Alcohol sensitivity, alcohol use and hypertension in an older Chinese population: the Guangzhou Biobank Cohort Study

Associations of cognitive impairment and longitudinal change in cognitive function with the risk of fatal stroke in middle-aged to older Chinese

It is unclear whether cognitive impairment and the longitudinal change in cognition are associated with the risk of fatal stroke in aging populations. Based on the Guangzhou Biobank Cohort Study data a sum of 26,064 participants at baseline and all deaths caused by stroke in a mean follow-up of 14.3 years (standard deviation = 3.2) were included, and the Cox proportional hazard regression was used in this prospective cohort study. Cognitive impairment was respectively associated with an increased risk of fatal strokes (the adjusted hazard ratio (aHR) = 1.38, 95% CI1.16-1.64, P < 0.001) and fatal ischaemic stroke (aHR = 1.39, 95% CI1.10-1.77, P = 0.007), compared to median cognition; the Delayed Word Recall Test (DWRT) score was associated with a decreasing trend for the risk of fatal strokes in a restricted cubic spline analysis; the longitudinal DWRT score decline was associated with the increased risks of fatal strokes (aHR = 1.42, 95% CI 1.11-1.82, P = 0.006) and fatal haemorrhagic stroke (aHR = 1.75, 95% CI 1.10-2.78, P = 0.02), compared to the longitudinal DWRT score rise. In summary, cognitive impairment and the longitudinal decline in DWRT scores were associated with the increased risk of fatal strokes; early screening of cognitive function should be conducive to predictive intervention in fatal stroke among relatively healthy middle-aged to older populations.

Genetic loci, rs17817449 and rs6567160, known for obesity and the risk of stroke events among middle-aged and older Chinese people

BACKGROUND

Fat Mass and Obesity-Associated (FTO) and the Melanocortin-4 Receptor (MC4R) genes are strongly associated with obesity, an established risk factor for stroke. We aimed to assess the associations between rs17817449 at the FTO and rs6567160 at the MC4R and the risk of stroke events in middle-aged and older Chinese people.

MATERIALS AND METHODS

Study data were obtained from the Guangzhou Biobank Cohort Study; a total of 148 participants with a self-reported history of stroke and an equal volume of age- and sex-matched participants were selected as the cases and the controls in a case-control study; a total of 13,967 participants at the first follow-up and all participants with fatal stroke (up to April 2021) were included in a retrospective cohort study. Conditional logistic regression and the Cox proportional hazards regression analyses were used to assess the associations of the two genetic loci with the risk of stroke events.

RESULTS

After adjusting for age, sex, education, job, smoking, alcohol consumption, body mass index, physical activity, hypertension, diabetes, and dyslipidemia, rs17817449 and rs6567160 shared minor alleles G and C, respectively, in the case-control analyses. The genotypes GG+GT of rs17817449 at the FTO were significantly associated with a decreased risk of fatal stroke occurrence, with fatal all strokes having an adjusted hazard ratio (aHR) of 0.71 (95% confidence intervals (CI) 0.52-0.97, P = 0.04) and fatal ischemic stroke having an aHR of 0.64 (95% CI 0.41-1.00, P = 0.05), when the genotype TT was taken as a reference and a series of multiplicities were adjusted; the risk of fatal all strokes was lowered by dyslipidemia (aHR = 0.63, 95% CI 0.39-1.00, P = 0.05) and non-diabetes (aHR = 0.68, 95% CI 0.46-0.99, P = 0.049) in the retrospective cohort analyses. Significances were observed neither in the associations between rs6567160 and the risk of stroke events nor in an interaction between rs17817449 and rs6567160 in the two-stage analyses.

CONCLUSION

The G allele of rs17817449 at the FTO, not rs6567160 at the MC4R, was associated with a decreased risk of fatal stroke occurrence; its functional role in stroke should be explored in relatively healthy middle-aged to older Chinese people.

Association of alcohol use with memory decline in middle-aged and older Chinese: a longitudinal cohort study

BACKGROUND

Previous studies on associations of alcohol use with memory decline showed inconclusive results. We examined these associations using longitudinal data from the Guangzhou Biobank Cohort Study (GBCS) and explored whether these associations varied by sex and age group.

METHODS

Memory function was assessed by delayed 10-word recall test (DWRT) and immediate 10-word recall test (IWRT) at both baseline (2003-2008) and follow-up (2008-2012) examinations, expressed as the mean annual change and mean annual rate of change in scores. Memory cognitive impairment was defined by DWRT scores of less than 4. Multivariable linear regression models and restricted cubic spline were used for data analysis.

RESULTS

Of 14,827 participants without memory cognitive impairment at baseline, 90.2% were never or occasional drinkers, 5% moderate drinkers, 1.5% excessive drinkers, and 3.3% former drinkers. The mean (standard deviation) age was 60.6 (6.6) years old. During an average of 4.1 years follow-up, 1000 (6.7%) participants developed memory cognitive impairment. After adjusting for confounders, compared with never or occasional drinkers, moderate and excessive drinkers had significant decline in DWRT scores (β, 95% confidence interval (CI) = -0.04 (-0.08 to -0.01), and - 0.07 (-0.14 to 0.01), respectively), and IWRT scores (β, 95% CI = -0.10 (-0.19 to -0.01), and - 0.15 (-0.30 to 0.01), respectively) annually. With respect to the mean annual rate of change, moderate and excessive drinkers also showed greater decline in DWRT scores (β, 95% CI = -1.02% (-1.87% to -0.16%), and - 1.64% (-3.14% to -0.14%), respectively). The associations did not vary by sex and age group (all P values for interaction ≥ 0.10).

CONCLUSION

Compared to never or occasional alcohol use, moderate and excessive alcohol users had greater memory decline and the associations did not vary by sex and age group.

Alcohol and Metabolic-associated Fatty Liver Disease

The diagnosis of metabolic-associated fatty liver disease is based on the detection of liver steatosis together with the presence of metabolic dysfunction. According to this new definition, the diagnosis of metabolic-associated fatty liver disease is independent of the amount of alcohol consumed. Actually, alcohol and its metabolites have various effects on metabolic-associated abnormalities during the process of alcohol metabolism. Studies have shown improved metabolic function in light to moderate alcohol drinkers. There are several studies focusing on the role of light to moderate alcohol intake on metabolic dysfunction. However, the results from studies are diverse, and the conclusions are often controversial. This review systematically discusses the effects of alcohol consumption, focusing on light to moderate alcohol consumption, obesity, lipid and glucose metabolism, and blood pressure.

Association between alcohol consumption and hypertension in Chinese adults: Findings from the CHNS

OBJECTIVES

To obtain information about alcohol consumption (henceforth "drinking") among Chinese adults from 1991 to 2011, and to explore the association between drinking behavior and hypertension.

METHODS

According to the longitudinal data obtained in the China Health and Nutrition Survey (1991-2011), 50,013 records of 12,577 adults were selected by applying eligibility criteria. The chi-test was employed to explore the association between drinking and hypertension, by considering the frequency of drinking, daily alcohol intake, alcohol type, and the prevalence of hypertension. A multilevel logistic regression model was used to analyze the longitudinal association between drinking frequency and the prevalence of hypertension.

RESULTS

The prevalence of hypertension was higher in participants with a high drinking frequency than in those with a low drinking frequency among both males and females (p < 0.001). A step increase in daily alcohol intake was not associated with any obvious changes in the prevalence of hypertension in males, but the prevalence in each drinking group was higher than that in the nondrinking group, the prevalence of hypertension in females was lowest among those with a daily alcohol intake below 15 g. The types of alcohol consumed differed significantly between males and females (p < 0.001). Longitudinal analysis results showed that compared with the nondrinking group, drinking frequency ≤2 times/week was positively correlated with hypertension in both males (OR = 1.51, 95% CI = 1.26-1.82, p < 0.001) and females (OR = 1.67, 95% CI = 1.08-2.58, p < 0.05) after adjusting for covariates, meanwhile, the same positive correlation also occurred in males with drinking frequency >2 times/week (OR = 2.13, 95% CI = 1.77-2.56, p < 0.05), the risk of hypertension increased with the increase in drinking frequency.

CONCLUSIONS

Drinking can increase the prevalence of hypertension in Chinese males and females. From the analysis results of longitudinal data, drinking alcohol is still an important risk factor for hypertension among Chinese subjects, especially those who drink with high frequency.

Childhood secondhand smoke exposure and pregnancy loss in never smokers: the Guangzhou Biobank Cohort Study

OBJECTIVE

Studies of secondhand smoke (SHS) exposure especially childhood SHS exposure and pregnancy loss are limited. We used baseline data of the Guangzhou Biobank Cohort Study (GBCS) to examine the association of childhood SHS exposure with a history of pregnancy loss.

METHODS

Never smoking women aged 50 years or above in GBCS from 2003 to 2008 were included. Propensity score matching (PSM) was used to control for confounding. Negative binomial regression and logistic regression were used to examine the association of childhood SHS, assessed by number of smokers in childhood household and frequency of exposure, with past pregnancy loss.

RESULTS

Of 19 562 women, 56.7% (11 096) had SHS exposure during childhood. In negative binomial regression, after adjusting for age, education, past occupational dust exposure, past home fuel exposure, oral contraceptive, adulthood SHS exposure, age at first pregnancy and age at first menarche, compared to non-exposure, the incidence rate ratio of one more pregnancy loss was 1.20 (95% CI1.05 to 1.37) in those who lived with ≥2 smokers in the same household, and 1.14 (95% CI 1.04 to 1.25) in those exposed ≥5 times/week. After similar adjustment, logistic regression showed that the OR of pregnancy loss ≥2 times (versus 0 to 1 time) was 1.25 (95% CI 1.00 to 1.57) and 1.20 (95% CI 1.03 to 1.40) for high density (≥2 smokers in the same household) and frequency (≥5 times/week) of childhood exposure, respectively.

CONCLUSIONS

Childhood SHS exposure was associated with higher risks of pregnancy loss in middle-aged and older Chinese women.

Alcohol sensitivity, alcohol use and high-sensitivity C-reactive protein in older Chinese men: The Guangzhou Biobank Cohort Study

Compared to other ethnic groups Asians are more likely to be sensitive to alcohol, due to polymorphisms of alcohol-metabolizing enzymes. Although previous studies have found positive association between regular alcohol use and high-sensitivity C-reactive protein (HsCRP), whether this association is modified by alcohol sensitivity has not been clarified. We therefore sought to examined this potential effect modification in a cross-sectional community sample with high prevalence of alcohol sensitivity, using data from 2903 men aged ≥50years recruited during phase 1 of the Guangzhou Biobank Cohort Study. Information on alcohol consumption and sensitivity (facial flushing, palpitation or dizziness after drinking) was obtained by questionnaire and HsCRP was measured by an immunoturbidometric assay. Elevated HsCRP was defined as HsCRP level equal to or higher than 2.81 mg/L(median). Excessive alcohol use was defined as use of ≥210 g ethanol per week. After adjustment for age, educational level, occupation, smoking status, physical activity and history of cardiovascular disease, alcohol use was associated with HsCRP in a dose-response pattern. The risks of elevated HsCRP were higher in those who drank daily (odds ratio (OR) = 1.38 (1.10, 1.72)) or drank excessively (1.57 (1.22, 2.02)), and were even higher in alcohol users with alcohol sensitivity (1.82 (1.24, 2.65) for daily users and 2.34 (1.48, 3.71) for excessive users). Results of this study have showed an important role of alcohol sensitivity in modifying the association between alcohol use and HsCRP level. Reduction of alcohol use should be an important public heath target, particularly among populations with high prevalence of alcohol sensitivity.

Trends in hypertension prevalence, awareness, treatment, and control rates in Shandong Province of China

The authors retrospectively examined data from 3 surveys on hypertension according to the 2010 Chinese Guidelines for the Management of Hypertension. These surveys were conducted in 1991, 1999, and 2007, and included 85,371 individuals 18 years and older who were living in Shandong Province, China. Age-standardized prevalent hypertension increased from 15.6% in 1991 to 17.3% in 1999 and 32.7% in 2007 (both P<.0001). The ascending prevalence can be partially explained by increasing body weight. Among individuals with hypertension, awareness increased significantly from 27.8% in 1991 to 39.1% in 1999 and 49.2% in 2007. The proportion of pharmacologic treatment also considerably improved, with the estimate of 12.9%, 28.1%, and 43.3% in the 3 surveys, respectively. Hypertension control increased from 3.0% to 4.4% to 7.1% in the past 20 years. The upward trend in blood pressure control was mostly attributable to a rise among men and persons at middle age. This study suggests that the prevalence of hypertension increased in the Shandong population from 1991 to 2007. Although substantially improved, control rates were still unacceptably low. Comprehensive strategies are urgently required to put into practice for the management of hypertension in Shandong Province, China.

Association of alcohol consumption with lipid profile in hypertensive men

AIMS

Alcohol consumption is known to be closely related with alterations in blood lipid levels as well as in blood pressure. The objective of this study was to evaluate the association between alcohol consumption and blood lipid levels in hypertensive men.

METHODS

A cross-sectional study involving participants (n = 2014) aged 20-69 years from the Korea National Health and Nutrition Examination Survey, 1998-2009. Demographic characteristics, dietary intake and medical history were obtained from the participants by questionnaire, and lipid levels were determined by analysis of blood samples.

RESULTS

After adjusting for demographic and dietary factors, alcohol consumption was negatively associated with risk of low high-density lipoprotein cholesterol [HDL-C; odds ratio (OR): 0.29, 95% confidence interval (CI): 0.22-0.40 in heavy (≥30 g/day) drinkers; P for trend <0.001], whereas the risk of high triglycerides increased with increasing alcohol consumption (OR: 2.04, 95% CI: 1.53-2.72 in heavy drinkers; P for trend <0.001). However, the OR of high non-HDL-C and the ratio of high triglycerides to HDL-C did not change significantly with an increase in alcohol consumption.

CONCLUSION

These data suggest that alcohol consumption differentially affected lipid measures according to the amount of alcohol intake in hypertensive men.

The utility of collaborative biobanks for cardiovascular research

Differences between animal and human atherosclerosis have led to the requirement for clinical data, imaging information and biological material from large numbers of patients and healthy persons. Where such "biobanks" exist, they have been fruitful sources for genomewide association, diagnostic accuracy, ethnicity, and risk stratification cohort studies. In addition once established, they attract funding for future projects. Biobanks require a network of medical contributors, secure storage facilities, bioinformatics expertise, database managers, and ethical working practices to function optimally. There is the opportunity for collaboration between individual biobanks to further amplify the advantages afforded.

Alcohol consumption and aortic arch calcification in an older Chinese sample: the Guangzhou Biobank Cohort Study

OBJECTIVE

To examine the association between alcohol consumption and aortic arch calcification (AAC) in an older Chinese sample.

METHODS

In 27,844 older people aged 50-85, socioeconomic position and lifestyle factors were assessed by a questionnaire. The presence and severity of AAC were diagnosed from chest X-ray by two experienced radiologists.

RESULTS

In men, the risk for AAC increased significantly in frequent or excessive drinkers [adjusted odds ratio (OR)=1.36 (95% confidence interval (CI) 1.16-1.59) and 1.49 (1.21-1.83) for those who drank >5 times/week and those who drank excessively, respectively] (P for trend from 0.002 to 0.001). When AAC was analyzed as an outcome variable with 3 categories of severity, significant dose-response relations between the severity of AAC and alcohol consumption were observed, with those who drank frequently (>5/week) or excessively having more serious AAC (P for trend=0.03 and 0.02, respectively). No significant association was found in women as few drank excessively.

CONCLUSION

The presence and severity of AAC were associated with quantity or frequency of alcohol consumption in a dose-response pattern, suggesting that alcohol drinking, even when moderate, has no benefit for AAC. Excessive drinking increased the risk of AAC by 50% compared to never drinkers.

History of antihypertensive therapy influences the relationships of alcohol with blood pressure and pulse pressure in older men

BACKGROUND

Blood pressure is known to be higher in heavy drinkers than in nondrinkers. The aim of this study was to determine whether the alcohol-blood pressure relationship is modified by therapy for hypertension in the elderly.

METHODS

Men aged > or = 65 years (n = 1,396) with or without current history of antihypertensive therapy were divided into four groups by alcohol intake (non-, light (<22 g ethanol/day), heavy (> or = 22 and <44 g ethanol/day), and very heavy (> or = 44 g ethanol/day) drinkers). Blood pressure and pulse pressure were compared among the groups.

RESULTS

Systolic blood pressure and pulse pressure were significantly higher in subjects receiving antihypertensive therapy than in subjects not receiving antihypertensive therapy, whereas diastolic blood pressure was not different between the two groups. In multivariate analysis with adjustment for age, smoking history, and body mass index (BMI), systolic and diastolic blood pressure and pulse pressure in the group not receiving antihypertensive therapy were significantly higher in heavy and very heavy drinkers than in nondrinkers, whereas in the group receiving antihypertensive therapy, systolic and diastolic blood pressure and pulse pressure were not different between each drinker group and the nondrinker group.

CONCLUSIONS

Alcohol intake was associated with blood pressure and pulse pressure in older men not receiving therapy for hypertension but not in those receiving antihypertensive therapy. The indicated possibility that changes in drinking do not have a substantial impact on blood pressure among treated hypertensives should be examined in longitudinal studies and preferably in clinical trials.