BackgroundThe incidence of young coronary heart disease (CHD, ≤45 years) in China is increasing. Secondary prevention to counter this trend is an important contemporary public health issure.MethodsA total of 5288 patients (≤45 years) diagnosed with CHD and hospitalized at the Chinese PLA General Hospital and Anzhen Hospital, both in Beijing, were enrolled after satisfying the inclusion criteria.ResultsYoung CHD patients increased in number from 2010 to 2014, especially men. Among the studied patients, there was no significant change over those years in blood pressure, but heart rate increased significantly (P < 0.05) and body mass index showed a rising trend (P > 0.05). The incidence of hypertension increased from 40.7 to 47.5%, diabetes from 20.3 to 26.1%, and hyperlipidemia from 27.3 to 35.7% (P < 0.05). However, the incidences of smoking and drinking both trended downward (P < 0.05). The levels of total cholesterol and triglycerides also showed a downward trend (P < 0.05), as did levels of low-density lipoprotein, but not to the point of statistical significance (P > 0.05). Mortality during hospitalization decreased significantly from 2010 to 2014 (P < 0.05), but there was no significant improvement in the incidences of cardiac death and major adverse cardiovascular events (MACE) after 1-year follow-up (P > 0.05).ConclusionsOver the 5 years studied, the overall incidence of cardiac death and MACE for young CHD patients (≤45 years) has shown little improvement. Secondary prevention of young CHD, and its risk factors, as well as appropriate courses of medical treatment must be further elucidated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0458-1) contains supplementary material, which is available to authorized users.

Background: Previous studies have reported inconsistent results on the relationship between body mass index (BMI) and clinical outcomes in implantable cardioverter defibrillator (ICD) patients. Additionally, research on ICD patients with nonischemic cardiomyopathy (NICM) is lacking. Hypothesis: This study aimed to investigate the impact of BMI on mortality and ventricular arrhythmias (VAs) in NICM patients with an ICD. Methods: This study retrospectively analyzed the data from the Study of Home Monitoring System Safety and Efficacy in Cardiac Implantable Electronic Deviceimplanted patients (SUMMIT) in China. Four hundred and eighty NICM patients with an ICD having BMI data were enrolled. Patients were divided into two groups: underweight and normal range group (BMI < 24 kg/m 2), overweight and obese group (BMI≥24 kg/m 2). The primary endpoint was all-cause mortality. The secondary endpoint was the first occurrence of VAs requiring appropriate ICD therapy or shock. Results: During a median follow-up of 61 (1-95) months, 70 patients (14.6%) died, 173 patients (36%) experienced VAs requiring appropriate ICD therapy, and 112 patients (23.3%) were treated with ICD shock. Multivariate Cox regression modeling indicated a decreased mortality risk in the overweight and obese group compared with the underweight and normal range group (hazard ratio = 0.44, 95% confidence interval 0.26-0.77, P = .003). However, the risk of VAs was similar in both groups in univariate and multivariate Cox models. Conclusions: Compared with underweight and normal weight, overweight and obesity are protective against mortality but have only a neutral impact on VAs risk in NICM patients with an ICD.

Objective: To clarify the impact of sex on physical activity (PA) levels among patients with implantable cardioverter-defibrillators/cardiac resynchronization therapy defibrillators (ICD/CRT-D) and its association with cardiac death and all-cause mortality.Methods: Overall, data of 820 patients with ICD/CRT-D from the SUMMIT registry were retrospectively analyzed. Baseline PA from 30 to 60 days after device implantation was measured using Biotronik accelerometer sensors. The primary and secondary endpoints were cardiac death and all-cause mortality, respectively.Results: Baseline PA levels were significantly higher in male patients than in female patients (11.40 ± 5.83% vs. 9.93 ± 5.49%, P = 0.001). Males had higher predictive PA cut-off values for cardiac death (11.16 vs. 7.15%) and all-cause mortality (11.33 vs. 7.17%). During the median follow-up time of 75.7 ± 29.1 months, patients with baseline PA&lt;cut-off values had higher cumulative incidence of cardiac death and all-cause mortality in both males and females. At a PA level between the cut-off values of males and females, males had a higher risk of cardiac death (hazard ratio = 4.952; 95%CI = 1.055-23.245, P = 0.043) and all-cause mortality (hazard ratio = 2.432; 95%CI = 1.095-5.402, P = 0.029).Conclusions: Males had higher predictive PA cut-off values for cardiac death and all-cause mortality in patients with ICD/CRT-D. Sex should be considered as an important contributing factor when deciding for PA targets.

Objective To investigate the obesity paradox and its interrelationship with objective physical activity (PA) in patients at high risk of sudden cardiac death (SCD). Methods 782 patients with implantable cardioverter-defibrillators (ICDs)/cardiac resynchronization therapy defibrillators (CRTDs) in the SUMMIT registry were retrospectively analysed and grouped by body mass index (BMI) (kg/m2): normal weight (18.5≤BMI&lt;25) and overweight or Class I obesity (25≤BMI&lt;35). PA was measured with home monitoring (HM), and categorized into four groups (Q1-Q4) by the baseline quartiles. The main endpoint was all-cause mortality. Results During a mean follow-up period of 59.9±21.9 months, 182 all-cause mortality events occurred. Mortality tended to be lower in overweight and obesity patients (18.9% vs 25.1%, P=0.061) and decreased by PA quartiles (44.1% vs 22.6% vs 15.3% vs 11.2%, Q1-Q4, P&lt;0.001). Multivariate Cox analysis indicated BMI (hazard ratio [HR] 0.918, 95% confidence interval [CI] 0.866-0.974, P=0.004) and PA (0.436, 0.301-0.631, quartile 2 vs quartile 1; 0.280, 0.181-0.431, quartile 3 vs quartile 1; 0.257, 0.158-0.419, quartile 4 vs quartile 1, P&lt;0.001 for all) were associated with reduced risk. The obesity paradox was significant in the total cohort (log rank P=0.049) and low PA group (log rank P=0.010), but disappeared in the high PA group (log rank P=0.692). Dose-response curves showed a significant reduction in risk with low-moderate PA, and the pattern varied between different BMI groups. Conclusions The obesity paradox only persisted in physically inactive patients. PA might be related to the development of the obesity paradox.

Objective This study aimed to explore the associations between abdominal obesity and cardiovascular death (CVD) in patients with permanent pacemakers (PPMs) implantation and to investigate the role of gender on the possible associations. In this regard, this study investigated the association between waist circumference (WC) and cardiovascular death in patients with permanent pacemakers (PPMs) implantation. Methods This was a retrospective cohort study that included the data of patients who underwent PPMs implantation in Fuwai Hospital, China from May 2010 to April 2014 using BIOTRONIK Home Monitoring® database. Waist circumference was classified into sex-specific quartiles and patients were divided into three groups according to their body mass index (BMI) values: normal (≤ 22.9 kg/m2), overweight (23–24.9 kg/m2), and obese (≥ b25 kg/m2). Cox proportional hazards models were used to calculate the hazard ratios and 95% confidence intervals for cardiovascular death based on the patient’s WC and BMI. Results A total of 492 patients with PPMs implantation were analyzed (mean age: 71.9 ± 10.8 years; 55.1% men [n = 271]). Data showed that after a mean follow-up period of 67.2 ± 17.5 months, 24 (4.9%) patients had experienced cardiovascular death and 71 (14.4%) were cases of all-cause mortality. The men in the third quartile of WC had a hazard ratio (HR) of 10.67 (Model 4, 95% CI: 1.00–115.21, P-trend = 0.04) for cardiovascular death. However, the association disappeared in the women patients (Model 4, HR = 3.99, 95% CI: 0.37–42.87, P-trend = 0.25). No association was found between BMI and cardiovascular death or all-cause mortality in both men and women patients. Conclusions Abdominal obesity was associated with an increased risk of cardiovascular death in patients with PPMs and this association is gender dependence where only men patients show this association.