Aortic Artery and Cardiac Valve Calcification are Associated with Mortality in Chinese Hemodialysis Patients： A 3.5 Years Follow-up

Background： This study was to investigate the relationship among aortic artery calcification （AAC）, cardiac valve calcification （CVC）, and mortality in maintenance hemodialysis （MHD） patients. Methods： All MHD patients in Shanghai Ruijin Hospital in July 2011 were included. To follow up tbr 42 months, clinical data, predialysis blood tests, echocardiography, and lateral lumbar X-ray plain radiography results were collected. Plasma FGF23 level was measured using a C-terminal assay. Results： Totally, 110 MHD patients were involved in this study. Of which, 64 （58.2%） patients were male, the mean age was 55.2 ± 1.4 years old, and the median dialysis duration was 29.85 （3.0-225.5） months. About 25.5% of the 110 MHD patients had CVC from echocardiography while 61.8% of the patients had visible calcification of aorta from lateral lumbar X-ray plain radiography. After 42 months follow-up, 25 （22.7%） patients died. Kaplan-Meier analysis showed that patients with AAC or CVC had a significant greater number of all-cause and cardiovascular deaths than those without. In multivariate analyses, the presence of AAC was a significant factor associated with all-cause±mortality （hazard ratio [HR]： 3.149, P = 0.025） in addition to lower albumin level and lower 25-hydroxy Vitamin D （25（OH）D） level. The presence of CVC was a significant factor associated with cardiovascular mortality （HR： 3.800, P - 0.029） in addition to lower albumin level and lower 25（OH）D level. Conclusion： Lateral lumbar X-ray plain radiography and echocardiography are simple methods to detect AAC and CVC in dialysis patients. The presence of AAC and CVC was independently associated with mortality in MHD patients. Regular follow-up by X-ray and echocardiography could be a useful method to stratify mortality risk in MHD patients.

2019 Chinese expert consensus statement on aspirin application in primary prevention of cardiovascular disease

Aspirin has been widely used in primary prevention of atherosclerotic cardiovascular disease(ASCVD)J141 Aspirin for primary prevention of ASCVD does not significantly reduce all-cause mortality or cardiovascular mortality,and the main benefit of aspirin for primary prevention of ASCVD is a significant reduction in non-fatal ischemic events including myocardial infarction,transient ischemic attack,ischemic stroke,and major cardiovascular events(cardiovascular death,non-fatal myocardial infarction,and non-fatal stroke),whereas the main risk is a significant increase in non-fatal major bleeding events including gastrointestinal bleeding and intracranial hemorrhage.1 Obviously,it makes sense to prescribe aspirin for primary prevention only if the benefits clearly outweigh the risks.In Europe and the United States,the benefit-risk ratio of aspirin for primary prevention has gradually decreased compared to the past due to the wide application of other primary prevention measures such as blood pressure reduction,smoking cessation,and the use of statins.Three recent large-scale clinical trials have shown that aspirin has no net clinical benefit when used in low-risk populations.19'1^Therefore,aspirin must be used with caution in the primary prevention of ASCVD.