Causal effects of circulating vitamin levels on the risk of heart failure:a Mendelian randomization study

BACKGROUND Observational studies suggest inverse associations between serum vitamin levels and the risk of heart failure(HF). However, the causal effects of vitamins on HF have not been fully elucidated. Here, we conducted a Mendelian randomization(MR) study to investigate the causal associations between genetically determined vitamin levels and HF.METHODS Genetic instrumental variables for circulating vitamin levels, including vitamins A, B, C, D, and E, which were assessed as either absolute or metabolite levels were obtained from public genome-wide association studies. Summary statistics for single-nucleotide-polymorphisms and HF associations were retrieved from the HERMES Consortium(47,309 cases and 930,014controls) and FinnGen Study(30,098 cases and 229,612 controls). Two-sample MR analyses were implemented to assess the causality between vitamin levels and HF per outcome database, and the results were subsequently combined by meta-analysis.RESULTS Our MR study did not find significant associations between genetically determined circulating vitamin levels and HF risk. For absolute vitamin levels, the odds ratio for HF ranged from 0.97(95% confidence interval [CI]: 0.85–1.09, P = 0.41) for vitamin C to 1.05(95% CI: 0.61–1.82, P = 0.85) for vitamin A. For vitamin metabolites, the odds ratio ranged between 0.94(95% CI:0.75–1.19, P = 0.62) for α-tocopherol and 1.11(95% CI: 0.98–1.26, P = 0.09) for γ-tocopherol.CONCLUSION Evidence from our study does not support the causal effects of circulating vitamin levels on HF. Therefore,there may be no direct beneficial effects of vitamin intake on the prevention of primary HF.

Prevalence of and risk factors for postprandial hypotension in older Chinese men

ObjectiveTo 估计流行并且冒险因素因为在旧、很旧的中国 men.MethodsThe 学习之中的饭后的低血压(PPH ) 65 包括了 349 个中国人并且更旧，组织了进二个年龄范畴：组 1 (旧) 65 ～ 80 年包括了 163 个人；组 2 (很旧) 超过 80 年包括了 186 个人。在饭以后的血压变化被估计由监视的回廊血压的每 15 min。在饭摄取以后并且在相对血压变化处于基线条件站起来和变化以后的症状连续地被观察。另外的基线数据包括了身体团索引，病历，和 PPH 的药 use.ResultsThe 流行总的来说是 59.3% 并且比组织 1 在组 2 是显著地更高的(63.4% 对 54.6% ， P &#x0003c；0.05 ) 。在组 2，在早餐(33.8%) 和午餐(32.1%) 以后的 PPH 的流行在晚饭(20.9%) 以后比那高， P &#x0003c；0.05。高血压和年龄是为 PPH 的重要风险因素(或 = 2.188， 95% CI：1.134 &#x02212； 4.223， P = 0.02；或 = 1.86， 95% CI：1.112 &#x02212； 3.11， P = 0.018，分别地) 。相反， acarbose 使用对 PPH 是保护的(或 = 0.4， 95% CI：0.189 &#x02212； 0.847， P = 0.017 ) 。在血压的减少在 PPH 期间是 20 &#x02212； 40 mmHg 和最大值是 90 mmHg。 PPH 通常发生在 30 &#x02212 ；在饭以后的 60 min 并且持续了 30 &#x02212 ； 120 min.ConclusionsThese 调查结果证明在超过 80 年的人的 PPH 的流行比在 65～80 年的人的那些显著地高，并且血压衰落为超过 80 年的人也是更高的。另外，高血压和年龄是为在老人的 PPH 的主要风险因素，它建议那阻止并且对待的 PPH 是值得的。

Sex Hormones and Androgen Receptor:Risk Factors of Coronary Heart Disease in Elderly Men

Objective To investigate the variation of sex hormone and its receptor level in elderly male patients with coronary heart disease (CHD) and to evaluate the correlations between CHD and sex hormone as well as sex hormone receptor. Methods Altogether 139 male CHD patients (CHD group) aged 60-92 years and 400 healthy men (control group) aged 60-90 years were included in this cross sectional study. The plasma concentrations of dehydroepiandrosterone sulfate (DHEAS),total testosterone (TT),free testosterone (FT),estradiol (E2),sex hormone binding globulin (SHBG),luteinizing hormone (LH),and follicle-stimulating hormone (FSH) were measured. The androgen receptor (AR) was tested by flow cytometry. Correlations between CHD and levels of sex hormones and AR were analyzed. Results Compared with the control group,the levels of DHEAS,TT,FT,SHBG,and the fluorescence intensity of AR in the CHD group significantly reduced (P<0.05),while the levels of FSH and E2 significantly increased (P<0.01). Age was negatively correlated with TT (r=-0.28,P=0.00) and FT (r=-0.17,P=0.01),while it was positively correlated with SHBG (r=0.14,P=0.04) and E2 (r=0.33,P=0.00). AR fluorescence intensity was negatively correlated with systolic blood pressure (r=-0.12,P=0.01). Binary logistic regression analysis showed that TT,SHBG,and AR were all negatively correlated with CHD (P<0.05). Conclusions Elderly male patients with CHD are found to have low levels of DHEAS,TT,FT,SHBG,and AR,while high concentrations of E2 and FSH. Low levels of TT and SHBG may be the potential risk factors of CHD in elderly men.

Prevalence of iron deficiency in patients aged 75 years or older with heart failure

Background The latest studies presented at the American Heart Association (AHA) meeting on heart failure and the update of the European Cardiology Society’s (ECS) recommendations on heart failure in 2016 recommend intravenous iron supplementation in patients with heart failure, reduced ejection fraction and iron deficiency for improves walking performance and quality of life, and reduces morbidity. In the present study, we investigated the prevalence of iron deficiency in heart failure patients aged 75 years or older, as there is currently no data on these patients. Methods We performed an observational study on hospitalized patients in Geriatric Cardiology Department. Among the 462 patients hospitalized during eight months, 176 were eligible for inclusion;22 patients was significant interference with an inflammatory syndrome (high ferritin with high C-reactive protein), and for 13 patients iron-related data were not available. For each patient included, a complete iron assessment and type of heart failure was available. Results A total of 141 patients were included, the mean age was 88 years (range: 75–101), and there were 52 (36.9%) of patients with reduced ejection fraction (EF), 37 (26.2%) with mid-range EF, and 52 (36.9%) with preserved EF. Irrespective of heart failure type, 73.8% had iron deficiency (95% CI: 65.7%–80.8%);this was found in 57.7%(95% CI: 43.2%–71.3%) of those with reduced EF, 78.4%(95% CI: 61.8%–90.2%) of those with mid-range EF, and 86.5%(95% CI: 74.2%–94.4%) of those with preserved EF (P = 0.003). Conclusion The prevalence of iron deficiency was very high in very elderly patients with heart failure, especially those with HF with mid-range EF or HF with preserved EF.

Associations of plasma homocysteine and high-sensitivity C-reactive protein levels with arterial stiffness in Chinese population： a community-based study

Background Arterial stiffness increases with age and is also associated with traditional cardiovascular risk factors. Little is known about the relations of homocysteine and high-sensitivity C-reactive protein （hs-CRP） to arterial stiffness in the Chinese community. The aim of the present study was to investigate the association of plasma homocysteine and hs-CRP levels with arterial stiffness in a community-based cohort. Methods We related levels of homocysteine and hs-CRP to four measures of arterial stiffness （carotid-femoral pulse wave velocity （PWV）, carotid-radial PWV, carotid-ankle PWV and heart rate corrected augmentation index） in 1680 participants from two communities of Beijing, China. Arterial stiffness was measured within two days of the time of biomarker measurement. Results In univariate analysis, homocysteine was positively associated with the carotid-femoral PWV （r=0.211, P 〈0.0001）, carotid-radial PWV （r=0.120, P 〈0.0001） and carotid-ankle PWV （r=0.148, P 〈0.0001）, whereas it was inversely related to the augmentation index （r= -0.052, P=0.016）. Hs-CRP was positively associated with the carotid-femoral PWV （r=0.074, P=0.001） and carotid-ankle PWV （r=0.050, P=0.02）. In multiple-adjusted models （R2=0.57）, homocysteine levels remained a significant determinant of the carotid-femoral PWV （standardized 13=0.065, P=0.007）, whereas the association of hs-CRP with measurements of arterial stiffness was not present. Conclusions In the Chinese population, plasma homocysteine levels are associated with alterations of aortic stiffness, whereas plasma levels of hs-CRP are not independently related to artery stiffening.

Prevalence and risk factors for left ventricular hypertrophy and left ventricular geometric abnormality in the patients with hypertension among Han Chinese

Background Left ventricular hypertrophy （LVH） and geometric abnormality are associated with morbidity and mortality of cardiovascular disease and stroke. Hypertension is the major cause of LVH. Yet the prevalence and other risk factors of LVH and geometric abnormality in Chinese hypertensive population are unknown. The objective of this study was to investigate the prevalence and risk factors of LVH and geometric abnormality in community-based Chinese hypertensive population. Methods The study was a community-based cross-sectional study, and comprised 4270 hypertension patients with integrated clinical and echocardiographic data. Left ventricular mass was measured by transthoracic echocardiography. LVH was diagnosed by using the criteria of over 49.2 g/m^2.7 for men and 46.7 g/m^2.7 for women. LV geometric patterns （normal, concentric remodeling, concentric or eccentric hypertrophy） were calculated according to LVH and relative wall thickness. Logistic regression model was used to determine the odds ratio （OR） and 95% confidence intervals （CI） of the risk factors of LVH. Results The prevalence of LVH was 42.7% in 4270 hypertensive patients, with 37.4% in males and 45.4% in females, respectively. The prevalence of concentric remodeling, concentric or eccentric hypertrophy was 24.7%, 20.2%, and 22.6%, respectively. In Logistic regression model, female （OR 1.3, 95%C/ 1.1-1.5, P 〈0.01）, age （OR 1.02, 95%C/ 1.01-1.03, P 〈0.01）, body mass index （OR 1.2, 95%C/1.15-1.20, P 〈0.01）, systolic blood pressure （OR 1.02, 95%C/ 1.01-1.03, P 〈0.01 ）, and serum triglyceride （OR 1.10, 95% CI 1.00-1.20, P 〈0.01 ） were risk factors of LVH. Female, age, body mass index, systolic blood pressure and serum triglyceride were also risk factors of left ventricular geometric abnormality. Conclusions The echocardiographic LVH is the major complication of patients with hypertension in rural area of China, especially for women. To effectively treat hypertension, weight loss and control of serum triglyceride may help to prevent LVH in hypertensive population.

Association between thyroid hormone levels and frailty in the community-dwelling oldest-old: a cross-sectional study

Background:Changes in thyroid hormone levels are commonly recognized characters among the elderly,which were reported to potentially influence incident frailty.Therefore,we examined the cross-sectional associations of thyroid hormones(THs)with frailty as well as the five components characterizing frailty(fatigue,resistance,ambulation,number ofillnesses,and loss of weight)among the oldest-old.Methods:Four hundred and eighty-seven community-dwelling oldest-old from a local community in Haidian District,Beijing,participated in our recruitment campaign between April 2019 and May 2020.The primary outcomes were a definitive diagnosis of frailty according to the FRAIL scale(Fatigue,Resistance,Ambulation,Illnesses,Loss of weight)and a positive score for each frailty subdomain.Demographic information(age,sex,marital status,and educational status),comorbidities,and details on the participants lifestyles were recorded.Serum THs including free triodothyronin(fT3),triiodothyronine(T3),free thyroxine(fT4),and thyroxine(T4)and thyroid stimulating hormone(TSH)levels were also measured at the beginning of our study.Logistic regressions were conducted to screen for potential risk factors for frailty and its subdomains.Results:Among the total 487 subjects at enrollment,60(12.23%)of them were diagnosed with subclinical hypothyroidism and 110(22.59%)of the total population scored positive for frailty.Logistic regression analyses adjusted for all potential confounders,showed that frailty was significantly associated with the serum TSH concentration(odds ratio[OR]:1.06),fT3 concentration(OR:0.54),and subclinical hypothyroidism score(OR:2.18).The association between fT4 and frailty was absent in our observational study.The fT3/fT4 ratio characterizing peripheral hormone conversion was also tested to be correlated with frailty.Conclusion:Subclinical hypothyroidism,higher TSH level,lower fT3 level,and decreased fT3/fT4 ratio were all associated with frailty assessed by the FRAIL scale among the community-dwelling oldest-old,suggesting a relevant role of thyroid function in aging.Future longitudinal studies are warranted to determine the casual relationship between thyroid dysfunction and frailty in the oldest-old.

Polymorphisms of angiotensin-converting enzyme 2 gene confer a risk to lone atrial fibrillation in Chinese male patients

Background Growing epidemiologic evidence has indicated that genetics can predispose individuals to the occurrence of lone atrial fibrillation （AF）. The angiotensin-converting enzyme 2 （ACE2） gene has been established to be associated with hypertension and left ventricular hypertrophy. The objective of our study was to investigate the association of ACE2 gene polymorphisms with lone AF. Methods A total of 265 consecutive lone AF patients and 289 healthy controls were successfully investigated. The polymorphisms rs2106809 and rs2285666 were genotyped by polymerase chain reaction （PCR） and direct sequencing. A Logistic regression model was used to determine the odds ratio （OR） and 95% confidence intervals （CO of variations of ACE2 for lone AF. Results The T allele of rs2106809 conferred an increased risk for lone AF （OR 1.24, 95% CI 1.01-1.52, P=0.03） in males after adjustment for conventional risk factors. SNP at rs2285666 in males was not significantly different between AF patients and controls. No association was found between the two polymorphisms in the female population with lone AF. After （36.3±4.5） months of follow-up, the end point data were obtained： death （cardiac and noncardiac）, ischemic stroke, and heart failure. In the male subgroup, the associations between rs2106809 T male carriers and combined end points including ischemic stroke, heart failure, and death in our study were of significance （OR 3.6, 95% CI 1.0-13.1, P=-0.04）. Conclusions The results indicate that polymorphism at ACE2 gene is associated with male lone AF in a Chinese Han population. Lone AF males who c.arrv the. rs2106809T alle.le, are. associate.d with adverse cardiac, e.ve.nts

A comparison between 18F-FDG PET/CT and classical physical examination package for cancer screening in asymptomatic Chinese patients

To the Editor:Cancer is the leading cause of death in China.[1]With rapid economic development,18F-fluorodeoxyglucose(FDG)positron emission tomography(PET)/computed tomography(CT)for screening cancer in asymptomatic patients is gaining popularity in China.PET/CT is a type of molecular imaging technology,which uses a specific tracer for localization and quantification of the disease at a molecular level.[2]However,the utility of such screening is still controversial.[3]Based on the past clinical experience,the previous physical examination protocol has been optimized,and a classical physical examination protocol has been set up at the author’s study center.So far,there is no evidence to know which approach was better for cancer screening in asymptomatic individuals.