Adverse trends of cardiovascular risk factors among low risk populations (1983-1994)--a cohort study of workers and farmers in Guangzhou, China.

BACKGROUND: The levels and trends of cardiovascular risk factors vary greatly throughout China. We examine 10-year trends of cardiovascular risk factors (1983-1994) and the factors related to these trends among low-risk cohorts of workers and farmers in Guangzhou, China. METHODS: This is a cohort study of 3,131 workers and 3,493 farmers aged 25-64 years at baseline with 10 years of follow-up. We performed a longitudinal analysis to account for the aging of the cohorts and the repeated measures of the same individual. RESULTS: At baseline the prevalence of overweight (including obese) ranged from 1.0% to 11.8%, hypertension ranged from 3.8% to 10.5%, and mean serum total cholesterol (TC) ranged from 155.4 mg/dl to 187.2 mg/dl. Although prevalence of smoking declined, blood pressure levels and body mass index (BMI) increased significantly, and lipid profiles changed unfavorably during the 10-year follow-ups. The prevalence of hypertension increased from 5.0 percentage points (female farmers) to 12.3 percentage points (male farmers). Mean TC increased significantly (e.g., +22.8 mg/dl and +17.0 mg/dl in male and female farmers, respectively). In the longitudinal data analyses, increase in BMI was associated with increase in blood pressure levels and TC. Significant adverse trends of risk factors persisted after adjustment for aging, education, BMI, smoking, and alcohol intake. CONCLUSION: Urgent action is needed to prevent and reverse the unhealthy trends occurring among these low risk Chinese workers and farmers.

[Association between heart rate and all-cause death and coronary event in the Chinese cohort: 16 years follow up results].

OBJECTIVE: To evaluate the association between resting heart rate (HR) and all-cause death and coronary heart disease (CHD) events in the Chinese cohort. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

A school-based program for control of group a streptococcal upper respiratory tract infections: a controlled trial in Southern China.

A prospective, school-based study included daily monitoring for incidence of symptomatic streptococcal-associated pharyngitis and monthly determinations of group A streptococcal prevalence. A treatment group received penicillin/erythromycin therapy at school for positive throat cultures; the control group sought medical care from their regular provider. Prevalence and incidence of group A streptococcal pharyngitis were significantly lower among the treatment group than in the controls.

Estimation of 10-year risk of fatal and nonfatal ischemic cardiovascular diseases in Chinese adults.

BACKGROUND: Stroke is much more prevalent than coronary heart disease in China; thus, any risk prediction model only for coronary heart disease may not be appropriate in application. Our objective is to develop a cardiovascular risk prediction model appropriate for the Chinese population. METHODS AND RESULTS: Cox proportional hazards regression was used to develop sex-specific optimal 10-year risk prediction models for ischemic cardiovascular disease (ICVD; including ischemic stroke and coronary events) from 17 years of follow-up data from the USA-PRC Collaborative Study of Cardiovascular Epidemiology cohort, in which 9903 participants were followed up every 2 years until 2000, and 371 ICVD events (266 strokes and 105 coronary heart disease events) occurred. The models showed ICVD was positively related to age, systolic blood pressure, serum total cholesterol, body mass index, current smoking status, and diabetes mellitus in both men and women. When the models were applied to the 17,329 participants in the China Multicenter Collaborative Study of Cardiovascular Epidemiology cohort, the areas under the receiver operating characteristic curve were 0.796+/-0.036 for men and 0.791+/-0.036 for women. The simplified point score model resulted in similar c statistics. Comparison of the observed with the estimated incidence of ICVD at different risk levels showed satisfactory precision. Meanwhile, application of recalibrated Framingham models significantly overestimated the coronary heart disease risk in both men (by approximately 97%) and women (by approximately 228%). CONCLUSIONS: The Cox regression prediction models and simplified point score model have satisfying predictive capability for estimating the 10-year integrated cardiovascular risk in Chinese, in whom stroke is the predominant cardiovascular disease.

Impact of dysglycemia, body mass index, and waist-to-hip ratio on the prevalence of systemic hypertension in a lean Chinese population.

The purpose of this study was to explore whether dysglycemia, and/or an increased body mass index, and/or an increased waist/hip ratio increased the risk of hypertension in a lean population of South China. The association among dysglycemia, obesity, and hypertension has been well documented in Western populations. A stratified cluster sampling method was used according to the National Diabetes Mellitus Epidemiology Survey Program in 1998. Blood pressure, fasting plasma glucose, and plasma glucose were measured 2 hours after 75-g oral glucose consumption using the enzymatic method in the morning. Body height, weight, and waist and hip measurements were also collected for the survey. The criteria for the diagnosis of hypertension and diabetes mellitus, including impaired glucose tolerance (IGT), were those published by the World Health Organization in 1999. A total of 11,402 participants were included in the investigation (5,195 men and 6,207 women; age 20 to 74 years). A total of 1,775 cases of hypertension were confirmed in the survey. The prevalence of hypertension was significantly higher in those with diabetes mellitus than in those with a normal blood glucose level, in those with IGT than in those with normal glucose tolerance test findings, and in obese participants than in those with a normal weight (45.5% vs 14.4%, 32.2% vs 14.5%, and 20.6% vs 12.1%, respectively). Multiple logistic regression analysis indicated that age and gender-adjusted odds ratio of hypertension was 2.24 (95% confidence interval 1.88 to 2.68) with IGT compared with those without IGT. The odds ratio for hypertension associated with an increased body mass index and waist/hip ratio was 1.19 (95% confidence interval 1.17 to 1.21) and 1.08 (95% confidence interval 1.07 to 1.09), respectively. In conclusion, the data from an epidemiologic study in South China demonstrated that dysglycemia and increased body mass index and/or waist/hip ratio increase the risk of hypertension even in a lean Chinese population.