The role of NAD-dependent deacetylase sirtuin-2 in liver metabolic stress through regulating pyruvate kinase M2 ubiquitination

NAD-dependent deacetylase Sirt2 is involved in mammalian metabolic activities, matching energy demand with energy production and expenditure, and is relevant to a variety of metabolic diseases. Here, we constructed Sirt2 knockout and adeno-associated virus overexpression mice and found that deletion of hepatic Sirt2 accelerated primary obesity and insulin resistance in mice with concomitant hepatic metabolic dysfunction. However, the key targets of Sirt2 are unknown. We identified the M2 isoform of pyruvate kinase (PKM2) as a key Sirt2 target involved in glycolysis in metabolic stress. Through yeast two-hybrid and mass spectrometry combined with multi-omics analysis, we identified candidate acetylation modification targets of Sirt2 on PKM2 lysine 135 (K135). The Sirt2-mediated deacetylation-ubiquitination switch of PKM2 regulated the development of glycolysis. Here, we found that Sirt2 deficiency led to impaired glucose tolerance and insulin resistance and induced primary obesity. Sirt2 severely disrupted liver function in mice under metabolic stress, exacerbated the metabolic burden on the liver, and affected glucose metabolism. Sirt2 underwent acetylation modification of lysine 135 of PKM2 through a histidine 187 enzyme active site-dependent effect and reduced ubiquitination of the K48 ubiquitin chain of PKM2. Our findings reveal that the hepatic glucose metabolism links nutrient state to whole-body energetics through the rhythmic regulation of Sirt2.

Wildfire particulate exposure and risks of preterm birth and low birth weight in the Southwestern United States

OBJECTIVES

Wildfire air pollution is a growing concern on human health. The study aims to assess the associations between wildfire air pollution and pregnancy outcomes in the Southwestern United States.

STUDY DESIGN

This was a retrospective cohort study.

METHODS

Birth records of 627,404 singleton deliveries in 2018 were obtained in eight states of the Southwestern United States and were linked to wildfire-sourced fine particulate matter (PM2.5) and their constituents (black carbon [BC] and organic carbon [OC]) during the entire gestational period. A double-robust logistic regression model was used to assess the associations of wildfire-sourced PM2.5 exposures and preterm birth and term low birth weight, adjusting for non-fire-sourced PM2.5 exposure and individual- and area-level confounder variables.

RESULTS

Wildfire-sourced PM2.5 contributed on average 15% of the ambient total PM2.5 concentrations. For preterm birth, the strongest association was observed in the second trimester (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.05-1.07 for PM2.5; 1.06, 95% CI: 1.05-1.07 for BC; 1.04, 95% CI: 1.03-1.05 for OC, per interquartile range increment of exposure), with higher risks identified among non-smokers or those with low socio-economic status. For term low birth weight, the associations with wildfire-sourced PM2.5 exposures were consistently elevated for all trimesters except for the exposure averaged over the entire gestational period. Overall, the associations between wildfire-sourced PM2.5 and pregnancy outcomes were stronger than those with total PM2.5.

CONCLUSIONS

Wildfire-sourced PM2.5 and its constituents are linked to higher risks of preterm birth and term low birth weight among a significant US population than the effects of ambient total PM2.5.

Pretreatment synthetic MRI features for triple-negative breast cancer

AIM

To evaluate the quantitative parameters derived from synthetic magnetic resonance imaging (SyMRI) for predicting triple-negative breast cancer (TNBC).

MATERIALS AND METHODS

This prospective study enrolled participants with invasive ductal breast carcinoma (IDBC) and separated them into a TNBC group and a Non-TNBC group. Preoperative breast MRI included both the SyMRI and conventional MRI sequences. The quantitative parameters derived from the SyMRI included T1 and T2 relaxation times, proton density (PD), and their standard deviations (SD). Clinicopathological characteristics, conventional MRI findings, and quantitative synthetic parameters were assessed for all participants. Multivariable logistic regression analysis was performed to determine the potential independent imaging predictors for TNBC preoperatively. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of these parameters.

RESULTS

A total of 231 participants with histopathological proven IDBC were included in this study (n=46 in the TNBC group and n=185 in the Non-TNBC group). The TNBC group had significantly larger tumour size (p=0.011) and more frequent intratumoural cystic or necrotic lesions (p<0.001) as compared to the Non-TNBC group. The univariate analysis showed that the TNBC tumours had significantly higher T1 (p=0.006) and T2 (p<0.001) values than Non-TNBC tumours. Subsequent multivariable analysis indicated that T2 values and the presence of cystic or necrotic lesions were the independent predictors for TNBC.

CONCLUSION

The T2 from synthetic imaging and the presence of cystic degeneration or necrosis within the breast cancer may serve as potential imaging biomarkers for preoperative differentiation of TNBC from Non-TNBC.

Role of SIRT2 in intestinal barrier under cold exposure

Prolonged cold exposure causes body stress and damages health. The intestinal environment is complex and variable, and direct contact with the external environment can easily cause stress, damage and even lead to diseases such as diarrhea.

AIMS

This study aimed to reveal the role of cold exposure on ileum damage and the role of SIRT2 in this process.

MAIN METHODS

C57BL6 mice and SIRT2 knockout mice were used to construct a chronic cold exposure model (21 days, random 4 °C exposure for 3 h per day), which was tested by various methods, including intestinal permeability assays, morphological assays, ultrastructural assays, western blotting, and fluorescence staining. In vitro assays were performed on the mouse small intestinal epithelial cell line MODE-K to investigate the role of endoplasmic reticulum stress, SIRT2 knockout, and autophagy on tight junctions.

KEY FINDINGS

The results showed that chronic cold exposure damaged the ileal epithelial barrier, with endoplasmic reticulum stress. Knockout of SIRT2 alleviates ileal injury via enhanced autophagy under cold exposure. And autophagy can restore the expression of ZO-1 under stress.

SIGNIFICANCE

This study can provide potential target and basic data for the treatment of IBD and other disorders of the intestinal barrier. Autophagy may be an important means of restoring damage to the intestinal barrier.

Prevalence and influencing factors of anaemia among pregnant women in rural areas of Northwestern China

OBJECTIVES

Anaemia during pregnancy is a significant public health problem that adversely impacts both the mother and foetus. However, the factors influencing maternal anaemia in deprived areas of Northwestern China have not yet been thoroughly investigated. This study aimed to describe the prevalence and potential influencing factors of anaemia among expectant mothers in rural areas of Northwestern China.

STUDY DESIGN

This was a cross-sectional survey.

METHODS

A cross-sectional survey of 586 expectant mothers was conducted to investigate the prevalence of anaemia, prenatal healthcare coverage, dietary diversity and nutrient supplementation intake. The study population was selected from the sample areas using a random sampling method. Data were collected through a questionnaire, and haemoglobin concentrations were measured by a capillary blood test.

RESULTS

The results show that 34.8% of the study population were anaemic, with 13% having moderate-to-severe anaemia. The results of the regression analysis showed that diet was not significantly associated with haemoglobin concentrations or the prevalence of anaemia. However, regular prenatal healthcare attendance was found to be an important influencing factor for both haemoglobin concentration (β = 3.67, P = 0.002) and the prevalence of anaemia (odds ratio = 0.59, P = 0.011).

CONCLUSIONS

Pregnant women receiving regular prenatal care were less likely to be anaemic; thus, it is essential to implement strategies to improve attendance at maternal public health services to reduce the prevalence of maternal anaemia.

Correlation between primary family caregiver identity and maternal depression risk in poor rural China

INTRODUCTION

Prenatal and postpartum depression are important public health challenges because of their long-term adverse impacts on maternal and neonatal health. This study investigated the risk of maternal depression among pregnant and postpartum women in poor rural China, along with the correlation between primary family caregiver identity and maternal depression risk.

METHODS

Pregnant women and new mothers were randomly selected from poor rural villages in the Qinba Mountains area in Shaanxi. Basic demographic information was collected regarding the women and their primary family caregivers. The Edinburgh Postnatal Depression Scale was used to identify women at risk of depression, and the Perceived Social Support Scale was used to evaluate perceived family support.

RESULTS

This study included 220 pregnant women and 473 new mothers. The mean proportions of women at risk of prenatal and postpartum depression were 19.5% and 18.6%, respectively. Regression analysis showed that identification of the baby's grandmother as the primary family caregiver was negatively correlated with maternal depression risk (β=-0.979, 95% confidence interval [CI]=-1.946 to -0.012, P=0.047). However, the husband's involvement in that role was not significantly correlated with maternal depression risk (β=-0.499, 95% CI=-1.579 to 0.581, P=0.363). Identification of the baby's grandmother as the primary family caregiver was positively correlated with family support score (β=0.967, 95% CI=-0.062 to 1.996, P=0.065).

CONCLUSION

Prenatal and postpartum depression are prevalent in poor rural China. The involvement of the baby's grandmother as the primary family caregiver may reduce maternal depression risk, but the husband's involvement in that role has no effect.

Cold exposure-induced endoplasmic reticulum stress regulates autophagy through the SIRT2/FoxO1 signaling pathway

Cold is a factor affecting health in humans and animals. The liver, a major metabolic center, is highly susceptible to ambient air temperature. Recent studies have shown that endoplasmic reticulum (ER) stress is associated with the liver, and regulates the occurrence and development of liver injury and autophagy. However, the mechanism underlying the relationship between cold exposure and ER stress in the liver is not well understood. In this study, we investigated the effect of ER stress on liver autophagy and its mechanism under cold exposure. AML12 cells were treated with Tg to construct an ER stress model, and the level of autophagy increased. To further explore the mechanism through which ER stress regulates autophagy, we knocked down SIRT2 with shRNA in Tg-treated AML12 cells. Knockdown of SIRT2 significantly increased ER stress and autophagy, increased FoxO1 acetylation, and promoted its entry into the nucleus. To further verify the results of in vitro experiments, we exposed mice to 4°C for 3 h per day for 3 weeks to exacerbate the burden on the liver after cold exposure. Cold exposure damaged the structure and function of the liver and promoted the inflammatory response. It also activated ER stress and promoted autophagy. In addition, cold exposure inhibited the expression of SIRT2, promoted FoxO1 acetylation, and enhanced the interaction with autophagy. Our findings indicated that cold exposure induces liver damage, ER stress, and autophagy through the SIRT2/FoxO1 pathway. These findings suggest that SIRT2 may be a potential target for regulating health under cold exposure.

Utilisation of village clinics in Southwest China: evidence from Yunnan Province

INTRODUCTION

Primary healthcare in rural China is underutilised, especially in village clinics in Southwest China. The aim of this study was to explore any relationships among the ethnicity of the healthcare provider, the clinical competence of the healthcare provider, and the utilisation of village clinics in Southwest China.

METHODS

This cross-sectional survey study involved 330 village healthcare providers from three prefectures in Yunnan Province in 2017. Multiple logistic regressions were adopted to investigate the utilisation of primary healthcare among different ethnic healthcare providers.

RESULTS

Primary healthcare utilisation was higher in village clinics where healthcare providers were Han Chinese than those where healthcare providers were ethnic minority (151 vs 101, P=0.008). The logistic regression analysis showed that clinical competence was positively associated with the utilisation of primary healthcare (odds ratio [OR]=1.49, 95% confidence interval [CI]=1.12-2.00; P=0.007) and that inadequate clinical competence of ethnic minority health workers may lead to a lag in the utilisation of primary healthcare (OR=0.45, 95% CI=0.23-0.89; P=0.022).

CONCLUSION

Our results confirm differences in the utilisation of primary healthcare in rural Yunnan Province among healthcare providers of different ethnicities. Appropriate enhancements of clinical competence could be conducive to improving the utilisation of primary healthcare, especially among ethnic minority healthcare providers.

Anthropometric measures and breast cancer risk among Hispanic women in Puerto Rico

INTRODUCTION

Increased risk of postmenopausal breast cancer associated with anthropometric measures including Body Mass Index (BMI), adult weight gain, and waist circumference has been observed in North American and European populations, but little evidence is available for Hispanic women. Breast cancer is the leading type of cancer, and leading cause of cancer-related deaths among Hispanic women in Puerto Rico (PR). However, compared with the United States, breast cancer incidence rates are lower but increasing more rapidly.

PURPOSE

To examine associations between anthropometric characteristics and breast cancer risk in Hispanic women in PR.

METHODS

Data from a population-based case-control study in the San Juan metropolitan region (cases = 315; controls = 348) were used to examine associations between anthropometric measures and breast cancer risk, also considering menopausal status and hormone therapy (HT).

RESULTS

Among premenopausal participants, there was a significant trend for lower odds of breast cancer with higher BMI and borderline significant with higher waist to height ratio (WHtR). For postmenopausal participants, a significant trend for lower odds of breast cancer was observed with higher WHtR, and waist to hip ratio (WHR), borderline significant with higher BMI, and higher odds with height. Among postmenopausal participants using HT, a significant trend for lower odds of breast cancer was observed with higher waist circumference, WHtR, WHR, and body shape index.

CONCLUSION

Our study provides evidence of anthropometric differences in relation to breast cancer risk in PR compared to previous studies. Future studies should include analyses of fat and lean mass distribution, and hormone receptor status to further understand anthropometry and breast cancer risk among Hispanic women.

Cold Exposure Induces Intestinal Barrier Damage and Endoplasmic Reticulum Stress in the Colon via the SIRT1/Nrf2 Signaling Pathway

Ambient air temperature is a key factor affecting human health. Long-term exposure to a cold environment can cause various diseases, while the impact on the intestine, the organ which has the largest contact area with the external environment, cannot be ignored. In this study, we investigated the effect of chronic cold exposure on the colon and its preliminary mechanism of action. Mice were exposed to 4°C for 3 hours a day for 10 days. We found that cold exposure damaged the morphology and structure of the colon, destroyed the tight junctions of the colonic epithelial tissue, and promoted inflammation of the colon. At the same time, cold exposure also activated the unfolded protein response (UPR) in the colon and promoted apoptosis in intestinal epithelial cells. Chronic cold exposure induced oxidative stress in vivo, but also significantly enhanced the response of the Nrf2 pathway that promotes an anti-oxidant effect. Furthermore, we demonstrated that chronic cold exposure promoted p65 acetylation to aggravate the inflammatory response by inhibiting SIRT1. Similar results were observed following SIRT1 knock-down by shRNA in Caco-2 cells treated with Thapsigargin (Tg). Knock-down of SIRT1 promoted nuclear localization of Nrf2, and increased the level of Nrf2 acetylation. Taken together, our study indicates that cold exposure may aggravate endoplasmic reticulum stress and damage epithelial tight junctions in the colon by inhibiting SIRT1, which promotes nuclear localization of Nrf2 and induces an anti-oxidant response to maintain intestinal homeostasis. These findings suggest that SIRT1 is a potential target for regulating intestinal health under cold exposure conditions.

[Association between tea consumption and all-cause mortality in Chinese adults]

Objective: To investigate the association between tea consumption and the risk of all-cause and cause-specific mortality among Chinese adults. Methods: This study was based on China Kadoorie Biobank (CKB). Tea consumption information was self-reported by participants at baseline. Death was mainly identified by linkage to the death registry system. Cox proportional hazard regression models estimated HR and 95%CI. Results: With a median follow-up of 11.1 years, there were 34 661 deaths in 438 443 participants. Compared with those who never drink tea, all-cause mortality HR(95%CI) were 0.89(0.86-0.91) and 0.92(0.88-0.95) for non-daily tea drinkers and daily tea drinkers, respectively. A statistically significant difference was found in the association of tea consumption and the risk of all-cause mortality between men and women(interaction P<0.05). The protective effect was mainly seen in men. Compared with those who never drink tea, daily tea drinkers had a reduced risk of death from ischemic heart disease, ischemic stroke, hemorrhagic stroke, cancer, respiration diseases and other causes of death, and the corresponding HR(95%CI) were 0.83(0.76-0.92), 0.82(0.69-0.97), 0.86(0.78-0.94), 1.03(0.97-1.09), 1.00(0.87-1.16), 0.84(0.78-0.90). Among never smokers and non-excessive drinkers, there was no statistically significant association between daily tea drinking and the risk of death from cancer. While smokers and excessive drinkers had an increased risk of death from cancer (interaction P<0.001). Conclusions: Tea consumers had reduced risks of all-cause mortality and partial cause-specific mortality, but not for the risk of death from cancer. On the contrary, daily tea drinkers with smoking habits and excessive alcohol drinking had an increased risk of death from cancer.

Relations of Variety and Quantity of Dietary Proteins Intake from Different Sources with Mortality Risk: A Nationwide Population-Based Cohort

OBJECTIVES

The relations of variety and quantity of dietary proteins intake from different sources with mortality risk were still controversial. We aimed to examine the associations of variety and quantity of different sourced proteins with all-cause mortality risk in adults and older adults.

MATERIALS AND METHODS

17,310 participants (mean age was 44.0 [SD: 15.9] years and 51.0% were females) with utilizable data from the China Health and Nutrition Survey were included. Dietary intake was collected using three consecutive 24-h dietary recalls combined with a household food inventory. The variety score of protein sources was defined as the number of proteins consumed at the appropriate level, accounting for both types and quantity of proteins. The primary outcome was all-cause mortality.

RESULTS

Over a median follow-up of 9.0 years, 1324 (7.6%) death cases were reported. There were reversed J-shaped relationships of percentages energy from total protein, and protein from legume with all-cause mortality; U-shaped relationships of proteins from unprocessed red meat, processed red meat, poultry and whole grain with all-cause mortality; L-shaped relationships of proteins from egg and fish with all-cause mortality; and a reversed L-shaped relationship of protein from refined grain with all-cause mortality (all P values for nonlinearity < 0.001). Moreover, there was a significant inverse association between the variety score of protein sources with overall mortality risk (per score increment, HR, 0.69; 95%CI, 0.66-0.72).

CONCLUSIONS

Greater variety of proteins with appropriate quantity from different food sources was associated with significantly lower risk of mortality in Chinese adults and older adults.

Single-cell transcriptomics reveals the heterogeneity of the decidual endothelial cells that participate in labor onset

OBJECTIVE

To investigate the heterogeneity of decidual endothelial cells and their changes during delivery.

PATIENTS AND METHODS

Single-cell RNA sequencing was used to characterize the transcriptomes of decidual endothelial cells before and after the onset of labor.

RESULTS

Decidual endothelial cells (9748 cells) were divided into five subgroups with different functions according to differences in the transcriptome. The functions of cluster 5 were enriched in vascular development and response to growth factors. After the onset of labor, the activities of each cluster were different, including the interleukin 17 pathway and regulation of ERK1 and ERK2 cascade. The downregulated genes were related to scavenger receptor (cluster 5), which may reflect the process of endothelial activation. In terms of genetic changes, cluster 5 may be more actively involved in labor than the other clusters.

CONCLUSIONS

Peripartum decidual endothelial cells are heterogeneous and participate in labor to varying degrees. One of the five subtypes of endothelial cells may be more actively involved in labor onset. Our findings may enable the assessment of decidual endothelial cells and labor onset.

Communication skills of providers at primary healthcare facilities in rural China

INTRODUCTION

Effective provider-patient communication has been confirmed to improve diagnosis, treatment planning, health outcomes, patient satisfaction, and treatment compliance. Few studies have measured the effectiveness of communication between patients and rural providers in China. To fill this gap in the literature, the present study describes the communication skills of providers at primary healthcare facilities in rural China and investigates the provider- and facility-level factors underlying these communication skills.

METHODS

The standardised patients successfully completed 504 interactions across two tiers of China's rural health system and engaged with providers at village clinics and township health centres. We assessed providers' communication skills based on recorded interactions between the providers and the standardised patients using the SEGUE Framework, which contains the following five dimensions: 'Set the stage', 'Elicit information', 'Give information', 'Understand the patient's perspective', and 'End the encounter'.

RESULTS

The providers' overall average score was 50.6% on the SEGUE communication tasks. They did well in 'Set the stage' (54.4%) and 'Elicit information' (56.2%) but performed poorly in 'End the encounter' (24.5%) and 'Understand the patient's perspective' (44.0%). Female and younger providers scored 0.75 (P<0.05) and 0.04 (P<0.01) points higher than their male and older counterparts on total SEGUE score, respectively.

CONCLUSION

Providers in rural China had relatively poor communication skills overall, especially in terms of their demonstration of care for patients and inviting them to participate in the interaction. Gender and age were significantly associated with providers' level of communication skills in rural China.

Clostridium butyricum promotes intestinal motility by regulation of TLR2 in interstitial cells of Cajal

OBJECTIVE

Clostridium butyricum (C. butyricum) as a probiotic has been reported to have an important role in the pathogenesis of gastrointestinal diseases. However, the effects of C. butyricum on regulation of intestinal motility of ulcerative colitis (UC) remain unclear. Our study aimed to explore the cross-regulation effect of C. butyricum and toll-like receptor 2 (TLR-2) on UC.

MATERIALS AND METHODS

Interstitial cells of Cajal (ICCs) were treated by C. butyricum for 2 h, the mRNA and protein levels of TLR-2, IL-6, and IL-8 were detected by RT-qPCR and Western blot. Then, TLR2-specific small interfering RNA (si-TLR2) was transfected into ICCs, and the relative expressions of IL-6 and IL-8, SCF, cell viability, ghrelin, SP, and ET were measured by RT-qPCR, Western blot, CCK-8, and ELISA. Besides, the signal pathways of NF-κB and JNK were determined by Western blot.

RESULTS

C. butyricum significantly increased TLR2, IL-6, and IL-8 expressions in ICCs. However, TLR2 silence alleviated C. butyricum-induced IL-6 and IL-8 expressions. Moreover, TLR2 silence significantly inhibited C. butyricum-induced cell viability in ICCs. Additionally, C. butyricum significantly increased SCF expression and promoted the secretion of ghrelin and SP. However, a significant reduction in the levels of SCF, ghrelin, and SP was evident in the silence of TLR2 expression. Besides, TLR2 silence reduced C. butyricum-activation NF-κB and JNK signal pathways in ICCs.

CONCLUSIONS

These findings revealed that C. butyricum promoted intestinal motility by regulation of TLR2 in ICCs, which contributed to understand the molecular mechanisms of C. butyricum on UC.

Quercetin reduces atherosclerotic lesions by altering the gut microbiota and reducing atherogenic lipid metabolites

AIMS

Epidemiological studies have correlated cardiovascular disease and atherosclerosis with lifestyle factors such as sedentary behaviour and a high-calorie diet. Recent studies of pathogenesis have highlighted the significance of the intestinal microbiota and chronic inflammation with respect to both the onset and development of atherosclerosis. This study examined the hypothesis that the oral administration of quercetin to low-density lipoprotein receptor-null (Ldlr^-/- ) mice would improve gut health by altering the gut microbiota and controlling the levels of atherogenic lipid metabolites and proinflammatory mediators in the intestine and serum.

METHODS AND RESULTS

Mice were maintained on a high-fat diet with or without oral quercetin administration for 12 weeks. Quercetin treatment suppressed body weight gains and reduced the extent of atherosclerotic lesions in the aortic sinus. Reduced malondialdehyde and increased interleukin 6 levels further indicated the protective effect of quercetin against immune/inflammatory responses and oxidative stress. Furthermore, quercetin led to decreased intestinal levels of cholesterol, lysophosphatidic acids and atherogenic lysophosphatidylcholine (LPC 18:1) and an increased level of coprostanol. A phylum-level microbial analysis revealed that quercetin treatment reduced the abundance of Verrocomicrobia and increased microbiome diversity and the abundances of Actinobacteria, Cyanobacteria and Firmicutes. A Spearman analysis revealed negative correlations of Actinobacteria with intestinal and plasma LPC 18:1 and caecal cholesterol levels and of Firmicutes and Cyanobacteria with the plasma LPC 18:1 level.

CONCLUSIONS

This study demonstrated the ability of quercetin treatment to reduce lipid levels, as well as the areas of atherosclerotic lesions and sizes of plaques. This treatment also altered the composition of the gut microbiota and decreased the levels of atherogenic lipid metabolites.

SIGNIFICANCE AND IMPACT OF THE STUDY

Oral quercetin treatment may represent a new approach to mitigating the onset and development of atherosclerosis.

P2637Hypertension as a risk factor for all-cause and cardiovascular mortality in women compared with men: a systematic review and meta-analysis of prospective cohort studies

Background

What is more, some recent meta-analysis have demonstrated the sex difference between smoking, diabetes, and atrial fibrillation, and the risk of CVD mortality. Whether and to what extent the excess risk of cause-specific mortality from CVD death conferred by hypertension differs among women and men remain unclear.

Objective

A systematic review with meta-analysis was performed to explore whether and to what extent the excess risk of cause-specific mortality from CVD death conferred by hypertension differs among women and men.

Methods

PubMed and EMBASE was systematically searched for prospective cohort studies published from inception to 7 October 2017. Eligible studies reported sex-specific relative risk (RR) estimates for mortality of all-cause, CVD, coronary heart disease (CHD) and stroke associated with hypertension. The data were pooled using random effects models with inverse variance weighting, and estimates of the women-to-men ratio of RRs (RRR) for each outcomes were derived.

Results

Twenty-four studies with 2,939,659 participants were included in this meta-analysis. The RR for CHD mortality associated with hypertension compared with no hypertension was 2.24 (95% CI 2.03–2.46) in women and 1. 72 (1.61–1.84) in men. The multiple-adjusted RRR for CHD mortality was 22% greater in women with hypertension than in men with hypertension (RRR 1.22, 95% CI 1.03–1.44) with no significant heterogencity between studies (I2=45%, P=0.11, Figure 1). No evidence was observed sex difference in the relationship between hypertension and the mortality from all-cause, CVD and stroke. Furthermore, the subgroup analyses showed that the pooled RRR for all-cause mortality, CVD and stroke mortality were not significantly associated with cohort region, the duration of follow-up, mean age of participants and the publication year of studies.

Conclusions

Hypertension is a major risk factor for all-cause, CVD, CHD and stroke among women and men. Moreover, women with hypertension have more than a 22% higher risk of CHD mortality compared with men with hypertension. Further studies need to identify the biological and/or lifestyle mechanisms involved in sex differences driving these associations.

P5495Sex differences in marital status and risk of cardiovascular disease, cancer, and all-cause mortality: a systematic review and meta-analysis of 7,881,040 individuals

Background

Marital status has been identified as an important social factor associated with mortality. In current epidemiologic research, being unmarried was observed to be a suboptimal health status in the global population. The growing number of unmarried people has health implications, in light of evidence suggesting that it is associated with an increase in the incidence of various diseases and high mortality. Few attempts have been made to produce an overall estimate and sufficiently clarified of the sex difference between unmarried status and mortality risks, this is still a matter of debate.

Purpose

To ascertain whether sex differences exist in the relationship between marital status and cardiovascular disease (CVD), cancer, all-cause mortality in the general population and to explore the potential effect of age, location, the duration of follow-up and publication years on these outcomes.

Methods

A systematic search was performed in PubMed and EMBASE from inception through to April 2018 and review of references. We used the sex-specific RRs (relative risk) to derive the women-to-men ratio of RRs (RRR) and 95% CIs from each study. Subsequently, the RRR for each outcome was pooled with random effects meta-analysis weighted by the inverse of the variances of the log RRRs.

Results

Twenty-one studies with 7,881,040 individuals were included for meta-analysis. Compared with married individuals, being unmarried was significantly associated with all-cause mortality, cancer mortality, CVD mortality and coronary heart disease (CHD) mortality, especially for singles, for both sexes (Figure 1). However, the association with death from all-cause and CVD was significantly stronger in men. Compared with women who were divorced/separated, divorced/separated men had significantly higher risk of all-cause mortality, cancer mortality and CVD mortality. Moreover, never married men had 31% and 9% higher excess risk of stroke mortality and all-cause mortality, respectively, compared with never married women. No sex differences were observed concerning the impact of any unmarried status on CHD mortality.

Conclusions

Being unmarried (widowed, divorced/separated or never married) conferred higher excess risk of stroke mortality and all-cause mortality for men than women. Moreover, divorced/separated men had significantly higher risk of cancer mortality and CVD mortality. Further studies are warranted to clarify the biological, behavioral, and/or social mechanisms involved in sex differences driving these associations.