Lifestyle improvement and the reduced risk of cardiovascular disease: the China-PAR project / 老年心脏病学杂志（英文版）

BACKGROUND@#The benefits of healthy lifestyles are well recognized. However, the extent to which improving unhealthy lifestyles reduces cardiovascular disease (CVD) risk needs to be discussed. We evaluated the impact of lifestyle improvement on CVD incidence using data from the China-PAR project (Prediction for Atherosclerotic Cardiovascular Disease Risk in China).@*METHODS@#A total of 12,588 participants free of CVD were followed up for three visits after the baseline examination. Changes in four lifestyle factors (LFs) (smoking, diet, physical activity, and alcohol consumption) were assessed through questionnaires from the baseline to the first follow-up visit. Cox proportional hazard models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). The risk advancement periods (RAPs: the age difference between exposed and unexposed participants reaching the same incident CVD risk) and population-attributable risk percentage (PAR%) were also calculated.@*RESULTS@#A total of 909 incident CVD cases occurred over a median follow-up of 11.14 years. Compared with maintaining 0-1 healthy LFs, maintaining 3-4 healthy LFs was associated with a 40% risk reduction of incident CVD (HR = 0.60, 95% CI: 0.45-0.79) and delayed CVD risk by 6.31 years (RAP: -6.31 [-9.92, -2.70] years). The PAR% of maintaining 3-4 unhealthy LFs was 22.0% compared to maintaining 0-1 unhealthy LFs. Besides, compared with maintaining two healthy LFs, improving healthy LFs from 2 to 3-4 was associated with a 23% lower risk of CVD (HR = 0.77, 95% CI: 0.60-0.98).@*CONCLUSIONS@#Long-term sustenance of healthy lifestyles or improving unhealthy lifestyles can reduce and delay CVD risk.

Association of cardiovascular diseases with milk intake among general Chinese adults / 中华医学杂志(英文版)

BACKGROUND@#The association of milk intake with cardiovascular disease (CVD) and cause-specific mortality remained controversial and evidence among the Chinese population was limited. We aimed to study the relationship between milk intake and CVDs among general Chinese adults.@*METHODS@#A total of 104,957 participants received questionnaire survey. Results of physical examination such as anthropometric measurements and biochemical tests during 2007 to 2008, demographic data and their information on milk intake were collected through standardized questionnaires. Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) of CVD incidence, cause-specific mortality and all-cause mortality related to milk intake. Restricted cubic splines (RCSs) were applied to examine dose-response associations.@*RESULTS@#Among the 91,757 participants with a median follow-up period of 5.8 years, we documented 3877 CVD cases and 4091 all-cause deaths. Compared with participants who never consumed milk, the multivariate-adjusted HRs (95% CIs) of CVD incidence for 1 to 150 g/day, 151 to 299 g/day, and ≥300 g/day were 0.94 (0.86-1.03) (P > 0.05), 0.77 (0.66-0.89) (P < 0.05), and 0.59 (0.40-0.89) (P < 0.05), respectively; each 100 g increase of daily milk intake was associated with 11% lower risk of CVD incidence (HR, 0.89; 95% CI: 0.85-0.94; P < 0.001), and 11% lower risk of CVD mortality (HR, 0.89; 95% CI: 0.82-0.97; P = 0.008) after adjustment for age, sex, residential area, geographic region, education level, family history of CVD, smoking, alcohol drinking, physical activity level, body mass index, and healthy diet status (ideal or not). RCS analyses also showed a linear dose-response relationship with CVD (P for overall significance of the curve <0.001; P for non-linearity = 0.979; P for linearity <0.001) and stroke (P for overall significance of the curve = 0.010; P for non-linearity = 0.998; P for linearity = 0.002) incidence, and CVD mortality (P for overall significance of the curve = 0.045; P for non-linearity = 0.768; P for linearity = 0.014) within the current range of daily milk intake.@*CONCLUSIONS@#Daily milk intake was associated with lower risk of CVD incidence and mortality in a linear inverse relationship. The findings provide new evidence for dietary recommendations in CVD prevention among Chinese adults and people with similar dietary pattern in other countries.

Trends in Serum Total Cholesterol During 1998 to 2015 Among the Population-based Cohorts of China / 中国循环杂志

Objectives: To explore the trends of serum total cholesterol (TC) among Chinese adult cohorts from 1998 to 2015. Methods: The subjects of this study came from China Multicenter Collaborative Study of Cardiovascular Epidemiology and International Collaborative Study of Cardiovascular Disease in Asia. The baseline investigations were completed during 1998-2001, and the two follow-ups were conducted during 2007-2008 and 2013-2015, respectively. A total of 9 477 participants aged 35-74 years with complete serum TC data from three surveys were included in this study. Analysis on variance of data regarding repeated measurements were used to investigate the variation of serum TC in different subgroups. The serum TC levels were represented by mean (standard errors). Results: During 1998-2015, the mean level of serum TC of all participants significantly elevated from 4.81(0.01) mmol/L to 4.91(0.01) mmol/L, and to 4.98(0.01) mmol/L, growth rates of which were 2.08% and 3.53% in the first and second follow-up, respectively (Ptrend<0.001), especially for females. The fastest growth was noted in the group of young women aged 35-45 years over time, with a growth rate of 11.43%. No such a significant change in the male group during follow-up. The serum TC level and its growth rate in urban residents was significantly higher than those in rural residents. Conclusions: Longitudinal data demonstrated that the mean serum TC level among Chinese adults was continuously increased during 1998~2015. Prevention strategy for hypercholesterolemia should focus more on young women and urban residents.

Metabolic syndrome and coronary artery calcification: a community-based natural population study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Little is known about the influence of metabolic syndrome (MetS) on coronary artery calcification (CAC) in China. In this article, we aimed to explore the distribution of CAC in populations with and without MetS, and estimate the influence of MetS and its components on CAC in a community-based population of Beijing.</p><p><b>METHODS</b>A total of 1647 local residents of Beijing, age 40-77 years, were recruited for a cardiovascular risk factors survey and were determined fasting plasma glucose (FPG), blood lipids, and 64 multi-detector computed tomography (64-MDCT) coronary artery calcium score (CACS) measurement (Agatston scoring). The distribution of CAC was described, and the influence of MetS components on CAC was evaluated.</p><p><b>RESULTS</b>In this population, the prevalence and extent of CAC increased with increasing age and both were higher in MetS subjects compared to nonMetS subjects (all P < 0.05), with the exception of those older than 65 years old. The risk of CAC increased with increasing numbers of MetS components, and the odds ratios for predicting positive CAC in subjects with 1, 2, 3, and = 4 MetS components were 1.60, 1.84, 2.12, and 3.12, respectively (all P < 0.05). Elevated blood pressure, elevated FPG, elevated triglycerides, and overweight increased the risk of CAC, yielding odds ratios of 2.64, 1.67, 1.32, and 1.37, respectively (all P < 0.05).</p><p><b>CONCLUSIONS</b>In the Beijing community-based population, MetS increases the risk of CAC. The risk of CAC increases with increasing numbers of MetS components. Not only the number, but also the variety of risk factors for MetS is correlated with the risk of CAC. Elevated blood pressure, hyperglycemia, hypertriglyceridemia and overweight increase the risk of CAC.</p>

Relationship between physical activity and the incidence of metabolic syndrome in Chinese adults: a prospective cohort study / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the association between physical activity (PA) and the incidence of metabolic syndrome (MS) in Chinese adults.</p><p><b>METHODS</b>Data on PA and other variables were obtained at the baseline examination of China Multi-center study of Cardiovascular Epidemiology in 1998 and of International Collaborative study of Cardiovascular Disease in Asia(InterASIA) during 2000 - 2001. Follow-up study was conducted in 2007 - 2008. A total of 11 512 Chinese adults aged 35 - 74 years (5563 men and 5949 women) were included in the final data analysis. Information on demographics, PA, smoking and alcohol consumption were obtained and components of MS were examined. Participants were divided into four groups according to quartile of total metabolic equivalent (MET) values per day. In addition, subjects were grouped into the following categories according to occupational PA: inactive, light, moderate and vigorous. Binary logistic model was used to examine the association between PA and the incidence of MS.</p><p><b>RESULTS</b>A total of 2527 cases with MS were documented during an average following up of 8.1 years. The annual incidence rate of MS was 2.71% (2527/93 178.68). After multivariate logistic regression analysis, compared with participants with total PA volume < 32.0 MET×h×d(-1) (annual incidence rate was 3.19% (697/21 830.74)), the RR (95%CI) value of participants with total PA volume during 32.00 - 37.85, 37.86 - 52.29, and ≥ 52.30 MET×h×d(-1) was 1.05(0.92 - 1.19), 0.98(0.86 - 1.12), and 0.68(0.59 - 0.80), respectively (χ(2)trend = 34.23, P < 0.05), with corresponding annual incidence rates of 2.82% (690/24 504.25), 2.73% (661/24 179.36) and 2.11% (479/22 664.33). In addition, compared to inactive occupational PA (annual incidence rate was 2.76% (402/14 588.33)), the corresponding RR (95%CI) value was 0.80 (0.69 - 0.92), 0.70 (0.59 - 0.82), and 0.54 (0.45 - 0.65) (χ(2)trend = 42.34, P < 0.05), and the annual incidence rates were 2.86% (648/22 663.41), 2.40% (455/18 956.14) and 1.89% (344/18 173.86) in participants with light, moderate and vigorous occupational PA, respectively.</p><p><b>CONCLUSION</b>Both increased total PA volume and occupational PA intensity are significantly associated with decreased risk of incidence of MS.</p>

The optimal cut-off value of waist-to-height ratio for detecting severe central obesity and low body weight adult Chinese population / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the optimal cut-off values of waist-to-height ratio (WHtR) for detecting the severe central obesity and low body weight in adult Chinese population.</p><p><b>METHODS</b>A total of 30 630 participants aged 35-59 years from different areas in mainland China were surveyed for cardiovascular diseases risk factors in two independent cross-sectional studies that carried out in 1992-1994 and 1998, respectively. Indices, such as sensitivity, specificity for hypertension, abnormal glucose, high serum total cholesterol, low serum high density lipoprotein cholesterol and clustering of risk factors (number ≥ 2) were calculated to evaluate the efficacy individual cut-off point of WHtR. The cut-off point value for obvious central obesity was fixed on the point whose specificity of the point was gathered more than 90%. And the cut-off point value to indicate low weight was determined by the percentile distribution of WHtR, at which the 5th percentile of point, both in male and female population. Based on the principle of convenient and practical for use, the optimal cut-off point values of WHtR for low weight and obvious central obesity were determined.</p><p><b>RESULTS</b>The cut-off values of WHtR to detect severe central obesity were 0.54 and 0.57 for men and women, respectively. Additionally, the cut-off points of WHtR for each of the 4 cardiovascular risk factors to evaluate the severity separately ranged from 0.54 to 0.55 in male, and ranged from 0.57 to 0.58 in female. The 5th percentile of WHtR, which was the point value of WHtR to indicate low body weight, was 0.40 in both male and female population.</p><p><b>CONCLUSION</b>Our data suggest that the optimal cut-off value of WHtR for defining severe central obesity and low body weight should be 0.57 and 0.40, respectively.</p>

Relation between uric acid and coronary artery calcification:a community-based cross-sectional survey among Beijing natural population / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the influence of uric acid on coronary artery calcification in the natural population in Beijing.</p><p><b>METHODS</b>From April to July 2012, 903 subjects from the natural population(aged 37-76 years for men, aged 42-76 years for women)in Xishan community, Beijing, were selected to accept a survey on the risk factors of cardiovascular. Blood tests and CT coronary artery calcium scans were carried out.</p><p><b>RESULTS</b>At the 1 Quartile(1 Q), 2 to 3 Quartile(2-3 Q)and 4 Quartile(4 Q)of uric acid levels, the prevalence rates of coronary artery calcium were 37.2% , 45.5% , 60.6% (P<0.001) and the coronary artery calcium scores were (109.7±333.1)AU, (133.9±356.9)AU, (200.8±459.4) AU (P < 0.001)respectively. Data from the univariate logistic regression analysis showed that with the increase of uric acid, the prevalence rates of coronary artery calcium also increased(OR2-3Q = 1.41, 95% CI:1.02-1.95, P = 0.040; OR4Q = 2.60, 95% CI:1.78-3.80, P < 0.001). However, the relationship between uric acid and coronary artery calcium disappeared when using the multivariate logistic regression analysis(OR2-3Q = 0.92, 95% CI: 0.60-1.43, P = 0.713;OR4Q = 1.38, 95% CI:0.80-2.39, P = 0.247).</p><p><b>CONCLUSION</b>Uric acid did not seem to be an independent risk factor for coronary artery calcium, although the prevalence and extent of coronary artery calcium increased along with the increasing trend of uric acid.</p>

Contrast and efficacy of waist circumference and waist-to-height ratio in predicting central obesity / 中华流行病学杂志

Objective To study the efficacy of waist circumference (WC) and waist-to-height ratio (WHtR) in predicting central obesity among the Chinese adult population.Methods A total of 30 630 participants aged 35-59 from different areas in mainland China were surveyed for the risk factors of cardiovascular diseases (CVD) in two independent cross-sectional studies that were carried out in 1992-1994 and 1998,respectively.In subgroups with different heights,consistency analysis for central obesity diagnosed by WHtR (≥0.50) and WC (≥85 cm for men,≥80 cm for women) were conducted.Sensitivity and specificity for predicting the clustering of risk factors (number ≥2) would include hypertension,abnormal glucose,high serum total cholesterol and low serum high density lipoprotein cholesterol and they were also calculated to evaluate the efficacy of prediction,with the two indices in the different height subgroups as well.Results The consistency of diagnosis on central obesity by WC and WHtR was good in the whole population (the Kappa value was 0.805 in men and 0.816 in women),but poor (all Kappa values ≤0.6) for those with tall (men's height ≥ 180 cm and women' s height ≥ 170 cm) or with short statures (men' s height ＜ 160 cm,and women's height ＜ 150 cm).Sensitivity in the shorty subgroups and specificity in the tall subgroups appeared poor in both genders,by using WC criteria to predict the clustering of risk factors.However,the sensitivity (ranged from 56.1％ to 64.1％ for men and 64.7％ to 73.2％ for women) and specificity (from 70.0％ to 74.5％ for men,59.2％ to 75.9％ for women) seemed good and stable in all the subgroups as well as in both genders by using the WHtR criteria.Conclusion WC and WHtR could both be applied in predicting the clustering of risk factors of CVD and in evaluating the central obesity in the whole population.With satisfactory efficacy,WHtR seemed to be better than WC in the prediction of central obesity,both in men or women with tall or short statures.

A community-based study on relations between metabolic syndrome and carotid atherosclerosis in a middle-aged population / 中华流行病学杂志

Objective To explore the association between metabolic syndromes (MS) and carotid atherosclerosis and to estimate the predictive effects of MS under 3 different definitions.Methods A cross-sectional study was conducted in 2 community-based populations in Beijing,in 2008.1266 subjects (598 men,668 women),aged 45-69,were included in the analyses.MS was defined by the criteria of International Diabetes Federation (IDF),the revised NCEPATPm (ATP Ⅲ-R) and "The Guidelines of Dyslipidemia Control for Chinese Adult" ( "Guidelines" ) in 2007.Results The prevalence rates of MS by the 3 criteria were 39.0%,43.3% and 30.9% respectively.The Kappa value for the measure of the agreement between each pair of the 3 definitions were 0.911,0.719 and 0.730 respectively.The intima-media thickness in common carotid artery (CCA-IMT) was significantly higher (P＜0.001) in all MS groups than in non-MS groups,diagnosed with the 3 criteria independent of age,gender,LDL-C,and current smoking status.After adjustment of age,gender,LDL-C,and current smoking status,the classification of MS significantly increased the risk of prevalence of carotid atberosclerotic plaques,compared to the non-MS group.OR value were 1.499 (95% CI:1.157-1.942) for IDF,1.696 (95% CI:1.314-2.189) for NCEP-R,1.763 (95% CI:1.344-2.312) for "Guideline" respectively.Conclusion Our research findings indicated that,when MS were defined with the 3 definitions,prediction on the risk of sub-clinical atberosclerosis would work beyond some of the conventional cardiovascular risk factors such as smoking,LDL-C.There might exist some differences in gender issue on the strength of association between MS when diagnosed by different criteria and carotid plaque.

The relationship between occupational physical activity intensity and peripheral arterial disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>to explore the relationship between occupational physical activity and peripheral arterial disease (PAD)assessed by ankle-brachial index (ABI).</p><p><b>METHODS</b>data including ABI, occupational physical activity intensity, health history, medication use, blood biochemistry and physical examinations derived from 16 446 subjects from 9 areas throughout China were analyzed. Univariate and multivariate adjusted logistic regression analysis were used for the data analyses.</p><p><b>RESULTS</b>occupational physical activity intensity was classified into 5 levels as jobless, very light, light, moderate and heavy intensity. With the increasing of physical activity intensity, the risk of PAD gradually decreased (P(trend) < 0.05). In comparison with jobless group, the ORs of PAD for other groups were 0.65 (95%CI: 0.52, 0.82), 0.70 (95%CI: 0.56, 0.87), 0.57 (95%CI: 0.44, 0.73), 0.65 (95%CI: 0.53, 0.80) respectively. After adjusting for gender, age, smoke, obesity/overweight, the history of hypertension, hypercholesterolemia, diabetes, cardiovascular disease and stroke, the ORs were 1.02 (95%CI: 0.80, 1.31), 0.91 (95%CI: 0.72, 1.15), 0.92 (95%CI: 0.70, 1.19), 0.90 (95%CI: 0.72, 1.12) (P(trend) < 0.05).</p><p><b>CONCLUSION</b>PAD risk reduced in proportion with increasing occupational physical activity.</p>

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.

Differences in goal attainment in clinical management of dyslipidemia in China evaluated by different guidelines / 中华心血管病杂志

<p><b>OBJECTIVE</b>To better understand the similarities and disparities between the newly issued Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults (CG) and exist relevant guidelines by comparing the actual effect on assessment of current clinical management of dyslipidemia in China, in order to promote the use of CG in clinical practice.</p><p><b>METHODS</b>Study participants included 2094 patients from the Second Multi-center Survey of Dyslipidemia Management in China. The goal attainment rate was defined as the proportion of participants who achieved their target low-density lipoprotein cholesterol (LDL-C) levels specified by CG, the Chinese Expert Recommendations on Prevention and Treatment of Dyslipidemia (CR), the updated Adult Treatment Panel III of the National Cholesterol Education Program (ATP III), respectively.</p><p><b>RESULTS</b>(1) The overall goal attainment rates were 62%, 34% and 50% according to CR, ATP III and CG, respectively. (2) With reference to the CG risk stratifications, the risk of nearly 40% of high risk patients and all very high risk patients were underestimated by CR, whereas the risk of more than 40% of patients in any risk groups were overestimated by ATP III. (3) The disparities in risk stratifications accounted for 90% of the difference in overall goal attainment rate (12%) between CR and CG, while the disparities in the risk stratifications and that in LDL-C target levels were responsible for 29% and 71% of the difference (16%) , respectively, between ATP III and CG.</p><p><b>CONCLUSIONS</b>There were significant differences in goal attainment rates assessed by different clinical practice guidelines. CG is more aggressive in risk stratification than CR but simpler and easier to use than ATP III, and hence more appropriate to Chinese patients and should be widely promoted in China.</p>

Association between heart rate and all-cause death and coronary event in the Chinese cohort: 16 years follow up results / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the association between resting heart rate (HR) and all-cause death and coronary heart disease (CHD) events in the Chinese cohort.</p><p><b>METHODS</b>Data were obtained from the PRC-USA Cooperative Study on Cardiovascular and Cardiopulmonary Epidemiology. Baseline screen surveys were conducted in 1983 and 1984 from people aged 35 to 59 years living in urban or rural areas of Beijing and Guangzhou. Follow-up visits were performed for end point events of all-cause death and first CHD events every two years till 2005. Resting HR was determined from 5 consecutive intervals between R waves on the 12-lead electrocardiogram.</p><p><b>RESULTS</b>A total of 9856 (4805 males) people were included in the study and the mean follow up duration was 16.2 years. There were 1523 deaths, including 200 CHD events during the follow up period. Mean resting HR was 67.9 beat per minute (bpm) in men and 71.6 bpm in women respectively which had a trend to increase with aging. Cox Proportional Hazards model indicated the relative risk of all-cause death increased constantly with the increase of HR percentile after control of age, fasting glucose, serum cholesterol, serum triglyceride, body mass index, systolic blood pressure and diastolic blood pressure. With HR 60-89 bpm as control group, the relative risk and 95% confidence interval in group HR < 50 bpm, 50 - 59 bpm, 90 - 99 bpm and > or = 100 bpm were 0.76 (0.49 - 1.17), 0.87 (0.75 - 1.02), 1.33 (1.06 - 1.68), 1.48 (1.03 - 2.14) respectively. However there was no significant correlation between HR and CHD events in studied population.</p><p><b>CONCLUSION</b>The risk of total death increased significantly in people with HR > or = 90 bpm suggesting higher resting heart rate might be an independent risk factor for all-cause death in the Chinese population.</p>

Profile and associations of carotid femoral pulse wave velocity in a community-based Beijing population of middle and old age / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the profile and related factors of carotid femoral pulse wave velocity (CFPWV) in a community-based Beijing population of middle and old age.</p><p><b>METHODS</b>A total of 1519 residents aged 44 - 79 years old from Shijingshan district, Beijing, were recruited for the cardiovascular risk factor survey and CFPWV measurements. One way ANOVA, pearson correlation and partial correlation, stepwise multi-linear regression were used for the data analysis.</p><p><b>RESULTS</b>(1) The age-adjusted mean value of CFPWV was significantly higher in men than that in women (11.4 vs. 11.1 m/s, P = 0.007). CFPWV increased significantly with age both for men and women (all P < 0.01). (2) After adjusting for age and gender, CFPWV was significantly higher in people with hypertension, diabetes and higher heart rate (> 70 beats/min) than people without these factors (P < 0.01). (3) CFPWV significantly correlated with age, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate (correlation coefficient ranged from 0.12 - 0.46, all P < 0.01). In female, CFPWV was positively correlated with total cholesterol and triglycerides (correlation coefficient 0.11 and 0.13, all P < 0.01). Multi-linear regression analysis showed age, gender, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate were independent predictors of CFPWV.</p><p><b>CONCLUSION</b>In this middle and old age Chinese population, age, sex, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate but not HDL-cholesterol and body mass index were associated with CFPWV.</p>

Cut offs and risk stratification of dyslipidemia in Chinese adults / 中华心血管病杂志

<p><b>OBJECTIVE</b>To establish cut offs and risk stratification of dyslipidemia in Chinese adults.</p><p><b>METHODS</b>Data from 2 widely cited studies: the PRC-US Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology and the China Multi-Provincial Cardiovascular Cohort Study, with a total of 40 719 Chinese adults, age 35 to 64 at baseline, about half men and half women, followed up for a total of 345 140.5 person years, were used to analyze the relationship between dyslipidemia and ischemic cardiovascular diseases (ICVD, including coronary heart events and ischemic stroke events) using a common data analysis protocol co-developed by the scientists from the 2 studies. The relative risk was estimated with the Cox proportional hazard model adjusting for other conventional cardiovascular risk factors. The 10-year absolute risk of ICVD for a 50 years-old person at different risk factor combinations was used to develop the risk stratification.</p><p><b>RESULTS</b>(1) There was a continuous linear relationship between baseline TC (or LDL-C) and ICVD risk without a threshold; (2) The incidence (absolute risk) of ICVD was similar for LDL-C < 3.37 mmol/L (130 mg/dl) and for TC < 5.18 mmol/L (200 mg/dl); and similar for LDL-C < 4.14 mmol/L (160 mg/dl) and for TC < 6.22 mmol/L (240 mg/dl); (3) The absolute ICVD risk for TC > or = 6.22 mmol/L (240 mg/dl) was slightly less but close to that for grade 1 hypertension; (4) ICVD risk increased as HDL-C decreased; (5) No significant association was found between baseline TG and subsequent ICVD; (6) At any TC level, the absolute ICVD risk for those having only hypertension was higher than that for those having 3 other risk factors.</p><p><b>CONCLUSION</b>The cut offs for diagnosis of dyslipidemia in Chinese adults can refer to those used in relevant international guidelines: TC < 5.18 mmol/L (200 mg/dl) [or LDL-C < 3.37 mmol/L (130 mg/dl)] as normal, TC 5.18 - 6.19 mmol/L (200 - 239 mg/dl) [or LDL-C 3.37 - 4.12 mmol/L (130 - 159 mg/dl)] as borderline high, and TC > or = 6.22 mmol/L (240 mg/dl) [or LDL-C > or = 4.14 mmol/L (160 mg/dl)] as high; HDL-C < 1.04 mmol/L (40 mg/dl) as low, 1.04 - 1.53 mmol/L (40 - 59 mg/dl) as normal and > or = 1.55 mmol/L (60 mg/dl) as optimal. In risk stratification scheme, hypertension plays a role that equals to that of any other 3 risk factors.</p>

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

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

The trends in clinical management of hyperlipidemia and goal attainment rate from 2000 to 2004 - 2006 in China / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the clinical management of hyperlipidemia and goal attainment rate in year 2000 to year 2004 - 2006 in China.</p><p><b>METHOD</b>Data from 2 retrospective surveys (2000 and 2004 - 2006) on clinical management of hyperlipidemia and goal attainment rate were analyzed. A total of 2136 patients were recruited in the 1st survey in year 2000 and 539 patients in the 2nd survey in year 2004 - 2006 from 25 and 21 tertiary hospitals of 12 metropolitan cities. Eligible patients had hyperlipidemia and received lipid-lowering therapy for more than 2 months at the time of survey. Serum lipid levels before and after treatment were analyzed and the goal attainment rate post therapy, defined according to the Chinese National Recommendations for Prevention and Treatment of Dyslipidaemia published in 1997, was calculated.</p><p><b>RESULTS</b>Clinical characteristics were comparable in patients from the 1st and 2nd survey: age (60.9 and 60.0 years), males (47.2% and 49.3%), type of lipid disorder (mixed hyperlipidemia 62.5% and 66.8%), and patients without coronary artery disease (CAD 61.2% and 68.6%). The percent of statins use was significantly higher in the 2nd survey than in the 1st survey (79.2% vs. 70.3%, P < 0.01). The goal attainment rate was significantly higher in the 2nd survey than in the 1st survey (39.9% vs. 26.6% for all patients, 40.2% vs. 28.8% for hypercholesterolaemia, 39.7% vs. 25.0% for mixed hyperlipidemia, 45.9% vs. 31.7 for patients without CAD, 26.7% vs. 16.6% for patients with CAD, 42.2% vs. 30.1% for patients using statins, and 38.5% vs. 28.3% for patients with diet control, all P value < 0.01).</p><p><b>CONCLUSIONS</b>Although the goal attainment rate has been significantly increased in treated hyperlipidemia patients over recent 5 years in China, it is still far from optimal as suggested by the recommendations. Further efforts should be made to increase the goal attainment rate in patients receiving lipid-lowering therapy.</p>

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

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

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

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

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

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