The prospective study of association between C-reactive protein and hypertension in community population / 中华预防医学杂志

<p><b>OBJECTIVE</b>The aim was to explore the association between high-sensitivity C-reactive protein level at baseline and hypertension in follow-up periods in a Chinese cohort.</p><p><b>METHODS</b>We analyzed data from a cohort established in "Prevention of metabolic syndrome and multi-metabolic disorders in Jiangsu province" in April 2000. A follow-up investigation was carried out for those whose follow up time met 5 years in June 2006. A total of 2035 persons completed investigation and hs-CRP was tested. Subjects with normal baseline blood pressure were classified into four groups(514, 498, 515 and 508 subjects in each group) according to quartiles of hs-CRP level (<1.3, 1.3-1.9, 2.0-3.2 and ≥ 3.3 mg/L). The relationship between the risk of hypertension and baseline level of hs-CRP were analyzed using Cox proportional hazards regression model.</p><p><b>RESULTS</b>The median of follow up time was 6.39 years among the 2035 subjects (926 males and 1109 females). Hypertension incidence was 2378/100 000 person-years, 2942/100 000 person-years, 3693/100 000 person-years and 4390/100 000 person-years in hs-CRP < 1.3, 1.3-1.9, 2.0-3.2 and ≥ 3.3 mg/L groups respectively. Compared to the group of hs-CRP < 1.3 mg/L, the relative risk (RR) (95%CI) of hypertension in groups of hs-CRP 1.3-1.9, 2.0-3.2 and ≥ 3.3 mg/L was 1.22 (0.87-1.72), 1.43 (1.03-2.00), 1.70 (1.21-2.41) respectively, adjusted for sex, age, baseline blood pressure, BMI, smoking, alcohol drinking, physical activity and family history of myocardial infarction and diabetes.When stratified by quartiles of baseline blood pressure, the incidence of hypertension in each group increased with level of hs-CRP.In the group whose baseline SBP < 110 mm Hg (1 mm Hg = 0.133 kPa) , compared to the group of hs-CRP < 1.3 mg/L, RR (95%CI) were 2.24 (1.32-4.03), 2.57 (1.57-4.57) and 3.57 (2.54-5.90) in hs-CRP 1.3-1.9, 2.0-3.2 and ≥ 3.3 mg/L groups respectively.In the group whose baseline DBP < 65 mm Hg, RR (95%CI) were 1.78 (1.03-3.24), 2.74 (1.63-4.93) and 4.13 (2.35-7.27) respectively.</p><p><b>CONCLUSION</b>Inflammation was an important process in the development of hypertension.</p>

Roles of peroxisome proliferator-activated receptors polymorphisms, haplotypes, levels on C-reactive protein and their interactions with abnormal body weight / 中华流行病学杂志

Objective To explore the roles of peroxisome proliferator-activated receptors (PPARs) on the levels of serum C-reactive protein (CRP) and the interactions of PPARs haplotypes with abnormal body weight.Methods Subjects (n=644) were randomly selected from the cohort ‘Prevention of Multiple metabolic disorders and Metabolic syndrome in Jiangsu province (PMMJS)'Variance test,t test and lineal regression were used to analyze the associations between PPARs polymorphisms and the levels of CRP.The association between PPARs haplotypes and serum CRP levels as well as the interaction of PPARs haplotypes with abnormal body weight were analyzed,under the SNPStats software.Results After adjusting for sex,age,blood pressure,cigarette smoking,alcohol drinking and so on,data showed that both rs1800206 and rs9794 were associated with the changes along with the levels of CRP (P＜0.05).After adjusting for the same factors,haplotypes of AVG and CVG in PPARα,CG in PPARδ appeared to be associated with the increase (P＜0.05) while haplotypes of CC in PPARδ,CPCAC in PPARγ were associated with the decrease of CRP levels (P＜0.05).Results from the Interaction analysis also noted that the interactions did exist between abnormal body weight and both AVG,CVG in PPARαt,and CG in PPARδ.Conclusion PPARs polymorphisms and haplotypes were associated with CRP.Interaction between PPAR α/δand abnormal body weight might contribute to the levels of CRP.

Association of both peroxisome proliferator-activated receptor, gene-gene interactions and the lipid accumulation product / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the association of ten single nucleotide polymorphisms (SNPs) in the peroxisome proliferator-activated receptors (PPARα, δ, γ) with lipid accumulation product (LAP) and the additional role of a gene-gene interactions among the 10 SNPs.</p><p><b>METHODS</b>Participants were recruited under the framework of the PMMJS (Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu province) cohort populations survey in the urban community of Jiangsu province of China. A total of 820 subjects were randomly selected and no individual was related. Ten SNPs (rs135539, rs4253778, rs1800206, rs2016520, rs9794, rs10865710, rs1805192, rs709158, rs3856806 and rs4684847) were selected from the HapMap database, which covered PPARα, PPARδ and PPARγ. A linear regression model was used to analyze the relations between ten SNPs in the PPARs and LAP. Mean difference (Difference) and 95% confident interval (95%CI)were calculated. Interactions were explored by using the method of Generalized Multifactor Dimensionality Reduction (GMDR).</p><p><b>RESULTS</b>After adjusting the factors as age, gender, smoking status, occupational physical activity, educational level, high-fat diet as well as low-fiber diet, both rs1800206, s1805192 and rs3856806 were significantly associated with the increased level of LAP. Difference (95% CI) values were 32.47 (22.62-42.31), 12.97 (4.61-21.33) and 12.49 (4.24-20.75). Whereas rs2016520 was significantly associated with the decreased level of LAP. Difference (95%CI) values was -14.67 ( -22.97--6.55). GMDR analysis showed a significant gene-gene interaction among rs135539, rs1800206 of PPARα, rs2016520 of PPARδ and rs10865710, rs3856806, rs709158, rs1805192, rs4684847 of PPARγ for eight-dimension models (P < 0.05), in which prediction accuracy was 0.5902 and cross-validation consistency was 10/10.</p><p><b>CONCLUSION</b>The rs1800206 of PPARα and rs1805192, rs3856806 of PPARγ were significantly associated with the increased level of LAP; rs2016520 of PPARδ was associated with the decreased level of LAP. There was a gene-gene interaction between multiple SNPs.</p>

Effects related to gene-gene interactions of peroxisome proliferator-activated receptor on essential hypertension / 中华流行病学杂志

Objective To explore the impact of the gene-gene interaction among the single nucleotide polymorphisms (SNPs) of peroxisome proliferator-activated receptor α/δ/γ on essential hypertension (EH).Methods Participants were recruited based on the previous work of the PMMJS (Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu Province) cohort study in Jiangsu province of China.A total number of 820 subjects were randomly selected from the cohort and received gene polymorphism detection covered ten SNPs:PPARα/δ/γ (PPARα:rs 135539,rs 1800206 and rs4253778 ; PPARδ:rs2016520 and rs9794; PPARγ:rs 10865710,rs 1805192,rs4684847,rs709158 and rs3856806).Generalized Multifactor Dimensionality Reduction (GMDR)model was used to evaluate the association between gene-gene interaction among the ten SNPs and EH.Results After adjusting factors as gender,age,BMI,FPG,TG,HDL-C,high fat diet,low fiber diet and physical activity,results from the GMDR analysis showed that the best qualitative trait models were 7/9-dimensional model (EH:cross-validation consistency were 9/10 and 10/10,prediction accuracy were 0.5862 and 0.5885),5/9-dimensional model (SBP:cross-validation consistency were 10/10 and 8/10,prediction accuracy were 0.6055 and 0.6011),and 8/9-dimensional model (DBP:cross-validation consistency both were 10/10,prediction accuracy were 0.5926 and 0.5972),while the best quantitative trait models were 4/5-dimensional model (SBP:cross-validation consistency were 10/10 and 8/10,prediction accuracy were 0.6111 and 0.6072),and 5-dimensional model (DBP:cross-validation consistency were 9/10,prediction accuracy were 0.5753).Conclusion Interactions among ten SNPs of PPARs seemed to have existed and with significant impact on the levels of blood pressure.

A prospective study on the association between dynamic change of waist circumference and incident hypertension / 中华流行病学杂志

Objective To study the impact on dynamic change of waist circumference(WC) through follow-up data on the incidence of hypertension in several cohort groups.Methods In this prospective study,2778 free-hypertension subjects were recruited from a program “Prevention of Multiple Metabolic disorders and metabolic syndrome (MS) in Jiangsu province” (PMMJS) to evaluate the risk of hypertension in relation to WC dynamic change on normal WC or abnorminal obesity group.Dynamic change of WC was measured by WC D-value,which was expressed by data on the difference of WC between baseline and the first follow up.Study outcome was defined as incident hypertension during the first to the second follow up period in this study.The association between dynamic change of WC and incident hypertension was analyzed by using Cox proportional hazards regression model.Results There were 2778 participants,660 subjects developed hypertension during the follow-up,regardless of the normality of the baseline WC,the risk of hypertension increased across the tertiles of WC,while the incidence of hypertension was higher in non-control group than that in control group.In populations with abdominal obesity and normal WC at baseline,RRs (95％CI) of hypertension were 1.95 (1.19-3.19) and 2.38 (1.89-2.99) in subjects with abdominal obesity seen at the first follow up period,compared to subjects with normal WC in the same period.After adjustment for gender,age and other hypertension related risk factors,in populations with abdominal obesity and normal WC at baseline survey,RRs (95％ CI) of hypertension were 4.36 (1.69-9.74) and 1.44( 1.03-2.35 ) respectively,for the non-control group.Conclusion WC dynamic change was associated with hypertension,WC control while WC reduction was important for early prevention on hypertension.

Gene-gene interactions among the peroxisome proliferator-activated receptor polymorphisms for hypertriglyceridemia / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the association of ten SNP at peroxisome proliferator-activated receptors (PPARα, δ, γ) with hypertriglyceridemia and the gene-gene interaction.</p><p><b>METHODS</b>Participants were recruited from the Prevention of MetS and Multi-metabolic Disorders in Jiangsu province of China Study (PMMJS). A total of 820 subjects were selected from the 4083 participants who had received follow-up examination, by using simple random sampling. Participants in baseline and follow-up study surveys were both collected blood samples 11 ml in the morning after at least 8 hours of fasting. Blood samples which collected at the baseline were subjected to PPARα, PPARδ and PPARγ genotype analyses. Blood samples which collected at the follow-up were used to measure serum triglyceride levels. The logistic regression model was used to analyze the association between different SNP and hypertriglyceridemia, and the generalized multifactor dimensionality reduction (GMDR) was applied to explore the gene-gene interaction.</p><p><b>RESULTS</b>The samples included 474 in the non-hypertriglyceridemia group and 346 in the hypertriglyceridemia group. The genotype frequencies of rs1800206 in the hypertriglyceridemia group were 211 (61.0%) for LL, 132 (38.2%) for LV and 3 (0.9%) for VV, and in the non-hypertriglyceridemia group were 411 (86.7%) for LL, 59 (12.4%) for LV and 4(0.8%) for VV (χ(2) = 74.18, P < 0.01). V allele frequencies of rs1800206 in the hypertriglyceridemia group was 138(19.9%), and in the non-hypertriglyceridemia group was 67 (7.1%) (χ(2) = 60.62, P < 0.01). The genotype frequencies of rs2016520 in the hypertriglyceridemia group were 177 (51.2%) for TT, 154 (44.5%) for TC and 15 (4.3%) for CC, and in the non-hypertriglyceridemia group were 211 (44.5%) for TT, 212 (44.7%) for TC and 51 (10.8%) for CC(χ(2) = 15.93, P < 0.01). C allele frequencies of rs2016520 in the hypertriglyceridemia group was 184(26.6%), and in the non-hypertriglyceridemia group was 314 (33.1%) (χ(2) = 8.07, P < 0.01). The genotype frequencies of rs3856806 in the hypertriglyceridemia group were 149 (43.1%) for CC, 156 (45.1%) for CT and 41 (11.8%) for TT, and in the non-hypertriglyceridemia group were 269 (56.8%) for CC, 170 (35.9%) for CT and 35 (7.4%) for TT (χ(2) = 15.93, P < 0.01). T allele frequencies of rs3856806 in the hypertriglyceridemia group was 238(34.4%), and was 240 (25.3%) in the non-hypertriglyceridemia group (χ(2) = 15.96, P < 0.01). The genotype frequencies of rs1805192 in the hypertriglyceridemia group were 145 (41.9%) for PP, 158(45.7%) for PA and 43(12.4%) for AA, and in the non-hypertriglyceridemia group were 314 (66.2%) for PP, 137(28.9%) for PA and 23(4.9%) for AA (χ(2) = 50.92, P < 0.01). A allele frequencies of rs1805192 in the hypertriglyceridemia group was 244(35.2%), and was 183 (19.3%) in the non-hypertriglyceridemia group(χ(2) = 52.89, P < 0.01). After adjusting age, gender, smoking, alcohol consumption, high-fat diet, low -fiber diet and occupational physical activity factors, rs1800206, rs2016520, rs3856806 and rs1805192 were significantly associated with hypertriglyceride, while the OR (95%CI) was 3.88 (2.69 - 5.60), 0.71 (0.52 - 0.96), 1.40 (1.03 - 1.90) and 2.56 (1.88 - 3.49), respectively (P < 0.05). GMDR model analysis showed that the second-order model (rs1800206 and rs1805192) was the best model when quality traits of triglyceride was chosen as outcome (P < 0.01); while third-order model (rs1800206, rs1805192 and rs2016520) was the best model when quantitative traits of triglyceride was chosen as outcome (P < 0.01).</p><p><b>CONCLUSION</b>The rs1800206, rs2016520, rs3856806 and rs1805192 were significantly associated with hypertriglyceridemia. There was a gene-gene interaction between multiple SNP.</p>

Impact of lifestyle and obesity to the risk of type 2 diabetes: a prospective study in Jiangsu province / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the relative contribution of lifestyle and obesity to the risk of developing type 2 diabetes.</p><p><b>METHODS</b>All baseline survey data were based on the program Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu Province (PMMJS) which was conducted during April 1999 to May 2004. In the baseline survey, 8685 participants were selected using multi-stage sampling method. Frem March 2006 to November 2007, 4582 participants who had been in the study for at least 5 years were included in the follow-up survey. A total of 3847 participants were followed and of them 3461 non-diabetic subjects were included in this analysis. High fat diet or not, low fiber diet or not, sedentary or not and occupational physical activity classification were defined as lifestyle variables and the incidence of type 2 diabetes at follow-up survey was defined as outcome variable. It was prospectively examined that the separate and joint association of lifestyle and obesity with the development of type 2 diabetes in subjects recruited from PMMJS, using logistic regression model.</p><p><b>RESULTS</b>A total of 162 incident cases of type 2 diabetes during 6.3 years of follow-up in total 3461 participants were documented. The incidence rate was 4.7%. After adjusted for sex, age, family history of diabetes, blood pressure, lipids and fast plasma glucose, risk of type 2 diabetes increased with lighter occupational physical activity (compared with vigorous group, moderate group aRR = 2.15, 95%CI: 1.26 - 3.68; light group aRR = 2.39, 95%CI: 1.12 - 4.87), sedentary lifestyle (aRR = 2.94, 95%CI: 1.90 - 4.54), low fiber diet (aRR = 1.58, 95%CI: 1.01 - 2.53), overweight (aRR = 1.33, 95%CI: 1.01 - 1.90) and obesity (aRR = 1.59, 95%CI: 1.07 - 3.75). In joint analysis of lifestyle and obesity, the impact of sedentary lifestyle (in BMI < 25 group, aRR = 3.42, 95%CI: 1.99 - 5.86; in BMI ≥ 25 group, aRR = 2.41, 95%CI: 1.13 - 5.12) and low fiber diet (in BMI < 25 group, aRR = 1.42, 95%CI: 0.81 - 2.54; in BMI ≥ 25 group, aRR = 2.63, 95%CI: 1.15 - 6.03) on diabetes were independent of overweight and obesity. When stratified by sedentary lifestyle or low fiber diet, there was no association between overweight/obesity and diabetes risk (sedentary aRR = 2.04, 95%CI 0.87 - 4.71, non sedentary aRR = 1.21, 95%CI: 0.82 - 1.78; non low fiber diet aRR = 1.26, 95%CI: 0.87 - 1.84, low fiber diet aRR = 1.88, 95%CI: 0.80 - 4.80).</p><p><b>CONCLUSION</b>Unhealthy lifestyle, overweight and obesity independently increase the risk of type 2 diabetes. The magnitude of risk contributed by sedentary lifestyle and low fiber diet are much greater than that imparted by overweight and obesity.</p>

Association between peroxisome proliferator-activatcd receptors gene polymorphism and essential hypertension / 中华流行病学杂志

Objective To investigate the association between ten single nucleotide polymorphism (SNP) in the peroxisome proliferator-aetivated receptor (PPAR) α/δ/γ and essential hypertension (EH).Methods Participants were recruited within the framework of a cohort populations survey from the PMMJS (Prevention of Multiple Metabolic Disorders and MS in Jiangsu Province) which was conducted in the urban community of Jiangsu province from 1999 to 2007.Eight handred and twenty subjects (551 non-hypertensive subjects,269 hypertensive subjects) were randomly selected but were not related to each other.Ten SN P ( rs 135539,rs1800206,rs4253778 of PPAR αt; rs2016520,rs9794 of PPARδ ; rs10865710,rs1805192,rs4684847,rs709158 and rs3856806 of PPARγ ) were selected from the HapMap database.x2 test was used to determine whether the whole population was in H-W genetic equilibrium.SHEsis software was used to examine the relations of SNP and linkage equilibrium.Logistic regression model was used to examine the association between ten SNP in the PPAR and EH.Results Difference on the distribution of four SNP genotypes including rs1800206,rs9794,rsl0865710 and rs4684847 between high blood pressure and non-high blood pressure group,high systolic blood pressure(SBP) and normal SBP group,high diastolic blood pressure(DBP) and normal DBP group was significant (P＜0.05).After adjusting factors as age,sex,body mass index,fasting plasma glucose,high density lipoprotein cholesterol-C,high-fat diet and compared with wildtype gene carriers,the OR(95％ CI) of objects with rs1800206 V allele appeared in high blood pressure,high SBP and high DBP were 0.60 (0A1-0.89),0.57 (0.37-0.88) and 0.61 (0.39-0.96),respectively.The OR(95％CI) of objects with G allele of rs9794 were 0.63 (0.46-0.87),0.51 (0.36-0.73) and 0.68(0.47-1.01).The OR (95％CI) of objects with G allele of rs10865710 were 1.62 (1.19-2.20),1.59(1.14-2.22) and 1.53 ( 1.07-2.18),respectively.While the OR (95％ CI) of objects with rs4684847 T allele were 1.42 ( 1.04-1.94),1.38 (1.03-1.92) and 1.37 ( 1.00-1.88),respectively.Conclusion The four SNPs including rs1800206 of PPARα,rs9794 of PPARδ and rs4684847,rs10865710 of PPARγ influenced high blood pressure,high SBP and high DBP to different degrees.

Association of both peroxisome proliferator-activated receptor, gene-gene interactions and the body mass index / 中华流行病学杂志

Objective To investigate the association of ten single nucleotide polymorphisms (SNPs) in the peroxisome proliferator-activated receptor ( α,δ,γ) with obesity and the additional role of a gene-gene interaction among 10 SNPs.Methods Participants were recruited within the framework of the PMMJS (Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu Province)-cohort-population-survey in the urban community of Jiangsu province,China.820 subjects (513 non obese subjects,307 obese subjects ) were randomly selected and no individuals were related to each other.Tea SNPs (rs135539,rs4253778,rs1800206,rs2016520,rs9794,rs10865710,rs1805192,rs709158,rs3856806,rs4684847) were selected from the HapMap database,which covered PPARα,PPARδ and PPARγ.Logistic regression model was used to examine the association between ten SNPs in the PPARs and obesity.Odds ratios (OR) and 95％ confident interval (95％CI) were calculated.Interactions were explored by using the Generalized Multifactor Dimensionality Reduction (GMDR).Results A group of 820 participants (mean age was 50.05 ± 9.41) was involved.The frequency of the mutant alleles of rs2016520 in obese populations was less than that in non-obese populations (26％ vs.33％,P＜ 0.0 1 ).The frequency of the mutant alleles of rs 10865710 in obese populations was more than that in non-obese populations (37％ vs.31％,P=0.01 ).C allele carriers had a significantly lower obesity occurrence than TT homozygotes [OR (95％ CI):0.63 (0.47-0.84) ] for rs2016520 but no significant association was observed between other SNP and incident obesity.GMDR analysis showed a significant gene-gene interaction among rs2016520,rs9794 and rs10865710 for the three-dimension models (P=0.0010),in which prediction accuracy was 0.5834 and cross-validation consistency was 9/10.It also showed a significant gene-gene interactions between rs2016520 and rs10865710 in all the two-dimensional models (P=0.0010),in which predictive accuracy was 0.5746 and cross-validation consistency was 9/10.Conclusion Our data showed that rs2016520 was associated with lower obesity risk,as well as interactions among rs2016520,rs9794 and rs 10865710 on incident obesity.

Interaction of both hypertriglyceridemic waist and impaired fasting glucose on the incidence of diabetes mellitus / 中华流行病学杂志

Objective To study the use ofhypertriglyceridemic waist (HTGW) to predict the occurrence of diabetes.Also to independently study whether there was an interaction between HTGW and impaired fasting glucose impaired fasting glucose (IFG) on the cause of diabetes.Methods We undertook a cohort study based on data from the “Prevention of Multiple Metabolic Disorders and Metabolic Syndrome (MS) Study in Jiangsu Province,China”.We used the logistic regression model to analyze the relations between both HTGW,IFG and diabetes mellitus and to evaluate the multiplied interaction between HTGW and IFG to include product terms method.Counting additive interaction was carried out under the Excel Calculation Sheet,compiled by Anderson and his colleagues.Results After adjusted for general risk factors and baseline fasting plasma glucose (FPG),results showed that subjects with HTGW had a 2.10 (95％ CI:1.36-3.25) adjusted relative risk (HR) of developing a diabetes when compared with those individuals without HTGW at the baseline study.When IFG was stratified,participants with HTGW were significantly associated with diabetes,regardless of IFG.The multi-adjusted HRs of diabetes were 3.09 (1.70-5.61) and 2.09 (1.08-4.02),respectively.Compared to the participants with non-HTGW and their FPG level below the threshold,those having HTGW and their FPG level was above the threshold,had the highest adjusted HR values [12.05 (95％CI:6.89-21.07)].Data from the additive interaction analysis showed that RERI as 7.00 (95％ CI:0.49-13.51),AP as 0.57 (95％ CI:0.32-0.82) and SI as 2.66 (95％ CI:1.36-5.21).Conclusion HTGW could predict the occurrence of diabetes,independent from IFG while the presence of HTGW with IFG could have an additive interaction on the cause of diabetes.

Association and interaction of peroxisome proliferator-activated receptor α with low high-density lipoprotein hyperlipidemia and with peroxisome proliferator-activated receptor γ / 中华流行病学杂志

Objective To investigate the association of ten single nucleotide polymorphisms (SNPs) in the peroxisome proliferator-activated receptors (α,δ,γ) with low high-density lipoproteincholesterol (HDL-C) hyperlipidemia and the additional role of a gene-gene interactions among the 10 SNPs.Methods Participants were recruited under the framework of the PMMJS (Prevention of Multiple Metabolic Disorders and MS in Jiangsu Province) cohort populations survey,in the urban community of Jiangsu province,China.820 subjects (579 normal HDL-C,241 low HDL-C) were randomly selected,with one of them related to each other.Ten SNPs (rs135539,rs4253778,rs1800206,rs2016520,rs9794,rs10865710,rs1805192,rs709158,rs3856806,rs4684847) were selected from the HapMap database,which covered PPARα,PPARδ and PPARγ.Logistic regression model was used to examine the association between ten SNPs in the PPARs and low HDL-C.Odds ratios (OR) and 95％ confident interval (95％CI) were calculated.Interactions were explored by using the method of Generalized Multifactor Dimensionality Reduction (GMDR).Results After adjusting the factors as age,sex,smoking status,occupational physical activity,high-fat diet as well as low-fiber diet,both rs 135539 and rs1800206 were significantly associated with the incidence of low HDL-C,with the OR (95％ CI) values as 1.46 (1.07-1.99) and 0.62 (0.42-0.90).No statistically significant difference was found between other SNPs and the occurrence of low HDL-C.Data from GMDR analysis showed significant gene-gene interaction among rs135539,rs4253778 of PPAR α and rs10865710,rs3856806,rs709158 and rs4684847 of PPARγ (P＝0.0107).Conclusion PPARα rs135539 was associated with the occurrence of low HDL-C,and had interacted with rs4253778,rs10865710,rs3856806,rs709158 and rs4684847.

Impact of dynamic change of waist circumference or body mass index in hypertension incidence / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the impact of dynamic change of waist circumference (WC) and body mass index(BMI) in two years on hypertension incidence in cohort populations.</p><p><b>METHODS</b>A perspective cohort study was conducted. The participants (5888 subjects) whose follow-time were 2 years or longer from the program Prevention of multiple metabolic disorders and metabolic syndrome (MS) in Jiangsu province were investigated. Amongst 5888 subjects, 4582 participants received the first follow-up investigation in January 2002. Among 4582 subjects who received first follow-up investigation and whose follow-time met 5 years, total 3847 participants received the second follow-up investigation in March 2006. Total 2778 free hypertension subjects were included in this analysis. Subjects with normal WC or BMI at baseline but abnormal WC or BMI at the first follow-up or subjects with abnormal WC or BMI both at baseline and the first follow-up were defined as non-control group. Subjects with abnormal WC or BMI at baseline but normal WC or BMI at the first follow-up or subjects with normal WC or BMI both at baseline and the first follow-up were defined as control group. The incidence of hypertension at second follow-up investigation was defined as the final variable(hypertension = 1, non-hypertension = 0). The association between dynamic change of WC or BMI and incident hypertension was analyzed by using Cox proportional hazards regression model. The OR, RR value and 95%CI were calculated through WC and BMI risk stratification.</p><p><b>RESULTS</b>Among 2778 participants without hypertension at baseline, 660 subjects developed hypertension. When both BMI difference value (D-value) and WC D-value were included in the regression model, WC D-value was associated with hypertension in both genders (males: OR = 1.04, 95%CI: 1.01 - 1.05; females: OR = 1.04, 95%CI: 1.02 - 1.06), but BMI D-value was not associated with hypertension in both men and women (males: OR = 1.04, 95%CI: 0.97 - 1.11; females: OR = 0.98, 95%CI: 0.93 - 1.03). Hypertension risk of WC non-control group was higher than that in WC control group in baseline normal and abnormal WC groups (normal baseline WC group: RR = 1.41, 95%CI: 1.01 - 2.39, abnormal baseline WC group: RR = 4.41, 95%CI: 1.66 - 9.80). But in baseline abnormal BMI group, there was no significant difference between BMI control and non-control group (RR = 1.33, 95%CI: 0.88 - 2.02). Whether BMI was controlled can not influence hypertension risk if WC was controlled (males: RR = 1.03, 95%CI: 0.36 - 2.96; females: RR = 1.02, 95%CI: 0.70 - 5.85), however, control WC could reduce hypertension risk obviously even though BMI was not controlled (males: RR = 4.03, 95%CI: 1.61 - 10.09; females: RR = 1.55, 95%CI: 1.13 - 3.60).</p><p><b>CONCLUSION</b>Both WC and BMI dynamic change were associated with change of hypertension. But reducing WC can decrease hypertension risk more than reducing BMI.</p>

A prospective study on the association between control of blood pressure and incidence of type 2 diabetes mellitus / 中华流行病学杂志

Objective To investigate the relationship on the effect of blood pressure (BP) control and the incidence of new diabetes mellitus (DM) in a follow-up study. Methods In this prospective study,non-diabetic subjects (n=3146,41% men) were recruited from the program "Prevention of Multiple Metabolic disorders and metabolic syndrome (MS) in Jiangsu province" (PMMJS) to evaluate the risk of DM in relation to BP control program on both healthy or hypertensive patients. Results During the follow-up period,102 subjects developed diabetes. In both healthy or hypertensive patients gropes,the incidence rates of diabetes increased along with the increase of either systolic or diastolic BP and were significantly higher in subjects who had become hypertension (5.6%) or patients with uncontrolled (7.1%) BP at baseline survey than in those who had maintained normal BP (1.9%) or with controlled BP at baseline surbey (2.2%). After adjusted for age,sex and other diabetes-related risk factors at baseline study,the aRR of diabetes incidence for subjects with normal BP at baseline who became hypertension (1.84,95%CI: 1.00-3.63) was higher than who maintained normal BP (1.90,95% CI: 1.03-3.74) after the follow-up program,and hypertensive patients with uncontrolled BP was higher than those with controlled BP. When adjusted for baseline MS,the aRR (95% CI) for subjects with normal BP at baseline who had developed hypertension was 1.70 (0.99-2.78) compared those remained normal BP levels after the follow-up program,and 1.90 (1.04-3.75) for hypertensive patients with uncontrolled BP when compared with those whose BP had been under control. Conclusion When the BP level had been effectively under control,the risk of deveploping a type 2 diabetes could be reduced.

A nested case-control study on the relationship between occupational physical activity,heredity factors and metabolic syndrome / 中华流行病学杂志

Objective To examine the associations between occupational physical activity,heredity factors and metabolic syndrome (MS) in a Chinese population.Methods Based on the MS cohort study in Jiangsu province,subjects were followed-up,and blood samples were collected at the same time for biochemical indicators measurement.Newly confirmed MS patients according to US.National Cholesterol Education Program Adult Treatment Guidelines Ⅲ (NCEP-ATP Ⅲ ) were recruited as eases.Controls were 1 :1 matched with eases by region,gender and age (±2 years).In total,389 MS patients and 389 eontrols were recruited as study subjects.Nested ease-control study was applied for the present analysis.TaqMan fluorescence probe method was used to detect the genetic polymorphism of PPARα intron 1A/C (rs135539).Results (1)Compared to low physical activity group,the subjects with heavy physical activity were positively associated with MS (OR=2.18,95%CI:1.08-4.38).(2)The subjects,with a family history of hypertension (OR= 1.44,95% CI:1.02-2.03 )or type 2 diabetes (OR=3.25,95CI:1.28-8.20),were significantly indreased the occurrence of MS.(3)The genotype(AA,AC,CC) of PPARα intron 1A/C was not found to be related to MS.The OR of AC and CC genotype (compared to the genotype AA) were 0.98(95%CI:0.70-1.36) and 0.75 (95% CI:0.44-1.29) ,respectively.(4) Effect modifications were observed between family history of hypertension and moderate physical activity (OR=2.47,95% CI:1.00-6.06 ) or heavy physical activity (OR=3.82,95%CI:1.31-11.15) on the development of MS.Conclusion Heavy physical activity,with family history of hypertension or type 2 diabetes,seemed to be positively correlated with the risk of MS.Effect modifications were observed between occupational physical activity and family history of hypertension which might be associated with an increased risk of MS.

A prospective study on the association between lipid accumulation product or body mass index and diabetes / 中华流行病学杂志

Objective To measure the association between lipid accumulation product (LAP) or body mass index (BMI) and diabetes. Methods In this prospective study, subjects were recruited and followed up for more than five years from the program "Prevention of Multiple Metabolic Disorders and MS in Jiangsu Province" (PMMJS). A total number of 3598 people participating in the follow-up program, with complete information. Incidence rates of diabetes and relative risk in different levels of LAP and BMI were compared and analyzed. Areas under the receiver operation characteristic curve for obesity indicators such as LAP, BMI, waist circumference (WC), waist-to-hip ratio (WHR) in predicting diabetes of cohort population were calculated. Results The number and the cumulative incidence of diabetes increased with the LAP levels in both men and women. After adjusting for age and other traditional risk factors on diabetes, the adjusted risk ratios (aRR) value of diabetes were 4.33(1.34-14.01) for men and 5.04(2.06-12.34) for women, between the highest and the lowest level of LAP groups. When further adjusted for BMI, the aRR value decreased to 3.15 (1.13-8.80) for men and 4.84(2.16-10.84) for women. The number and the cumulative incidence of diabetes also increased with the BMI levels in both men and women but not significantly as the LAP showed, and the aRR values were 1.34 (0.61-2.93) for men and 1.69 (0.91-3.06) for women in the highest level of BMI group, when compared with the lowest level group. Again, when further adjusted for LAP, the aRR values decreased to 1.23 (0.59-2.69) for men and 1.39(0.74-2.60) for women. The area under the ROC curve(AUC) for the four kinds of obesity indicators in predicting diabetes in the descending order were LAP, WHR, WC, BMI in both men and women. Conclusion LAP seemed more associated to diabetes than to BMI. When comparing with weight gain, diabetes might be more closely associated with the lipid accumulation product.

Relationship between peroxisome proliferator-activated receptor alpha intron 1A/C genetic polymorphism and metabolic syndrome / 中华预防医学杂志

<p><b>OBJECTIVE</b>To identify the relationship between genetic polymorphisms of peroxisome proliferator-activated receptor alpha (PPARalpha) intron 1A/C and metabolic syndrome (MS) in a Chinese population.</p><p><b>METHODS</b>A population-based case-control study was conducted in Suzhou city, Changshu County and Ganyu County in Jiangsu Province China, on the basis of an ongoing cohort study and 2348 cases were investigated. After the exclusion of the known MS cases, 1847 eligible subjects were successfully followed-up and their waist circumference (WC), body mass index, blood pressure, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides (TG) and fasting plasma glucose were measured. Newly diagnosed MS patients were recruited as cases, controls were individual matched with each case. TaqMan fluorescence probe method was used to detect the genetic polymorphism of PPARalpha intron 1A/C.</p><p><b>RESULTS</b>The current analysis consisted of 389 MS patients and 389 matched controls. The C allele gene frequency of PPARalpha intron 1A/C in the case group was 22.24% (173/778), lower than that in the control group, which was 24.68% (192/778); whereas the difference was not statistically significant (chi(2) = 1.29, P > 0.05). In the genotypes AA + AC and CC, MS patients were accounted for 50.70% (363/716) and 41.94% (26/62) and hyperglycemia accounted for 21.37% (153/716) and 11.29% (7/62). Compared to the genotypes AA + AC, genotype CC was observed to be inversely associated with hyperglycemia (the adjusted OR = 0.39; 95%CI: 0.17 - 0.90) but not related to the occurrence of MS (OR = 0.75; 95%CI: 0.44 - 1.28) and other components of MS e.g., abdominal obesity (the adjusted OR = 0.67; 95%CI: 0.38 - 1.17), hypertriglyceridemia (the adjusted OR = 0.97; 95%CI: 0.53 - 1.76), low HDL-C (the adjusted OR = 0.72; 95%CI: 0.41 - 1.25) and hypertension (the adjusted OR = 0.72; 95%CI: 0.42 - 1.25) all P values > 0.05.</p><p><b>CONCLUSION</b>C allele of PPARalpha intron 1A/C is not found to be associated with MS in the Chinese population. But comparing with the genotypes AA + AC, there is an inverse association between CC genotype and hyperglycemia.</p>

A comparison between the metabolic syndrome score and the Framingham risk score in the prediction of cardiovascular disease / 中华流行病学杂志

Objective To compare metabolic syndrome(MS)score with the 10-year-Framingham risk score(FRS)to predict the occurrence of cardiovascular disease(CVD).Methods MS score for prediction of CVD was developed based on the 10-year FRS.Cox proportional hazard model and receiver-operating characteristic(ROC)curves were used to compare the predictive effects,based on data from a cohort study on the prevention of multiple metabolic disorders and MS in Jiangsu province.Results Area under the curve(AUC)increased after changing MS components into continuous variables.AUC of MS score/MS components aggregation was 0.70/0.65,P＜0.05 and sensitivity of MS score/MS components aggregation was 80.5%/74.4% for a given specificity.After mutually adjusted risk factors of MS score and the FRS,when age was exclusively excluded,AUC of the FRS decreased from 0.78 to 0.65(P＜0.05).However,when age was included,the AUC of MS score increased to 0.78(sensitivity of MS score including the age/the FRS:90.2% vs.87.8 %);In Cox proportional hazards multiple risk factors analysis,MS score including age appeared greater association with CVD than FRS on the same exposed subjects.Conclusion The new developed MS score with age included was a valid tool for predicting CVD and its predictive ability was as good as the FRS.

A prospective study on the association between dyslipidemia and hypertension / 中华流行病学杂志

Objective To discuss the risks of hypertension development with relation to the level of lipid variables among populations who had normal blood pressure at baseline study. Methods In April 2000, under the support of project "prevention of metabolic syndrome and multi-metabolic disorders in Jiangsu province", a cohort study was performed to obtain the baseline data among 8685 persons from age 34 to 74. In June of 2006, a follow-up investigation was carried out among those who had been in the study for 5 years after the baseline study started. 2603 persons who met the selection criteria and showed normal blood pressure during baseline study, were recruited in this investigation. The interval from the baseline to the follow-up studies was 6.38 years on average. Relationship between the risk of developing hypertension and the baseline level of lipid variables were analyzed. Results Relations between baseline lipid levels and the incidence of hypertension during the follow-up was discovered. In gender and age adjusted model, the lipid variables were all associated with hypertension(Wend test, P<0.01). In multivariable-adjusted model, HDL-C [aRR=0.71 (95%CI: 0.61-0.99)], non-HDL-C [αRR=1.28 (95%CI: 1.14-1.83)], TC/HDL-C ratio[aRR=1.41 (95%CI: 1.25-2.03)] and TG [αRR=1.49(95%CI: 1.30-2.13)] were again associated with hypertension (trend test, P<0.05). Even the αRR was much weakened after the baseline SBP, DBP were adjusted with Cox model, the significant relation of hypertension to HDL-C, TC/HDL-C ratio and TG still existed. Excluding the two factors of obesity (BMI≥28) and diabetes which had been recognized in marked linking with hypertension, lipid variables were still associated with hypertension. Conclusion Dyslipidemia might occur before being hypertensive. Hypertension was associated with HDL-C, TC/HDL-C and TG or even exclusion of obesity, diabetes and factors of smoking and drinking or baseline level of SBP, DBP were adjusted.

A comparison of applicability in three diagnostic criteria of metabolic syndrome in Jiangsu population / 中华预防医学杂志

<p><b>OBJECTIVE</b>To compare the applicability of the three diagnostic criteria for metabolic syndrome (MS) proposed by the International Diabetes Federation (IDF) in 2005, Adult Treatment Panel III of National Cholesterol Education Program (NCEP-ATP III) in 2005 and Chinese Diabetes Socie (CDS) in 2004.</p><p><b>METHODS</b>Based on the findings of cohort study of multiple metabolic disorders and metabolic syndrome (1971 cases) in Jiangsu province, MS was diagnosed according to these three definitions respectively, and by calculating the sensitivity, specificity, and ROC curve distance, those with lower false positive and false negative rates were identified as to detecting cardio vascular diseases (CVD) and type 2 diabetes mellitus (T2DM). While, through Cox regression analysis, to compare their relative risk (RR) and 95% confidential interval (CI) was wade.</p><p><b>RESULTS</b>Among three diagnostic criteria, the specificity by CDS of MS was higher than the other criteria (83.52%, 76.36%, 89.57%; 85.02%, 78.67%, 92.28%), however the sensitivity of CDS of MS was low (40.82%, 29.47%). When using CDS, over 50 percent of diagnosis might be missed. ATP III definition corresponded to the shortest distance in ROC curve, namely, at the diagnostic criteria, the rates of false positive and false negative for identifying clustering of CVD and T2DM were minimum (0.4369; 0.5777). The incidence of CVD [5.59 (2.62 - 11.92) vs 2.90 (1.41 - 5.93)], T2DM [3.36 (1.92 - 5.79) vs 1.97 (1.16 - 3.34)] was significantly higher in cases of ATP III+/IDF-than ATP III+/IDF+, as compared with ATP III-/IDF-.</p><p><b>CONCLUSION</b>Among three diagnostic criteria, the ATP III definition of the MS should be the most applicable diagnostic criteria for MS in Jiangsu population.</p>

Association and interaction between the components of metabolic syndrome and cardiovascular disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the association and interaction between the components of metabolic syndrome (MS) and cardiovascular disease (CVD).</p><p><b>METHOD</b>In this cohort study, participants (total 3598, male 1451) were recruited and followed up for five years from the program "prevention of multiple metabolic disorders and MS in Jiangsu province". We used modified Asian criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) to define the presence of MS. COX regression was used to analyze the association between the MS and its components with CVD; both the multiplication of blood pressure (BP) and 2, 3, or 4 other components of MS in the logistic regression model and the estimation of the relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP), and the synergy index (S) and 95% confidence intervals (95%CI) were used to evaluate the interactions between the components of MS.</p><p><b>RESULTS</b>After adjustment for traditional CVD risks, the adjusted risk ratio (aRR) of CVD was 2.49 (95%CI: 1.59 - 3.90) in the MS group compared with the non-MS group at baseline. The aRRs of MS components to CVD were as follows: 1.44 (95%CI: 0.88 - 2.37) for waist circumference; 2.84 (95%CI: 1.73 - 4.68) for BP; 1.31 (95%CI: 0.83 - 2.07) for low high density lipoprotein; 1.84 (95%CI: 1.19 - 2.85) for triglyceride; 1.55(95%CI: 0.98 - 2.45) for fasting plasma glucose, respectively. BP was the single component significantly related to CVD (aRR = 2.58, 95%CI: 1.55 - 4.29). The risk of CVD was significantly increased (aOR = 4.47, 95%CI: 2.35 - 8.51) when BP was combined with 2, 3 or 4 other components of MS in the participants.</p><p><b>CONCLUSIONS</b>Only BP is an independent CVD risk factor in the components of MS, the risk of CVD was significantly increased when BP was combined with other components of MS in this cohort.</p>