Yutang Wang

Chinese PLA General Hospital (301 Hospital), Peping, Beijing, China

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Publications (15)64.03 Total impact

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    ABSTRACT: ABSTRACT BACKGROUND Much of the epidemiology of atrial fibrillation (AF) is based on data from Western populations. Despite the huge population of Asia, data on the clinical epidemiology of AF in Asian countries are limited. OBJECTIVE The present study aimed to investigate the prevalence and incidence of newly diagnosed (ie. incident) AF, as well as lifetime risk in China, and to determine the clinical risk factors contributing to its development. METHODS Using a medical insurance database involving in more than 10 million individuals for the years 2001 to 2012 in the Southwest of China, trends in incident AF were calculated using Kaplan-Meier analysis and Cox regression. The usefulness of the CHADS2 and CHA2DS2-VASc scores was tested in predicting the occurrence of incident AF. RESULTS There were 471,446 individuals (aged ≥20 years) studied, with 1,924,975 person-years experience. We identified 921 patients with incident AF (62% males, mean age 62 years). The prevalence of incident AF in subjects age ≥20 years was 0.2 per 100 persons, with an incidence of AF of 0.05 per 100 person-years overall. Over an 11-year period, the prevalence of AF increased 20-fold, while AF-related stroke increased 13-fold. The lifetime risk for AF was approximately 1 in 5 amongst Chinese adults, which increased with advancing age. The CHA2DS2-VASc score was superior to CHADS2 in predicting the risk for incident AF in our Chinese population (DeLong test, Z=6.621, P<0.001). CONCLUSION AF burden, as well as the risk of AF-related stroke, has increased significantly over past 11 years in the southwest of China. The public health burden of AF and its complications ere greatest in the very elderly, with major implications for healthcare systems given the global burden of this common arrhythmia.
    Chest 06/2014; · 5.85 Impact Factor
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    ABSTRACT: Abstract Background: High sensitivity C-reactive protein (hs-CRP) is an inflammatory marker associated with increased cardiovascular disease risk. Health-related behaviors and factors decrease the risk of cardiovascular disease events, but the association between ideal cardiovascular health behaviors and hs-CRP is not clear. This study evaluated the relationship between the number of ideal cardiovascular health metrics and hs-CRP levels. Methods: We conducted a cross-sectional study from 2006 to 2007 that included 93,967 healthy subjects and 7869 diabetic patients. hs-CRP was measured by high-sensitivity nephelometry. Multivariate logistic regression was performed to analyze the association between the number of ideal cardiovascular health metrics and hs-CRP levels in the general population and in non-diabetic and diabetic subjects. Results: We found that hs-CRP levels decreased as the number of ideal cardiovascular health metrics increased in the general population, different genders, non-diabetic and diabetic subgroups. After adjusting for traditional risk factors, logistic regression analyses revealed that the risk of hs-CRP >3 mg/L in the general population with 6-7 ideal cardiovascular health metrics was 0.39 times lower than in those with 0-1 ideal metrics. Similarly, the risks were 0.39 times lower than in those with 0-1 ideal metrics in non-diabetic population. The risk of hs-CRP >3 mg/L in the diabetic population with 4-6 ideal cardiovascular health metrics was 0.45 times lower than those with 0-1 ideal metrics. Conclusions: Our findings demonstrate an inverse relationship between the number of ideal health metrics and hs-CRP in the general population, and similar relationships were observed for different gender, non-diabetic and diabetic subgroups.
    Clinical Chemistry and Laboratory Medicine 05/2014; · 3.01 Impact Factor
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    ABSTRACT: Glycated hemoglobin (HbA1c) is associated with an increased risk of cardiovascular disease. The aim of this study was to examine the relationship between HbA1c levels and the complexity of coronary artery lesions among the older patients with diabetes mellitus (DM). This retrospective study enrolled a total of 3805 consecutive type 2 DM patients aged 60 years and older who underwent their first elective coronary angiography and had their HbA1c levels measured at the Chinese PLA General Hospital between December 2005 and December 2012.The complexity of the coronary artery lesions was evaluated using the Syntax score, and the subjects were divided into three groups according to their HbA1c levels. Logistic regression and Pearson correlation were used to analyze the association between the measured HbA1c levels and Syntax score. The mean age was 72.3±10.6 years. The higher HbA1c levels were significantly associated with higher Syntax score (p<0.001). The unadjusted correlation coefficient of HbA1c levels and the Syntax score was 0. 371 (p<0.001). In addition, the higher HbA1c categories were able to independently predict patients with intermediate or high Syntax score (Syntax score ≥23) after adjustment for age, sex, hypertension, smoking, dyslipidemia and creatinine levels in the logistic regression analysis. HbA1c is significantly associated with the complexity of coronary lesions among older patients with DM. A higher HbA1c value is an independent predictor of the prevalence of complex coronary lesions. Further prospective multi-centre studies are needed to confirm this finding.
    PLoS ONE 01/2014; 9(3):e91972. · 3.53 Impact Factor
  • Journal of the American Geriatrics Society 08/2013; 61(8):1435-7. · 3.98 Impact Factor
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    ABSTRACT: Renal dysfunction has been proposed for the risk factor for stroke and bleeding in atrial fibrillation (AF). The impact of changes in renal dysfunction over time and the relationship to stroke and bleeding risk in these patients remain unknown. We investigated sequential change in renal function (estimated glomerular filtration rate, eGFR) and the risk for clinical events (ischaemic stroke, death and major bleeding) over time in a cohort of 617 AF patients followed up for 2years. eGFR was estimated at baseline, 6months and 12months using three formulas (Modification of Diet in Renal Disease equation, MDRD, Chronic Kidney Disease Epidemiology Collaboration, CKD-EPI, and Cockcroft-Gault equation). Changes in eGFR and the risk for clinical events were analysed by Cox models, receiver operating curves (ROC), and Kaplan-Meier survival curves. When patients with eGFR≤60ml/min/1.73m(2) were compared to patients with eGFR>60ml/min/1.73m(2), there was an increase over time in stroke or death, or death, with impaired renal function (all p<0.05). An absolute decrease in eGFR≥15ml/min/1.73m(2) on Cockcroft-Gault and CKD-EPI and ≥25ml/min/1.73m(2) on MDRD were associated with an increased risk for stroke or death, death, and ischaemic stroke at 6months (all p<0.05), but not major bleeding. A relative reduction (decline of ≥25%) in eGFR was also an independent risk. ROC analysis showed that a relative reduction in eGFR ≥25% at 6months and 12months modestly predicted the occurrence of stroke or death in patients with AF (c-indexes: 0.57 to 0.61, p<0.05). In patients with AF, an absolute decrease in eGFR ≥15ml/min/1.73m(2) on Cockcroft-Gault and CKD-EPI, and ≥25ml/min/1.73m(2) on MDRD, or a relative reduction (≥25%) in eGFR, independently predicted the risk for the endpoints 'stroke or death', 'death' or (at 6months) ischaemic stroke. Deteriorating renal function increases the risk of death in AF patients.
    International journal of cardiology 07/2013; · 6.18 Impact Factor
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    ABSTRACT: Background Recent studies have suggested that carbohydrate antigen 125 (CA 125) serum levels are remarkably elevated in patients with heart failure. We hypothesized that there was a relationship between serum levels of tumor markers and the four stages of chronic heart failure (CHF) in patients aged 85 years and older with CHF.Methods The retrospective study enrolled 2115 patients aged 85 years and older suffering from CHF between January 2004 and January 2011. The levels of various tumor markers, N-terminal proB-type natriuretic peptide (NT-proBNP) in the different stages of CHF, and clinical risk factors were analyzed. All patients were followed for 180 days, and major cardiovascular events were recorded.ResultsOnly the CA 125 level increased as the stage of CHF increased (p < 0.05) among the tumor markers. Significantly higher CA 125 serum levels were found in patients with pleural fluids or peripheral edema, compared with patients without pericardial effusion or peripheral edema (p < 0.01). During 180 days of follow-up, CA 125 values were significantly higher in patients who died or were rehospitalized, compared with those who remained alive or did not undergo rehospitalization. Linear regression analysis between CA 125 and NT-proBNP serum levels showed a statistically significant relation (r = 0.5103, p < 0.05).Conclusions Among the tumor markers evaluated, only CA 125 appeared to be related to the severity of CHF and NT-proBNP, along with the presence of pleural fluid or peripheral edema in patients aged 85 years and older with CHF.
    European Journal of Internal Medicine 07/2013; 24(5):440–443. · 2.05 Impact Factor
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    ABSTRACT: BACKGROUND: Female patients with atrial fibrillation (AF) are at increased risk of stroke. It is unclear what contributes to the gender-related differences in stroke and mortality amongst AF patients. This is pertinent since oral anticoagulation use results in a significant reduction in stroke, as well as all-cause mortality. OBJECTIVE: We investigated gender-related risk factors for stroke and mortality in a cohort of Chinese patients with AF. METHODS: We studied 1034 AF patients (27% females, median age 75years) who were followed-up for an average of 1.9years for the principal primary endpoint of 'ischaemic stroke and death'. Gender-specific effect of risk factors for stroke and death was analyzed. RESULTS: Patients at high stroke risk (CHADS(2) or CHADS(2)-VASc≥2) and HAS-BLED≥3 had higher rates of ischaemic stroke and death, but ischaemic stroke rates in females with HAS-BLED≥3 did not differ between CHADS(2) 0-1 and ≥2 (~3 per 100 person-years). On multivariate analysis of non-anticoagulated patients (n=885), independent predictors of 'ischaemic stroke and death' in both males and females were age>75, prior stroke and renal dysfunction (all p<0.05). Independent predictors of 'ischaemic stroke' in females were prior stroke, vascular disease and renal dysfunction (all p<0.05). When females were compared to males, adjusted for baseline characteristics, independent predictors for 'ischaemic stroke and death' amongst females were prior stroke (hazard ratio, HR 2.40; 95% confidence interval, CI, 1.17-4.91, p=0.017) and renal dysfunction (HR 5.30; 95%CI 2.39-11.74, p<0.001). When females were compared to males, renal dysfunction remained a predictor for the secondary endpoints of ischaemic stroke (HR 4.37, p=0.05) and all-cause mortality (HR 4.15, p=0.003). CONCLUSIONS: Renal dysfunction may be a contributor to the greater risk of stroke and death in female Chinese patients with AF. This increased risk is largely driven by the impact on all-cause mortality.
    International journal of cardiology 01/2013; · 6.18 Impact Factor
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    ABSTRACT: Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein (hs-CRP) are associated with increased risk of cardiovascular disease. However, ideal cardiovascular health indicates lower risk of cardiovascular disease. This study aimed to investigate the effect of ideal cardiovascular health behaviors and health factors on hs-CRP levels among a hypertensive population. From 2006 to 2007, a cross-sectional study was conducted to survey 41,476 hypertensive subjects among the employees of Kailuan Corporation. Data from unified questionnaires and blood biochemical examinations were collected. The effects of ideal cardiovascular health behaviors and health factors on hs-CRP levels were evaluated through multivariate logistic regression analysis. A negative correlation was observed between hs-CRP levels and the number of ideal cardiovascular health metrics. The mean hs-CRP levels of subjects with zero to one, two, three, and four to six ideal cardiovascular health metrics were 1.11, 0.96, 0.90, and 0.80 mg/L, respectively (P<0.01). Multivariate logistic regression analysis revealed that after adjustment for sex, age, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and other risk factors, the risks for subjects with two, three, and four to six ideal health metrics with serum hs-CRP >3 mg/L were lower than those with zero to one ideal health metrics, with corresponding odd ratios of 0.86 (95%CI: 0.79-0.93, P<0.01), 0.76 (95%CI: 0.69-0.83, P<0.01), and 0.68 (95%CI: 0.64-0.75, P<0.01), respectively. This finding suggests that ideal cardiovascular health behaviors and health factors were related to decreased hs-CRP levels in a hypertensive population. UNIQUE IDENTIFIER: ChiCTR-TNC-11001489.
    PLoS ONE 01/2013; 8(12):e81597. · 3.53 Impact Factor
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    ABSTRACT: BACKGROUND: Risk stratification schemes assessing stroke and thromboembolism (stroke/TE) and bleeding relating to atrial fibrillation (AF) have largely been derived and validated in Western populations. We assessed risk factors that constitute scores for assessing stroke/TE (CHADS(2), CHA(2)DS(2)-VASc) and bleeding (HAS-BLED), and the predictive value of these scores in a large cohort of Chinese patients with AF. METHODS AND RESULTS: We studied 1034 AF patients (27.1% female, median age 75; 85.6% non-anticoagulated) with mean follow-up of 1.9years. On multivariate analysis, vascular disease was independently associated with stroke/TE in non-anticoagulated patients (p=0.04). In patients with a CHADS(2) or CHA(2)DS(2)-VASc score=1, the rate of stroke/TE was 2.9% and 0.9% respectively, but in patients at "high risk" (scores≥2), this rate was 4.6% and 4.5%, respectively. The c-statistics for predicting stroke/TE with CHADS(2) and CHA(2)DS(2)-VASc were 0.58 (p=0.109) and 0.72 (p<0.001), respectively. Compared to CHADS(2), the use of CHA(2)DS(2)-VASc would result in a Net Reclassification Improvement (NRI) of 16.6% (p=0.009) and an Integrated Discrimination Improvement (IDI) of 1.1% (p=0.002). Cumulative survival of the patients with a CHA(2)DS(2)-VASc score≥2 was decreased compared to those with a CHA(2)DS(2)-VASc score 0-1 (p<0.001), but the CHADS(2) was not predictive of mortality. There was an increased risk of major bleeding with increasing HAS-BLED score (c-statistic 0.61, 95% CI: 0.51-0.71, p=0.042). CONCLUSIONS: Vascular disease was a strong independent predictor of stroke/TE in Chinese patients with AF. The CHA(2)DS(2)-VASc score performed better than CHADS(2) in predicting stroke/TE in this Chinese AF population. Cumulative survival of the patients at high risk with the CHA(2)DS(2)-VASc score (but not using CHADS(2)) was significantly decreased.
    International journal of cardiology 11/2012; · 6.18 Impact Factor
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    ABSTRACT: BACKGROUND: The risk of stroke associated with atrial fibrillation (AF) is higher in Far Eastern population than in Western population, and warfarin use suboptimal. There is uncertainty whether the novel oral anticoagulants (NOACs) would have a major impact on stroke prevention in Far Eastern populations with AF. OBJECTIVES: We investigated current antithrombotic therapy use on stroke and bleeding risk, determinants of warfarin use and performed a modeling analysis of the net clinical benefit of the NOACs (apixaban, dabigatran) in a large cohort of Chinese patients with AF. METHODS: We studied 1034 Chinese patients (27.1% female, median age 75years, interquartile range [IQR]: 63-83) with AF who were followed-up for an average of 1.9years (IQR: 1.43-2.64). Stroke/thromboembolism (TE), and major bleeding associated to antithrombotic treatment were investigated. A modeling analysis was performed for the net clinical benefit balancing major bleeding against stroke/TE for dabigatran 110mg bid, dabigatran 150mg bid and apixaban, using their respective recent clinical trial outcome data. RESULTS: Using a Cox proportional hazard model, the Hazard Ratio [HR (95% confidence interval, CI)] for stroke/TE compared to no-antithrombotic therapy (no ATT) was 1.27 (0.65-2.50) on aspirin, 1.40 (0.35-3.57) on clopidogrel, 1.52 (0.72-3.23) on dual antiplatelets and 1.65 (0.76-3.57) on warfarin. The risk for major bleeding was 0.35 (0.14-0.85) on aspirin, 0.74 (0.24-2.29) on clopidogrel, 0.35 (0.11-1.10) on dual antiplatelets, and 0.88 (0.36-2.17) on warfarin. Binary logistic regression analysis showed persistent/permanent AF (Odds Ratio, OR, 2.03 [95%CI 1.05-3.92], p=0.035) was associated with warfarin use, but age ≥75years (0.26 [0.16-0.42], p<0.001), aspirin (0.18 [0.12-0.27], p<0.001) and clopidogrel (0.17 [0.08-0.33], p<0.001) were independent determinants of non-use of warfarin. On modeling net clinical benefit (per 100 person-years [95% CI]), apixaban use compared to antiplatelet agents or no ATT was 3.29 (2.15-4.30) using Singer's method and 2.08 (1.18-3.21) with Connolly's method amongst high-risk patients. The use of dabigatran 110mg bid and 150mg bid compared to antiplatelet agents could reduce an additional 18.1 stroke/TE and 24.3 stroke/TE events, respectively. Compared to warfarin, dabigatran 150mg bid had the best net clinical benefit. CONCLUSIONS: There was suboptimal stroke prevention with no difference between antiplatelet and OAC treated patients, perhaps reflecting an inappropriate Target INR range. On modeling analyses, the use of the NOACs (apixaban and dabigatran) could provide better stroke prevention compared to antiplatelet (or warfarin) use in this Chinese AF population, with a positive net clinical benefit.
    International journal of cardiology 10/2012; · 6.18 Impact Factor
  • European Journal of Internal Medicine 09/2012; 23(6):e162-3. · 2.05 Impact Factor
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    ABSTRACT: BACKGROUND: Late stent thrombosis related to delayed endothelialization is a major concern after drug-eluting stent (DES) implantation. The long-term vascular response towards DES implantation remains unclear. Optical coherence tomography (OCT) is a high-resolution imaging modality which provides new opportunities for evaluating neointimal coverage and stent strut apposition after stent implantation. METHODS: Fifty two patients who accepted 64 sirolimus-eluting stents (SESs, Cypher Select) were enrolled in the study. The OCT procedure was performed in 20 patients at 12 months (group 1), 17 patients at 24 months (group 2), and 15 patients at 48 months (group 3) after SESs implantation, respectively. The neointimal hyperplasia (NIH) thickness and stent strut apposition were assessed at 1-mm interval, and the presence of thrombus was observed in each stent. RESULTS: The NIH thickness was significantly higher at 48 months than that of 12 months (0.1694 ± 0.1455 mm in G3 vs. 0.1455 ± 0.1373 mm in G1, P < 0.01) and 24 months (0.1514 ± 0.1296 mm in G2, P <0.01) after SESs implantation, but no significant difference existed between that of 12 months and 24 months (P > 0.05). Longer follow-up time was associated with significant decrease in the prevalence of uncovered struts (17.3% in group 1 vs. 8.8% in group 2 vs. 2.6% in group 3, P < 0.01) and malapposed struts (14.2% in group 1 vs. 10.3% in group 2 vs. 4.7% in group 3, P < 0.01). The incidence of intracoronary thrombus steadily decreased from 3.6% at 12 months to 2.4% at 24 months, and to 0.8% at 48 months (P < 0.01). CONCLUSION: Neointimal growth continued for as long as 48 months after SES implantation. NIH thickness increased insignificantly from 12 to 24 months, but markedly increased at 48 months after stent implantation. Late neointimal growth was accompanied by a higher rate of covered struts and lower rate of malapposed stent struts. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 05/2012; · 2.51 Impact Factor
  • Journal of the American Geriatrics Society 05/2012; 60(5):984-5. · 3.98 Impact Factor
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    ABSTRACT: BACKGROUND: Optical coherence tomography (OCT) is an imaging technology with high resolution which provides new opportunities for evaluating the vascular healing reaction after stent implantation. We used OCT to compare neointimal coverage and stent strut apposition with different types of drug-eluting stent (DES) at more than 12months follow-up. METHODS: Fifty five patients who accepted 72 DESs (19 sirolimus-eluting stents [SES, Cypher Select], 27 paclitaxel-eluting stents [PES, Taxus Liberte], 26 zotarolimus-eluting stents [ZES, Endeavor]) were enrolled in our study. OCT was performed at 12-18months after stent implantation. The neointimal hyperplasia (NIH) thickness and stent strut apposition at 1-mm interval and the presence of thrombus in each stent were observed. RESULTS: The average NIH thickness (0.1806±0.1726mm in SES vs. 0.2558±0.2187mm in PES vs. 0.2983±0.2567mm in ZES, p<0.001) and percentage of NIH area (17.21±14.05% in SES vs. 23.09±14.53% in PES vs. 28.73±20.47% in ZES, p=0.002) were significantly greater in ZES than in other DESs. The prevalence of uncovered struts (8.96% in SES vs. 6.19% in PES vs. 2.98% in ZES, p<0.01) and malapposed struts (6.36% in SES vs. 2.32% in PES vs. 1.69% in ZES, p<0.01) was significantly lower in ZES than in other DESs. Thrombus was less frequently observed in ZES than in other DESs (SES 1.70% vs. PES 0.83% vs. ZES 0.17%, p<0.01). CONCLUSIONS: Compared with SES and PES, ZES showed lower prevalence of uncovered struts and malapposed struts at more than 12months follow-up.
    International journal of cardiology 06/2011; · 6.18 Impact Factor
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    ABSTRACT: Although "chest distress" is the most frequent complication in the aged with chronic atrial frbrillation (AF) in clinical practice, there are few data on the association between chronic AF and coronary artery disease (CAD) in the aged in terms of medical treatment and long-term outcome. We assessed coronary artery lesions in such patients and evaluated the efficacy of medical treatment in long-term follow-ups. Of 315 elderly patients (mean age: 77.39 ± 6.33 years) who had undergone coronary angiography for chest distress, 297 exhibited sinus rhythm (SR), whereas 18 patients exhibited chronic AF. Patients with AF were followed for 4.22 ± 2.21 years. Average diastolic blood pressure (DBP) of AF patients was observed to be markedly less than that of patients with SR (57.33 ± 6.87 mmHg vs 71.08 ± 10.54 mmHg, t-test: P < 0.01). Compared with SR patients, severe stenosis of the coronary artery in AF patients was reduced (73.06% vs 44.44%, Chi-square test: P < 0.01). AF patients with chest distress had high CHADS2 score (3.72 ± 1.27), but only 33.3% patients received oral anticoagulants, and such patients had a significantly lower rate of revascularization (21.43% vs 55.63%, Chi-square test: P < 0.01), and higher rate of all-cause death (22.22% vs 4.38%, Chi-square test: P < 0.01) and thromboembolism (16.67% vs 1.68%, Chi-square test: P < 0.01) in the long-term follow-ups compared with SR patients. Chest distress in the aged with AF was related to insufficient coronary blood supply that was primarily due to a reduced DBP rather than to occult CAD. Adequate and safe medical therapy was difficult to achieve in these patients. Such patients typically have a poor prognosis, and optimal therapeutic strategies to treat them are urgently needed.
    Clinical Interventions in Aging 01/2011; 6:193-8. · 2.65 Impact Factor