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Chen J, Li X, Wang Y, Zhang C, Yang L, Zhao L, Zhu Q, Wang L, Zhou Y. Cognition of diet quality and dietary management in elderly patients with coronary and other atherosclerotic vascular disease in western China, a qualitative research study. BMC Geriatr 2024; 24:525. [PMID: 38886659 PMCID: PMC11184894 DOI: 10.1186/s12877-024-05058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 05/08/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Healthy eating is one of the most important nonpharmacologic treatments for patients with atherosclerosis(AS). However, it is unclear how elderly AS patients in western China perceive their dietary status and which type of nutritional assistance they would be willing to receive. Therefore, the primary purpose of this study was to understand the level of knowledge about current dietary habits and healthy eating habits among elderly AS patients in western China, and the secondary purpose was to identify acceptable nutritional assistance measures or pathways for those patients to help them manage disease progression. METHODS An implementation study approach was used to recruit elderly patients with AS-related diseases in western China for semistructured interviews. RESULTS 14 participants were included in the study, and the following three themes were identified from the interviews:(1) the diet with regional characteristics; (2) low nutrition-related health literacy; (3) complex attitudes towards nutritional assistance. Most participants had misconceptions about healthy eating, and the sources of their knowledge might not be trustworthy. Participants expressed a preference for personalized nutritional assistance, especially that provided by medical-nursing combined institutions. CONCLUSION Patients in western China need nutritional assistance for their regional dietary habits; therefore, healthy dietary patterns consistent with the regional culture are proposed to improve the prevailing lack of knowledge about healthy diets, improve the dietary structure of patients, and control the development of the disease.
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Affiliation(s)
- Jiamengying Chen
- Nursing School, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Xiaojie Li
- Nursing School, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Yun Wang
- Nursing School, Guizhou Medical University, Guiyang City, Guizhou Province, China
| | - Chunling Zhang
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Li Yang
- The Second Affiliated Hospital, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Lvheng Zhao
- Nursing School, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Qingqing Zhu
- Nursing School, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Li Wang
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou City, Jiangsu Province, China.
| | - Yixia Zhou
- Nursing School, Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China.
- Nursing School, Guizhou Medical University, Guiyang City, Guizhou Province, China.
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Zhang Z, Zhao L, Lu Y, Xiao Y, Zhou X. Insulin resistance assessed by estimated glucose disposal rate and risk of incident cardiovascular diseases among individuals without diabetes: findings from a nationwide, population based, prospective cohort study. Cardiovasc Diabetol 2024; 23:194. [PMID: 38844981 PMCID: PMC11157942 DOI: 10.1186/s12933-024-02256-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Recent studies have suggested that insulin resistance (IR) contributes to the development of cardiovascular diseases (CVD), and the estimated glucose disposal rate (eGDR) is considered to be a reliable surrogate marker of IR. However, most existing evidence stems from studies involving diabetic patients, potentially overstating the effects of eGDR on CVD. Therefore, the primary objective of this study is to examine the relationship of eGDR with incidence of CVD in non-diabetic participants. METHOD The current analysis included individuals from the China Health and Retirement Longitudinal Study (CHARLS) who were free of CVD and diabetes mellitus but had complete data on eGDR at baseline. The formula for calculating eGDR was as follows: eGDR (mg/kg/min) = 21.158 - (0.09 × WC) - (3.407 × hypertension) - (0.551 × HbA1c) [WC (cm), hypertension (yes = 1/no = 0), and HbA1c (%)]. The individuals were categorized into four subgroups according to the quartiles (Q) of eGDR. Crude incidence rate and hazard ratios (HRs) with 95% confidence intervals (CIs) were computed to investigate the association between eGDR and incident CVD, with the lowest quartile of eGDR (indicating the highest grade of insulin resistance) serving as the reference. Additionally, the multivariate adjusted restricted cubic spine (RCS) was employed to examine the dose-response relationship. RESULTS We included 5512 participants in this study, with a mean age of 58.2 ± 8.8 years, and 54.1% were female. Over a median follow-up duration of 79.4 months, 1213 incident CVD cases, including 927 heart disease and 391 stroke, were recorded. The RCS curves demonstrated a significant and linear relationship between eGDR and all outcomes (all P for non-linearity > 0.05). After multivariate adjustment, the lower eGDR levels were founded to be significantly associated with a higher risk of CVD. Compared with participants with Q1 of eGDR, the HRs (95% CIs) for those with Q2 - 4 were 0.88 (0.76 - 1.02), 0.69 (0.58 - 0.82), and 0.66 (0.56 - 0.79). When assessed as a continuous variable, per 1.0-SD increase in eGDR was associated a 17% (HR: 0.83, 95% CI: 0.78 - 0.89) lower risk of CVD, with the subgroup analyses indicating that smoking status modified the association (P for interaction = 0.012). Moreover, the mediation analysis revealed that obesity partly mediated the association. Additionally, incorporating eGDR into the basic model considerably improve the predictive ability for CVD. CONCLUSION A lower level of eGDR was found to be associated with increased risk of incident CVD among non-diabetic participants. This suggests that eGDR may serve as a promising and preferable predictor and intervention target for CVD.
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Affiliation(s)
- Zenglei Zhang
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, 100037, Xicheng DistrictBeijing, China
| | - Lin Zhao
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, 100037, Xicheng DistrictBeijing, China
| | - Yiting Lu
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, 100037, Xicheng DistrictBeijing, China
| | - Yan Xiao
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, 100037, Xicheng DistrictBeijing, China.
| | - Xianliang Zhou
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, 100037, Xicheng DistrictBeijing, China.
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Gupta R, Gaur K, Ahuja S, Anjana RM. Recent studies on hypertension prevalence and control in India 2023. Hypertens Res 2024; 47:1445-1456. [PMID: 38379011 DOI: 10.1038/s41440-024-01585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 02/22/2024]
Abstract
Hypertension is the most important chronic disease risk factor in India. Recent epidemiological studies have reported that hypertension is increasing in India with a more rapid increase in rural and young populations. Fifth National Family Health Survey (NFHS-5) and Indian Council of Medical Research-INDIAB surveys have reported that there are substantial geographic variations in hypertension prevalence with greater prevalence in more developed states and districts of the country. There is a high prevalence of young-age hypertension, especially in the less developed states. The incidence of adverse events from hypertension-related cardiovascular disease is significantly greater in India than in more developed countries. A low level of hypertension awareness, treatment, and control, especially in rural and underserved urban populations is an important finding. In this narrative review, we highlight recent nationwide studies and unique features of hypertension in India and suggest strategies for better hypertension management and control.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology & Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, India.
- Research Board, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India.
| | - Kiran Gaur
- Department of Statistics, Mathematics and Computer Science, Government SKN Agriculture University, Jobner, Jaipur, India
| | - Shiva Ahuja
- Department of Orthodontics, Jaipur Dental College, Jaipur, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Research Centre, Chennai, India
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Zhou S, Liu L, Ye B, Xu Y, You Y, Zhu S, Ju J, Yang J, Li W, Xia M, Liu Y. Gut microbial metabolism is linked to variations in circulating non-high density lipoprotein cholesterol. EBioMedicine 2024; 104:105150. [PMID: 38728837 PMCID: PMC11090025 DOI: 10.1016/j.ebiom.2024.105150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Non-high-density lipoprotein cholesterol (non-HDL-c) was a strong risk factor for incident cardiovascular diseases and proved to be a better target of lipid-lowering therapies. Recently, gut microbiota has been implicated in the regulation of host metabolism. However, its causal role in the variation of non-HDL-c remains unclear. METHODS Microbial species and metabolic capacities were assessed with fecal metagenomics, and their associations with non-HDL-c were evaluated by Spearman correlation, followed by LASSO and linear regression adjusted for established cardiovascular risk factors. Moreover, integrative analysis with plasma metabolomics were performed to determine the key molecules linking microbial metabolism and variation of non-HDL-c. Furthermore, bi-directional mendelian randomization analysis was performed to determine the potential causal associations of selected species and metabolites with non-HDL-c. FINDINGS Decreased Eubacterium rectale but increased Clostridium sp CAG_299 were causally linked to a higher level of non-HDL-c. A total of 16 microbial capacities were found to be independently associated with non-HDL-c after correcting for age, sex, demographics, lifestyles and comorbidities, with the strongest association observed for tricarboxylic acid (TCA) cycle. Furthermore, decreased 3-indolepropionic acid and N-methyltryptamine, resulting from suppressed capacities for microbial reductive TCA cycle, functioned as major microbial effectors to the elevation of circulating non-HDL-c. INTERPRETATION Overall, our findings provided insight into the causal effects of gut microbes on non-HDL-c and uncovered a novel link between non-HDL-c and microbial metabolism, highlighting the possibility of regulating non-HDL-c by microbiota-modifying interventions. FUNDING A full list of funding bodies can be found in the Sources of funding section.
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Affiliation(s)
- Shiyi Zhou
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Ludi Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Bingqi Ye
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Yingxi Xu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Yi You
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Shanshan Zhu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Jingmeng Ju
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Jialu Yang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Wenkang Li
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Min Xia
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, PR China.
| | - Yan Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, PR China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, PR China.
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Li Y, Wang C, Feng Z, Tian L, Yao S, Wang M, Zhao M, Lan L, Xue H. Premature coronary heart disease complicated with hypertension in hospitalized patients: Incidence, risk factors, cardiovascular-related comorbidities and prognosis, 2008-2018. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200253. [PMID: 38496330 PMCID: PMC10943034 DOI: 10.1016/j.ijcrp.2024.200253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/25/2024] [Indexed: 03/19/2024]
Abstract
Background The clinical characteristics and risk factors of all-cause mortality in young hospitalized patients with comorbid coronary heart disease and hypertension (CAD + HT) are not well-characterized. Method A total of 2288 hospitalized CAD patients (age<45 years) with or without hypertension in the Chinese PLA General Hospital from August 5, 2008 to June 22, 2018 were conducted. The risk factors of all-cause mortality were estimated in young CAD + HT patients by COX models. Results The overall prevalence of hypertension in young CAD patients was 50.83% (n = 1163). CAD + HT patients had older age, higher heart rate, BMI, uric acid, triglyceride and lower level of eGFR and HDL-C than CAD patients (P < 0.05). The proportion of cardiovascular-related comorbidities (including obesity, diabetes mellitus, hyperuricemia and chronic kidney disease [CKD]) in the CAD + HT group was significantly higher than that in CAD group (P < 0.0001). The risk of all-cause mortality was higher in CAD + HT patients, although after adjusting for all covariates, there was no significant difference between the two groups. Furthermore, CKD (HR, 3.662; 95% CI, 1.545-8.682) and heart failure (HF) (HR, 3.136; 95%CI, 1.276-7.703) were associated with an increased risk of all-cause mortality and RAASi (HR, 0.378; 95%CI, 0.174-0.819) had a beneficial impact in CAD + HT patients. Conclusions Hypertension was highly prevalent in young CAD patients. Young CAD + HT patients had more cardiovascular metabolic risk factors, more cardiovascular-related comorbidities and higher risk of all-cause mortality. CKD and HF were the risk factors, while RAASi was a protective factor, of all-cause mortality in CAD + HT patients.
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Affiliation(s)
- Yanjie Li
- School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Chi Wang
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Zekun Feng
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Lu Tian
- School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Siyu Yao
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Miao Wang
- School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Maoxiang Zhao
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Lihua Lan
- School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Hao Xue
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
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Zheng C, Cai A, Wang X, Qiu J, Song Q, Gu R, Cao X, Tian Y, Hu Z, Fonarow GC, Lip GY, Wang Z, Feng Y. Prognostic implications of heart failure stages among Chinese community populations: insight from a nationwide population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101072. [PMID: 38706523 PMCID: PMC11067477 DOI: 10.1016/j.lanwpc.2024.101072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
Background In light of high burden of heart failure (HF) in China, studies of prognostic implication of HF stages are important. We aimed to evaluate the relationship between HF stages and mortality risk in Chinese community populations. Methods Nationwide representative populations aged ≥35 years (n = 23,284, mean age 56.9 years, women 53.2%) were enrolled from 2012 to 2016. According to the international HF guidelines, participants were divided into stage A, B and C, and those who did not qualify these stages were categorized as apparently-healthy group. Association between HF stages and all-cause, cardiovascular [CV] and non-CV death was evaluated using multivariable-adjusted Cox proportional regression analysis. Findings During a median follow-up of 4.7 years (109,902.8 person-years), 1314 deaths occurred. Age-adjusted incidence rate of all-cause death was 5.3 in apparently-healthy, 7.8 in stage A, 8.6 in stage B and 24.6 in stage C groups per 1000 person-years. In reference to apparently-healthy group, adjusted hazard ratio for all-cause death was 1.90 (95% CI: 1.47-2.45), 2.43 (95% CI: 1.89-3.13) and 6.40 (95% CI: 4.56-8.99) for stage A, B and C. Advancing HF stages were associated with increasing risks for all-cause, CV and non-CV death (P-trend <0.05). For all-cause death, population attributable fraction due to stage A, B and C were 21.2%, 33.4% and 4.9%, accounting for 1,933,385, 3,045,993 and 446,867 deaths in China in 2018. Interpretation Advancing HF stages were associated with increasing risk mortality. Development and implementation of early screening and targeted interventions are urgently needed to reduce HF burdens in China. Funding This work was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (grant 2017-I2M-1-004), the Projects in the Chinese National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (No.: 2011BAI11B01), and the Project Entrusted by the National Health Commission of the People's Republic of China (NHC2020-609).
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Affiliation(s)
- Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Jiayuan Qiu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, 201701, China
| | - Qingjie Song
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, 201701, China
| | - Runqing Gu
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Xue Cao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Yixin Tian
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Zhen Hu
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Gregg C. Fonarow
- Division of Cardiology, Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Yingqing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
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Li M, Li Y, Liu Z, Hystad P, Rangarajan S, Tse LA, Lear SA, Ma Y, Chen M, Han G, Li R, Yusuf S, Liu L, Hu B, Li W. Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study. ENVIRONMENT INTERNATIONAL 2024; 187:108627. [PMID: 38636273 DOI: 10.1016/j.envint.2024.108627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China). METHODS The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes. RESULTS Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants. CONCLUSION Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.
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Affiliation(s)
- Mengya Li
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China
| | - Yang Li
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China; Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhiguang Liu
- Clinical Trial Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Yuanting Ma
- Dongguan Street Community Health Service Center, Xining, Qinghai Province, China
| | - Mengxin Chen
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China
| | - Guoliang Han
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China
| | - Ruotong Li
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lisheng Liu
- Beijing Hypertension League Institute, Beijing, China.
| | - Bo Hu
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China.
| | - Wei Li
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China.
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Yang X, Chen S, Song H, Shu R, Wang J, Wang G, Liu P, Li M, Wu L, Li N, Cui L, Wu S. Association between cardiac conduction block and cardiovascular disease and all-cause mortality: The kailuan study. Int J Cardiol 2024; 399:131666. [PMID: 38141733 DOI: 10.1016/j.ijcard.2023.131666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Although bundle branch block and atrioventricular block are recognized to be association with cardiovascular disease (CVD) and mortality, the relationship between cardiac conduction block (CCB) and both CVD and all-cause mortality has yet to be explored. AIMS To explore the relationship between CCB and CVD and all-cause mortality. METHODS AND RESULTS We included 145,805 subjects (mean age 49.7 years, 81.2% males) from the kailuan study. CCB was diagnosed through a 12‑lead electrocardiograph (ECG). Mortality and CVD events were ascertained through multiple sources, including a municipal social insurance institution, hospital records, death certificates, and regular active follow-ups. After a mean follow-up of 12.5 years, 18,301 cases developed all-cause mortality. After excluding 4443 subjects with CVD presence at baseline, 13,208 cases of CVD occurred among the 141,362 study subjects during follow-up. Compared with non-CCB group, the cumulative incidence of CVD and all-cause mortality for CCB group was 18.38% VS 12.14% and 33.45% VS 14.18%, respectively. The multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) with CCB group were 1.25(1.17-1.34) for CVD, and 1.31(1.25-1.38) for all-cause mortality. Additionally, there were generally stronger associations for CCB with all-cause mortality and CVD in younger participants compared with their older counterparts (Ps-interaction <0.001). CONCLUSION CCB can increase the risk of CVD and all-cause mortality in the general population. Our findings highlight the importance of strategies for preventing CCB to reduce the risk of CVD and mortality.
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Affiliation(s)
- Xuemei Yang
- Department of Rheumatic Disease, Kailuan General Hospital, Tangshan, Hebei, China; Graduate school, North China University of Science and Technology, Tangshan, Hebei, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Haicheng Song
- Department of Rheumatic Disease, Kailuan General Hospital, Tangshan, Hebei, China
| | - Rong Shu
- Department of Rheumatic Disease, Kailuan General Hospital, Tangshan, Hebei, China
| | - Jierui Wang
- Department of Rheumatic Disease, Kailuan General Hospital, Tangshan, Hebei, China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Peipei Liu
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Man Li
- Graduate school, North China University of Science and Technology, Tangshan, Hebei, China
| | - Lili Wu
- Department of Cardiology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Na Li
- Department of Rheumatic Disease, Kailuan General Hospital, Tangshan, Hebei, China
| | - Liufu Cui
- Department of Rheumatic Disease, Kailuan General Hospital, Tangshan, Hebei, China.
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China.
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9
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Guo Z, Wu Q, Wang X, Dai Y, Ma Y, Qiu Y, Zhang Y, Wang X, Jin J. Effects of message framing and risk perception on health communication for optimum cardiovascular disease primary prevention: a protocol for a multicenter randomized controlled study. Front Public Health 2024; 12:1308745. [PMID: 38550324 PMCID: PMC10972929 DOI: 10.3389/fpubh.2024.1308745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/04/2024] [Indexed: 04/02/2024] Open
Abstract
Background Although several guidelines for cardiovascular disease (CVD) management have highlighted the significance of primary prevention, the execution and adherence to lifestyle modifications and preventive medication interventions are insufficient in everyday clinical practice. The utilization of effective risk communication can assist individuals in shaping their perception of CVD risk, motivating them to make lifestyle changes, and increasing their willingness to engage with preventive medication, ultimately reducing their CVD risks and potential future events. However, there is limited evidence available regarding the optimal format and content of CVD risk communication. Objective The pilot study aims to elucidate the most effective risk communication strategy, utilizing message framing (gain-framed, loss-framed, or no-framed), for distinct subgroups of risk perception (under-perceived, over-perceived, and correctly-perceived CVD risk) through a multi-center randomized controlled trial design. Methods A multi-center 3 × 3 factorial, observer-blinded experimental design was conducted. The participants will be assigned into three message-framing arms randomly in a 1:1:1 ratio and will receive an 8-week intervention online. Participants are aged 20-80 years old and have a 10-year risk of absolute CVD risk of at least 5% (moderate risk or above). We plan to enroll 240 participants based on the sample calculation. The primary outcome is the CVD prevention behaviors and CVD absolute risk value. Data collection will occur at baseline, post-intervention, and 3-month follow-up. Discussion This experimental study will expect to determine the optimal matching strategy between risk perception subgroups and risk information format, and it has the potential to offer health providers in community or clinic settings a dependable and efficient health communication information template for conducting CVD risk management.Clinical trial registration: https://www.chictr.org.cn/bin/project/edit?pid=207811, ChiCTR2300076337.
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Affiliation(s)
- Zhiting Guo
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Qunhua Wu
- Referral Office, The People’s No.3 Hospital of Hangzhou Xiaoshan, Hangzhou, China
| | - Xiaomei Wang
- School of Media, Hangzhou City University, Hangzhou, China
| | - Yuehua Dai
- Office of Chronic Disease Management, Nanxing Community Health Service Center, Hangzhou, China
| | - Yajun Ma
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - YunJing Qiu
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Xuyang Wang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
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10
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Qin M, Wu Y, Fang X, Pan C, Zhong S. Polygenic risk score predicts all-cause death in East Asian patients with prior coronary artery disease. Front Cardiovasc Med 2024; 11:1296415. [PMID: 38414927 PMCID: PMC10896892 DOI: 10.3389/fcvm.2024.1296415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/31/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Coronary artery disease (CAD) is a highly heritable and multifactorial disease. Numerous genome-wide association studies (GWAS) facilitated the construction of polygenic risk scores (PRS) for predicting future incidence of CAD, however, exclusively in European populations. Furthermore, identifying CAD patients with elevated risks of all-cause death presents a critical challenge in secondary prevention, which will contribute largely to reducing the burden for public healthcare. Methods We recruited a cohort of 1,776 Chinese CAD patients and performed medical follow-up for up to 11 years. A pruning and thresholding method was used to calculate PRS of CAD and its 14 risk factors. Their correlations with all-cause death were computed via Cox regression. Results and discussion We found that the PRS for CAD and its seven risk factors, namely myocardial infarction, ischemic stroke, angina, heart failure, low-density lipoprotein cholesterol, total cholesterol and C-reaction protein, were significantly associated with death (P ≤ 0.05), whereas the PRS of body mass index displayed moderate association (P < 0.1). Elastic-net Cox regression with 5-fold cross-validation was used to integrate these nine PRS models into a meta score, metaPRS, which performed well in stratifying patients at different risks for death (P < 0.0001). Combining metaPRS with clinical risk factors further increased the discerning power and a 4% increase in sensitivity. The metaPRS generated from the genetic susceptibility to CAD and its risk factors can well stratify CAD patients by their risks of death. Integrating metaPRS and clinical risk factors may contribute to identifying patients at higher risk of poor prognosis.
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Affiliation(s)
- Min Qin
- School of Medicine, South China University of Technology, Guangzhou, China
- Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yonglin Wu
- Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Center for Intelligent Medicine Research, Greater Bay Area Institute of Precision Medicine (Guangzhou), School of Life Sciences, Fudan University, Guangzhou, China
| | - Xianhong Fang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Cuiping Pan
- Center for Intelligent Medicine Research, Greater Bay Area Institute of Precision Medicine (Guangzhou), School of Life Sciences, Fudan University, Guangzhou, China
- Center for Evolutionary Biology, Fudan University, Shanghai, China
| | - Shilong Zhong
- School of Medicine, South China University of Technology, Guangzhou, China
- Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
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11
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Islam MM, Oyarzun-Gonzalez X, Bose-Brill S, Donneyong MM. Supplemental Nutrition Assistance Program and Adherence to Antihypertensive Medications. JAMA Netw Open 2024; 7:e2356619. [PMID: 38393731 PMCID: PMC10891466 DOI: 10.1001/jamanetworkopen.2023.56619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/22/2023] [Indexed: 02/25/2024] Open
Abstract
Importance Nonadherence to antihypertensive medications is associated with uncontrolled blood pressure, higher mortality rates, and increased health care costs, and food insecurity is one of the modifiable medication nonadherence risk factors. The Supplemental Nutrition Assistance Program (SNAP), a social intervention program for addressing food insecurity, may help improve adherence to antihypertensive medications. Objective To evaluate whether receipt of SNAP benefits can modify the consequences of food insecurity on nonadherence to antihypertensive medications. Design, Setting, and Participants A retrospective cohort study design was used to assemble a cohort of antihypertensive medication users from the linked Medical Expenditure Panel Survey (MEPS)-National Health Interview Survey (NHIS) dataset for 2016 to 2017. The MEPS is a national longitudinal survey on verified self-reported prescribed medication use and health care access measures, and the NHIS is an annual cross-sectional survey of US households that collects comprehensive health information, health behavior, and sociodemographic data, including receipt of SNAP benefits. Receipt of SNAP benefits in the past 12 months and food insecurity status in the past 30 days were assessed through standard questionnaires during the study period. Data analysis was performed from March to December 2021. Exposure Status of SNAP benefit receipt. Main Outcomes and Measures The main outcome, nonadherence to antihypertensive medication refill adherence (MRA), was defined using the MEPS data as the total days' supply divided by 365 days for each antihypertensive medication class. Patients were considered nonadherent if their overall MRA was less than 80%. Food insecurity status in the 30 days prior to the survey was modeled as the effect modifier. Inverse probability of treatment (IPT) weighting was used to control for measured confounding effects of baseline covariates. A probit model was used, weighted by the product of the computed IPT weights and MEPS weights, to estimate the population average treatment effects (PATEs) of SNAP benefit receipt on nonadherence. A stratified analysis approach was used to assess for potential effect modification by food insecurity status. Results This analysis involved 6692 antihypertensive medication users, of whom 1203 (12.8%) reported receiving SNAP benefits and 1338 (14.8%) were considered as food insecure. The mean (SD) age was 63.0 (13.3) years; 3632 (51.3%) of the participants were women and 3060 (45.7%) were men. Although SNAP was not associated with nonadherence to antihypertensive medications in the overall population, it was associated with a 13.6-percentage point reduction in nonadherence (PATE, -13.6 [95% CI, -25.0 to -2.3]) among the food-insecure subgroup but not among their food-secure counterparts. Conclusions and Relevance This analysis of a national observational dataset suggests that patients with hypertension who receive SNAP benefits may be less likely to become nonadherent to antihypertensive medication, especially if they are experiencing food insecurity. Further examination of the role of SNAP as a potential intervention for preventing nonadherence to antihypertensive medications through prospectively designed interventional studies or natural experiment study designs is needed.
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Affiliation(s)
- Md. Mohaimenul Islam
- Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus
| | - Ximena Oyarzun-Gonzalez
- Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Macarius M. Donneyong
- Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus
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12
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Bao H, Wang X, Zhou H, Zhou W, Liao F, Wei F, Yang S, Luo Z, Li W. PCSK9 regulates myofibroblast transformation through the JAK2/STAT3 pathway to regulate fibrosis after myocardial infarction. Biochem Pharmacol 2024; 220:115996. [PMID: 38154546 DOI: 10.1016/j.bcp.2023.115996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
Cardiac fibrosis is pivotal in the progression of numerous cardiovascular diseases. This phenomenon is hallmarked by an excessive deposition of ECM protein secreted by myofibroblasts, leading to increased myocardial stiffness. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease that belongs to the proprotein-converting enzyme family. It has emerged as a viable therapeutic target for reducing plasma low-density lipoprotein cholesterol. However, the exact mechanism via which PCSK9 impacts cardiac fibrosis remains unclear. In the present research, an increase in circulating PCSK9 protein levels was observed in individuals with myocardial infarction and rat models of myocardial infarction. Moreover, the inhibition of circulating PCSK9 in rats was found to reduce post-infarction fibrosis. In vitro experiments further demonstrated that overexpression of PCSK9 or stimulation by extracellular PCSK9 recombinant protein enhanced the transformation of cardiac fibroblasts to myofibroblasts. This process also elevated collagen Ⅰ, and Ⅲ, as well as α-SMA protein levels. However, these effects were countered when co-incubated with the STAT3 inhibitor S3I-201. This study suggests that PCSK9 may function as a novel regulator of myocardial fibrosis, primarily via the JAK2/STAT3 pathway.
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Affiliation(s)
- Hailong Bao
- Department of Cardiovascular Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China; Department of Cardiovascular Medicine, Gui Qian International General Hospital, Guiyang 550018, Guizhou, China
| | - Xu Wang
- Department of Cardiovascular Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China; The Key Laboratory of Myocardial Remodeling Research, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Haiyan Zhou
- Department of Cardiovascular Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China; The Key Laboratory of Myocardial Remodeling Research, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Wei Zhou
- Department of Cardiovascular Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China; The Key Laboratory of Myocardial Remodeling Research, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Fujun Liao
- Department of Cardiovascular Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China; The Key Laboratory of Myocardial Remodeling Research, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Fang Wei
- Department of Cardiovascular Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China; The Key Laboratory of Myocardial Remodeling Research, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Shiyu Yang
- Department of Cardiovascular Medicine, Gui Qian International General Hospital, Guiyang 550018, Guizhou, China
| | - Zhenhua Luo
- Department of Central Lab, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou, China.
| | - Wei Li
- Department of Cardiovascular Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China; The Key Laboratory of Myocardial Remodeling Research, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China.
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13
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Li X, Dehghan M, Tse LA, Lang X, Rangarajan S, Liu W, Hu B, Yusuf S, Wang C, Li W. Associations of dietary copper intake with cardiovascular disease and mortality: findings from the Chinese Perspective Urban and Rural Epidemiology (PURE-China) Study. BMC Public Health 2023; 23:2525. [PMID: 38110915 PMCID: PMC10726617 DOI: 10.1186/s12889-023-17441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Previous in vitro and animal experiments have shown that copper plays an important role in cardiovascular health. Dietary copper is the main source of copper in the human body and the association between dietary copper and cardiovascular disease remains unclear. Our study aimed to investigate the associations of dietary copper intake with the risk of major cardiovascular disease incidence, cardiovascular disease mortality, and all-cause mortality in Chinese adults. METHODS Our study is based on Prospective Urban Rural Epidemiology China (PURE-China), a large prospective cohort study of 47 931 individuals aged 35-70 years from 12 provinces in China. Dietary intake was recorded using a validated semi-quantitative food frequency questionnaire designed specifically for the Chinese population. The daily intake of copper was obtained by multiplying the daily food intake with the nutrient content provided in the Chinese Food Composition Table (2002). Cox frailty proportional hazards models were developed to evaluate the association between dietary copper intake with mortality, major cardiovascular disease events, and their composite. RESULTS A total of 45 101 participants (mean age: 51.1 ± 9.7 years old) with complete information were included in the current study. The mean dietary copper intake was 2.6 ± 1.1 mg/d. During the 482 833 person-years of follow-up, 2 644(5.9%) participants died, 4 012(8.9%) developed new cardiovascular diseases, and 5 608(12.4%) participants experienced the composite endpoint. Compared with those in the first and second quartile of dietary copper intake, individuals in the third and fourth quantile had higher risk of composite outcomes, all-cause death, cardiovascular disease death, major cardiovascular disease and stroke occurrences. The associations remained similar in the subgroup and sensitivity analyses. CONCLUSIONS Our findings demonstrated that excessive dietary copper intake was associated with higher risks of death and cardiovascular diseases in Chinese adults. Further studies in populations with different dietary characteristics are needed to obtain dose-response relationships and to refine global dietary recommendations.
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Affiliation(s)
- Xiaocong Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Mahshid Dehghan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xinyue Lang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Weida Liu
- State Key Laboratory for Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Chuangshi Wang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Wei Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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14
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Xu Z, Li X, Ding L, Zhang Z, Sun Y. The dietary inflammatory index and new-onset hypertension in Chinese adults: a nationwide cohort study. Food Funct 2023; 14:10759-10769. [PMID: 37975169 DOI: 10.1039/d3fo03767c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Purpose: The development of hypertension is shown to be triggered by chronic low-grade inflammation. The dietary inflammatory index (DII) is a parameter for assessing the potential of a diet to cause inflammation. The prospective association between the DII and new-onset hypertension in Chinese adults remains unclear. Materials and methods: The nationwide cohort study included 10694 participants from 7 rounds of the China Health and Nutrition Survey. Dietary nutrient intake data were collected by 3-day 24 h dietary recalls and used to calculate the DII. The time-dependent Cox regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for studying the risk of new-onset hypertension, and stratified analyses were used to examine factors that may modify the association. Restricted cubic spline (RCS) regression was used to examine the non-linear relationship between the DII and new-onset hypertension. The relationship between the DII and physical activity was analyzed with the time-dependent Cox regression model. Results: The highest quartile of the DII had a significantly higher risk of new-onset hypertension compared to the lowest quartile (adjusted HR, 1.13; 95% CI, 1.02, 1.24). RCS regression results showed that the risk of new-onset hypertension increased significantly after the DII above 1.09 (P for non-linearity <0.001). The interaction results showed that the DII may play a better role (P < 0.05) in the female, age < 45 years, baseline SBP < 130 mmHg, DBP < 80 mmHg, BMI < 24 kg m-2 and moderate/heavy physical activity level subgroup. Stratified analysis results showed that the baseline SBP, DBP, obesity, and physical activity level modified the association between the DII and hypertension (P for interaction < 0.05). Conclusion: Reducing the inflammatory potential of the diet is an effective strategy to prevent hypertension in Chinese adults.
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Affiliation(s)
- Ze Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao 266071, China.
| | - Xue Li
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Li Ding
- Qingdao West Coast New District Health Bureau, Huangdao District, Qingdao 266000, China
| | - Zhaofeng Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing 100191, China.
- Key Laboratory of Food Safety Toxicology Research and Evaluation, Beijing 100191, China
| | - Yongye Sun
- Department of Nutrition and Food Hygiene, School of Public Health, Qingdao University, Qingdao 266071, China.
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15
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Zhu Y, Wang Y, Shrikant B, Tse LA, Zhao Y, Liu Z, Wang C, Xiang Q, Rangarajan S, Li S, Liu W, Li M, Han A, Tang J, Hu B, Yusuf S, Li W. Socioeconomic disparity in mortality and the burden of cardiovascular disease: analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study. Lancet Public Health 2023; 8:e968-e977. [PMID: 38000890 DOI: 10.1016/s2468-2667(23)00244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Although socioeconomic inequality in cardiovascular health has long been a public health focus, the differences in cardiovascular-disease burden and mortality between people with different socioeconomic statuses has yet to be adequately addressed. We aimed to assess the effects of socioeconomic status, measured via three socioeconomic-status indicators (ie, education, occupation, and household wealth and a composite socioeconomic-status disparity index, on mortality and cardiovascular-disease burden (ie, incidence, mortality, and admission to hospital) in China. METHODS For this analysis, we used data from the Prospective Urban Rural Epidemiology (PURE)-China cohort study, which enrolled adults aged 35-70 years from 115 urban and rural areas in 12 provinces in China between Jan 1, 2005, and Dec 31, 2009. Final follow-up was on Aug 30, 2021. Indicators of socioeconomic status were education, occupation, and household wealth; these individual indicators were also used to create an integrated socioeconomic-status index via latent class analysis. Standard questionnaires administered by trained researchers were used to obtain baseline data and were supplemeted by physical measurements. The primary outcomes were all-cause mortality, cardiovascular-disease mortality, non-cardiovascular-disease mortality, major cardiovascular disease, and cardiovascular-disease admission to hospital. Hazard ratios (HRs) and average marginal effects were used to assess the association between the primary outcomes and socioeconomic status. FINDINGS Of 47 931 participants enrolled in the PURE-China study, 47 278 (98·6%) had complete information on sex and follow-up. After excluding 1189 (2·5%) participants with missing data on education, household wealth, and occupation at baseline, 46 089 participants were included in this analysis. Median follow-up was 11·9 years (IQR 9·5-12·6); 26 860 (58·3%) of 46 089 participants were female and 19 229 (41·7%) were male. Having no or primary education, unskilled occupation, or being in the lowest third of household wealth was associated with a higher risk of all-cause mortality, cardiovascular-disease mortality, non-cardiovascular-disease mortality, major cardiovascular disease, and cardiovascular-disease admission to hospital compared with having higher education, a professional or managerial occupation, or more household wealth. After adjustment for confounders, people categorised as having low integrated socioeconomic status based on the index had a higher risk of all-cause mortality (HR 1·65 [95% CI 1·42-1·92]), cardiovascular-disease mortality (2·19 [1·68-2·85]), non-cardiovascular disease mortality (1·43 [1·18-1·72]), major cardiovascular disease (1·43 [1·27-1·61]) and cardiovascular-disease admission to hospital (1·14 [1·01-1·28]) compared with people categorised as having high integrated socioeconomic status. INTERPRETATION Socioeconomic-status inequalities in mortality and cardiovascular-disease outcomes exist in China. Targeted policies of equal health-care resource allocation should be promoted to equitably benefit people with fewer years of education and less household wealth. FUNDING Funding sources are listed at the end of the Article.
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Affiliation(s)
- Yingxuan Zhu
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bangdiwala Shrikant
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiguang Liu
- Clinical Trial Unit, Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chuangshi Wang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Quanyong Xiang
- Centers for Disease Control and Prevention in Jiangsu Province, Nanjing, China
| | - Sumathy Rangarajan
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sidong Li
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Weida Liu
- State Key Laboratory for Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Mengya Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Aiying Han
- Bayannao'er Center for Disease Control and Prevention, Bayannao'er, China
| | - Jinhua Tang
- Department of General Practice, Xiaohang Hospital, Nanjing, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Wei Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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16
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Guo H, Wang M, Ye Y, Huang C, Wang S, Peng H, Wang X, Fan M, Hou T, Wu X, Huang X, Yan Y, Zheng K, Wu T, Li L. Short-Term Exposure to Nitrogen Dioxide Modifies Genetic Predisposition in Blood Lipid and Fasting Plasma Glucose: A Pedigree-Based Study. BIOLOGY 2023; 12:1470. [PMID: 38132296 PMCID: PMC10740487 DOI: 10.3390/biology12121470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023]
Abstract
(1) Background: Previous studies suggest that exposure to nitrogen dioxide (NO2) has a negative impact on health. But few studies have explored the association between NO2 and blood lipids or fasting plasma glucose (FPG), as well as gene-air pollution interactions. This study aims to fill this knowledge gap based on a pedigree cohort in southern China. (2) Methods: Employing a pedigree-based design, 1563 individuals from 452 families participated in this study. Serum levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC), and FPG were measured. We investigated the associations between short-term NO2 exposure and lipid profiles or FPG using linear mixed regression models. The genotype-environment interaction (GenoXE) for each trait was estimated using variance component models. (3) Results: NO2 was inversely associated with HDLC but directly associated with TG and FPG. The results showed that each 1 μg/m3 increase in NO2 on day lag0 corresponded to a 1.926% (95%CI: 1.428-2.421%) decrease in HDLC and a 1.400% (95%CI: 0.341-2.470%) increase in FPG. Moreover, we observed a significant genotype-NO2 interaction with HDLC and FPG. (4) Conclusion: This study highlighted the association between NO2 exposure and blood lipid profiles or FPG. Additionally, our investigation suggested the presence of genotype-NO2 interactions in HDLC and FPG, indicating potential loci-specific interaction effects. These findings have the potential to inform and enhance the interpretation of studies that are focused on specific gene-environment interactions.
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Affiliation(s)
- Huangda Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (H.G.)
| | - Mengying Wang
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing 100191, China
| | - Ying Ye
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350012, China
| | - Chunlan Huang
- Department of Hygiene, Nanjing Country Center for Disease Control and Prevention, Nanjing 363600, China
| | - Siyue Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (H.G.)
| | - Hexiang Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (H.G.)
| | - Xueheng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (H.G.)
| | - Meng Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (H.G.)
| | - Tianjiao Hou
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (H.G.)
| | - Xiaoling Wu
- Department of Hygiene, Nanjing Country Center for Disease Control and Prevention, Nanjing 363600, China
| | - Xiaoming Huang
- Department of Hygiene, Nanjing Country Center for Disease Control and Prevention, Nanjing 363600, China
| | - Yansheng Yan
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350012, China
| | - Kuicheng Zheng
- Fujian Provincial Center for Disease Control and Prevention, Fuzhou 350012, China
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (H.G.)
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
- Key Laboratory of Reproductive Health, Ministry of Health, Beijing 100191, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; (H.G.)
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing 100191, China
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Li Y, Yang Y, Ju L, Piao W, Wei X, Zhao L, Yu D. Association of the Protective Dietary Pattern for Blood Pressure with Elevated Blood Pressure and Hypertension among Chinese Children and Adolescents Aged 6-17 Years Old: Data from China Nutrition and Health Surveillance (2015-2017). Nutrients 2023; 15:4927. [PMID: 38068785 PMCID: PMC10708381 DOI: 10.3390/nu15234927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
Studies focused on the association between dietary patterns and elevated blood pressure (BP) and hypertension (HTN) among children and adolescents remain insufficient. This study aimed to explore a dietary pattern that could be helpful for the prevention of abnormal BP and to investigate the association between this dietary pattern and elevated BP and HTN among Chinese children and adolescents. A total of 52,080 Chinese children and adolescents aged 6~17 years old from the China Nutrition and Health Surveillance (CNHS) 2015-2017 were included in the current study. The reduced rank regression (RRR) method was applied to derive a dietary pattern that is associated with BP. Multivariable logistic regression was used to assess the association between dietary pattern (DP) and elevated BP and HTN. The Dietary Approach to Stop Hypertension (DASH) score was also calculated for each participant as a comparative method to validate the dietary pattern derived with the RRR method. A protective dietary pattern (PDP) for BP among Chinese children and adolescents was derived, which was characterized by high intakes of dairy products, mushrooms/edible fungi, fresh vegetables, fresh fruits, fresh eggs, aquatic products, mixed legumes, soybeans and related products, offal, dried fruits, and coarse cereals, with low intakes of refined grains. After multiple adjustments, there were significant inverse associations between PDP scores and the odds of elevated BP and HTN (elevated BP: Q5 vs. Q1, OR = 0.849, 95%CI = 0.755-0.931, P-trend < 0.05; HTN: Q5 vs. Q1, OR = 0.795, 95%CI = 0.694-0.911, P-trend < 0.05). The DASH diet was also observed to have protective effects on elevated BP in model I (Q5 vs. Q1, OR = 0.899, 95%CI = 0.828-0.975, P-trend < 0.05), but was not observed to have protective effects on HTN (HTN: Q5 vs. Q1, OR = 0.958, 95%CI = 0.876-1.048, P-trend > 0.05). The current study suggested that greater adherence to the PDP for BP among Chinese children and adolescents might be associated with lower odds of elevated BP and HTN.
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Affiliation(s)
| | | | | | | | | | | | - Dongmei Yu
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (Y.L.); (Y.Y.); (L.J.); (W.P.); (X.W.); (L.Z.)
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18
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Wang H, Zhang H, Zou Z. Changing profiles of cardiovascular disease and risk factors in China: a secondary analysis for the Global Burden of Disease Study 2019. Chin Med J (Engl) 2023; 136:2431-2441. [PMID: 37341657 PMCID: PMC10586832 DOI: 10.1097/cm9.0000000000002741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Understanding the changing profiles of cardiovascular disease (CVD) and modifiable risk factors is essential for CVD prevention and control. We aimed to report the comprehensive trends in CVD and risk factors in China from 1990 to 2019. METHODS Data on the incidence, death, and disability-adjusted life years (DALYs) of total CVD and its 11 subtypes for China were obtained from the Global Burden of Disease Study 2019. The CVD burden attributable to 12 risk factors was also retrieved. A secondary analysis was conducted to summarize the leading causes of CVD burden and attributable risk factors. RESULTS From 1990 to 2019, the number of CVD incidence, death, and DALYs considerably increased by 132.8%, 89.1%, and 52.6%, respectively. Stroke, ischemic heart disease, and hypertensive heart disease accounted for over 95.0% of CVD deaths in 2019 and remained the top three causes during the past 30 years. Between 1990 and 2019, the age-standardized rate of stroke decreased significantly (percentage of decreased incidence: -9.3%; death: -39.8%; DALYs: -41.6%), while the rate of ischemic heart disease increased (percentage of increased incidence: 11.5%; death: 17.6%; DALYs: 2.2%). High systolic blood pressure, unhealthy diet, tobacco, and air pollution continued to be the major contributors to CVD deaths and DALYs (attributing to over 70% of the CVD burden), and the high body mass index (BMI)-associated CVD burden had the largest increase between 1990 and 2019. CONCLUSIONS The significant increases in the number of CVD incident cases, deaths, and DALYs suggest that the CVD burden is still a concern. Intensified strategies and policies are needed to maintain promising progress in stroke and to reduce the escalating burden of ischemic heart disease. The CVD burden attributable to risk factors has not yet made adequate achievements; even worse, high BMI has contributed to the increasing CVD burden.
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Affiliation(s)
- Huan Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
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Warming PE, Ågesen FN, Lynge TH, Garcia R, Banner J, Prescott E, Lange T, Jabbari R, Tfelt-Hansen J. The impact of modifiable risk factors in the association between socioeconomic status and sudden cardiac death in a prospective cohort study: equal access to healthcare, unequal outcome. Eur J Prev Cardiol 2023; 30:1526-1534. [PMID: 36943322 DOI: 10.1093/eurjpc/zwad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/23/2023]
Abstract
AIMS Low socioeconomic status is associated with all-cause mortality and cardiac risk factors. Furthermore, sudden cardiac death (SCD) is among the leading causes of death in the general population, and an identification of high-risk subgroups is needed. The aim of this study was to investigate the association between income and education level and incidence of SCD and to calculate the impact of modifiable mediating risk factors. METHODS AND RESULTS Participants in the Copenhagen City Heart Study were followed up from 1993 to 2016. Sudden cardiac death was identified using high-quality death certificates, autopsy reports, discharge summaries, and national registry data. Hazard ratios were calculated using Cox proportional hazards regression, and adjusted cumulative incidences were predicted using cause-specific Cox models. Mediation analyses were performed using a marginal structural model approach. During 24 years of follow-up, 10 006 people participated, whereof 5514 died during the study period with 822 SCDs. Compared with long education, persons with elementary school level education had an SCD incidence rate ratio (IRR) of 2.48 [95% confidence interval (CI) 1.86-3.31], and low income was likewise associated with an SCD IRR of 2.34 (95% CI 1.85-2.96) compared with high income. In the association between education and SCD, the combined mediating effect of smoking, physical activity, and body mass index accounted for ∼20% of the risk differences. CONCLUSION We observed an inverse association between both income and education and the risk of SCD, which was only in part explained by common cardiac risk factors, implying that further research into the competing causes of SCD is needed and stressing the importance of targeted preventive measures.
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Affiliation(s)
- Peder Emil Warming
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Frederik Nybye Ågesen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Rodrigue Garcia
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
- Cardiology Department, University Hospital of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France
- Centre d'Investigation Clinique 1402, University Hospital of Poitiers, 2 rue de la Milétrie, Poitiers 86000, France
| | - Jytte Banner
- Department of Forensic Medicine, Faculty of Health and Medical Sciences, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg Hospital, Ebba Lunds Vej 40A, 2400 København NV, Denmark
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 København K, Denmark
| | - Reza Jabbari
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
- Department of Forensic Medicine, Faculty of Health and Medical Sciences, Frederik V's Vej 11, 2100 Copenhagen, Denmark
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20
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Yao F, Ma J, Cui Y, Huang C, Lu R, Hu F, Zhu X, Qin P. Dietary intake of total vegetable, fruit, cereal, soluble and insoluble fiber and risk of all-cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies. Front Nutr 2023; 10:1153165. [PMID: 37854351 PMCID: PMC10579821 DOI: 10.3389/fnut.2023.1153165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
Objectives To conduct a systematic review and meta-analysis of prospective cohort studies to investigate the association between total, vegetable, fruit, cereal, soluble and insoluble fiber intake and risk of all causes, cardiovascular disease (CVD), and cancer mortality and quantitatively assess the dose-response relation. Methods Eligible studies were identified by searching PubMed, Embase and Web of science before August 2023. Random effects models were used to calculate summary relative risk (RR) and 95% confidence intervals (CI) and restricted cubic splines to model the linear/non-linear association. Results The summary RR for all-cause, CVD and cancer mortality of dietary fiber was 0.90 (95% CI: 0.86,0.93), 0.87 (0.84,0.91), 0.91 (0.88,0.93), respectively. Significant association was observed for all-cause and CVD mortality with fruit, vegetable cereal and soluble fiber intake and cancer mortality with cereal fiber intake. No significant association was found for insoluble fiber, vegetable or fruit fiber intake and cancer mortality. Dose-response analysis showed a significant non-linear relation of dietary fiber intake with all-cause mortality, and linear relation for others. Conclusions Higher dietary fiber including different type and food sources of fiber intake were associated with lower risk of mortality. Our findings provide more comprehensive evidence on dietary fiber intake with mortality. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier: CRD42022338837.
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Affiliation(s)
- Feifei Yao
- Clinical Public Health Center, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Jianping Ma
- Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Yong Cui
- Department of Oncology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Cuihong Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ruiqi Lu
- School of Public Health, Shantou University, Shantou, Guangdong, China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, Shenzhen University Health Science Center, School of Public Health, Shenzhen, Guangdong, China
| | - Xiaoming Zhu
- Department of Biostatistics and Epidemiology, School of Public Health, Xi'an Medical University, Xi'an, Shanxi, China
| | - Pei Qin
- Clinical Public Health Center, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
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21
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Lima Dos Santos CC, Matharoo AS, Pinzón Cueva E, Amin U, Perez Ramos AA, Mann NK, Maheen S, Butchireddy J, Falki VB, Itrat A, Rajkumar N, Zia Ul Haq M. The Influence of Sex, Age, and Race on Coronary Artery Disease: A Narrative Review. Cureus 2023; 15:e47799. [PMID: 38021526 PMCID: PMC10676710 DOI: 10.7759/cureus.47799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiovascular disease has remained one of the leading causes of mortality in the world. The basic pathophysiology of coronary artery disease (CAD) is a reduction of the blood flow in coronary vessels, leading to restricted blood flow to the heart muscle. Both modifiable and non-modifiable risk factors contribute to its multifactorial etiology. The clinical presentation ranges from asymptomatic to typical symptoms like chest pain, shortness of breath, and left arm or jaw pain. The purpose of this review is to investigate and analyze the variation of CAD depending on the biological sex, age, race, or ethnicity and how it might differ in the studied population while comparing the symptoms and prognosis of CAD. For this research, PubMed's database was used. A total of 926 articles were selected using pre-determined inclusion and exclusion criteria, with 74 articles eligible to be included in the narrative review. Studies were selected from the general population of patients with CAD, regardless of their severity, stage of diagnosis, and treatment plan. The scale for the assessment of non-systematic review articles (SANRA) was used to assess the quality of the study. As humans age, the incidence of CAD increases, and people over 75 are more likely to have multiple-vessel CAD. It has been observed that South Asians have the highest rate of CAD at 24%, while the White population has the lowest at 8%. The prevalence of CAD also depends on race, with the White population having the lowest rate at 3.2%, followed by Hispanics at 5%, Black women at 5.2%, and Black men at 5.7%. Younger Black women tend to have more chest pain. Men with CAD commonly experience chest pain, and women are more likely to present with atypical symptoms. Modifiable risk factors such as smoking and alcoholism are more commonly observed in young men than in young women. Coronary artery disease in the elderly, female, minority, and Black patients is associated with a higher mortality rate. Acknowledging the prevalence of certain risk factors, signs, results, and responses to treatment in certain socio-demographic groups, as well as the provision and accessibility of diagnosis and treatment, would lead to a better outcome for all individuals. The impact of this shift can range from an earlier diagnosis of CAD to a faster and more customized treatment plan tailored to each patient's individual requirements.
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Affiliation(s)
| | | | | | - Uzma Amin
- Pathology, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Navpreet K Mann
- Cardiology, Government Medical College and Rajindra Hospital, Patiala, IND
| | - Sara Maheen
- General Medicine, Odessa National Medical University, Odessa, UKR
| | - Jyothsna Butchireddy
- Cardiology, Government Medical College, Omandurar Government Estate, Chennai, IND
| | | | - Abeeha Itrat
- Cardiology, Lutheran General Hospital, Illinois, USA
| | | | - Muhammad Zia Ul Haq
- Epidemiology and Public Health, Emory University Rollins School of Public Health, Atlanta, USA
- Noncommunicable Diseases and Mental Health, World Health Organization, Cairo, EGY
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22
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Zhang J, Du W, Huang F, Li L, Bai J, Wei Y, Wang Z, Zhang B, Wang H. Longitudinal study of dietary patterns and hypertension in adults: China Health and Nutrition Survey 1991-2018. Hypertens Res 2023; 46:2264-2271. [PMID: 37337099 PMCID: PMC10550817 DOI: 10.1038/s41440-023-01322-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/21/2023]
Abstract
China is undergoing the nutrition transition that may explain partly the high prevalence of hypertension. We aimed to investigate the longitudinal association between dietary patterns and hypertension in Chinese adults over 28 years of follow-up. We used data collected in the China Health and Nutrition Survey from 1991 to 2018. Adults aged 18 years and above (n = 15,929) were included in the analysis, for whom questionnaires and anthropometric data were collected during at least two waves. Factor analysis was conducted to derive food patterns based on 18 foods or food groups. We constructed three-level mixed-effect linear regression models to estimate systolic blood pressure (SBP) and diastolic blood pressure (DBP) in relation to quartiles of dietary pattern score and performed three-level mixed-effect logistic regression models to assess the risk of hypertension. Participants in the top quartile of the modern pattern had a decrease in SBP (β = - 0.51; 95% CI -0.86, -0.16; P < 0.01) when adjusted for all potential confounders, whereas participants in the top quartile of the meat pattern had an increase in DBP (β = 0.31; 95% CI 0.08, 0.53; P < 0.01). Participants in the highest quartile of the meat pattern were more likely to have hypertension (OR = 1.14; 95% CI 1.03, 1.24; P < 0.01). Adherence to the modern pattern characterized by high intake of fruits and dairy products was inversely associated with SBP, whereas the meat pattern was positively associated with DBP and the risk of hypertension. These findings may well have important public health implications.
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Affiliation(s)
- Jiguo Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29, Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Wenwen Du
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29, Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Feifei Huang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29, Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Li Li
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29, Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Jing Bai
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29, Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Yanli Wei
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29, Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Zhihong Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29, Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Bing Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29, Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Huijun Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No. 29, Nanwei Road, Xicheng District, Beijing, 100050, China.
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23
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Tian F, Chen L, Qian Z(M, Xia H, Zhang Z, Zhang J, Wang C, Vaughn MG, Tabet M, Lin H. Ranking age-specific modifiable risk factors for cardiovascular disease and mortality: evidence from a population-based longitudinal study. EClinicalMedicine 2023; 64:102230. [PMID: 37936651 PMCID: PMC10626167 DOI: 10.1016/j.eclinm.2023.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 11/09/2023] Open
Abstract
Background Cardiovascular disease (CVD) remains a paramount contemporary health challenge. This study examined age-specific effects of 14 risk factors on CVD and mortality in different age groups. Methods We analyzed data from 226,759 CVD-free participants aged 40 years and older in the UK Biobank during the period from baseline time (2006-2010) to September 30, 2021. The primary CVD outcome was a composite of incident coronary artery disease, heart failure, and stroke. We calculated age-specific hazard ratios (HRs) and population-attributable fractions (PAF) for CVD and mortality associated with 14 potentially modifiable risk factors. Findings During 12.17-year follow-up, 23,838 incident CVD cases and 11,949 deaths occurred. Age-specific disparities were observed in the risk factors contributing to CVD, and the overall PAF declined with age (PAF of 56.53% in middle-age; 49.78% in quinquagenarian; 42.45% in the elderly). Metabolic factors had the highest PAF in each age group, with hypertension (14.04% of the PAF) and abdominal obesity (9.58% of the PAF) being prominent. Behavioral factors had the highest PAF in the middle-aged group (10.68% of the PAF), and smoking was the leading behavioral factor in all age groups. In socioeconomic and psychosocial risk clusters, low income contributed most among middle-aged (3.74% of the PAF) and elderly groups (3.66% of the PAF), while less education accounted more PAF for quinquagenarian group (4.46% of the PAF). Similar age-specific patterns were observed for cardiovascular subtypes and mortality. Interpretation A large fraction of CVD cases and deaths were associated with modifiable risk factors in all age groups. Targeted efforts should focus on the most impactful risk factors, as well as age-specific modifiable risk factors. These findings may inform the development of more precise medical strategies to prevent and manage CVD and related mortality. Funding The work was supported by the Bill & Melinda Gates Foundation (grant number: INV-016826 to Hualiang Lin) and the National Natural Science Foundation of China (grant number: 82373534 to Hualiang Lin).
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Affiliation(s)
- Fei Tian
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Lan Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhengmin (Min) Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, 63104, USA
| | - Hui Xia
- Center for Health Care, Longhua District, Shenzhen, China
| | - Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jingyi Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China
| | - Michael G. Vaughn
- School of Social Work, Saint Louis University, Saint Louis, MO, 63103, USA
| | - Maya Tabet
- College of Global Population Health, University of Health Sciences and Pharmacy in St. Louis, 1 Pharmacy Place, St. Louis, MO, 63110, USA
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
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24
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Crea F. Challenges and opportunities in prognostication: focus on ischaemic heart disease and atrial fibrillation. Eur Heart J 2023; 44:3391-3394. [PMID: 37738644 DOI: 10.1093/eurheartj/ehad614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Guo Z, Chen Y, Zhang Y, Ding C, Li M, Xu L, Jin J. Associations among risk perception, health efficacy, and health behaviors for cardiovascular disease: an application of risk perception attitude framework. Front Cardiovasc Med 2023; 10:1201789. [PMID: 37771673 PMCID: PMC10525708 DOI: 10.3389/fcvm.2023.1201789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
Background There is currently a pervasive prevalence of cardiovascular disease (CVD) risk worldwide and an inadequate amount of action is being taken to promote healthy lifestyle habits. The risk perception attitude (RPA) framework, which classifies individuals based on their risk perception and efficacy belief, enables us to predict their preventive behaviors. We applied the RPA framework to analyze CVD prevention behaviors among Chinese adults and extended its application to CVD objective risk. Methods A cross-sectional survey was performed in two sites in Zhejiang Province, from March to August 2022, which contained self-reported CVD risk perception, objective CVD risk, efficacy belief, physical activity, healthy diet, and covariates. We used the RPA framework to categorize participants into four groups, then analysis was conducted to estimate inter-group differences in healthy behaviors. We further conducted a hierarchical logistic regression analysis with individuals' health behaviors as the dependent variable, using three blocks of independent variables. Results Among 739 participants, healthy physical activity and healthy diet had significant differences among four RPA groups, post hoc tests clarified that the proportion of respondents with healthy PA in the responsive group (61.6%) was significantly higher than that in the other three groups. Risk perception and efficacy belief significantly predicted health behavior against CVD; the relationship between absolute CVD risk and health behavior was moderated by efficacy belief. Conclusions Early CVD risk screening is crucial, but tailored support and a proper understanding of personal risk are essential to promote healthy behaviors. Developing communication and behavioral counseling intervention strategies on the basis of the RPA framework has the potential to promote healthy behaviors for CVD prevention.
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Affiliation(s)
- Zhiting Guo
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Yun Chen
- Public Health Department, Changxing County People’s Hospital, Huzhou, China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Chuanqi Ding
- Emergency Department, Changxing County People’s Hospital, Huzhou, China
| | - Mei Li
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Linyan Xu
- Nursing Department, Lishui University School of Medicine, Lishui, China
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, China
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Wang JG, Zhang W, Li Y, Liu L. Hypertension in China: epidemiology and treatment initiatives. Nat Rev Cardiol 2023; 20:531-545. [PMID: 36631532 DOI: 10.1038/s41569-022-00829-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
The past two to three decades have seen a steady increase in the prevalence of hypertension in China, largely owing to increased life expectancy and lifestyle changes (particularly among individuals aged 35-44 years). Data from the China hypertension survey conducted in 2012-2015 revealed a high prevalence of grade 3 hypertension (systolic blood pressure ≥180 mmHg and diastolic blood pressure ≥110 mmHg) in the general population, which increased with age to up to 5% among individuals aged ≥65 years. The risk profile of patients with hypertension in China has also been a subject of intense study in the past 30 years. Dietary sodium and potassium intake have remained largely the same in China in the past three decades, and salt substitution strategies seem to be effective in reducing blood pressure levels and the risk of cardiovascular events and death. However, the number of individuals with risk factors for hypertension and cardiovascular disease in general, such as physical inactivity and obesity, has increased dramatically in the same period. Moreover, even in patients diagnosed with hypertension, their disease is often poorly managed owing to a lack of patient education and poor treatment compliance. In this Review, we summarize the latest epidemiological data on hypertension in China, discuss the risk factors for hypertension that are specific to this population, and describe several ongoing nationwide hypertension control initiatives that target these risk factors, especially in the low-resource rural setting.
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Affiliation(s)
- Ji-Guang Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wei Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lisheng Liu
- Beijing Hypertension League Institute, Beijing, China
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Shi W, Huang X, Schooling CM, Zhao JV. Red meat consumption, cardiovascular diseases, and diabetes: a systematic review and meta-analysis. Eur Heart J 2023; 44:2626-2635. [PMID: 37264855 DOI: 10.1093/eurheartj/ehad336] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 04/01/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
AIMS Observational studies show inconsistent associations of red meat consumption with cardiovascular disease (CVD) and diabetes. Moreover, red meat consumption varies by sex and setting, however, whether the associations vary by sex and setting remains unclear. METHODS AND RESULTS This systematic review and meta-analysis was conducted to summarize the evidence concerning the associations of unprocessed and processed red meat consumption with CVD and its subtypes [coronary heart disease (CHD), stroke, and heart failure], type two diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) and to assess differences by sex and setting (western vs. eastern, categorized based on dietary pattern and geographic region). Two researchers independently screened studies from PubMed, Web of Science, Embase, and the Cochrane Library for observational studies and randomized controlled trials (RCTs) published by 30 June 2022. Forty-three observational studies (N = 4 462 810, 61.7% women) for CVD and 27 observational studies (N = 1 760 774, 64.4% women) for diabetes were included. Red meat consumption was positively associated with CVD [hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.05 to 1.16 for unprocessed red meat (per 100 g/day increment); 1.26, 95% CI 1.18 to 1.35 for processed red meat (per 50 g/day increment)], CVD subtypes, T2DM, and GDM. The associations with stroke and T2DM were higher in western settings, with no difference by sex. CONCLUSION Unprocessed and processed red meat consumption are both associated with higher risk of CVD, CVD subtypes, and diabetes, with a stronger association in western settings but no sex difference. Better understanding of the mechanisms is needed to facilitate improving cardiometabolic and planetary health.
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Affiliation(s)
- Wenming Shi
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Southern District, Hong Kong SAR, China
| | - Xin Huang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Southern District, Hong Kong SAR, China
| | - C Mary Schooling
- School of Public Health and Health Policy, City University of New York, 55 W 125th St, New York, NY 10027, USA
| | - Jie V Zhao
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Southern District, Hong Kong SAR, China
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Crea F. Cardiovascular and dementia prevention: role of scores, diet, and rehabilitation. Eur Heart J 2023; 44:2501-2505. [PMID: 37477627 DOI: 10.1093/eurheartj/ehad449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Liu H, Lin W, Tu K, Zhou Q, Wang C, Sun M, Li Y, Liu X, Lin G, Li S, Bao W. Prevalence, awareness, treatment, and risk factor control of high atherosclerotic cardiovascular disease risk in Guangzhou, China. Front Cardiovasc Med 2023; 10:1092058. [PMID: 37522083 PMCID: PMC10379630 DOI: 10.3389/fcvm.2023.1092058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Background Identifying individuals at high risk of atherosclerotic cardiovascular disease (ASCVD) and implementing targeted prevention strategies might be the key to reducing the heavy disease burden in China. This study aimed to evaluate the prevalence, awareness, treatment, and risk factor control among individuals with high 10-year ASCVD risk in Guangzhou, China. Methods This study included 15,165 adults (aged 18 years and older) from 138 urban and rural communities in the 2018 survey of China Chronic Disease and Risk Factors Surveillance in Guangzhou. 10-year ASCVD risk was estimated using the risk assessment models recommended in the Chinese Guideline for the Prevention of Cardiovascular Disease 2017. The prevalence, awareness, treatment, and risk factor control of high ASCVD risk (defined as 10-year risk ≥10%) were examined. Results Among the study population, the weighted proportion of men was 51.9%, and the mean age was 41.27 ± 0.52 years. The overall standardized prevalence of high 10-year ASCVD risk was 13.8% (95% CI, 12.4%-15.3%). The awareness rates for hypertension, diabetes, and hyperlipidemia were 48.0% (95% CI, 42.8%-53.4%), 48.3% (95% CI, 43.0%-53.7%), and 17.9% (95% CI, 14.4%-22.1%) among those with corresponding risk factors. The proportions of drug use in prevention were relatively low in primary prevention, with the rates of using BP-lowering, glucose-lowering, lipid-lowering, and aspirin being 37.7% (95% CI, 32.8%-42.8%), 41.4% (95% CI, 35.8%-47.3%), 6.7% (95% CI, 4.5%-10.0%), and 1.0% (95% CI, 0.6%-1.8%), respectively. As for risk factor control, only 29.3% (95% CI, 25.7%-33.2%), 16.8% (95% CI, 15.0%-18.6%), and 36.0% (95% CI, 31.1%-41.2%) of individuals with high ASCVD risk had ideal levels of blood pressure, LDL-C, and body weight. Conclusion The estimated prevalence of 10-year high ASCVD risk was high in Guangzhou, while the rates of treatment and risk factor control in primary prevention were still far from optimal, especially for lipid management. These findings suggested that substantial improvement in ASCVD prevention is needed in this population.
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Affiliation(s)
- Hui Liu
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou, China
| | - Weiquan Lin
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou, China
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Kexin Tu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qin Zhou
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou, China
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Chang Wang
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou, China
| | - Minying Sun
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou, China
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Yaohui Li
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou, China
| | - Xiangyi Liu
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou, China
| | - Guozhen Lin
- Department of Basic Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou, China
| | - Sidong Li
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei Bao
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Li W, Huang G, Tang N, Lu P, Jiang L, Lv J, Qin Y, Lin Y, Xu F, Lei D. Effects of heavy metal exposure on hypertension: A machine learning modeling approach. CHEMOSPHERE 2023; 337:139435. [PMID: 37422210 DOI: 10.1016/j.chemosphere.2023.139435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023]
Abstract
Heavy metal exposure is a common risk factor for hypertension. To develop an interpretable predictive machine learning (ML) model for hypertension based on levels of heavy metal exposure, data from the NHANES (2003-2016) were employed. Random forest (RF), support vector machine (SVM), decision tree (DT), multilayer perceptron (MLP), ridge regression (RR), AdaBoost (AB), gradient boosting decision tree (GBDT), voting classifier (VC), and K-nearest neighbour (KNN) algorithms were utilized to generate an optimal predictive model for hypertension. Three interpretable methods, the permutation feature importance analysis, partial dependence plot (PDP), and Shapley additive explanations (SHAP) methods, were integrated into a pipeline and embedded in ML for model interpretation. A total of 9005 eligible individuals were randomly allocated into two distinct sets for predictive model training and validation. The results showed that among the predictive models, the RF model demonstrated the highest performance, achieving an accuracy rate of 77.40% in the validation set. The AUC and F1 score for the model were 0.84 and 0.76, respectively. Blood Pb, urinary Cd, urinary Tl, and urinary Co levels were identified as the main influencers of hypertension, and their contribution weights were 0.0504 ± 0.0482, 0.0389 ± 0.0256, 0.0307 ± 0.0179, and 0.0296 ± 0.0162, respectively. Blood Pb (0.55-2.93 μg/dL) and urinary Cd (0.06-0.15 μg/L) levels exhibited the most pronounced upwards trend with the risk of hypertension within a specific value range, while urinary Tl (0.06-0.26 μg/L) and urinary Co (0.02-0.32 μg/L) levels demonstrated a declining trend with hypertension. The findings on the synergistic effects indicated that Pb and Cd were the primary determinants of hypertension. Our findings underscore the predictive value of heavy metals for hypertension. By utilizing interpretable methods, we discerned that Pb, Cd, Tl, and Co emerged as noteworthy contributors within the predictive model.
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Affiliation(s)
- Wenxiang Li
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China.
| | - Guangyi Huang
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China
| | - Ningning Tang
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China
| | - Peng Lu
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China
| | - Li Jiang
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China
| | - Jian Lv
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China
| | - Yuanjun Qin
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China
| | - Yunru Lin
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China
| | - Fan Xu
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China.
| | - Daizai Lei
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Nanning, 530021, China.
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Li Y, Yu D, Yang Y, Cheng X, Piao W, Guo Q, Xu X, Zhao L, Wang Y. Comparison of Several Adiposity Indexes in Predicting Hypertension among Chinese Adults: Data from China Nutrition and Health Surveillance (2015-2017). Nutrients 2023; 15:2146. [PMID: 37432280 DOI: 10.3390/nu15092146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 07/12/2023] Open
Abstract
The current study is to explore the association of the Chinese visceral adiposity index (CVAI) with hypertension, and to compare the predictive power of different adiposity indexes regarding hypertension among Chinese adults aged over 45 years. A total of 99,201 participants aged over 45 years from the China Nutrition and Health Surveillance 2015-2017 were included in this study. Multivariate adjusted logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of hypertension. Multivariate adjusted restricted cubic spline analyses were applied to explore the association of adiposity indexes with hypertension. Receiver operating characteristic (ROC) analyses were used to compare the predictive powers of different adiposity indexes of hypertension. All eight adiposity indexes included in this study were positively associated with hypertension. Compared with those in the lowest quartile of the CVAI, the participants in the highest quartile showed a significantly higher risk of hypertension (OR = 3.70, 95% CI = 3.54-3.86) after multiple adjustments. The ROC analyses suggested that the CVAI was the strongest predictor of hypertension compared to other adiposity indexes in both genders. The findings supported that the CVAI could serve as a reliable and cost-effective method for early identifying hypertension risk.
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Affiliation(s)
- Yuge Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yuxiang Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xue Cheng
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Wei Piao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Qiya Guo
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaoli Xu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- NHC Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yuying Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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Zhao Y, Guo Q, Zhao J, Bian M, Qian L, Shao J, Wang Q, Duan X. Long-term exposure to fine particulate matter modifies the association between physical activity and the risk of hypertension. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:43690-43701. [PMID: 36658317 DOI: 10.1007/s11356-023-25256-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
The trade-off between the potentially detrimental effects of fine particulate matter (PM2.5) and the benefits of physical activity (PA) is unclear. We aimed to explore the independent and interaction effects between long-term PM2.5 exposure and PA on blood pressure (BP) and hypertension. A total of 8704 adults (≥45 years) without hypertension at baseline in a nationwide cohort of the China Health and Retirement Longitudinal Study (CHARLS) were followed from 2011 to 2015. The participants were selected using a four-stage, stratified, and cluster sampling procedure. The annual PM2.5 concentrations at the residential address were estimated from a two-stage machine learning model with a 10 km × 10 km resolution. A standard questionnaire collected information on PA and potential confounders, and metabolic equivalents (MET·h/wk), which combined frequency, intensity, and duration information, were used to assess PA levels. We adopted mixed-effects regression models to explore the independent and interaction effects between long-term PM2.5 exposure and PA on BP and risk of hypertension. Systolic blood pressure (SBP) decreased by -0.84 mmHg (95% CI: -1.34, -0.34) per an IQR (interquartile range, 175.5 MET·h/wk) increase in PA, and diastolic blood pressure (DBP) decreased by -0.42 mmHg (95% CI: -0.76, -0.07). Each IQR (36.1 μg/m3) increment in PM2.5 was associated with 0.48 mmHg (95% CI: -0.24, 1.20) in SBP and -0.02 mmHg (95% CI: -0.44, 0.39) in DBP. PM2.5 showed an elevated effect with risks of hypertension (odds ratio, OR = 1.01; 95% CI: 1.00, 1.03), while PA showed the inverse result (OR = 0.98; 95% CI: 0.97, 0.99). Interaction analyses indicated PA maintained the beneficial effects on BP, but the negative association was attenuated, accompanied by the increase of PM2.5. PA decreased the BP and hypertension risks, while PM2.5 showed the opposite results. PM2.5 attenuated the beneficial effects of PA on BP and modified the association between PA and the risk of hypertension.
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Affiliation(s)
- Yuchen Zhao
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Qian Guo
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Jiahao Zhao
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Mengyao Bian
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Liqianxin Qian
- School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Jing Shao
- National Institute of Sports Medicine, General Administration of Sport of China, Beijing, 100029, China
| | - Qirong Wang
- National Institute of Sports Medicine, General Administration of Sport of China, Beijing, 100029, China
| | - Xiaoli Duan
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
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Li Z, Gong X, Wang S, Liu M, Liu S, Wang Y, Wu D, Yang M, Li R, Li H, Li X, Chen S, Zhang X, Jia R, Guo J, He Y, Wang Y. Cognitive impairment assessed by Mini-Mental State Examination predicts all-cause and CVD mortality in Chinese older adults: A 10-year follow-up study. Front Public Health 2022; 10:908120. [PMID: 36518570 PMCID: PMC9744251 DOI: 10.3389/fpubh.2022.908120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Cognitive impairment (CI) has been demonstrated as a useful proxy measure of mortality in Western populations. However, the predictive value of CI in Chinese populations is unknown. We aimed to explore whether CI is independently associated with increased long-term all-cause and cardiovascular disease (CVD) mortality in Chinese older adults and the association of performance in specific MMSE sub-domains to subsequent mortality. Methods and results A total of 4,499 older adults [mean (SD) age, 70.3(6.7) years] who received a sample investigation from 2011 to 2014 were followed up till 2021 for mortality. The Mini-Mental State Examination was used to assess cognitive function, and Cox's proportional hazard models were used to evaluate the effects of cognitive function on the risk of all-cause and CVD mortality. Demographic characteristics, lifestyle, and health status were included as covariates. During a 10-year follow-up, a total of 667 (14.8%) died. In the fully adjusted model, compared with cognitively normal participants with CI had a 1.33-fold [HR, 1.33; (95% CI, 1.10-1.61)] greater risk of all-cause mortality and a 1.45-fold [HR, 1.45; (95% CIs, 1.11-1.92)] greater risk of CVD mortality. After a similar multivariable adjustment, a per-SD increase in MMSE scores was associated with a reduced risk of all-cause mortality [HR, 0.85; (95% CI, 0.78-0.93)] and CVD mortality [HR, 0.74; (95% CI, 0.65-0.84)]. In the unadjusted model, MMSE sub-domains (apart from immediate recall) were associated with mortality. But only orientation and calculation and attention were still independently associated with all-cause and CVD mortality in a multivariable model. Conclusion These findings confirmed that CI is a marker of all-cause and CVD mortality risk in Chinese older adults, independently of other commonly assessed risk factors, and some sub-domains of the MMSE may have stronger associations with mortality. Further research is needed to identify the mechanisms underlying the observed associations.
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Affiliation(s)
- Zhiqiang Li
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Xinran Gong
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Shengshu Wang
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China,Department of Healthcare, Agency for Offices Administration, Central Military Commission, Beijing, China
| | - Miao Liu
- Department of Epidemiology and Statistics, Graduate School of Chinese PLA General Hospital, Beijing, China
| | - Shaohua Liu
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yanding Wang
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Di Wu
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Meitao Yang
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Rongrong Li
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Haowei Li
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xuehang Li
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shimin Chen
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiushan Zhang
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Ruizhong Jia
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Jinpeng Guo
- Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Yao He
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Institute of Geriatrics, Second Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China,State Key Laboratory of Kidney Diseases, Department of Epidemiology, Chinese People's Liberation Army General Hospital, Beijing, China,Yao He
| | - Yong Wang
- School of Public Health, China Medical University, Shenyang, China,Chinese People's Liberation Army Center for Disease Control and Prevention, Beijing, China,*Correspondence: Yong Wang
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Wang Y, Liu H, He D, Zhang B, Liu Y, Xu K, Cao S, Huo Y, Liu J, Zeng L, Yan H, Dang S, Mi B. Association between physical activity and major adverse cardiovascular events in northwest China: A cross-sectional analysis from the Regional Ethnic Cohort Study. Front Public Health 2022; 10:1025670. [PMID: 36466532 PMCID: PMC9713839 DOI: 10.3389/fpubh.2022.1025670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background To examine the association between daily physical activity (PA) and major adverse cardiovascular events (MACEs) in northwest China. Methods The data in this analysis were part of the baseline survey of the Regional Ethnic Cohort Study in Northwest China from June 2018 to May 2019 in Shaanxi Province. This study used standardized self-reported total physical activity (continuous and categorical variables) and self-reported outcomes of MACEs. All analyses were conducted using the logistic regression model and stratified by age, sex, body mass index (BMI), and region. The dose-response relationships were assessed with a restricted cubic spline. Results The average level of total PA was 17.60 MET hours per day (MET-h/d). Every increase of four MET-h/d of total PA was associated with a lower risk of MACEs [adjusted OR = 0.95 (95% CI, 0.93~0.98)]. Compared with participants in the bottom quartile of total PA, a lower risk of MACEs was observed in the top quartile group [≥23.3 MET-h/d, 0.68 (0.55~0.83)]. Stratified analyses showed similar results in males, females, participants over 45 years old, participants in the rural region, and normal weight range participants (BMI < 24 kg/m2). Total participants also observed a dose-response relationship after adjusting for socioeconomic and lifestyle factors. Conclusions A higher level of PA was associated with a lower MACE risk. Future research should examine the longitudinal association of prospectively measured PA and the risk of MACEs.
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Seed Waste from Custard Apple (Annona squamosa L.): A Comprehensive Insight on Bioactive Compounds, Health Promoting Activity and Safety Profile. Processes (Basel) 2022. [DOI: 10.3390/pr10102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Annona squamosa L. (custard apple or sugar apple), belonging to the Annonaceae family, is a small tree or shrub that grows natively in subtropical and tropical regions. Seeds of the custard apple have been employed in folk medicines because of the presence of bioactive chemicals/compounds such as alkaloids, flavonoids and phenolic compounds and acetogenins and cyclopeptides that are responsible for various biological activities. The seeds also show the presence of tannins, vitamin C, vitamin E and a higher content of amino acids. From investigations, it has been shown that the seeds of A. squamosa have considerable potential to be used as an antibacterial, hepatoprotective, antioxidant and antitumor/anticancer agent. Cyclosquamosin B, extracted from the custard apple seed, possesses vasorelaxant properties. Tocopherols and fatty acids, notably oleic acid and linoleic acid, are also found in the seed oil. A. squamosa seeds contain a high amount of annonaceous acetogenins compounds, which are potent mitochondrial complex I inhibitors and have high cytotoxicity. A survey primarily based on the nutritional, phytochemical and biological properties showed that A. squamosa seeds can be used for the discovery of novel products, including pharmaceutical drugs. Although there are sufficient in vitro and in vivo experimental investigations supporting the benefits of seeds, clinical investigations/trials are still needed to determine the health contributing benefits of A. squamosa seeds.
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Chen F, Hu W, Chen S, Si A, Zhang Y, Ma J. Stroke mortality attributable to high red meat intake in China and South Korea: An age-period-cohort and joinpoint analysis. Front Nutr 2022; 9:921592. [PMID: 36313118 PMCID: PMC9614311 DOI: 10.3389/fnut.2022.921592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
The high intake of red meat is well recognized as a major health concern worldwide. It has been recognized as a risk factor for several non-communicable chronic diseases, including stroke. However, previously published studies have not performed a comprehensive analysis of the long-time trend of stroke mortality attributable to high red meat intake in China and South Korea, two countries with similar dietary patterns and changing trends. Therefore, this study aimed to reveal the influence of age, time period, and birth cohort on long-term trends of stroke mortality attributable to high red meat intake and relative gender differences in China and South Korea. Data were obtained from the Global Burden of Disease 2019 database. The age–period–cohort model was used to estimate the effect of age, time period, and birth cohort. The average and annual percent changes were estimated using the joinpoint regression analysis. Results indicated that the overall attributable age-standardized mortality rates of stroke in China decreased by 1.0% (P < 0.05) for female and 0.1% (P > 0.05) for male individuals, compared with a decrease of 4.9% for female and 3.7% for male individuals in South Korea (both P < 0.05). Age–period–cohort analysis revealed that the attributable stroke mortality decreased along with the time period, and increased along with age. Significant gender differences were observed, male individuals in both countries were at higher risk than their female counterparts, especially in China. Joinpoint analysis suggested that the attributable stroke mortality for both genders in South Korea and female individuals in China showed a decreasing trend, while it is stable for male individuals in China. Although prominent reductions were observed during the past decades, the attributable stroke mortality risk in China and South Korea is still high. Our findings indicate that controlling the intake of red meat may be a cost-effective strategy to reduce stroke mortality risk and the corresponding disease burden, especially for Chinese male individuals.
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Affiliation(s)
- Fangyao Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China,Department of Radiology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Weiwei Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Shiyu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Aima Si
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Yuxiang Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jiaojiao Ma
- Department of Neurology, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China,*Correspondence: Jiaojiao Ma,
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Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Wei J, Wang P, Xia F, Miao J, Zhou X, Yang Z, Gong Z, Chen L, Wang T. Time trends in cardiovascular disease mortality attributable to non-optimal temperatures in China: An age-period-cohort analysis using the Global Burden of Disease Study 2019. Front Public Health 2022; 10:1075551. [PMID: 37089862 PMCID: PMC10113563 DOI: 10.3389/fpubh.2022.1075551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 04/25/2023] Open
Abstract
Background Associations between non-optimal temperatures and cardiovascular disease (CVD) mortality risk have been previously reported, yet the trends of CVD mortality attributable to non-optimal temperatures remain unclear in China. We analyzed trends in CVD mortality attributable to non-optimal temperatures and associations with age, period, and birth cohort. Methods Data were obtained from the Global Burden of Disease Study (GBD) 2019. Joinpoint regression analysis was used to calculate annual percent change (APC) and average annual percent change (AAPC) from 1990 to 2019. We used the age-period-cohort model to analyze age, period, and cohort effects in CVD mortality attributable to non-optimal temperatures between 1990 and 2019. Results The age-standardized mortality rate (ASMR) of CVD attributable to non-optimal temperature generally declined in China from 1990 to 2019, whereas ischemic heart disease (IHD) increased slightly. Low temperatures have a greater death burden than high temperatures, but the death burden from high temperatures showed steady increases. Joinpoint regression analysis showed that CVD mortality decreased in all age groups except for IHD, and the decreases were greater in females than in males. The mortality of CVD attributable to non-optimal temperatures of males was higher than females. The mortality rate showed an upwards trend with age across all CVD categories. Period risks were generally found in unfavorable trends. The cohort effects showed a progressive downward trend during the entire period. Conclusion Although there have been reductions in CVD mortality attributable to non-optimum temperatures, the mortality of IHD has increased and the burden from non-optimal temperatures remains high in China. In the context of global climate change, our results call for more attention and strategies to address climate change that protect human health from non-optimal temperatures.
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