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Li J, Zhao D, Cai J, Chen S, Wu S, Qi Y. Cost-effectiveness of treatment in adults with blood pressure of 130-139/80-89 mmHg and high cardiovascular risk in China: a modelling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 42:100962. [PMID: 38045985 PMCID: PMC10689267 DOI: 10.1016/j.lanwpc.2023.100962] [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: 07/02/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023]
Abstract
Background The most recent updated hypertension guidelines recommend individuals with systolic blood pressure (SBP)/diastolic blood pressure (DBP) of 130-139/80-89 mmHg and high cardiovascular risk should receive antihypertensive drug treatment. This study aimed to assess the benefits and cost-effectiveness of medication for people aged ≥35 years with this blood pressure stratum and high cardiovascular risk in China. Methods The benefits of drug treatment in adults aged ≥35 years with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk were evaluated in decision-analytic simulation models. Decreasing numbers of cardiovascular disease (CVD) events and premature deaths from all causes and increasing quality-adjusted life-years (QALYs) from drug treatment were estimated in 10-year and lifetime horizons. The incremental cost-effectiveness ratios (ICER) for drug treatment were calculated. Findings Among approximately 106.60 million Chinese adults aged ≥35 years with this blood pressure stratum and high cardiovascular risk, drug treatment was estimated to prevent 2,060,000 strokes and 660,000 myocardial infarctions over a 10-year time horizon. Adults prescribed antihypertensive drugs could gain 0.034 incremental QALYs. Over a lifetime horizon, adults who start treatment earlier could benefit more in preventing CVD and gaining incremental QALYs. The medication treatment is cost-effective either over a 10-year time horizon with an ICER of Int$13321.29 per QALY gained or over the remaining lifetime. Interpretation Antihypertensive treatment of adults with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk would gain substantial benefits with cost-effectiveness. The young and middle-aged population would derive the most benefit. Funding National Natural Science Foundation of China, and Beijing Natural Science Foundation.
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Affiliation(s)
- Jiangtao Li
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Dong Zhao
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Rd. 167, Xicheng District, Beijing 100037, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, 57 Xinhua East Rd, Tangshan 063000, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, 57 Xinhua East Rd, Tangshan 063000, China
| | - Yue Qi
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodelling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
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A Novel and Noninvasive Risk Assessment Score and Its Child-to-Adult Trajectories to Screen Subclinical Renal Damage in Middle Age. Bioengineering (Basel) 2023; 10:bioengineering10020257. [PMID: 36829751 PMCID: PMC9952229 DOI: 10.3390/bioengineering10020257] [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: 01/13/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
This study aimed to develop a noninvasive, economical and effective subclinical renal damage (SRD) risk assessment tool to identify high-risk asymptomatic people from a large-scale population and improve current clinical SRD screening strategies. Based on the Hanzhong Adolescent Hypertension Cohort, SRD-associated variables were identified and the SRD risk assessment score model was established and further validated with machine learning algorithms. Longitudinal follow-up data were used to identify child-to-adult SRD risk score trajectories and to investigate the relationship between different trajectory groups and the incidence of SRD in middle age. Systolic blood pressure, diastolic blood pressure and body mass index were identified as SRD-associated variables. Based on these three variables, an SRD risk assessment score was developed, with excellent classification ability (AUC value of ROC curve: 0.778 for SRD estimation, 0.729 for 4-year SRD risk prediction), calibration (Hosmer-Lemeshow goodness-of-fit test p = 0.62 for SRD estimation, p = 0.34 for 4-year SRD risk prediction) and more potential clinical benefits. In addition, three child-to-adult SRD risk assessment score trajectories were identified: increasing, increasing-stable and stable. Further difference analysis and logistic regression analysis showed that these SRD risk assessment score trajectories were highly associated with the incidence of SRD in middle age. In brief, we constructed a novel and noninvasive SRD risk assessment tool with excellent performance to help identify high-risk asymptomatic people from a large-scale population and assist in SRD screening.
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Yan Y, Wang D, Sun Y, Ma Q, Wang K, Liao Y, Chen C, Jia H, Chu C, Zheng W, Hu J, Yuan Y, Wang Y, Wu Y, Mu J. Triglyceride-glucose index trajectory and arterial stiffness: results from Hanzhong Adolescent Hypertension Cohort Study. Cardiovasc Diabetol 2022; 21:33. [PMID: 35216614 PMCID: PMC8876112 DOI: 10.1186/s12933-022-01453-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/05/2022] [Indexed: 02/07/2023] Open
Abstract
Background The triglyceride-glucose index (TyG index) has emerged as a reliable surrogate marker of insulin resistance associated with arterial stiffness. However, most studies were based on a cross-sectional design, and few studies have evaluated the longitudinal impact of the TyG index on arterial stiffness. This study aimed to investigate the associations of single time point measurement and the long-term trajectory of the TyG index with arterial stiffness in a Chinese cohort. Methods Data are derived from the Hanzhong Adolescent Hypertension Cohort study. A total of 2480 individuals who participated in the 2017 survey was included in the cross-sectional analysis. A sample of 180 individuals from the sub-cohort with follow-up data in 2005, 2013, and 2017 was enrolled in the longitudinal analysis. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2), and arterial stiffness was determined using brachial-ankle pulse wave velocity (baPWV). The latent class growth mixture modeling method was used to identify the TyG index trajectories from 2005 to 2017. Results In the cross-sectional analysis, the median age of the study population was 42.8 (39.8, 44.9) years, and 1351 (54.5%) were males. Each one-unit increment in TyG index was associated with a 37.1 cm/s increase (95% confidence interval [CI] 23.7–50.6 cm/s; P < 0.001) in baPWV, and similar results were observed when the TyG index was in the form of quartiles. In the longitudinal analysis, we identified three distinct TyG index trajectories and found that the highest TyG index trajectory carried the greatest odds of increased arterial stiffness, with a fully adjusted odds ratio (OR) of 2.76 (95% CI 1.40, 7.54). Conclusions Elevated levels of baseline TyG index and higher long-term trajectory of TyG index were independently associated with increased arterial stiffness. Monitoring immediate levels and longitudinal trends of the TyG index may help with the prevention of arterial stiffness in the long run. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01453-4.
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Affiliation(s)
- Yu Yan
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Dan Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yue Sun
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Qiong Ma
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Keke Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yueyuan Liao
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Chen Chen
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Hao Jia
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Chao Chu
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Wenling Zheng
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Jiawen Hu
- Department of Cardiovascular Surgery, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
| | - Yue Yuan
- Department of Cardiovascular Medicine, Jiangsu Province Hospital, Nanjing, China
| | - Yang Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yuliang Wu
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Jianjun Mu
- Department of Cardiology, First Affiliated Hospital of Medical School, Key Laboratory of Molecular Cardiology of Shaanxi Province, Ministry of Education, Xi'an Jiaotong University, Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), NO.277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China.
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Zou T, Yao S, Du MF, Mu JJ, Chu C, Hu GL, Liao YY, Chen C, Wang D, Ma Q, Yan Y, Jia H, Wang KK, Sun Y, Niu ZJ, Zhang X, Yan RC, Man ZY, Ren DF, Wang L, Gao WH, Li H, Wu YX, Li CH, Gao K, Zhang J, Yang TL, Wang Y. Associations of corin genetic polymorphisms with salt sensitivity, blood pressure changes, and hypertension incidence in Chinese adults. J Clin Hypertens (Greenwich) 2021; 23:2115-2123. [PMID: 34846782 PMCID: PMC8696215 DOI: 10.1111/jch.14401] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/17/2023]
Abstract
Corin, a transmembrane serine protease that can cleave pro‐atrial natriuretic peptide (Pro‐ANP) into smaller bioactive molecule atrial natriuretic peptide, has been shown to be involved in the pathophysiology of hypertension, cardiac hypertrophy. We sought to examine the associations of corin genetic variations with salt sensitivity, blood pressure (BP) changes and hypertension incidence. We studied participants of the original Baoji Salt‐Sensitive cohort, recruited from 124 families from seven Chinese villages in 2004 who sequentially received a usual baseline salt diet, a 7‐day low salt diet (3 g/day) and a 7‐day high salt diet (18 g/day), respectively. They were followed up for 8 years (in 2009, 2012) to evaluate the development of hypertension. Corin SNP rs3749584 was significantly associated with diastolic BP (DBP) and mean arterial pressure (MAP) response to low‐salt diet, while rs4695253, rs17654278 were associated with pulse pressure (PP) response to low‐salt diet. SNPs rs4695253, rs12509275, rs2351783, rs2271036, rs2271037 were significantly associated with systolic BP (SBP), DBP, and MAP responses to high‐salt diet. In addition, SNPs rs12641823, rs6834933, rs2271036, and rs22710367 were significantly associated with the longitudinal changes in SBP, DBP, MAP, or PP over 8 years of follow‐up. SNP rs73814824 was significantly associated with the incidence of hypertension over 8 years. Gene‐based analysis showed that corin gene was significantly associated with longitudinal BP changes and hypertension incidence after 8‐year follow‐up. This study suggests that corin may play a role in salt sensitivity, BP progression, and development of hypertension.
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Affiliation(s)
- Ting Zou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Shi Yao
- National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ming-Fei Du
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Jian-Jun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Chao Chu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Gui-Lin Hu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yue-Yuan Liao
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Chen Chen
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Dan Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Qiong Ma
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Yu Yan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Hao Jia
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ke-Ke Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Yue Sun
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Ze-Jiaxin Niu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Xi Zhang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rui-Chen Yan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Zi-Yue Man
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Dan-Feng Ren
- Department of Infectious Diseases, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lan Wang
- Department of Cardiology, Xi'an International Medical Center Hospital, Xi'an, China
| | - Wei-Hua Gao
- Department of Cardiology, Xi'an No.1 Hospital, Xi'an, China
| | - Hao Li
- Department of Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yong-Xing Wu
- Department of Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chun-Hua Li
- Department of Ophthalmology, Xi'an People's Hospital, Xi'an, China
| | - Ke Gao
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jie Zhang
- Department of Cardiology, Xi'an People's Hospital, Xi'an, China
| | - Tie-Lin Yang
- Biomedical Informatics & Genomics Center, School of Life Science and Technology, Xi'an Jiaotong University, Key Laboratory of Biomedical Information Engineering of Ministry of Education, Xi'an, China
| | - Yang Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
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