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Zheng R, Xu Y, Li M, Lu J, Wu S, Niu J, Zhao Z, Chen L, Huo Y, Xu M, Wang T, Wang S, Lin H, Qin G, Yan L, Wan Q, Chen L, Shi L, Hu R, Tang X, Su Q, Yu X, Qin Y, Chen G, Gao Z, Wang G, Shen F, Luo Z, Chen Y, Zhang Y, Liu C, Wang Y, Wu S, Yang T, Li Q, Mu Y, Zhao J, Wang W, Ning G, Bi Y. Examining the Linear Association Between Blood Pressure Levels and Cardiovascular Diseases in the Absence of Major Risk Factors in China. Circ Cardiovasc Qual Outcomes 2022; 15:e008774. [PMID: 36065814 DOI: 10.1161/circoutcomes.121.008774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many studies demonstrate a J-shaped association between blood pressure and cardiovascular diseases (CVDs), but the findings are plagued by confounding from other traditional cardiovascular risk factors (CVRFs). Our aims were to examine the associations of systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with CVD in individuals without major CVRFs and whether there were thresholds for the association. METHODS In the 4C study (China Cardiometabolic Disease and Cancer Cohort), 36 042 CVRF-free participants without CVD, diabetes, dyslipidemia, hypertension, or smoking were identified during 2011 to 2012. Among CVRF-free participants, 17 476 CVRF-preferable individuals with better glycemic (fasting glucose, <110 mg/dL; 2-hour post-load glucose, <140 mg/dL) and lipid profile (total cholesterol, <200 mg/dL; LDL [low-density lipoprotein] cholesterol, <130 mg/dL) were selected. The total person-years of follow-up for CVRF-free subjects and CVRF-preferable subjects were 130 147 and 63 573 person-years, respectively. Information on the development of major CVDs was collected during 2014 to 2016. Cox proportional hazard models were performed to estimate the risks for incident CVD by SBP and DBP groups, respectively. RESULTS We found that both baseline SBP and DBP presented significantly linear associations with CVD risks in CVRF-free and CVRF-preferable participants. There is significant increase in the CVD risk among CVRF-free participants with baseline SBP level of 110 to 119 mm Hg (hazard ratio, 1.79 [95% CI, 1.19-2.71]), 120 to 129 mm Hg (hazard ratio, 2.03 [95% CI, 1.36-3.03]), and 130 to 139 mm Hg (hazard ratio, 2.15 [95% CI, 1.40-3.28]) compared with SBP <110 mm Hg. Significant increases were also observed for DBP level of 80 to 89 mm Hg (hazard ratio, 1.43 [95% CI, 1.03-1.97]) compared with DBP <70 mm Hg. Similar results were observed in CVRF-preferable participants. CONCLUSIONS SBP and DBP with levels currently considered normal were significantly and linearly associated with incident CVD without thresholds above 110/70 mm Hg among Chinese adults without major CVRFs.
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Affiliation(s)
- Ruizhi Zheng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Shujing Wu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Jingya Niu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Li Chen
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China. Qilu Hospital of Shandong University, Jinan, China (Li Chen)
| | - Yanan Huo
- Jiangxi Provincial People's Hospital Affiliated to Nanchang University, China (Y.H.)
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Hong Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Guijun Qin
- The First Affiliated Hospital of Zhengzhou University, China (G.Q.)
| | - Li Yan
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China (L.Y.)
| | - Qin Wan
- The Affiliated Hospital of Southwest Medical University, Luzhou, China (Q.W.)
| | - Lulu Chen
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Lulu Chen)
| | - Lixin Shi
- Affiliated Hospital of Guiyang Medical College, China (L.S.)
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, China (R.H.)
| | - Xulei Tang
- The First Hospital of Lanzhou University, China (X.T.)
| | - Qing Su
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China (Q.S.)
| | - Xuefeng Yu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.Y.)
| | - Yingfen Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China (Y.Q., Z.L.)
| | - Gang Chen
- Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China (G.C.)
| | | | - Guixia Wang
- The First Hospital of Jilin University, Changchun, China (G.W.)
| | - Feixia Shen
- The First Affiliated Hospital of Wenzhou Medical University, China (F.S.)
| | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China (Y.Q., Z.L.)
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Yinfei Zhang
- Central Hospital of Shanghai Jiading District, China (Y.Z.)
| | - Chao Liu
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China (C.L.)
| | - Youmin Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei, China (Y.W.)
| | - Shengli Wu
- Karamay Municipal People's Hospital, Xinjiang, China (Shengli Wu)
| | - Tao Yang
- The First Affiliated Hospital of Nanjing Medical University, China (T.Y.)
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, China (Q.L.)
| | - Yiming Mu
- Chinese People's Liberation Army General Hospital, Beijing (Y.M.)
| | - Jiajun Zhao
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China (J.Z.)
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.).,Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics (R.Z., Y.X., M.L., J.L., Shujing Wu, J.N., Z.Z., M.X., T.W., S. Wang, H.L., Y.C., Y.B., G.N., W.W.)
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