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Huang XD, Lin JY, Huang XW, Zhou TT, Xie LD. A nomogram based on endothelial function and conventional risk factors predicts coronary artery disease in hypertensives. BMC Cardiovasc Disord 2023; 23:217. [PMID: 37118701 PMCID: PMC10148409 DOI: 10.1186/s12872-023-03235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/11/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND There is currently a lack of a precise, concise, and practical clinical prediction model for predicting coronary artery disease (CAD) in patients with essential hypertension (EH). This study aimed to construct a nomogram to predict CAD in patients with EH based on flow-mediated dilation (FMD) of brachial artery and traditional risk factors. METHODS Clinical data of 1752 patients with EH were retrospectively collected. High-resolution vascular ultrasound was used to detect FMD in all patients at the Fujian Hypertension Research Institute, China. Patients were divided into two groups, i.e. training group (n = 1204, from August 2000 to December 2013) and validation group (n = 548, from January 2014 to May 2016) according to the time of enrollment. Independent predictors of CAD were analyzed by multivariable logistic regression in the training group, and a nomogram was constructed accordingly. Finally, we evaluated the discrimination, calibration, and clinical applicability of the model using the area under curve (AUC) of receiver operating characteristic analysis, calibration curve combined with Hosmer-Lemeshow test, and decision curve, respectively. RESULTS There were 263 (21.8%) cases of EH combined with CAD in the training group. Multivariate logistic regression showed that FMD, age, duration of EH, waist circumference, and diabetes mellitus were independent influencing factors for CAD in EH patients. Smoking which was close to statistical significance (P = 0.062) was also included in the regression model to increase the accuracy. Ultimately, the nomogram for predicting CAD in EH patients was constructed according to above predictors after proper transformation. The AUC values of the training group and the validation group were 0.799 (95%CI 0.770-0.829) and 0.836 (95%CI 0.787-0.886), respectively. Calibration curve and Hosmer-Lemeshow test showed that the model had good calibration (training group: χ2 = 0.55, P = 0.759; validation group: χ2 = 1.62, P = 0.446). The decision curve also verified the clinical applicability of the nomogram. CONCLUSION The nomogram based on FMD and traditional risk factors (age, duration of EH disease, smoking, waist circumference and diabetes mellitus) can predict CAD high-risk group among patients with EH.
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Affiliation(s)
- Xiao-Dong Huang
- Department of Emergency, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
- Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
- Xiamen Key Laboratory for Clinical Efficacy and Evidence-Based Research of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Ji-Yan Lin
- Department of Emergency, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
- Xiamen Key Laboratory for Clinical Efficacy and Evidence-Based Research of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Xian-Wei Huang
- Department of Emergency, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
- Xiamen Key Laboratory for Clinical Efficacy and Evidence-Based Research of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China
| | - Ting-Ting Zhou
- Department of Cardiovascular Medicine, Xiamen Haicang Hospital, Xiamen, 361026, China
| | - Liang-Di Xie
- Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
- Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
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Phi Thi Nguyen N, Luong Cong T, Tran TTH, Nhu Do B, Tien Nguyen S, Thanh Vu B, Ho Thi Nguyen L, Van Ngo M, Trung Dinh H, Duong Huy H, Xuan Vu N, Nguyen Trung K, Ngoc Vu D, The Pham N, Dinh Le T. Lower Plasma Albumin, Higher White Blood Cell Count and High-Sensitivity C-Reactive Protein are Associated with Femoral Artery Intima-Media Thickness Among Newly Diagnosed Patients with Type 2 Diabetes Mellitus. Int J Gen Med 2022; 15:2715-2725. [PMID: 35300147 PMCID: PMC8922038 DOI: 10.2147/ijgm.s351342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Low albumin levels, high levels of high-sensitivity C-reactive protein (hs-CRP), and high white blood cell count were risk factors for changes in arterial intima-media thickness (IMT). Femoral artery IMT damages were one of the common peripheral artery type 2 diabetes. This study was conducted to determine the association between femoral artery IMT and plasma albumin, hs-CRP levels, and white blood cell count in newly diagnosed patients with type 2 diabetes mellitus (nT2D). Materials and Methods From January 2015 to May 2020, 306 patients with nT2D were recruited for this cross-sectional descriptive study at Vietnam’s National Endocrinology Hospital. We measured IMT by Doppler ultrasound. Results There was a statistically significant difference in albumin, hs-CRP levels, hs-CRP-to-albumin ratio, and white blood cell counts between three different IMT groups namely normal IMT, thick IMT, and atherosclerosis (p = 0.003, p = 0.001, p = 0.001 and p = 0.049, respectively). In the multivariate linear regression analysis, white blood cell count, and hs-CRP levels showed a significantly positive correlation to IMT (standardized B and p of 0.17, 0.015 and 0.163, 0.024, respectively), but albumin levels were a significantly negative correlation to IMT (standardized B = –0.151, p = 0.029). The multivariate logistic regression analysis showed that albumin (OR = 0.79, 95% CI 0.65–0.90, p = 0.018), hs-CRP (OR = 1.09, 95% CI 1.01–1.18, p = 0.026), and white blood cell count (OR = 1.36, 95% CI 1.03–1.81, p = 0.033) had correlation to atherosclerosis of femoral artery. Conclusion Reduced plasma albumin, elevated hs-CRP, and white blood cell count associated with IMT increased the odds for atherosclerosis of femoral artery among nT2D.
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Affiliation(s)
- Nga Phi Thi Nguyen
- Department of Endocrinology, Military Hospital 103, Hanoi, Vietnam
- Department of Rheumatology and Endocrinology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thuc Luong Cong
- Cardiovascular Center, Military Hospital 103, Hanoi, Vietnam
- Department of Cardiology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thi Thanh Hoa Tran
- Emergency Resuscitation Department, National Hospital of Endocrinology, Hanoi, Vietnam
| | - Binh Nhu Do
- Division of Military Science, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Son Tien Nguyen
- Department of Endocrinology, Military Hospital 103, Hanoi, Vietnam
- Department of Rheumatology and Endocrinology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Binh Thanh Vu
- Department of Internal Medicine, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- Binh Thanh Vu, Department of Internal Medicine, Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Ky Ba Ward, Thai Binh, Vietnam, Tel +84 334588298, Email
| | - Lan Ho Thi Nguyen
- Department of General Internal Medicine, National Hospital of Endocrinology, Hanoi, Vietnam
| | - Manh Van Ngo
- Postgraduate Training Management Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Hoa Trung Dinh
- Department of Requested Treatment, National Hospital of Endocrinology, Hanoi, Vietnam
| | - Hoang Duong Huy
- Department of Neurology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Nghia Xuan Vu
- Department of Blood Transfusion, 108 Military Central Hospital, Hanoi, Vietnam
| | - Kien Nguyen Trung
- Department of Science Management, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Duong Ngoc Vu
- Department of Imaging Diagnosis, Hanoi Medical University, Hanoi, Vietnam
| | - Nghia The Pham
- Department of Imaging Diagnosis, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Dinh Le
- Department of Rheumatology and Endocrinology, Vietnam Military Medical University, Hanoi, Vietnam
- Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
- Correspondence: Tuan Dinh Le, Center of Emergency, Critical Care Medicine and Clinical Toxicology, Military Hospital 103, Vietnam Military Medical University, 261 Phung Hung Street, Phuc La Ward, Ha Dong District, Hanoi, Vietnam, Tel +84 388166078, Email
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