Prevalence and Clustering of Cardiovascular Disease Risk Factors among Tibetan Adults in China: A Population-Based Study

Blood-Blister Aneurysms of the Internal Carotid Artery in Tibetan and Han Populations : A Retrospective Observational Study

OBJECTIVE

Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality rates. Although research on BBAs is well documented in different populations, the study of BBAs in the Tibetan population is extremely rare. This study aimed to evaluate the characteristics of BBAs and analyze the treatment modalities and long-term outcomes in the Tibetan population in comparison with the Han population.

METHODS

The characteristics of patients with BBAs of the ICA from January 2009 to January 2021 at our institution were reviewed. The features of aneurysms, treatment modalities, complications, and follow-up outcomes were retrospectively analyzed.

RESULTS

A total of 130 patients (41 Tibetan and 89 Han patients) with BBAs of the ICA who underwent treatment were enrolled. Compared with the Han group, the Tibetan group significantly demonstrated a high ratio of BBAs among ICAs (8.6%, 41/477 vs. 1.6%, 89/5563; p<0.05), a high ratio of vasospasm (34.1%, 14/41 vs. 6.7%, 6/89; p=0.001), a high risk of ischemic events (43.9%, 18/41 vs. 22.5%, 20/89; p<0.05), and a low ratio of good outcomes (modified Rankin scale, 0-2) at the 1-year follow-up (51.2%, 21/41 vs. 74.2%, 66/89; p<0.05). The multivariate regression model showed that ischemic events significantly contributed to the prediction of outcomes at 1 year. Further analysis revealed that microsurgery and vasospasm were associated with ischemic events.

CONCLUSION

In comparison with Han patients, the Tibetan population had a high ratio of BBA occurrence, a high incidence of ischemic events, and a high ratio of poor outcomes. The endovascular approach showed more benefits in BBA patients.

Population Pharmacokinetics of Atorvastatin in High-Altitude and Plain Patients with Hyperlipidemic

The pharmacokinetic (PK) characteristics of drugs were altered under high-altitude hypoxia. We aim to describe the population PK of atorvastatin (ATV) to identify patient characteristics that are predictive of variability in the PK parameters of the ATV and investigate the effects of high-altitude hypoxia on the blood concentration of ATV in patients with hyperlipidemia. A total of 160 plasma concentrations were collected from 40 patients with hyperlipidemia in plateau areas and 40 in plain areas. The population pharmacokinetic model of patients with hyperlipidemia in plateau and plain areas of China was established by a nonlinear mixed-effects model. The PK of ATV were described by a 1-compartment model with first-order elimination. The main PK parameters of ATV were the first-order absorption rate (0.76 hour-1 fixed); clearance (174.22 L/h) and apparent volume of distribution (1119.62 L). The values of area and age were identified as significant covariates for the clearance, area, age, and urea for the volume of distribution. The steady-state peak concentration in the plateau area was higher than that in the plain area. This study may suggest dose reduction is necessary for patients with hyperlipidemia in high altitudes.

Health status of the population in Naqu, Tibet and its latent class analysis: a cross-sectional survey

Background

Through a survey and analysis of the population's present state of health, it is possible to give data support for improving the health status of inhabitants in Naqu, Tibet. Additionally, it is possible to provide specific recommendations for the development of medical and healthcare facilities in Tibet.

Methods

The health scores of the participants were based on their responses to the four main sections of the questionnaire: dietary habits, living habits, health knowledge, and clinical disease history, and the variability of health status among groups with different characteristics was analyzed based on the scores. The four major sections were used to create classes of participants using latent class analysis (LCA). Using logistic regression, the factors influencing the classification of latent classes of health status were investigated.

Results

A total of 995 residents from 10 counties in Naqu were selected as the study subjects. And their demographic characteristics were described. The mean health score of residents after standardization was 81.59 ± 4.68. With the exception of gender, health scores differed between groups by age, education level, different occupations, marital status, and monthly income. The health status in Naqu, Tibet, was divided into two groups (entropy = 0.29, BLRT = 0.001, LMRT = 0.001) defined as the "good health group" and the "general health group." A monthly income of more than ¥5000 adverse to good health in Naqu, Tibet.

Discussion

Single, well-educated young adults in Naqu, Tibet, have outstanding health. The vast majority of people in Tibet's Naqu region were in good health. Furthermore, the population's latent health status was divided into two classes, each with good dietary and living habits choices, low health knowledge, and a history of several clinical diseases. Univariate and multivariate logistic regression analysis showed that monthly income more than ¥5000 was an independent risk factor for poor health status.

Education level as a predictor of the onset of health problems among China's middle-aged population: Cox regression analysis

Background

Despite the importance of midlife with reference to one's health, educational inequalities in midlife health have attracted little attention in China. Using Cox proportional hazards regression analysis, this study examined the association between educational attainment and the onset of midlife health problems and investigated the potential mediating effects of socioeconomic position (SEP) other than educational attainment, depression, and health behavior.

Methods

Data were extracted from the China Health and Retirement Longitudinal Survey (CHALRS) from 2011 (baseline) to 2018 (latest data). Participants aged 45-59 years at baseline were studied (N = 8,050). Health outcomes included the onset of poor self-rated health (SRH), limitation in activities of daily living (ADL) and instrumental ADL (IADL), multimorbidity, hypertension, dyslipidemia, heart diseases, and stroke over the 7-year follow-up period. Cox proportional hazard models were used to examine the associations of the outcomes with educational attainment, while controlling for potential mediators (other SEP, depression, and health behaviors).

Results

Lower educational level was associated with increased incidences of poor SRH and ADL/IADL limitations, but with decreased incidences of dyslipidemia and heart disease. After adjusting for baseline covariates, the RII was 2.17 (95% confidence interval [CI]: 1.74, 2.70) for poor SRH, 2.15 (95% CI: 1.42, 3.26) for ADL limitation, 3.84 (95% CI: 2.98, 4.94) for IADL limitation, 0.52 (95% CI: 0.40, 0.68) for dyslipidemia, and 0.55 (95% CI: 0.40, 0.74) for heart disease. Significant proportions (2.1 to 27.0%) of the RII were explained by the mediators. No sex or urban-rural differences were found in this study.

Conclusion

Our findings suggest that educational attainment is an important predictor of the incidences of key midlife health problems, with significant mediating effects exerted by other indicators of SEP, depression, and health behavior.

Prevalence and clustering of cardiovascular risk factors among resident of coastal areas in Qinzhou, Guangxi, China

OBJECTIVE

We aimed to estimate the prevalence of CRFs and investigate its associated social-economic factors among adults in coastal areas of Qinzhou, Guangxi.

METHODS

A representative sample of 1836 participants aged 20 to 70 years was included in Qinzhou, Guangxi in 2020. Data were collected by the questionnaire, anthropometric and laboratory measurements. The prevalence of CRFs, including hypertension, dyslipidemia, diabetes, overweight or obesity, alcohol consumption, and smoking were calculated by standardization. The multivariate logistic regression analysis was performed to explore the independent factors associated with the presence of CRFs.

RESULTS

The age-standardized prevalence of hypertension, dyslipidemia, diabetes, overweight or obesity alcohol consumption, and smoking was 42.7%, 39.5%, 0.9%, 38.5%, 18.4% and 15.7%, respectively. The prevalence of clustering of at least one and at least two cardiovascular disease risk factors were 82.2% and 45.3% in total. There were differences in the aggregation of cardiovascular risk factors among different age, education, and income levels. There appeared higher clustering of at least one and at least two CRFs among adults with lower education level, higher income level and those elderly.

CONCLUSIONS

Compared with other regions in China, a higher prevalence of CRFs exists among adults in Guangxi and several social-economic factors were associated with the presence of CRFs. These findings suggest that we should implement effective measures to control the CRFs, to reduce the risk of cardiovascular disease in adults.

Association of dietary pattern and Tibetan featured foods with high-altitude polycythemia in Naqu, Tibet: A 1:2 individual-matched case-control study

This study focused on the association of dietary patterns and Tibetan featured foods with high-altitude polycythemia (HAPC) in Naqu, Tibet, to explore the risk factors of HAPC in Naqu, Tibet, to raise awareness of the disease among the population and provide evidence for the development of prevention and treatment interventions. A 1:2 individual-matched case-control study design was used to select residents of three villages in the Naqu region of Tibet as the study population. During the health examination and questionnaire survey conducted from December 2020 to December 2021, a sample of 1,171 cases was collected. And after inclusion and exclusion criteria and energy intake correction, 100 patients diagnosed with HAPC using the “Qinghai criteria” were identified as the case group, while 1,059 patients without HAPC or HAPC -related diseases were identified as the control group. Individuals were matched by a 1:2 propensity score matching according to gender, age, body mass index (BMI), length of residence, working altitude, smoking status, and alcohol status. Dietary patterns were determined by a principal component analysis, and the scores of study subjects for each dietary pattern were calculated. The effect of dietary pattern scores and mean daily intake (g/day) of foods in the Tibetan specialty diet on the prevalence of HAPC was analyzed using conditional logistic regression. After propensity score matching, we found three main dietary patterns among residents in Naqu through principal component analysis, which were a “high protein pattern,” “snack food pattern,” and “vegetarian food pattern.” All three dietary patterns showed a high linear association with HAPC (p < 0.05) and were risk factors for HAPC. In the analysis of the relationship between Tibetan featured foods and the prevalence of HAPC, the results of the multifactorial analysis following adjustment for other featured foods showed that there was a positive correlation between the average daily intake of tsampa and the presence of HAPC, which was a risk factor. Additionally, there was an inverse correlation between the average daily intake of ghee tea and the presence of HAPC, which was a protective factor.

Prevalence, Management, and Associated Factors of Obesity, Hypertension, and Diabetes in Tibetan Population Compared with China Overall

Tibetans’ life expectancy lags behind China’s average. Obesity and noncommunicable diseases (NCDs) contribute to health disparity, but NCD patterns among Tibetans are unknown. To examine the prevalence, management, and associated factors for obesity, hypertension, and diabetes among Tibetans, compared with China’s average, we systematically searched PubMed and China National Knowledge Infrastructure databases for studies between January 2010 and April 2021. Thirty-nine studies were included for systematic review, among thirty-seven that qualified for meta-analysis, with 115,403 participants. Pooled prevalence was 47.9% (95% CI 38.0–57.8) for overweight/obesity among adults (BMI ≥ 24 kg/m²) and 15.4% (13.7–17.2) among children using Chinese criteria, which are lower than the national rates of 51.2% and 19.0%, respectively. The estimate for hypertension (31.4% [27.1–35.7]) exceeded China’s average (27.5%), while diabetes (7.5% [5.2–9.8]) was lower than average (11.9%). Men had a higher prevalence of the three conditions than women. Residents in urban areas, rural areas, and Buddhist institutes had monotonically decreased prevalence in hypertension and diabetes. Awareness, treatment, and control rates for hypertension and diabetes were lower than China’s average. Urban residence and high altitude were consistent risk factors for hypertension. Limited studies investigated factors for diabetes, yet none exist for obesity. Tibetans have high burdens of obesity and hypertension. Representative and longitudinal studies are needed for tailored interventions. There are considerable variations in study design, study sample selection, and data-analysis methods, as well as estimates of reviewed studies.

Prevalence of hypertension and its relationship with altitude in highland areas: a systematic review and meta-analysis

This systematic review and meta-analysis synthesized the pooled prevalence of hypertension at high altitudes and explored its correlation with altitude using studies published in Chinese and English from database inception to February 2021. A systematic literature search was conducted among bibliographic databases (PubMed, Embase, and Web of Science) and three Chinese databases (CNKI, VIP, and Wanfang data) to identify eligible studies. A random-effects model was used to calculate the overall pooled prevalence of hypertension. The I² statistic was used to assess heterogeneity across studies. Random-effects meta-regression was conducted to investigate covariates that may have influenced between-study heterogeneity. The pooled prevalence of hypertension among the general population in high-altitude areas was 33.0% (95% CI: 29.0-38.0%), with high between-study heterogeneity (I² = 99.4%, P < 0.01). Subgroup analyses showed the pooled prevalence of hypertension in Tibetan individuals was significantly higher than that in non-Tibetan individuals living in the Himalayas and Pamir Mountains (41% vs. 18%). A trend toward an increase in the prevalence of hypertension was found with every 100-m increase in elevation (coefficient: 0.012, 95% CI: -0.001 to 0.025, P = 0.069) only in Tibetan individuals. In addition, in these individuals, we found an increase in mean diastolic BP with each 100-m increase in altitude (coefficient: 0.763, 95% CI: 0.122-1.403, P = 0.025). Our meta-analysis suggests that the pooled prevalence of hypertension among the general population in high-altitude areas is 33.0%. Subjects of Tibetan ethnicity were more prone to developing hypertension at high altitudes. However, a very weak relationship between altitude and the prevalence of hypertension was found only in Tibetan individuals.

Modifiable cardiovascular disease risk factors among adults in southern Ethiopia: a community-based cross-sectional study

OBJECTIVE

To assess the prevalence, magnitude and factors associated with the number of major modifiable cardiovascular disease (CVD) risk factors.

DESIGN

Community-based cross-sectional study.

SETTING

General population in urban and rural Wolaita, southern Ethiopia.

PARTICIPANTS

A total of 2483 adults aged 25-64 years were selected using the three-stage random sampling.

OUTCOME MEASURES

Prevalence of major modifiable CVD risk factors, co-occurrences and the number of modifiable CVD risk factors.

RESULTS

The major modifiable CVD risk factors documented in the Wolaita area were smoking with a weighted prevalence of 0.8%, hypercholesterolaemia 5.0%, hypertriglyceridaemia 15.5%, low high-density lipoprotein cholesterol (HDL-C) 31.3%, high systolic blood pressure 22.2%, high diastolic blood pressure 22.4%, physical inactivity 44.1%, obesity 2.8% and hyperglycaemia 3.7%. The numbers of participants having ≥1, ≥2 and ≥3 major modifiable CVD risk factors in the study area were 2013, 1201 and 576 with a weighted prevalence of 75.8%, 42.3% and 19.4%, respectively. In general, there were 28 different combinations of major modifiable CVD risk factor co-occurrences. The combination of physical inactivity with low HDL-C was found in 19.7% of the study participants, followed by physical inactivity with hypertension of 17.8%. Urban residence, male gender, sugar-sweetened food consumption and older age had a positive association with the number of major modifiable CVD risk factors, while being a farmer had a negative association.

CONCLUSIONS

The prevalence and magnitude of major modifiable CVD risk factors in the study area were high. The components of the most prevalent combinations of major modifiable CVD risk factors should be targeted. Therefore, public health measures against major modifiable CVD risk factors such as promotion of physical exercise and reduction of sugar-sweetened food consumption have to be taken, targeting the vulnerable groups such as urban residents and older age.

A Qualitative Content Analysis of Cardiovascular Diseases Related Health Information Targeted at the Hui Minority on Chinese WeChat Official Accounts

In this study, we focus on the information available in WeChat official accounts about cardiovascular diseases (CVDs), which are a leading cause of death in China. We are particularly interested in information targeting the Chinese Hui minority people, who have a high prevalence of cardiovascular risk factors (CVRFs). Our exploratory research therefore investigates whether and how the articles on WeChat official accounts are targeted at the Hui people. We used a qualitative approach to analyze 108 articles. Two related themes emerged: descriptions of how to live a healthy life; and explanations of CVDs and CVRFs. Traditional Chinese medicine likewise surfaced from the analysis as a specific and unique theme in the Chinese social and cultural context. Despite the high prevalence of CVRFs among the Hui, none of the articles included information tailored to them.

Diabetes increases the risk of COVID-19 in an altitude dependent manner: An analysis of 1,280,806 Mexican patients

AIMS

The objective of this study is to analyze how the impact of Diabetes Mellitus [DM] in patients with COVID-19 varies according to altitudinal gradient.

METHODS

We obtained 1,280,806 records from adult patients with COVID-19 and DM to analyze the probability of COVID-19, development of COVID-19 pneumonia, hospitalization, intubation, admission to the Intensive Care Unit [ICU] and case-fatality rates [CFR]. Variables were controlled by age, sex and altitude of residence to calculate adjusted prevalence and prevalence ratios.

RESULTS

Patients with DM had a 21.8% higher prevalence of COVID-19 and an additional 120.2% higher prevalence of COVID-19 pneumonia. The adjusted prevalence was also higher for these outcomes as well as for hospitalization, intubation and ICU admission. COVID-19 and pneumonia patients with DM had a 97.0% and 19.4% higher CFR, respectively. With increasing altitudes, the probability of being a confirmed COVID-19 case and the development of pneumonia decreased along CFR for patients with and without DM. However, COVID-19 patients with DM were more likely to require intubation when residing at high altitude.

CONCLUSIONS

The study suggests that patients with DM have a higher probability of being a confirmed COVID-19 case and developing pneumonia. Higher altitude had a protective relationship against SARS-CoV-2 infection; however, it may be associated with more severe cases in patients with and without DM. High altitude decreases CFR for all COVID-19 patients. Our work also shows that women are less affected than men regardless of altitude.

Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Older Adults in Malaysia: A Cross-Sectional Study of Prevalence and Clustering

The co-occurrence of multiple modifiable risk factors increases the risk of cardiovascular disease (CVD) morbidity or mortality. This study examines the prevalence and clustering of self-reported modifiable CVD risk factors among older adults in Malaysia. A total of 7117 adults aged ≥50 years participated in the National Health and Morbidity Survey (NHMS) 2018: Elderly Health, a community-based cross-sectional survey. Data were collected using a standardized structured questionnaire. Multivariable logistic regression was used to determine the factors associated with the clustering of self-reported modifiable CVD risk factors. The prevalence of self-reported diabetes, hypertension, hypercholesterolemia, overweight/obesity, and current smoking was 23.3%, 42.2%, 35.6%, 58.4%, and 17.5%, respectively. Overall, the prevalence of clustering of ≥1, ≥2, and ≥3 modifiable CVD risk factors was 83.3%, 75.4%, and 62.6%, respectively. Multivariable logistic regression analysis showed that men, 60–69 age group, urban dwellers, having no formal education, unemployed/retirees/homemakers, and being physically inactive were independently associated with self-reported modifiable CVD risk factors clustering. There are also ethnic differences in self-reported modifiable CVD risk factors clustering. Our findings underscore the necessity of targeted interventions and integrated strategies for early detection and treatment of modifiable CVD risk factors among older adults, considering age, sex, ethnicity, and socioeconomic status.

Health Information Related to Cardiovascular Diseases Broadcast on Chinese Television Health Programs

This study aims to add to the knowledge about information depicted in television health programs in China. Cardiovascular diseases (CVDs) are the leading cause of death in the country. The threat it poses is particularly notable among the Hui ethnic minority people, who have a higher prevalence of cardiovascular risk factors. Little research has been conducted thus far on content concerning CVDs in Chinese television health programs, and this study aims to fill this lacuna. Qualitative content analysis was conducted to analyze The Doctor Is In and Health Body Light. The results revealed that these two programs presented information about what CVDs and CVRFs are, how the former are treated, and what strategies are used to communicate health information. A new topic also stood out: discussions on how traditional Chinese medicine prevents and cures these diseases.

Association of age and blood pressure among 3.3 million adults: insights from China PEACE million persons project

OBJECTIVE

To assess the association between blood pressure (BP) with age and its heterogeneity across various sociodemographic subgroups in China.

METHODS

In this cross-sectional study, we analysed the data from nearly 3.3 million individuals aged 35-75 years from all 31 provinces in mainland China collected from September 2014 through August 2019. On the basis of possible combinations of eight characteristics and antihypertensive status, subgroups of at least 10 000 individuals were created and the age--blood pressure relationship was determined for each group.

RESULTS

The study included 3 291 058 participants (59.6% women), with a mean age of 55.8 ± 9.8 years. The prevalence of hypertension was 47.6%, of which 30.0% were taking antihypertensive medications. The mean SBP was 135.9 ± 20.2 mmHg. SBP increased at a mean unadjusted rate of 0.639 ± 0.001 mmHg/year. For 95% of the 25 145 subgroups, the SBP increased by 0.28--0.85 mmHg/year. The most common characteristics in the subgroups with the steepest association were female sex, rural area, low education, low-income family, Tibet region, and farmer occupation. The increase in SBP ranged from 0.13 to 0.41 mmHg/year for 95% of the treated subgroups and from 0.33 to 0.82 mmHg/year for 95% of the untreated subgroups.

CONCLUSION

Blood pressure is positively associated with age in this study, with almost three-fold variation across subgroups, indicating subgroup differences in biology, behaviour, or exposures. Antihypertension strongly blunts the association of age and blood pressure and diminishes the variation.

Epidemiological Features of Glycemic Levels and Relative Determinants at Different Altitudes Among Tibetans in China: A Cross-Sectional Population-Based Study

Risk factors associated with diabetes mellitus have been widely researched worldwide, but the determinants of glycemic levels among Tibetans in China are currently unclear. We thus aimed to determine the relationship between altitude and glycemic levels and to identify factors associated with glycemic levels among Tibetans in China. In 2011, a total of 1,659 Tibetans (aged ≥18 years) from Changdu, China, were enrolled to this cross-sectional research. Potential factors associated with postprandial glucose (PPG), fasting plasma glucose (FPG), and insulin (INS) levels were assessed. FPG and PPG levels increased with age and total cholesterol (TC) level. In addition, FPG levels were higher among patients with rural residence and hypertension, while PPG levels increased with increasing BMI. INS levels increased with residence, lower education, higher BMI, and higher TG levels and decreased with higher altitude and TC levels. Moreover, risk factors for FPG, PPG, and INS differed in those residing at a higher altitude. These findings identify several important risk factors that affect glycemic levels and may be used to develop effective strategies for metabolic disease prevention among populations in high-altitude areas. Furthermore, these findings suggest that it is necessary to formulate a standard for PPG, FPG, and INS in high-altitude areas.

Metabolic Risk Factors and Left Ventricular Diastolic Function in Middle-Aged Chinese Living in the Tibetan Plateau

Background

Data regarding the metabolic risk factors clustering on the risk of left ventricular diastolic dysfunction (LVDD) are lacking among people living at high altitude and under hypoxic conditions. In this study, we explored the association between metabolic risk factor clustering and LVDD among the Tibetan population of China.

Methods and Results

We conducted a cross‐sectional survey in a representative sample of 1963 Tibetans in 2014 to 2016. Grading LVDD was based on recommendations for the evaluation of LV diastolic function by echocardiography (2009). The prevalence of LVDD among 1963 participants (mean age: 51.51 years, 41.11% male) was 34.39%. Odds ratios (95% CI) of LVDD for the 1, 2, and 3 to 5 risk factors clustering were 1.45 (0.96–2.17), 2.68 (1.8–3.98), and 2.9 (1.9–4.43), respectively (P for trend <0.001). The association between metabolic risk factors clustering and LVDD was much more pronounced in the middle‐aged group than in the elderly (P for interaction=0.0170). High altitude was one of the major independent risk factors for LVDD; however, habitation altitude had no significant effect on the association between metabolic risk factors and LVDD (P for interaction=0.1022). The multivariable dominance analysis indicated that abdominal obesity, hypertension, and elevated blood glucose were the significant contributors to LVDD.

Conclusions

There was a significant positive association between the metabolic risk factor clustering number and LVDD among a population living at high altitude, especially in middle‐aged adults. However, habitation altitude itself has no significant effect on the association between metabolic risk factors and LVDD.

The U-shaped association of altitudes with prevalence of hypertension among residents in Tibet, China

We aimed to evaluate the association of altitudes with the prevalence of hypertension among residents aged 15 years and above in Tibet, China. Data for 11,407 Tibetan residents from the National Health Services Survey in 2013 were analyzed. Association between altitudes and prevalence of physician-diagnosed hypertension was assessed by two logistic regression models as follows: (i) a base model adjusted for age and gender, and (ii) a full model additionally adjusted for body mass index, education, marital status, area of residence, distance to the nearest medical institute, smoking, drinking, and exercise. Nonlinear relationship between altitudes and prevalence of hypertension was explored by restricted cubic spline analyses. Sensitivity analyses were conducted by restricting to residents of rural and/or nomadic areas. The prevalence of hypertension was estimated to be 37.6%. We found a U-shaped association between altitudes and prevalence of physician-diagnosed hypertension with a turning point at around 3800 m (12,467 ft). For residents living above 3800 m, a 1000 m increase in altitudes was associated with 2.05 (95% confidence interval [CI]: 1.62-2.61) times higher odds of having physician-diagnosed hypertension, after adjusting for age and gender. When further controlling for all covariates, the odds ratio (OR) dropped to 1.87 (95% CI: 1.46-2.41). For residents living below 3800 m, a 1000 m increase was associated with 0.29 (95% CI: 0.19-0.44) times less likelihood of having physician-diagnosed hypertension in the full model. Sensitivity analyses among residents in rural and/or nomadic areas showed similar associations. To conclude, altitudes were in a U-shaped association with prevalence of hypertension.

Prevalence of self-reported coronary heart disease and its associated risk factors in Tabari cohort population

BACKGROUND

Prevalence of coronary heart disease (CHD) risk factors are increasing in developing countries. The present study aimed to assess the prevalence of self-reported CHD and evaluate the role of various risk factors on its prevalence in the Tabari cohort study (TCS) population.

METHODS

The enrollment phase of TCS was performed between June 2015 and November 2017. In the current study, data were derived from information collecting from the enrollment phase of TCS. In the enrollment phase, 10,255 individuals aged 35-70 living in urban and mountainous areas of Sari (northern part of Iran) were entered into the study. Educational level, socioeconomic and marital status, history of smoking, opium and alcohol abuse/addiction, level of daily physical activity, indices of obesity, and traditional risk factors of the participants were determined.

RESULTS

The prevalence of CHD was measured at 9.2%. Older individuals (P<0.001), people with a body mass index≥30kg/m2 (P<0.001), diabetics (P<0.001), and hypertensive (P<0.001) have been shown to have an increased risk for CHD compared with participants of without CHD. Furthermore, the CHD was more prevalent in individuals with higher waist circumference (P<0.001), higher low-density lipoprotein cholesterol (P<0.001), lower high-density lipoprotein cholesterol (P<0.001), and a higher waist to hip ratio (P<0.001). In addition, individuals with low socioeconomic status, illiterate people, and opium users had a higher prevalence of CHD (P<0.001). The results of the multivariable logistic regression analysis showed that the probability of CHD among individuals who had 8-10 risk factors was estimated at 8.41 (95% confidence interval: 5.75-12.31) times higher than those with less than 3 risk factors.

CONCLUSION

According to the results of the present study, it seems that the prevalence of CHD in the Iranian population is relatively high.

Metabolic syndrome and its relation to dietary patterns among a selected urbanised and semi-urbanised Tibetan population in transition from nomadic to settled living environment

OBJECTIVE

To explore the scope of metabolic syndrome (MetS) and its relationship to the major dietary patterns among an urbanised and semi-urbanised Tibetan population in transition from nomadic to settled settings.

DESIGN

Cross-sectional.

SETTING

Community-based.

PARTICIPANTS

Urbanised and semi-urbanised Tibetan adults (n 920, aged 18-90 years), who have moved from nomadic to settled living environments, answered questionnaires on food consumption frequency and lifestyle characteristics through structured face-to-face interviews and completed anthropometric measurement and metabolic biomarker tests.

RESULTS

MetS prevalence was 30·1 % in males and 32·1 % in females. Low HDL-cholesterol and central obesity were the leading metabolic abnormalities (86·3 and 55·8 %, respectively). Three major dietary patterns - urban, western and pastoral - were identified. Beef/mutton was an important food group for all three identified dietary patterns. In addition, the urban dietary pattern was characterised by frequent consumption of vegetables, tubers/roots and refined carbohydrates; the western pattern was characterised by sweetened drinks, snacks and desserts; and the pastoral pattern featured tsamba (roasted Tibetan barley), Tibetan cheese, butter tea/milk tea and whole-fat dairy foods. Individuals in the highest quintile of urban dietary pattern scores were found to be at a higher risk of developing MetS (OR 2·43, 95 % CI 1·41, 4·18) and central obesity (OR 1·91, 95 % CI 1·16, 3·14) after controlling for potential confounders.

CONCLUSIONS

MetS was common among urbanised and semi-urbanised Tibetan adult population in transition. The urban dietary pattern, in particular, was a risk factor for MetS. To prevent MetS, nutrition interventions need to be tailored to address the variety of local diet patterns to promote healthy eating.

Risk factors for cardiovascular disease from a population-based screening study in Tianjin, China: a cohort study of 36,215 residents

Background

Cardiovascular disease (CVD) is a harmful disease that poses a serious threat to human life. By effectively controlling its risk factors, the occurrence and development of CVD can be reduced, and people’s health status and quality of life can be improved.

Methods

A total of 36,215 participants were collected from participants of the Early Screening and Comprehensive Intervention Program for High Risk Population of Cardiovascular Disease in Tianjin on July 31, 2017. We analyzed the relationship between CVD risk and personal information, personal and family medical history, biochemical index, and physical fitness index using Pearson’s chi-squared test with and without Yates’s correction for continuity, and Fisher’s exact test. CVD risk-related factors were examined through logistic regression and decision tree analysis.

Results

A personal history of hypertension and apoplexy had a contingency coefficient with CVD risk of more than 0.3. A higher risk of CVD was also found to be associated with biochemical markers of cholesterol, low-density lipoprotein cholesterol, and blood sugar. Logistic regression analysis revealed 12 indicators to be influencing factors of CVD, including age, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the number of people aged >90 in the family. Hypertension, SBP, BMI, cholesterol, and blood glucose were associated with five or more other indicators.

Conclusions

The prevalence of CVD risk factors in Tianjin residents is relatively high. Family disease history and individual physical fitness indicators need to be taken into account during CVD screening and intervention, to reduce the risk of CVD.

Metabolic syndrome in native populations living at high altitude: a cross-sectional survey in Derong, China

OBJECTIVE

The metabolic syndrome is a major risk factor for cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome at high-altitude areas in China. We aimed to estimate the prevalence of metabolic syndrome and its individual components at high altitude.

METHODS

A cross-sectional survey of 5053 adults living in Derong from elevation of 2060 to 3820 m was carried out in 2013. Metabolic syndrome was defined according to the Chinese Diabetes Society criteria.

RESULTS

The overall prevalence of metabolic syndrome was 3.6% (5.9% in men and 1.8% in women) in Derong, China. Obesity and hypertension were more prevalent among adults than dyslipidaemia and hyperglycaemia at high altitude. The prevalence of metabolic syndrome was higher in township than countryside residents (6.6%, 11.9% in men and 1.5% in women vs 3.0%, 4.6% in men and 1.8% in women). Men with age 30-59 years old had a much higher prevalence of metabolic syndrome than women. Men, township, middle and old age residents had a higher risk of metabolic syndrome. The risk of obesity and dyslipidaemia decreased and the risk of hypertension increased in very high altitude (≥3000 m) residents.

CONCLUSION

In Derong, despite the relatively low prevalence of metabolic syndrome, hypertension and obesity are more prevalent in adult residents. And metabolic syndrome is more concentrated in township and male residents. These people also have a higher risk of metabolic syndrome. Therefore, it is necessary to develop a national strategy for the prevention and treatment of metabolic syndrome for high-risk population at high altitude in China.

Prevalence of hypertension and associated factors in female prison correctional officers in a national sample in Brazil

OBJECTIVES

To estimate hypertension prevalence and associated factors among female correctional officers (FCO) in female Brazilian prisons.

METHODS

Cross-sectional, analytical study conducted in 15 female prisons in all five Brazilian regions between January 2014 and December 2015. The study population consisted of correctional officers with at least 6 months in the position. The sampling included 40% of FCO present in the prison during data collection, yielding 295 FCOs. Data were collected via Audio Computer-Assisted Self-Interview. A physical examination of participants was conducted including blood pressure, weight, and waist and hip circumference. The Odds Ratio and confidence intervals for independent factors were estimated.

RESULTS

Hypertension prevalence in correctional officers was 37.9%, (95% CI 32.1-44.0). Hypertension was associated with obesity (95% CI = 1.884-9.947), cardiovascular disease (95% CI = 3.348-16.724), and participation in the specific training course for the relevant position (95% CI = 1.413-9.564).

CONCLUSIONS

While findings, except for the last factor, are not novel, this is the first such study conducted in Brazil. Hypertension prevalence among this pool of all female correctional officers is higher than in the average population, and FCOs associate this with the prison environment. Current training does not appear to address this problem. Especially since prison populations are growing in Brazil, this problem needs to be addressed for the health of the FCOs and the prisoners in their care.

Understanding the Chinese Hui Ethnic Minority's Information Seeking on Cardiovascular Diseases: A Focus Group Study

The Chinese Hui ethnic minority group is an Islamic minority. The Hui people comprise the third largest minority population in China and are widely distributed throughout the country. Previous research shows that the Hui had a higher prevalence of cardiovascular risk factors (CVRFs) than most other ethnic groups. Therefore, the availability of health information relating to these factors is especially important for the Hui minority’s preventive healthcare. They do, however, experience difficulties in obtaining health-related information. The current research aims to identify the needs of the Hui people on where and how they obtain cardiovascular disease (CVD) related information from the media and other sources. Six focus groups were conducted in Shenyang City. The results revealed that the participants relied on different sources to get advice about CVDs, of which the internet and television were the most prominent ones. The participants expressed a desire for credible and professional information from different sources and asked for mediated health communication programs specifically targeted at the Hui. In addition, the participants felt ignored by the Chinese mainstream media at large, which created barriers for them to get health information.

Buddhist Activities related to Sedentary behavior and Hypertension in Tibetan monks

Previous studies suggest sedentary behavior (SB) is a risk factor for hypertension. However, buddhist activities related to SB in Tibetan monks is quite different from common SB. Meditation, chanting, and buddhist teaching are the main features during sitting. There is no study to examine the association between buddhist activities related to sitting and hypertension. There were 594 Tibetan monks included for analysis. Buddhist activities related to SB involve hours of meditation, chanting, and buddhist teaching for a typical weekday and weekend day. After controlling potential risk factors, compared with Tibetan monks who has the sedentary time < 8 h/d, those with 10 h/d ≤ sedentary time < 11 h/d was associated with about 80% decrease in the risk of hypertension (OR = 0.22;95% CI = 0.07-0.71), and about 90% decrease (OR = 0.11; 95% CI = 0.03-0.40) in those with sedentary time ≥ 11 h/d. In hypertension subgroup, buddhist activities related to SB is associated with a decrease in BP during linear regression analysis (standard β = -0.355; P = 0.004 for SBP; standard β = -0.345; P = 0.013 for DBP). We conclude that sitting might not simply represent the extremely low energy expenditure of the physical activity continuum. Psychosocial activities may play an important role in SB.

The prevalence of hyperuricemia and its correlates in Ganzi Tibetan Autonomous Prefecture, Sichuan Province, China

Background

Hyperuricemia is a common and serious public health problem. There has been no broad epidemiological survey of hyperuricemia in China, especially in Tibetan area. This study was therefore investigated the prevalence of hyperuricemia and its correlated factors among people aged 18–85 years in Ganzi Tibetan Autonomous Prefecture, Sichuan Province, China.

Methods

We carried out a cross-sectional study among 3093 participants in Ganzi Tibetan Autonomous Prefecture using questionnaires in face-to-face interviews, anthropometric measurements and biochemical tests. We included 1416 subjects with complete data including serum uric acid and medical history to analyze the prevalence of hyperuricemia and correlated factors. Hyperuricemia was defined as a fasting serum uric acid level higher than 420 μmol/L in men and 360 μmol/L in women.

Results

The overall crude prevalence of hyperuricemia was 37.2%, and was greater in men than women (41% vs 34.4%, P = 0.011). The age-adjusted prevalence was 33.0%. Characteristics linked to hyperuricemia were farmers-herdsmen (OR: 1.749, 95% CI: 1.022–2.992), low to moderate education level (low OR:1.57, 95% CI: 1.102–2.237; moderate OR: 1.86, 95% CI: 1.167–2.963), current drinking (OR: 1.795, 95% CI: 1.193–2.702), hypertension (OR: 1.48, 95% CI: 1.091–2.006), higher body mass index (1 unit increase) (OR: 1.116, 95% CI: 1.077–1.156) and higher serum creatinine (1 unit increase) (OR: 1.046, 95% CI: 1.034–1.059). Serum uric acid was positively related to triglycerides and total cholesterol and negatively related to high density lipoprotein cholesterol in all subjects. Hyperuricemia was a risk factor for high triglyceride ((OR: 2.13, 95% CI: 1.156–3.9266) and high total cholesterol (OR: 2.313, 95% CI: 1.364–3.923) in men and for high low-density lipoprotein cholesterol (OR: 2.696, 95% CI: 1.386–5.245) in women.

Conclusion

There is a high prevalence of hyperuricemia in Ganzi Tibetan Autonomous Prefecture. The government needs to prevent and manage hyperuricemia in this area.

Association between dietary patterns and hypertension among Han and multi-ethnic population in southwest China

Background

Different dietary patterns and the risks of hypertension in various diet exposures among multi-ethnic population in southwest China remain extremely scarce. The aim of this study is to identify dietary patterns and explore the association between dietary patterns and the risk of hypertension among Han and multi-ethnic population in southwest China.

Methods

A representative sample of 3591 participants of Han, and multi-ethnic population were recruited by stratified cluster sampling in Diqing of Yunnan Province, southwest China from September 2012 to January 2013. Participants who were under 18 years old or who could not clearly answer the questions and those who used the anti-hypertensive medication were excluded from this survey. All participants reported their dietary intakes using validated food frequency questionnaires (FFQ), and their blood pressures were measured by standardized procedures. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg. Dietary patterns were identified by factor analysis with principal component. Logistic regression was used to explore the association between dietary patterns and hypertension.

Results

The overall prevalence of hypertension was 30.5% among Han and multi-ethnic population in Diqing, Yunnan Province. Three dietary patterns were identified in this study, defined as ‘Grassland healthy’, ‘Tuber and meat’, and ‘Fruit and vegetable’. Participants in the 5th quintile of the three dietary patterns were at a lower risk of hypertension compared with those in the 1st quintile. The odds ratio (OR) for the 5th quintile of ‘Grassland healthy’ pattern, ‘Tuber and meat’ and ‘Fruit and vegetable’ was 0.693 (95% CI: 0.537–0.893, p = 0.005), 0.678 (95% CI: 0.530–0.868, p = 0.002), 0.759 (95% CI: 0.593–0.970, p = 0.028), respectively. After further adjustment of participants’ age, the negative association between the ‘Grassland healthy’ pattern and the prevalence of hypertension persisted (OR = 0.703, 95% CI: 0.535–0.924, p = 0.012). However, the significant associations between the other two dietary patterns and hypertension disappeared.

Conclusions

The ‘Grassland healthy’ dietary pattern is associated with lower risk of hypertension, whereas there is no significant associations between the other two dietary patterns and hypertension among Han and multi-ethnic population in Diqing of Yunnan province, southwest China.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6003-7) contains supplementary material, which is available to authorized users.

Limited contribution of health behaviours to expanding income-related chronic disease disparities based on a nationwide cross-sectional study in China

This study estimated the association of income and prevalence of cardiovascular diseases (CVD) and hypertension, and then quantified the contribution of health behaviors to the association in China. Using the 2013 survey of the China Health and Retirement Longitudinal Study (CHARLS), a logit model was applied to examine income-related health disparities in relation to CVD and hypertension. A four-step regression method was then constructed to measure the role of health behaviors in income-related health disparities. Using indirect effects, mediation by health behaviors was examined. Income-related health disparities in chronic diseases were found to exist in China. Specifically, individuals in the high-income group had a 14% (OR = 0.86; 95% CI 0.73-1.02) and 14% (OR = 0.86; 95% CI 0.76-0.97) lower odds of suffering from CVD and hypertension than those in the low-income group. However, limited evidence shows this association was mediated by health behaviors. The Heaviness of Smoking Index (HSI), heavy drinking, irregular eating, and nap time did not significantly mediate the association of income and prevalence of CVD and hypertension. To curb the rising prevalence of CVD and hypertension in China, policies should focus on the low-income subpopulation. However, healthy behaviors interventions targeting smoking, heavy drinking, unhealthy napping and irregular eating habits among low-income people may be ineffective in reduction of income-related disparities in prevalence of CVD and hypertension.

Prevalence and clustering of cardiovascular risk factors: a cross-sectional survey among Nanjing adults in China

OBJECTIVES

To estimate prevalence and clustering of cardiovascular risk factors (CRFs), and investigate the association between relevant characteristics and CRF clustering among adults in eastern China.

DESIGN

Community-based cross-sectional study.

SETTING

Data were collected by interview survey, physical measurements and laboratory examinations from the 2011 Nanjing Chronic Disease and Risk Factor Surveillance.

PARTICIPANTS

A representative sample of 41 072 residents aged ≥18 years volunteered to participate in the survey, with a response rate of 91.3%. We excluded 1232 subjects due to missing data or having a history of cardiovascular diseases; a total of 39 840 participants were included in the analysis.

OUTCOME MEASURES

Prevalence and clustering of five major CRFs including hypertension, diabetes, dyslipidaemia, overweight or obesity and current smoking.

RESULTS

Of 39 840 participants (mean age 47.9±16.2 years), 17 964 (45.1%) were men and 21 876 (54.9%) were women. The weighted prevalence of CRFs ranged between 6.2% for diabetes and 35.6% for overweight or obesity. The proportion of CRFs tended to be higher in men, the elderly, participants who lost a life partner, or lived in rural areas, or had lower level of education and total annual income. Overall, 30.1% and 35.2% of participants had one and at least two CRFs, respectively. Multivariate logistic regression revealed that men, older age, loss of a life partner, lower level of socioeconomic status, rural areas, insufficient physical activity or unhealthy diets were positively associated with CVD risk factor clustering, compared with their counterparts.

CONCLUSIONS

High regional prevalence of hypertension, dyslipidaemia, overweight or obesity and their clustering are present in Nanjing. The Nanjing government should develop effective public health policies at the regional level especially for high-risk groups, such as enhancing the public's health awareness, organising health promotion programmes, implementing smoke-free law, producing healthy nutrient foods, providing free or low-cost public sports and fitness facilities.

The prevalence of and risk factors for diabetes mellitus and impaired glucose tolerance among Tibetans in China: a cross-sectional study

The prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) has increased worldwide, although their prevalence and determinants among Tibetans are currently unknown. We thus aimed to explore the prevalence of and risk factors for DM and IGT among Tibetans in China. In 2011, 1659 Tibetan adults (aged ≥ 18 years) from Changdu, China, were recruited to this cross-sectional study. They completed a questionnaire and underwent physical examinations and laboratory testing to assess risk factors for DM and IGT. The age-standardized prevalence of DM and IGT among Tibetans was 6.2% and 19.7%, respectively. A higher annual family income, alcohol consumption, and higher fasting plasma glucose (FPG) level were risk factors for DM, with odds ratio (ORs) and 95% confidence intervals (CIs) of 3.48 (1.43-8.48; P = 0.006) for those with family incomes of > 1600 USD/year, 3.06 (1.31-7.17; P = 0.010) for alcohol consumption, and 13.99 (7.76-25.22; P < 0.001) for FPG level. However, altitude was found to be negatively associated with the risk of DM; compared to individuals living at < 3500 meters, the risk of DM decreased by 65% for those living at 3500-3999 meters (P = 0.034) and by 89% for those living at ≥ 4000 meters (P = 0.015). Age, FPG levels, and low-density lipoprotein cholesterol levels were significantly associated with IGT among Tibetans aged ≥ 18 years. These findings suggest that the prevalence of DM in Tibetans may continue to increase in future decades following rapid economic development, and it is crucial to address the management of conventional risk factors for reducing the disease burden of DM among Tibetans.

Large-Scale Epidemiologic Studies of Cardiovascular Diseases in China: Need for Improved Data Collection, Methods, Transparency, and Documentation

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.

Risk of Type 2 Diabetes Mellitus Development in the Native Population of Low- and High-Altitude Regions of Kyrgyzstan: Finnish Diabetes Risc Score Questionnaire Results

Moldobaeva, Marina S., Anastasiya V. Vinogradova, and Marina K. Esenamanova. Risk of type 2 diabetes mellitus development in the native population of low- and high-altitude regions of Kyrgyzstan: Finnish Diabetes Risc Score questionnaire results. High Alt Med Biol. 18:428-435, 2017.

OBJECTIVE

The number of patients with diabetes is steadily growing, but likely only half of all cases are ever identified. The Kyrgyz, native inhabitants of Central Asia, live in the mountainous area and have a particular lifestyle and nutrition. However, the risk of type 2 diabetes mellitus (T2DM) in our population is not well defined. Therefore, we aimed at determining the risk of T2DM development in the Kyrgyz population residing in low- and high-altitude (HAlt) regions by using the Finnish Diabetes Risc Score (FINDRISC) questionnaire.

METHODS

We included in the study 3190 randomly selected participants, including 1780 low-altitude (LAlt) residents (Chu region, 500-1200 m) and 1410 HAlt residents (Naryn region, 2000-4500 m), among whom there were 1207 men and 1983 women. Assessment of T2DM development was conducted by using the FINDRISC questionnaire and risk stratification was performed by region of residency, gender, and age.

RESULTS

An irregular intake of vegetables and fruits, increased waist circumference (WC), and increased body mass index (BMI) were identified as leading risk factors of T2DM development in native residents of Chu and Naryn regions of Kyrgyzstan. The 10-year risk stratification of T2DM development revealed the absence of a very high-risk group; high-risk status was more frequently identified among residents of the LAlt Chu district (4.7% of women and 2.1% of men), as compared with the HAlt population (1.9% of women and 1% of men) (p = 0.0018 for women and p = 0.09 for men).

CONCLUSIONS

In the Kyrgyz population, a 10-year high risk of T2DM development is greater among residents of LAlts as compared with HAlts, irrespective of gender. No very high-risk group was detected in residents of low or HAlts. The leading composites of FINDRISC score are increased WC and BMI, possibly due to irregular intake of vegetables and fruits that are dependent on the altitude of residence and age.

Clustering of cardio metabolic risk factors in Iranian adult population: A growing problem in the north of Iran

INTRODUCTION

The clustering of components of metabolic syndrome (MetS) is a major concern in a transition population because of dramatic changing toward modern life styles. The objective of this study was to determine the prevalence of clustering of various combinations of MetS and its association with obesity.

METHODS AND SUBJECTS

In a population- based cross-sectional study, a representative samples of 1000 adults were recruited in Babol, the north of Iran. The demographic data, blood pressure, body mass index and waist circumference (WC) were measured with standard method. Fasting blood sugar, serum levels of triglycerides, high density lipoprotein were measured with enzymatic method.

RESULTS

A quarter of population had only one component of MetS. The prevalence of just two components was 30.7% and 26.2% in men and women respectively and about 67.1% of men and 73.3% of women had ≥2 risk factors (P=0.001). While the joint prevalence of three and four components was 22.0% and 12.0% in male and 27.3% and 16.5% in female respectively. The combination of high WC with any of other four components of MetS were significantly higher compared with any other joint combinations in particularly among women (P=0.001). The adjusted odds ratio for having clustering (≥2 risk factors) increased 5.6 times (95%CI: 2.15, 6.04) in obese subjects and remained at significant level after adjustment for age, sex, level of education.

CONCLUSION

An emerging high rate of clustering of joint combination of cardio metabolic risk factors highlights an urgent intervention for life style modification in public health management.

Lipid Profiles, Glycated Hemoglobin, and Diabetes in People Living at High Altitude in Nepal

This study aimed to describe lipid profiles and the distribution of glycated hemoglobin (HbA1c) in a sample of a high altitude population of Nepal and to explore associations between these metabolic risk variables and altitude. A cross-sectional survey of cardiovascular disease and associated risk factors was conducted among 521 people living at four different altitude levels, all above 2800 m, in the Mustang and Humla districts of Nepal. Urban participants (residents at 2800 m and 3620 m) had higher total cholesterol (TC) and triglyceride (TG) than rural participants. A high ratio of TC to high-density lipoprotein-cholesterol (HDL) (TC/HDL ≥ 5.0) was found in 23.7% (95% CI 19.6, 28.2) and high TG (≥1.7 mmol/L) in 43.3% (95% CI 38.4, 48.3) of participants overall. Mean HbA1c levels were similar at all altitude levels although urban participants had a higher prevalence of diabetes. Overall, 6.9% (95% CI 4.7, 9.8) of participants had diabetes or were on hypoglycaemic treatment. There was no clear association between lipid profiles or HbA1c and altitude in a multivariate analysis adjusted for possible confounding variables. Residential settings and associated lifestyle practices are more strongly associated with lipid profiles and HbA1c than altitude amongst high altitude residents in Nepal.

Effects of AMPD1 gene C34T polymorphism on cardiac index, blood pressure and prognosis in patients with cardiovascular diseases: a meta-analysis

Background

The meta-analysis was aimed to evaluate the effects of AMPD1 gene C34T polymorphism on cardiac function indexes, blood pressure and prognosis in patients with cardiovascular diseases (CVD).

Methods

Eligible studies were retrieved through a comprehensive search of electronic databases and manual search. Then the high-quality studies met the rigorous inclusion and exclusion criteria, as well as related to the subject was selected for the study. Comprehensive data analyses were conducted using STATA software 12.0.

Results

The study results revealed that CVD patients with CT + TT genotype of AMPD1 C34T polymorphism presented elevated left ventricular ejection fraction (LVEF) (%) and reduced left ventricular end diastolic dimension (LVEDD) (mm) as compared with CC genotype, moreover, the subgroup analysis found that the LVEF (%) was markedly higher in heart failure (HF) patients carrying CT + TT genotype than CC genotype. Besides, the systolic blood pressure (SBP) (mmHg) in CVD patients with CT + TT genotype was obviously decreased in contrast with the CC genotype. Patients suffered from HF with different genotypes (CT + TT and CC) of AMPD1 C34T polymorphism exhibited no significant differences in total survival rate and cardiac survival rate.

Conclusions

Our current meta-analysis indicated that the T allele of AMPD1 gene C34T polymorphism may be correlated with LVEF, LVEDD and SBP, which plays a protective role in the cardiac functions and blood pressure in CVD patients, but had no effects on total survival rate and cardiac survival rate for HF.

Socioeconomic status and prevalence of type 2 diabetes in mainland China, Hong Kong and Taiwan: a systematic review

BACKGROUND

China is estimated to have had the largest number of people with diabetes in the world in 2015, with extrapolation of existing data suggesting that this situation will continue until at least 2030. Type 2 diabetes has been reported to be more prevalent among people with low socioeconomic status (SES) in high-income countries, whereas the opposite pattern has been found in studies from low- and middle-income countries. We conducted a systematic review to describe the cross-sectional association between SES and prevalence of type 2 diabetes in Chinese in mainland China, Hong Kong and Taiwan.

METHODS

We conducted a systematic literature search in Medline, Embase and Global Health electronic databases for English language studies reporting prevalence or odds ratio for type 2 diabetes in a Chinese population for different SES groups measured by education, income and occupation. We appraised the quality of included studies using a modified Newcastle-Ottawa Scale. Heterogeneity of studies precluded meta-analyses, therefore we summarized study results using a narrative synthesis.

RESULTS

Thirty-three studies met the inclusion criteria and were included in the systematic review. The association between education, income and occupation and type 2 diabetes was reported by 27, 19 and 12 studies, respectively. Most, but not all, studies reported an inverse association between education and type 2 diabetes, with odds ratios (OR) and 95% confidence interval (CI) ranging from 0.39 (CI not reported) to 1.52 (95% CI 0.91 - 2.54) for the highest compared to the lowest education level. The association between income and type 2 diabetes was inconsistent between studies. Only a small number of studies identified a significant association between occupation and type 2 diabetes. Retired people and people working in white collar jobs were reported to have a higher risk of type 2 diabetes than other occupational groups even after adjusting for age.

CONCLUSIONS

This first systematic review of the association between individual SES and prevalence of type 2 diabetes in China found that low education is probably associated with an increased prevalence of type 2 diabetes, while the association between income and occupation and type 2 diabetes is unclear.

Magnitude of and gender differences in cardiovascular risk profiles among community residents in Shenzhen, China

OBJECTIVES

Understanding the prevalence of cardiovascular disease (CVD) risk factors has an impact on the public policy for initiating CVD prevention. This study aimed to examine the prevalence of current smoking, overweight/obesity, hypertension, diabetes mellitus (DM), and dyslipidemia among Shenzhen residents and to investigate gender differences in CVD risk profiles to identify the subgroups at higher risk.

STUDY DESIGN

A large cross-sectional study was conducted between April and May 2015.

METHODS

Using multistage cluster random sampling methods, a total of 1784 residents finished the face-toface interview survey. Physical examinations and blood tests were performed by qualified professionals.

RESULTS

The prevalence of current smoking, overweight/obesity, hypertension, DM, and dyslipidemia were 21.8%, 40.6%, 17.6%, 4.8%, and 35.7%, respectively. Clustering of two or more or three or more of CVD risk factors was noted in 35.7% and 14.1% of participants. The prevalence of current smoking (45.0% vs 1.1%, P < 0.001), overweight/obesity (48.5% vs 33.4%, P < 0.001), hypertension (19.7% vs 15.7%, P < 0.05), and dyslipidemia (46.5% vs 20.5%, P < 0.001) was found higher among male than among female participants.

CONCLUSIONS

This study adds to the evidence suggesting high prevalence rates of CVD risk factors and composite measures among Shenzhen residents. The higher level of CVD risk factors in male than in female residents is suggested. Effective population-based intervention programs such as smoking cessation, early detection, management, and treatment of hypertension, DM, and dyslipidemia should be initiated and enhanced especially among the males.

Prevalence and risk factors associated with hypertension and prehypertension in a working population at high altitude in China: a cross-sectional study

Background

Little information is available on the epidemiology of hypertension and prehypertension at high altitude in China, the aim of this study was to determine the prevalence of hypertension, prehypertension and their risk factors among Chinese working population at high altitude regions.

Methods

A cross-sectional survey was performed in an occupational sample of 4198 employees aged 20–59 years on Qinghai-Tibet Plateau between May to July 2013. Information from a self-administered questionnaire, physical examinations and laboratory measurements were obtained from each participant. Multivariable analysis was performed to determine the association of various risk factors with hypertension and prehypertension.

Results

The total crude prevalence of hypertension and prehypertension was 28.1 and 41.5%, respectively; the overall standardized prevalence of hypertension and prehypertension was 26.7 and 41.3%, respectively. Multivariate logistic regression showed that age, sex, ethnicity, job position, overweight or obesity, frequent drinking, family history of hypertension, diabetes and hyperuricemia were risk factors for hypertension, and age, sex, education, job position, overweight or obesity, current smoking and family history of hypertension were risk factors for prehypertension. Among the hypertensives, 36.5% were aware of their condition, 19.4% were being treated and 6.2% had their blood pressure (BP) controlled; among the treated hypertensives, 31.9% had their BP under control.

Conclusions

There is a high prevalence of hypertension and prehypertension in the working population at high altitude in China, but with very low awareness, treatment and control rates. Workplace-based BP screening and intervention programs that aim to modify risk factors such as high BMI, tobacco use, alcohol consumption and inappropriate use of antihypertensive medicine are urgently needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12199-017-0634-7) contains supplementary material, which is available to authorized users.

Diabetes in Immigrant Tibetan Muslims in Kashmir, North India

Tibetan Muslims have migrated from Lhasa (3000 m altitude) to Srinagar, India (altitude 1500 m) about 55 years back. We set out to study the prevalence of diabetes and prediabetes among this immigrant population. All consenting adults aged ≥18 years were questioned about a previous history of diabetes or any other medical history. Anthropometric data were recorded. Fasting blood glucose was measured in duplicate by Accu-check glucometer and HbA1C levels were measured. Of the 281 participants, 26 (9.25%) had diabetes whereas 46 (16.4%) had pre-diabetes; 24 reporting doctor-diagnosed diabetes. Participants with diabetes/pre-diabetes were more likely to be obese, smokers and hypertensive. Multiple logistic regression analysis revealed age to be significantly associated with a higher prevalence of diabetes. One in four adults ≥18 years among Tibetan Muslims have diabetes or prediabetes. Migration to lower altitude could have contributed to this high prevalence.

Minerals and Trace Elements Intakes and Food Consumption Patterns of Young Children Living in Rural Areas of Tibet Autonomous Region, P.R. China: A Cross-Sectional Survey

BACKGROUND AND OBJECTIVES

Several studies revealed clinical signs of stunting and rickets among rural populations of Tibet Autonomous Region (T.A.R.), and especially amid children. Further, these populations are affected by a bone disease named Kashin-Beck disease (KBD). However, little is known about the dietary status of this population. This survey aimed to assess the usual intakes of young Tibetan children living in rural areas around Lhasa for energy, water, and ten minerals and trace elements (Na, K, Ca, P, Mg, Fe, Zn, Cu, Mn, and Se) involved in bone metabolism.

DESIGN

A cross-sectional survey was designed. Totally, 250 pre-school children aged 3-5 years living in rural areas were enrolled. The 24-h food recall method was used to collect the intakes for two days, during two different seasons (September 2012 and April 2013). Because Tibetan foods are mainly derived from local agriculture and artisanal production, a combination of food composition tables was compiled, including specific and local food composition data.

RESULTS

The Chinese dietary recommended intakes are not met for most of the elements investigated. Intake of sodium is much too high, while usual intakes are too low for K, Ca, Zn, Cu, and Se. Bioavailability of Ca, Fe, and Zn may be of concern due to the high phytic acid content in the diet.

CONCLUSION

These nutrient imbalances may impact growth and bone metabolism of young Tibetan children. The advantages of the implementation of food diversification programs are discussed as well as the relevance of supplements distribution.

Geographical variation in the progression of type 2 diabetes in Peru: The CRONICAS Cohort Study

BACKGROUND

The study aims were to estimate the incidence and risk factors for T2D in four settings with different degree of urbanization and altitude in Peru.

METHODS

Prospective cohort study conducted in urban, semi-urban, and rural areas in Peru. An age- and sex-stratified random sample of participants was taken from the most updated census. T2D was defined as fasting blood glucose ⩾7.0mmol/L or taking anti-diabetes medication. Exposures were divided into two groups: geographical variables (urbanization and altitude), and modifiable risk factors. Incidence, relative risks (RR), 95% confidence intervals (95%CI), and population attributable fractions (PAF) were estimated.

RESULTS

Data from 3135 participants, 48.8% males, mean age 55.6years, was analyzed. Overall baseline prevalence of T2D was 7.1% (95%CI 6.2-8.0%). At follow-up, including 6207 person-years of follow-up, a total of 121 new T2D cases were accrued, equating to an incidence of 1.95 (95%CI 1.63-2.33) per 100 person-years. There was no urban to rural gradient in the T2D incidence; however, compared to sea level sites, participants living in high altitude had a higher incidence of diabetes (RR=1.58; 95%CI 1.01-2.48). Obesity had the highest attributable risk for developing T2D, although results varied by setting, ranging from 14% to 80% depending on urbanization and altitude.

CONCLUSIONS

Our results suggest that the incidence of T2D was greater in high altitude sites. New cases of diabetes were largely attributed to obesity, but with substantial variation in the contribution of obesity depending on the environment. These findings can inform appropriate context-specific strategies to reduce the incidence of diabetes.

Assessing agreement of blood pressure-measuring devices in Tibetan areas of China: a systematic review

BACKGROUND

The validity of blood pressure (BP)-measuring tools at very high altitudes is uncertain. Therefore, the objective of this review was to examine the degree of agreement of BP-measuring devices in Tibet.

METHODS

We conducted electronic searches in Medline, Embase, Cinahl, Cochrane Library, Global Health Library and the ISI Web of Science. Randomised and observational studies were considered for inclusion. The methodological characteristics of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Our primary outcome was the difference in mean BP measurements between the new device and the gold standard.

RESULTS

We identified three eligible studies, out of which two with a total of 162 participants were included. The studies differed in their methodology. One study reported significantly higher systolic blood pressure (SBP) measurement with electronic sphygmomanometer (Omron) compared with mercury sphygmomanometer (mean difference 5.8±4.7 mm Hg; p<0.001), with no significant difference in diastolic blood pressure (DBP) measurement (0.4±3.9 mm Hg; p=0.23). The second study reported mean differences of 1.0±5.9 mm Hg and -3.1±4.6 mm Hg for SBP and DBP, respectively.

CONCLUSION

The limited evidence from published studies suggests that automated (Omron) BP monitors show a high degree of agreement for DBP when compared against mercury sphygmomanometer at high altitudes. However, the degree of such agreement for SBP is not consistent. Few studies assessing the validity of automated BP monitors at high altitudes have been conducted, and they differ in design and methodology. Further research assessing the suitability of BP-measuring instruments at high altitudes is therefore warranted.

Types of Obesity and Its Association with the Clustering of Cardiovascular Disease Risk Factors in Jilin Province of China

Cardiovascular disease (CVD) has become a serious public health problem in recent years in China. Aggregation of CVD risk factors in one individual increases the risk of CVD and the risk increases substantially with each additional risk factor. This study aims to explore the relationship between the number of clustered CVD risk factors and different types of obesity. A multistage stratified random cluster sampling design was used in this population-based cross-sectional study in 2012. Information was collected by face to face interviews. One-way analysis of variance (ANOVA), chi-square test, Kruskal-Wallis test and multiple logistic regression were used in this study. The prevalence of general obesity, central obesity and compound obesity were 0.3%, 36.1% and 14.7%, respectively. The prevalence of hypertension, hyperlipidemia and diabetes in the compound obesity group were higher than those in other groups (compound obesity > central obesity > general obesity > non-obesity), while smoking rate in the non-obesity group was higher than those in other groups (non-obesity > general obesity > central obesity > compound obesity). People with obesity were more likely to have one or more CVD risk factor compared with non-obesity subjects (general obesity (OR: 2.27, 95% CI: 1.13-4.56), central obesity (OR: 2.64, 95% CI: 2.41-2.89), compound obesity (OR: 5.09, 95% CI: 4.38-5.90). The results were similar when the number of clustered CVD risk factors was ≥ 2 and ≥ 3. As a conclusion, more than half of the residents in Jilin Province have a problem of obesity, especially central obesity. Government and health department should take measures to improve people's awareness of central obesity in Jilin Province of China. The prevalence of hypertension, hyperlipidemia and diabetes are associated with obesity types. Compound obesity has a greater risk to cluster multiple CVD risk factors than central obesity and general obesity. Taking measures to control obesity will reduce the prevalence of CVD in Jilin Province.

Risk Factors for Cardiovascular Disease and Their Clustering among Adults in Jilin (China)

BACKGROUND

Clustering of cardiovascular disease (CVD) risk factors constitutes a major public health challenge. Although a number of researchers have investigated the CVD risk factor clusters in China, little is known about the related prevalence and clustering associated with demographics in Jilin Province in China; this study aims to reveal that relationship.

METHODS

A cross-sectional survey based on a sample of 16,834 adults aged 18 to 79 years was conducted in Jilin in 2012. The prevalence and clustering of CVD risk factors were analysed through complex weighted computation. Quantitative variables were compared by the t test, and categorical variables were compared by the Rao-Scott-χ² test. Finally, multivariable logistic regression analysis was used to evaluate the CVD risk factor clusters associated with demographics.

RESULTS

The prevalences of hypertension, diabetes, dyslipidemia, overweight and smoking were 37.3%, 8.2%, 36.8%, 47.3%, and 31.0%, respectively, and these risk factors were associated with gender, education level, age, occupation and family income (p < 0.05). Overall, compared with females, the adjusted ORs of ≥1, ≥2 and ≥3 risk factors clusters in males were 3.70 (95%CI 3.26 to 4.20), 4.66 (95%CI 4.09 to 5.31), and 5.76 (95%CI 5.01 to 6.63), respectively. In particular, the adjusted ORs of ≥1, ≥2 and ≥3 risk factors increased with age.

CONCLUSIONS

CVD risk factor clusters are common among adults in northeast China, and they constitute a major public health challenge. More effective attention and interventions should be directed toward the elderly and toward persons with lower incomes and low levels of education.