Investigation on status of dyslipidemia in Chinese females aged 35 years or above / 中华心血管病杂志

Objective: To investigate the prevalence, awareness, treatment and control status of dyslipidemia among females aged ≥35 years old across China. Methods: Participants were selected by stratified multistage random sampling method in the "Twelfth Five-Year Plan" National Science and Technology Support Project "Survey on the Prevalence of Important Cardiovascular Diseases and Key Technology Research in China" project. This study is a retrospective, cross-sectional study. A total of 17 418 females aged 35 years and over were included in the current study. The basic information such as age, medical history and menopause was collected by questionnaire. The blood lipid parameters were derived from clinical laboratory examinations. The prevalence of dyslipidemia and the rate of awareness, treatment, and control of dyslipidemia were analyzed in females aged 35 years and over. Results: The age of participants was (56.2±13.0) years old, and the prevalence of dyslipidemia was 33.1% (5 765/17 418). The prevalence rates of high total cholesterol, hypertriglyceridemia, low HDL-C and high LDL-C were 9.7% (1 695/17 418), 11.1% (1 925/17 418), 10.9% (1 889/17 418) and 7.3% (1 262/17 418), respectively. The prevalence of dyslipidemia increased with age and the prevalence of dyslipidemia in women who were not married, Han, menarche age>16 years, obesity, central obesity, alcohol consumption, diabetes, hypertension and family history of cardiovascular disease were higher than those without such characteristics (P<0.05). There were 10 432 (59.9%) menopausal females in this cohort and prevalence of dyslipidemia of these participants was 38.8% (4 048/10 432), which was higher than that of non-postmenopausal females (24.6%, 1 717/6 986) (P<0.05). The awareness rates, treatment rates and control rates of dyslipidemia were 33.9% (1 953/5 765), 15.1% (870/5 765) and 2.5% (143/5 765) respectively among females aged 35 years and over in China. Conclusion: The prevalence of dyslipidemia in Chinese females aged 35 years and over is high, and its awareness, treatment, and control rates need to be optimized.

Current status of hypertension prevalence, treatment and control rate among young and middle-aged population in China / 中华心血管病杂志

Objective: To estimate the prevalence, awareness, treatment and control rate of hypertension among young and middle-aged population in China. Methods: The analysis was based on the results of 2012-2015 China Hypertension Survey, which was a cross-sectional stratified multistage random sampling survey. A total of 229 593 subjects were included in the final analysis. The data including sex, age, living in urban and rural areas, prevalence of hypertension, history of stroke, family history of coronary heart disease and drinking, physical examination, heart rate were collected. Hypertension was defined as mean systolic blood pressure (SBP) ≥140 mmHg (1 mmHg=0.133 kPa), and (or) diastolic blood pressure (DBP) ≥90 mmHg, and (or) self-report a history of hypertension, and (or) use of antihypertensive medicine within 2 weeks before survey. Prehypertension was defined as SBP between 120-139 mmHg, and (or) DBP between 80-89 mmHg. Control of hypertension was considered for hypertensive individuals with SBP<140 mmHg and DBP<90 mmHg. The prevalence of prehypertension, hypertension, awareness, treatment, control rate were calculated, and the control rate among those with antihypertensive medication was also calculated. Results: The prevalence of prehypertension and hypertension was 43.8% (95%CI: 42.3%-45.4%), and 22.1% (95%CI: 20.8%-23.3%), respectively. The prevalence of prehypertension and hypertension was significantly higher among male than female across different age groups. The awareness, treatment, control rate of hypertension and control rate among treated hypertensive participants were 43.8%, 33.2%, 16.7%, and 40.2%, respectively. The prevalence was higher, and the control rate was lower among individuals with higher heart rate. Conclusion: The prevalence of prehypertension and hypertension among young and middle-aged population is high, the awareness, treatment and control rate need to be further improved in this population. The prevention and treatment of hypertension should be strengthened in the future to improve the control rate of hypertension in China.

The incidence of hypertension, overweight, and obesity and relationship with cardiovascular events among middle-aged Chinese: 6 years follow-up results / 中华心血管病杂志

Objective: To identify the incidence of hypertension, overweight/obesity in middle-aged population in China, and explore their impact on cardiovascular events. Methods: From 2009 to 2010, 12 areas were sampled in China, and about 1 000 subjects aged 35 - 64 from each area were enrolled to collect the basic information, physical examination and blood tests were also performed. From 2016 to 2017, data from 8 835 subjects, who completed the 6 years follow-up, were analyzed.Blood pressure and body mass index(BMI) at both baseline and the follow-up, as well as incidence of hypertension, overweight and obesity, were calculated. Cox proportional hazard model was used to investigate the impacts of hypertension, overweight and obesity on cardiovascular events after adjusting confounders. Results: At the end of follow-up, both BMI and systolic and diastolic blood pressure increased significantly compared with the baseline levels (all P<0.001). The cumulative incidence of hypertension, overweight and obesity within 6 years was 39.3%(1 146/2 918), 11.5%(406/3 544) and 4.3%(302/7 025), respectively. Compared with subjects with both normal BMI and blood pressure, people with overweight, obesity, hypertension, overweight with hypertension, and obesity with hypertension faced significantly increased risk of cardiovascular disease (HRs (95%CIs) were 2.394(1.130-5.073), 3.341(1.454-7.674), 6.047(2.978-12.279), 5.808(2.924-11.539) and 8.716(4.391-17.302), respectively, all P<0.05), after adjusting for other confounders. Conclusions: The incidence of overweight, obesity, and hypertension is high in middle-aged people in China. Overweight, obesity and hypertension are associated with significantly increased risk of cardiovascular events during the 6 years follow up.

Protective effects of traditional Tibetan medicine Zuo-Mu-A Decoction () on the blood parameters and myocardium of high altitude polycythemia model rats / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the protective effects of Tibetan medicine Zuo-Mu-A Decoction (, ZMAD) on the blood parameters and myocardium of high altitude polycythemia (HAPC) model rats.</p><p><b>METHODS</b>Forty male Wistar rats were randomly divided into 4 groups by a random number table, including the normal, model, Rhodiola rosea L. (RRL) and ZMAD groups (10 in each group). Every group was raised in Lhasa to create a HAPC model except the normal group. After modeling, rats in the RRL and the ZMAD groups were administered intragastrically with RRL (20 mL/kg) and ZMAD (7.5 mL/kg) once a day for 2 months, respectively; for the normal and the model groups, 5 mL of distilled water was administered intragastrically instead of decoction. Then routine blood and hematologic rheology parameters were taken, levels of erythropoietin and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were tested, and ultrastructural change in the left ventricular myocardium was observed using transmission electron microscopy.</p><p><b>RESULTS</b>Compared with the model group, ZMAD significantly reduced the red blood cell count, hemoglobin levels, whole blood viscosity at low/middle shear rates, plasma viscosity, erythrocyte electrophoretic time, erythropoietin and 8-OHdG levels, and also increased the erythrocyte deformation index (P<0.05). There was no difference in all results between the RRL and the ZMAD groups. The cardiac muscle fibers were well-protected, mitochondrial matrix swelled mildly and ultrastructure changes were less prominent in the ZMAD group compared with the model group.</p><p><b>CONCLUSION</b>ZMAD has significant protective effects on the blood parameters against HAPC, and also has the beneficial effect in protecting against myocardial injury.</p>

Hypertension Control in Communities (HCC): evaluation result of blood pressure management among hypertensive / 中华流行病学杂志

Objective To determine the effects related to community-based standardized blood pressure management programs on the control of hypertension. Methods A protocol of community-based standardized blood pressure management was developed based on the current Chinese guideline for prevention, treatment of hypertension. Grass-roots caretakers from community health service centers across China were trained using this protocol and required to manage hypertensive patients according to the protocol. Patients were treated on therapeutic life style change or/and medication, and followed up based on the criteria of risk stratification. The control rate of hypertension was evaluated after 1 year. Effect of intervention (EI) was estimated as '1 year rate (mean)' minus the number showed at the baseline. Results By the end of 2008, a total of 29 411 hypertensive patients (47.2% for male, mean age 61.4+10.9 years) with full information had been under management for one year according to the protocol. Among all patients, 8.9% were classified as under low risk, 50.8% as moderate risk and 40.3% as high and very high risk showed in baseline data. After standardized management, the EI of smoking, drinking and systolic/diastolic blood pressure were -7.1% (P<0.05) , -7.3% (P<0.05) , and-14.8/-8.3 mm Hg (P<0.05) , respectively. However, EI of overweight/obesity was 0.3% (P>0.05). For all patients, the control rate rose to 74.7%,with EI as 53.1%, and all of the sub-groups, including age, risk stratification, had significant increases. The longer the management was under, the higher the control rate was seen. Results from the multivariate logistic regression showed that older age, male and having higher blood level were adverse factors for the undertaking the control and management programs of hypertension. Conclusion Results from our study showed that standardized management could significantly improve the program on the control of hypertension at the community level, in China.

Validation and generalizability of the predictive model of ischemic cardiovascular diseases in Chinese / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the applicability of developed prediction models of ischemic cardiovascular diseases (ICVD) in Chinese to other Chinese populations.</p><p><b>METHOD</b>We used the independent prospective cohort established in early 1990's from China Multi-Center Collaborative Study of Cardiovascular Epidemiology (MUCA), as the validation cohort, to test the hypothesis. The area under ROC curve (AUC) based on the application of the Cox optimal model and the simplified model to the validation cohort were calculated and to test the ability of the prediction models to discriminate events from nonevents. Applicability was evaluated by comparing the mean probability estimates in each decile of probability in the validation cohort with the observed incidence with the Hosmer-Lemeshow test.</p><p><b>RESULTS</b>The validation cohort enrolled a total of 17 329 men and women aged 35 to 59 years baseline 1992 - 1994. In this paper, we used data from the remaining 15 100 participants after excluding 2229 subjects for at missing value of risk factors. During 11-year follow up of the cohort, there were 347 ICVD events (206 for men and 141 for women), including 83 coronary heart disease events (56 men and 27 women) and 268 ischemic strokes (154 men and 114 women). ROC curves for men and women showed good and almost identical discrimination for optimal model (the AUCs (95% CI) were 0.796 (0.762 - 0.829) for men and 0.791 (0.755 - 0.828) for women), simplified model (the AUCs (95% CI) were 0.792 (0.758 - 0.825) for men and 0.783 (0.746 - 0.821) for women) and score system (the AUCs (95% CI) were 0.791 (0.757 - 0.825) for men and 0.779 (0.741 - 0.817) for women) in the validation cohort. The predicted 10-year risk of ICVD by optimal models and observed incidence of ICVD in the validation cohort in each decile were compared. Hosmer-Lemeshow chi2 was 3.7 for men (P = 0.879) and 27.7 for women (P < 0.001). Whereas the largest difference between the observed rate and the predicted rate was only 1%.</p><p><b>CONCLUSIONS</b>The prediction models for estimating 10-year risk of ICVD had satisfied predictive capability when they were applied to the validation cohort and are applicable to other Chinese populations.</p>

A cohort study on parental history and risk factors of stroke in Chinese population / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess the relationship between parental history and the incidence of stroke in Chinese populations.</p><p><b>METHODS</b>A total of 15,131 individuals (7015 men and 8116 women, aged from 35 to 59 years) in China were enrolled and followed up from 1992 to 2005. Information on the parental history of stroke of the participants was collected at baseline study under face to face interview. Individuals were divided into three groups according to their parental history of hypertension: those with no parental history of hypertension (Group 1), those with only one parent having the history of hypertension (Group 2) and those with both parents having the history of hypertension (Group 3). The hazard ratio and its 95% confidence interval were calculated using the Cox proportional hazard model.</p><p><b>RESULTS</b>There were 370 stroke events during 163 858 person-years of observation. After adjusting for age and sex, the hazard ratioon stroke for group 1, group 2 and group 3 were 1.00, 1.74 (1.33-2.29), 3.61 (1.86-7.01), respectively. After adjusting for age, sex, smoking, drinking, serum total cholesterol (TC), high density lipid cholesterol (HDL-C), fasting glucose, body mass index (BMI) and systolic blood pressure (SBP) in the model, the hazard ratio for stroke of those three groups were 1.00, 1.34 (1.02-1.77), 2.50 (1.29-4.87), respectively.</p><p><b>CONCLUSION</b>Individuals with parental history of stroke had a higher risk of stroke, and this was especially true for those with both parents having the history of stroke.</p>

A cohort study on parental history of hypertension and the risk of cardiovascular disease in Chinese population / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the relationship between parental history of hypertension and the incidence of cardiovascular disease in Chinese populations.</p><p><b>METHODS</b>A total of 15 131 individuals (7015 men and 8116 women, aged from 35 to 59 years) in China were enrolled and followed up from 1992 to 2005. The information on the parental history of hypertension of the participants was collected. The individuals were divided into three groups according to their parental history of hypertension: those without parental history of hypertension (group 1), those with one parent history of hypertension (group 2) and those with both parents history of hypertension (group 3). The hazard ratio and its 95% confidence interval were calculated using the Cox proportional hazard model.</p><p><b>RESULTS</b>There were 448 cardiovascular events (including 82 cardiac events and 370 stroke events and 4 with both cardiac and stroke events) during the 163 858 person-years of observation. After adjusting for age, smoking and drinking, the hazard ratio for cardiovascular disease for group 1, group 2 and group 3 were 1.00, 1.34 (1.01 - 1.78), 2.58 (1.62 - 4.11) in men respectively and 1.00, 1.77 (1.27 - 2.45), 2.55 (1.44 - 4.54) in women respectively. After further adjusting for serum total cholesterol (TC), high density lipid cholesterol (HDL-C), fasting glucose, body mass index (BMI) and systolic blood pressure (SBP) in the model, the hazard ratio for cardiovascular disease for those three groups were 1.00, 1.01 (0.76 - 1.35), 1.72 (1.07 - 2.75) in men respectively and 1.00, 1.31 (0.94 - 1.84), 1.76 (0.98 - 3.15) in women respectively.</p><p><b>CONCLUSION</b>The individuals with parental history of hypertension have a higher risk of cardiovascular disease, especially for those with both parents history of hypertension.</p>

Study on the baseline physical activity and the risk of ischemic cardiovascular diseases / 中华流行病学杂志

<p><b>OBJECTIVE</b>To examine the associations between physical activity measures [metabolic equivalents of energy expenditure (MET) per hour per day] and ischemic cardiovascular diseases (ICVD) in Chinese population.</p><p><b>METHODS</b>A survey on cardiovascular risk factors was conducted in different areas of China in fall 1998. People aged 35 to 59 but without a history of coronary heart and stroke at baseline were prospectively followed and 11 849 subjects whose information were complete at the end of second follow-up were valid. Cox regression was used to estimate the hazard ratios (HRs) for incident ischemic cardiovascular diseases and the different measures of physical activity.</p><p><b>RESULTS</b>During a mean follow-up period of 5.9 years, 84 incident ischemic cardiovascular events were ascertained. We examined the HRs of ischemic cardiovascular events for a 1-unit change in METs value, which were included in the models as continuous variable. There were negative association of METs values found with ischemic cardiovascular events in total, urban, rural, male and female subjects, and statistical significance in the urban (HRs = 0.22, 95% CI: 0.05-0.95) but the association was weakened after adjustment for demographic factors. When further adjustment for other intermediate factors, the significance in the urban was again attenuated. When the urban males and females, rural males and females were divided into 3 groups according to their respective tertiles and the combination of different population groups, the factors of male/female and urban/ rural were equally distributed in different groups, and no more adjustment in the Cox model. The multivariate - adjusted (age and education attainment) HRs associated with the tertiles, from lowest to highest, were: 1, 1.03 and 0.65 (P(trend) = 0.170) for the total, 1, 0.72 and 0.64 for the urban, 1, 1.49 and 0.72 for the rural, 1, 1.05 and 0.59 for men, 1, 0.90 and 0.84 for women.</p><p><b>CONCLUSION</b>The totality of our findings pointed to METs per hour per day seemed to be weakly associated with a reduction in ischemic cardiovascular events incidence among urban middle-aged adults.</p>

The cut-off point of waist circumference for identifying metabolic syndrome in Chinese adults / 中华心血管病杂志

<p><b>OBJECTIVE</b>Metabolic syndrome has attracted more attention from scientists of related areas due to its association with increased risk of cardiovascular disease and diabetes. The clinical identification criteria for metabolic syndrome issued by ATP III of NECP indicate the enlarged waist as the first component using the cut-offs derived from Caucasians. The purpose of this study is to investigate the appropriate cut-offs of waist circumference for Chinese adults as a component of metabolic syndrome.</p><p><b>METHODS</b>Database of 13732 Chinese adults with 35 - 59 years from the risk factor survey in 1998 (the 9(th) Five Year National Project on trends and prediction of cardiovascular disease) was used to analyze the ORs of clustering of risk components by different strata of waist circumference. The sensitivity, specificity and distance in ROC curve by different cut-offs of waist circumference for identifying two or more risk components of metabolic syndrome were estimated to find the cut-off point for men and women with the shortest distance in ROC curve.</p><p><b>RESULTS</b>The ORs of clustering of risk components increased significantly with the size of waist circumference. The waist circumference (>/= 85 cm for men, >/= 80 cm for women) corresponded to the shortest distance in ROC curve, namely, at these cut-offs, the rates of false positive and false negative for identifying clustering of two or more risk components were the minimum.</p><p><b>CONCLUSIONS</b>If a person had three or more of the following components, metabolic syndrome could be defined: waist circumference >/= 85 cm in men or >/= 80 cm in women, SBP >/= 130 mm Hg or DBP >/= 85 mm Hg, TG >/= 1.69 mmol/L, HDL-C < 1.03 mmol/L and fasting blood glucose >/= 6.1 mmol/L. The prevalence of metabolic syndrome was 19.3% and 13.9% in middle-aged men and women respectively. In these patients the combination of enlarged waist, high blood pressure and high TG was the most frequent. This recommendation need further confirmed in representative sample of Chinese population.</p>

A cohort study on the relationship between nutrients intake and the incidence of hypertension in middle-aged Chinese / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the relationship between nutrient intake and the incidence of hypertension in middle-aged Chinese.</p><p><b>METHODS</b>A prospective study was conducted in 653 men and women of Beijing and Guanzhou, aged 35-59 years. The subjects had no hypertension or other cardiovascular diseases at baseline risk factor and dietary survey carried out in 1983-1984. The baseline information of nutrient intake was collected by using a 24-hour recall method on three consecutive days. The incidence of hypertension was determined through the follow-up survey in 1993-1994. The subjects were categorized into three groups according to tritiles of each baseline nutrient intake and the relative risk for hypertension incidence in each group was calculated by using the logistic regression model with the group of lowest risk as the referent.</p><p><b>RESULTS</b>During the period of 1983-1984 to 1993-1994, 170 among 653 subjects had developed hypertension; 92 were men and 78 were women. After adjustment for other risk factors, the relative risk of hypertension for different protein intake groups was 1.0, 0.87 (95% CI 0.54-1.40) and 0.52 (95% CI 0.32-0.87), respectively, and the p value for trend analysis was 0.011; the relative risk of hypertension for different sodium intake groups was 1.0, 1.12 (95% CI 0.66-1.88) and 1.85 (95% CI 1.09-3.14), respectively, and the p value for trend analysis was 0.015. There was no significant relationship between the other nutrient intake and hypertension incidence.</p><p><b>CONCLUSION</b>Among middle-aged Chinese, protein and sodium may be two of the most important dietary factors affecting the incidence of hypertension. Increasing protein intake and reducing sodium intake might be helpful for the prevention of hypertension.</p>

Alcohol consumption and incidence of ischemic stroke in male Chinese / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess the relationship between incidence of ischemic stroke and alcohol consumption.</p><p><b>METHODS</b>The information on alcohol consumption and other cardiovascular risk factors such as SBP, DBP, TC was collected among 10 populations in northern and southern parts of China according to the international standardized methods. A total number of 30 560 men and women aged 35 - 59 were enrolled and followed up for an average of 15.2 years. Complete data on 12,352 men was analyzed.</p><p><b>RESULTS</b>The risk on ischemic stroke incidence showed a graded association. Compared with nondrinkers, the relative risks of incidence of ischemic stroke for those who drank alcohol less then 15 gram per day, 15-30 gram per day, 30-60 gram per day, above 60 gram per day were 0.86 (95% confidence interval 0.57-1.27), 1.20 (0.87-1.65), 1.26 (0.86-1.84) and 1.96 (1.30-2.93), respectively.</p><p><b>CONCLUSION</b>Our study revealed that in male Chinese, heavy alcohol intake significantly increased the risk while mild alcohol drinking did not increase the risk of ischemic stroke.</p>

Relationship between the severity, course, fatality of severe acute respiratory syndrome patients and the timing of hospitalization / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the relationship of timing of hospitalization and the severity, course, fatality of severe acute respiratory syndrome (SARS) patients.</p><p><b>METHOD</b>1291 hospital records of clinically diagnosed SARS patients with complete data gathered from "2003 Beijing SARS Clinical Database" were analyzed.</p><p><b>RESULTS</b>SARS cases were categorized into four groups, according to the time of hospitalization after onset of the disease: within 3 days, during day 4 to day 7, during day 8 to day 14 and after day 14. The numbers of cases for each group were 568, 496, 177 and 50 respectively. Data showed that from group 1 to 4, the prevalence rates of major symptoms on the first day of hospitalization were: (1) 9.7%, 16.5%, 23.1% and 24.0% for "feeling chest pain" (P < 0.001), (2) 7.4%, 13.7%, 19.2% and 22.0% for "suffering from breathing obstruction" (P < 0.001), (3) 32.8%, 44.8%, 59.9% and 48.0%, for "coughing" (P < 0.001) and (4) 14.1%, 22.4%, 27.1% and 18.0% for "coughing up phlegm" (P = 0.0002), respectively. The rates of high respiratory frequency (>or= 24 bits/min.) were 11.1%, 15.5%, 22.8% and 25.5% (P < 0.001). The rates of abnormal chest X-ray were 80.3%, 89.0%, 92.3% and 88.9%, respectively (P = 0.002). The average numbers of abnormal lung field (the lung were divided into 6 fields) were 1.7, 1.9, 2.5 and 2.6 (P < 0.001); The numbers of cases receiving continuous oxygen supply treatment were 33.6%, 50.0%, 53.7% and 74.0% (P < 0.001), and the numbers of cases receiving glucocorticosteroids treatment were 28.2%, 35.9%, 53.7% and 62.0% (P < 0.001), respectively. With cases having had chronic baseline diseases prior to SARS infection, the age-standardized fatality rates were 14.9%, 11.7%, 50.0% and 33.9% (P < 0.001), and the average courses of the disease were 30.3, 34.2, 42.9 and 47.5 days (P < 0.001), respectively. In cases without chronic baseline diseases, the age-standardized fatality rates were 5.3%, 9.8%, 9.2% and 8.3% (P = 0.101), and the average courses for each group were 32.4, 35.3, 40.9 and 47.6 days (P < 0.001), respectively.</p><p><b>CONCLUSION</b>Delayed hospitalization would cause the situation of SARS patient to deteriorate, losing the best chance for treatment and increase case fatality. In terms of control program on SARS, emphasize should be paid on decreasing the panic of patients to the disease so as to get early hospitalization.</p>