Cardiovascular events in a prehypertensive Chinese population: four-year follow-up study.

OBJECTIVES: This study aimed to determine the occurrence of cardiovascular (CV) events in a prehypertensive Chinese population. METHODS: Participants meeting the JNC 7 diagnostic criteria for prehypertension (n=30,027) and ideal blood pressure (n=15,614) were enrolled in this prospective, observational cohort. New CV events were collected during follow-up of 38-53 months (mean 47.58 ± 3.19 months). A multivariate Cox proportional hazard regression model was used to analyze factors influencing CV events. RESULTS: Four hundred sixty-one CV events occurred during the follow-up period. Cumulative incidence rates for total CV events, cerebral infarct, cerebral hemorrhage, myocardial infarct, and deaths due to CV in the prehypertensive population were 1.19%, 0.57%, 0.20%, 0.23%, and 0.23%, respectively. These rates were higher than those of the ideal blood pressure group (0.67%, 0.27%, 0.12%, 0.17%, and 0.15% respectively). After correcting for traditional CV risk factors, relative risks (RRs) for total CV events, cerebral infarct and cerebral hemorrhages in the prehypertensive population were 1.32 (95% confidence intervals (CI): 1.06-1.65), 1.55 (95% CI: 1.10-2.18) and 1.40 (95% CI: 0.82-2.37) higher than those in the ideal blood pressure population. Compared to the ideal blood pressure group, the prehypertensive population was older, more likely male, and had higher triglycerides, total cholesterol, low-density lipoprotein cholesterol, and body mass index (p<0.05). CONCLUSION: Prehypertension is an independent risk factor for total CV events and stroke.

Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city.

BACKGROUND: The American Heart Association Committee recently developed definitions of "ideal," "intermediate," and "poor" cardiovascular health based on 7 cardiovascular disease (CVD) risk factors or health behaviors. This study evaluated the prevalence of "ideal" American Heart Association cardiovascular health metrics from June 2006 to October 2007 in the Kailuan cohort (n=101 510; age 18-98 years) in northern China and its relationship with the 4-year CVD incidence. METHODS AND RESULTS: We used Cox proportional hazards regression to calculate hazard ratios and 95% confidence intervals for baseline health behaviors and risk factor categories. The majority of participants (63,676; 69.45%) presented with ≤3 ideal cardiovascular health metrics, whereas 8342 participants (9.1%) had 5 to 7 ideal metrics. Only 93 of 91,698 participants (0.1%) had all 7 metrics in the ideal range. There was a strong relationship between the cumulative incidence of CVD events in the 4-year follow-up and the number of ideal health metrics at baseline; the 1111 participants with 6 and 7 ideal metrics had a significantly lower cumulative incidence of CVD than subjects with no or only 1 ideal health metric (0.8% versus 3.3%). Men had higher rates of CVD events than women (2.46% versus 1.18%). CONCLUSIONS: Few adults had ideal cardiovascular health according to the modified American Heart Association definition. We detected a strong inverse relationship between the cumulative CVD incidence and the number of ideal health metrics at baseline. Population-wide prevention, especially lifestyle improvement, is critical to increase the low-risk prevalence and thereafter decrease CVD events. Clinical Trial Registration- URL: http://www.chictr.org/cn/proj/show.aspx?proj=1441. Unique identifier: ChiCTR-TNC-11001489.