Chinese Coronary Heart Disease Patients Research Articles

Clinical and Prognostic Value of Non-Fasting Lipoproteins and Apolipoproteins in Chinese Patients with Coronary Heart Disease.

Lipid profiles differ naturally between individuals and between populations. So far, the data relating to non-fasting lipid profiles has been derived predominantly from studies on Western population. The characteristics and clinical significance of non-fasting lipids in Chinese patients with coronary heart disease (CHD) in response to traditional Chinese diets remain poorly understood. A total of 1022 Chinese CHD patients with coronary artery luminal stenosis 40% as diagnosed by coronary artery angiography were enrolled in the study. All patients received standard treatment for CHD, including statins. They were divided into an intermediate stenosis group (luminal stenosis 40-70%, n = 486) or a severe stenosis group (luminal stenosis 70%, n = 536). Their blood lipid profiles were measured in the fasting state, and 4 hours after normal breakfast. All participants were followed up for five years. Major adverse cardiovascular events (MACE) including all-cause death, cardiac death, myocardial infarction, unscheduled coronary revascularization and stroke were recorded. After normal breakfast intake, patients with intermediate or severe stenosis showed an apparent increase in the levels of triglyceride (TG), remnant cholesterol (RC) and Apo (apolipoprotein) A1 compared to the fasting state, but a significant reduction in the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), Apo B and Apo E. In addition to the traditional risk factors (older age, male, diabetes and smoking) and coronary artery stenosis, the fasting levels of LDL-C and Apo B, as well as non-fasting levels of HDL-C and Apo A1, were identified as independent predictors of 5-year MACE occurrence by multivariate Cox proportional hazards analysis. Patients in the 1st tertile of the non-fasting HDL-C group ( 0.86 mmol/L) showed a significantly higher risk of MACE than 3rd tertile ( 1.07 mmol/L) (1st tertile: 2.786, 95% CI (confidence intervals) [1.808, 4.293], p 0.001). This prospective observational study found that lipid profiles in either the fasting or non-fasting states were associated with the long-term risk of MACE in Chinese CHD patients. In addition to the fasting LDL-C level, a low non-fasting HDL-C level may also be an independent risk factors for cardiovascular events. Measurement of lipid profiles during the non-fasting state may be feasible for the management of CHD patients in routine clinical practice in China.

Health-Related Quality of Life and Its Influencing Factors in Patients with Coronary Heart Disease in China.

PurposeThis study aimed to comprehensively evaluate Chinese coronary heart disease (CHD) patients’ health-related quality of life (HRQoL) using various measures and explore influencing factors associated with HRQoL.MethodsA cross-sectional study was conducted from April to September 2019 in the General Hospital of Tianjin Medical University. A convenience sampling framework was used to successively recruit 316 inpatients with CHD. Two generic preference-based instruments (EQ-5D-5L and 15D), a disease-specific instrument (Seattle Angina Questionnaire, SAQ), and the WHO-5 well-being index (WHO-5) were administered. Tobit regression model and multiple linear regression were used for data analyses.ResultsA total of 305 patients (mean age was 62.9) with CHD participated in this study. The mean health state utility (HSU) scores of EQ-5D-5L and 15D were 0.85 (SD=0.14) and 0.89 (SD=0.07), respectively. For EQ-5D-5L, pain/discomfort was the most frequently reported, followed by anxiety/depression. As for 15D, discomfort and symptoms was the most severely impaired dimension. For SAQ, more limitations were found in the domains of angina stability and disease perception. For WHO-5, the mean score was 16.93. Marital status, disease state and comorbidity were influencing factors associated with HRQoL, patient’s subjective well-being had a positive impact on HRQoL.ConclusionTo improve the HRQoL of CHD patients in China, more attention needs to be paid to unmarried and relapsed patients, especially those with comorbidity of hypertension. Additionally, more social support and psychological counseling should be provided to patients.

Efficacy evaluation of PCSK9 monoclonal antibody (Evolocumab) in combination with Rosuvastatin and Ezetimibe on cholesterol levels in patients with coronary heart disease (CHD): A retrospective analysis from a single center in China

Background and purposeProprotein convertase subtilisin-kexin type 9(PCSK9) monoclonal antibody (Mab; Evolocumab) has been reported to inhibit low-density lipoprotein cholesterol (LDL-C) and Lipoprotein(a) [LP(a)] in coronary heart diseases (CHD) patients in America, Europe and Japan. However, little is known about the effect of Evolocumab in Chinese population. This retrospective study in Chinese CHD patients compared the efficacy without or with Evolocumab therapy added to the conventional treatment with a statin (Rosuvastatin) and a gut cholesterol absorption inhibitor (Ezetimibe). MethodsCHD patients from our hospital were divided into three therapeutic groups, A) the statin monotherapy group (10 mg Rosuvastatin every night); B) the statin/cholesterol absorption inhibitor group (10 mg Rosuvastatin and 10 mg Ezetimibe daily); and C) the triple therapy with PCSK9 Mab group (10 mg Rosuvastatin daily, 10 mg Ezetimibe daily, and 140 mg Evolocumab once 2 weeks). The plasma lipid data were collected at 0, 4, 12, and 24 Week(s). The Graphpad Prism 7 program was used to perform all the statistical analysis. ResultsOut of 103 patients 91 were eligible for further evaluation with 31 in group A, 31 in group B, and 29 in group C. The plasma LDL-C levels were reduced only by 33.82% in the Rosuvastatin monotherapy group, 52.13% in the Rosuvastatin/Ezetimibe group, and 73.59% in the Evolocumab/Rosuvastatin/Ezetimibe group (P < 0.0001) at 24 weeks compared to the prior therapy levels. Neither the statin therapy alone (5.95%; P = 0.6), nor the double therapy (5.27%; P = 0.7) affected LP(a) levels. In contrast, addition of Evolocumab to the double therapy significantly decreased LP(a) level by 37.2% (P < 0.0001). ConclusionAddition of Evolocumab to the standard double therapy in Chinese CHD patients improved the efficacy in LDL-C reduction when compared to Rosuvastatin alone or in Rosuvastatin/Ezetimibe double therapy. Furthermore, the addition of Evolocumab lowered LP(a) level in Chinese CHD patients.

A preliminary identification of PIN1 SNP linkage in patients with coronary heart disease from Handan, China

Our aim was to perform an initial assessment of the polymorphic patterns of the PIN1 gene in patients with coronary heart disease (CHD). The PIN1-encoded protein (Pin1) suppresses eNOS-NO signaling and may impair cardiovascular function. Blood collection, DNA extraction, PCR amplification and gene sequencing were performed for thirty CHD participants living in central China, focusing on nine single nucleotide polymorphisms (SNPs). Their genetic linkages were revealed and their allele frequencies were compared with SNP data from the NCBI. Three major linkage patterns were identified: [1.rs2287839-5.rs2233682], [3.rs2233679-4.rs1077220–8.rs2287838] and [6.rs889162-7.rs2010457], suggesting correlated involvement in CHD and possible simultaneous genetic origin in ancient times. The frequencies of six SNPs are consistent with the NCBI data, while the frequencies of three SNPs (2.rs2233678, 4.rs1077220 and 9.rs4804461) are not consistent with the NCBI. Especially, the 3.rs2233679–4.rs1077220 linkage is different from other populations worldwide and may be an interesting genetic characteristic of Chinese CHD patients. Predictably, 1.rs2287839, 2.rs2233678, 3.rs2233679 and 5.rs2233682 may be strongly associated with CHD risk, although this requires future verification. The PIN1 SNP linkages lay a new genetic foundation for discovering novel molecular mechanisms of CHD and for exploring PIN1-based targeted treatment of CHD with nitric oxide regulatory therapies in clinical practice.

2436-PUB: Predicting Risk for New-Onset Type 2 Diabetes in Chinese People with Coronary Heart Disease and Impaired Glucose Tolerance

Background and Aims: Patients with cardiovascular disease are at high risk of type 2 diabetes (T2D), but little has been done to provide robust T2D risk estimates. We used Acarbose Cardiovascular Evaluation (ACE) trial data to develop a T2D risk calculator for Chinese people with coronary heart disease (CHD) and impaired glucose tolerance (IGT). Methods: ACE recruited 6522 Chinese CHD patients with IGT, randomized 1:1 to acarbose or placebo, with prospective ascertainment of new-onset diabetes over median 5.0 years. Logistic regression was used to develop basic and full risk prediction models in the 6238 with the requisite baseline data. Clinically relevant variables and variables showing a univariate association (P&amp;lt;0.1) with incident diabetes were included. Results: Overall 918 (15%) of 6238 participants developed diabetes. The basic model, using only clinical variables, was a poor fit with an area under the receiver-operating characteristic curve (AUC) of 0.60, whilst the full model including routinely-available laboratory results had an AUC of 0.76 with excellent goodness of fit (Table). Conclusion: In Chinese people with IGT and CHD, lower age, male sex, obesity, prior hypertension, calcium channel blocker use, nondiabetic hyperglycaemia and dyslipidaemia were major determinants for new-onset diabetes. A model comprising these factors can be used to predict 5-year T2D risk. Disclosure S. Xu: None. C.A. Scott: None. R.L. Coleman: None. J. Tuomilehto: Advisory Panel; Self; Novo Nordisk A/S. Board Member; Self; AstraZeneca. Research Support; Self; Bayer AG. R.R. Holman: Advisory Panel; Self; Bayer AG, Novartis AG, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Bayer AG, Merck Sharp &amp; Dohme Corp. Other Relationship; Self; AstraZeneca, Bayer AG, GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc.

The Association between Plasma Levels of Trimethylamine N-Oxide and the Risk of Coronary Heart Disease in Chinese Patients with or without Type 2 Diabetes Mellitus.

Aim Trimethylamine N-oxide (TMAO) has been demonstrated as an independent risk factor for cardiovascular disease. Our objective was to determine the plasma levels of TMAO in Chinese coronary heart disease (CHD) patients with or without type 2 diabetes mellitus (T2DM). Methods A total of 132 control participants, 243 CHD patients, and 175 CHD patients with T2DM were enrolled. Plasma levels of TMAO in all patients were measured and analyzed. Results The plasma levels of TMAO were significantly higher in CHD patients than in control subjects (3.08 ± 0.13 μM versus 1.49 ± 0.05 μM; P < 0.01). In addition, plasma levels of TMAO were remarkably increased in CHD patients with T2DM compared with CHD patients (7.63 ± 0.97 μM versus 3.08 ± 0.13 μM; P < 0.01). The receiver operating characteristic analysis revealed that the area under the curve of TMAO was 0.794 and 0.927 to predict CHD or CHD-T2DM patients (P < 0.01). Univariate and multivariate logistic regression analysis showed that TMAO was an independent predictor in CHD patients with or without T2DM. The level of TMAO was correlated with high-sensitive troponin I (hs-TnI) and creatine kinase MB (CKMB). Conclusions TMAO was an independent predictor of CHD in Chinese patients; moreover, the TMAO levels were highly associated with diabetes in CHD patients.

Role of depression in secondary prevention of Chinese coronary heart disease patients receiving percutaneous coronary intervention.

IntroductionCoronary heart disease (CHD) patients who have undergone percutaneous coronary intervention (PCI) have higher rates of depression than the general population. However, few researchers have assessed the impact of depression on the secondary prevention of CHD in China.ObjectiveThe main purpose of this investigation was to explore the relationship between depression and secondary prevention of CHD in Chinese patients after PCI.MethodsThis descriptive, cross-sectional one-site study recruited both elective and emergency PCI patients one year after discharge. Data from 1934 patients were collected in the clinic using questionnaires and medical history records between August 2013 and September 2015. Depression was evaluated by the 9-item Patient Health Questionnaire. Secondary prevention of CHD was compared between depression and non-depression groups.ResultsWe found that depression affected secondary prevention of CHD in the following aspects: lipid levels, blood glucose levels, smoking status, physical activity, BMI, and rates of medication use.ConclusionsDepressive patients with CHD are at increased risk of not achieving the lifestyle and risk factor control goals recommended in the 2006 AHA guidelines. Screening should focus on patients after PCI because treating depression can improve outcomes by improving secondary prevention of CHD.

The Association between the C5263T Mutation in the Mitochondrial ND2 Gene and Coronary Heart Disease among Young Chinese Han People

ObjectiveThis study aimed to investigate the genetic background of mitochondrial genes in young patients with Coronary heart disease (CHD) to provide a foundation for the early prevention of young patients with CHD. Methods115 cases of young (≤ 45 years) CHD Chinese Han patients (case group), 100 cases of older (> 45 years) Chinese Han CHD patients (experimental group) hospitalized and 100 cases of healthy people through physical examination (control group) at the General Hospital of PLA between January 2014 and December 2015 were selected. General information, clinical assessment, pedigree analysis, and mitochondrial full sequence scanning were performed. The pedigrees of one patient harbouring the C5263T mutation were recruited. Mitochondrial functional analysis including cellular reactive oxygen species (ROS) levels and mitochondrial membrane potential (MMP) were performed on pedigrees with the C5263T mutation (mutation group) and without the mutation (non-mutation group). ResultsThe differences in biochemical tests (P > 0.05) between the case group and experimental group were not significant. The C5263T single-nucleotide mutation of the mitochondrial ND2 gene was observed in 2 young CHD patients in the case group. The premature CHD of these 2 patients followed a pattern of maternal inheritance. The mutation group (I1, II2) had higher ROS levels (4750.82 ± 1045.55 vs. 3888.58 ± 487.60, P = 0.022) and lower MMP levels (P = 0.045) than the non-mutation group (II1, III1, III2). ConclusionWe speculated that the mitochondrial C5263T mutation might be associated with the occurrence CHD in Chinese Han young people.

A large-scale, multicenter, retrospective study on efficacy of bivalirudin use during peri-percutaneous coronary intervention period for Chinese patients with coronary heart disease

To observe the efficacy and safety of bivalirudin use in Chinese patients with coronary heart disease (CHD) during the peri-percutaneous coronary intervention(PCI) period. A total of 3 271 patients who underwent PCI and received periprocedural bivalirudin treatment between July 2013 and October 2015 from 88 centers of China were involved in this study. The primary outcome was 30-day net adverse clinical events (NACE a composite of major adverse cardiac or cerebral events (MACE, all-cause death, reinfarction, urgent target vessel revascularization, or stroke) or bleeding), the secondary outcome was stent thrombosis at 30 days. The mean age of enrolled patients was (65.12±12.44) years old, 27.4%(889/3 244) of them were female. Percent of stable coronary disease (SCD), non-ST segment elevation acute coronary syndrome (NSTE-ACS) and ST elevation myocardial infarction (STEMI) was 5.0%(162/3 248), 44.6%(1 450/3 248) and 50.4%(1 636/3 248) respectively. Radial access was performed in 89.5% (2 879/3 271) patients, and 9.7% (316/3 271) and 34.1% (1 115/3 271) patients also received ticagrelor and tirofiban medication. 69.3% (2 266/3 271) patients received post-procedural bivalirudin infusion, in which 46.3% (1 050/2 266) was treated at PCI-does, with a median duration of 2.5(1.0, 4.0) h. During the 30-day follow-up, NACE occurred in 3.45% (103/2 988) patients, the incidence of MACE, death was 2.17% (65/2 994) and 1.03% (31/3 017), respectively and bleeding events were recorded in 1.37% (41/2 996) patients. Four cases (0.13%) of stent thrombosis (3 acute stent thrombosis) were recorded. Peri-PCI Bivalirudin use is safe and related with low bleeding risk in Chinese CHD patients.

Profile and Correlates of Health-related Quality of Life in Chinese Patients with Coronary Heart Disease.

Background:Although coronary heart disease (CHD) is one of the major cardiovascular diseases, risk factors associated with the health-related quality of life (HRQoL) of CHD patients remain unclear. The present study was designed to determine the profile and significant factors of the HRQoL in CHD patients.Methods:A cross-sectional study was conducted in rural communities of Fangshan District, Beijing, China. Socio-demographic, lifestyle, and comorbidity information of CHD patients were collected by a structured questionnaire and medical records. HRQoL was measured using European Quality of Life 5-dimensions (EQ-5D) scale and EQ Visual Analog Scale (EQ-VAS). Multiple linear and logistic regressions were performed to explore the association of potential risk factors with HRQoL scores and each EQ-5D, respectively.Results:Totally, 1928 CHD patients (mean age 61.64 ± 9.24 years; female:male = 2.4:1) were enrolled in the study. The mean score of EQ-5D index and EQ-VAS were 0.889 ± 0.172 and 71.56 ± 17.65, respectively. Multiple linear regression revealed that marital status, physical activity, moderate alcohol drinking, and family's population were positive independent correlates of EQ-VAS, whereas diabetes mellitus and stroke were negative independent correlates (all P < 0.05). Age and stroke were negatively while physical activity, moderate alcohol drinking, family's population and household income were positively correlated with EQ-5D index (all P < 0.05) independently. In addition, each of the five HRQoL dimensions had various specific determinants, including obesity, underweight, smoking or education.Conclusions:Findings of the study highlight certain socio-demographic, lifestyle factors, and comorbid stroke or diabetes mellitus as correlates of HRQoL in Chinese CHD patients. Large-scale cohort studies should be carried out to confirm our results in the future.

Gender differences in lipid goal attainment among Chinese patients with coronary heart disease: insights from the DYSlipidemia International Study of China

Despite great advances in lipid-lowering therapy, the gender-based disparities in lipid goal success among Chinese coronary heart disease (CHD) patients receiving lipid-lowering treatment remained uncharacterized. Furthermore, little is known about potential causes for this gender imbalance. This cross-sectional trial included 25 697 patients treated with lipid-lowering agents from 122 centres between April 2012 and October 2012; data for 9420 participants with CHD were analysed in the present study; all underwent clinical examination and had their latest fasting lipid profiles while on lipid-lowering therapy recorded. Logistic regression was used to explore possible factors associated with gender disparity in goal attainment rates, and to what extent each factor contributes. Of 9420 CHD patients (42.5% women) evaluated, women had a significantly lower overall low-density lipoprotein cholesterol (LDL-C) success rate than men (46.2 vs. 62.7%, P < 0.0001). Among CHD patients with diabetes, only 31.5% of women and 46.4% of men ( P < 0.0001) attained the optional LDL-C target of <80 mg/dL. More than half (54.0%) of female patients failed to attain their non-high-density lipoprotein cholesterol (HDL-C) goal. Approximately 7.5, 8.8, 7.5, and 6.8% of gender disparity in LDL-C goal attainment rate was attributable to the gender difference in use of an anti-diabetic, anti-hypertensive, anti-platelet treatment, and the dosage of statin treatment, respectively. Although great improvements have been made over the past decade, there is still a preventive gap in high-risk and very high-risk CHD patients regarding LDL-C and non-HDL-C levels and that this gap is apparently greater in women.

The CAA repeat polymorphism in the ZFHX3 gene is associated with risk of coronary heart disease in a Chinese population.

Coronary heart disease (CHD) is a disease resulting from the interaction between genetic variations and environmental factors. Zinc finger homeobox 3 (ZFHX3) is a transcription factor and contains a poly-glutamine tract in a compositionally biased region that is encoded by exon 9, containing a cluster of CAG and CAA triplets followed by the polymorphic CAA repeats: (CAG)2(CAA)2(CAG)3CAACAG(CAA)nGCA. Thus, nine successive glutamine residues precede the poly-glutamine tract, encoded by the polymorphic CAA repeats. The aim of this study was to investigate the association of the CAA repeat polymorphism in exon 9 of the ZFHX3 gene with the risk of CHD in a Chinese population. The CAA repeat polymorphism was determined by polymerase chain reaction followed by DNA sequencing in 321 CHD patients. Genotype frequencies were compared using the non-parametric mood median test. Four alleles of CAG(CAA)10GCA, CAG(CAA)8GCA, CAG(CAA)9GCA, and CAG(CAA)11GCA were found in Chinese CHD patients in exon 9 of the ZFHX3 gene. The CAG(CAA)10GCA was a major allele (95.95%), and the CAG(CAA)8GCA was a minor allele (3.58%). The CAG(CAA)9GCA and CAG(CAA)11GCA were rare alleles (0.31% and 0.16%). The CAG(CAA)10GCA allele encodes a poly-glutamine tract of 19 residues. Importantly, the CHD patients homozygous for the CAG(CAA)10GCA allele had a higher risk of CHD, compared to the heterozygous patients carrying a CAG(CAA)8GCA allele. Moreover, the CAG(CAA)10GCA allele was significantly associated with hypertension, diabetes mellitus, or dyslipidemia (P < 0.05). Thus, the CAA repeat polymorphism in exon 9 of the ZFHX3 gene contributes to the CHD susceptibility in the Chinese population.

Effects of eNOS rs1799983 and ACE rs4646994 polymorphisms on the therapeutic efficacy of salvianolate injection in Chinese patients with coronary heart disease.

The purpose of the present study was to clarify the association of eNOS 894G/T and ACE I/D genetic polymorphisms with the risk of coronary heart disease (CHD) and to explore the effects of these polymorphisms on the therapeutic efficacy of salvianolate injection in Chinese CHD patients. In all, 153 CHD patients and 198 healthy controls were enrolled in the study. We collected 5mL peripheral blood for DNA extraction. Genetic diagnosis of eNOS 894G/T was determined by direct sequencing. Polymerase chain reaction-restriction fragment length polymorphism analysis was used to detect ACE I/D genotypes. We observed significant differences in the frequency distribution of eNOS and ACE polymorphisms between CHD patients and healthy controls (P<0.05). Binary logistic regression stepwise analysis revealed that the genotypes had an additive and dominant effect on patients' therapeutic responses (P<0.05). These data suggest that the genetic polymorphisms of ACE I/D and eNOS 894G/T probably play a role in the development of CHD and these genetic polymorphisms may affect the response to salvianolate injection in Chinese CHD patients.

Use of Traditional Chinese Medicine in Chinese Patients with Coronary Heart Disease

ObjectiveTo study the use of traditional Chinese medicine (TCM) or both TCM and guideline-recommended Western medicine (WM) in Chinese patients with coronary heart disease (CHD). MethodsA cross-sectional nationwide survey of 2803 CHD outpatients was completed by collecting information, including general demographic data, disease history, and use of drugs (including TCM and WM). ResultsOf the 2712 CHD outpatients with complete drug treatment data, only 3.1% received TCM without any WM for CHD, 30.0% received both TCM and WM recommended by current CHD guidelines, and 66.9% received only WM. Patients with a longer history of CHD or with a history of stroke, were more likely to use TCM. However, 90.6% of CHD patients who used TCM also used certain WM. Furthermore, patients who used more types of TCM tended to use much less WM recommended by current guidelines. ConclusionA substantial proportion of Chinese CHD outpatients use both TCM and WM for secondary prevention of CHD. It is important to assess the effect of combined TCM and WM on major clinical outcomes in Chinese CHD patients.

Clinical Features of Chinese Coronary Heart Disease Patients with Chronic Kidney Disease

Objectives: To investigate the prevalence of chronic kidney disease (CKD) by stage in Chinese patients with coronary heart disease (CHD) and to identify the clinical features and examine control of cardiovascular risk factors. Methods and results: Clinical data of hospitalized patients were collected by investigators in China. CKD stages were classified according to estimated glomerular filtration rate (eGFR). A total of 2509 participants with CHD were included in the final statistical analysis. The overall prevalence of CKD stage 3 and greater (eGFR of less than 60 mL/min/1.73 m2) in the CHD patients was 32.5%. As the CKD stage increased, fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and high-sensitivity C-reactive protein (HS-CRP) levels all worsened. As the CKD stage became more severe, CHD patients had comorbidities such as diabetes mellitus, periphery arterial disease, and ischemic stroke, and more CHD patients had triple vessel disease increased. Even when patients received treatment of CHD and risk factors, control of cardiovascular risk factors such as SBP, DBP, FBG, and low-density lipoprotein was worsened as CKD stage became more severe over a 6-week follow-up. Conclusions: The data suggested a high prevalence of CKD in Chinese patients with CHD. Many conventional risk factors and comorbidities were correlated with high prevalence of CKD in CHD patients. Control of cardiovascular risk factors in those patients was poor.

Validating the Type D personality construct in Chinese patients with coronary heart disease

Objective Type D personality predicts poor prognosis in coronary heart disease (CHD) but little is known about Type D in non-Western cultures. We examined the (a) validity of the Type D construct and its assessment with the DS14 scale in the Chinese culture, (b) prevalence of Type D, and (c) gender vs. Type D discrepancies in depression/anxiety, among Chinese patients with CHD. Method Patients with CHD ( N=326) completed the Chinese version of the DS14. The NEO Five Factor Inventory (NEO-FFI), Hospital Anxiety and Depression Scale (HADS), and Stress Symptom Checklist (SSC) were administered to subsamples to establish construct and discriminant validity. Administration of the DS14, HADS, and SSC was repeated at 1 month after hospital discharge in 66 patients, and stability of the DS14 was examined in another subsample of 100 patients. Results The theoretical structure of the Type D construct in the Chinese culture was supported ( χ 2/ df=2.89, root mean square error of approximation=0.08, normal fit index=0.91, non-normal fit index=0.91, comparative fit index=0.93). The Negative Affectivity (NA) and Social Inhibition (SI) subscales of the DS14 in the entire sample were internally consistent (Cronbach's alpha=0.89/0.81), measured stable traits (3-month test–retest ICC=0.76/0.74), and correlated significantly with the neuroticism (NA/neuroticism, r=0.78, P<.001) and extraversion subscales (SI/extraversion, r=−0.64, P<.001) of the NEO-FFI, respectively. The prevalence of Type D personality was 31%. Type D was not related to transient emotional states. However, Chinese patients with a Type D personality were at increased concurrent risk of anxiety ( P=.002) and depression ( P=.016). Conclusion Type D personality is a cross-culturally valid construct, is associated with an increased risk of anxiety and depression, and deserves prompt attention in estimating the prognostic risk of Chinese CHD patients.

Health care professionals’ perceptions of hospital‐based cardiac rehabilitation in mainland China: an exploratory study

To explore Chinese health care professionals' perceptions of cardiac rehabilitation for patients with coronary heart disease in mainland China. Coronary heart disease is a rapidly growing major health problem in mainland China and little is known about the current provision of rehabilitation for this population. A qualitative study. Face-to-face interviews were conducted with 18 Chinese health care professionals. The interviews were tape-recorded, transcribed and content analysis was used to identify categories. Content analysis of the data revealed three major categories: underdeveloped cardiac rehabilitation services, multiple obstacles to the establishment of a cardiac rehabilitation programme and a perceived need for professional guidance to patients. The current situation of cardiac rehabilitation in hospitals of China is poor with multiple obstacles prohibiting the development of cardiac rehabilitation services in the country and this has resulted in high rates of recurrence of heart attacks, coronary risk factors going undetected and/or untreated and psychological distress being observed among Chinese coronary heart disease patients. Relevance to clinical practice. The findings provide useful pointers for Chinese health professionals to explore ways of providing an effective, safe, convenient and culturally sensitive rehabilitation programme for Chinese patients with coronary heart disease.

Application of the Type D Scale (DS14) in Chinese coronary heart disease patients and healthy controls

Objective To examine the psychometric properties of the Type D Scale (DS14) in mainland China. Methods One hundred and seventy-eight coronary heart disease (CHD) patients and 376 healthy controls were recruited. They completed the Chinese version of the DS14, the Zung Self-Rating Depression Scale, the Positive Affect and Negative Affect Scale, the Perceived Social Support Scale, and the Social Avoidance and Distress Scale. Thirty-five of the patients were also rated by their family members on the DS14. Results The two-factor structure of the DS14 was replicated. The Cronbach's α coefficients for the negative affectivity (NA) and social inhibition (SI) subscales were 0.90 and 0.85, respectively, for the CHD patients and 0.87 and 0.69, respectively, for the healthy subjects. The correlations between the self-reports and the observer ratings ( r NA=0.56, r SI=0.69) supported satisfactory consensual validity. Good convergent validity was shown by the expected correlations and the scale-level factor analyses of NA with depression and negative affect, and SI with perceived social support and social avoidance and distress. With the standardized cut-off of NA ≥10 and SI ≥10, 31.4% of the CHD patients and 31.9% of the healthy controls in China were defined as having a Type D personality. Conclusions The results indicate that the Type D construct is valid and reliable in Chinese populations. The Chinese version of the DS14 shows good psychometric properties. The prevalence of Type D personality in China falls within the range of what has been found in Western countries, at least for CHD patients. This study indicates that it is possible to use the DS14 among Chinese populations in future cross-cultural studies.

A psychometric evaluation of the Chinese version of the Cardiovascular Limitations and Symptoms Profile in patients with coronary heart disease

The aim of this study was to translate from English and evaluate the validity, reliability and cultural relevance of the Cardiovascular Limitations and Symptoms Profile (CLASP) as a health-related quality-of-life (HRQL) measure in Chinese patients with coronary heart disease. Improvement in HRQL is increasingly used as a primary outcome in determining the treatment benefit using a generic instrument. However, disease-specific instruments are being cited as more responsive and sensitive in detecting even the smallest changes in health status. Therefore, valid and reliable disease-specific measures for patients with coronary heart disease are now being developed and evaluated. Questionnaire design. The translation equivalence and content validity of the Chinese version of CLASP were evaluated by an expert panel. Measurement performance was tested on a convenience sample of 369 Chinese coronary heart disease patients. The instrument demonstrated good content validity (content validity index 0.94), acceptable internal consistency (>0.70), except for two subscales of angina and tiredness and significant positive correlations among the subscales of CLASP, Hospital Anxiety Depression Scale and the Short Form 36 Health Survey. Principal components analysis revealed nine factors that together explained 69% of the variance. The results of this study support that CLASP is a valid and reliable disease-specific health status measure for Chinese patients with coronary heart disease. However, further item modifications and testings are needed when considering the cross-cultural context. The use of disease-specific HRQL measures could effectively evaluate nursing interventions in clinical practice. Further validations of CLASP among different diagnostic groups, such as patients with heart failure and those who have survived an acute myocardial infarction, would provide further empirical support for its use with all patients with heart disorders.

Genetic variation in heat shock protein 60 gene and coronary heart disease in China: tagging-SNP haplotype analysis in a case-control study

High levels of circulating heat shock protein 60 (Hsp60) and antibody to human Hsp60 have been associated with greater risk of coronary heart disease (CHD) in several studies, but associations between polymorphisms of the hsp60 gene and CHD risk have not been investigated. By resequencing DNA from 30 unrelated Han Chinese and using HapMap Phase I Chinese data of hsp60 gene, we selected four tagging single nucleotide polymorphisms (tagSNPs) named rs2340690, rs788016, rs2305560, and rs2565163, and determined their frequencies in 1,003 Chinese CHD patients and 1,003 age- and sex-frequency-matched controls. Furthermore, we used PHASE 2.0 software to reconstruct haplotypes and logistic regression to control for potential confounders in multivariate analyses. We found 13 SNPs in hsp60 gene (including four novel SNPs) in Han Chinese subjects. Our results showed no significant differences in four selected SNPs in patients with CHD and controls after adjusting for other conventional risk factors and stratifying by age, sex, smoking status, past history of hypertension and DM; however, our results showed that subjects with the GCTC haplotype had about twofold higher risk of CHD than those with the GTTC haplotype (OR = 1.91, 95%CI: 1.26-2.89, P = 0.002). Our results suggest that the GCTC haplotype in the hsp60 gene is significantly associated with higher CHD risk in a Chinese population.