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Qi Y, Duan Y, Deng Q, Yang N, Sun J, Li J, Hu P, Liu J, Liu J. Independent Relationship of Lipoprotein(a) and Carotid Atherosclerosis With Long-Term Risk of Cardiovascular Disease. J Am Heart Assoc 2024; 13:e033488. [PMID: 38639362 PMCID: PMC11179924 DOI: 10.1161/jaha.123.033488] [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: 12/29/2023] [Accepted: 03/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Lipoprotein(a) (Lp(a)) is considered to be a causal risk factor of atherosclerotic cardiovascular disease (ASCVD), but whether there is an independent or joint association of Lp(a) and atherosclerotic plaque with ASCVD risk remains uncertain. This study aims to assess ASCVD risk independently or jointly conferred by Lp(a) and carotid atherosclerotic plaque. METHODS AND RESULTS A total of 5471 participants with no history of cardiovascular disease at baseline were recruited and followed up for ASCVD events (all fatal and nonfatal acute coronary and ischemic stroke events) over a median of 11.5 years. Independent association of Lp(a), or the joint association of Lp(a) and carotid plaque with ASCVD risk, was explored using Cox proportional hazards models. Overall, 7.6% of the participants (60.0±7.9 years of age; 2649 [48.4%] men) had Lp(a) ≥50 mg/dL, and 539 (8.4/1000 person-years) incident ASCVD events occurred. Lp(a) concentrations were independently associated with long-term risk of total ASCVD events, as well as coronary events and ischemic stroke events. Participants with Lp(a) ≥50 mg/dL had a 62% higher risk of ASCVD incidence (95% CI, 1.19-2.21) than those with Lp(a) <10 mg/dL, and they exhibited a 10-year ASCVD incidence of 11.7%. This association exists even after adjusting for prevalent plaque. Moreover, participants with Lp(a) ≥30 mg/dL and prevalent plaque had a significant 4.18 times higher ASCVD risk than those with Lp(a) <30 mg/dL and no plaque. CONCLUSIONS Higher Lp(a) concentrations are independently associated with long-term ASCVD risk and may exaggerate cardiovascular risk when concomitant with atherosclerotic plaque.
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Affiliation(s)
- Yue Qi
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
- The Key Laboratory of Remodeling‐Related Cardiovascular Diseases, Ministry of EducationBeijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Youling Duan
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
- The Key Laboratory of Remodeling‐Related Cardiovascular Diseases, Ministry of EducationBeijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Qiuju Deng
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
- The Key Laboratory of Remodeling‐Related Cardiovascular Diseases, Ministry of EducationBeijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Na Yang
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
- The Key Laboratory of Remodeling‐Related Cardiovascular Diseases, Ministry of EducationBeijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Jiayi Sun
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
- The Key Laboratory of Remodeling‐Related Cardiovascular Diseases, Ministry of EducationBeijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Jiangtao Li
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
- The Key Laboratory of Remodeling‐Related Cardiovascular Diseases, Ministry of EducationBeijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Piaopiao Hu
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
- The Key Laboratory of Remodeling‐Related Cardiovascular Diseases, Ministry of EducationBeijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Jun Liu
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
- The Key Laboratory of Remodeling‐Related Cardiovascular Diseases, Ministry of EducationBeijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Jing Liu
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical UniversityBeijingChina
- Beijing Institute of Heart, Lung and Blood Vessel DiseasesBeijingChina
- The Key Laboratory of Remodeling‐Related Cardiovascular Diseases, Ministry of EducationBeijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
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Huang Y, Zhao H, Deng Q, Qi Y, Sun J, Wang M, Chang J, Hu P, Su Y, Long Y, Liu J. Association of neighborhood physical activity facilities with incident cardiovascular disease. Int J Health Geogr 2023; 22:16. [PMID: 37516882 PMCID: PMC10386722 DOI: 10.1186/s12942-023-00340-9] [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: 03/24/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND The availability of physical activity (PA) facilities in neighborhoods is hypothesized to influence cardiovascular disease (CVD), but evidence from individual-level long-term cohort studies is limited. We aimed to assess the association between neighborhood exposure to PA facilities and CVD incidence. METHODS A total of 4658 participants from the Chinese Multi-provincial Cohort Study without CVD at baseline (2007-2008) were followed for the incidence of CVD, coronary heart disease (CHD), and stroke. Availability of PA facilities was defined as both the presence and the density of PA facilities within a 500-m buffer zone around the participants' residential addresses. Time-dependent Cox regression models were performed to estimate the associations between the availability of PA facilities and risks of incident CVD, CHD, and stroke. RESULTS During a median follow-up of 12.1 years, there were 518 CVD events, 188 CHD events, and 355 stroke events. Analyses with the presence indicator revealed significantly lower risks of CVD (hazard ratio [HR] 0.80, 95% confidence interval ([CI] 0.65-0.99) and stroke (HR 0.76, 95% CI 0.60-0.97) in participants with PA facilities in the 500-m buffer zone compared with participants with no nearby facilities in fully adjusted models. In analyses with the density indicator, exposure to 2 and ≥ 3 PA facilities was associated with 35% (HR 0.65, 95% CI 0.47-0.91) and 28% (HR 0.72, 95% CI 0.56-0.92) lower risks of CVD and 40% (HR 0.60, 95% CI 0.40-0.90) and 38% (HR 0.62, 95% CI 0.46-0.84) lower risks of stroke compared with those without any PA facilities in 500-m buffer, respectively. Effect modifications between presence of PA facilities and a history of hypertension for incident stroke (P = 0.049), and a history of diabetes for incident CVD (P = 0.013) and stroke (P = 0.009) were noted. CONCLUSIONS Residing in neighborhoods with better availability of PA facilities was associated with a lower risk of incident CVD. Urban planning intervention policies that increase the availability of PA facilities could contribute to CVD prevention.
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Affiliation(s)
- Yulin Huang
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
- National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China
- The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China
| | - Huimin Zhao
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, Beijing, 100084, China
| | - Qiuju Deng
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
- National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China
- The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China
| | - Yue Qi
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
- National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China
- The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China
| | - Jiayi Sun
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
- National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China
- The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China
| | - Miao Wang
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
- National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China
- The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China
| | - Jie Chang
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
- National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China
- The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China
| | - Piaopiao Hu
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
- National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China
- The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China
| | - Yuwei Su
- School of Urban Design, Wuhan University, Wuhan, 430072, China
| | - Ying Long
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, Beijing, 100084, China.
| | - Jing Liu
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China.
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China.
- National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China.
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China.
- The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China.
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Zhou J, Wang R, Mao J, Gu Y, Shao A, Liu F, Zhang J. Prognostic models for survival and consciousness in patients with primary brainstem hemorrhage. Front Neurol 2023; 14:1126585. [PMID: 36908614 PMCID: PMC9995821 DOI: 10.3389/fneur.2023.1126585] [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: 12/18/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives Primary brainstem hemorrhage (PBSH) is one of the most catastrophic spontaneous intracerebral hemorrhage diseases, with a mortality rate of 70-80%. We explored the predictive factors for survival and consciousness in patients with PBSH (ClinicalTrials.gov ID: NCT04910490). Methods We retrospectively reviewed 211 patients with PBSH admitted to our institution between January 2014 and October 2020. Clinical outcomes included the 30-day survival rate and the 90-day consciousness rate as evaluated by the National Institutes of Health Stroke Scale score. Multiple logistic regression analysis was performed. Results The overall 30-day survival rate of 211 patients with PBSH was 70%. Several predictive factors including hematoma volume, hematoma location, activated partial thromboplastin time (APTT) upon admission, and therapeutic strategy were significantly related to 30-day survival. Compared with conservative treatment, stereotactic aspiration in our prediction model is strongly associated with improved 30-day survival (odds ratio, 6.67; 95% confidence interval, 3.13-14.29; P < 0.001). The prognosis prediction model of 90-day consciousness including factors such as mydriasis, APTT value, hematoma location, and hematoma volume upon admission has a good predictive effect (AUC, 0.835; 95% confidence interval, 0.78-0.89; P < 0.001). Conclusion In patients with PBSH, conscious state upon admission, coagulation function, hematoma volume, hematoma location, and therapeutic strategy were significantly associated with prognosis. Stereotactic aspiration could significantly reduce the 30-day mortality rate.
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Affiliation(s)
- Jingyi Zhou
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Rui Wang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jizhong Mao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, Zhejiang, China
| | - Yichen Gu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Anwen Shao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fengqiang Liu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China
- Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China
- Stroke Research Center for Diagnostic and Therapeutic Technologies of Zhejiang Province, Hangzhou, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, China
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Predictive Value of the Age, Creatinine, and Ejection Fraction (ACEF) Score in Cardiovascular Disease among Middle-Aged Population. J Clin Med 2022; 11:jcm11226609. [PMID: 36431085 PMCID: PMC9692582 DOI: 10.3390/jcm11226609] [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: 09/29/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To explore the predictive value of ACEF scores for identifying the risk of cardiovascular disease (CVD) in the general population. METHODS A total of 8613 participants without a history of CVD were enrolled in the follow-up. The endpoint was CVD incidence, defined as stroke or coronary heart disease (CHD) diagnosed during the follow-up period. Cox regression analyses were used to calculate hazard ratios (HRs) with respect to the age, creatinine, and ejection fraction (ACEF) scores and CVD. A Kaplan-Meier curve was used to analyze the probability of CVD in different quartiles of ACEF. Restricted cubic spline was used to further explore whether the relationship between ACEF and CVD was linear. Finally, we assessed the discriminatory ability of ACEF for CVD using C-statistics, net reclassification index, and integrated discrimination improvement (IDI). RESULTS During a median follow-up period of 4.66 years, 388 participants were diagnosed with CVD. The Kaplan-Meier curve showed that ACEF was associated with CVD, and participants with high ACEF scores were significantly more likely to be diagnosed with CVD compared to participants with low ACEF scores in the general population. In the multivariate Cox regression analysis, the adjusted HRs for four quartiles of ACEF were as follows: the first quartile was used as a reference; the second quartile: HR = 2.33; the third quartile: HR = 4.81; the fourth quartile: HR = 8.00. Moreover, after adding ACEF to the original risk prediction model, we observed that new models had higher C-statistic values of CVD than the traditional model. Furthermore, the results of both NRI and IDI were positive, indicating that ACEF enhanced the prediction of CVD. CONCLUSIONS Our study showed that the ACEF score was associated with CVD in the general population in northeastern China. Furthermore, ACEF could be a new tool for identifying patients at high risk of primary CVD in the general population.
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Zhou H, Ding X, Yang Q, Chen S, Li Y, Zhou X, Wu S. Associations of Hypertriglyceridemia Onset Age With Cardiovascular Disease and All-Cause Mortality in Adults: A Cohort Study. J Am Heart Assoc 2022; 11:e026632. [PMID: 36250656 DOI: 10.1161/jaha.122.026632] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Limited studies have involved new-onset hypertriglyceridemia, and this study was to evaluate the associations of hypertriglyceridemia onset age with cardiovascular diseases (CVD) and all-cause mortality. Methods and Results This population-based prospective study enrolled 98 779 participants free of hypertriglyceridemia and CVD at baseline in the Kailuan study initiated in June 2006. All participants underwent health checkups biennially until December 2017, and a total of 13 832 participants developed new hypertriglyceridemia. A 1:1 age- (±1 year) and sex-matched analysis was applied to select control subject of the same year for each new-onset case. There were 13 056 case-control pairs included. The total follow-up time was 179 409 person-years, with a median follow-up time of 7.0 years. Primary outcomes were CVD and all-cause mortality, and hazard ratios were estimated after adjustment for baseline characteristics. A total of 807 incident CVD events and 600 all-cause mortality events were documented. After multivariable adjustment, participants with hypertriglyceridemia onset age <45 years had the highest risk compared with matched controls, with hazard ratios of 2.61 (95% CI, 1.59-4.27) for CVD, 4.69 (95% CI, 2.34-9.40) for all-cause mortality, 2.23 (95% CI, 0.67-7.38) for myocardial infarction, and 2.68 (95% CI, 1.56-4.62) for stroke. The risk estimates gradually decreased with each decade increase in the onset age of hypertriglyceridemia. Conclusions Among Chinese adults, hypertriglyceridemia identified at an earlier onset age was associated with higher risks for CVD and all-cause mortality.
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Affiliation(s)
- Hui Zhou
- Xiangya School of Nursing Central South University Changsha China
| | - Xiong Ding
- School of Public Health Wuhan University Wuhan China
| | - Qing Yang
- Department of Cardiology Tianjin Medical University General Hospital Tianjin China
| | - Shuohua Chen
- Department of Cardiology Kailuan General Hospital Tangshan China
| | - Yun Li
- School of Public Health Wuhan University Wuhan China
| | - Xin Zhou
- Department of Cardiology Tianjin Medical University General Hospital Tianjin China
| | - Shouling Wu
- Department of Cardiology Kailuan General Hospital Tangshan China
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Association of Serum Potassium Levels with Mortality and Cardiovascular Events: Findings from the Chinese Multi-provincial Cohort Study. J Gen Intern Med 2022; 37:2446-2453. [PMID: 34505984 PMCID: PMC9360291 DOI: 10.1007/s11606-021-07111-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dyskalemia involves critical electrolyte abnormalities and increases mortality risk in patients with acute clinical conditions. However, the association between dyskalemia and adverse outcomes in the general population is less well established. OBJECTIVE To investigate the association of serum potassium levels with mortality and cardiovascular events in the general population and to explore the characteristics of individuals at high risk. DESIGN A prospective cohort study. PARTICIPANTS A total of 5220 participants aged 50-79 years in the Chinese Multi-provincial Cohort Study. MAIN MEASURES Serum potassium levels were measured by the ion-selective electrode method. The outcomes were incident cardiovascular disease (CVD), CVD death, non-CVD death, and total death. KEY RESULTS Of the 5220 participants, 48.2% were men, and the mean age was 62.3 (SD 7.6) years. Hyperkalemia was found in 8.7% of the participants and was significantly associated with total death (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.18-2.23) and CVD death (HR, 2.12; 95% CI, 1.25-3.61) after adjustment. Furthermore, the HRs (95% CIs) of hyperkalemia combined with 2 and ≥ 3 risk factors were 2.37 (1.50-3.74) and 4.06 (2.37-6.95) for total death and 3.26 (1.56-6.80) and 8.42 (4.06-17.50) for CVD death, respectively. The 10-year cumulative incidence of total death was 17.4% for participants with 2 or more risk factors. CONCLUSION Hyperkalemia is associated with an increased risk of all-cause and CVD death, and this risk is more pronounced in patients with multiple risk factors. Our findings suggest that early identification and management of hyperkalemia in the general population are warranted.
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Sun Y, Li X, Ding Y, Han B, Wang J, Meng K, Han Y. Balloon Angioplasty vs. Stenting for Symptomatic Intracranial Arterial Stenosis. Front Neurol 2022; 13:878179. [PMID: 35775041 PMCID: PMC9237476 DOI: 10.3389/fneur.2022.878179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
AimsWe performed a meta-analysis to indirectly compare the treatment effectiveness of balloon angioplasty and stenting for patients with intracranial arterial stenosis.MethodsLiterature searches were performed in well-known databases to identify eligible studies published before January 04, 2021. The incidence of restenosis, transient ischemic attack (TIA), stroke, death, and dissection after balloon angioplasty or stenting were pooled. An indirect comparison of balloon angioplasty vs. stenting was performed, and the ratios of incidence (RIs) with 95% confidence intervals (CIs) were calculated using the random-effects model.Results120 studies that recruited 10,107 patients with intracranial arterial stenosis were included. The pooled incidence of restenosis after balloon angioplasty and stenting were 13% (95%CI: 8-17%) and 11% (95%CI: 9-13%), respectively, with no significant difference between them (RI: 1.18; 95%CI: 0.78–1.80; P = 0.435). Moreover, the pooled incidence of TIA after balloon angioplasty and stenting was 3% (95%CI: 0–6%) and 4% (95%CI: 3%-5%), and no significant difference was observed (RI: 0.75; 95%CI: 0.01–58.53; P = 0.897). The pooled incidence of stroke after balloon angioplasty and stenting was 7% (95%CI: 5–9%) and 8% (95%CI: 7–9%), respectively, and the difference between groups was found to be statistically insignificant (RI: 0.88; 95%CI: 0.64–1.20; P = 0.413). Additionally, the pooled incidence of death after balloon angioplasty and stenting was 2% (95%CI: 1–4%) and 2% (95%CI: 1–2%), with no significant difference between groups (RI: 1.00; 95%CI: 0.44–2.27; P = 1.000). Finally, the pooled incidence of dissection after balloon angioplasty and stenting was 13% (95%CI: 5–22%) and 3% (95%CI: 2–5%), respectively, and balloon angioplasty was associated with a higher risk of dissection than that with stenting for patients with intracranial arterial stenosis (RI: 4.33; 95%CI: 1.81–10.35; P = 0.001).ConclusionThis study found that the treatment effectiveness of balloon angioplasty and stenting were similar for patients with symptomatic intracranial arterial stenosis.
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Affiliation(s)
- Yaxuan Sun
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China
- *Correspondence: Yaxuan Sun
| | - Xihua Li
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yongxia Ding
- College of Nursing, Shanxi Medical University, Taiyuan, China
| | - Bin Han
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Jing Wang
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Kun Meng
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Yan Han
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
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Rehman S, Rehman E, Mumtaz A, Jianglin Z. Cardiovascular Disease Mortality and Potential Risk Factor in China: A Multi-Dimensional Assessment by a Grey Relational Approach. Int J Public Health 2022; 67:1604599. [PMID: 35574277 PMCID: PMC9101313 DOI: 10.3389/ijph.2022.1604599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aims to investigate the impact of hypertension, diabetes, and high blood cholesterol on increased mortality from cardiovascular diseases such as coronary heart disease, stroke, and pulmonary heart disease in a multi-dimensional way. Methods: The grey relational analysis methodology is adopted to assess the connection between cardiac risk factors and related mortality. The Hurwicz and the Conservative (Min-Max) criterion approach are also utilized to identify the prospective risk factor that contributes the most to increased cardiac mortality. Results: The findings reveal that hypertension has a more grounded relationship with stroke and pulmonary heart disease mortality, whereas high blood cholesterol appears to be the leading contributor to deaths from coronary heart disease. The results based on the Hurwicz and the Min-Max criterion show a robust connection between dyslipidemia, coronary heart disease, and cardiovascular disease mortality. Conclusion: Combating uncontrolled blood cholesterol and blood pressure levels would necessitate a multi-pronged strategy at both the national and local levels. Besides, the suggested methodologies provide a valuable tool and additional practical knowledge for public health policymakers and decision-makers in drawing rational decisions to combat China's rising CVD burden.
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Affiliation(s)
- Shazia Rehman
- Department of Dermatology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The first Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.,Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, China.,Department of Biomedical Sciences, Pak-Austria Fachhochschule: Institute of Applied Sciences and Technology, Haripur, Pakistan
| | - Erum Rehman
- School of Economics, Shandong University of Finance and Economics, Jinan, China
| | - Ayesha Mumtaz
- School of Public Administration, Hangzhou Normal University, Hangzhou, China
| | - Zhang Jianglin
- Department of Dermatology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The first Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.,Candidate Branch of National Clinical Research Center for Skin Diseases, Shenzhen, China
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He F, Blackberry I, Yao L, Xie H, Mnatzaganian G. Geographical Disparities in Pooled Stroke Incidence and Case Fatality in Mainland China, Hong Kong, and Macao: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc 2022; 11:e32566. [PMID: 35040797 PMCID: PMC8808348 DOI: 10.2196/32566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Geographical variations in stroke incidence and case fatality in China have been reported. Nonetheless, pooled estimates in major Chinese regions are unknown. Objective This systematic review and meta-analysis aims to investigate pooled estimates of incidence and short-term case fatality of stroke in Mainland China, Hong Kong, and Macao. Methods Longitudinal studies published in English and indexed in PubMed/MEDLINE, Embase, CINAHL, and Web of Science, or in Chinese and indexed in SinoMed and CQVIP will be targeted. Articles reporting on adults living in China who experience first-ever stroke or die within 1 year from newly onset stroke will be included. The 95% confidence intervals of the event will be estimated using the exact method based on the Poisson distribution. The log incidence rates together with their corresponding log standard errors will be meta-analyzed using DerSimonian and Laird random effects models. Pooled case fatality rates will also be estimated using a random effect model. Time trends in pooled age-standardized stroke incidence and case fatality will be estimated. The heterogeneity of the included studies will be measured using the I2 statistic and meta-regressions will be run to analyze the effect of reported covariates on found heterogeneity. Risk of bias will be examined using the Newcastle-Ottawa Scale. Publication bias will be tested using funnel plots and Egger tests. Sensitivity analysis will be run by risk of bias. Results This study was funded and registered in 2020. The systematic searches, study selections, and quality assessments were completed in July 2021. Data extraction and analysis and manuscript writing are scheduled to be completed by December 2021. Conclusions This will be the first study to provide regional differences in pooled estimates of stroke incidence with case fatality in Mainland China, Hong Kong, and Macao. This study will assist in addressing inequalities in stroke care across China. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020170724; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170724 International Registered Report Identifier (IRRID) PRR1-10.2196/32566
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Affiliation(s)
- Fan He
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, Australia
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, Australia
| | - Liqing Yao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haiyan Xie
- Department of Health Care, Peking Union Medical College Hospital, Beijing, China
| | - George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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10
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Li S, Liu Z, Joseph P, Hu B, Yin L, Tse LA, Rangarajan S, Wang C, Wang Y, Islam S, Liu W, Lu F, Li Y, Hou Y, Qiang D, Zhao Q, Li N, Lei R, Chen D, Han A, Liu G, Zhang P, Zhi Y, Liu C, Yang J, Resalaiti A, Ma H, Ma Y, Liu Y, Xing X, Xiang Q, Liu Z, Sheng Y, Tang J, Liu L, Yusuf S, Li W. OUP accepted manuscript. Eur Heart J 2022; 43:2852-2863. [PMID: 35731140 DOI: 10.1093/eurheartj/ehac268] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/24/2022] [Accepted: 05/10/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sidong Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiguang Liu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Bo Hu
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Chuangshi Wang
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shofiqul Islam
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Weida Liu
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fanghong Lu
- Shandong Academy of Medical Sciences, Basic Medical Institute, Jinan, China
| | - Yindong Li
- Shunyi District Center for Disease Control and Prevention, Beijing, China
| | - Yan Hou
- Balingqiao Community Health Service Center, Taiyuan, China
| | - Deren Qiang
- Wujin District Center for Disease Control and Prevention, Changzhou, China
| | - Qian Zhao
- West China Hospital of Sichuan University, Chengdu, China
| | - Ning Li
- Qingshanhu Community Health Service Station, Nanchang, China
| | - Rensheng Lei
- Center for Disease Control and Prevention of Nanchang County, Nanchang, China
| | - Di Chen
- Jishuitan Hospital, Beijing, China
| | - Aiying Han
- Bayannaoer Center for Disease Control and Prevention, Bayannaoer, China
| | - Guoqin Liu
- Jingle People's Hospital, Xinzhou, China
| | - Peng Zhang
- Health Center of Guanshan Town, Xi'an, China
| | - Yahong Zhi
- Hospital of Xi'an University of Electronic Science and Technology, Xi'an, China
| | - Chunmei Liu
- Mengla District Center for Disease Control and Prevention, Xishuangbanna, China
| | - Jinkui Yang
- Central hospitals of Menglong District, Xishuangbanna, China
| | | | - Haibin Ma
- Xining Center for Disease Control and Prevention, Xining, China
| | - Yuanting Ma
- Xining east area of Dongguan Street Community Health Service Center, Xining, China
| | - Yu Liu
- 242 Hospital, Shenyang, China
| | - Xiaojie Xing
- The Red Cross hospital of Shenyang, Shenyang, China
| | - Quanyong Xiang
- Jiangsu Centers for Disease Control and Prevention, Nanjing, China
| | - Zhengrong Liu
- Jiangxinzhou Community Health Service Center, Nanjing, China
| | - Yundong Sheng
- Jiangxinzhou Community Health Service Center, Nanjing, China
| | | | - Lisheng Liu
- Beijing Hypertension League Institute, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Wei Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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11
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Kim E, Baek J, Kim M, Lee H, Bae JW, Kim HC. Trends in Regional Disparity in Cardiovascular Mortality in Korea, 1983–2019. Korean Circ J 2022; 52:829-843. [PMID: 36347519 PMCID: PMC9643572 DOI: 10.4070/kcj.2022.0156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/28/2022] [Accepted: 08/24/2022] [Indexed: 11/05/2022] Open
Abstract
Mortality from cardiovascular diseases (CVDs) had been significantly improved in several decades. However, the recent reduction was slowed down, and the burden remained high. Understanding regional disparity in cardiovascular deaths would help facilitate the improvement. Thus, we investigated geographic variation in CVD mortality and its spatiotemporal trend in Korea between 1983 and 2019. The findings showed higher mortality in the southeastern regions, while the regional disparity converged over time. It suggested that these regions call for action in terms of prevention and management of CVDs, in addition to an effort to reduce the death rates in other regions. Background and Objectives Despite remarkable reduction in cardiovascular disease (CVD) mortality, the burden has remained the leading cause of death. Since little research has focused on regional disparity in CVD mortality, this study aims to investigate its spatiotemporal trends in Korea from 1983 to 2019. Methods Using the causes of death statistics in Korea, we analyzed the geographic variation in deaths from CVDs from 1983 to 2019. The sex and age-standardized mortality rate was calculated according to the 17 administrative regions. The analyses include all diseases of the circulatory system (International Classification of Diseases-10 codes, I00–I99), along with the following 6 subcategories which were not mutually exclusive: total heart disease (I00–I13 and I20–I51), hypertensive heart disease (I10–I13), ischemic heart disease (I20–I25), myocardial infarction (I21–I23), heart failure (I50), and cerebrovascular disease (I60–I69). Results Overall, heart failure death rate increased across all regions, and other CVD death rates showed a decreasing trend. Regional disparity in mortality was substantial in the early 1980s but converged over time. In all types of cardiovascular mortality, Busan, Ulsan and Gyeongnam remained the highest, although they showed a downward trend like other regions. Jeju continued to have a relatively low CVD mortality rate. Conclusions The regional disparity substantially decreased compared to the 1980s. However, the relatively high burden of CVD mortality in the southeastern region has not been fully resolved.
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Affiliation(s)
- Eunji Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jongmin Baek
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
| | - Min Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Korea
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12
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Cai X, Zhou J, Li W, Cheng L, Yuan Z, Xiao Y. Potential Influential Factors of In-Hospital Myocardial Reinfarction in ST-Segment Elevation Myocardial Infarction (STEMI) Patients: Finding from the Improving Care for Cardiovascular Disease in China- (CCC-) Acute Coronary Syndrome (ACS) Project. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9977312. [PMID: 34659644 PMCID: PMC8514929 DOI: 10.1155/2021/9977312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/15/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
In this study, 39915 inpatients with a discharge diagnosis of STEMI from the CCC-ACS project phase I and II were included. The prevalence of the medical history, clinical complications on admission and treatment during hospitalization in the STEMI inpatients with and without in-hospital reinfarction was presented. The factors that were differentially distributed and of critical clinical significance (e.g., age, sex, heart rate, smoking, MI history, HF history, COPD history, stroke, hypertension, diabetes, PCI treatment, administration of DAPT, and statins) were entered into standard Cox regression model and competing risk model for potential influential factors of in-hospital reinfarction. Patients with a higher heart rate (OR 1.018; 95% CI 1.003 to 1.033) were more susceptible to in-hospital reinfarction. Myocardial infarction history (OR 2.840; 95% CI 1.160 to 6.955) was a risk factor of in-hospital reinfarction independent of hypertension, diabetes, and dyslipidaemia.
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Affiliation(s)
- Xiaojie Cai
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Juan Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wenyuan Li
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lele Cheng
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yihui Xiao
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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13
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Dong Y, Liu X, Zhao Y, Chai Q, Zhang H, Gao Y, Liu Z. Attenuating the Variability of Lipids Is Beneficial for the Hypertension Management to Reduce the Cardiovascular Morbidity and Mortality in Older Adults. Front Cardiovasc Med 2021; 8:692773. [PMID: 34222383 PMCID: PMC8245783 DOI: 10.3389/fcvm.2021.692773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 01/13/2023] Open
Abstract
Objective: To investigate the beneficial of attenuating the variability of lipids to the hypertension management in older adults. Methods: Between April 2008 and November 2010, 1,244 hypertensive patients aged ≥60 years were recruited and randomized into placebo and rosuvastatin groups. Outcomes and inter-visit plasma lipids variability were assessed. Results: Over an average follow-up of 83.5 months, the coefficients of variation (CVs) in total cholesterol (TCHO), triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were significantly lower in the rosuvastatin group than the placebo group (p < 0.05). The risks of composite cardiovascular event, myocardial infarction, coronary revascularization, heart failure, total stroke, ischemic stroke, cardiovascular death, and all-cause death were significantly lower in the rosuvastatin group than the placebo group (all p < 0.05). The differences in the risks were significantly diminished after the CVs for TCHO, triglycerides, HDL-c, and LDL-c were separately included as confounders. One-SD of CVs for TCHO, triglycerides, HDL-c, and LDL-c increment were significantly associated with the risks of composite cardiovascular event, myocardial infarction, heart failure, total stroke, ischemic stroke, cardiovascular death, and all-cause death, respectively (all p < 0.05). Conclusions: Rosuvastatin significantly attenuated the intra-visit variability in lipids and decreased the risk of cardiovascular mortality and morbidity. Controlling the variability of lipids is as important as antihypertensive treatment to reduce the cardiovascular morbidity and mortality in the management of older hypertensive patients. Clinical Trial Registration:ChiCTR.org.cn, ChiCTR-IOR-17013557.
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Affiliation(s)
- Yuanli Dong
- Department of Community, Lanshan District People Hospital, Linyi, China
| | - Xukui Liu
- Basic Medical College, Shandong First Medical University, Jinan, China
| | - Yingxin Zhao
- Basic Medical College, Shandong First Medical University, Jinan, China.,Cardio-Cerebrovascular Control and Research Center, Institute of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qiang Chai
- Basic Medical College, Shandong First Medical University, Jinan, China.,Cardio-Cerebrovascular Control and Research Center, Institute of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hua Zhang
- Basic Medical College, Shandong First Medical University, Jinan, China.,Cardio-Cerebrovascular Control and Research Center, Institute of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yumei Gao
- Department of Cardiology, Hekou District People Hospital, Dongying, China
| | - Zhendong Liu
- Basic Medical College, Shandong First Medical University, Jinan, China.,Cardio-Cerebrovascular Control and Research Center, Institute of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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14
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Rao Z, Hua J, Li R, Fu Y, Li J, Xiao W, He J, Hu G. Changes in Six-Month Prevalence of Circulatory System Diseases among People Aged 20 Years and Older between 2013 and 2018 in Hunan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052599. [PMID: 33807674 PMCID: PMC7967526 DOI: 10.3390/ijerph18052599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
Recent changes in population-based prevalence for circulatory system diseases (CSDs) remain unreported either nationally or locally for China. Data were from the two-round health service household interview survey of Hunan Province, China, in 2013 and 2018. A Rao–Scott chi-square test was performed to examine prevalence differences across socio-demographic variables. The overall age-standardized prevalence of CSDs increased substantially between 2013 and 2018 for inhabitants aged 20 years and older (14.25% vs. 21.25%; adjusted odds ratio (OR) = 1.59, 95% CI: 1.24–2.04). Hypertensive disease was the most prevalent type of CSD, accounting for 87.24% and 83.83% of all CSDs in 2013 and in 2018, respectively. After controlling for other socio-demographic factors, the prevalence of CSDs was significantly higher in 2018 (adjusted OR = 1.40), urban residents (adjusted OR = 1.43), females (adjusted OR = 1.12) and older age groups (adjusted OR = 5.36 for 50–59 years, 9.51 for 60–69 years, 15.19 for 70–79 years, and 12.90 for 80 years and older) than in 2013, rural residents, males and the youngest age group (20–49 years). The recent increase in the overall age-standardized CSD prevalence and the large prevalence disparities across urban/rural residents, sex and age groups merit the attention of policymakers and researchers. Further prevention efforts are needed to curb the increasing tendency and to reduce the prevalence of disparities across socio-demographic groups.
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Affiliation(s)
| | | | | | | | | | | | | | - Guoqing Hu
- Correspondence: ; Tel.: +86-0731-84805414
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15
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Qin H, Chen Y, Liu G, Turnbull I, Zhang R, Li Z, Wang Y, Liu L, Zhao X, Chen Z, Wang Y. Management characteristics and prognosis after stroke in China: findings from a large nationwide stroke registry. Stroke Vasc Neurol 2021; 6:1-9. [PMID: 32571805 PMCID: PMC8005905 DOI: 10.1136/svn-2020-000340] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE There is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China. This study aimed to assess clinical characteristics, in-hospital and after-discharge management characteristics and prognosis for stroke types in China. METHODS A nationwide registry recruited 14 244 imaging-confirmed first-ever incident strokes from 132 hospitals across 31 provinces of China during 2007-2008, recording presenting characteristics, diagnostic procedures and in-hospital treatment. After hospital discharge, patients were followed up for 6 months. Conventional statistical methods were used to examine the patterns of management and prognosis. RESULTS Overall, 68.7%, 26.9% and 4.4% were ischaemic stroke (IS), intracerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH), respectively. Only 20% were managed in a dedicated stroke unit. Among IS, 1.3% received thrombolysis within 3 hours after symptom onset, whereas the proportions of receiving in-hospital antiplatelet therapy, neuroprotective agents and traditional Chinese medicines (TCM) were 88.4%, 69.7% and 70.6%, respectively. For ICH, 63.3% and 36.3% received neuroprotective agents and TCM in hospital, respectively. At discharge, 70.7% and 38.0% of the patients with IS were given antiplatelet and statin therapies, respectively, decreasing to 64.8% and 23.9%, respectively, at 6 months. In-hospital mortality was 3.2%, 9.3% and 10.1% for IS, ICH and SAH, respectively, with a further 8.6%, 18.2% and 22.0%, respectively, died by 6 month. Meanwhile, in-hospital recurrence rate was 2.6%, 1.9% and 7.2% for IS, ICH and SAH, respectively, with a further 8.0%, 5.1% and 7.5%, respectively, recurred by 6 month. CONCLUSIONS In China, the mortality rate of stroke is lower than that reported from west populations, though most strokes are not managed in specialised stroke unit. There is widespread use of some unproven therapies but limited proven treatments, especially after discharge, leading to unnecessary recurrent risks.
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Affiliation(s)
- Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Iain Turnbull
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zhengming Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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16
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Li Y, Zhao D, Wang M, Sun JY, Liu J, Qi Y, Hao YC, Deng QJ, Liu J, Liu J, Liu M. Combined effect of menopause and cardiovascular risk factors on death and cardiovascular disease: a cohort study. BMC Cardiovasc Disord 2021; 21:109. [PMID: 33622241 PMCID: PMC7903751 DOI: 10.1186/s12872-021-01919-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Observational studies suggest that early menopause is associated with increased risk of death and cardiovascular disease (CVD); however, the results of these studies have been inconsistently. We aimed to assess the association of menopause with death and CVD and whether this association was modified by cardiovascular risk factors. METHODS The study population was women age 35-64 years living in two communities of Beijing who were enrolled in the Chinese Multi-provincial Cohort Study in 1992. Participants were followed until first cardiovascular event, death, or the end of follow-up (2018). Self-reported age at menopause was recorded. Multivariate Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of death and CVD after adjusting for baseline covariates of age, family history of CVD, and white blood cell count, as well as time-varying covariates of menopause, use of oral estrogen, and conventional risk factors. Additionally, we assessed the combined effect of age at menopause and risk factors on the primary endpoint. RESULTS Of 2104 eligible women, 124 died and 196 had a first CVD event (33 fatal CVD and 163 non-fatal CVD). Compared with women who experienced menopause at age 50-51 years, the risk of death was higher in women with menopause at age 45-49 years (HR 1.99, 95% CI 1.24-3.21; P = 0.005), and the risk of ischemic stroke was higher in women with menopause at age < 45 years (HR 2.16, 95% CI 1.04-4.51; P = 0.04) and at age 45-49 years (HR 2.05, 95% CI 1.15-3.63; P = 0.01). Women who had menopause before age 50 years and at least one elevated risk factor at baseline had a higher risk of death (HR 11.10, 95% CI 1.51-81.41; P = 0.02), CVD (HR 3.98, 95% CI 1.58-10.01; P = 0.003), ischemic CVD (HR 4.53, 95% CI 1.63-12.62; P = 0.004), coronary heart disease (HR 8.63, 95% CI 1.15-64.50; P = 0.04), and stroke (HR 2.92, 95% CI 1.03-8.29; P = 0.04) than those with menopause at age 50-51 years and optimal levels of all risk factors. CONCLUSIONS Earlier menopause may predict death and ischemic stroke. Furthermore, there is a combined effect of earlier menopause and elevated risk factors on death and CVD.
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Affiliation(s)
- Yan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Miao Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jia-Yi Sun
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yue Qi
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yong-Chen Hao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Qiu-Ju Deng
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
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Yao Q, Zhang J, Yan K, Zheng Q, Li Y, Zhang L, Wu C, Yang Y, Zhou M, Zhu C. Development and validation of a 2-year new-onset stroke risk prediction model for people over age 45 in China. Medicine (Baltimore) 2020; 99:e22680. [PMID: 33031337 PMCID: PMC7544427 DOI: 10.1097/md.0000000000022680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Multiple factors, including increasing incidence, poor knowledge of stroke and lack of effective, noninvasive and convenient stroke risk prediction tools, make it more difficult for precautions against stroke in China. Effective prediction models for stroke may assist to establish better risk awareness and management, healthier lifestyle, and lower stroke incidence for people.The China Health and Retirement Longitudinal Survey was the development cohort. Logistic regression was applied to model's development, in which the candidate variables with statistically significant coefficient were included in the prediction model. The area under receiver operating characteristic curve (AUC) and 10-times cross-validation were used for internal validation. Cutoff point of high-risk group was measured by Youden index. The China Health and Nutrition Survey was the validation cohort.The development cohort and the validation cohort included 16557 and 5065 participants, and the incidence density was 358.207/100,000 person-year and 350.701/100,000 person-year, respectively. The model for 2-year new-onset stroke risk prediction included age, hypertension, diabetes, heart disease, and smoking. The AUC and cross-validation AUC were 0.707 (95% confidence interval[CI]: 0.664, 0.750) and the 0.710 (95% CI: 0.650, 0.736). The sensitivity, specificity and accuracy of the cutoff point were 0.774, 0.545, and 0.319. The AUC and cross-validation AUC were 0.800 (95% CI: 0.744, 0.856) and 0.811(95% CI:0.714, 0.847), and the sensitivity, specificity and accuracy of cutoff point being 0.857,0.569, and 0.426 in external validation.A simple prediction tool using 5 noninvasive and easily accessible factors can assist in 2-year new-onset stroke risk prediction in Chinese people over 45 years old, which is believed to be applicable in identifying high-risk individuals and health management in China.
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Affiliation(s)
- Qiang Yao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Jing Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Ke Yan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Qianwen Zheng
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Yawen Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Lu Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Chenyao Wu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Yanling Yang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
| | - Muke Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University
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Liu Q, Xu X, Fang J, Deng Y, He L. Comparison and Analysis of Epidemiologic Characteristics of Stroke in Sichuan Province, China. Front Neurol 2020; 11:877. [PMID: 32973659 PMCID: PMC7481474 DOI: 10.3389/fneur.2020.00877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 07/09/2020] [Indexed: 11/24/2022] Open
Abstract
Previous studies have shown that there is a geographic variation in the prevalence of stroke, with a lower prevalence of stroke in Sichuan province. And a stroke transition was found during the period of economic development as well. However, as the center of Southwest China, with a greatly developed economy, whether the geographic variation remained with lower burden of stroke in Sichuan province is unknown. Therefore, in this study, we analyzed the secular stroke status in Sichuan province to help explore the potential reasons for geographic disparity. From a cross-sectional study conducted based on eight national disease surveillance points (DSPs) in Sichuan province in 2013, the epidemiologic data of stroke were collected. Data of risk factors were obtained from a cross-sectional study based on 12 national DSPs in Sichuan province in 2013. The results showed that the age-standardized prevalence, incidence, and mortality of stroke in Sichuan province were 338.6/100,000 people [95% confidence interval (CI), 267.8–409.4], 147.1/100,000 person-years (95% CI = 100.6–193.6), and 72.4/100,000 person-years (95% CI = 40.0–104.8), respectively, which were significantly lower than those determined from the contemporary data of China in 2013. The analysis of the risk factors showed that the weights of contribution of the potential risk factors to stroke were in consistency with those published reports from other areas. In conclusion, the disparity of lower stroke burden in Sichuan than the average China remained, although with the great developments in Sichuan province over all those decades. In addition to traditional modifiable factors, we suggest that unknown or intrinsic differences such as genetic factors might play an important role in geographic disparity, which should be investigated in future studies.
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Affiliation(s)
- Qian Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyin Xu
- Sichuan Center for Disease Control and Prevention, Sichuan, China
| | - Jinghuan Fang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Deng
- Sichuan Center for Disease Control and Prevention, Sichuan, China
- *Correspondence: Ying Deng
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Li He
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Dong W, Wan EYF, Bedford LE, Wu T, Wong CKH, Tang EHM, Lam CLK. Prediction models for the risk of cardiovascular diseases in Chinese patients with type 2 diabetes mellitus: a systematic review. Public Health 2020; 186:144-156. [PMID: 32836004 DOI: 10.1016/j.puhe.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/23/2020] [Accepted: 06/07/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Diabetes mellitus (DM) is a serious public health issue worldwide, and DM patients have higher risk of cardiovascular diseases (CVDs), which is the leading cause of DM-related deaths. China has the largest DM population, yet a robust model to predict CVDs in Chinese DM patients is still lacking. This systematic review is carried out to summarize existing models and identify potentially important predictors for CVDs in Chinese DM patients. STUDY DESIGN Systematic review. METHODS Medline and Embase were searched for data from April 1st, 2011 to May 31st, 2018. A study was eligible if it developed CVD (defined as total CVD or any major cardiovascular component) risk prediction models or explored potential predictors of CVD specifically for Chinese people with type 2 DM. Standardized forms were utilized to extract information, appraise applicability, risk of bias, and availabilities. RESULTS Five models and 29 studies focusing on potential predictors were identified. Models for a primary care setting, or to predict total CVD, are rare. A number of common predictors (e.g. age, sex, diabetes duration, smoking status, glycated hemoglobin (HbA1c), blood pressure, lipid profile, and treatment modalities) were observed in existing models, in which urine albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) are highly recommended for the Chinese population. Variability of blood pressure (BP) and HbA1c should be included in prediction model development as novel factors. Meanwhile, interactions between age, sex, and risk factors should also be considered. CONCLUSIONS A 10-year prediction model for CVD risk in Chinese type 2 DM patients is lacking and urgently needed. There is insufficient evidence to support the inclusion of other novel predictors in CVDs risk prediction functions for routine clinical use.
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Affiliation(s)
- W Dong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - E Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China; Department of Pharmacology and Pharmacy, The University of Hong Kong, L02-56, 2/F, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong, China.
| | - L E Bedford
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - T Wu
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - C K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - E H M Tang
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - C L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
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Yu B, Jin S, Wang C, Yan S, Zhou X, Cui X, Tang Z, Luan Q, Guo Y, Bian Z, Li L, Chen Z, Na L. The association of outdoor temperature with blood pressure, and its influence on future cardio-cerebrovascular disease risk in cold areas. J Hypertens 2020; 38:1080-1089. [PMID: 32371798 PMCID: PMC7614986 DOI: 10.1097/hjh.0000000000002387] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore whether lower outdoor temperature increases cardio-cerebrovascular disease risk through regulating blood pressure and whether indoor heating in winter is beneficial to prevent cardio-cerebrovascular disease in cold areas. METHODS We analyzed the data of 38 589 participants in Harbin from the China Kadoorie Biobank (CKB) during 2004-2008, with an average of 7.14-year follow-up. Linear regression analysis was performed to estimate the relationship between outdoor temperature and blood pressure. Cox regression analysis and logistic regression analysis were used to analyze the association of blood pressure with cardio-cerebrovascular event risk. Mediation analysis was performed to explore the role of blood pressure in the association between outdoor temperature and cardio-cerebrovascular events risk. RESULTS There was an increase of 6.7 mmHg in SBP and 2.1 mmHg in DBP for each 10 °C decrease in outdoor temperature when outdoor temperature was higher than 5 °C. There was an inverse association between outdoor temperature and cardio-cerebrovascular event morbidity. The increases in blood pressure and cardio-cerebrovascular event morbidity were attenuated in months when central heating was fully provided. Participants with hypertension have higher risks of cardio-cerebrovascular disease (hazard ratio 1.347; 95% CI 1.281--1.415), CVD (hazard ratio 1.347; 95% CI 1.282--1.416), MACE (hazard ratio 1.670; 95% CI 1.560--1.788) and stroke (hazard ratio 1.683; 95% CI 1.571--1.803). Mediation analysis demonstrated that the association between outdoor temperature and cardio-cerebrovascular events risk was potentially mediated by blood pressure. CONCLUSION Temperature-driven blood pressure potentially mediates the association between outdoor temperature and cardio-cerebrovascular events risk. Indoor heating in winter is probably beneficial to cardio-cerebrovascular disease prevention by inhibition of blood pressure increase.
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Affiliation(s)
- Bo Yu
- Department of Chronic Disease, Harbin Nangang District CDC, Harbin, China
| | - Shanshan Jin
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
- Collaborative Innovation Center for Biomedicine, Medical Technology College, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Chi Wang
- Department of Chronic Disease, Harbin Nangang District CDC, Harbin, China
| | | | - Xue Zhou
- Heilongjiang Provincial CDC, Harbin, China
| | | | - Zhen Tang
- Harbin Nangang District CDC, Harbin, China
| | - Qing Luan
- Department of Chronic Disease, Harbin Nangang District CDC, Harbin, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Liming Li
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lixin Na
- Collaborative Innovation Center for Biomedicine, Medical Technology College, Shanghai University of Medicine & Health Sciences, Shanghai, China
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Yan L, Carter E, Fu Y, Guo D, Huang P, Xie G, Xie W, Zhu Y, Kelly F, Elliott P, Zhao L, Yang X, Ezzati M, Wu Y, Baumgartner J, Chan Q. Study protocol: The INTERMAP China Prospective (ICP) study. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15470.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Unfavourable blood pressure (BP) level is an established risk factor for cardiovascular diseases (CVD), while the exact underlying reasons for unfavourable BP are poorly understood. The INTERMAP China Prospective (ICP) Study is a prospective cohort to investigate the relationship of environmental and nutritional risk factors with key indicators of vascular function (BP, arterial stiffness, carotid-intima media thickness) among middle-aged/older men and women. Methods: A total of 839 Chinese participants aged 40-59 years from three diverse regions of China were enrolled in INTERMAP in 1997/98; data collection included repeated BP measurements, 24-hour urine specimens, and 24-hour dietary recalls. In 2015/16, 574 of these 839 persons were re-enrolled along with 208 new participants aged 40-59 years that were randomly selected from the same study villages. Participant’s environmental and dietary exposures and health outcomes were assessed in this open cohort study, including BP, 24-hour dietary recalls, personal exposures to air pollution, grip strength, arterial stiffness, carotid-media thickness and plaques, cognitive function, and sleep patterns. Serum and plasma specimens were collected with 24-hour urine specimens. A follow-up visit has been scheduled for 2020-2021. Discussion: Winter and summer assessments of a comprehensive set of vascular indicators and their environmental and nutritional risk factors were conducted with high precision. We will leverage advances in exposome research to identify biomarkers of exposure to environmental and nutritional risk factors and improve our understanding of the mechanisms and pathways of their hazardous cardiovascular effects. The ICP Study is observational by design, thus subject to several biases including selection bias (e.g., loss to follow-up), information bias (e.g., measurement error), and confounding that we sought to mitigate through our study design and measurements. However, extensive efforts will apply to minimize those limitations (continuous observer training, repeated measurements of BP, standardized methods in data collection and measurements, and on-going quality control).
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22
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Wang M, Wu T, Yu C, Gao W, Lv J, Wu Y, Qin X, Tang X, Gao P, Zhan S, Cao W, Zhao Q, Huang S, Yang D, Li L, Hu Y. Association between blood pressure levels and cardiovascular deaths: a 20-year follow-up study in rural China. BMJ Open 2020; 10:e035190. [PMID: 32102826 PMCID: PMC7045167 DOI: 10.1136/bmjopen-2019-035190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline recommended 130/80 mm Hg as blood pressure (BP) target goals. However, the generalisability of this recommendation to populations at large with hypertension remains controversial. We assessed the association between BP and cardiovascular diseases (CVDs) mortality using a 20-year follow-up study among Chinese populations. DESIGN Prospective cohort study. PARTICIPANTS 7314 participants were followed up for a median of 20 years in Fangshan District, Beijing, China. METHODS The primary outcome variable was death from cardiovascular causes. The adjusted HR for CVDs mortality associated with baseline BP was calculated using Cox regression analysis. RESULTS We identified 350 deaths from CVDs (148 stroke, 113 coronary heart disease and 89 other CVDs) during follow-up. Hypertension (defined by systolic BP (SBP)/diastolic BP (DBP) ≥140/90 mm Hg) was significantly associated with mortality due to CVDs (HR=2.49, 95% CI=1.77 to 3.50) among people aged 35-59 years rather than people aged ≥60 years. In addition, there was no significant association between stage 1 hypertension defined by the 2017 ACC/AHA (SBP/DBP of 130-139/80-89 mm Hg) and CVDs mortality when compared with SBP/DBP of <120/80 in neither the participants aged <60 years (HR=0.90, 95% CI=0.54 to 1.50) nor participants aged ≥60 years (HR=1.47, 95% CI=0.94 to 2.29). CONCLUSION The study revealed hypertension of SBP/DBP≥140/90 mm Hg was an important risk factor of CVDs mortality, especially among people aged 35-59 years. However, stage 1 hypertension under the definition of 2017 ACC/AHA was not associated with an increased risk of CVDs mortality. This study indicated that whether adopting the new hypertension definition needs further consideration in rural Chinese populations.
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Affiliation(s)
- Mengying Wang
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Tao Wu
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Canqing Yu
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Wenjing Gao
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Jun Lv
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Yiqun Wu
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Xueying Qin
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Xun Tang
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Pei Gao
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Siyan Zhan
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Weihua Cao
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Qingshui Zhao
- General Office, Fangshan District Health Commission, Beijing, China
| | - Shaoping Huang
- General Office, Fangshan District Health Commission, Beijing, China
| | - Dongli Yang
- General Office, Fangshan District Health Commission, Beijing, China
| | - Liming Li
- Epidemiology and Biostatistics, Peking University, Beijing, China
| | - Yonghua Hu
- Epidemiology and Biostatistics, Peking University, Beijing, China
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He L, Yang N, Ping F, Xu L, Li W, Li Y, Zhang H. Long Sleep Duration is Associated with Increased High-Sensitivity C-Reactive Protein: A Nationwide Study on Chinese Population. Diabetes Metab Syndr Obes 2020; 13:4423-4434. [PMID: 33235480 PMCID: PMC7680170 DOI: 10.2147/dmso.s265465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE High-sensitivity C-reactive protein (hs-CRP) has been shown as an important predictor of cardiovascular risk, and sleep duration is an important factor influencing health outcomes. However, the association between hs-CRP and sleep duration among Chinese adults remained unknown and controversial. We aimed to explore the associations between sleep duration and hs-CRP levels among Chinese adults, and the differences in sex and geographical regions. METHODS This cross-sectional study was based on nationally representative Chinese samples from the 2009 China Health and Nutrition Survey, which employed multistage, random cluster designs. Habitual sleep duration was self-reported with short and long sleep duration defined as ≤6h and ≥9h per day, respectively. Participants were divided into 4 groups based on the categories of self-reported sleep duration (≤6h, 7h, 8h, ≥9h per day), excluding hs-CRP levels ≥10 mg/L. Subset samples were stratified by sex and geographical regions. RESULTS A total of 8170 Chinese adults with a mean age of 50.0±14.9 years and 4369 (53.5%) men were included. Participants sleeping eight hours had the lowest hs-CRP levels. Long sleep duration (≥9h) was significantly associated with elevated hs-CRP levels after adjusting for multiple covariates in full samples (β=0.0356; 95% CI: 0.0050-0.0663; P=0.0228), but the associations of short sleep duration (≤ 6h) were limited to the unadjusted model. Long sleep duration was associated with elevated hs-CRP levels in women (β= 0.0512; 95% CI: 0.0097-0.0927; P=0.0155) and in the northern region of China (β=0.0699; 95% CI: 0.0210-0.1187; P=0.0051), but not in men or the southern region. CONCLUSION Long but not short sleep duration was positively associated with elevated hs-CRP levels, independent from traditional risk factors among Chinese adults, and sex and geographical differences were observed. Our findings imply that modifications of long sleep duration might be added to behavioral therapy to reduce cardiovascular risk in Chinese adults.
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Affiliation(s)
- Liyun He
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Na Yang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Huabing Zhang Address: Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of ChinaTel/Fax +86-010-69155073 Email
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Opoku S, Gan Y, Fu W, Chen D, Addo-Yobo E, Trofimovitch D, Yue W, Yan F, Wang Z, Lu Z. Prevalence and risk factors for dyslipidemia among adults in rural and urban China: findings from the China National Stroke Screening and prevention project (CNSSPP). BMC Public Health 2019; 19:1500. [PMID: 31711454 PMCID: PMC6849283 DOI: 10.1186/s12889-019-7827-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/21/2019] [Indexed: 12/27/2022] Open
Abstract
Background Dyslipidemia is a modifiable risk factor for cardiovascular disease (CVD). We investigated the prevalence and associated risk factors of dyslipidemia- raised total cholesterol (TC), raised triglycerides (TG), raised low-density lipoprotein (LDL-C), low high-density lipoprotein (HDL-C), and raised non-high-density lipoprotein (non-HDL-C) in rural and urban China. Methods We analyzed data from 136,945 participants aged 40–100 years of the CNSSPP project for 2014. Dyslipidemia was defined by the NCEP-ATP III and the 2016 Chinese guidelines for the management of dyslipidemia in adults. Complete data on demographic, metabolic and lifestyle characteristics were used. Chi-square tests and multivariable logistic regression were used to obtain age- and sex-adjusted prevalence and risk factors for dyslipidemia among participants. Results A total of 53.1% participants lived in rural areas. The prevalence of dyslipidemia was similar among rural and urban participants (43.2% vs. 43.3%). Regarding the components of dyslipidemia: urban compared with rural participants had a higher prevalence of low HDL-C (20.8% vs. 19.2%), whereas the prevalence of raised LDL-C (7.8% vs. 8.3%), raised TC (10.9% vs.11.8%) and raised non-HDL-C (10.0% vs. 10.9%) were lower in urban residents, (all p < 0.001). Women were more likely to have raised TC than men (adjusted OR [AOR] =1.83, 95% confidence interval [CI]:1.75–1.91), raised LDL-C (AOR = 1.55, 95% CI: 1.47–1.63) and high non-HDL-C (AOR = 1.52 95% CI: 1.45–1.59) (all p < 0.001). Compared with rural, urban participants had higher odds of dyslipidemia: low HDL-C (AOR = 1.04, 95% CI: 1.01–1.07), and raised TG (AOR = 1.06, 95% CI: 1.04–1.09). Hypertension and current drinker were less likely to get low HDL-C with AOR 0.93 (95% CI: 0.90–0.96) and AOR 0.73 (95% CI: 0.70–75), respectively. Overweight, obesity, central obesity and diabetes had higher odds of all dyslipidemias (p < 0.001). Conclusions Low HDL-C was higher in urban areas, whereas the remaining dyslipidemia types were more common in rural areas. Dyslipidemia was more common in women in both areas of residence. Overweight, obesity, central obesity and diabetes were associated with dyslipidemias. The need to intensify intervention programs to manage dyslipidemia and risk factors should be prioritized.
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Affiliation(s)
- Sampson Opoku
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Wenning Fu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Dajie Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China
| | - Emmanuel Addo-Yobo
- Department of Internal Medicine, SUNY Upstate Medical University, New York, USA
| | - Diana Trofimovitch
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital, Capital medical University, Beijing, China
| | - Zhihong Wang
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen University, Shenzhen, Guangdong, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, China.
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Yan L, Carter E, Fu Y, Guo D, Huang P, Xie G, Xie W, Zhu Y, Kelly F, Elliott P, Zhao L, Yang X, Ezzati M, Wu Y, Baumgartner J, Chan Q. Study protocol: The INTERMAP China Prospective (ICP) study. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15470.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Unfavourable blood pressure (BP) level is an established risk factor for cardiovascular diseases (CVD), while the exact underlying reasons for unfavourable BP are poorly understood. The INTERMAP China Prospective (ICP) Study is a prospective cohort to investigate the relationship of environmental and nutritional risk factors with key indicators of vascular function including BP, arterial stiffness, and carotid-intima media thickness. Methods: A total of 839 Chinese participants aged 40-59 years from three diverse regions of China were enrolled in INTERMAP in 1997/98; data collection included repeated BP measurements, 24-hour urine specimens, and 24-hour dietary recalls. In 2015/16, 574 of these 839 persons were re-enrolled along with 208 new participants aged 40-59 years that were randomly selected from the same study villages. Participant’s environmental and dietary exposures and health outcomes were assessed in this open cohort study, including BP, 24-hour dietary recalls, personal exposures to air pollution, grip strength, arterial stiffness, carotid-media thickness and plaques, cognitive function, and sleep patterns. Serum and plasma specimens were collected with 24-hour urine specimens. Discussion: Winter and summer assessments of a comprehensive set of vascular indicators and their environmental and nutritional risk factors were conducted with high precision. We will leverage advances in exposome research to identify biomarkers of exposure to environmental and nutritional risk factors and improve our understanding of the mechanisms and pathways of their hazardous cardiovascular effects. The ICP Study is observational by design, thus subject to several biases including selection bias (e.g., loss to follow-up), information bias (e.g., measurement error), and confounding that we sought to mitigate through our study design and measurements. However, extensive efforts will apply to minimize those limitations (continuous observer training, repeated measurements of BP, standardized methods in data collection and measurements, and on-going quality control).
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Hu S, Cui B, Mlynash M, Zhang X, Mehta KM, Lansberg MG. Stroke epidemiology and stroke policies in China from 1980 to 2017: A systematic review and meta-analysis. Int J Stroke 2019; 15:18-28. [DOI: 10.1177/1747493019873562] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Stroke is the leading cause of death and years of life lost in China, and this problem is growing because stroke risk factors such as hypertension and hypercholesteremia have been on the rise as China experiences the demographic transition. The Chinese government has created public health initiatives in the form of guidelines, policies and programs to combat this problem, but the dissemination and effectiveness of these policies are not well known. Aims The aim of this study was to determine trends in stroke incidence, prevalence, and stroke-related mortality in China and to report these trends in the context of stroke initiatives that have been enacted by the Chinese government. Summary of review We systematically reviewed articles on stroke rates and stroke initiatives from 1980 to 2017. A meta-regression including 11 studies showed that stroke incidence remained stable at 128.3 per 100,000 per year from 1980 to 2005 and has increased by 21.3 per 100,000 per year since then to 298.7 per 100,000 per year in 2013. A meta-regression including seven studies demonstrated a gradual decline in stroke-related mortality by 6.5 per 100,000 per year since 1980 (a decline from 369.2 in 1980 to 154.7 per 100,000 per year in 2013). Average stroke prevalence was 898.4 per 100,000 over the entire time-period. Limitations included heterogeneity between the studies. We identified 12 stroke initiatives, the first of which was enacted in 2006. Conclusions Despite numerous public health initiatives aimed at combating stroke that started in 2006, stroke incidence in China has increased over the last decade, likely as a result of aging and urbanization of the Chinese population.
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Affiliation(s)
- Sophia Hu
- Asia Health Policy Program, Stanford University, Stanford, CA, USA
| | - Bijun Cui
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Michael Mlynash
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Xin Zhang
- Acon Biotech (Hangzhou) Co. Ltd., Zhejiang, China
- Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Kala M Mehta
- Department of Epidemiology, University of California San Francisco, San Francisco, CA, USA
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Ren H, Wan X, Wei C, Yang G. Spatiotemporal variations in cardiovascular disease mortality in China from 1991 to 2009. BMC Cardiovasc Disord 2019; 19:159. [PMID: 31266467 PMCID: PMC6604372 DOI: 10.1186/s12872-019-1128-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In China, the spatiotemporal variations in cardiovascular disease (CVD) mortality are seldom characterized to understand their epidemiological features. It would be helpful to evaluate the performance of CVD-related interventions for subsequent adjustments. METHODS The 2010 Census data as well as the coronary heart disease (CHD) and stroke mortality data from the Disease Surveillance Points (DSPs) were used to calculate the age standardized death rates (ASDRs) of CVD in the DSP counties during 1991-1995, 1996-2000, 2004-2005, and 2006-2009. The ordinary kriging (OK) method was used to estimate the county-level death rates of CHD and stroke and achieved satisfactory results. RESULTS The goodness-of-fit between measured and estimated values of CVD mortality was significant at the 0.01 level (0.34 < R2 < 0.98). The counties with high CHD death rates (> 75 per 105) were located in the Northwest, North, and Northeast in 1991-2000 and then extended toward the North, Central, and South, yielding an inverted-triangle-shaped area in 2004-2009. The counties with a CHD death rate increase greater than 100% were concentrated in the Northeast and South. The Northeast-Southwest regions with a high stroke death rate gradient (> 150 per 105) narrowed in1991-2000, was followed by a slight expansion during 2004-2005, finally reducing in 2006-2009. The counties with a stroke mortality increase greater than 100% were scattered across the Northeast, Northwest, Central, and South. CONCLUSION The epidemiological characteristics of both CHD and stroke mortality in China was spatiotemporally featured on the county level during 1991-2009.
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Affiliation(s)
- Hongyan Ren
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101 China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, #5 Dong Dan San Tiao, Dongcheng District, Beijing, 100005 China
| | - Cao Wei
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101 China
| | - Gonghuan Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, #5 Dong Dan San Tiao, Dongcheng District, Beijing, 100005 China
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Gao L, DU M, Li J, Zhao NJ, Yang Y, Dong C, Sun XL, Chi B, Wang Q, Chen W, Tian C, Zhang N, Li L, Niu LW, Zheng H, Bao H, Liu Y, Sun J. Effects of occupation on intracerebral hemorrhage-related deaths in Inner Mongolia. INDUSTRIAL HEALTH 2019; 57:342-350. [PMID: 30089766 PMCID: PMC6546581 DOI: 10.2486/indhealth.2018-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/25/2018] [Indexed: 06/08/2023]
Abstract
This study assessed the relationship between occupation and Intracerebral Hemorrhage-related deaths and compared the differences in ICH-related deaths rates between the eastern and midwestern regions of Inner Mongolia. We used the case-control method. Cases included Intracerebral Hemorrhage-related deaths that occurred from 2009 to 2012 in Inner Mongolia while controls included non-circulatory system disease deaths that occurred during the same period. Odds ratios (ORs) for Intracerebral Hemorrhage-related deaths were calculated using logistic regression analysis, estimated according to occupation, and adjusted for marital status and age. The Intracerebral Hemorrhage mortality rate in the eastern regions (125.19/100000) was nearly 3 times higher than that in the midwestern regions (45.31/100000). ORs for agriculture-livestock workers, service professionals and general workers, professional workers and senior officials were in descending order. The age-adjusted OR for Intracerebral Hemorrhage-related deaths was lowest in unmarried men senior officials (OR 0.37, 95% CI 0.14-0.99). The Intracerebral Hemorrhage mortality rate in the eastern regions was much higher than that of the midwestern regions, since about 90% of Intracerebral Hemorrhage-related deaths in the eastern regions were those of agriculture-livestock workers who has the largest labor intensity of any other occupation assessed.
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Affiliation(s)
- Liqun Gao
- Inner Mongolia Medical University, China
| | - Maolin DU
- Inner Mongolia Medical University, China
| | - Jiayi Li
- Beijing Health Vocational College, China
| | - Neng Jun Zhao
- The Affiliated People's Hospital of Inner Mongolia Medical University, China
| | - Ying Yang
- Inner Mongolia Medical University, China
| | - Chao Dong
- Inner Mongolia Medical University, China
| | | | | | | | | | - Chunfang Tian
- Inner Mongolia Autonomous Region Hospital of Traditional Chinese Medicine, China
| | - Nan Zhang
- Inner Mongolia Medical University, China
| | - Lehui Li
- Inner Mongolia Medical University, China
| | - Li Wei Niu
- Inner Mongolia Medical University, China
| | | | - Han Bao
- Inner Mongolia Medical University, China
| | - Yan Liu
- Inner Mongolia Medical University, China
| | - Juan Sun
- Inner Mongolia Medical University, China
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Drug Treatment of Hyperlipidemia in Chinese Patients: Focus on the Use of Simvastatin and Ezetimibe Alone and in Combination. Am J Cardiovasc Drugs 2019; 19:237-247. [PMID: 30714088 DOI: 10.1007/s40256-018-00317-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Elevated serum low-density lipoprotein cholesterol (LDL-C) is a major risk factor for coronary heart disease (CHD). Many guidelines recommend LDL-C as a primary treatment target, and statins represent the cornerstone of treatment for lipid management. Recently revised guidelines recommend even more intense management of LDL-C, especially in patients at moderate and high risk. However, LDL-C levels in the Chinese population differ from those in Western populations, and the benefits and safety of the maximum allowable dose of statins have yet to be determined. Furthermore, in practice, many patients do not achieve the increasingly stringent LDL-C goals. Consequently, alternative approaches to lipid management are required. Combination therapy with ezetimibe and a statin, which have complementary mechanisms of action, is more effective than statin monotherapies, even at high doses. Several clinical studies have consistently shown that combination therapy with ezetimibe and simvastatin lowers LDL-C more potently than statin monotherapies. Moreover, the safety and tolerability profile of the combination therapy appears to be similar to that of low-dose statin monotherapies. This review discusses the role of simvastatin in combination with ezetimibe in controlling dyslipidemia in Chinese patients, particularly the efficacy and safety of combination therapy in light of recently published clinical data.
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Du X, Wang C, Ni J, Gu H, Liu J, Pan J, Tu J, Wang J, Yang Q, Ning X. Association of Blood Pressure With Stroke Risk, Stratified by Age and Stroke Type, in a Low-Income Population in China: A 27-Year Prospective Cohort Study. Front Neurol 2019; 10:564. [PMID: 31191445 PMCID: PMC6548813 DOI: 10.3389/fneur.2019.00564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/10/2019] [Indexed: 01/05/2023] Open
Abstract
Association of stroke risk with new blood pressure criterion 2017 is unknown in China. We assessed the association between blood pressure (BP) values and stroke risk in a low-income population in Tianjin, China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were categorized into five strata and strokes were recorded as stroke, ischemic stroke, and hemorrhagic stroke. Stroke risk was analyzed according to blood pressure stratum using Cox regression analysis. Overall, 4,017 residents (age, ≥18 years) were included in this prospective cohort study. Over a 27-year follow-up period (total, 86,515.78 person-years), 638 participants experienced first-ever strokes. The stroke risk was higher among individuals with SBPs ≥140 mmHg or DBPs ≥90 mmHg than among those with SBPs < 130 mmHg or DBPs < 80 mmHg (reference group), after adjusting for covariates. However, hemorrhagic stroke risk increased only in participants with SBPs ≥160 mmHg. The stroke risk increased for individuals < 65-years-old having BP values ≥130/80 mmHg and for individuals ≥65-years-old with BP values ≥160/90 mmHg. To reduce the stroke burden in China, target BP goals must be established for adults, with different targets for the middle-aged and the elderly segments of the population. These results are very important for guiding clinical practice and may be generalized to other developing countries experiencing rapid economic development and where transitions in the spectrum of prevalent diseases have occurred.
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Affiliation(s)
- Xin Du
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Conglin Wang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Hongfei Gu
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Jing Pan
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
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Xing L, Jing L, Tian Y, Liu S, Lin M, Du Z, Ren G, Sun Q, Shi L, Dai D, Liu S. High prevalence of stroke and uncontrolled associated risk factors are major public health challenges in rural northeast China: A population-based study. Int J Stroke 2019; 15:399-411. [PMID: 31092151 DOI: 10.1177/1747493019851280] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke has become a major burden and public health problem in rural China. We aimed to comprehensively assess the current status of stroke burden as well as the associated risk factors in rural northeast China. METHODS This population-based, cross-sectional study was conducted in 10,926 adults (response rate 85.3%) aged ≥40 years residing in rural northeast China. A multistage cluster sampling method was used to select the representative sample. The prevalent stroke cases were considered as stroke survivors on 31 August 2017. Stroke was diagnosed according to the World Health Organization's recommendations and was classified as ischemic stroke and hemorrhagic stroke based on the results of computed tomography or magnetic resonance imaging. The status of related risk factors was also evaluated. RESULTS Of the 10,926 participants, 731 were diagnosed with stroke (602 patients with ischemic stroke, 151 with hemorrhage stroke, and 22 with both ischemic stroke and hemorrhage stroke). The crude prevalence of overall stroke, ischemic stroke, and hemorrhage stroke was 6690.5, 5509.8, and 1382.0 per 100,000 people, respectively, and the age-standardized rate was 4903.8, 4041.7, and 990.9 per 100,000 people. Among the overall stroke population, 13.4% were living with consequences of stroke. Hypertension (86.7%), dyslipidemia (37.2%), and diabetes (24.5%) were highly prevalent in stroke participants. However, most of those comorbidities remained uncontrolled (93.7, 44.7, and 88.9%, respectively). CONCLUSION The burden of stroke in rural northeast China was substantial, with a high prevalence of stroke, recurrence, and disabilities. Uncontrolled comorbidities will likely contribute to recurrence and worsening disabilities in the coming decades. Strategies of long-term management of stroke and related risk factors are urgently required in rural northeast China.
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Affiliation(s)
- Liying Xing
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China.,Disease Control and Prevention of Liaoning Province, Shenyang, People's Republic of China
| | - Li Jing
- Disease Control and Prevention of Liaoning Province, Shenyang, People's Republic of China
| | - Yuanmeng Tian
- Disease Control and Prevention of Liaoning Province, Shenyang, People's Republic of China
| | - Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Min Lin
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhi Du
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Guocheng Ren
- Central Hospital of Chao Yang City, Chaoyang, People's Republic of China
| | - Qun Sun
- Disease Control and Prevention of Chao Yang City, Chaoyang, People's Republic of China
| | - Lei Shi
- Disease Control and Prevention of Liao Yang City, Liaoyang, People's Republic of China
| | - Dong Dai
- Disease Control and Prevention of Dan Dong City, Dandong, People's Republic of China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, People's Republic of China
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Tang X, Zhang D, He L, Wu N, Si Y, Cao Y, Huang S, Li N, Li J, Dou H, Gao P, Hu Y. Performance of atherosclerotic cardiovascular risk prediction models in a rural Northern Chinese population: Results from the Fangshan Cohort Study. Am Heart J 2019; 211:34-44. [PMID: 30831332 DOI: 10.1016/j.ahj.2019.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 01/26/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Performance of Pooled Cohort Equations (PCEs) for atherosclerotic cardiovascular disease (ASCVD) risks varied across populations. Whether the recently developed Prediction for ASCVD Risk in China (China-PAR) model could accurately predict cardiovascular risks in real practice remains unclear. METHODS A population-based cohort study in rural Beijing in the "stroke belt" in North China was used to externally validate PCE and China-PAR models for 5-year ASCVD risk prediction. Expected 5-year prediction risk using China-PAR model was compared with PCE (white). The models were assessed for calibration, discrimination, and reclassification. RESULTS Among 11,169 adults aged 40 to 79 years over a median 6.44 years of follow-up, 1,921 participants developed a first ASCVD event during total 70,951 person-years. China-PAR model fairly predicted ASCVD risk in men but overestimated by 29.4% risk in women (calibration χ2 = 81.4, P < .001). Underestimations were shown by PCE as 76.2% in men and 88.2% in women with poor calibration (both P < .001). However, discrimination was similar in both models: C-statistics in men were 0.685 (95% CI 0.660-0.710) for China-PAR and 0.675 (95% CI 0.649-0.701) for PCE; C-statistics in women were 0.711 (95% CI 0.694-0.728) for China-PAR and 0.714 (95% CI 0.697-0.731) for PCE. Moreover, China-PAR did not substantially improve accuracy of reclassification compared with PCE. CONCLUSIONS China-PAR outperformed PCE in 5-year ASCVD risk prediction in this rural Northern Chinese population at average population risk level, fairly predicted risk in men, but overestimated risk in women; however, China-PAR did not meaningfully improve the accuracy of discrimination and reclassification at individual risk level.
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Du CN, Yang MF, Zhang Q, Jin XQ, Yan C, Huang YW. Establishment and Verification of the Hematoma Expansion Prediction Score of Intracerebral Hemorrhage in the Qinghai-Tibetan Plateau. World Neurosurg 2019; 123:e465-e473. [DOI: 10.1016/j.wneu.2018.11.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/26/2022]
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Wang T, Yang K, Luo J, Gao P, Ma Y, Wang Y, Li L, Liu Y, Feng Y, Wang X, Jiao L. Outcomes after stenting for symptomatic intracranial arterial stenosis: a systematic review and meta-analysis. J Neurol 2019; 267:581-590. [PMID: 30612142 DOI: 10.1007/s00415-018-09176-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stenting is a common endovascular therapy for symptomatic intracranial arterial stenosis (ICAS). We sought to update the evaluation of global short-term safety and long-term efficacy outcomes after stenting for symptomatic ICAS and explore their distributional characteristics. METHODS Major databases including Cochrane Library, MEDLINE, EMBASE were systematically searched from January 1st, 2005, for RCTs and observational studies which reported short- and long-term outcomes after stenting for symptomatic ICAS. Each outcome was pooled with meta-analysis and the impacts of study location, publication time, and other population characteristics were further assessed by the univariate and multivariate Poisson regression analyses. RESULTS A total of 8408 patients were identified in 92 studies from 16 countries across five WHO regions. The estimated rate of short-term stroke or death was 6.68% (95% CI 5.60-8.36%), and the rate of long-term stroke or death was 4.43% (95% CI 2.61-6.60%). After adjustment of age, sex, study location, preprocedual stenosis, publication period and study design, multivariate regression analysis showed that the rate of short-term stroke or death was different between Western and Eastern countries (10.27% versus 5.52%, p = 0.018). The rates of short-term, stroke, ischemic stroke and long-term death were also significantly higher in Western compared to Eastern countries. CONCLUSION This systematic review provided the worldwide profile of short- and long-term outcomes of stenting for symptomatic ICAS. The generally acceptable outcomes indicate that stenting may still be feasible in selected patients. Regional disparity calls for more cautious decisions and future studies.
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Affiliation(s)
- Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Yiran Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, China.
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Qi Y, Han X, Zhao D, Wang W, Wang M, Sun J, Liu J, Li Y, Gao S, Hao Y, Deng Q, Liu J. Long-Term Cardiovascular Risk Associated With Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline. J Am Coll Cardiol 2018; 72:1201-1210. [DOI: 10.1016/j.jacc.2018.06.056] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
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He W, Liu Y, Feng J, Huang Q, Xu J, Liu X, Yu C, Zhu W, Wang T, Jin D, Liu H, Huang Y, Chen B. The Epidemiological Characteristics of Stroke in Hunan Province, China. Front Neurol 2018; 9:583. [PMID: 30072946 PMCID: PMC6060238 DOI: 10.3389/fneur.2018.00583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/28/2018] [Indexed: 11/13/2022] Open
Abstract
Previous studies have shown that Hunan Province has a high incidence of stroke and a high proportion of intracerebral hemorrhage (ICH). Considering the changes over the past three decades, little is known about the current epidemiological characteristics of stroke in Hunan Province. In 2013, a cross-sectional study was conducted at seven national disease surveillance points (DSPs) in Hunan Province. A multistage cluster sampling method was used to select a representative sample. A total of 21,156 participants aged 20 years and older were examined. Among the 21,156 participants, the number of prevalent strokes, incident strokes and deaths was 307, 87, and 36, respectively. The 2010 China census-standardized prevalence, incidence and mortality were 1191.0 per 100,000 people [95% confidence interval (CI) 1044.8-1337.2], 333.6 per 100,000 person-years (95% CI 255.7-411.5) and 129.7 per 100,000 person-years (95% CI 81.1-178.3), respectively. Ischemic stroke (IS), ICH, subarachnoid hemorrhage (SAH), and stroke of undetermined type (UND) constituted 50.6, 41.4, 5.7, and 2.3% of all incident stroke cases, respectively. Tianxin, Liuyang, Wuling, and Hongjiang have high proportions of ICH (61.5, 58.3, 60, and 50%, respectively). Hypertension is the most common risk factor for prevalent stroke (71.34%), followed by smoking (30.62%) and alcohol use (25.73%). In conclusion, Hunan Province has an extremely heavy stroke burden. The high proportion of ICH is not limited to the Changsha community; it represents an important issue for all of Hunan Province.
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Affiliation(s)
- Wei He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yunhai Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Ji Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaojuan Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Cheng Yu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Wenbin Zhu
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Te Wang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Donghui Jin
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Huilin Liu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Yuelong Huang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Biyun Chen
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
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Twenty-year epidemiologic study on LDL-C levels in relation to the risks of atherosclerotic event, hemorrhagic stroke, and cancer death among young and middle-aged population in China. J Clin Lipidol 2018; 12:1179-1189.e4. [PMID: 30037589 DOI: 10.1016/j.jacl.2018.06.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lowering elevated low-density lipoprotein cholesterol (LDL-C) levels is a key strategy in primary prevention of atherosclerotic cardiovascular disease (ASCVD), but the optimal LDL-C level is not well established in Chinese. OBJECTIVE We aimed to search for the LDL-C level that associated with the lowest long-term ASCVD risk without excess risk of other life-threatening diseases. METHODS Totally 20,954 participants aged 35-64 years were followed up for about 20 years. Cumulative and relative risks of ASCVD, hemorrhagic stroke, and cancer death, according to baseline LDL-C levels, were calculated using modified Kaplan-Meier and Fine & Gray models, considering competing risks. Preventable ASCVD cases against increased harms were estimated by simulation, replacing elevated LDL-C levels with lower LDL-C levels in the risk prediction models for individuals with different ASCVD risk. RESULTS The lower the baseline LDL-C, the lower the 20-year risk of ASCVD in participants with LDL-C levels ranging from the lowest category (<40 mg/dL) to the highest (≥160 mg/dL). We found no association between lower LDL-C levels and long-term risk of cancer death. If all people with LDL-C ≥130 mg/dL were assumed to have the LDL-C level <70 mg/dL and other risk factors remained unchanged, a substantial number of ASCVD cases would be preventable. However, for uncontrolled hypertensive patients, the LDL-C level <70 mg/dL would have extra harm from hemorrhagic stroke. CONCLUSION Participants with baseline LDL-C <40 mg/dL had the lowest ASCVD risk. An excess risk of hemorrhagic stroke was observed in patients with uncontrolled hypertension and LDL-C <70 mg/dL. LDL-C 70-99 mg/dL had reasonably low ASCVD risk without excess risk of other life-threatening diseases.
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Li TC, Wang HC, Li CI, Liu CS, Lin WY, Lin CH, Yang SY, Lin CC. Establishment and validation of a prediction model for ischemic stroke risks in patients with type 2 diabetes. Diabetes Res Clin Pract 2018; 138:220-228. [PMID: 29458073 DOI: 10.1016/j.diabres.2018.01.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/06/2017] [Accepted: 01/30/2018] [Indexed: 11/27/2022]
Abstract
AIMS A risk scoring system for predicting ischemic stroke incidence may identify type 2 diabetes patients at high risk for ischemic stroke who can benefit from preventive intervention programs. Such a risk scoring system can serve as a benchmark to test novel putative risk factors. METHODS The study adopted a retrospective cohort, including 28,124 Chinese patients with type 2 diabetes aged 30-84 years during 2001-2004. Participants were randomly assigned to the derivation and validation sets at a 2:1 ratio. Cox's proportional hazard regression model was used to identify risk factors of ischemic stroke incidence in the derivation set. And then the steps proposed by the Framingham Heart Study for establishing an ischemic stroke prediction model with a scoring system was used. RESULTS Among 9374 patients in the validation set, 1076 subjects (11.48%) developed ischemic stroke with a mean follow up period of 8.0 years. We identified the following risk factors: age, gender, smoking habit, duration of type 2 diabetes, blood pressure, HbA1c level, total cholesterol to high-density lipoprotein ratio, creatinine, fasting plasma glucose variation (FPG-CV), arterial embolism and thrombosis, diabetes retinopathy, hypoglycemia, anti-diabetes medication use, and cardiovascular medication. The area under receiver operating characteristic curve of the 3-year, 5-year, and 8-year ischemic stroke incidence risks were 0.72, 0.71, and 0.68 for the validation set, respectively. CONCLUSIONS This proposed ischemic stroke incidence risk prediction model is the first model established for Chinese patients with type 2 diabetes recruited from nationwide clinical settings.
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Affiliation(s)
- Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Hsiang-Chi Wang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Sing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
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Li S, Xu F, He J, Wang Z, Tse LA, Xiong Y, Chen D. Re-look at socioeconomic inequalities in stroke prevalence among urban Chinese: is the inflexion approaching? BMC Public Health 2018; 18:367. [PMID: 29554881 PMCID: PMC5859657 DOI: 10.1186/s12889-018-5279-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 03/08/2018] [Indexed: 11/17/2022] Open
Abstract
Background The present association between socioeconomic status (SES) and stroke is positive in developing communities, but it is negative in developed countries where a positive SES-stroke relationship was recorded several decades ago. We hypothesized that the SES-stroke relationship in developing societies mirrors the trajectory of the Western countries at some stage of economic development. This study aimed to examine whether this inflexion is approaching in China. Methods This study comprises of two cross-sectional surveys conducted in the same urban areas of Nanjing, China in 2000 (S2000) and 2011 (S2011) using the same selection criteria (i.e., aged≥35 years) and sampling approach. Physician-diagnosed stroke was the outcome event, while family average income (FAI) was the explanatory variable and tertiled in our anlaysis. Mixed-effects models were used to examine the FAI-stroke association. Results Overall, 19,861 (response rate = 90.1%) and 7824 (response rate = 82.8%) participants participated in the S2000 and S2011, respectively. The prevalence of stroke increased by 2.5-folds (95%CI = 2.2, 2.9) from 2000 (2.1%, 95%CI = 1.9%, 2.3%) to 2011 (5.1%, 95%CI = 4.6%, 5.6%) (p < 0.01). Compared with the lower FAI category, the positive association between stroke prevalence and the higher FAI group decreased from 1.99 (95%CI = 1.55, 2.56) in 2000 to 1.49 (95%CI = 1.09, 2.03) in 2011 after control for potential confounders. A similar pattern was also observed for the middle FAI group (1.60, 95% CI = 1.23, 2.08 in 2000 vs. 1.37, 95%CI = 1.01, 1.88 in 2011). Conclusions This study revealed that socioeconomic inequalities in stroke were diminishing in regional China during the recent 11-year period, although the SES-stroke association was still positive. Tailored intervention against stroke should currently target on SES-vulnerable people.
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Affiliation(s)
- Shenghua Li
- Department of Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jing He
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhiyong Wang
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Lap Ah Tse
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yaqing Xiong
- Jiangsu Province Geriatric Hospital, 30, Luojia Road, Nanjing, 210024, China.
| | - Daowen Chen
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, 264, Guangzhou Road, Nanjing, 210029, China.
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Abstract
BACKGROUND With rapid economic development, urbanization, and an aging population, cardiovascular diseases (CVDs) have become the leading cause of death in China. OBJECTIVES The aim of this study was to provide a comprehensive review on the prevalence, awareness, treatment, and control of hypertension (HTN) as well as blood pressure (BP)-related morbidity and mortality of CVD in Chinese adults over time. FINDINGS The prevalence of HTN in China is high and increasing. Recent estimates are variable but indicate 33.6% (35.3% in men and 32% in women) or 335.8 million (178.6 million men and 157.2 million women) of the Chinese adult population had HTN in 2010, which represents a significant increase from previous surveys. BP-related CVD remains the leading cause of death in Chinese adults, with stroke being the predominant cause of cardiovascular deaths. Of those with HTN, 33.4% (30.4% in men and 36.7% in women) were aware of their condition, 23.9% (20.6% in men and 27.7% in women) were treated, and only 3.9% (3.5% in men and 4.3% in women) were controlled to the currently recommended target of BP <140/90 mm Hg. Awareness and treatment of HTN have improved over time, but HTN control has not. Geographic differences in the prevalence, awareness, treatment, and control of HTN are evident, both in terms of a north-south gradient and urban-rural disparity. CONCLUSIONS The prevalence of HTN is high and increasing, while the control rate is low in Chinese adults. Combatting HTN and BP-related morbidity and mortality will require a comprehensive approach at national and local levels. The major challenge moving forward is to develop and implement effective, practical, and sustainable prevention and treatment strategies in China.
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Affiliation(s)
- Joshua D Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
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Li L, He ZY, Wang YZ, Liu X, Yuan LY. Associations between thromboxane A synthase 1 gene polymorphisms and the risk of ischemic stroke in a Chinese Han population. Neural Regen Res 2018; 13:463-469. [PMID: 29623931 PMCID: PMC5900509 DOI: 10.4103/1673-5374.228729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Thromboxane A synthase 1 (TBXAS1) catalyses the synthesis of thromboxane A2 (TXA2), which plays an important role in the pathogenesis of ischemic stroke. Thus, the TBXAS1 gene was investigated as a candidate gene involved in the formation of atherosclerosis. This case-control study collected peripheral blood specimens and clinical data of 370 ischemic stroke patients and 340 healthy controls in the Northern Chinese Han population from October 2010 to May 2011. Two TBXAS1 single-nucleotide polymorphisms, rs2267682 and rs10487667, were analyzed using a SNaPshot Multiplex sequencing assay to explore the relationships between the single-nucleotide polymorphisms in TBXAS1 and ischemic stroke. The TT genotype frequency and T allele frequency of rs2267682 in the patients with ischemic stroke were significantly higher than those in the controls (P < 0.01 and P = 0.02). Furthermore, compared with the GG + GT genotype, the TT rs2267682 genotype was associated with increased risk of ischemic stroke (odds ratio (OR) = 1.80, 95% confidence interval (CI): 1.16–2.79, P < 0.01). Multivariate logistic analysis with adjustments for confounding factors revealed that rs2267682 was still associated with ischemic stroke (OR = 1.94, 95% CI : 1.13–3.33, P = 0.02). The frequency of the T-G haplotype in the patients was significantly higher than that in the controls according haplotype analysis (OR = 1.49, 95% CI: 1.10–2.00, P < 0.01). These data reveal that the rs2267682 TBXAS1 polymorphism is associated with ischemic stroke. The TT genotype of TBXAS1 and T allele of rs2267682 increase susceptibility to ischemic stroke in this Northern Chinese Han population. The protocol has been registered with the Chinese Clinical Trial Registry (registration number: ChiCTR-COC-17013559).
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Affiliation(s)
- Lei Li
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhi-Yi He
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yan-Zhe Wang
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xu Liu
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Li-Ying Yuan
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Qu H, Lu Y, Gudbranson E, Bucholz EM, Xuan S, Masoudi FA, Spertus JA, Zheng X, Li J, Krumholz HM. Large-Scale Epidemiologic Studies of Cardiovascular Diseases in China: Need for Improved Data Collection, Methods, Transparency, and Documentation. Glob Heart 2017; 13:3-12.e4. [PMID: 29248362 DOI: 10.1016/j.gheart.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/07/2017] [Accepted: 07/19/2017] [Indexed: 02/07/2023] Open
Abstract
With the advent of international precision medicine initiatives, it is important to evaluate existing large-scale studies to inform future investigation. This study sought to review, describe, and evaluate all large-scale cardiovascular disease (CVD) studies completed in China. We undertook a review of all large-scale CVD studies completed in China to describe and evaluate their design, implementation, and dissemination in published medical reports. Seventeen studies met the inclusion criteria. There were substantial variations in study design, geographic location, and data collection. Most studies lacked standard study names, did not publish their methods, and provided no publicly available data. Few studies included underdeveloped regions or minority groups. Most published articles contained only descriptions of the average population at risk of CVD, and no study predicted individual CVD risk or identified people at high risk. Future CVD studies in China may need to incorporate stronger systematic data collection methods, increased data transparency, clearer documentation, and standard study names to most gain from China's burgeoning field of CVD research.
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Affiliation(s)
- Hui Qu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Yale School of Public Health, New Haven, CT, USA
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Emily Gudbranson
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Bucholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Boston Children's Hospital, Boston, MA, USA
| | - Si Xuan
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Yale School of Public Health, New Haven, CT, USA
| | - Frederick A Masoudi
- University of Colorado Anschutz Medical Campus and the Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO, USA
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; The Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
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Cheng Q, Li YK, Lu F, Yin L, Wang YZ, Wei W, Lin Q. Interactions between ACYP2 genetic polymorphisms and environment factors with susceptibility to ischemic stroke in a Han Chinese Population. Oncotarget 2017; 8:97913-97919. [PMID: 29228661 PMCID: PMC5716701 DOI: 10.18632/oncotarget.18430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/14/2017] [Indexed: 11/25/2022] Open
Abstract
Aims To investigate the association of several single nucleotide polymorphisms (SNPs) within ACYP2 gene and additional gene- environment interaction with ischemic stroke (IS) risk in a Chinese population. Results IS risk was significantly higher in carriers with the G allele of rs11896604 than those with CC genotype (CG or GG versus CC), adjusted OR (95%CI) =1.60 (1.18-2.20), and higher in carriers with the A allele of rs12615793 than those with GG genotype (GA or AA versus GG), adjusted OR (95%CI) = 1.66 (1.24-2.15). GMDR model shown a significant two-locus model (p = 0.0010) involving rs11896604 and alcohol drinking, and a significant two-locus model (p = 0.0010) involving rs12615793 and smoking. Current smokers with rs12615793- GA or AA genotype have the highest IS risk, compared to never- smokers with rs12615793-GG genotype, OR (95%CI) = 2.72 (1.64-3.86); current drinkers with rs11896604-CG or GG genotype have the highest IS risk, compared to never- drinkers with rs11896604-CC genotype, OR (95%CI) = 2.51 (1.70-3.40). Materials and Methods A total of 1202 participants (660 males, 542 females) were selected, including 600 IS patients and 602 control participants. The mean age of all participants was 68.2 ± 15.8 years. Generalized multifactor dimensionality reduction (GMDR) was used to screen the best interaction combination. Logistic regression was performed to investigate the impact of 4 SNPs within ACYP2 gene, additional gene-smoking or drinking interaction on IS risk. Conclusions We found that the G allele of rs11896604 and the A allele of rs12615793 within ACYP2 gene, rs12615793- smoking interaction, and rs11896604-alcohol drinking interaction were all associated with increased IS risk.
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Affiliation(s)
- Qiong Cheng
- Department of Neurology, Fujian Provincial Hospital, Provincial Clinical Department of Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Yong-Kun Li
- Department of Neurology, Fujian Provincial Hospital, Provincial Clinical Department of Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Feng Lu
- The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, 350003, Fujian Province, China
| | - Lianhua Yin
- The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, 350003, Fujian Province, China
| | - Yin-Zhou Wang
- Department of Neurology, Fujian Provincial Hospital, Provincial Clinical Department of Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Wen Wei
- Department of Rehabilitation of GanZhou Municipal Hospital, GanZhou, 341000, Jiangxi Province, China
| | - Qian Lin
- Department of Neurology, Fuzhou Second Hospital, Fuzhou, 350007, Fujian Province, China
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Qi Y, Liu J, Wang W, Wang M, Zhao F, Sun J, Liu J, Zhao D. Apolipoprotein E-containing high-density lipoprotein (HDL) modifies the impact of cholesterol-overloaded HDL on incident coronary heart disease risk: A community-based cohort study. J Clin Lipidol 2017; 12:89-98.e2. [PMID: 29217413 DOI: 10.1016/j.jacl.2017.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Experimental studies have shown that cholesterol-overloaded high-density lipoprotein (HDL) can promote the formation of apolipoprotein E (APOE)-containing HDL, a process correcting the atherogenic function of cholesterol-overloaded HDL. OBJECTIVE The objective of the study was to explore whether APOE-containing HDL can attenuate the defective impact of cholesterol-overloaded HDL on the development of coronary heart disease (CHD) in humans. METHODS We measured APOE-HDL cholesterol (APOE-HDLC), HDL cholesterol (HDLC), and HDL particle number in 1112 participants aged 45 to 74 years at baseline in a community-based cohort study. Cholesterol molecules per HDL particle (HDL-C/P ratio) were calculated as the ratio of HDLC to HDL particle number. The ratio of APOE-HDLC to total HDLC (APOE-HDLC/HDLC ratio) was calculated to assess the relative proportion of APOE-HDLC in total HDLC. RESULTS The HDL-C/P ratio was strongly correlated with APOE-HDLC (partial-r: 0.615). Participants with cholesterol-overloaded HDL (indicated by the highest level of the HDL-C/P ratio) had a high APOE-HDLC/HDLC ratio. Baseline cholesterol-overloaded HDL significantly increased the 10-year risk of incident CHD (hazard ratio = 2.42; 95% confidence interval = 1.06-8.32), but this was attenuated by an increased APOE-HDLC/HDLC ratio. Participants with high HDL-C/P ratio and APOE-HDLC/HDLC ratio had a 42% lower risk, whereas those with a high HDL-C/P ratio and low APOE-HDLC/HDLC ratio had a 2.54-fold higher risk, than those with low HDL-C/P ratio and APOE-HDLC/HDLC ratio after multiple adjustments. CONCLUSION Cholesterol-overloaded HDLs are related with increased APOE-containing HDL species. APOE-containing HDL was found to attenuate the impact of cholesterol-overloaded HDL on increased incident CHD risk, suggesting that APOE-containing HDL may correct the dysfunction of cholesterol-overloaded HDL.
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Affiliation(s)
- Yue Qi
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Miao Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Fan Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jiayi Sun
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
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Han TS, Wang HHX, Wei L, Pan Y, Ma Y, Wang Y, Wang J, Hu Z, Sharma P, Chen R. Impacts of undetected and inadequately treated hypertension on incident stroke in China. BMJ Open 2017; 7:e016581. [PMID: 28993383 PMCID: PMC5640060 DOI: 10.1136/bmjopen-2017-016581] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/11/2017] [Accepted: 08/21/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES China carries the greatest burden of stroke given its largest volume of people with hypertension. This study assessed the impacts of suboptimal controls of hypertension on incident stroke and projected the number of patients with stroke saved after the control of blood pressure improved in population. SETTING Anhui, China. PARTICIPANTS We examined data from the Anhui cohort of 2001-2011, consisting of 3336 participants aged ≥60 years who were randomly recruited from the urban and rural Anhui. 2852 participants (89.2%) had hypertensive status measured and no stroke at baseline, and were followed up until 2011 in three surveys using a standard method of interview. RESULTS At baseline, 1646 participants (57.7%) were identified to have hypertension, among whom 912 (55.4%) were previously undetected, 115 (7.0%) detected but not treated, 452 (27.5%) treated but not controlled and only 127 (7.7%) controlled. During the 10-year follow-up, 211 incident stroke cases (12.8/1000 person-years) occurred. Compared with normotensive individuals at baseline, multivariate adjusted HR for having stroke increased in those with undetected hypertension by 1.63 (95%CI 1.15 to 2.32), untreated by 2.21 (1.26-3.85) and uncontrolled hypertension by 3.34 (2.28-4.88), but did not differ from those with controlled hypertension (1.34; 0.60-2.99). Based on a two-fold increase in the detection and management of current levels of hypertension and algorithms on the current situation in China, approximately 250 000 incident stroke cases could be prevented annually. CONCLUSIONS In China, hypertension is frequently undetected or inadequately treated. With appropriate management of hypertension, a substantial number of people could be saved form stroke.
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Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
- Department of Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Surrey, UK
| | - Harry Hao-Xiang Wang
- School of Public Health, School of Public Health, Sun Yat-Sen University, Guangzhou, China
- General Practice and Primary Care, Institute of Health and Wellbeing, Glasgow University, Glasglow, UK
| | - Li Wei
- Department of Practice and Policy, University College London, London, UK
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Ma
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Yu Wang
- Pojen General Hospital, Taipei, China
| | - Jiaji Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Zhi Hu
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
- Department of Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Surrey, UK
- Department of Medicine, Imperial College London NHS Trust, London, UK
| | - Ruoling Chen
- Centre for Health and Social Care Improvement, Faculty of Education, Health and Wellbeing, Wolverhampton University, Wolverhampton, UK
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Lifetime risk of stroke in young-aged and middle-aged Chinese population: the Chinese Multi-Provincial Cohort Study. J Hypertens 2017; 34:2434-2440. [PMID: 27512963 PMCID: PMC5106079 DOI: 10.1097/hjh.0000000000001084] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Supplemental Digital Content is available in the text Objective: Stroke is a major cause of premature death in China. Early prevention of stroke requires a more effective method to differentiate the stroke risk among young-aged and middle-aged individuals than the 10-year risk of cardiovascular disease. This study aimed to establish a lifetime stroke risk model and risk charts for the young-aged and middle-aged population in China. Methods: The Chinese Multi-Provincial Cohort Study participants (n = 21 953) aged 35–84 years without cardiovascular disease at baseline were followed for 18 years (263 016 person-years). Modified Kaplan–Meier method was used to estimate the mean lifetime stroke risk up to age of 80 years and the lifetime stroke risk according to major stroke risk factors for the population aged 35–60 years. Results: A total of 917 participants developed first-ever strokes. For the participants aged 35–40 years (98 stroke cases), the lifetime stroke risk was 18.0 and 14.7% in men and women, respectively. Blood pressure most effectively discriminated the lifetime stroke risk. The lifetime risk of stroke for the individuals with all risk factors optimal was 8–10 times lower compared with those with two or more high risk factors at age 35–60 years at baseline. Conclusion: In young-aged and middle-aged population, the lifetime stroke risk will keep very low if major risk factors especially blood pressure level is at optimal levels, but the risk substantially increases even with a slight elevation of major risk factors, which could not be identified using 10-year risk estimation.
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Li N, Zhou H, Tang Q. Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases. DISEASE MARKERS 2017; 2017:7089493. [PMID: 29038615 PMCID: PMC5606102 DOI: 10.1155/2017/7089493] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
The red blood cell distribution width (RDW) obtained from a standard complete blood count (CBC) is a convenient and inexpensive biochemical parameter representing the variability in size of circulating erythrocytes. Over the past few decades, RDW with mean corpuscular volume (MCV) has been used to identify quite a few hematological system diseases including iron-deficiency anemia and bone marrow dysfunction. In recent years, many clinical studies have proved that the alterations of RDW levels may be associated with the incidence and prognosis in many cardiovascular and cerebrovascular diseases (CVDs). Therefore, early detection and intervention in time of these vascular diseases is critical for delaying their progression. RDW as a new predictive marker and an independent risk factor plays a significant role in assessing the severity and progression of CVDs. However, the mechanisms of the association between RDW and the prognosis of CVDs remain unclear. In this review, we will provide an overview of the representative literatures concerning hypothetical and potential epidemiological associations between RDW and CVDs and discuss the underlying mechanisms.
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Affiliation(s)
- Ning Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Heng Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
| | - Qizhu Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan 430060, China
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Wan X, Ren H, Ma E, Yang G. Mortality trends for ischemic heart disease in China: an analysis of 102 continuous disease surveillance points from 1991 to 2009. BMC Public Health 2017; 18:52. [PMID: 28743245 PMCID: PMC5526279 DOI: 10.1186/s12889-017-4558-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 06/30/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the past 20 years, the trends of ischemic heart disease (IHD) mortality in China have been described in divergent claims. This research analyzes mortality trends for IHD by using the data from 102 continuous Disease Surveillance Points (DSP) from 1991 to 2009. METHOD The 102 continuous DSP covered 7.3 million people during the period 1991-2000, and then were expanded to a population of 52 million in the same areas for 2004-2009. The data were adjusted by using garbage code redistribution and underreporting rate, mapped from international classification of diseases ICD-9 to ICD-10. The mortality rates for IHD were further adjusted by the crude death proportion multiplied by the total number of deaths in the mortality envelope, which was calculated by using logrt = a + bt. Age-standard death rates (ASDRs) were computed using China's 2010 census population structure. Trend in IHD was calculated from ASDRs by using a joinpoint regression model. RESULTS The IHD ASDRs increased in total in regions with an average annual percentage change (AAPC) 4.96%, especially for the Southwest (AAPC = 7.97%) and Northeast areas (AAPC = 7.10%), and for male and female subjects (with 5% AAPC) as well. In rural areas, the year 2000 was a cut-off point for mortality rate with annual percentage change increasing from 3.52% in 1991-2000 to 9.02% in 2000-2009, which was much higher than in urban areas (AAPC = 1.05%). And the proportion of deaths increased in older adults, and more male deaths occurred before age 60 compared to female deaths. CONCLUSION By observing a wide range of areas across China from 1991 to 2009, this paper concludes that the ASDR trend for IHD increased. These trends reflect changes in the Chinese standard of living and lifestyle with diets higher in fat, higher blood lipids and increased body weight.
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Affiliation(s)
- Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, No. 5 Dong Dan San Tiao, Dongcheng District, Beijing, 100005 China
| | - Hongyan Ren
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, No.11 Datuan Load A, Chaoyang District, Beijing, 100101 China
| | - Enbo Ma
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575 Japan
| | - Gonghuan Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, No. 5 Dong Dan San Tiao, Dongcheng District, Beijing, 100005 China
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Zhang Y, Fang X, Hua Y, Tang Z, Guan S, Wu X, Liu H, Liu B, Wang C, Zhang Z, Gu X, Hou C, Liu C. Carotid Artery Plaques, Carotid Intima-Media Thickness, and Risk of Cardiovascular Events and All-Cause Death in Older Adults: A 5-Year Prospective, Community-Based Study. Angiology 2017; 69:120-129. [PMID: 28675103 DOI: 10.1177/0003319717716842] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We assessed the effect of asymptomatic carotid atherosclerosis (CAS) on the development of cardiovascular diseases (CVDs) in a community-based population aged ≥55 years in China. A total of 1376 residents underwent CAS assessment by ultrasonography in July 2009. New CVD events, including stroke and coronary heart events, were collected at the follow-up survey at the end of 2014. After adjusting for baseline demographic characteristics and traditional CVD risk factors, the risk of CVD in patients with minimal CAS (mean common carotid artery intima-media thickness [CCA-IMT] ≥1 mm and no plaques), nonstenotic plaques (carotid stenosis <50%), and stenotic plaques (carotid stenosis ≥50%) was 0.8 (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.33-1.69), 2.0 (HR: 2.01, 95% CI: 1.24-3.25), and 3.1 (HR: 3.05, 95% CI: 1.62-5.74) times greater, respectively, than that of patients without CAS (CCA-IMT <1 mm and no plaques). Our findings provide direct evidence of the independent predictive value of the severity of asymptomatic CAS for the development of CVD in older Chinese adults.
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Affiliation(s)
- Yanlei Zhang
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xianghua Fang
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Hua
- 2 Department of vascular ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shaochen Guan
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoguang Wu
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongjun Liu
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Beibei Liu
- 2 Department of vascular ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunxiu Wang
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongying Zhang
- 3 Geriatric department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang Gu
- 4 Geriatric department, Friendship Hospital, Capital Medical University, Beijing, China
| | - Chengbei Hou
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Liu
- 1 Evidence-based Medical Center, Xuanwu Hospital, Capital Medical University, Beijing, China
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