Gender-specific association of decreased estimated glomerular filtration rate and left vertical geometry in the general population from rural Northeast China

Abstract Background Left ventricular hypertrophy (LVH) is common and associated with cardiovascular outcomes among patients with known chronic kidney disease (CKD). However, the link between decreased estimated glomerular filtration rate (eGFR) and left ventricular (LV) geometry remains poorly explored in general population. In this study, we examined the gender-specific association between eGFR and LVH in the general population from rural Northeast China. Methods This survey was conducted from July 2012 to August 2013. A total of 10907 participants (5,013 men and 5,894 women) from the rural Northeast China were randomly selected and examined. LV mass index (LVMI) was used to define LVH (LVMI\u2009>\u200946.7\ua0g/m 2.7 in women; > 49.2\ua0g/m 2.7 in men). LV geometry was defined as normal, or with concentric remodeling, eccentric or concentric hypertrophy, according to relative wall thickness (RWT) and LVMI. Mildly decreased eGFR was defined as eGFR\u2009\u2265\u200960 and\u2009<\u200990\ua0ml/min/1.73\ua0m 2 , and moderate-severely decreased eGFR was defined as eGFR\u2009<\u200960\ua0ml/min/1.73\ua0m 2 . Results As eGFR decreased, LVH showed a gradual increase in the entire study population. Multivariate analysis revealed a gender-specific relationship between eGFR and LV geometry. Only in men, mildly decreased eGFR was associated with concentric remodeling [odds ratio (OR): =1.58; 95% CI: 1.14\u20132.20; P \u2009<\u20090.01] and concentric LVH OR \u2009=\u20091.63; 95% CI: 1.15\u20132.31; P \u2009<\u20090.01). And only in men, moderate-severely decreased eGFR was a risk factor for concentric LVH ( OR \u2009=\u20094.56; 95% CI: 2.14\u20139.73; P \u2009<\u20090.001) after adjusting for confounding factors. Conclusions These findings suggested that decreased eGFR was a risk factor for LV geometry in men, and a gender-specific difference should be taken into account in clinical practice

Decreased Glomerular Filtration Rate Is Associated with Mortality and Cardiovascular Events in Patients with Hypertension: A Prospective Study

BACKGROUND: Few studies reported the associations between decreased glomerular filtration rate (GFR) and mortality, coronary heart disease (CHD), and stroke in hypertensive patients. We aim to assess the associations between GFR and mortality, CHD, and stroke in hypertensive patients and to evaluate whether low GFR can improve the prediction of these outcomes in addition to conventional cardiovascular risk factors. METHODS AND FINDINGS: This is an observational prospective study and 3,711 eligible hypertensive patients aged ≥5 years from rural areas of China were used for the present analysis. The associations between eGFR and outcomes, followed by a median of 4.9 years, were evaluated using Cox proportional hazards models adjusting for other potential confounders. Low eGFR was independently associated with risk of all-cause mortality, cardiovascular mortality, and incident stroke [multivariable adjusted hazard ratios (95% confidence intervals) for eGFR <60 ml/min/1.73 m(2) relative to eGFR ≥90 ml/min/1.73 m(2) were 1.824 (1.047-3.365), 2.371 (1.109-5.068), and 2.493 (1.193-5.212), respectively]. We found no independent association between eGFR and the risk of CHD. For 4-year all-cause and cardiovascular mortality, integrated discrimination improvement (IDI) was positive when eGFR were added to traditional risk factors (1.51%, P = 0.016, and 1.99%, P = 0.017, respectively). For stroke and CHD events, net reclassification improvements (NRI) were 5.9% (P = 0.012) and 1.8% (P = 0.083) for eGFR, respectively. CONCLUSIONS: We have established an inversely independent association between eGFR and all-cause mortality, cardiovascular mortality, and stroke in hypertensive patients in rural areas of China. Further, addition of eGFR significantly improved the prediction of 4-year mortality and stroke over and above that of conventional risk factors. We recommend that eGFR be incorporated into prognostic assessment for patients with hypertension in rural areas of China. LIMITATIONS: We did not have sufficient information on atrial fibrillation to control for the potential covariate. These associations should be further confirmed in future

Associations of trajectories in body roundness index with incident cardiovascular disease: a prospective cohort study in rural China

AimsThe body roundness index (BRI) has good predictive ability for both body fat and visceral adipose tissue. Longitudinal BRI trajectories can reveal the potential dynamic patterns of change over time. This prospective study assessed potential associations between BRI trajectories and incident cardiovascular disease (CVD) in rural regions of Northeast China.MethodsIn total, 13,209 participants (mean age: 49.0 ± 10.3 years, 6,856 [51.9%] male) were enrolled with three repeated times of BRI measurements at baseline (2004–2006), 2008, and 2010, and followed up until 2017 in this prospective study. Using latent mixture model, the BRI trajectories were determined based on the data from baseline, 2008 and 2010. Composite CVD events (myocardial infarction, stroke, and CVD death combined) was the primary endpoint. Cox proportional-hazards models were used to analyze the longitudinal associations between BRI trajectories and incident CVD.ResultsThree distinct BRI trajectories were identified: high-stable (n = 538), moderate-stable (n = 1,542), and low-stable (n = 11,129). In total, 1,382 CVD events were recorded during follow-up. After adjustment for confounders, the moderate-stable and high-stable BRI groups had a higher CVD risk than did the low-stable BRI group, and the HR (95%CI) were 1.346 (1.154, 1.571) and 1.751 (1.398, 2.194), respectively. Similar associations were observed between the trajectories of BRI and the risk of stroke and CVD death. The high-stable group was also significantly and independently associated with CVD, myocardial infarction, stroke, and CVD death in participants aged &lt;50 years.ConclusionBRI trajectory was positively associated with incident CVD, providing a novel possibility for the primary prevention of CVD in rural regions of China

Effect of short-term exercise intervention on cardiovascular functions and quality of life of chronic heart failure patients: A meta-analysis

AbstractObjectiveThe purpose of this study was to comprehensively evaluate the effect of short-term exercise intervention on the cardiovascular functions and quality of life (QoL) of patients with chronic heart failure (CHF).MethodsThis meta-analysis was analyzed using RevMan5.3 and Stata 13.0. The parameters of cardiovascular functions and QoL were assessed. Weighted mean differences and their corresponding 95% confidence intervals (CIs) were computed for continuous variables.ResultsData from 2533 CHF patients enrolled in 28 published studies of randomized controlled trials (RCTs) were collated. There were significant differences in VO2 max prior to and after exercise intervention in CHF patients who are 50–55 years old (5 RCTs; 95% CI, −4.86 to −2.29; I2 = 50.5%), 60–65 years old (10 RCTs; 95% CI, −2.66 to −2.04; I2 = 0%), and 69–75 years old (5 RCTs; 95% CI, −1.88 to −0.34; I2 = 38.5%). VO2 max was significantly increased by aerobic exercise (9 RCTs; 95% CI, −3.45 to −1.92; I2 = 37.7%) and combined aerobic resistance exercise (4 RCTs; 95% CI, −4.41 to −0.26; I2 = 76.6%). There were significant differences in cardiac output (n = 303; 95% CI, −0.25 to −0.02; I2 = 12%) and QoL (n = 299; 95% CI, 3.19 to 9.70; I2 = 17%) prior to and after short-term exercise.ConclusionAerobic exercise and aerobic with resistance exercise can significantly improve the aerobic capacity of CHF patients, whereas resistance exercise cannot. The improvement in aerobic capacity caused by aerobic exercise and aerobic with resistance exercise decreases with age. Systolic blood pressure and ventricle structures and functions of CHF patients show no significant changes after the short-term exercise intervention

Validation of an adaptive transfer function method to estimate the aortic pressure waveform

Aortic pulse wave reflects cardiovascular status, but, unlike the peripheral pulse wave, is difficult to be measured reliably using noninvasive techniques. Thus, the estimation of aortic pulse wave from peripheral ones is of great significance. This study proposed an adaptive transfer function (ATF) method to estimate the aortic pulse wave from the brachial pulse wave. Aortic and brachial pulse waves were derived from 26 patients who underwent cardiac catheterization. Generalized transfer functions (GTF) were derived based on the autoregressive exogenous model. Then, the GTF was adapted by its peak resonance frequency. And the optional peak resonance frequency for an individual was determined by regression formulas using brachial systolic blood pressure. The method was validated using the leave-one-out cross validation method. Compared with previous studies, the ATF method showed better performance in estimating the aortic pulse wave and predicting the feature parameters. The prediction error of the aortic systolic blood pressure and pulse pressure were 0.2 ± 3.1 and -0.9 ± 3.1 mmHg, respectively. The percentage errors of augmentation index, percentage notch amplitude, and ejection duration were -2.1 ± 32.7%, 12.4 ± 9.2%, and -2.4 ± 3.3%, respectively

The numerical simulation study on the dynamic variation of residual oil with water drive velocity in water flooding reservoir

The results of core displacement experiments show that increasing the water drive velocity when it is bigger than the limit value can effectively reduce the residual oil saturation and improve the oil displacement efficiency under the same PV. However, the existing commercial simulators (Eclipse, CMG et al.) cannot simulate the effect of water velocity on the relative permeability curve in the process of numerical simulation.In this article, capillary number (Ca), defined as the dimensionless ratio of viscous force to capillary force, is used to characterize the relationship between water drive velocity and residual oil. Second, a new Boltzmann (BG) equation is proposed to match the nonlinear relationship between Ca and residual oil. The BG equation is a continuous function, which is very beneficial to the stability of numerical calculation. Finally, a new reservoir numerical simulator is established which captures the dynamic variation of residual oil saturation with water drive velocity in a water flooding reservoir based on the black oil model. The new simulator was verified by comparing it with the commercial reservoir simulator ECLIPSE and experimental data. The simulation results show that compared with the common model, the model considering the dynamic variation of residual oil saturation with water drive velocity reduced the residual oil saturation near the main flow line after enhanced injection rate. The oil phase flow capacity in the model is enhanced, the water cut is decreased, and the oil recovery rate is higher. The history matching of the S oilfield in Bohai Bay is achieved with the new simulator, and the history matching accuracy is obviously higher than that of Eclipse. The findings of this study can help with a better understanding of the distribution law and flow law of remaining oil in the high water cut stage of the reservoir and have good theory and application value for water flooding offshore oilfields

A novel criterion of metabolically healthy obesity could effectively identify individuals with low cardiovascular risk among Chinese cohort

Background and objectiveObesity has become a serious public health problem and brings a heavy burden of cardiovascular disease. Metabolically healthy obesity (MHO) is defined as individuals with obesity with no or only minor metabolic complications. Whether individuals with MHO have a lower cardiovascular risk remains controversial. In this study, a new criterion was used to define MHO and assess its predictive value for cardiovascular events and death. At the same time, the new criterion and the traditional criterion are compared to analyze the differences between different diagnostic criteria.MethodsA prospective cohort was established in northeast rural China from 2012 to 2013. Follow-up was conducted in 2015 and 2018 to investigate the incidence of cardiovascular events and survival. Subjects were grouped according to the metabolic health and obesity status. Kaplan-Meier curves were drawn to describe the cumulative risk of endpoint events in the four groups. Cox regression analysis model was constructed to evaluate the risk of endpoint events. Analysis of variance and post hoc analyses were used to calculate and compare differences in metabolic markers between MHO subjects diagnosed by novel and traditional criteria.ResultsA total of 9345 participants 35 years of age or older without a history of cardiovascular disease were included in this study. After a median follow-up of 4.66 years, the data showed that participants in the MHO group had no significant increase in the risk of composite cardiovascular events and stroke, but had a 162% increase in the risk of coronary heart disease (HR: 2.62; 95%CI: 1.21-5.67). However, when using conventional criteria for metabolic health, mMHO group had a 52% increase in combined CVD risk (HR: 1.52; 95%CI: 1.14-2.03). By comparing the differences of metabolic indicators between MHO subjects diagnosed by the two criteria, MHO subjects diagnosed by the new criterion had higher WC, WHR, TG, FPG, and lower HDL-C levels except for lower blood pressure, showing more exposure to cardiovascular risk factors.ConclusionsThe risk of combined CVD and stroke was not increased in MHO subjects. The new metabolic health criterion is superior to the traditional criterion and can effectively identify individuals with obesity with a lower risk of combined CVD. Blood pressure levels may be responsible for the inconsistent risk of combined CVD in MHO subjects diagnosed with both criteria