-lowering treatment,as well as standardized diagnosis and treatment among patients with ischemic stroke.

Community-based prevention and treatment of cardiovascular diseases

The Annual Report on Cardiovascular Health and Diseases in China(2022)intricate landscape of cardiovascular health in China.This is the third section of the report with a specific focus on community-based prevention and treatment of cardiovascular diseases(CVD).This section of the report underscores the importance of initiatives outlined in the"Healthy China 2030 Plan,"emphasizing the comprehensive prevention and control strategy for chronic diseases.A key aspect of this plan involves the establishment of national demonstration areas aimed at comprehensive prevention and control of chronic diseases.By 2020,488 such areas had been set up across China,surpassing the initial target and covering a significant proportion of counties and districts.The report highlights the successful implementation of these strategies in Lishan district,Anshan city,where demonstration areas for comprehensive prevention and control of chronic diseases were launched in 2013.Over the course of seven years,the number of healthy units increased substantially,leading to improvements in managing risk factors for CVD among residents.Significant reductions in prevalence rates of overweight,obesity,smoking,passive smoking,and drinking were observed,along with the development of healthier behaviors among residents.Similarly,Qiaokou district in Wuhan City,designated as a national demonstration area in 2014,implemented comprehensive public health promotion initiatives.Notably,special clinics for hypertension intervention were established,contributing to an increase in self-reported rates of hypertension,a slight decrease in prevalence,and a remarkable improvement in the control rate among treated patients.Overall,these efforts underscore the effectiveness of community-based approaches in driving positive health outcomes and advancing the comprehensive prevention and control of chronic diseases,particularly cardiovascular diseases,in China.

Pulmonary embolism and deep venous thrombosis in China

The Annual Report on Cardiovascular Health and Diseases in China(2022) intricate landscape of cardiovascular health in China.In connection with the previous section,this eighth section of the report offers a comprehensive analysis of pulmonary embolism and deep venous thrombosis.In recent years,research in the field of pulmonary vessel in China has made great progress.A number of nationwide multi-center registry research results have filled the gaps in the epidemiology,diagnosis and treatment of pulmonary hypertension and venous thromboembolism.Different types of pulmonary hypertension still need attention to the identification of risk factors and/or risk stratification,and venous thromboembolism needs attention in the prevention and the overall management inside and outside hospital.In the future,we look forward to the publication of more high-quality research in China,which could be able to improve relevant guidelines for pulmonary vascular diseases both domestically and inter-nationally.

Carotid versus axillary artery cannulation for descending aorta remodeling in type A acute aortic dissection

BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulation.Postoperative descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P<0.001]compared to the CA group.CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.

Report on cardiovascular health and diseases in China 2021: an updated summary

In 2019,cardiovascular disease(CVD)accounted for 46.74%and 44.26%of all deaths in rural and urban areas,respectively.Two out of every five deaths were attributed to CVD.It is estimated that approximately 330 million individuals in China are affected by CVD.Among them,there are 13 million cases of stroke,11.4 million cases of coronary heart disease,5 million cases of pulmonary heart disease,8.9 million cases of heart failure,4.9 million cases of atrial fibrillation,2.5 million cases of rheumatic heart disease,2 million cases of congenital heart disease,45.3 million cases of lower extremity artery disease,and 245 million cases of hypertension.With the dual challenges of population aging and a steady increase in the prevalence of metabolic risk factors,the burden of CVD in China is expected to continue rising.Consequently,new demands arise for CVD prevention,treatment,and the allocation of medical resources.Emphasizing primary prevention to reduce disease prevalence,increasing the allocation of medical resources for CVD emergency and critical care,and providing rehabilitation services and secondary prevention to reduce the risk of recurrence,rehospitalization,and disability among CVD survivors are of paramount importance.Hypertension,dyslipidemia,and diabetes affect millions of individuals in China.Since blood pressure,blood lipids,and blood sugar levels often rise insidiously,vascular disease and serious events such as myocardial infarction and stroke occur by the time they are detected in this population.Therefore,it is crucial to implement strategies and measures to prevent risk factors such as hypertension,dyslipidemia,diabetes,obesity,and smoking.Furthermore,greater efforts should be directed towards assessing cardiovascular health status and conducting research on early pathological changes to enhance prevention,treatment,and understanding of CVD.

China cardiovascular diseases report 2015： a summary

1 Introduction Major and profound changes have taken place in China over the past 30 years. An epidemic of cardiovascular diseases （CVD） in China is emerging as a result of lifestyle changes, urbanization, and the accelerated process of aging. The incidence of CVD is continuously increasing and will remain an upward trend in the next decade. Since 2005,

China cardiovascular diseases report 2018: an updated summary

1 Introduction Rapid socioeconomic progress has greatly affected the lifestyle in China.Consequently,owing to lifestyle changes,urbanization,and accelerated population aging,the risk of cardiovascular diseases(CVD)has increased.The incidence of CVD has been increasing continuously and this upward trend is projected to continue in the next decade.The growing burden of CVD has become a major public health issue.

Better parameters of ventilation-CO2 output relationship predict death in CHF patients

Objective: Measures of ventilation-co_2 output relationship have been shown to be more prognostic than peak O_2 uptake in assessing life expectancy in patients with chronic heart failure(CHF). Because both the ratios(V4e/V4co_2) and slopes(V4e-vs-V4co_2) of ventilation-co_2 output of differing durations can be used, we aim to ascertain which measurements best predicted CHF life expectancy. Methods: Two hundred and seventy-one CHF patients with NYHA class II-IV underwent incremental cardiopulmonary exercise testing(CPET) and were followed-up for a median duration of 479 days. Four different linear regression V4e-vsV4co_2 slopes were calculated from warm-up exercise onset to: 180 s, anaerobic threshold(AT), ventilatory compensation point(VCP); and peak exercise. Five V4e/V4co_2 ratios were calculated for the following durations: rest(120 s), warm-up(30 s), AT(60 s), lowest value(90 s), and peak exercise(30 s). Death or heart transplant were considered end-points. Multiple statistical analyses were performed. Results: CHF patients had high lowest V4e/V4co_2(41.0±9.2, 141±30%pred), high V4e/V4co_2 at AT(42.5±10.4, 145±35%pred), and high V4e-vs-V4co_2 slope to VCP(37.6±12.1, 126±41%pred). The best predictor of death was a higher lowest V4e/V4co_2(≥42, ≥141%pred), whereas the V4e-vs-V4co_2 slope to VCP was less variable than other slopes. For death prognosis in 6 months, %pred values were superior: for longer times, absolute values were superior. Conclusion: The increased lowest V4e/V4co_2 ratio easily identifiable and simply measured during exercise, is the best measurement to assess the ventilation-co_2 output relationship in prognosticating death in CHF patients.

Tissue Extracts From Infarcted Myocardium of Rats in Promoting the Differentiation of Bone Marrow Stromal Cells Into Cardiomyocyte-like Cells

Objective To investigate whether cardiac tissue extracts from rats could mimic the cardiac microenvironment and act as a natural inducer in promoting the differentiation of bone marrow stromal cells （BMSCs） into cardiomyocytes. Methods Three kinds of tissue extract or cell lysate [infarcted myocardial tissue extract （IMTE）, normal myocardial tissue extract （NMTE） and cultured neonatal myocardial lysate （NML）] were employed to induce BMSCs into cardiomyocyte-like cells. The cells were harvested at each time point for reverse transcription-polymerase chain reaction （RT-PCR） detection, immunocytochemical analysis, and transmission electron microscopy. Results After a 7-day induction, BMSCs were enlarged and polygonal in morphology. Myofilaments, striated sarcomeres, Z-lines, and more mitochondia were observed under transmission electron microscope. Elevated expression levels of cardiac-specific genes and proteins were also confirmed by RT-PCR and immunocytochemistry. Moreover, IMTE showed a greater capacity of differentiating BMSCs into cardiomyocyte-like cells. Conclusions Cardiac tissue extracts, especially IMTE, can effectively differentiate BMSCs into cardiomyocyte-like cells.

Outcomes of cardiac surgery in senior aged patients with ventricular dysfunction:analysis of a large national database

OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western surgical populations involving specific surgery types,our aim is to evaluate the real-world characteristics and perioperative outcomes of surgery in senior-aged heart failure patients with reduced EF across a broad range cardiac surgeries.METHODS Data were obtained from the China Heart Failure Surgery Registry(China-HFSR)database,a nationwide multicenter registry study in China's Mainland.Multiple variable regression analysis was performed in patients over 75 years old to identify risk factors associated with mortality.RESULTS From 2012 to 2017,578 senior-aged(>75 years)patients were enrolled in China HFSR,21.1%of whom were female.Isolated coronary bypass grafting(CABG)were performed in 71.6%of patients,10.1%of patients underwent isolated valve surgery and 8.7%received CABG combined with valve surgery.In-hospital mortality was 10.6%,and the major complication rate was 17.3%.Multivariate analysis identified diabetes mellitus(odds ratio(OR)=1.985),increased creatinine(OR=1.007),New York Heart Association(NYHA)Class III(OR=1.408),NYHA class IV(OR=1.955),cardiogenic shock(OR,6.271),and preoperative intra-aortic balloon pump insertion(OR=3.426)as independent predictors of in-hospital mortality.CONCLUSIONS In senior-aged patients,preoperative evaluation should be carefully performed,and strict management of reversible factors needs more attention.Senior-aged patients commonly have a more severe disease status combined with more frequent comorbidities,which may lead to a high risk in mortality.

Mass Spectrometry Imaging-Based Single-Cell Lipidomics Profiles Metabolic Signatures of Heart Failure

Heart failure(HF),leading as one of the main causes of mortality,has become a serious public health issue with high prevalence around the world.Single cardiomyocyte(CM)metabolomics promises to revolutionize the understanding of HF pathogenesis since the metabolic remodeling in the human hearts plays a vital role in the disease progression.Unfortunately,current metabolic analysis is often limited by the dynamic features of metabolites and the critical needs for high-quality isolated CMs.Here,high-quality CMs were directly isolated from transgenic HF mice biopsies and further employed in the cellular metabolic analysis.The lipids landscape in individual CMs was profiled with a delayed extraction mode in time-of-flight secondary ion mass spectrometry.Specific metabolic signatures were identified to distinguish HF CMs from the control subjects,presenting as possible single-cell biomarkers.The spatial distributions of these signatures were imaged in single cells,and those were further found to be strongly associated with lipoprotein metabolism,transmembrane transport,and signal transduction.Taken together,we systematically studied the lipid metabolism of single CMs with a mass spectrometry imaging method,which directly benefited the identification of HF-associated signatures and a deeper understanding of HF-related metabolic pathways.

Advances in China＇s Organ Transplantation Achieved with the Guidance of Law

＂Transplantation＂ （Volume 97, Number 8, April 27, 2014） published an open letter from Professor Delmonico along with other seven professors to Mr. Xi Jinping, President of the People＇s Republic of China： China＇s Fight Against Corruption in Organ Transplantation. The article sharply posed this concern, thus evoking great attention at home and abroad within the transplant community. To this end, we hereby state our views and declare our position with regard to the concerns mentioned in the open letter about China＇s organ transplant undertaking.

The New Era of Organ Transplantation in China

On June 13, 2016, the US congress passed the bill H. Res. 343 based on the false statements regarding organ transplantation in China, which indicated serious miscommunication and misjudgment between China and the US on the issue. The bill is preceded and followed by a series distorted media reports by the Cable News Network and the New York Times.II,21 It is a typical act ofdemonizing China with colored glasses that boldly ignored the facts and fabricated the evidence for political purposes.

Comparison of two radiofrequency ablation devices for atrial fibrillation concomitant with a rheumatic valve procedure

Background: Perioperative and median-term follow-up outcomes have not been compared among procedures using radiofrequency ablation devices for permanent atrial fibrillation with concomitant rheumatic valve disease. We compared the sinus rhythm restoration efficacy of "non-irrigation" ablation forceps and an "irrigation" ablation device in patients with rheumatic valve disease undergoing a modified Cox maze radiofrequency ablation procedure due to permanent atrial fibrillation. Methods: Data of 278 patients with rheumatic valve disease from the Cardiac Surgery Department of Sichuan Provincial People’s Hospital who underwent the modified Cox maze radiofrequency ablation procedure between May 2013 and May 2017 were reviewed. The procedure was performed using "non-irrigation" ablation forceps (AtriCure, group A) in 149 patients and an "irrigation" ablation device (Medtronic, group M) in 129 patients. Data were collected prospectively, and follow-up was documented and compared between the groups. Results: The radiofrequency procedure duration was 28.9 ± 3.8 min in group A and 29.5 ± 2.8 min in group M (t = 1.623, P = 0.106). The predicted radiofrequency time to the left atrium diameter was (Ya = 0.4964 X + 0.3762, R^2 = 0.74) in group A and (Ym = 0.4331 X + 4.3563, R2 = 0.8435) in group M. The sinus rhythm (SR) conversion rate without use of anti-arrhythmic drugs was similarly good in groups A and M, with 75.2%, 72.5%, and 70.5% vs. 73.6%, 71.3%, and 69.8% at discharge, 6 and 12 months, respectively (F = 0.084, F = 0.046, F = 0.046, P > 0.05, respectively). Conclusion: Two types of radiofrequency ablation devices characteristic of "non-irrigation" and "irrigation" bipolar ablation forceps were similarly efficient at SR restoration.