Burden of hemorrhagic stroke and hypertensive heart disease attributed to alcohol consumption in China / 中华流行病学杂志

Objective: To describe the prevalence of alcohol consumption and the burden of hemorrhagic stroke and hypertensive heart disease attributed to alcohol consumption in adults aged ≥20 years in 31 provinces in China from 2005 to 2018. Methods: Data from several national representative surveys was used to estimate provincial alcohol exposure level of adults aged ≥20 years from 2005 to 2018 by using kriging interpolation and locally weighted regression methods. Global disease burden research method and data, and China's death cause surveillance data were used to calculate the population attributable fraction (PAF) of hemorrhagic stroke and hypertensive heart disease and the deaths due to alcohol consumption in men and women aged ≥20 years in 31 provinces in China. China census data of 2010 were used to calculate the attributable standardized mortality rate. Results: In 2005 and 2018, the prevalence of alcohol consumption was 58.7% (95%CI: 57.8%-59.5%) and 58.4% (95%CI: 57.6%-59.3%), respectively, in men and 17.0% (95%CI: 16.6%-17.4%) and 18.7% (95%CI:18.1%-19.3%), respectively, in women. The daily alcohol intake was 24.6 (95%CI: 23.8-25.3) g and 27.7 (95%CI: 26.8-28.7) g, respectively, in men and 6.3 (95%CI: 6.0-6.5) g and 5.3 (95%CI: 5.0-5.6) g, respectively, in women. Alcohol exposure level was higher in the provinces in central and eastern China than in western provinces. The lowest exposure level was found in northwestern provinces. From 2005 to 2018, the PAF of hemorrhagic stroke death due to alcohol consumption increased from 5.5% to 6.8%, the attributable deaths increased from 50 200 to 59 100, while the PAF of hypertensive heart disease death due to alcohol consumption increased from 7.0% to 7.7%, the attributable deaths increased from 15 200 to 29 300. The PAF of hypertensive heart disease and hemorrhagic stroke was higher in men than in women, and in central and eastern provinces than in western provinces. In 2018, the standardized mortality rates of hemorrhagic stroke and hypertensive heart disease attributed to alcohol consumption were 4.58/100 000 and 2.11/100 000, respectively. Conclusions: The prevalence of alcohol consumption in men and daily alcohol intake of drinkers were relatively high in China, especially in eastern provinces. Alcohol exposure level was lower in women than in men. Regional measures should be taken to reduce the alcohol intakes in men and current drinkers in order to reduce the health problems caused by alcohol consumption.

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.

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.

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.

Prevalence of Ideal Cardiovascular Health Status and Its Association With Socioeconomic Status in Chinese Enterprise Employees / 中国循环杂志

Objectives: To investigate the prevalence of ideal cardiovascular health behaviors and factors, and its association with socioeconomic status (SES) in enterprise employees. Methods: The cluster sampling method was adopted to recruit 27 607 employees aged 18 to 60 years from 45 enterprises across China. The ideal cardiovascular health metrics including behaviors and factors, which were defined according to the AHA criteria, were obtained, and SES was measured by education and occupational class. Multilevel logistic regression models were used to analyze the association between SES and ideal cardiovascular health metrics. Results: Overall, the prevalence of ideal cardiovascular health behavior (smoking, body mass index, salt intake, physical activity) was 51.3%, 67.9%, 14.0%, 31.2%, respectively; prevalence of the ideal cardiovascular factors (fasting blood glucose, total cholesterol, blood pressure) was 72.9%, 81.6%, 27.3%,respectively in this cohort. Among the employees, only 0.6% population met all 7 cardiovascular health metrics. After adjusting the individual and workplace factors, employees with high school (OR=1.18, 95%CI: 1.08-1.29) and college or above education (OR=1.52, 95%CI: 1.37-1.69) were more likely to have ideal cardiovascular health status compared with those with less education; white-collar workers were more likely to have ideal cardiovascular health status compared with blue-collar workers (OR=1.18; 95%CI: 1.08-1.29). Conclusions: The prevalence of ideal cardiovascular health behaviors and factors is low, and is positively associated with SES, suggesting the importance of promoting the cardiovascular health behavior, monitoring/controlling the related cardiovascular factors and reducing the socioeconomic inequalities among Chinese enterprise employees.

Correlation Factor Analysis for Cardiac Morphology and Valvular Regurgitation in Normal Tibetan Population at High Altitude Area / 中国循环杂志

Objective: To explore the correlation factors for cardiac morphology and valvular regurgitation in normal Tibetan population at high altitude area. Methods: Based onTibetan permanent resident population, a 4-stage cluster random sampling was conducted to drawn normal Tibetan subjects. Personal information and medical history were collected; physical parameters including blood and urine tests, ECG, chest X-ray and echocardiography were examined; cardiac morphology and valvular stenosis and regurgitation were detected. Canonical correlation study and Logistic regression analysis were performed to investigate the correlation factors for cardiac structure and function. Results: A population of 4 688 in Tibetan area were involved and 1 820 normal subjects were studied including 694 from Lhasa, 575 from Naqu, 286 from Nyingchi and 265 from Shigatse area. Canonical correlation analysis revealed that in normal Tibetan population, the major relevant physiological parameters for measuring right ventricle were age, blood oxygen saturation and body weight; for left ventricle were body weight, age and height; gender had no real differences. Logistic regression analysis presented that body weight, pulse and blood oxygen saturation were negatively related to mild tricuspid regurgitation; age was positively related to mild mitral and aortic regurgitations, all P<0.01. Conclusion: Age and body weight were the correlation factors for cardiac morphology and mild valvular regurgitation in normal Tibetan population at high altitude area, which should be alert in heart disease investigation.

A single-site retrospective study of pediatric arterial ischemic stroke etiology, clinical presentation, and radiologic features / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Stroke occurs upon obstruction of cerebral blood circulation and is clinically characterized by sudden onset symptoms. Advanced age is the main risk factor of stroke, but cases of pediatric stroke have been rarely reported. This study aimed to determine the etiology, clinical presentation, and radiologic features of neurological deficit for pediatric arterial ischemic stroke (PAIS).</p><p><b>METHODS</b>The medical records of 42 PAIS patients (age range: 9 months to 13 years) treated at Wuhan Children's Hospital between July 2007 and January 2011 were retrospectively reviewed. Infarction location was first determined by craniocerebral computed tomography and magnetic resonance (MR) imaging. The stenotic or occluded main cerebral arteries and/or branches were determined by MR angiography and digital subtraction angiography.</p><p><b>RESULTS</b>The majority of the 42 PAIS cases (66.7%, n = 28) were ≤ 3 years old (vs. >3 years old: 33.3%, n = 14; P<0.05), but the male: female ratio was similar in both groups (P > 0.05). The most frequently reported signs and symptoms for both age groups were limited physical activity followed by convulsions and delirium, but convulsions were more prevalent in children ≤ 3 years-old. Children > 3 years-old mainly experienced the limited physical activity symptoms, including hemiparalysis, aphasia, and ataxia. For all 42 cases, the most frequent etiologies were infections (38.1%, n = 16), iron deficiency anemia (16.7%, n = 7), and moyamoya syndrome (11.9%, n = 5). The predominant infarcts among all cases were middle cerebral artery (63.6%, n = 21) and basal ganglia (64.3%, n = 27).</p><p><b>CONCLUSIONS</b>PAIS occurs more frequently in younger children and this group most frequently presents with convulsion as the initial symptom. The overall etiologies of PAIS may be different from those of adult stroke and the involved regions may be distinguishing features of PAIS or its different forms, but more research is required.</p>

The current situation of blood pressure control and the influencing factors on hypertensive patients in residential communities of China / 中华流行病学杂志

Objective To understand the situation of blood pressure control and the major factors influencing the programs among those hypertensive patients living in the communities from different parts of China.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 under the requirement of this protocol to manage the hypertensive patients.In this study,the hypertensive patients who had been registered in the project centers from Beijing,Hebei,Gansu,Jiangsu,Zhejiang,Guangdong provinces,were selected as the study subjects,and the baseline data for these patients was analyzed.Results By the end of 2010,a total of 242 182 patients were registered.The mean age was 61.0 ± 10.5,with 48.5％ of them being males.The overall control rate of blood pressure was 27.4％.The control rate was significant lower among patients who were in lower age group,being male,with higher BMI,smoking,drinking or with more salt consumption.However,the control rate was significant higher among those patients who had family history of hypertension,always undertook physical exercise or receiving medical treatment.Conclusion The blood pressure control rate for community hypertensive patients in China was still in a relatively low level.Standardization management measures should be strengthened so as to improve the rate of control on high blood pressure.

Association between chronic kidney disease and cardiovascular events in middle-to-old-aged Chinese population / 中华流行病学杂志

Objective This study aimed to determine the relationships between estimated glomerular filtration rate (eGFR) and cardiovascular events. Methods 2500 residents aged more than 40 years old were selected from Shougang community, Shijingshan district, in Beijing. 2315 of them took part in the survey. First morning urinary sample was collected for all the participants.Albumin and creatinine were measured and eGFR was calculated using simplified MDAD formula.Cardiovascular risk factors were also investigated. The participants were followed up for 4 years, and all-cause mortality and cardiovascular events were collected. The subjects were divided into three groups according to eGFR[ml/(min·1.73 m2)]: ＜60, 60-90,＞90.Cox regression model was used to analyze the relationships between eGFR, all events, and cardiovascular events after adjusting for confounders. Results The prevalence of eGFR ＜60 was 3.3%. The incidence rates of cardiovascular events were 43.9, 21.8 and 11.5/1000 person-years among three groups, and the incidence rates of all events (all-cause mortality and cardiovascular events) were 53.7, 28.8 and 14.6/1000 person-years,respectively. After adjusting for age, gender, smoking, body mass index, serum lipids, diabetes mellitus, cardiovascular disease, the hazard risk (HR) for cardiovascular events was 1.29 (95%CI:0.85-1.96) in eGFR＜60 group and 2.14 (95% CI: 1.02-4.50) in 60≤eGFR＜90 group, when compared with the eGFR＞90 group; the HR for all events were 1.25 (95%CI: 0.86-1.81 ) and 1.95(95% CI: 1.00-3.80) , respectively. Conclusion In the population studied, eGFR＜60 seemed an independent predictor for cardiovascular events and all-cause events.

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.

Prevalence and trend of metabolic syndrome in middle-aged Chinese population / 中华流行病学杂志

Objective To analyze the current prevalence of metabolic syndrome (MS) and its trend in the past 5 years in China. Methods In 2004-2005, cross-sectional sampling surveys were conducted in 13 research populations from southern and northern parts, urban and rural areas in China, with internationally standardized criteria and measurement. 1000-2000 participants for each group, even number of man and women, were examined. Out of them, there were 13 732 participants aged 35-59 years. Comparison was made for 10 populations with comparable data in 1998 to observe the trend in the past 5 years. MS was defined according to Chinese Medical Association Diabetes Branch definition set in 2004. Results The prevalence of MS was 12.1%. The adjusted prevalence was higher in men (13.9%) than in women (8.5%), higher in residents from the northern (15.0%) than the southern (6.8%) and from urban (11.3%) than rural (10.1%). Out of the participants with MS, 60.4% were with obesity, high blood pressure or with dyslipidemia. Comparing with data in 1998, the adjusted prevalence rates of MS in 2004--2005 had a significantly increase (10.0% vs. 7.2%, P<0.05), in men than in women, in residents from the northern part than in the south (P<0.05). Regardless the geographic areas as from the north or south, from urban or rural, the mean levels of triglyceride, body mass index and waist circumference were higher in 2004 - 2005 than that in 1998. Conclusion The prevalence of MS was increasing in middle aged Chinese population. Prevention and treatment of obesity, high blood pressure and dyslipidemia were effective ways to control MS.

Evaluation on the case management program of hypertension in Zhongguancun community, Beijing / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore a suitable model regarding community-based case management of hypertension in the urban areas.</p><p><b>METHODS</b>Based on the guidelines set by the Chinese Hypertension League (CHL), the goal of case management of hypertension was set as: to maintain blood pressure at the normal range. Family doctors were guided to take care of case management. Hypertension patients who had been contracted to the family doctors were followed by a team of family doctors for half a year.</p><p><b>RESULTS</b>After the 6-month intervention, the rate of hypertension under control had increased from 50.44% to 69.84% (P < 0.0001) while the means of systolic blood pressure decreased by 3.72 mm Hg and diastolic blood pressure decreased by 2.67 mm Hg (P < 0.0001) respectively. The means of SBP decreased by 8.59 mm Hg and diastolic blood pressure decreased by 5.26 mm Hg in patients whose baseline blood pressure were not under control. The rates of smoking, higher salt intake and no physical exercise had significantly decreased (P < 0.05). The mean number of hospital visits in the six-month follow-up period was 7.69 +/- 2.37. The "rate of control" among those who had followed schedule was higher than that of those who were not on schedule (P < 0.0001). The rate among those who had followed the schedule tended to have increased with aging and the level of education (P < 0.001).</p><p><b>CONCLUSION</b>The community-based case management program on hypertension played an important and effective role in the control of hypertension in urban areas. Patients received great benefit when following the guidance from their doctors.</p>

Trends in prevalence, awareness, treatment and control of hypertension in middle-aged Chinese population / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze the trends in prevalence, awareness, treatment, control of hypertension among middle-aged Chinese.</p><p><b>METHODS</b>The study comprised two cross-sectional surveys including urban and rural residents, manual workers, farmers and fishermen in different southern and northern parts of China. There were 13 populations under research with comparable data. 18 746 (in 1992 - 1994) and 13 504 (in 1998) participants, aged 35 through 59 years, equal number of men and women, were examined in each of the surveys, on blood pressure measurement, in 1992 - 1994 and in 1998. Hypertension was defined as systolic pressure >/= 140 mm Hg, and/or diastolic pressure >/= 90 mm Hg, and/or reported treatment with antihypertensive medications. Awareness and treatment on hypertension were assessed with standardized questions. Hypertension control was defined as measured blood pressure of less than 140/90 mm Hg. Awareness, treatment and control of hypertension were standardized according to the WHO world standard population.</p><p><b>RESULTS</b>In 1998, 24.0% of participants had hypertension, an increase of 2.3% from 1992 - 1994. Prevalence of hypertension was higher in urban area (25.4%), increasing with age, and higher in men among the younger groups and lower in women among the older groups. Overall, in 1998, 42.6% were aware of their hypertensive status (increase of 5.3%), 31.3% were treated (increase of 3.8%), and the rate under control was 6.0% (increase of 2.6%). The rates of awareness, treatment and control, which tended to increase with age except those aged above 55 years, which were higher in urban areas and women compared with rural areas and men. For people with treated hypertension, the rates of those under control were ranged from 12.7% in 1992 - 1994, to 19.9% in 1998.</p><p><b>CONCLUSION</b>Prevalence of hypertension was increasing in China, while the rates of control, although improving, continued to be low. This implied that effective public measures needed to be developed to enhance the awareness and rates of treatment.</p>

A study on the association between tea consumption and stroke / 中华流行病学杂志

<p><b>OBJECTIVE</b>The aim of the study was to investigate the association between tea consumption and stroke.</p><p><b>METHODS</b>A cross sectional study was conducted in autumn, 1998. The subjects were from 12 provinces in China. 15 groups of populations were selected by cluster randomized sampling and each group had about 1000 persons, aged from 35 to 60 years old. 14 212 subjects had complete data for analysis. Data regarding tea drinking would include drinking status, dose and type of teas. Logistic regression was used to analyze the association between tea consumption and stroke.</p><p><b>RESULTS</b>There was a strong inverse correlation between tea drinking and stroke after adjusting other risk factors of stroke (P < 0.05). The odds ratio (OR) of stroke was 0.60 [95% confidence interval (CI): 0.42 - 0.85] for subjects who drank tea compared to those who did not. Increased amount of tea consumption per month was associated with decreased stroke prevalence. The association for tea consumption over 150 gram per month and stroke was statistically significant (P < 0.05) with an OR value of 0.56 (95% CI: 0.36 - 0.89). Analytical results indicated that the OR value was 0.24 (95% CI: 0.06 - 1.01) for black tea and other tea (P = 0.05). The OR value was 0.35 (95% CI: 0.18 - 0.72) for green tea (P < 0.01), and 0.75 (95% CI: 0.51 - 1.11) for jasmine tea (P > 0.05).</p><p><b>CONCLUSION</b>Tea drinking was independently associated with prevalence of stroke which might play a role in the prevention of the disease.</p>