The coronavirus disease 2019(COVID-19), which is caused by SARS-CoV-2, has become a worldwide public health crisis. Published clinical data from China and other countries have shown a much higher risk of developing CO...The coronavirus disease 2019(COVID-19), which is caused by SARS-CoV-2, has become a worldwide public health crisis. Published clinical data from China and other countries have shown a much higher risk of developing COVID-19 and dying from the disease among the elderly, especially among those who had preexisting hypertension, cardiovascular diseases(CVD) and diabetes mellitus[1].展开更多
AIM:To investigate whether impaired fasting glucose(IFG)confers cardiovascular risk.METHODS:A non-diabetic population-based sample representative of middle-aged and elderly Turks was studied at 8.5 years’follow-up fo...AIM:To investigate whether impaired fasting glucose(IFG)confers cardiovascular risk.METHODS:A non-diabetic population-based sample representative of middle-aged and elderly Turks was studied at 8.5 years’follow-up for incident diabetes and coronary heart disease(CHD).Metabolic syndrome(MetS)was defined by ATP-Ⅲcriteria modifiedfor male abdominal obesity,and IFG and type 2 diabetes were identified by criteria of the American Diabetes Association.Stratification by presence of MetS was used.Outcomes were predicted providing estimates for hazard ratio(HR)obtained by use of Cox proportional hazards regression analysis in models that controlled for potential confounders.RESULTS:In 3181 adults(aged 52±11.5 years at baseline),analysis stratified by MetS,gender and IFG status distinguished normoglycemic subjects by a"hypertriglyceridemic waist"phenotype consisting of significantly higher waist circumference,fasting triglyceride and lower high-density lipoprotein-cholesterol,regardless of gender and MetS.Additionally,lipoprotein(Lp)(a)tended to be lower in(especially female)participants with MetS.Multivariable linear regression in a subset of the sample demonstrated decreased Lp(a)levels to be associated with increased fasting glucose and insulin concentrations,again particularly in women.In Cox regression analysis,compared with normoglycemia,baseline IFG adjusted for major confounders significantly predicted incident diabetes at a 3-fold HR in men and only women with MetS.Cox models for developing CHD in 339 individuals,adjusted for conventional risk factors,revealed that IFG status protected against CHD risk[HR=0.37(95%CI:0.14-0.998)]in subjects free of MetS,a protection that attenuated partly in male and fully in female participants with MetS.CONCLUSION:IFG status in non-diabetic people without MetS displays reduced future CHD risk,yet is modulated by MetS,likely due to autoimmune activation linked to serum Lp(a).展开更多
There is some published evidence suggesting micro vascular endothelial dysfunction and dysautonomia involvement in Chagas disease in association with cardiomyocyte changes favoring disease progression. The combined tr...There is some published evidence suggesting micro vascular endothelial dysfunction and dysautonomia involvement in Chagas disease in association with cardiomyocyte changes favoring disease progression. The combined treatment between angiotensin converting enzyme (ACE) inhibitor drugs;Simvastatin, muscarinic antibody immunoadsorbent together with fungicidal drugs would open therapeutic possibilities in this disease.展开更多
Aortic Stenosis (AS) has become the most frequent valvular heart disease in the western countries with increased prevalence in the elderly. It is associated with very poor prognosis in the absence of surgical treatmen...Aortic Stenosis (AS) has become the most frequent valvular heart disease in the western countries with increased prevalence in the elderly. It is associated with very poor prognosis in the absence of surgical treatment and worse quality of life. Patients aged between 80 - 85 years with no major comorbidities and left ventricular ejection fraction between 30% - 50% are still not referred to valve surgery, even if these subjects would likely benefit from surgery in terms of duration and quality of life as compared with the expected outcome of the disease. The decision making process in octogenarian population are not only related to the decision of whether to operate or not, but also to the timing of surgery. The identification of symptoms related to AS is difficult in the elderly and this also delay surgery. Balloon Aortic Valvuloplasty (BAV) and, in the recent years, Transcatheter Aortic Valve Implantation (TAVI) seem to offer an additional chance of valve correction, in patients at high surgical risk or inoperable. For ethical reasons, the first TAVI cases were performed exclusively on patients who had contraindications to surgery because of end stage heart disease and/or severe comorbidities. This accounted for high mid-term mortality rates;however, these findings demonstrated the feasibility of this alternative approach. An overall patient evaluation based on a team approach (involving cardiologists, surgeons and geriatricians) is essential. Results from randomized clinical trials on elderly patients who underwent TAVI are encour-aging and result from one and two years follow-up are now available.展开更多
Background Atrial fibrillation (AF) is a common arrhythmia associated with increased cardiovascular morbidity and mortality This study was undertaken to analyze the epidemiological factors and evaluate the current sta...Background Atrial fibrillation (AF) is a common arrhythmia associated with increased cardiovascular morbidity and mortality This study was undertaken to analyze the epidemiological factors and evaluate the current status of treatment in patients with AF in China's Mainland Methods Retrospective analysis of hospital records were taken from patients with primary diagnosis of AF, discharged from January 1999 to December 2001 A total of 9297 cases (mean age 65 5 years) with AF were enrolled from 40 hospitals in major parts of China Results The percentage of hospital admissions with AF was gradually increased comparing to those of total cardiovascular admission during three years, with the average of 7 9% The cases distribution progressively rose with age The causes and associated conditions of AF: advanced age 58 1%, hypertension 40 3%, coronary heart disease 34 8%, heart failure 33 1%, rheumatic valvular disease 23 9%, idiopathic AF 7 4%, cardiomyopathy 5 4%, diabetes 4 1% The most common coexistence among these variables was advanced age with hypertension Permanent AF almost accounted for half of these cases (49 5%), paroxysmal and persistent AF were 33 7% and 16 7%, respectively Paroxysmal AF was mainly treated with rhythm control (56 4%) However, 82 8% of patients with chronic AF had therapeutic strategy of rate control In patients with persistent AF, the cardioversion had been attempted in cases more than 50%, with only 31 1% of these patients who could maintain stabilized sinus rhythm The prevalence of stroke in this group was 17 5% In nonvalvular AF patients the risk factors that significantly associated with stroke included advanced age, history of hypertension, coronary heart disease and type of AF Sixty four point five percent of these patients received antithrombotic therapy with dominated use of antiplatelet agents The long term prevention with anticoagulants only accounted for 6 6% In this investigation patients with antiplatelets as well as patients with anticoagulants showed significant lower stroke rate in comparison with those managed neither However, the difference between antiplatelets and anticoagulants in terms of stroke rate was not significant Conclusions Most epidemiological factors of AF from this group showed highly in accordance with those from the reports from other countries, such as age distribution, causes and associated conditions, type of AF, dominantly with approach of rate control Both antiplatelet and anticoagulant treatments significantly reduced stroke rate But there was no significant difference between these two kinds of treatments in reducing stroke rate展开更多
Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients'quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past 2 decades,th...Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients'quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past 2 decades,there have been significant breakthroughs in AF risk prediction and screening,stroke prevention,rhythm control,catheter ablation,and integrated management.During this period,the scale,quality,and experience of AF management in China have greatly improved,providing a solid foundation for the development of guidelines for the diagnosis and management of AF.To further promote standardized AF management,and apply new technologies and concepts to clinical practice in a timely and comprehensive manner,the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation.The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA,DS,-VASc-60 stroke risk score based on the characteristics of AF in the Asian population.The guidelines have also reevaluated the clinical application of AF screening,emphasized the significance of early rhythm control,and highlighted the central role of catheter ablation in rhythm control.展开更多
文摘The coronavirus disease 2019(COVID-19), which is caused by SARS-CoV-2, has become a worldwide public health crisis. Published clinical data from China and other countries have shown a much higher risk of developing COVID-19 and dying from the disease among the elderly, especially among those who had preexisting hypertension, cardiovascular diseases(CVD) and diabetes mellitus[1].
文摘AIM:To investigate whether impaired fasting glucose(IFG)confers cardiovascular risk.METHODS:A non-diabetic population-based sample representative of middle-aged and elderly Turks was studied at 8.5 years’follow-up for incident diabetes and coronary heart disease(CHD).Metabolic syndrome(MetS)was defined by ATP-Ⅲcriteria modifiedfor male abdominal obesity,and IFG and type 2 diabetes were identified by criteria of the American Diabetes Association.Stratification by presence of MetS was used.Outcomes were predicted providing estimates for hazard ratio(HR)obtained by use of Cox proportional hazards regression analysis in models that controlled for potential confounders.RESULTS:In 3181 adults(aged 52±11.5 years at baseline),analysis stratified by MetS,gender and IFG status distinguished normoglycemic subjects by a"hypertriglyceridemic waist"phenotype consisting of significantly higher waist circumference,fasting triglyceride and lower high-density lipoprotein-cholesterol,regardless of gender and MetS.Additionally,lipoprotein(Lp)(a)tended to be lower in(especially female)participants with MetS.Multivariable linear regression in a subset of the sample demonstrated decreased Lp(a)levels to be associated with increased fasting glucose and insulin concentrations,again particularly in women.In Cox regression analysis,compared with normoglycemia,baseline IFG adjusted for major confounders significantly predicted incident diabetes at a 3-fold HR in men and only women with MetS.Cox models for developing CHD in 339 individuals,adjusted for conventional risk factors,revealed that IFG status protected against CHD risk[HR=0.37(95%CI:0.14-0.998)]in subjects free of MetS,a protection that attenuated partly in male and fully in female participants with MetS.CONCLUSION:IFG status in non-diabetic people without MetS displays reduced future CHD risk,yet is modulated by MetS,likely due to autoimmune activation linked to serum Lp(a).
文摘There is some published evidence suggesting micro vascular endothelial dysfunction and dysautonomia involvement in Chagas disease in association with cardiomyocyte changes favoring disease progression. The combined treatment between angiotensin converting enzyme (ACE) inhibitor drugs;Simvastatin, muscarinic antibody immunoadsorbent together with fungicidal drugs would open therapeutic possibilities in this disease.
文摘Aortic Stenosis (AS) has become the most frequent valvular heart disease in the western countries with increased prevalence in the elderly. It is associated with very poor prognosis in the absence of surgical treatment and worse quality of life. Patients aged between 80 - 85 years with no major comorbidities and left ventricular ejection fraction between 30% - 50% are still not referred to valve surgery, even if these subjects would likely benefit from surgery in terms of duration and quality of life as compared with the expected outcome of the disease. The decision making process in octogenarian population are not only related to the decision of whether to operate or not, but also to the timing of surgery. The identification of symptoms related to AS is difficult in the elderly and this also delay surgery. Balloon Aortic Valvuloplasty (BAV) and, in the recent years, Transcatheter Aortic Valve Implantation (TAVI) seem to offer an additional chance of valve correction, in patients at high surgical risk or inoperable. For ethical reasons, the first TAVI cases were performed exclusively on patients who had contraindications to surgery because of end stage heart disease and/or severe comorbidities. This accounted for high mid-term mortality rates;however, these findings demonstrated the feasibility of this alternative approach. An overall patient evaluation based on a team approach (involving cardiologists, surgeons and geriatricians) is essential. Results from randomized clinical trials on elderly patients who underwent TAVI are encour-aging and result from one and two years follow-up are now available.
文摘Background Atrial fibrillation (AF) is a common arrhythmia associated with increased cardiovascular morbidity and mortality This study was undertaken to analyze the epidemiological factors and evaluate the current status of treatment in patients with AF in China's Mainland Methods Retrospective analysis of hospital records were taken from patients with primary diagnosis of AF, discharged from January 1999 to December 2001 A total of 9297 cases (mean age 65 5 years) with AF were enrolled from 40 hospitals in major parts of China Results The percentage of hospital admissions with AF was gradually increased comparing to those of total cardiovascular admission during three years, with the average of 7 9% The cases distribution progressively rose with age The causes and associated conditions of AF: advanced age 58 1%, hypertension 40 3%, coronary heart disease 34 8%, heart failure 33 1%, rheumatic valvular disease 23 9%, idiopathic AF 7 4%, cardiomyopathy 5 4%, diabetes 4 1% The most common coexistence among these variables was advanced age with hypertension Permanent AF almost accounted for half of these cases (49 5%), paroxysmal and persistent AF were 33 7% and 16 7%, respectively Paroxysmal AF was mainly treated with rhythm control (56 4%) However, 82 8% of patients with chronic AF had therapeutic strategy of rate control In patients with persistent AF, the cardioversion had been attempted in cases more than 50%, with only 31 1% of these patients who could maintain stabilized sinus rhythm The prevalence of stroke in this group was 17 5% In nonvalvular AF patients the risk factors that significantly associated with stroke included advanced age, history of hypertension, coronary heart disease and type of AF Sixty four point five percent of these patients received antithrombotic therapy with dominated use of antiplatelet agents The long term prevention with anticoagulants only accounted for 6 6% In this investigation patients with antiplatelets as well as patients with anticoagulants showed significant lower stroke rate in comparison with those managed neither However, the difference between antiplatelets and anticoagulants in terms of stroke rate was not significant Conclusions Most epidemiological factors of AF from this group showed highly in accordance with those from the reports from other countries, such as age distribution, causes and associated conditions, type of AF, dominantly with approach of rate control Both antiplatelet and anticoagulant treatments significantly reduced stroke rate But there was no significant difference between these two kinds of treatments in reducing stroke rate
文摘Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients'quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past 2 decades,there have been significant breakthroughs in AF risk prediction and screening,stroke prevention,rhythm control,catheter ablation,and integrated management.During this period,the scale,quality,and experience of AF management in China have greatly improved,providing a solid foundation for the development of guidelines for the diagnosis and management of AF.To further promote standardized AF management,and apply new technologies and concepts to clinical practice in a timely and comprehensive manner,the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation.The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA,DS,-VASc-60 stroke risk score based on the characteristics of AF in the Asian population.The guidelines have also reevaluated the clinical application of AF screening,emphasized the significance of early rhythm control,and highlighted the central role of catheter ablation in rhythm control.
