Heart Disease In China Research Articles

Trend analysis of the burden of ischemic heart disease in China, 1990 to 2015

Objective: The objective of this study is to analyze the trend of burden of ischemic heart disease (IHD) in China between 1990 and 2015. Methods: Data were collected from the results of 2015 Global Burden of Disease Study. We arranged and analyzed the mortality and disability-adjusted life year (DALY) for IHD by sexes, ages and provinces (excluding Taiwan, China) in China between 1990 and 2015. The age-standardized rates were determined using the average world population age structure in the period of 2010-2035 as a reference, and the changes of the related indicators were calculated. Results: In 2015, IHD caused 1 461 thousand deaths, and its age-standardized death rate was 114.8 per 100 000. Number of DALYs from IHD were 25 765 thousand in 2015, with the age-standardized DALY rate at 1 760.2 per 100 000. From 1990 to 2015, the age-standardized death rate for IHD in China increased by 13.3% but age-standardized DALY rate decreased by 3.9%. Number of IHD DALYs among male (16 664 thousand) was higher than it among female (9 101 thousand) in China in 2015, and 83.5% of total DALYs from IHD occurred among people aged over 50 years old. Province with highest age-standardized death rate was Heilongjiang, with rate at 187.4 per 100 000 in 2015. Qinghai (54.0%) increased most and Macao (-52.3%) decreased most from 1990 to 2015. Province with highest age-standardized DALY rate was Xinjiang, with rate at 3 040.8 per 100 000 in 2015. Qinghai (33.2%) increased most while Macao (-59.0%) decreased most between 1990 and 2015. Conclusion: Burden of IHD in China increased remarkably from 1990 to 2015, especially among males and people aged over 50 years old. The differences among provinces were obvious.

Mortality trends for ischemic heart disease in China: an analysis of 102 continuous disease surveillance points from 1991 to 2009

BackgroundIn the past 20 years, the trends of ischemic heart disease (IHD) mortality in China have been described in divergent claims. This research analyzes mortality trends for IHD by using the data from 102 continuous Disease Surveillance Points (DSP) from 1991 to 2009.MethodThe 102 continuous DSP covered 7.3 million people during the period 1991–2000, and then were expanded to a population of 52 million in the same areas for 2004–2009. The data were adjusted by using garbage code redistribution and underreporting rate, mapped from international classification of diseases ICD-9 to ICD-10. The mortality rates for IHD were further adjusted by the crude death proportion multiplied by the total number of deaths in the mortality envelope, which was calculated by using logrt = a + bt. Age-standard death rates (ASDRs) were computed using China’s 2010 census population structure. Trend in IHD was calculated from ASDRs by using a joinpoint regression model.ResultsThe IHD ASDRs increased in total in regions with an average annual percentage change (AAPC) 4.96%, especially for the Southwest (AAPC = 7.97%) and Northeast areas (AAPC = 7.10%), and for male and female subjects (with 5% AAPC) as well. In rural areas, the year 2000 was a cut-off point for mortality rate with annual percentage change increasing from 3.52% in 1991–2000 to 9.02% in 2000–2009, which was much higher than in urban areas (AAPC = 1.05%). And the proportion of deaths increased in older adults, and more male deaths occurred before age 60 compared to female deaths.ConclusionBy observing a wide range of areas across China from 1991 to 2009, this paper concludes that the ASDR trend for IHD increased. These trends reflect changes in the Chinese standard of living and lifestyle with diets higher in fat, higher blood lipids and increased body weight.

Impact and clinical outcome of intra-aortic balloon pump use during percutaneous coronary intervention

Objective: To observe the impact and clinical outcome of intra-aortic balloon pump(IABP) use in patients underwent percutaneous coronary intervention (PCI). Methods: From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI were enrolled.After 2 years' follow-up, the incidence of major adverse cardiovascular and cerebrovascular events such as death, myocardial infarction, stent thrombosis, revascularization, recurrent stroke were recorded, propensity score was used to match baseline data, and the clinical outcomes in patients with IABP and non-IABP were compared. Results: The overall use of IABP was 1.3%(143/10 724), clinical and angiographic risks were significantly higher in IABP group than non-IABP group.The rate of cardiac shock was significantly higher (9.8%(14/143) vs. 0.2%(16/10 581), P<0.01) and left ventricular ejection fraction was significantly lower (54.3%±11.0% vs. 62.9%±7.2%, P<0.01) in the IABP group than in the non-IABP group.Patients in IABP group had a significantly higher rate of left main or triple-vessel disease (P<0.01), and their SYNTAX score, target lesion number, stent number were also significantly higher compared with non-IABP patients (all P<0.01). During the 2-year follow-up, all-cause mortality was significantly higher in IABP group than in non-IABP group (10.5%(15/142) vs. 1.1%(116/10 581), P<0.001). Multivariable analyses indicated that IABP was associated with increased mortality (HR=3.51, 95%CI 1.71-7.17, P=0.001). However, after propensity score matched analyses (137 pairs), IABP use was no longer an independent predictor of all-cause mortality (HR=2.09, 95%CI 0.72-6.13, P=0.177). Conclusions: In this single large center of coronary heart disease in China, the IABP usage was about 1.3%.Propensity score matched analyses showed that during the 2 years' follow-up, adverse effect including similar long-term mortality is similar between PCI patients with or without IABP after adjusting for confounders.

Importance of neonatal screening for congenital heart disease in China

Importance of neonatal screening for congenital heart disease in China

Use of cardiovascular prevention treatments after acute coronary syndrome in China and associated factors

BackgroundPrevention of repeat cardiovascular events is an important means of addressing the increasing burden of coronary heart disease in China, however there is minimal information about the use of cardiovascular prevention treatment following acute coronary syndrome (ACS) in China. MethodsWe analysed data from baseline and 6, 12, 18, and 24-month follow-up surveys of 15,140 consecutive ACS patients recruited in 70 hospitals from 17 provinces of China. We describe the use of indicated cardiovascular prevention medicines, risk factor control, change over time and factors associated with continued prevention. Results12,094 patients had follow-up data up to 12months. At discharge, 86.1% were on a combination of antiplatelet, statin and blood pressure (BP) lowering drugs. Use of this combination fell to 68.0% at 12months and 59.7% in patients followed to 24months. Patients admitted to tertiary hospitals were more likely to be on the combination compared to secondary hospitals (at discharge 90.1% vs. 79.5%, p<0.0001; at 12months 71% vs. 64%, p<0.001 respectively). At 12months 25.2% achieved control in ≥four of five guideline levels of risk factors and this was similar by hospital level. Prescription of BP-lowering drugs and statins at discharge was the strongest predictor of use at 12months follow-up. Lower income was associated with less use of both. ConclusionsUse of cardiovascular prevention treatment declines steadily over time following an ACS. The largest proportional decline is in the first six months. Ensuring patients are discharged on these therapies and addressing barriers for low-income earners may help address this gap.

Effect of particulate air pollution on coronary heart disease in China: Evidence from threshold GAM and Bayesian hierarchical model

There are few multicity studies to address the effect of short-term effect of particulate matter air pollution on daily Coronary Heart Disease (CHD) mortality in developing countries, much fewer to further discuss its threshold and seasonal effect. This study investigates the season-varying association between particulate matter less than or equal to 10 μm in aerodynamic diameter (PM10) and daily CHD mortality in seven cities of China. Time series threshold Poisson regression model is specified to estimate the health effect for four cities with the threshold effect, and conventional linear Poisson model is used to analyze the effect for three cities without threshold. We apply the Bayesian hierarchical model to pool the city-specific estimates into overall level. On average, a 10 μg/m3 increase of the moving average concentrations of current-day and previous-day PM10 is associated with an increase of 0.81% (95% Posterior Interval, PI: −0.04%, 1.67%) in daily CHD mortality for all the cities as a whole. The associations are smaller than reported in developed countries or regions with lower polluted level, which is consistent to the findings in the literature. The hazardous effect are higher in hot summer and cold winter (1.15% and 0.89%) but lower in relative warm spring and fall (0.85% and 0.69%). In summary, we found significant associations between short-term exposure to PM10 and CHD mortality in China. The sensitivity analyses in the study support the robustness of our results.

Optimal dietary macronutrient distribution in China (ODMDC): a randomised controlled-feeding trial protocol.

Findings from observational studies in China show that increased dietary fat consumption might be a contributor to the developing obesity epidemic. However, some cohort studies suggest that carbohydrate intake, especially from white rice, is a risk factor for obesity, type 2 diabetes and coronary heart disease in China. Our study aims to determine whether the traditional lower-fat, higher-carbohydrate Chinese or the Western higher-fat, lower-carbohydrate dietary pattern is more effective for weight control and the related cardiometabolic profiles increasingly found among contemporary Chinese. The Optimal Dietary Macronutrient Distribution in China (ODMDC) trial is a 6-month, multi-centre, three-arm controlled feeding study. Based on the macronutrient transition in the past 30 years in China, three isoenergetic diets with a spectrum of fat and carbohydrate intake, but same protein contents, have been formulated. Percentages of fat, carbohydrate, and protein energy are one of 20, 66 and 14%; 30, 56 and 14%; 40, 46 and 14%, respectively. Participants will be provided with all their food and most beverages for 6 months. The study population is planned to be 300 healthy non-obese adults aged 18 to 35 years. The primary outcome is body weight and the secondary variables are waist circumference and cardiometabolic risk factors. The ODMDC trial will have implications for nutrition policy in regard to weight control and related cardiometabolic disturbances among otherwise healthy non-obese Chinese.

Effects of a hospital-community partnership transitional program in patients with coronary heart disease in Chengdu, China: A randomized controlled trial.

To evaluate the effects of a hospital-community partnership transitional program among patients with coronary heart disease. This was a randomized controlled trial with 236 patients who were randomized into two groups. The patients in the control group received the usual care. In contrast, the patients in the study group received the transitional care program. The data were collected at the baseline, 30 days, and 90 days after discharge. The primary outcomes were the 30 and 90 day readmission rates after discharge. The secondary outcomes included the quality-of-care transitions, medicine adherence, and chronic disease self-efficacy. The findings indicated that: (i) the patients in the study group reported significantly lower 30 and 90 day readmission rates after their discharge than those in the control group; (ii) statistically significant differences were found in the quality-of-care transitions at 30 days postdischarge between the two groups as the patients in the study group reported significantly higher quality-of-care transitions, compared to those in the control group; and (iii) the patients in the study group reported significantly higher scores in medication adherence and chronic disease self-efficacy at 30 and 90 days after discharge than those in the control group. This study is an original effort to establish and evaluate a hospital-community partnership transitional care program in patients with coronary heart disease in China and the findings have demonstrated its effects.

The Effects of Age, Period, and Cohort on Mortality from Ischemic Heart Disease in China

In contrast with most developed countries, mortality due to ischemic heart disease (IHD) continues to rise in China. We examined the effects of age, period, and cohort on IHD mortality in urban and rural populations from 1987 to 2013 to identify the drivers of this trend. Region-specific data on annual IHD mortality among adults aged 20 to 84 years and corresponding population statistics were collected. We then tested for age, period, and cohort effects using the Intrinsic Estimator approach. Our results indicated that IHD mortality in China increased significantly over the three decades studied. There was a log-linear increase in the age effect on IHD mortality as those aged 80–84 showed 277 and 161 times greater IHD mortality risk than those aged 20–24 in urban and rural populations, respectively. While there was an upward trend in the period effect in both populations, the influence of the cohort effect on mortality decreased over time for those born from 1904 to 1993. The age, period, and cohort effects on mortality in China were generally comparable between urban and rural populations. The results suggest that population aging is a major driver behind the rapid rise in IHD mortality. Increased exposure to air pollution may also have played a role in driving the period effect

A hospital-based survey of patients with severe valvular heart disease in China

ObjectivesDue to increasing aging, the epidemiology of VHD may have changed in China. This study aimed to provide contemporary information on the prevalence, distribution patterns, and etiology of severe VHD in China. MethodsThis was a retrospective survey at Second Affiliated Hospital of Zhejiang University, which included all consecutive patients between 2010 and 2015. ResultsIn all, 139,496 patients were enrolled. Among severe valve diseases, MR was the most frequent (n=946, 0.68%) followed by MS (n=524, 0.38%), AS (n=392, 0.28%), and AR (n=371, 0.27%). Severe MR and AS prevalence rates increased strikingly with age. Rheumatic heart disease had an prevalence of 1.56% (n=2179), and remained one of the most common causes of severe VHD in patients younger than 65years old (99.5% of MS with rheumatic; 27.6% of MR with rheumatic; 25.7% of AS with rheumatic; 31.6% of AR with rheumatic). Aortic valve calcification was the predominant AS etiology, and its prevalence greatly increased with age. In severe AR, rheumatic fever was the most common etiology in patients below 65; in those above 65, etiology was mostly degenerative. In severe primary MR, mitral valve prolapse was the most common cause. Prevalence of secondary MR increased with age, from 16.4% in 18–44years old to 51.7% in individuals ≥75. ConclusionsSevere valvular diseases are very common; rheumatic fever and degenerative valvular changes remain predominant causes in patients below 65 and older ones, respectively. Young adults present mainly with primary MR, while secondary MR is more common in elderly ones.

Traditional Chinese medicine, Danlou tablets alleviate adverse left ventricular remodeling after myocardial infarction: results of a double-blind, randomized, placebo-controlled, pilot study.

BackgroundDanlou tablets, a patented Chinese Medicine, have been long approved for the treatment of ischemic heart disease in China. While numerous empirical observations suggested Danlou tablets could decrease frequency and duration of angina pectoris attacks, evidence supporting its efficacy on cardiac remodeling remains inadequate. Therefore, this pilot trial was designed to determine whether Danlou tablets would reduce adverse left ventricular (LV) remodeling in patients with myocardial infarction (MI).Methods and ResultsEligible patients with acute MI were enrolled and randomly assigned to Danlou tablets or placebo groups, superimposed on standard treatment for MI. Then, in addition to assessment of the clinical outcome, the changes in LV volumes were evaluated by a serial echocardiography. In total, 83 patients (Danlou tablets 42 and placebo 41) completed 90 days of treatment and had complete baseline and outcome data. Standard echocardiographic evaluations revealed significant differences in the change of LV end-diastolic volume index (LVEDVi) between group of patients treated with Danlou tablets and the placebo group (−4.49 ± 7.29 vs. −0.34 ± 9.01 mL/m2, P < 0.001). The reduction in LVEDVi was independent of beta-blocker, ACE inhibitors/ARBs use. Furthermore, treatment with Danlou tablets significantly reduced LV end-systolic volume index (−4.09 ± 5.85 vs. −0.54 ± 5.72 mL/m2, P < 0.001) and improved the LV ejection fraction (4.83 ± 9.23 vs. 0.23 ± 8.15 %, P < 0.001), as compared to placebo. Meaningfully, the incidence of the major adverse cardiovascular events was also lower in patients receiving Danlou tablets (P < 0.05).ConclusionSuperimposed on the standard pharmacologic treatment, Danlou tablets significantly reversed post-MI adverse LV remodeling, thereby contributed to the overall positive clinical outcome.Trial registrationclinicaltrials.gov identifier NCT02675322 (February 1, 2016).Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1406-4) contains supplementary material, which is available to authorized users.

Increasing mortality from ischaemic heart disease in China from 2004 to 2010: disproportionate rise in rural areas and elderly subjects. 438 million person-years follow-up.

We sought to ascertain the changes in mortality from ischaemic heart disease (IHD) from 2004 to 2010 in China as the sheer size of China's population makes disease patterns relevant globally. Data on IHD mortality were obtained from the Chinese Centre for Disease Control and Prevention National Disease Surveillance Point System, which includes 161 counties and a population of over 73 million-a representative sample of over 6% of the entire population of China. Both crude and World Health Organization (WHO)-standardized IHD mortality increased, in both men and women and in both urban and rural locations, during the study period, demonstrating the effect of urbanization, economic growth, and epidemiological transition on cardiovascular health. WHO-standardized IHD mortality increased for rural males by 9.2% per year (95% CI: 6.7-11.7%; P < 0.0001), and the trend was statistically significantly higher (P = 0.0001) than in urban males by 6.4% per year (95% CI: 3-10%; P = 0.02). WHO-standardized IHD mortality rate increased for rural females by 7.0% per year (95% CI: 4.6-9.4%; P < 0.0001); this was statistically significantly higher than urban females by 4.3% per year (95% CI: 1-8%; P = 0.02). The age group over 80 years showed the greatest increase in IHD mortality. Mortality from IHD is increasing in China, in contrast to decreasing in other countries. This is largely driven by increasing IHD mortality in rural areas and subjects over 80 years old. This needs urgent attention by public health workers and policymakers.

The development of a mobile phone based intervention to improve adherence to secondary prevention of coronary heart disease in China

The development of a mobile phone based intervention to improve adherence to secondary prevention of coronary heart disease in China

Increasing Mortality from Ischaemic Heart Disease in China from 2004 - 2010: 438 Million Person-Years Follow Up

Increasing Mortality from Ischaemic Heart Disease in China from 2004 - 2010: 438 Million Person-Years Follow Up

PM297 A WHF-Sponsored Pilot Study of a Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Disease in China: The Takemeds Study

PM297 A WHF-Sponsored Pilot Study of a Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Disease in China: The Takemeds Study

Dioscin improves heart function by increasing sodium influx via NCX in rat cardiomyocytes

ObjectiveDioscin (Dio) is widely used for the treatment of ischemic heart disease in China. The molecular mechanism underlying the inotropic effects of Dio, however, remains poorly understood.Methods and ResultsLeft ventricle contractile function was measured using the Langendorff non‐recirculating mode of isolated rat heart perfusion. Effects of Dio on cardiac function were assessed by measuring left ventricular systolic pressure (LVSP) and left ventricular end diastolic pressure (LVEDP) as well as the peak rate of rise/fall of left ventricular pressure (±dP/dtmax), in absence or presence of a sodium‐calcium exchanger inhibitor SEA0400. Our ex vivo data show that within the concentrations of 0.1–1μmol/L, Dio significantly increased the LVSP and +dP/dtmax, and these effects were significantly antagonized by 1 μmol·L−1 SEA0400. Furthermore, we investigated the effect of Dio on sodium current (INa) and L‐type calcium current (ICa,L). Intriguingly, the ICa,L was found to be inhibited by Dio, while the INa was augmented by Dio. The effect of Dio on contractile function and ICa,L appears to be contradictory. Therefore, we assessed the effect of Dio on the [Ca2+]i in H9c2 cells. Dio significantly increases the relative fluorescence intensity of intracellular calcium (n=8, P&lt;0.01 vs control), which was partially attenuated by either SEA0400 or calcium‐free or sodium‐free extracellular fluid. Mitochondrial membrane potential was further detected with multifunctional microplate reader in order to determine whether Dio causes mitochondrial injuries. Our data show that Dio barely affected the mitochondrial membrane potential at the concentration of 0.1–1 μmol·L−1, while 10 μmol·L−1 dioscin results in a slight decrease in the mitochondrial membrane potential.ConclusionOur results demonstrate that Dio exerts the positive inotropic effect through elevating [Ca2+]i and increasing sodium influx and sodium‐calcium exchange via the Na+/Ca2+ exchanger (NCX) in rat cardiomyocytes.Support or Funding InformationSupported by Youth Project of Tianjin Natural Fundation (14JCQNJC13700) to Yongqiang Yin

NaoXinTong Inhibits the Advanced Atherosclerosis and Enhances the Plaque Stability in Apolipoprotein E Deficient Mice.

Buchang NaoXinTong (NXT), a Chinese medicine, has been widely used to treat patients with coronary heart disease in China. However, the underlying mechanisms need more elucidations. In this study, we investigated if NXT can inhibit the progression of the established lesions while stabilizing plaques. Apolipoprotein E deficient (apoE(-/-)) mice in 3 groups received following treatment: group 1 was fed a high-fat diet (HFD) for 18 weeks; group 2 was prefed HFD for 12 weeks followed by HFD containing NXT for additional 6 weeks; group 3 was prefed HFD for 8 weeks followed by HFD containing NXT for additional 10 weeks. After treatment, serum and aorta samples were collected and determined lipid profiles, lesions, collagen content, mineralization, and macrophage accumulation in aortic root, respectively. NXT had slight effect on serum lipid profiles but significantly reduced progression of the advanced lesions. In aortic wall, NXT increased smooth muscle cell/collagen content in lesion cap while reducing buried fibrous caps, mineralization, and macrophage accumulation within lesions, which suggests that NXT can stabilize plaques. In addition, NXT increased expression of smooth muscle 22α mRNA while inhibiting expression of matrix metalloproteinase-2 and tumor necrosis factor α mRNA in aortas. Our study demonstrates that NXT can reduce advanced atherosclerosis and enhance the plaque stability in apoE(-/-) mice.

Association of Elevated High Sensitivity Cardiac Troponin T(hs-cTnT) Levels with Hemorrhagic Transformation and 3-Month Mortality in Acute Ischemic Stroke Patients with Rheumatic Heart Disease in China.

Background and ObjectiveElevated levels of high sensitivity cardiac troponin T (hs-cTnT) occur in a substantial proportion of patients with acute ischemic stroke (AIS) and can predict poor outcome and mortality after stroke. Whether elevated hs-cTnT levels can also predict hemorrhagic transformation (HT) or prognosis in AIS patients with rheumatic heart disease (RHD) remains unclear.MethodsData from the Chengdu Stroke Registry on consecutive AIS patients with RHD admitted to West China Hospital within1 month of stroke onset from October 2011 to February 2014 were examined. Clinico-demographic characteristics, HT, functional outcomes and stroke recurrence were compared between patients with elevated hs-cTnT levels(≥14ng/L) and patients with normal hs-cTnT levels (<14ng/L).ResultsThe final analysis involved 84 patients (31 males; mean age, 61.6±12.2years), of whom serum hs-cTnT levels were elevated in 58.3%. Renal impairment was independently associated with elevated hs-cTnT levels (OR 4.184, 95%CI 1.17 to 15.01, P = 0.028), and patients with elevated hs-cTnT levels were at significantly higher risk of HT, 3-month mortality and 3-month disability/mortality (all P≤0.029). After controlling for age, sex, hypertension, renal impairment and National Institutes of Health Stroke Scale score on admission, the risk of HT and 3-month mortality was, respectively, 4.0- and 5.5-fold higher in patients with elevated hs-cTnT levels than in patients with normal hs-cTnT levels.ConclusionElevated hs-cTnT levels are independently associated with HT and 3-month mortality in AIS patients with RHD. These results with a small cohort should be verified and extended in large studies.

Trends in the prevalence of heart diseases over a ten-year period from single-center observations based on a large echocardiographic database.

There is a paucity of data regarding trends in the incidence of heart disease in China during recent years. Using a large echocardiography database in our center, we analyzed trends in the prevalence of several common heart diseases from Dec. 2003. This study retrospectively analyzed the echocardiographic database in our Department from 2003 to 2012. A total of 385 682 cases were included in the study. The prevalence of rheumatic heart disease decreased over the 10-year period, from 4.04% in 2003 to 3.06% in 2012 (P<0.01). Infective endocarditis also decreased, from a mean prevalence of 0.37% in July 2003 to 0.27% in Dec. 2008 (P<0.001). The prevalence of hypertrophic cardiomyopathy, which includes 20% apical hypertrophic cardiomyopathy and 20% hypertrophic obstructive cardiomyopathy, was about 1.8%. The prevalence of the three most common adult congenital heart diseases (CHDs) decreased by about 10% from July 2003 to Dec. 2008 (all P<0.001). The prevalence of moderate pulmonary arterial hypertension (PAH) or left ventricular systolic dysfunction (LVSD) decreased during the 10-year period (P<0.001), but there was no change in the prevalence of severe PAH or LVSD (P>0.05). The present study indirectly demonstrates that the prevalence of several common heart diseases in China has declined in recent years.

Association of elevated high sensitivity cardiac troponin T (hs-cTnT) levels with hemorrhagic transformation and 3-month mortality in acute ischemic stroke patients with rheumatic heart disease in China

Association of elevated high sensitivity cardiac troponin T (hs-cTnT) levels with hemorrhagic transformation and 3-month mortality in acute ischemic stroke patients with rheumatic heart disease in China