Preliminary survey report on the clinical validation of in-use electronic sphygmomanometers in China / 中华心血管病杂志

Objective: To explore the percentage of in-use electronic sphygmomanometers independently validated clinically in China. Methods: We conducted a cross-sectional survey and Beijing, Shenzhen, Shijiazhuang, Datong, and Shihezi were selected according to the geographical location and economic level. In each site, one tertiary hospital, two community health centers, and 20 families with electronic sphygmomanometers in use were chosen. The information of electronic sphygmomanometers including brand, model, manufacturer and production date were obtained by the trained staff. Ten electronic sphygmomanometers from each hospital, five electronic sphygmomanometers from each community health center, and one electronic sphygmomanometer from each family were surveyed, and the user's subjective judgment results and judgment basis on the accuracy of the electronic sphygmomanometer measurement were collected. We searched six registration websites (Medaval, Stride BP, dabl Educational Trust, British and Irish Hypertension Society, American Medical Association and Hypertension Canada) and two research databases (PubMed and CNKI) for the clinical validation status of each electronic sphygmomanometer. Results: A total of 200 electronic sphygmomanometers were investigated in this study, of which only 29.0% (58/200) passed independent clinical validation. When stratified by users, the percentage of being clinical validated was 46.0% (23/50) for electronic sphygmomanometers in hospitals, 42.0% (21/50) for those in community health centers and 14.0% (14/100) for those in home use, respectively, and the proportions between the three groups were significantly difference (P<0.001). Doctors in tertiary hospitals and community health service centers judged the accuracy of electronic sphygmomanometers mainly on the basis of "regular correction" (41.0% (41/100)) and "comparison with other electronic sphygmomanometers" (20.0% (20/100)), while among home users, 41.0% (41/100) were not clear about the accuracy of electronic sphygmomanometers, and 40.0% (40/100) made the judgment by "comparison with the devices in hospitals". Conclusion: The clinical validation of in-use electronic sphygmomanometers in China is low. Most of users, including healthcare professionals, are not aware of clinical validation of electronic sphygmomanometers.

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>

Prevalence of atrial fibrillation in China and its risk factors / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the prevalence of atrial fibrillation (AF) and the relation with its risk factors in China.</p><p><b>METHODS</b>A total of 19 363 participants (8635 males and 10 728 females) aged ⋝35 years in geographically dispersed urban and rural regions of China were included in this cross-sectional survey. All participants received questionnaire, physical and blood examination. Echocardiography were performed for AF patients found in the survey.</p><p><b>RESULTS</b>Of the 19 363 participants, 199 were diagnosed with AF. The estimated age-standardized prevalence of AF was 0.78% in men and 0.76% in women. The prevalence of AF in participants aged <60 years was 0.41% in men and 0.43% in women, and was 1.83% in both men and women aged ⋝60 years. About 19.0% of males and 30.9% of females with AF were diagnosed with valve disease. Age- and sex-adjusted multivariable logistic regression analysis revealed that myocardial infarction, left ventricular hypertrophy (LVH), obesity, and alcohol consumption were associated with a increased risk of AF(P<0.05).</p><p><b>CONCLUSION</b>The age standardized prevalence of AF is 0.77% in the participants enrolled in the present study. The number of AF cases aged ⋝35 years is 5.26 million according to 2010 Chinese Census. Most risk factors for AF, identified mainly in Western countries, are also detected in China.</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.

Short-term impact of modified blood-lipid reports on physicians' lipid lowering drug prescribing behavior and knowledge improvement on dyslipidemia / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the physicians' lipid lowering drug prescribing behavior and knowledge on dyslipidemia before and at 8 months after new-issued blood-lipid reports in our hospital.</p><p><b>METHOD</b>Blood-lipid reports in our hospital is newly modified in that the classification of dyslipidemia and lipid-lowering guideline and target lipid level are listed on the back of lipid report besides the normal lipid value listed immediately after the measured lipid levels. Physicians' lipid lowering drug prescribing behavior and knowledge on dyslipidemia before and at 8 months after new-issued blood-lipid reports were examined in 143 doctors from various departments before and at 8 months after new-issued lipid reports.</p><p><b>RESULTS</b>At 8 months after the new issued lipid reports, doctors' cognition rate about the guideline was significantly increased [83.9% (120/143) vs. 67.1% (96/143), P < 0.001] and the guideline was considered more helpful on daily practice [75.3% (58/77) vs. 55.8% (43/77), P = 0.005] compared to baseline. However, the prescription rate of dyslipidemia therapy did not change significantly (69.2% vs. 63.2%, P = 0.117) at 8 months after the new issued lipid reports.</p><p><b>CONCLUSIONS</b>The modification of the blood-lipid reports improved doctors' knowledge on dyslipidemia and on the "Chinese guidelines on prevention and treatment of dyslipidemia in adults". However, the lipid lowering drug prescribing behavior remained unchanged at 8 months after the modification of the lipid reports. Further investigation is warranted to see if the lipid lowering drug prescribing behavior could be changed in the long-term.</p>

Distribution characteristics and risk factors of carotid atherosclerosis in middle-aged and elderly Chinese / 中华心血管病杂志

<p><b>OBJECTIVE</b>To describe the distribution characteristics of carotid atherosclerosis and to analyze its association with cardiovascular risk factors in middle-aged and elderly Chinese.</p><p><b>METHODS</b>In 2007, the second cross-sectional examination for cardiovascular risk factors and B-mode ultrasound imaging on carotid arteries were performed in a Chinese population consisting of 2681 subjects aged 43-81 years old from two cohorts participants of the People's Republic of China/United States of America collaborative study (USA-PRC study) and the Chinese multi-provincial cohort study (CMCS). The association of cardiovascular risk factors with intima-media thickening (ITM) and plaque of carotid arteries was analyzed.</p><p><b>RESULTS</b>(1) The mean intima-media thickening (Mean-IMT) of carotid artery was 0.68 mm, the maximal intima-media thickening (Max-IMT) was 1.07 mm. (2) The prevalence rate of carotid plaque was 60.3% in all subjects. As for the different sites of carotid arteries, the plaque prevalence rate at carotid bulb was 61.2% for male and 51.6% for female (chi2 = 23.44, P < 0.01), and at the internal carotid artery was 24.7% for male and 12.2% for female (chi2 = 69.57, P < 0.01), at the common carotid artery was 20.9% for male and 13.8% for female (chi2 = 23.18, P < 0.01). (3) After adjusting for age and other cardiovascular risk factors, the Mean-IMT and Max-IMT increased with elevated levels of systolic blood pressure, plasma glucose and low density lipoproteins cholesterol (LDL-C) (all P < 0.05). Hypertension, diabetes, smoking and high LDL-C (P < 0.05) were independent predict factors for the risk of carotid plaque.</p><p><b>CONCLUSION</b>The carotid atherosclerosis was common in middle and older age Chinese and was positively associated with classical cardiovascular disease risk factors.</p>

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>

Prediction value of blood lipid levels on newly identified carotid plaque in middle-aged and elderly Chinese population / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the prediction value of blood lipid levels on the newly-identified carotid plaque in middle-aged and elderly Chinese population.</p><p><b>METHODS</b>All study subjects were recruited from two cohorts from 2002 to 2007 [the People's Republic of China/United States of America collaborative study (USA-PRC study) and the Chinese multi-provincial cohort study (CMCS)]. The baseline examination including cardiovascular disease risk factors and B-mode ultrasound of carotid artery was performed in 2002 and the second examination was made in September to October, 2007. The relationship between baseline lipids and carotid plaque incidence was analyzed in a total of 2000 subjects aged 47 to 79 years (mean 63 years).</p><p><b>RESULTS</b>(1) During these 5 years, the prevalence of carotid plaque increased from 30.3% to 62.2% and from 21.5% to 51.5% for men and women, respectively. The newly-identified carotid plaque incidence was 41.8% for men and 34.1% for women. (2) The incidence of artery plaque significantly increased in both sexes in proportion to increase of baseline total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and total to high-density cholesterol ratio (TC/HDL-C) levels (P < 0.05 or P < 0.01). (3) Cross-stratification analysis of LDL-C, triglyceride (TG) and HDL-C for carotid plaque incidence indicated the existence of conjoint effects between LDL-C and HDL-C, LDL and TG, as well as between TG and HDL-C, on the increased incidence of carotid plaque. (4) Multi-factorial analysis showed that higher LDL-C, non-HDL-C and TC/HDL-C were independent risk factors for development of new carotid plaque [OR = 1.44 (95%CI = 1.07 - 1.94), OR = 1.45 (95% CI = 1.08 - 1.96), OR = 1.59(95% CI = 1.14 - 2.23) in men;OR = 1.47 (95% CI = 1.13 - 1.92), OR = 1.35 (95% CI = 1.04 - 1.75), OR = 1.64 (95% CI = 1.20 - 2.23) in women].</p><p><b>CONCLUSIONS</b>The prevalence of carotid plaque increased rapidly in this cohort between 2002 and 2007. Elevated LDL-C, non-HDL-C and TC/HDL-C levels were independent predictors of newly developed carotid plaque.</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>

The second multi-center survey of dyslipidemia management in China: goal attainment rate and related factors / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the current status in dyslipidemia management in China.</p><p><b>METHODS</b>We recruited 2306 patients who received lipid-lowering drugs between January 1, 2004 and February 28, 2006, and maintained on the treatment for at least 2 months, from 21 provincial level hospitals and 6 prefecture and country level hospitals. The goal attainment rate was defined as the percentage of patients reaching cholesterol goals recommended by the updated Adult Treatment Panel III (ATPIII) of the National Cholesterol Education Program and the new Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults.</p><p><b>RESULTS</b>(1) Among 2094 patients who met guidelines' criteria for initiating drug therapy, there were 80% patients treated in provincial level hospitals, 60% aged 60 years and above, 57% hyperlipidemia, 15% with normal lipids values, 68% coronary heart disease and other atherosclerotic diseases, 75% hypertensive, 80% high or very high risk patients, 84% statin-users and 83% referred to diet change. (2) According to ATPIII 2004, overall 34% patients attained the LDL-C goal. The goal attainment rates was 85%, 78%, 61%, 31% and 22% for patients at low risk, moderate, moderate high, high and very high risk respectively (P for trends < 0.001). According to the new Chinese guidelines, the goal attainment rate was 50% for overall patients and was 91%, 77%, 49% and 38% for patients at low risk, moderate, high and very high risk respectively (P for trend < 0.001). (3) The goal attainment rate was 51% for patients using combination therapy, 35% for those using statins, 23% for those using fibrates, 24% for those using niacin, 28% for those using other lipid-lowering medications (P < 0.001). (4) Among 1808 patients treated with statins, a multi-variable Logistic regression analysis showed that the dosage of statins (high vs. low dose, OR = 1.72, 95% CI: 1.15 - 2.58), risk of patients (very high vs. low risk, OR = 0.02, 95% CI: 0.01 - 0.03), baseline LDL-C [every 0.259 mmol/L (10 mg/dl) increase, OR = 0.83, 95% CI: 0.80 - 0.86] and sex (women vs. men, OR = 0.77, 95% CI: 0.60 - 0.99) were major factors that affected goal attainment.</p><p><b>CONCLUSIONS</b>The characteristics of target patients taking lipid-lowering drugs have changed significantly in China and were used not only for lipid lowering but also for other purposes, which is well in accordance with current guidelines. However, current clinical management of dyslipidemia in China is still far behind the desirable goals derived both Chinese guidelines and the updated ATPIII guidelines, especially for high and very high risk patients. To further improve the clinical management of dyslipidemia, it is necessary to strengthen the choice of drugs and dosage, new drug development to allow better and safer combination therapy, intensive therapeutic lifestyle changes, patient health education, etc.</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>

Self-reported prevalence of allergic rhinitis in eleven cities in China / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The aim of this study is to investigate the self-reported prevalence and other epidemiological characteristics of allergic rhinitis from 11 cities throughout the mainland of China.</p><p><b>METHODS</b>Telephone interviews were conducted in the two main municipalities (Beijing, Shanghai) and eight capital cities (Changsha, Changchun, Hangzhou, Guangzhou, Nanjing, Shenyang, Wuhan, Urumqi and Xi'an) of main provinces throughout the mainland of China after sampling target phone numbers by the approach of random digital dialing (RDD) via computer.</p><p><b>RESULTS</b>In total, the survey had sampled 684 blocks of telephone numbers in 11 cities, and dialed 119 319 telephone numbers. Of the 38 203 respondents, 4253 subjects reported allergic rhinitis, while the other 33 950 were screened negative in the telephone interviews. The self-reported prevalence of allergic rhinitis was lowest in Xi'an (8.0%), and highest in Urumqi (21.4%), with Nanjing having intermediate value (11.5%). The gender-adjusted prevalence ranged from 8.5% in Xi'an to 21.3% in Urumqi, while the age-adjusted prevalence of self-reported allergic rhinitis ranged from 8.7% in Beijing to 24.1% in Urumqi.</p><p><b>CONCLUSIONS</b>The study demonstrates that the self-reported prevalence of allergic rhinitis in 11 cities throughout the mainland of China has wide variations, and the strategy of prevention for allergic rhinitis should be conducted according to the epidemic features of it.</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>

Study on the relationship between Gln223arg variant in leptin receptor gene and obesity / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the association between Gln223Arg variant in leptin receptor (LEPR) gene and obesity.</p><p><b>METHODS</b>The subjects were from Yu county, Shanxi province, China. Data on cardiovascular risk factors was collected with questionnaire and their Gln223Arg variants in LEPR gene were genotyped. The relation between Gln223Arg variant in LEPR and obesity was analyzed.</p><p><b>RESULTS</b>The genotype frequencies of G. G, G. A and AA were 0.7679, 0.2171 and 0.015 respectively and the allele frequencies of G and A were 0.8764 and 0.1236. The distribution of genotype was in Hardy-Weinberg equilibrium (P = 0.934). The results of single factor analysis showed that the carriers with the Arg223 alleles had higher weight (63.2 kg vs. 61.9 kg; P= 0.0307) and body mass index (24.4 kg/rn vs. 24.1 kg/m2; P = 0.0898) than those noncarriers of these alleles. Results from multivariate analysis indicated that the carriers with the Arg223 alleles had higher body mass index (24.5 kg/m2 vs. 24.1 kg/m ;P= 0.0396) and prevalence of obesity (OR = 1.30, 95% CI: 0.957-1.767; P= 0.0935).</p><p><b>CONCLUSION</b>These data indicated that Gln223Arg variant in LEPR gene was possibly associated with obesity, respectively.</p>