Characteristics of High Cardiovascular Risk in 1.7 Million Chinese Adults

Association between metabolic phenotypes of overweight/obesity and cardiovascular diseases in postmenopausal women

BACKGROUND AND AIM

Obesity and metabolic abnormalities were associated with an increased risk of cardiovascular disease. However, it is unclear how metabolic weight phenotypes relate to cardiovascular diseases in postmenopausal women. This study aimed to explore the relationships in postmenopausal women.

METHODS AND RESULTS

We included 15,575 postmenopausal women aged 35-75 years (median age, 60.6) without cardiovascular disease at baseline from a subcohort of the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project. Metabolically unhealthy phenotype was defined as having ≥2 risk factors of metabolic syndrome: blood pressure ≥130/85 mm Hg or current use of antihypertensive drugs, fasting glucose ≥5.6 mmol/L or current use of antidiabetic agents, triglycerides ≥1.7 mmol/L, and high-density lipoprotein cholesterol <1.3 mmol/L. Cox regression analysis was used to evaluate the risks of cardiovascular diseases. Over a median follow-up period of 3.55 (interquartile range, 2.59-4.44) years, a total of 1354 cardiovascular events occurred. Compared to metabolically healthy normal weight, the multivariate-adjusted hazard ratios and their 95% confidence intervals were 1.41 (1.16-1.72) for metabolically unhealthy normal weight, 1.42 (1.16-1.73) for metabolically healthy overweight/obesity, and 1.75 (1.48-2.08) for metabolically unhealthy overweight/obesity. Subdividing overweight/obesity into separate groups revealed higher total cardiovascular disease risk only in metabolically unhealthy individuals across body mass index categories.

CONCLUSION

In postmenopausal women, both metabolically healthy overweight/obesity and metabolically unhealthy normal weight were associated with a higher risk of cardiovascular disease compared to metabolically healthy normal weight, and the greatest risk was observed in the metabolically unhealthy overweight/obesity category.

Healthy lifestyle, statin, and mortality in people with high CVD risk: A nationwide population-based cohort study

Objective

To examine the joint association of healthy lifestyles and statin use with all-cause and cardiovascular mortality in high-risk individuals, and evaluate the survival benefits by life expectancy.

Methods

During 2015-2021, participants aged 35-75 years were recruited by the China Health Evaluation And risk Reduction through nationwide Teamwork. Based on number of healthy lifestyles related to smoking, alcohol drinking, physical activity, and diet, we categorized them into: very healthy (3-4), healthy (2), and unhealthy (0-1). Statin use was determined by self-report taking statin in last two weeks.

Results

Among the 265,209 included participants at high risk, 6979 deaths were observed, including 3236 CVD deaths during a median 3.6 years of follow-up. Individuals taking statin and with a very healthy lifestyle had the lowest risk of all-cause (HR: 0.70; 95 %CI: 0.57-0.87) and cardiovascular mortality (0.56; 0.40-0.79), compared with statin non-users with an unhealthy lifestyle. High-risk participants taking statin and with a very healthy lifestyle had the highest years of life gained (5.90 years at 35-year-old [4.14-7.67; P < 0.001]) compared with statin non-users with an unhealthy lifestyle among high-risk people. And their life expectancy was comparable with those without high risk but with a very healthy lifestyle (4.49 vs. 4.68 years).

Conclusion

The combination of preventive medication and multiple healthy lifestyles was associated with lower risk of all-cause and cardiovascular mortality and largest survival benefits. Integrated strategy to improve long-term health for high-risk people was urgently needed.

Ambient PM2.5 and cardiopulmonary mortality in the oldest-old people in China: A national time-stratified case-crossover study

BACKGROUND

Evidence on the associations of fine particulate matter (PM2.5) with cardiopulmonary mortality in the oldest-old (aged 80+ years) people remains limited.

METHODS

We conducted a time-stratified case-crossover study of 1,475,459 deaths from cardiopulmonary diseases in China to estimate the associations between short-term exposure to ambient PM2.5 and cardiopulmonary mortality among the oldest-old people.

FINDINGS

Each 10 μg/m3 increase in PM2.5 concentration (6-day moving average [lag05]) was associated with higher mortality from cardiopulmonary diseases (excess risks [ERs] = 1.69%, 95% confidence interval [CI]: 1.54%, 1.84%), cardiovascular diseases (ER = 1.72%, 95% CI: 1.54%, 1.90%), and respiratory diseases (ER = 1.62%, 95% CI: 1.33%, 1.91%). Compared to the other groups, females (ER = 1.94%, 95% CI: 1.73%, 2.15%) (p for difference test = 0.043) and those aged 95-99 years (ER = 2.31%, 95% CI: 1.61%, 3.02%) (aged 80-85 years old was the reference, p for difference test = 0.770) presented greater mortality risks. We found 14 specific cardiopulmonary causes associated with PM2.5, out of which emphysema (ER = 3.20%, 95% CI: 1.57%, 4.86%) had the largest association. Out of the total deaths, 6.27% (attributable fraction [AF], 95% CI: 5.72%, 6.82%) were ascribed to short-term PM2.5 exposure.

CONCLUSIONS

This study provides evidence of PM2.5-induced cardiopulmonary mortality and calls for targeted prevention actions for the oldest-old people.

FUNDING

This work was supported by the National Key Research and Development Program of China, the National Natural Science Foundation of China, the Foreign Expert Program of the Ministry of Science and Technology, the Natural Science Foundation of Guangdong, China, and the Science and Technology Program of Guangzhou.

Interaction between serum neutrophil gelatinase associated lipocalin and visceral fat area on cardiovascular health in a cohort of community-based individuals

BACKGROUND

We assessed the predictive values of neutrophil gelatinase-associated lipocalin (NGAL), fat distribution, and their interaction on the development of major adverse cardiovascular events (MACE) in a community-based cohort of middle-aged and older individuals.

METHODS

This prospective study involved 1349 adults (43.2% men) aged 50-80 y, without baseline cardiovascular diseases, from communities in 2013-2014. All participants were followed up for a mean of 7.6 y via phone calls and medical records. Serum NGAL concentrations were analyzed at baseline. Fat distribution, including subcutaneous fat area and visceral fat area (VFA), was assessed by magnetic resonance imaging.

RESULTS

In fully-adjusted Cox regression models, baseline high NGAL concentrations were related to an increased risk of MACE in women [HR 1.75, 95% CI 1.03-2.99], compared with low NGAL concentrations. After stratification by VFA concentrations, the observed association was more predominant in women with baseline low VFA (HR 1.24, 95% CI 1.11-1.38). Moreover, the association between NGAL and MACE was interacted by VFA, strengthening the association at low VFA concentrations (Pinteraction < 0.05).

CONCLUSIONS

Serum NGAL determined at baseline predicts the development of MACE, and the association is modified by VFA in women.

Effect of Air Pollution Particulate Matter on Ischemic and Hemorrhagic Stroke: A Scoping Review

Air pollution particulate matter (PM) exposure has been established as a risk factor for stroke. However, few studies have investigated the effects of PM exposure on stroke subtypes (ischemic and hemorrhagic stroke). Ischemic (IS) and hemorrhagic strokes (HS) involve distinctive pathophysiological pathways and may be differentially influenced by PM exposure. This review aims to characterize the effects of PM exposure on ischemic and hemorrhagic strokes. It also identifies subpopulations that may be uniquely vulnerable to PM toxicity. Pubmed was queried from 2000 to 2023 to identify clinical and epidemiological studies examining the association between PM exposure and stroke subtypes (ischemic and hemorrhagic stroke). Inclusion criteria were: 1) articles written in English 2) clinical and epidemiological studies 3) studies with a clear definition of stroke, IS, HS, and air pollution 4) studies reporting the effects of PM and 5) studies that included distinct analyses per stroke subtype. Two independent reviewers screened the literature for applicable studies. A total of 50 articles were included in this review. Overall, PM exposure increases ischemic stroke risk in both lightly and heavily polluted countries. The association between PM exposure and hemorrhagic stroke is variable and may be influenced by a country's ambient air pollution levels. A stronger association between PM exposure and stroke is demonstrated in older individuals and those with pre-existing diabetes. There is no clear effect of sex or hypertension on PM-associated stroke risk. Current literature suggests PM exposure increases ischemic stroke risk, with an unclear effect on hemorrhagic stroke risk. Older patients and those with pre-existing diabetes may be the most vulnerable to PM toxicity. Future investigations are needed to characterize the influence of sex and hypertension on PM-associated stroke risk.

Prognostic value of triglyceride glucose index in population at high cardiovascular disease risk

BACKGROUND

Early identification of populations at high cardiovascular disease (CVD) risk and improvement of risk factors can significantly decrease the probability of CVD development and improve outcomes. Insulin resistance (IR) is a CVD risk factor. The triglyceride glucose (TyG) index is a simple and reliable index for evaluating IR. However, no clinical studies on the prognostic value of the TyG index in a high risk CVD population have been conducted. This study evaluated the relationship between the TyG index and prognosis in a high risk CVD population.

METHODS

This study enrolled 35,455 participants aged 35-75 years who were at high CVD risk and visited selected health centers and community service centers between 2017 and 2021. Their general clinical characteristics and baseline blood biochemical indicators were recorded. The TyG index was calculated as ln[fasting triglyceride (mg/dl)× fasting blood glucose (mg/dl)/2]. The endpoints were all-cause death and cardiovascular death during follow-up. Cox proportional hazard models and restricted cubic spline (RCS) analysis were used to evaluate the correlation between the TyG index and endpoints.

RESULTS

In the overall study population, the mean age of all participants was 57.9 ± 9.6 years, 40.7% were male, and the mean TyG index was 8.9 ± 0.6. All participants were divided into two groups based on the results of the RCS analysis, with a cut-off value of 9.83. There were 551 all-cause deaths and 180 cardiovascular deaths during a median follow-up time of 3.4 years. In the multivariate Cox proportional hazard model, participants with a TyG index ≥ 9.83 had a higher risk of all-cause death (Hazard ratio [HR] 1.86, 95% Confdence intervals [CI] 1.37-2.51, P<0.001) and cardiovascular death (HR 2.41, 95%CI 1.47-3.96, P = 0.001) than those with a TyG index < 9.83. Subgroup analysis revealed that there was no interaction between the TyG index and variables in all subgroup analyses.

CONCLUSIONS

The high TyG index was associated with an increased risk of all-cause death and cardiovascular death in people at high risk of CVD. This finding demonstrates the value of the TyG index in the primary prevention of CVD.

TRIAL REGISTRATION

retrospectively registered, the registration number is K2022-01-005 and the date is 2022.01.30.

Prevalence, awareness, treatment, and risk factor control of high atherosclerotic cardiovascular disease risk in Guangzhou, China

Background

Identifying individuals at high risk of atherosclerotic cardiovascular disease (ASCVD) and implementing targeted prevention strategies might be the key to reducing the heavy disease burden in China. This study aimed to evaluate the prevalence, awareness, treatment, and risk factor control among individuals with high 10-year ASCVD risk in Guangzhou, China.

Methods

This study included 15,165 adults (aged 18 years and older) from 138 urban and rural communities in the 2018 survey of China Chronic Disease and Risk Factors Surveillance in Guangzhou. 10-year ASCVD risk was estimated using the risk assessment models recommended in the Chinese Guideline for the Prevention of Cardiovascular Disease 2017. The prevalence, awareness, treatment, and risk factor control of high ASCVD risk (defined as 10-year risk ≥10%) were examined.

Results

Among the study population, the weighted proportion of men was 51.9%, and the mean age was 41.27 ± 0.52 years. The overall standardized prevalence of high 10-year ASCVD risk was 13.8% (95% CI, 12.4%-15.3%). The awareness rates for hypertension, diabetes, and hyperlipidemia were 48.0% (95% CI, 42.8%-53.4%), 48.3% (95% CI, 43.0%-53.7%), and 17.9% (95% CI, 14.4%-22.1%) among those with corresponding risk factors. The proportions of drug use in prevention were relatively low in primary prevention, with the rates of using BP-lowering, glucose-lowering, lipid-lowering, and aspirin being 37.7% (95% CI, 32.8%-42.8%), 41.4% (95% CI, 35.8%-47.3%), 6.7% (95% CI, 4.5%-10.0%), and 1.0% (95% CI, 0.6%-1.8%), respectively. As for risk factor control, only 29.3% (95% CI, 25.7%-33.2%), 16.8% (95% CI, 15.0%-18.6%), and 36.0% (95% CI, 31.1%-41.2%) of individuals with high ASCVD risk had ideal levels of blood pressure, LDL-C, and body weight.

Conclusion

The estimated prevalence of 10-year high ASCVD risk was high in Guangzhou, while the rates of treatment and risk factor control in primary prevention were still far from optimal, especially for lipid management. These findings suggested that substantial improvement in ASCVD prevention is needed in this population.

Sex difference in the association of the triglyceride glucose index with obstructive coronary artery disease

Insulin resistance (IR) is associated with cardiovascular disease in non-diabetic patients. The triglyceride-glucose (TyG) index, incorporating serum glucose and insulin concentrations, is a surrogate insulin resistance marker. We investigated its association with obstructive coronary artery disease (CAD) and sex differences therein. Patients with stable angina pectoris requiring invasive coronary angiography between January 2010 and December 2018 were enrolled. They were divided into two groups according to TyG index. Two interventional cardiologists diagnosed obstructive CAD by angiography review. Demographic characteristics and clinical outcomes were compared between groups. Relative to lower index, patients with higher (≥ 8.60) TyG index had higher BMIs and more prevalent hypertension, diabetes, and elevated lipid profiles [total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), fasting plasma glucose (FPG)]. Higher TyG index increased women's obstructive CAD risk after multivariate adjustment (adjusted odds ratio (aOR) 2.15, 95% confidence interval (95% CI) 1.08-4.26, p = 0.02) in non-diabetic populations compared with men. No sex difference was found for diabetic patients. Higher TyG index significantly increased the obstructive CAD risk, overall and for non-diabetic women. Larger-scale studies are needed to confirm our findings.

Ambient nitrogen dioxide and cardiovascular diseases in rural regions: a time-series analyses using data from the new rural cooperative medical scheme in Fuyang, East China

Most of studies relating ambient nitrogen dioxide (NO₂) exposure to hospital admissions for cardiovascular diseases (CVDs) were conducted among urban population. Whether and to what extent these results could be generalizable to rural population remains unknown. We addressed this question using data from the New Rural Cooperative Medical Scheme (NRCMS) in Fuyang, Anhui, China. Daily hospital admissions for total CVDs, ischaemic heart disease, heart failure, heart rhythm disturbances, ischaemic stroke, and haemorrhagic stroke in rural regions of Fuyang, China, were extracted from NRCMS between January 2015 and June 2017. A two-stage time-series analysis method was used to assess the associations between NO₂ and CVD hospital admissions and the disease burden fractions attributable to NO₂. In our study period, the average number (standard deviation) of hospital admissions per day were 488.2 (117.1) for total CVDs, 179.8 (45.6) for ischaemic heart disease, 7.0 (3.3) for heart rhythm disturbances, 13.2 (7.2) for heart failure, 267.9 (67.7) for ischaemic stroke, and 20.2 (6.4) for haemorrhagic stroke. The 10-μg/m³ increase of NO₂ was related to an elevated risk of 1.9% (RR: 1.019, 95% CI: 1.005 to 1.032) for hospital admissions of total CVDs at lag0-2 days, 2.1% (1.021, 1.006 to 1.036) for ischaemic heart disease, and 2.1% (1.021, 1.006 to 1.035) for ischaemic stroke, respectively, while no significant association was observed between NO₂ and hospital admissions for heart rhythm disturbances, heart failure, and haemorrhagic stroke. The attributable fractions of total CVDs, ischaemic heart disease, and ischaemic stroke to NO₂ were 6.52% (1.87 to 10.94%), 7.31% (2.19 to 12.17%), and 7.12% (2.14 to 11.85%), respectively. Our findings suggest that CVD burdens in rural population are also partly attributed to short-term exposure to NO₂. More studies across rural regions are required to replicate our findings.

Association between triglyceride glucose-body mass index and hypertension in Chinese adults: A cross-sectional study

The triglyceride glucose-body mass index (TyG-BMI) has been considered an alternative marker of insulin resistance (IR). This cross-sectional study was designed to mainly investigate the association between TyG-BMI, triglyceride glucose combined with body mass index, and hypertension in Chinese adults. The relationship between TyG-BMI and hypertension was examined by multivariate logistic regression and restricted cubic spline model. Multiple logistic regression models were also performed to examine the associations between the individual components of TyG-BMI (BMI, TyG index, TG and FBG) and hypertension. The incremental ability of TyG-BMI versus its individual components for hypertension discrimination was evaluated by C-statistic and net reclassification index. Subgroup analysis was performed to examine potential interactions. A total of 92,545 participants (38.9% men, mean age 53.7 years) were included for final analysis. Logistic regression models showed TyG-BMI and its individual components were all significantly associated with the odds of hypertension (p for trend < .001). The restricted cubic spline regression manifested a linear association between TyG-BMI and hypertension (p for non-linear = .062). The addition of TyG-BMI, in comparison with each individual component, exhibited the maximum incremental value for the discrimination of hypertension on the basis of base model (C-statistic: 0.679, 95% CI: 0.675-0.683 for base model vs. 0.695, 95% CI: 0.691-0.699 for base model + TyG-BMI; net reclassification index: 0.226, 95% CI: 0.215-0.234). TyG-BMI was significantly associated with the odds of hypertension and can be a better discriminator of hypertension.

Joint Associations of Short-Term Exposure to Ambient Air Pollutants with Hospital Admission of Ischemic Stroke

BACKGROUND

Studies have estimated the associations of short-term exposure to ambient air pollution with ischemic stroke. However, the joint associations of ischemic stroke with air pollution as a mixture remain unknown.

METHODS

We employed a time-stratified case-crossover study to investigate 824,808 ischemic stroke patients across China. We calculated daily mean concentrations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), maximum 8-h average for O3 (MDA8 O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) across all monitoring stations in the city where the IS patients resided. We conducted conditional logistic regression models to estimate the exposure-response associations.

RESULTS

Results from single-pollutant models showed positive associations of hospital admission for ischemic stroke with PM2.5 (excess risk [ER] = 0.38%, 95% confidence interval [CI]: 0.29% to 0.47%, for 10 μg/m3), MDA8 O3 (ER = 0.29%, 95% CI: 0.18% to 0.40%, for 10 μg/m3), NO2 (ER = 1.15%, 95% CI: 0.92% to 1.39%, for 10 μg/m3), SO2 (ER = 0.82%, 95% CI: 0.53% to 1.11%, for 10 μg/m3) and CO (ER = 3.47%, 95% CI: 2.70% to 4.26%, for 1 mg/m3). The joint associations (ER) with all air pollutants (for interquartile range width increases in each pollutant) estimated by the single-pollutant model was 8.73% and was 4.27% by the multipollutant model. The joint attributable fraction of ischemic stroke attributable to air pollutants based on the multipollutant model was 7%.

CONCLUSIONS

Short-term exposures to PM2.5, MDA8 O3, NO2, SO2, and CO were positively associated with increased risks of hospital admission for ischemic stroke. The joint associations of air pollutants with ischemic stroke might be overestimated using single-pollutant models. See video abstract at, http://links.lww.com/EDE/C8.

Estimated Burden of Stroke in China in 2020

IMPORTANCE

Stroke is the leading cause of death in China. However, recent data about the up-to-date stroke burden in China are limited.

OBJECTIVE

To investigate the urban-rural disparity of stroke burden in the Chinese adult population, including prevalence, incidence, and mortality rate, and disparities between urban and rural populations.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study was based on a nationally representative survey that included 676 394 participants aged 40 years and older. It was conducted from July 2020 to December 2020 in 31 provinces in mainland China.

MAIN OUTCOMES AND MEASURES

Primary outcome was self-reported stroke verified by trained neurologists during a face-to-face interviews using a standardized protocol. Stroke incidence were assessed by defining first-ever strokes that occurred during 1 year preceding the survey. Strokes causing death that occurred during the 1 year preceding the survey were considered as death cases.

RESULTS

The study included 676 394 Chinese adults (395 122 [58.4%] females; mean [SD] age, 59.7 [11.0] years). In 2020, the weighted prevalence, incidence, and mortality rates of stroke in China were 2.6% (95% CI, 2.6%-2.6%), 505.2 (95% CI, 488.5-522.0) per 100 000 person-years, and 343.4 (95% CI, 329.6-357.2) per 100 000 person-years, respectively. It was estimated that among the Chinese population aged 40 years and older in 2020, there were 3.4 (95% CI, 3.3-3.6) million incident cases of stroke, 17.8 (95% CI, 17.5-18.0) million prevalent cases of stroke, and 2.3 (95% CI, 2.2-2.4) million deaths from stroke. Ischemic stroke constituted 15.5 (95% CI, 15.2-15.6) million (86.8%) of all incident strokes in 2020, while intracerebral hemorrhage constituted 2.1 (95% CI, 2.1-2.1) million (11.9%) and subarachnoid hemorrhage constituted 0.2 (95% CI, 0.2-0.2) million (1.3%). The prevalence of stroke was higher in urban than in rural areas (2.7% [95% CI, 2.6%-2.7%] vs 2.5% [95% CI, 2.5%-2.6%]; P = .02), but the incidence rate (485.5 [95% CI, 462.8-508.3] vs 520.8 [95% CI, 496.3-545.2] per 100 000 person-years; P < .001) and mortality rate (309.9 [95% CI, 291.7-328.1] vs 369.7 [95% CI, 349.1-390.3] per 100 000 person-years; P < .001) were lower in urban areas than in rural areas. In 2020, the leading risk factor for stroke was hypertension (OR, 3.20 [95% CI, 3.09-3.32]).

CONCLUSIONS AND RELEVANCE

In a large, nationally representative sample of adults aged 40 years or older, the estimated prevalence, incidence, and mortality rate of stroke in China in 2020 were 2.6%, 505.2 per 100 000 person-years, and 343.4 per 100 000 person-years, respectively, indicating the need for an improved stroke prevention strategy in the general Chinese population.

Bioinformatics prediction and experimental verification of a novel microRNA for myocardial fibrosis after myocardial infarction in rats

Background

MicroRNAs (miRNAs) are endogenous noncoding single-stranded small RNAs. Numerous studies have shown that miRNAs have pivotal roles in the occurrence and development of myocardial fibrosis (MF). However, miRNA expression profile in rats with MF after myocardial infarction (MI) is not well understood. The present study aimed to find the potential miRNA for MF post MI.

Methods

SPF male Sprague-Dawley (SD) rat models of acute myocardial infarction (AMI) were established by ligating the anterior descending branch of the left coronary artery, while sham-operated rats were only threaded without ligation as a control group. Hematoxylin-eosin and Masson trichrome staining were used to detect myocardial histopathological changes for model evaluation. The differentially expressed miRNAs were detected by using the Agilent Rat miRNA gene chip in the myocardial tissue of the infarct marginal zone. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed by DAVID. The expression of miR-199a-5p was verified by real-time fluorescence quantitative PCR (qRT-PCR). Transfected miR-199a-5p mimics into cardiac fibroblasts (CFs) to construct cell models of miR-199a-5p overexpression. Dual-luciferase reporter assay was employed to validate the target gene of miR-199a-5p. The protein expression of the target gene in CFs transfected with miR-199a-5p mimics were detected by Western blot.

Results

Myocardial fibrosis was exacerbated in the model group compared with the control group. Thirteen differentially expressed miRNAs between the two groups were screened and their expression levels in the model group were all higher than those in the control group. The expression of miR-199a-5p was significantly increased in the model group in qRT-PCR, which was consistent with the results of the gene chip. KEGG enrichment analysis showed that the target genes of miR-199a-5p were enriched in the insulin signaling pathway. Furthermore, dual-luciferase reporter assay indicated that miR-199a-5p could negatively regulate the expression of GSK-3β. After transfection, the expression of miR-199a-5p was increased in the miR-199a-5p mimics group. The protein expression of GSK-3β was decreased in CFs transfected with miR-199a-5p mimics.

Conclusion

Our study identified miR-199a-5p could promote the progression of myocardial fibrosis after myocardial infarction by targeting GSK-3β, which provides novel targets for diagnosis and treatment of MF.

Higher Adherence to Plant-Based Diet Lowers Type 2 Diabetes Risk among High and Non-High Cardiovascular Risk Populations: A Cross-Sectional Study in Shanxi, China

This study aimed to investigate the association between the plant-based diet index (PDI) score and T2D risk among residents of Shanxi Province, China, and explore whether the association was influenced by different levels of cardiovascular risk. A total of 50,694 participants aged 35-75 years were recruited between 2017 and 2019, and they were further divided into the high cardiovascular risk population (HCRP; n = 17,255) and the non-high cardiovascular risk population (non-HCRP; n = 33,439). The PDI was calculated based on food frequency from a food frequency questionnaire (FFQ). Incident T2D was defined based on elevated plasma glucose (≥7 mmol/L) or hypoglycemic medicine use. We investigated the association of the PDI andT2D risk using a two-level generalized estimating equation and restricted cubic splines model. The results showed that quartile 4 of the PDI indicated significantly reduced T2D risk in the total population (OR: 0.83; 95% CI: 0.75-0.92), HCRP (OR: 0.80; 95% CI: 0.71-0.91), and non-HCRP (OR: 0.80; 95% CI: 0.74-0.87) compared with corresponding quartile 1 (OR = 1). In stratified analysis, the negative associations between PDI and T2D risk were stronger in the total population with the elderly (age > 60 years), BMI < 24, and men, and in the non-HCRP with men and BMI 24-28, and in the HCRP with the elderly and BMI < 24 than those with corresponding subgroups (p_interaction < 0.05). Linear curves were observed for the total population and non-HCRP, but an L-shaped association was observed for the HCRP. Therefore, our results suggest that higher PDI scores may effectively attenuate the T2D risk in the Chinese population and non-HCRP, and a beneficial association of PDI with T2D risk was observed in the HCRP at a certain threshold level. Longitudinal studies and intervention trials are required to validate our study findings.

Two-year changes in body composition and future cardiovascular events: a longitudinal community-based study

BACKGROUND

The risk of cardiovascular diseases has rapidly increased among middle-aged and elderly. However, little is known about the relationship of body composition changes with the risk of cardiovascular events among this population in China. We explored the associations of 2-year changes in fat percentage (fat%) and fat-free mass percentage (FFM%) with subsequent cardiovascular events in a middle-aged and elderly community-based cohort.

METHODS

This study included 1048 participants (456 men [43.51%], aged 50-80 years) without overt cardiovascular disease, who underwent two examinations during 2013-2014 and 2015-2016. All participants were followed up until 2022 for cardiovascular events. A bioelectrical impedance analyzer was used to calculate fat% and FFM% change.

RESULTS

At baseline, the median body mass index (BMI), fat%, and FFM% were 23.9 (22.1-25.9) kg/m², 27.2 (20.8-33.6)%, and 72.8 (66.4-79.2)%, respectively. Two-year changes in fat% and FFM% were 0.31 (- 5.53 to 6.87)% and - 0.12 (- 2.36 to 2.06)%. During an average follow-up of 5.5 years, 86 cardiovascular events (8.21%) occurred. Cox regression models showed that hazard ratios (HRs) of every 2% change in fat% and FFM% for cardiovascular events were 1.04 (95% confidence interval [CI] 1.01-1.07) and 0.84 (95% CI 0.74-0.95), respectively. Compared with participants with stable fat% (-2% ≤ ⊿fat% < 2%), those with fat% gain ≥ 2% had an increased risk of cardiovascular events (HR 2.07, 95% CI 1.08-3.97). FFM% loss > 8% was associated with a higher risk of cardiovascular events (HR 3.83, 95% CI 1.29-11.4).

CONCLUSIONS

In a middle-aged and elderly community-based Chinese population, fat% gain or FFM% loss was associated with an increased risk of cardiovascular events.

Association between famine exposure in early life and risk of hospitalization for heart failure in adulthood

Background

Few studies have reported the association of early life exposure to famine with the risk of heart failure. The current study aimed to investigate whether exposure to famine in early life is associated with a higher risk of hospitalization for heart failure in adulthood.

Methods

We used data from participants included in the sub-cohort of the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project in Guangdong Province. Specific years of birth were used to define the famine-exposed group (born during the famine of 1959-1962), the pre-famine group (born before the famine [1954-1957], and the post-famine group (born after the famine [1964-1967]). Multivariable-adjusted generalized linear models were used to examine the associations of early life famine exposure with the risk of hospitalization for heart failure.

Results

A total of 36,212 participants were enrolled in this analysis with a median age of 57.4 years and 37.5% of them were men. Compared with the post-famine group, famine births and pre-famine births were associated with increased risk of heart failure (OR: 1.96 [1.56-2.48] and OR: 1.62 [1.07-2.47], respectively). When compared with the age-balanced non-exposed group, the famine-exposed group was also significantly associated with increased risk of heart failure (OR: 1.32 [1.11-1.57]). The associations were stronger in participants with better economic status and in participants with hypertension, diabetes, and dyslipidemia (P for interaction < 0.05).

Conclusion

Early life exposure to the Chinese famine is associated with an elevated risk of hospitalization for heart failure in adulthood.

Short-term effects of exposure to ambient PM1, PM2.5, and PM10 on ischemic and hemorrhagic stroke incidence in Shandong Province, China

BACKGROUND

Short-term exposure to ambient PM_2.5 and PM₁₀ is associated with increased risk of mortality and hospital admissions for stroke. However, there is less evidence regarding the effect of exposure to PM₁ on stroke incidence. We estimated the incidence risk of stroke and the attributable fractions related to short-term exposure to ambient PM₁, PM_2.5 and PM₁₀ in China.

METHODS

County-specific incidence of stroke was obtained from health statistics in years 2014-2019. We linked county-level mean daily concentrations of PM₁, PM_2.5 and PM₁₀ with stroke incidence. We used the time stratified case-crossover design to estimate the associations between stroke incidence and exposure to PM₁, PM_2.5 and PM₁₀. We also estimated the disease burden fractions attributable to PM₁, PM_2.5, and PM₁₀.

RESULTS

The study included a total of 2,193,954 stroke, from which 1,861,331 were ischemic and 332,623 were hemorrhagic stroke. PM₁, PM_2.5, and PM₁₀ levels were associated with increased risks of total stroke and ischemic stroke at when assessing the associations in exposure at lag0-4 days. The increase of 10 μg/m³ in PM₁, PM_2.5, and PM₁₀ was associated with total stroke, and the relative risks were 1.012 (95% confidence interval: 1.008, 1.015), 1.006 (1.004, 1.007) and 1.003 (1.002, 1.004), while the associations with ischemic stroke were 1.013 (1.010, 1.017), 1.006 (1.005, 1.008) and 1.003 (1.002, 1.004), respectively. There was no significant association between PM and risk of hemorrhagic stroke. The attributable fractions of total stroke were 6.9% (5.1%, 8.5%), 5.6% (4.2%, 6.8%) and 5.6% (3.9%, 7.1%) for PM₁, PM_2.5, and PM₁₀, respectively.

CONCLUSIONS

PM₁ showed a stronger association with stroke, with a larger attributable fraction of outcomes, than PM_2.5 and PM₁₀. Clean air policies should target the whole scope of PM, including PM₁.

Latent class cluster analysis of knowledge on acute myocardial infarction in community residents: a cross-sectional study in Tianjin, China

OBJECTIVE

Public knowledge of early onset symptoms and risk factors (RF) of acute myocardial infarction (AMI) is very important for prevention, recurrence and guide medical seeking behaviours. This study aimed to identify clusters of knowledge on symptoms and RFs of AMI, compare characteristics and the awareness of the need for prompt treatment.

DESIGN

Multistage stratified sampling was used in this cross-sectional study. Latent GOLD Statistical Package was used to identify and classify the respondent subtypes of the knowledge on AMI symptoms or modifiable RFs. Multivariable logistic regression was performed to identify factors that predicted high knowledge membership.

PARTICIPANTS

A structured questionnaire was used to interview 4200 community residents aged over 35 in China. 4122 valid questionnaires were recovered.

RESULTS

For AMI symptoms and RFs, the knowledge levels were classified into two or three distinct clusters, respectively. 62.7% (Symptom High Knowledge Cluster) and 39.5% (RF High Knowledge Cluster) of the respondents were able to identify most of the symptoms and modifiable RFs. Respondents who were highly educated, had higher monthly household income, were insured, had regular physical examinations, had a disease history of AMI RFs, had AMI history in immediate family member or acquaintance or had received public education on AMI were observed to have higher probability of knowledge on symptoms and RFs. There was significant difference in awareness of the prompt treatment in case of AMI occurs among different clusters. 'Calling an ambulance' was the most popular option in response of seeing others presenting symptoms of AMI.

CONCLUSIONS

A moderate or relatively low knowledge on AMI symptoms and modifiable RFs was observed in our study. Identification of Knowledge Clusters could be a way to detect specific targeted groups with low knowledge of AMI, which may facilitate health education, further reduce the prehospital delay in China and improve patient outcomes.

A polygenic risk score improves risk stratification of coronary artery disease: a large-scale prospective Chinese cohort study

AIMS

To construct a polygenic risk score (PRS) for coronary artery disease (CAD) and comprehensively evaluate its potential in clinical utility for primary prevention in Chinese populations.

METHODS AND RESULTS

Using meta-analytic approach and large genome-wide association results for CAD and CAD-related traits in East Asians, a PRS comprising 540 genetic variants was developed in a training set of 2800 patients with CAD and 2055 controls, and was further assessed for risk stratification for CAD integrating with the guideline-recommended clinical risk score in large prospective cohorts comprising 41 271 individuals. During a mean follow-up of 13.0 years, 1303 incident CAD cases were identified. Individuals with high PRS (the highest 20%) had about three-fold higher risk of CAD than the lowest 20% (hazard ratio 2.91, 95% confidence interval 2.43-3.49), with the lifetime risk of 15.9 and 5.8%, respectively. The addition of PRS to the clinical risk score yielded a modest yet significant improvement in C-statistic (1%) and net reclassification improvement (3.5%). We observed significant gradients in both 10-year and lifetime risk of CAD according to the PRS within each clinical risk strata. Particularly, when integrating high PRS, intermediate clinical risk individuals with uncertain clinical decision for intervention would reach the risk levels (10-year of 4.6 vs. 4.8%, lifetime of 17.9 vs. 16.6%) of high clinical risk individuals with intermediate (20-80%) PRS.

CONCLUSION

The PRS could stratify individuals into different trajectories of CAD risk, and further refine risk stratification for CAD within each clinical risk strata, demonstrating a great potential to identify high-risk individuals for targeted intervention in clinical utility.

Atherosclerotic Cardiovascular Disease Risk and Lipid-Lowering Therapy Requirement in China

Background

Lipid-lowering therapy (LLT) is one of the key strategies for reducing the atherosclerotic cardiovascular disease (ASCVD) burden. However, little is known about the percentage of people in need of different LLT regimens to achieve optimal targets of low-density lipoprotein cholesterol (LDL-C), and the corresponding cost and benefit.

Methods

We conducted a simulation study based on the data from the nationwide China PEACE MPP population cohort (2015–2020), from which we included 2,904,914 participants aged 35–75 years from all the 31 provinces in mainland China. Participants were grouped based on their 10-year ASCVD risks, then entered into a Monte Carlo model which was used to perform LLT intensification simulation scenarios to achieve corresponding LDL-C goals in each risk stratification.

Results

After standardizing age and sex, the proportions of participants included at low, moderate, high, and very-high risk were 70.8%, 15.6%, 11.5%, and 2.1%, respectively. People who failed to achieve the corresponding LDL-C goals −8.1% at low risk, 19.6% at moderate risk, 53.2% at high risk, and 93.6% at very-high risk (either not achieving the goal or not receiving LLT)—would be in need of the LLT intensification simulation. After the use of atorvastatin 20 mg was simulated, over 99% of the population at low or moderate risk could achieve the LDL-C goals; while 11.3% at high and 24.5% at very-high risk would still require additional non-statin therapy. After the additional use of ezetimibe, there were still 4.8% at high risk and 11.3% at very-high risk in need of evolocumab; and 99% of these two groups could achieve the LDL-C goals after the use of evolocumab. Such LLT intensification with statin, ezetimibe, and evolocumab would annually cost $2.4 billion, $4.2 billion, and $24.5 billion, respectively, and prevent 264,170, 18,390, and 17,045 cardiovascular events, respectively.

Conclusions

Moderate-intensity statin therapy is pivotal for the attainment of optimal LDL-C goals in China, and around 10–25% of high- or very-high-risk patients would require additional non-statin agents. There is an opportunity to reduce the rising ASCVD burden in China by optimizing LLT.

The Impact of Risk Factor Control on Health-Related Quality of Life in Individuals with High Cardiovascular Disease Risk: A Cross-sectional Study Based on EQ-5D Utility Scores in Inner Mongolia, China

Objectives

To assess the impact of cardiovascular disease (CVD) risk factor control on health-related quality of life (HRQoL), as well as the other influencing factors of HRQoL among high CVD risk individuals.

Methods

From 2015 to 2017, residents of six villages or communities in Inner Mongolia, selected using a multi-stage stratified cluster random sampling method, were invited to complete a questionnaire and undergo physical examination and laboratory testing. We selected participants whose predicted 10-year risk for CVD exceeded 10% as those with high CVD risk. HRQoL in individuals with high CVD risk was investigated based on the EuroQol-5 Dimension (EQ-5D) scale. The Chinese utility value integral system was used to calculate EQ-5D utility scores, and the Tobit regression model was used to analyze the influencing factors of HRQoL among individuals with high CVD risk.

Results

Of 13,359 participants with high CVD risk, 65.63% reported no problems in any of the five dimensions; the most frequently reported difficulty was pain/discomfort. The median utility score was 1.000 (0.869, 1.000). Participants with hypertension, and uncontrolled glycemic and blood lipids had lower HRQoL. In addition, sex, age, living environment, education level, household income, and medical insurance were influencing factors of HRQoL.

Conclusion

Sex, age, living environment, education level, household income, medical insurance, hypertension, and whether glycemic and blood lipids control or not are related to HRQoL of high CVD risk individuals.

Diagnostic Model of Alzheimer's Disease in the Elderly Based on Protein and Metabolic Biomarkers

BACKGROUND

With the accelerating aging process, the number of participants with Alzheimer's disease (AD) is rising sharply, causing a huge economic burden.

OBJECTIVE

This study aimed to identify blood protein and metabolic biomarkers and explore the diagnostic model for AD among elderly in southeast China.

METHODS

We established a cohort among population with high risk AD in Zhejiang Province in 2018. Case and control groups each consisting of 45 subjects, matched for gender and age, were randomly selected from the cohort. Based on bioinformatics research, PRM/MRM technology was used to detect candidate biomarkers. Ensemble-based feature selection and machine learning methods was used to screen important variables as risk indicators for AD. Based on the risk biomarkers, the risk diagnostic model of AD in the elderly was constructed and evaluated.

RESULTS

Cystine and CPB2 were evaluated as biomarkers. The diagnostic model is constructed using logistic regression algorithm with the best cutoff value, sensitivity, specificity, and accuracy of 0.554, 0.895, 0.976, and 0.938, respectively, which determined by Youden's index. The results showed that the model with protein and metabolite had a high efficiency.

CONCLUSION

It showed that the diagnostic model constructed by Cystine and CPB2 had a good performance on sample classification. This study was of great significance for the early screening and diagnosis of AD, timely intervention, control and delay the development of dementia in southeast China.

The blood pressure control and arteriosclerotic cardiovascular risk among Chinese community hypertensive patients

The present study aimed to describe the blood pressure (BP) control rate and 10-years arteriosclerotic cardiovascular disease (ASCVD) risk estimation among community hypertensive patients. A total of 196,803 subjects were enrolled. The control rates calculated as the intensive (SBP < 130 mmHg and DBP < 80 mmHg) and standard (SBP < 140 mmHg and DBP < 90 mmHg) threshold. Multivariable logistic analysis was employed to assess the associations between cardiovascular factors and BP control. Sensitivity, specificity and Youden’s index were used to identify the ability of high risk of ASCVD estimation by different thresholds. The control rate was 16.34% and 50.25% by the intensive and standard threshold, respectively. Besides regular medication, the risk factors for BP control included older age, male, unhealthy lifestyle, obesity, dyslipidemia and abnormal FPG. 25.08% of subjects had high risk of 10-years ASCVD estimation. The sensitivity, specificity and Youden’s index of intensive threshold was 84.37%, 16.15% and 0.51%, and were significantly different from 50.55%, 50.42% and 0.98% of the standard threshold, respectively. Half of community hypertensive patients did not control BP, and nearly a quarter have high risk of 10-years ASCVD risk estimation. The intensive threshold resulted in a one-third reduction in the control rate compared to the standard threshold. No matter which threshold was used, a single BP control status seemed not a suitable indicator for identification of high risk of 10-years ASCVD risk estimation.

Prediction of 10-year atherosclerotic cardiovascular disease risk among community residents in Shanghai, China - a comparative analysis of risk algorithms

BACKGROUND AND AIMS

The accuracy of various 10-year atherosclerotic cardiovascular disease (ASCVD) risk models has been debatable. We compared two risk algorithms and explored clustering patterns across different risk stratifications among community residents in Shanghai.

METHODS AND RESULTS

A total of 28,201 residents (aged 40-74 years old) who were free of ASCVD were selected from the Shanghai Survey in China. The 10-year ASCVD risk was estimated by applying the 2013 Pooled Cohort Equations (PCEs) and Prediction for ASCVD Risk in China (China-PAR). The agreement was assessed between PCEs and China-PAR using Cohen's kappa statistics. The mean absolute 10-year ASCVD risk calculated by PCEs and China-PAR was about 10.0% and 6.0%, respectively. PCEs estimated that 44.9% of participants [with a 95% confidence interval (CI):44.0%-45.8%] were at high risk, while China-PAR estimated only 16.7% (95%CI:15.8%-18.0%) were at high risk. In both models, the percentage of high ASCVD risk was higher for participants who were older, men, less educated, current smokers, drinkers and manual workers. Among high-risk individuals, almost all participants (PCEs:90.5%; China-PAR:98.6%) had at least one risk factor; hypertension being the most prevalent. The concordance between PCEs and China-PAR was moderate (kappa:0.428, 95%CI: 0.420-0.434) with a better agreement for women (kappa:0.503,95%CI: 0.493-0.513) than for men (kappa:0.211,95%CI: 0.201-0.221).

CONCLUSION

The proportion of participants with a 10-year ASCVD high risk predicted by China-PAR was lower than the results of the PCEs. The risk stratifications of the two algorithms were inconsistent in terms of demographic and life-behaviour characteristics.

Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China

Background

World Health Organization (WHO) released region-specific cardiovascular disease (CVD) risk prediction charts recently, but the extent to which the charts can apply to Chinese population is unknown. We aimed to validate the WHO CVD risk charts for East Asia, and evaluate their practicability combining with China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) equations among Chinese adults.

Methods

The China-PAR cohort with 93,234 participants aged 40–80 years was followed up during 1992–2015, including 29,337 participants from three sub-cohorts with follow-up period of over 10 years. We validated the WHO CVD risk charts using the China-PAR cohort by assessment of the predicted number of events, C index, calibration χ², and calibration plots, further elaborated the concordance between the China-PAR equations and the WHO risk charts.

Findings

During an average follow-up of 13•64 years, 1849 incident CVD cases were identified from 29,337 participants. Both the laboratory-based and non-laboratory-based charts overestimated CVD events by 59% and 58% in men, and by 72% and 85% in women, respectively. However, 92% of participants identified as high risk by the China-PAR equations could be successfully detected by the laboratory-based charts at the cut-off point of 10%. We also observed that the non-laboratory-based charts demonstrated the poor performance for diabetic population, with high proportion of high-risk individuals (17% for men, 31% for women) would be missed.

Interpretation

Although the WHO CVD risk charts for East Asia apparently overestimated CVD risk among Chinese population, they could be pragmatic pre-selection tools, as potential supplement to the China-PAR equations. The widespread use of the WHO risk charts along with the China-PAR equations might facilitate the implementation of the risk-based CVD prevention in China.

Funding

Full funding sources are listed at the end of the paper (see Acknowledgments).

Hypolipidemic, anti-inflammatory, and anti-atherosclerotic effects of tea before and after microbial fermentation

BACKGROUND

Microbial fermentation significantly affects the flavor and efficacy of tea. It is generally believed that fermented tea is more effective in lowering lipids, while unfermented tea can more effectively inhibit inflammation. However, there is not sufficient evidence to support this claim. To systematically compare the hypolipidemic, anti-inflammatory, and anti-atherosclerotic effects of tea before and after microbial fermentation, hyperlipidemic rats and inflammatory injury cells were treated with Monascus purpureus-fermented pu-erh tea water extract (MPT) and sun-dried green tea water extract (SGT), respectively.

RESULTS

MPT, with higher levels of theabrownins, flavonoids, gallic acid (GA), and lovastatin, was more effective in reducing serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and inflammatory cytokines (TNF-α, IL-1β, and IL-6), while SGT, with higher levels of tea polyphenols, amino acids, (-)-epigallocatechin gallate (EGCG), and theaflavins, was more effective in increasing serum high-density lipoprotein cholesterol (HDL-C) in hyperlipidemic rats. The foam cells on the arterial wall of the rats in the MPT group were visibly less, and the thrombosis time was longer than that in the SGT group. Cell experiments showed that MPT was more effective in protecting endothelial cells from damage than SGT.

CONCLUSION

Surprisingly, Monascus purpureus-fermented pu-erh tea not only had better hypolipidemic and anti-atherosclerotic effects than its raw material (sun-dried green tea), but also was superior in anti-inflammatory effects to the latter, which was possibly attributable to the great changes in functional ingredients during microbial fermentation.

Associations between short-term exposure to PM2.5 and stroke incidence and mortality in China: A case-crossover study and estimation of the burden

Stroke and fine particulate matter (PM_2.5) are two important public health concerns worldwide. Although numerous studies have reported the associations between PM_2.5 and stroke, scientific evidence in China is incomplete, particularly the effect of PM_2.5 on the acute incidence and national acute health burdens of stroke attributed to PM_2.5 pollution. This study identified about 131,947 registered patients and 23,018 deaths due to stroke in 10 counties located in various regions from 2013 to 2017. Using a time-stratified case-crossover design, this study evaluated the associations between short-term exposure to PM_2.5 and the risks of acute incidence and mortality for different types of stroke on the same spatiotemporal scale. With a 10 μg/m³ increase in the PM_2.5 concentration, the acute incidence risk increased by 0.37% (0.15%, 0.60%) for stroke, 0.46% (0.21%, 0.72%) for ischemic stroke, and -0.13% (-0.73%, 0.48%) for hemorrhagic stroke. The corresponding values for the mortality risk were 0.71% (0.08%, 1.33%), 1.09% (0.05%, 2.14%), and 0.43% (-0.44%, 1.31%) for stroke, ischemic stroke and hemorrhagic stroke, respectively. Compared with the other groups, females and patients aged over 64 years presented higher incidence and mortality risks, while the group aged >75 years may exhibit a greater risk of mortality. Based on the estimated effects, we evaluated 43,300 excess deaths and 48,800 acute incidences attributed to short-term PM_2.5 exposure across China in 2015. This study provided robust estimates of PM_2.5-induced stroke incidence and mortality risks, and susceptible populations were identified. Excess mortality and morbidity attributed to short-term PM_2.5 exposure indicate the necessity to implement health care and prevention strategies, as well as medical resource allocation for noncommunicable diseases in regions with high levels of air pollution.

Gender-specific cardiovascular outcomes in patients undergoing percutaneous coronary intervention in Chinese populations

BACKGROUND

Data was limited on the rates of in-hospital and 30-days composite outcomes between male and female patients with coronary heart disease (CHD) undergoing percutaneous coronary intervention (PCI).

METHODS

This was a retrospective study and CHD patients undergoing PCI between January and December of 2018 were screened and recruited. Baseline characteristics, in-hospital and 30-days composite outcomes were compared by gender. The factors influencing gender-outcome associations were evaluated.

RESULTS

A total of 672 CHD patients undergoing PCI were included into current analysis. Compared to males, females were older (53.8 ± 12.7 years vs 50.6 ± 11.8 years), more likely to be obese (32.9% vs 29.4%) and had higher prevalence of hypertension (46.7% vs 41%). Females were less likely to be smoker (30.3% vs 1.1%), have prior history of CHD (4.4% vs 10.9%), and lower socioeconomic status [SES; full-time employment (64.4% vs 71.9%), education attainment ≥ college (29.6% vs 36.8%) and annual income ≥60,000 RMB (23.7% vs 27.1%)]. Hospitalized stay was longer in females (median 5.2 vs 4.0 days), and females were more likely to experience in-hospital bleeding (3.0% vs 1.2%) and 30-days non-fatal myocardial infarction (5.9% vs 2.9%). In unadjusted model, compared to males, females had a crude odds ratio (OR) of 2.05 (95% confidence interval [CI] 1.68-2.59) for in-hospital composite outcomes and 2.16 (95% CI 1.74-2.63) for 30-days post-PCI composite outcomes. After adjustment for potential covariates, female gender remains independently associated with in-hospital and 30-days post-PCI composite outcomes. OR change was the greatest with adjustment for SES when compared to other covariates.

CONCLUSION

Compared to male patients, female patients had a higher risk of in-hospital and 30-days composite outcomes post-PCI treatment, which were mainly attributed to the differences in SES.

Study of cardiovascular disease prediction model based on random forest in eastern China

Cardiovascular disease (CVD) is the leading cause of death worldwide and a major public health concern. CVD prediction is one of the most effective measures for CVD control. In this study, 29930 subjects with high-risk of CVD were selected from 101056 people in 2014, regular follow-up was conducted using electronic health record system. Logistic regression analysis showed that nearly 30 indicators were related to CVD, including male, old age, family income, smoking, drinking, obesity, excessive waist circumference, abnormal cholesterol, abnormal low-density lipoprotein, abnormal fasting blood glucose and else. Several methods were used to build prediction model including multivariate regression model, classification and regression tree (CART), Naïve Bayes, Bagged trees, Ada Boost and Random Forest. We used the multivariate regression model as a benchmark for performance evaluation (Area under the curve, AUC = 0.7143). The results showed that the Random Forest was superior to other methods with an AUC of 0.787 and achieved a significant improvement over the benchmark. We provided a CVD prediction model for 3-year risk assessment of CVD. It was based on a large population with high risk of CVD in eastern China using Random Forest algorithm, which would provide reference for the work of CVD prediction and treatment in China.

Secondary prevention of cardiovascular disease in China

OBJECTIVE

We aimed to estimate the current use of secondary prevention drugs and identify its associated individual characteristics among those with established cardiovascular diseases (CVDs) in the communities of China.

METHODS

We studied 2 613 035 participants aged 35-75 years from 8577 communities in 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, a government-funded public health programme conducted from 2014 to 2018. Participants self-reported their history of ischaemic heart disease (IHD) or ischaemic stroke (IS) and medication use in an interview. Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of individual characteristics with the reported use of secondary prevention therapies.

RESULTS

Among 2 613 035 participants, 2.9% (74 830) reported a history of IHD and/or IS, among whom the reported use rate either antiplatelet drugs or statins was 34.2% (31.5% antiplatelet drugs, 11.0% statins and 8.3% both). Among the 1 530 408 population subgroups, which were defined by all possible permutations of 16 individual characteristics, reported use of secondary prevention drugs varied substantially (8.4%-60.6%). In the multivariable analysis, younger people, women, current smokers, current drinkers, people without hypertension or diabetes and those with established CVD for more than 2 years were less likely to report taking antiplatelet drugs or statins.

CONCLUSIONS

The current use of secondary prevention drugs in China is suboptimal and varies substantially across population subgroups. Our study identifies target populations for scalable, tailored interventions to improve secondary prevention of CVD.

Lipid-Lowering Therapy and Low-Density Lipoprotein Cholesterol (LDL-C) Goal Achievement in High-Cardiovascular-Risk Patients in Fuzhou, China

PURPOSE

This study aims to analyze the treatment patterns and goal attainment of low-density lipoprotein cholesterol (LDL-C) among patients with atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus (DM) in the real-world setting in Fuzhou, China.

METHODS

Patients aged ≥20 years with a valid LDL-C measurement (index date) in 2016 were selected from National Healthcare Big Data in Fuzhou, China. Patients were stratified into mutually exclusive cardiovascular risk categories: ASCVD (including recent acute coronary syndrome [ACS], chronic coronary heart disease [CHD], stroke, and peripheral arterial disease [PAD]), and DM alone (without ASCVD). Lipid-modifying medication and LDL-C attainment at the index date were assessed.

RESULTS

A total of 21 989 patients met the inclusion criteria, including 17 320 (78.8%) with ASCVD and 4669 (21.2%) with DM alone; 47.7% of patients received current statin therapy in the overall cohort (53.5% in ASCVD, 26.5% for DM); 20.5% ASCVD population achieved LDL-C target with the highest in patients with recent ACS (33.8%), followed by chronic CHD (21.2%), PAD (20.9%), and ischemic stroke (17.3%); 49.0% of patients with DM achieved LDL-C target. Higher LDL-C attainment was observed in high-intensity statin and a combination of statin and nonstatin groups. Atorvastatin was the most commonly used statin with the highest LDL-C attainment, followed by rosuvastatin.

CONCLUSION

Compared with previous studies in China, our study found a relatively low statin use and LDL-C target attainment, but higher than similar studies in Europe. Guidelines should be well complied and more prescription of high-intensity statin or statin and nonstatin combination should be advocated.

Comparison of prevalence and associated risk factors of cognitive function status among elderly between nursing homes and common communities of China: A STROBE-compliant observational study

Dementia among elderly is a serious problem worldwide. This study was conducted to estimate the prevalence and associated risk factors of dementia and mild cognitive impairment (MCI) in nursing homes (NHs) and common communities (CCs) among elderly in China.A cross-sectional survey was conducted in 4 communities across 12 cities in Southern China from May to November of 2014. Qualified psychiatrists and trained nurses carried out relevant diagnosis, assessments, interviews, and information collection. Screening test of mini-mental state examination was conducted among participants firstly, then confirmed diagnosis was carried out among the ones with positive results. Student t test, χ test, univariate, and multivariate logistic regression analysis were conducted to analyze data.A total of 2015 participants aged 65 or older were included in the final analysis; 908 came from NHs while 1107 came from CCs. The crude prevalence rates of dementia and MCI were 22.0% and 15.8%, respectively among all the participants. Dementia prevalence was 42.4% among those living in NHs, which was significantly higher than that of 5.3% in CCs (P < .0001). There were more moderate and severe dementia in NHs compared with CCs (P < .0001). It showed that older age, illiterate compared with high level of education (adjusted odds ratio, AOR = 3.32, 95% CI: 1.53-7.21), heavy drinking (AOR = 1.51 (1.00-2.24), having a medical history of diabetes (AOR = 1.41, 95% CI: 1.02-2.33), and stroke (AOR = 1.21, 95% CI: 1.01-1.23) were associated with dementia in NHs, and middle socioeconomic status might be a protective factor for dementia (AOR = 0.33, 95% CI: 0.21-0.51).The problem of senile dementia in NHs is much more serious than our estimation, and there are not enough trained nursing staffs in NHs. More population-based strategies in NHs, including conducting cognitive screening accompanied with routine physical examination among elderly population, carrying out related primary prevention policies and public health services, and paying attention to some modifiable associated risk factors such as heavy smoking and drinking are needed.