Impact of individual and combined assessment of age- and sex-specific brachial-ankle pulse wave velocity and pulse pressure on all-cause mortality / 中华心血管病杂志

Objective: To evaluate the impact of individual and combined assessment of age- and sex-specific brachial-ankle pulse wave velocity (baPWV) and pulse pressure (PP) on all-cause mortality. Methods: This study is a prospective cohort study. Individuals participated in the Kailuan Study and completed baPWV measurements between 2010 and 2016 were included in this study. After stratifying by sex, 75th percentile baPWV and PP values for different age group were calculated at five years interval. BaPWV and PP values below the 75th percentile were defined as normal, and those above or equal to the 75th percentile were defined as increased. The participants were allocated to four groups according to their PP and baPWV status: normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group. The primary outcome was all-cause mortality during the follow-up period. Cox proportional hazards models were used to explore the impact of individual and combined assessment of baPWV and PP on all-cause mortality events. Results: A total of 39 339 participants were enrolled in this study, aged (49.3±12.8) years, of which 28 731 (73.03%) were males. There were 23 268, 6 025, 6 210 and 3 836 cases in the normal baPWV/PP group, high baPWV/normal PP group, normal baPWV/high PP group and high baPWV/PP group, respectively. The average follow-up duration was (4.98±2.53) years. During the follow-up period, all-cause mortality occurred in 998 individuals. Multivariate Cox regression analysis showed increased risk of all-cause mortality in the high baPWV/normal PP group (HR=1.27, 95%CI 1.07-1.50), and in the high baPWV/PP group (HR=1.33, 95%CI 1.08-1.65) compared to the normal baPWV/PP group. Increased pulse pressure alone had no impcat on all-cause death (HR=1.06, 95%CI 0.87-1.29). Conclusions: The risk of all-cause mortality significantly increases with increased age-and sex-specific baPWV and PP values. BaPWV may be a better predictor of all-cause mortality than PP in this cohort.

A cohort study on the association between resting heart rate and the risk of new-onset heart failure / 中华心血管病杂志

Objective: To prospectively explore the relationship between resting heart rate (RHR) and risk of new-onset heart failure. Methods: It was a prospective cohort study. People who attended the physical examination of Kailuan Group Company in 2006 and with complete electrocardiography (ECG) recordings were eligible for this study. A total of 88 879 participants aged 18 years old or more who were free of arrhythmia, a prior history of heart failure and were not treated with β-blocker were included. Participants were divided into 5 groups according to the quintiles of RHR at baseline (Q(1) group, 40-60 beats/minutes (n=18 168) ; Q(2) group, 67-70 beats/minutes (n=18 970) ; Q(3) group, 71-74 beats/minutes (n=13 583) ; Q(4) group, 75-80 beats/minutes (n=22 739) ; and Q(5) group,>80 beats/minutes (n=15 419) ) .The general clinical data and laboratory test results were collected. The outcome was the first occurrence of heart failure at the end of follow-up (December 31, 2016) .We used Cox regression model to examine the association between RHR and the risk of new-onset heart failure. Hazard ratio (HR) with 95% confidence intervals (CI) were calculated using Cox regression modeling. Results: Among the included patients 68 411 participants were male, mean age was (51.0±12.3) years old, and RHR was (74±10) beats/minutes. Statistically significant differences among the RHR quintiles were found for the following variables: age, gender, systolic blood pressure, diastolic blood pressure, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, body mass index, the level of high-sensitivity C-reactive protein, education status, physical activity, smoking status, drinking status, history of diabetes, history of hypertension and history of use antihypertensive drugs (all P<0.01) . Higher RHR was linked with higher prevalence of diabetes, hypertension history, and higher systolic blood pressure, diastolic blood pressure and FBG levels (all P<0.01). After a mean follow-up of 9.5 years, the incidence of new-onset heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.60%(290/18 168), 1.36%(258/18 970), 1.80%(245/13 583), 1.76%(400/22 739) and 2.35%(362/15 419),respectively (P<0.01) . The person-year incidence of heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.7, 1.5, 1.9, 1.9 and 2.6 per 1 000 person-years respectively. Compared with the Q(2) group, multivariate analysis with adjustment for major traditional cardiovascular risk factors showed that HRs of Q(3),Q(4),and Q(5) group were 1.23 (95%CI 1.03-1.48, P<0.05) , 1.19 (95%CI 1.01-1.41, P<0.05) , 1.39 (95%CI 1.18-1.65, P<0.01) , respectively. In the absence of hypertension, diabetes, smoking and acute myocardial infarction, the Cox regression model showed that compared with Q(2) group, the HR of new-onset heart failure in Q(5) group was 1.58 (95%CI 1.02-2.45, P<0.05) . Conclusion: Increased RHR is associated with increased risk of new-onset heart failure in this cohort.

Impact of change of ideal cardiovascular behavior and related factors on healthy vascular aging / 中华心血管病杂志

Objective: To investigate the impact of change of ideal cardiovascular behavior and related factors on healthy vascular aging(HVA). Methods: This study was a multi-center cross-sectional survey. Six thousand three hundred and sixteen participants who underwent at least 2 healthy examinations from 2006 to 2015 at 11 hospitals, including Kailuan Hospital and so on, and examined brachial-ankle pulse wave velocity (baPWV) during 2010 and 2016, with available information about cardiovascular behavior and factors were included. The cardiovascular health score (CHS) was calculated. Basic CHS was collected from the first examination. The second CHS derived from the healthy examination in the same year of baPWV examination. Change of cardiovascular health score (ΔCHS) was calculated. Participants were defined into 5 groups according to ΔCHS, namely ΔCHS≤-2 (n=2 166), ΔCHS=-1 (n=1 284), ΔCHS=0 (n=1 187), ΔCHS=1 (n=860), and ΔCHS≥2 (n=819). Participants' characteristics, value of baPWV and proportion of HVA were compared among different groups. Multiple logistic regression analysis was used to investigate the association between ΔCHS and HVA. The ΔCHS was recalculated and included in multiple logistic regression analysis model again after each component of the cardiovascular health metrics was removed separately in order to investigate effects of removal factors on HVA by observing changes in effect values. Results: The percentage of the participants with HVA in the group of ΔCHS≤-2, ΔCHS=-1, ΔCHS=0, ΔCHS=1 and ΔCHS≥2 were 23.3%(505/2 166), 27.8%(357/1 284), 28.7%(341/1 187),31.9%(274/860) and 33.9%(278/819), respectively. After adjustment for age, sex, income, education, alcohol consumption and the basic CHS, a significant positive association between ΔCHS and proportion of participants with HVA was observed (OR=1.50, 95%CI 1.44-1.56). Multiple regression analysis after removing each single cardiovascular behavior or factor showed that the OR value decreased as follow systolic blood pressure (OR=1.04, 95%CI 1.00-1.09), fasting blood glucose (OR=1.14, 95%CI 1.09-1.18), physical exercise (OR=1.16, 95%CI 1.11-1.21), salt intake (OR=1.17, 95%CI 1.12-1.22), body mass index (OR=1.18, 95%CI 1.13-1.23), smoking(OR=1.18, 95%CI 1.13-1.23) and total cholesterol (OR=1.20, 95%CI 1.16-1.24). Conclusion: The improvement of every ideal cardiovascular behavior and factor is associated with the increase of the proportion of HVA population.

Analysis of Inflammatory Factors and Related Factors in Population With Overweight Combining Abdominal Obesity and High-normal Blood Pressure / 中国循环杂志

Objective: To explore the changes of inflammatory factors and related factors in the population with overweight combining abdominal obesity and high-normal blood pressure (BP). Method: Our research included in 2 groups: Group A: n=189 subjects with high-normal BP, overweight and abdominal obesity, their BMI ≥ 24 kg/m2, waist circumference (WC) ≥ 90 cm in male, WC ≥ 85 cm in female, SBP(120-139) mmHg or DBP (80-89) mmHg; Group B, n=87 healthy subjects with matched age, BMI < 24 kg/m2, BP < 120/80 mmHg as normal control. Blood lipids and other biochemical parameters were examined; serum levels of intercellular adhesion molecule-1 (ICMA1), monocyte chemoattractant protein-1 (MCP1), chemokines-1 (CXCL-1), CXCL-2 and oxidized low density lipoprotein (oxLDL) were measured by ELISA. Results: Compared with Group B, Group A had increased TG, fasting blood glucose and non-HDL-C, all P<0.05; elevated serum levels of ICMA1 and MCP1, both P<0.05. Correlation analysis indicated that in Group A, ICMA1 was positively related to BMI, SBP, LDL-C and negatively related to age, which had gender difference; MCP1 was positively related to WC, SBP, LDL-C, non-HDL-C and negatively related to HDL-C, which also had gender difference; oxLDL was positively related to SBP, LDL-C; no evidence showed that CXCL-1 and CXCL-2 were related to obesity, BP and metabolic parameters; in Group B, no evidence showed that inflammatory factors were related to the other parameters. Linear regression analysis for inflammatory parameters found that after excluding other factors, in Group A, ICMA1 was positively related to BMI (t=2.901, P=0.005); in male gender, MCP1 was positively related to SBP (t=5.076, P=0.000), negatively related to DBP (t=-3.369, P=0.001). oxLDL was positively related to age (t=2.168, P=0.032) and LDL-C (t=2.146, P=0.034); CXCL-1 was negatively related to HDL-C (t=-2.013, P=0.047). Conclusion: The subjects with overweight abdominal obesity and high-normal BP were usually having abnormal metabolism of glucose and lipids, elevated serum levels of inflammatory parameters, blood levels of inflammatory factors were increasing with elevated BMI and SBP accordingly which implied the association with critical range of BP.

Incidence, Development, and Prognosis of Diabetic Kidney Disease in China: Design and Methods / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although that glomerulonephritis is the major cause of end-stage renal disease in developing countries such as China, the increasing prevalence of diabetes has contributed to the changing spectrum of predialysis chronic kidney disease. Recent studies have revealed an increased proportion of patients with diabetic kidney disease (DKD) in hemodialysis populations in large cities in China. However, studies regarding the clinical phenotype of DKD in China are extremely limited. The incidence, development, and prognosis of diabetic kidney disease (INDEED) study aims to investigate the incidence, progression, and prognosis of DKD, as well as the associated genetic, behavioral, and environmental factors and biomarkers in patients with DKD in China.</p><p><b>METHODS</b>INDEED study is a prospective cohort study based on all participants with diabetes in the Kailuan study, which is a general population-based cohort study in northern China. Altogether, over 10,000 participants with diabetes will be followed biennially. Questionnaires documenting general characteristics, behavioral and environmental factors, and medical history will be administrated. Anthropometric measurements and a series of laboratory tests will be performed in one central laboratory. The DNA, plasma, and urine samples of every participant will be stored in a biobank for future research.</p><p><b>CONCLUSIONS</b>INDEED study will provide essential information regarding the clinical phenotype and prognosis of patients with DKD in China and will be valuable to identify factors and biomarkers associated with patients with DKD in China.</p>

Effects of the traditional chinese medicine sanzipaitantang combined with ambroxol in the treatment of airway mucus hypersecretion in rats with asthma / 解放军医学杂志

Objective To investigate the effects of the traditional Chinese medicine SanZiPaiTanTang combined with ambroxol in the treatment of airway mucus hypersecretion in rats with asthma. Methods Forty SD rats were randomly divided into 5 groups (8 each): normal group, asthma group, SanZiPaiTanTang group (Chinese medicine group), ambroxol group (Western medicine group), SanZiPaiTanTang combined with ambroxol group (The combinational group). The rat asthma model was reproduced with ovalbumin (OVA), and all these rats were morphologically scored on the 42th and 56th day. Airway inflammation was observed pathologically with HE staining, and the expression of lung tissue mucin (MUC5AC) was examined by immunohistochemistry The IL-13 content in serum was measured by enzyme-linked immunosorbent assay (ELISA), and the proliferation of goblet cells in airway was detected by periodic acid Schiff (PAS) staining. Results The morphological score and airway inflammation decreased in all drug treated groups as compared with those in asthma group. The MUC5AC levels were higher in asthma group than in normal group (0.530 ± 0.035 vs 0.132 ± 0.020, P<0.05), the combination group (0.254 ± 0.029), the Chinese medicine group (0.359 ± 0.025) and the Western medicine group (0.386 ± 0.030) (P<0.05), while the difference between combinational group and Chinese medicine group or Western medicine group was statistically significant (P<0.05). The IL-13 contents markedly decreased in the combinational group, Chinese medicine group and Western medicine group compared with that in asthma group (42.41 ± 3.15, 46.31 ± 3.07, 43.05 ± 2.70 vs 51.65 ± 4.07, P<0.05), and the difference between the combinational group and Chinese medicine group was statistically signifcant (P<0.05), but no signifcant difference was found between the combinational group and the Western medicine group. Te goblet cell hyperplasia area was signifcantly lower in the three drug treated groups than in asthma group (41.21 ± 2.88, 48.10 ± 3.44, 51.06 ± 3.51 vs 63.25 ± 5.02, P<0.05), and the difference between combinational group and Chinese medicine group or Western medicine group was statistically signifcant (P<0.05). Conclusion SanZiPaiTanTang combined with ambroxol can suppress the hypersecretion of airway mucus in asthma rats probably by reducing the expression of IL-13 and the proliferation of goblet cells, and its efficacy is higher than that of Chinese medicine or Western medicine alone.

Study on the effects of different risk stratifications in patients with diabetes mellitus: a clinical endpoint event / 中华流行病学杂志

Objective To estimate the relationship between the risk stratification of patients with diabetes and their clinical endpoint events.Methods In this cohort study,we prospectively followed 8302 individuals under the following situations: contents of fasting plasma glucose ≥7.0 mmol/L,being diagnosed as diabetes or having used hypoglycemic drugs from Kailuan study in which 101510 employees (81110 males,20400 females,who were being employed and those retired from the company were included) from the Kailuan Company,were screened.During the 38-53(48.01 ± 3.14) months of follow-up period,a new heart or cerebrovascular events were ascertained every six months.The impacts of different risk stratification in diabetic population on the incidence rates of cardiovascular and cerebrovascular events were estimated.Results Using the definitions of “people with ischemic cardiovascular disease incidence of 10-year risk assessment methods”developed by the Chinese Academy of Medical Sciences,Institute of Cardiovascular Disease,the study cohort was divided into four groups,namely,very low-risk,low risk,medium risk and high risk.(1) Along with the increasing risk of the disease,the incidence rates of total cardiovascular and cerebrovascular events,myocardial infarction,stroke,cardiovascular death and all-cause death rate also gradually increased and the differences were statistically significant (P＜0.01).However,the difference on incidence rate of sudden death was not significantly different (P＞0.05).(2)Compared to the very low-risk group,the age and sex adjusted relative risk for cardiovascular and cerebrovascular events were 1.42 (95％CI: 1.02-1.96,P＜0.05),2.26 (95％CI: 1.67-3.04,P＜0.01 ) for those with medium and high risk groups,respectively.Conclusion In diabetic patients,those risk factors as age,hypertension,body mass index,total cholesterol and smoking having been used on ischemic cardiovascular disease,could also be used to predict the occurrence of cardiovascular events.Along with the increasing risk factors,the risk of cardiovascular events incidence also increased.

Mediating effects on depression regarding the relationship between negative life events and suicide ideation among college students / 中华流行病学杂志

Objective To understand the relationship between negative life events and suicide ideation,and how it was influenced by the mediating effect of depression.Methods 1145 college students from one university were selected using cluster sampling.Both Symptom Check List (SCL-90) and Qestionnaire were administered to measure depression and suicide ideation in the past week and on the prevalence of negative life events and related information.Recent negative life events would include physical illness,academic problem,financial problem and interpersonal conflict etc.Multiple logistic regressions were used to identify the mediating effect of depression.Results Physical illness (OR=2.5,P=0.028),interpersonal conflict (OR=7.2,P=0.002) and financial problem (OR =1.6,P =0.026) were significantly associated with suicide ideation,but academically-related problems did not seem to be significantly associated with suicide ideation (OR=1.8,P=0.090).After adjusted for depression,both physical illness and interpersonal conflicts were not but financial problem remained significantly associated with suicide ideation (OR =1.7,P =0.014).Our data showed that depression fully mediated the relationship between physical illness,interpersonal conflict and suicide ideation,but did not mediate the relationship between financial problem and suicide ideation.Conclusion Depression played different mediating roles between different negative life events and suicide ideation.The findings from this study might be able to provide some clues for the prevention interventions on college students.

The prevalence and distribution of ideal cardiovascular health behavior in employees of Kailuan Group cohort / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the prevalence and distribution of ideal cardiovascular health behavior.</p><p><b>METHODS</b>Health examination data between 2008 to 2009 from the employees of Kailuan Group were analyzed.</p><p><b>RESULTS</b>A total of 101 333 subjects took part in the health examination, subjects with previous myocardial infarction (n = 871), stroke (n = 2255), myocardial infarction and stroke (n = 162) and subjects with incomplete examination data (n = 9311) were excluded and 88 534 subjects were included for final analysis [mean age (50.6 ± 12.3) years, male 69 916]. (1) Body mass index (BMI), systolic and diastolic pressure, cholesterol (TC) and triglyceride were significantly higher in males than in females (all P < 0.05), women's income and the education lever were significantly higher than men (P < 0.05). (2) The distribution of ideal cardiovascular health behavior (smoking, BMI, physical exercise, salt intake) was 55.8%, 41.4%, 18.9% and 14.0% respectively among the population; the ideal cardiovascular factors (fasting blood glucose, TC, blood pressure) was 80.9%, 61.8% and 18.5%, respectively. (3) The subjects with distribution of seven, six, five, four ideal cardiovascular health behavior and factors was 0.1%, 1.9%, 9.1%, 20.3%, respectively. (4) Multiple logistic regression analysis showed that female, age < 55 and high education level were associated with the ideal cardiovascular health status with a RR value (95%CI) of 4.52 (4.32 - 4.72), 1.46 (1.39 - 1.53) and 2.23 (2.10 - 2.37), respectively.</p><p><b>CONCLUSION</b>The prevalence of ideal cardiovascular health is extremely low in the study population, most persons were not in the ideal cardiovascular health behavior and factors and female, age < 55 and high education level are linked with ideal cardiovascular health status.</p>

Association of polymorphisms in ACE and CYP11B2 genes with antihypertensive effects of hydrochlorothiazide / 中华心血管病杂志

<p><b>OBJECTIVE</b>To determine whether the blood pressure (BP) response to hydrochlorothiazide (HCTZ) was associated with the angiotensin converting-enzyme (ACE) I/D and aldosterone synthase (CYP11B2)-344T/C polymorphisms.</p><p><b>METHODS</b>The BP response to HCTZ 12.5 mg once daily for 6 weeks was assessed in 829 subjects with mild or moderate essential hypertension, and compared across the ACE and CYP11B2 genotypes.</p><p><b>RESULTS</b>Of the 829 enrolled subjects, 785 completed the study. The systolic BP response differed according to the ACE (DD 9.4 +/- 15.7 mm Hg, ID 4.8 +/- 16.3 mm Hg, and II 5.1 +/- 14.8 mm Hg, P < 0.01), but not the CYP11B2 genotype (P > 0.05). Subjects with the combination of ACE DD and CYP11B2 CC genotypes tended to have a more pronounced systolic BP reduction than the other genotypic combinations of these 2 genes. Multiple linear regression analyses showed that the ACE DD genotype and serum aldosterone concentration at baseline were associated with the systolic BP reduction after treatment. None of the genetic associations with changes in diastolic BP or mean arterial pressure reached statistical significance (P > 0.05).</p><p><b>CONCLUSIONS</b>The present study suggested that the ACE DD genotype was associated with the systolic BP response to HCTZ, and that the subjects with the combination of ACE DD and CYP11B2 CC genotypes might have a better BP response to HCTZ than the other genotypic combinations of these 2 genes.</p>