[Relationship of genetic variants and cardiovascular risk factors with interleukin-6 and interleukin-10 secreted by monocytes].

OBJECTIVE: To examine the relationship of interleukin (IL)-6 and IL-10 genetic variants and cardiovascular factors [oxygenized low density lipoprotein (ox-LDL), lower physical activity, overweight, etc.] with IL-6 and IL-10 secreted by monocytes. METHODS: In the study, 40 health persons, aged from 51 to 80 years, without stroke and myocardial infarction, were randomly sampled from a community-based population in Beijing in 2010. Their data on smoking, drinking, blood pressure, fasting glucose, and lipid were collected. The single nucleotide polymorphisms (SNPs) of IL-6 (rs1800796, rs1524107, rs2066992) and IL-10 (rs1800872, rs1554286, rs3021094) were genotyped. The human monocytes were cultivated in RPMI 1640 medium for 24 h; then divided into two equal parts, in which ox-LDL (50 mg/L) and phosphate buffer solution (PBS) were added for another 48 h. Finally, the secretions of IL-6 and IL-10 in the culture supernatants were measured with ELISA. RESULTS: Paired Wilcoxon tests showed that the IL-6, IL-10, and IL-6/IL-10 were significantly higher in ox-LDL medium than in PBS one (all P < 0.01). The concentrations in PBS/ox-LDL taken as repeated measurements, and adjusted for age and gender, the repeated general linear models showed: IL-10 was significantly lower for those overweight (BMI ≥ 26 kg/m(2)) than for those normal weight (P = 0.007), and IL-6/IL-10 was significantly higher in those overweight (P = 0.003). The IL-6/IL-10 was significantly higher in those with lower physical activity [metabolic equivalent of energy, METS < 166 kJ/(kg.d)] than those with higher physical activities (P = 0.046). IL-6 and IL-10 were significantly higher in alcohol drinkers (P = 0.049 and P = 0.006). IL-6 was significantly higher in those with higher high-density lipoprotein-cholesterol (HDL-c, ≥ 56.4 mg/dL, P = 0.027). There were significant interactions between IL-10 SNPs and ox-LDL on IL-10 (all P < 0.05), but no significant interactions between IL-6 gene SNPs and ox-LDL on IL-6. CONCLUSION: The ox-LDL together with lower physical activity and overweight shifts the balance of pro-inflammatory and anti-inflammatory in the direction of pro-inflammatory. The interaction between IL-10 gene and ox-LDL is intensively correlated with the secretion of the anti-inflammatory cytokine IL-10.

[Relationship between physical activity and the incidence of metabolic syndrome in Chinese adults: a prospective cohort study].

OBJECTIVE: To investigate the association between physical activity (PA) and the incidence of metabolic syndrome (MS) in Chinese adults. METHODS: Data on PA and other variables were obtained at the baseline examination of China Multi-center study of Cardiovascular Epidemiology in 1998 and of International Collaborative study of Cardiovascular Disease in Asia(InterASIA) during 2000 - 2001. Follow-up study was conducted in 2007 - 2008. A total of 11 512 Chinese adults aged 35 - 74 years (5563 men and 5949 women) were included in the final data analysis. Information on demographics, PA, smoking and alcohol consumption were obtained and components of MS were examined. Participants were divided into four groups according to quartile of total metabolic equivalent (MET) values per day. In addition, subjects were grouped into the following categories according to occupational PA: inactive, light, moderate and vigorous. Binary logistic model was used to examine the association between PA and the incidence of MS. RESULTS: A total of 2527 cases with MS were documented during an average following up of 8.1 years. The annual incidence rate of MS was 2.71% (2527/93 178.68). After multivariate logistic regression analysis, compared with participants with total PA volume < 32.0 MET×h×d(-1) (annual incidence rate was 3.19% (697/21 830.74)), the RR (95%CI) value of participants with total PA volume during 32.00 - 37.85, 37.86 - 52.29, and ≥ 52.30 MET×h×d(-1) was 1.05(0.92 - 1.19), 0.98(0.86 - 1.12), and 0.68(0.59 - 0.80), respectively (χ(2)trend = 34.23, P < 0.05), with corresponding annual incidence rates of 2.82% (690/24 504.25), 2.73% (661/24 179.36) and 2.11% (479/22 664.33). In addition, compared to inactive occupational PA (annual incidence rate was 2.76% (402/14 588.33)), the corresponding RR (95%CI) value was 0.80 (0.69 - 0.92), 0.70 (0.59 - 0.82), and 0.54 (0.45 - 0.65) (χ(2)trend = 42.34, P < 0.05), and the annual incidence rates were 2.86% (648/22 663.41), 2.40% (455/18 956.14) and 1.89% (344/18 173.86) in participants with light, moderate and vigorous occupational PA, respectively. CONCLUSION: Both increased total PA volume and occupational PA intensity are significantly associated with decreased risk of incidence of MS.

[Application of wavenumber-linear scaling to the calculated Raman frequencies of polyenes and carotenoids].

Raman spectra of two typical carotenoids (beta-carotene and lutein) and some short (n = 2-5) polyenes were calculated using density functional theory. The wavenumber-linear scaling (WLS) and other frequency scaling methods were used to calibrate the calculated frequencies. It was found that the most commonly used uniform scaling (UFS) method can only calibrate several individual frequencies perfectly, and the systematic result of this method is not very good. The fitting parameters obtained by the WLS method are upsilon(obs)/upsilon(calc)) = 0.999 9-0.000 027 4upsilon(calc) and upsilon(obs)/upsilon(calc)= 0.993 8-0.000 024 8upsilon(calc) for short polyenes and carotenoids, respectively. The calibration results of the WLS method are much better than the UFS method. This result suggests that the WLS method can be used for the frequency scaling of the molecules as large as carotenoids. The similar fitting parameters for short polyenes and carotenoids indicate that the fitting parameters obtained by WLS for short polyenes can be used for calibrating the calculated vibrational frequencies of carotenoids. This presents a new frequency scaling method for vibrational spectroscopic analysis of carotenoids.

[The optimal cut-off value of waist-to-height ratio for detecting severe central obesity and low body weight adult Chinese population].

OBJECTIVE: To explore the optimal cut-off values of waist-to-height ratio (WHtR) for detecting the severe central obesity and low body weight in adult Chinese population. METHODS: A total of 30 630 participants aged 35-59 years from different areas in mainland China were surveyed for cardiovascular diseases risk factors in two independent cross-sectional studies that carried out in 1992-1994 and 1998, respectively. Indices, such as sensitivity, specificity for hypertension, abnormal glucose, high serum total cholesterol, low serum high density lipoprotein cholesterol and clustering of risk factors (number ≥ 2) were calculated to evaluate the efficacy individual cut-off point of WHtR. The cut-off point value for obvious central obesity was fixed on the point whose specificity of the point was gathered more than 90%. And the cut-off point value to indicate low weight was determined by the percentile distribution of WHtR, at which the 5th percentile of point, both in male and female population. Based on the principle of convenient and practical for use, the optimal cut-off point values of WHtR for low weight and obvious central obesity were determined. RESULTS: The cut-off values of WHtR to detect severe central obesity were 0.54 and 0.57 for men and women, respectively. Additionally, the cut-off points of WHtR for each of the 4 cardiovascular risk factors to evaluate the severity separately ranged from 0.54 to 0.55 in male, and ranged from 0.57 to 0.58 in female. The 5th percentile of WHtR, which was the point value of WHtR to indicate low body weight, was 0.40 in both male and female population. CONCLUSION: Our data suggest that the optimal cut-off value of WHtR for defining severe central obesity and low body weight should be 0.57 and 0.40, respectively.

Lifestyle improvement and the reduced risk of cardiovascular disease: the China-PAR project.

BACKGROUND: The benefits of healthy lifestyles are well recognized. However, the extent to which improving unhealthy lifestyles reduces cardiovascular disease (CVD) risk needs to be discussed. We evaluated the impact of lifestyle improvement on CVD incidence using data from the China-PAR project (Prediction for Atherosclerotic Cardiovascular Disease Risk in China). METHODS: A total of 12,588 participants free of CVD were followed up for three visits after the baseline examination. Changes in four lifestyle factors (LFs) (smoking, diet, physical activity, and alcohol consumption) were assessed through questionnaires from the baseline to the first follow-up visit. Cox proportional hazard models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). The risk advancement periods (RAPs: the age difference between exposed and unexposed participants reaching the same incident CVD risk) and population-attributable risk percentage (PAR%) were also calculated. RESULTS: A total of 909 incident CVD cases occurred over a median follow-up of 11.14 years. Compared with maintaining 0-1 healthy LFs, maintaining 3-4 healthy LFs was associated with a 40% risk reduction of incident CVD (HR = 0.60, 95% CI: 0.45-0.79) and delayed CVD risk by 6.31 years (RAP: -6.31 [-9.92, -2.70] years). The PAR% of maintaining 3-4 unhealthy LFs was 22.0% compared to maintaining 0-1 unhealthy LFs. Besides, compared with maintaining two healthy LFs, improving healthy LFs from 2 to 3-4 was associated with a 23% lower risk of CVD (HR = 0.77, 95% CI: 0.60-0.98). CONCLUSIONS: Long-term sustenance of healthy lifestyles or improving unhealthy lifestyles can reduce and delay CVD risk.

Effects of the total physical activity and its changes on incidence, progression, and remission of hypertension.

OBJECTIVES: Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines. However, the degree to which the total physical activity (TPA) and its changes benefit normotensives and hypertensives is uncertain. We aimed to examine the effects of TPA and its changes on the incidence, progression, and remission of hypertension in the large-scale prospective cohorts. METHODS: A total of 73,077 participants (55,101 normotensives and 17,976 hypertensives) were eligible for TPA analyses. During a mean follow-up of 7.16 years (394,038 person-years), 12,211 hypertension cases were identified. TPA was estimated as metabolic equivalents and categorized into quartiles. Cox proportional hazards regression and multivariable logistic regression were used to estimate associations of TPA and changes in TPA with incident hypertension and progression/remission of hypertension. RESULTS: Compared with the lowest quartile of TPA, normotensives at the third and the highest quartile had a decreased risk of incident hypertension, with hazard ratios (HRs) of 0.86 [95% confidence interval (CI): 0.81-0.91] and 0.81 (95% CI: 0.77-0.86), respectively. Hypertensives at the highest quartile of TPA demonstrated a decreased risk of progression of hypertension [odds ratio (OR) = 0.87, 95% CI: 0.79-0.95], and an increased probability of hypertension remission (OR = 1.17, 95% CI: 1.05-1.29). Moreover, getting active from a sedentary lifestyle during the follow-up period could reduce 25% (HR = 0.75, 95% CI: 0.58-0.96) risk of incident hypertension, whereas those becoming sedentary did not achieve benefit from initially being active. CONCLUSIONS: Our findings indicated that increasing and maintaining TPA levels could benefit normotensives, whereas higher TPA levels were needed to effectively control progression and improve remission of hypertension. Physical activity played undoubtedly an essential role in both primary and secondary prevention of hypertension.

[Hypertension and peripheral arterial diseases].

OBJECTIVE: To explore the relationship between different blood pressure levels and peripheral arterial disease (PAD) assessed by ankle-brachial index (ABI). METHODS: Data including ABI,blood pressure, health history, medication use, blood biochemistry and physical examinations derived from 15 817 subjects from 9 areas throughout China were analyzed. Univariate and multivariate adjusted Logistic regression analyses were used for the data analyses. RESULTS: Blood pressure levels were classified into 5 levels as normal blood pressure, high normal blood pressure, primary hypertension, secondary hypertension and the third grade of hypertension. With the increasing of blood pressure levels, the risk of PAD gradually increased (Ptrend<0.05). In comparison with normal blood pressure group, the ORs of PAD for the other groups were 1.10 (95%CI: 0.93-1.29), 1.17 (95% CI: 0.97-1.40), 1.91 (95% CI: 1.55-2.37), and 2.64 (95% CI: 1.99-3.49), respectively. After adjusting for gender(only for total population), age, urban/rural, smoke, obesity/overweight, the history of hypercholesterolemia and diabetes, the ORs were 1.11 (95%CI: 0.94-1.32), 1.13 (95% CI: 0.93-1.38), 1.85(95% CI: 1.47-2.33), and 2.66 (95% CI: 1.98-3.57) (Ptrend<0.05). CONCLUSION: PAD risk increases in proportion with the increasing blood pressure level.

[The relationship between occupational physical activity intensity and peripheral arterial disease].

OBJECTIVE: to explore the relationship between occupational physical activity and peripheral arterial disease (PAD)assessed by ankle-brachial index (ABI). METHODS: data including ABI, occupational physical activity intensity, health history, medication use, blood biochemistry and physical examinations derived from 16 446 subjects from 9 areas throughout China were analyzed. Univariate and multivariate adjusted logistic regression analysis were used for the data analyses. RESULTS: occupational physical activity intensity was classified into 5 levels as jobless, very light, light, moderate and heavy intensity. With the increasing of physical activity intensity, the risk of PAD gradually decreased (P(trend) < 0.05). In comparison with jobless group, the ORs of PAD for other groups were 0.65 (95%CI: 0.52, 0.82), 0.70 (95%CI: 0.56, 0.87), 0.57 (95%CI: 0.44, 0.73), 0.65 (95%CI: 0.53, 0.80) respectively. After adjusting for gender, age, smoke, obesity/overweight, the history of hypertension, hypercholesterolemia, diabetes, cardiovascular disease and stroke, the ORs were 1.02 (95%CI: 0.80, 1.31), 0.91 (95%CI: 0.72, 1.15), 0.92 (95%CI: 0.70, 1.19), 0.90 (95%CI: 0.72, 1.12) (P(trend) < 0.05). CONCLUSION: PAD risk reduced in proportion with increasing occupational physical activity.

Association of cardiovascular diseases with milk intake among general Chinese adults.

BACKGROUND: The association of milk intake with cardiovascular disease (CVD) and cause-specific mortality remained controversial and evidence among the Chinese population was limited. We aimed to study the relationship between milk intake and CVDs among general Chinese adults. METHODS: A total of 104,957 participants received questionnaire survey. Results of physical examination such as anthropometric measurements and biochemical tests during 2007 to 2008, demographic data and their information on milk intake were collected through standardized questionnaires. Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) of CVD incidence, cause-specific mortality and all-cause mortality related to milk intake. Restricted cubic splines (RCSs) were applied to examine dose-response associations. RESULTS: Among the 91,757 participants with a median follow-up period of 5.8 years, we documented 3877 CVD cases and 4091 all-cause deaths. Compared with participants who never consumed milk, the multivariate-adjusted HRs (95% CIs) of CVD incidence for 1 to 150 g/day, 151 to 299 g/day, and ≥300 g/day were 0.94 (0.86-1.03) (P > 0.05), 0.77 (0.66-0.89) (P < 0.05), and 0.59 (0.40-0.89) (P < 0.05), respectively; each 100 g increase of daily milk intake was associated with 11% lower risk of CVD incidence (HR, 0.89; 95% CI: 0.85-0.94; P < 0.001), and 11% lower risk of CVD mortality (HR, 0.89; 95% CI: 0.82-0.97; P = 0.008) after adjustment for age, sex, residential area, geographic region, education level, family history of CVD, smoking, alcohol drinking, physical activity level, body mass index, and healthy diet status (ideal or not). RCS analyses also showed a linear dose-response relationship with CVD (P for overall significance of the curve <0.001; P for non-linearity = 0.979; P for linearity <0.001) and stroke (P for overall significance of the curve = 0.010; P for non-linearity = 0.998; P for linearity = 0.002) incidence, and CVD mortality (P for overall significance of the curve = 0.045; P for non-linearity = 0.768; P for linearity = 0.014) within the current range of daily milk intake. CONCLUSIONS: Daily milk intake was associated with lower risk of CVD incidence and mortality in a linear inverse relationship. The findings provide new evidence for dietary recommendations in CVD prevention among Chinese adults and people with similar dietary pattern in other countries.

Beneficial effects of moderate to vigorous physical activity on cardiovascular disease among Chinese adults.

BACKGROUND: In China, lack of evidence remains a significant challenge for the national initiative to promote physical activity (PA). We aimed to quantify the beneficial effects of meeting or maintaining the recommended PA level [150 minutes per week (min/wk) of moderate PA or 75 min/wk of vigorous PA or an equivalent combination] on incident cardiovascular disease (CVD) among Chinese population. METHODS: We included 100,560 participants without history of CVD from three cohorts in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD events and its subtypes, including stroke, coronary heart disease, heart failure, and CVD death. RESULTS: During a median follow-up of 7.3 years (range: 6-15 years), 777,163 person-years and 4693 incident CVD events were observed. Compared with participants who were inactive at baseline, the multivariable adjusted HR (95% CI) of developing CVD was 0.74 (0.69-0.79) for those who met recommended moderate to vigorous physical activity (MVPA) level at baseline. Furthermore, the risk of CVD incidence was reduced with increment of MVPA (P trend < 0.001), and the HR (95% CI) of highly-active versus inactive category was 0.62 (0.56-0.68). Compared with individuals who were inactive both at the baseline and follow-up, those keeping active over the period of follow-up had a substantial lower risk of incident CVD with the HR (95% CI) of 0.57 (0.43-0.77). CONCLUSIONS: The findings demonstrated that meeting and maintaining the recommended MVPA level could reduce the cardiovascular risk. Wider adoption of the PA recommendations would have considerable health impacts to the Chinese population.

Cross-sectional and longitudinal association of cigarette smoking with carotid atherosclerosis in Chinese adults.

OBJECTIVE: To assess the cross-sectional and longitudinal association of cigarette smoking with carotid atherosclerosis in middle-aged and older Chinese adults. METHODS: The study population consisted of 1132 residents in Beijing (748 women and 384 men) aged 35 to 64 years. Information on baseline smoking characteristics, including smoking status and pack-years was collected in 1993-1994. The cohort was resurveyed in 2002 and common carotid artery intima-media thickness (CCA-IMT) and carotid plaques were measured by B-mode ultrasound. RESULTS: The multivariable-adjusted mean CCA-IMT at resurvey was significantly associated with smoking status at both resurvey and baseline, and was 0.72 mm for consistent current smokers, 0.71 mm for former and inconsistent smokers, and 0.70 mm for consistent never smokers at both surveys, respectively (p-trend<0.01). The multivariable-adjusted odds ratio [OR, 95% confidence interval (CI)] of having carotid plaques was 1.5 (1.0-2.1) for consistent current smokers vs consistent never smokers. In addition, there was a significant dose-response relationship between baseline smoking pack-years and multivariable-adjusted mean CCA-IMT and risk of having carotid plaques at resurvey. CONCLUSION: Smoking is associated with carotid atherosclerosis in middle-aged and older Chinese adults both cross-sectionally and longitudinally. Smoking cessation may play a significant role in prevention and control of cardiovascular diseases in China.

[Differences in goal attainment in clinical management of dyslipidemia in China evaluated by different guidelines].

OBJECTIVE: To better understand the similarities and disparities between the newly issued Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults (CG) and exist relevant guidelines by comparing the actual effect on assessment of current clinical management of dyslipidemia in China, in order to promote the use of CG in clinical practice. METHODS: Study participants included 2094 patients from the Second Multi-center Survey of Dyslipidemia Management in China. The goal attainment rate was defined as the proportion of participants who achieved their target low-density lipoprotein cholesterol (LDL-C) levels specified by CG, the Chinese Expert Recommendations on Prevention and Treatment of Dyslipidemia (CR), the updated Adult Treatment Panel III of the National Cholesterol Education Program (ATP III), respectively. RESULTS: (1) The overall goal attainment rates were 62%, 34% and 50% according to CR, ATP III and CG, respectively. (2) With reference to the CG risk stratifications, the risk of nearly 40% of high risk patients and all very high risk patients were underestimated by CR, whereas the risk of more than 40% of patients in any risk groups were overestimated by ATP III. (3) The disparities in risk stratifications accounted for 90% of the difference in overall goal attainment rate (12%) between CR and CG, while the disparities in the risk stratifications and that in LDL-C target levels were responsible for 29% and 71% of the difference (16%) , respectively, between ATP III and CG. CONCLUSIONS: There were significant differences in goal attainment rates assessed by different clinical practice guidelines. CG is more aggressive in risk stratification than CR but simpler and easier to use than ATP III, and hence more appropriate to Chinese patients and should be widely promoted in China.

[Association between heart rate and all-cause death and coronary event in the Chinese cohort: 16 years follow up results].

OBJECTIVE: To evaluate the association between resting heart rate (HR) and all-cause death and coronary heart disease (CHD) events in the Chinese cohort. METHODS: Data were obtained from the PRC-USA Cooperative Study on Cardiovascular and Cardiopulmonary Epidemiology. Baseline screen surveys were conducted in 1983 and 1984 from people aged 35 to 59 years living in urban or rural areas of Beijing and Guangzhou. Follow-up visits were performed for end point events of all-cause death and first CHD events every two years till 2005. Resting HR was determined from 5 consecutive intervals between R waves on the 12-lead electrocardiogram. RESULTS: A total of 9856 (4805 males) people were included in the study and the mean follow up duration was 16.2 years. There were 1523 deaths, including 200 CHD events during the follow up period. Mean resting HR was 67.9 beat per minute (bpm) in men and 71.6 bpm in women respectively which had a trend to increase with aging. Cox Proportional Hazards model indicated the relative risk of all-cause death increased constantly with the increase of HR percentile after control of age, fasting glucose, serum cholesterol, serum triglyceride, body mass index, systolic blood pressure and diastolic blood pressure. With HR 60-89 bpm as control group, the relative risk and 95% confidence interval in group HR < 50 bpm, 50 - 59 bpm, 90 - 99 bpm and > or = 100 bpm were 0.76 (0.49 - 1.17), 0.87 (0.75 - 1.02), 1.33 (1.06 - 1.68), 1.48 (1.03 - 2.14) respectively. However there was no significant correlation between HR and CHD events in studied population. CONCLUSION: The risk of total death increased significantly in people with HR > or = 90 bpm suggesting higher resting heart rate might be an independent risk factor for all-cause death in the Chinese population.

Fasting glucose and its association with 20-year all-cause and cause-specific mortality in Chinese general population.

OBJECTIVE: The aim of this study was to explore the relationship between fasting glucose levels and all-cause and cause-specific mortality in Chinese population. METHODS: The role of fasting blood glucose levels as a predictor of all-cause and cause-specific mortality was estimated in 9930 participants from four Chinese general populations with a 20-year follow-up. Multivariate Cox proportional hazard models were used to identify the relationship between fasting glucose and mortality. RESULTS: There were 1471 deaths after a median follow-up of 20.2 years (a total of 187,374 person-years), including 310 cardiovascular deaths, 581 cancer deaths, and 580 other-cause deaths. After adjustment for age, sex, urban or rural, northern or southern of China, types of work, education level, physical exercise, smoking status, drinking status, body mass index, systolic blood pressure, and serum total cholesterol at baseline, the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality in the fasting blood glucose categories of <60, 60-69, 70-79, 90-99, 100-109, 110-125, and ≥126 mg/dl were 1.38 (1.04-1.84), 1.20 (1.01-1.43), 1.18 (1.03-1.36), 1.18 (0.99-1.41), 1.48 (1.16-1.88), 1.17 (0.84-1.62), and 2.23 (1.72-2.90), respectively, in contrast to the reference group (80-89 mg/dl). The HRs and 95% CIs for cardiovascular disease mortality in these groups were 2.58 (1.44-4.61), 1.41 (0.95-2.10), 1.56 (1.15-2.11), 1.29 (0.88-1.89), 1.36 (0.78-2.37), 1.05 (0.52-2.11), and 2.73 (1.64-4.56), respectively. CONCLUSIONS: Both low and high fasting glucose were significantly associated with increased risk of all-cause and cardiovascular mortality in Chinese general population.

[Profile and associations of carotid femoral pulse wave velocity in a community-based Beijing population of middle and old age].

OBJECTIVE: To explore the profile and related factors of carotid femoral pulse wave velocity (CFPWV) in a community-based Beijing population of middle and old age. METHODS: A total of 1519 residents aged 44 - 79 years old from Shijingshan district, Beijing, were recruited for the cardiovascular risk factor survey and CFPWV measurements. One way ANOVA, pearson correlation and partial correlation, stepwise multi-linear regression were used for the data analysis. RESULTS: (1) The age-adjusted mean value of CFPWV was significantly higher in men than that in women (11.4 vs. 11.1 m/s, P = 0.007). CFPWV increased significantly with age both for men and women (all P < 0.01). (2) After adjusting for age and gender, CFPWV was significantly higher in people with hypertension, diabetes and higher heart rate (> 70 beats/min) than people without these factors (P < 0.01). (3) CFPWV significantly correlated with age, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate (correlation coefficient ranged from 0.12 - 0.46, all P < 0.01). In female, CFPWV was positively correlated with total cholesterol and triglycerides (correlation coefficient 0.11 and 0.13, all P < 0.01). Multi-linear regression analysis showed age, gender, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate were independent predictors of CFPWV. CONCLUSION: In this middle and old age Chinese population, age, sex, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate but not HDL-cholesterol and body mass index were associated with CFPWV.

[The trends in clinical management of hyperlipidemia and goal attainment rate from 2000 to 2004 - 2006 in China].

OBJECTIVE: To compare the clinical management of hyperlipidemia and goal attainment rate in year 2000 to year 2004 - 2006 in China. METHOD: Data from 2 retrospective surveys (2000 and 2004 - 2006) on clinical management of hyperlipidemia and goal attainment rate were analyzed. A total of 2136 patients were recruited in the 1st survey in year 2000 and 539 patients in the 2nd survey in year 2004 - 2006 from 25 and 21 tertiary hospitals of 12 metropolitan cities. Eligible patients had hyperlipidemia and received lipid-lowering therapy for more than 2 months at the time of survey. Serum lipid levels before and after treatment were analyzed and the goal attainment rate post therapy, defined according to the Chinese National Recommendations for Prevention and Treatment of Dyslipidaemia published in 1997, was calculated. RESULTS: Clinical characteristics were comparable in patients from the 1st and 2nd survey: age (60.9 and 60.0 years), males (47.2% and 49.3%), type of lipid disorder (mixed hyperlipidemia 62.5% and 66.8%), and patients without coronary artery disease (CAD 61.2% and 68.6%). The percent of statins use was significantly higher in the 2nd survey than in the 1st survey (79.2% vs. 70.3%, P < 0.01). The goal attainment rate was significantly higher in the 2nd survey than in the 1st survey (39.9% vs. 26.6% for all patients, 40.2% vs. 28.8% for hypercholesterolaemia, 39.7% vs. 25.0% for mixed hyperlipidemia, 45.9% vs. 31.7 for patients without CAD, 26.7% vs. 16.6% for patients with CAD, 42.2% vs. 30.1% for patients using statins, and 38.5% vs. 28.3% for patients with diet control, all P value < 0.01). CONCLUSIONS: Although the goal attainment rate has been significantly increased in treated hyperlipidemia patients over recent 5 years in China, it is still far from optimal as suggested by the recommendations. Further efforts should be made to increase the goal attainment rate in patients receiving lipid-lowering therapy.

[Validation and generalizability of the predictive model of ischemic cardiovascular diseases in Chinese].

OBJECTIVE: To evaluate the applicability of developed prediction models of ischemic cardiovascular diseases (ICVD) in Chinese to other Chinese populations. METHOD: We used the independent prospective cohort established in early 1990's from China Multi-Center Collaborative Study of Cardiovascular Epidemiology (MUCA), as the validation cohort, to test the hypothesis. The area under ROC curve (AUC) based on the application of the Cox optimal model and the simplified model to the validation cohort were calculated and to test the ability of the prediction models to discriminate events from nonevents. Applicability was evaluated by comparing the mean probability estimates in each decile of probability in the validation cohort with the observed incidence with the Hosmer-Lemeshow test. RESULTS: The validation cohort enrolled a total of 17 329 men and women aged 35 to 59 years baseline 1992 - 1994. In this paper, we used data from the remaining 15 100 participants after excluding 2229 subjects for at missing value of risk factors. During 11-year follow up of the cohort, there were 347 ICVD events (206 for men and 141 for women), including 83 coronary heart disease events (56 men and 27 women) and 268 ischemic strokes (154 men and 114 women). ROC curves for men and women showed good and almost identical discrimination for optimal model (the AUCs (95% CI) were 0.796 (0.762 - 0.829) for men and 0.791 (0.755 - 0.828) for women), simplified model (the AUCs (95% CI) were 0.792 (0.758 - 0.825) for men and 0.783 (0.746 - 0.821) for women) and score system (the AUCs (95% CI) were 0.791 (0.757 - 0.825) for men and 0.779 (0.741 - 0.817) for women) in the validation cohort. The predicted 10-year risk of ICVD by optimal models and observed incidence of ICVD in the validation cohort in each decile were compared. Hosmer-Lemeshow chi2 was 3.7 for men (P = 0.879) and 27.7 for women (P < 0.001). Whereas the largest difference between the observed rate and the predicted rate was only 1%. CONCLUSIONS: The prediction models for estimating 10-year risk of ICVD had satisfied predictive capability when they were applied to the validation cohort and are applicable to other Chinese populations.

[Cut offs and risk stratification of dyslipidemia in Chinese adults].

OBJECTIVE: To establish cut offs and risk stratification of dyslipidemia in Chinese adults. METHODS: Data from 2 widely cited studies: the PRC-US Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology and the China Multi-Provincial Cardiovascular Cohort Study, with a total of 40 719 Chinese adults, age 35 to 64 at baseline, about half men and half women, followed up for a total of 345 140.5 person years, were used to analyze the relationship between dyslipidemia and ischemic cardiovascular diseases (ICVD, including coronary heart events and ischemic stroke events) using a common data analysis protocol co-developed by the scientists from the 2 studies. The relative risk was estimated with the Cox proportional hazard model adjusting for other conventional cardiovascular risk factors. The 10-year absolute risk of ICVD for a 50 years-old person at different risk factor combinations was used to develop the risk stratification. RESULTS: (1) There was a continuous linear relationship between baseline TC (or LDL-C) and ICVD risk without a threshold; (2) The incidence (absolute risk) of ICVD was similar for LDL-C < 3.37 mmol/L (130 mg/dl) and for TC < 5.18 mmol/L (200 mg/dl); and similar for LDL-C < 4.14 mmol/L (160 mg/dl) and for TC < 6.22 mmol/L (240 mg/dl); (3) The absolute ICVD risk for TC > or = 6.22 mmol/L (240 mg/dl) was slightly less but close to that for grade 1 hypertension; (4) ICVD risk increased as HDL-C decreased; (5) No significant association was found between baseline TG and subsequent ICVD; (6) At any TC level, the absolute ICVD risk for those having only hypertension was higher than that for those having 3 other risk factors. CONCLUSION: The cut offs for diagnosis of dyslipidemia in Chinese adults can refer to those used in relevant international guidelines: TC < 5.18 mmol/L (200 mg/dl) [or LDL-C < 3.37 mmol/L (130 mg/dl)] as normal, TC 5.18 - 6.19 mmol/L (200 - 239 mg/dl) [or LDL-C 3.37 - 4.12 mmol/L (130 - 159 mg/dl)] as borderline high, and TC > or = 6.22 mmol/L (240 mg/dl) [or LDL-C > or = 4.14 mmol/L (160 mg/dl)] as high; HDL-C < 1.04 mmol/L (40 mg/dl) as low, 1.04 - 1.53 mmol/L (40 - 59 mg/dl) as normal and > or = 1.55 mmol/L (60 mg/dl) as optimal. In risk stratification scheme, hypertension plays a role that equals to that of any other 3 risk factors.

Validation of spot urine in predicting 24-h sodium excretion at the individual level.

Background: Evidence for the effect of dietary sodium intake on the risk of cardiovascular disease has been controversial. One of the main explanations for the conflicting results lies in the great variability associated with measurement methods for sodium intake. Spot urine collection is a convenient method commonly used for sodium estimation, but its validity for predicting 24-h urinary sodium excretion at the individual level has not been well evaluated among the general population.Objective: The aim of this study was to evaluate the validity of the Kawasaki, the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT), and the Tanaka formulas in predicting 24-h urinary sodium excretion by using spot urine samples in Chinese adults.Design: We analyzed the relative and absolute differences and misclassification at the individual level from 3 commonly used methods for estimating sodium intake among 141 Chinese community residents.Results: The mean measured 24-h sodium excretion was 220.8 mmol/d. The median (95% CIs) differences between measured sodium and those estimated from the Kawasaki, INTERSALT, and Tanaka methods were 6.4 mmol/d (-17.5, 36.8 mmol/d), -67.3 mmol/d (-96.5, -46.9 mmol/d), and -42.9 mmol/d (-59.1, -24.8 mmol/d), respectively. The proportions of relative differences >40% with the Kawasaki, INTERSALT, and Tanaka methods were 31.2%, 41.1%, and 22.0%, respectively; and the absolute difference for the 3 methods was >51.3 mmol/d (3 g salt) in approximately half of the participants. The misclassification rate was 63.1% for the Kawasaki method, 78.7% for the INTERSALT method, and 66.0% for the Tanaka method at the individual level.Conclusion: The results from our study do not support the use of spot urine to estimate 24-h urinary sodium excretion at the individual level because of its poor performance with respect to misclassification. This trial was registered at www.chictr.org.cn as ChiCTR-IOR-16010278.

[A cohort study on parental history of hypertension and the risk of cardiovascular disease in Chinese population].

OBJECTIVE: To assess the relationship between parental history of hypertension and the incidence of cardiovascular disease in Chinese populations. METHODS: A total of 15 131 individuals (7015 men and 8116 women, aged from 35 to 59 years) in China were enrolled and followed up from 1992 to 2005. The information on the parental history of hypertension of the participants was collected. The individuals were divided into three groups according to their parental history of hypertension: those without parental history of hypertension (group 1), those with one parent history of hypertension (group 2) and those with both parents history of hypertension (group 3). The hazard ratio and its 95% confidence interval were calculated using the Cox proportional hazard model. RESULTS: There were 448 cardiovascular events (including 82 cardiac events and 370 stroke events and 4 with both cardiac and stroke events) during the 163 858 person-years of observation. After adjusting for age, smoking and drinking, the hazard ratio for cardiovascular disease for group 1, group 2 and group 3 were 1.00, 1.34 (1.01 - 1.78), 2.58 (1.62 - 4.11) in men respectively and 1.00, 1.77 (1.27 - 2.45), 2.55 (1.44 - 4.54) in women respectively. After further adjusting for serum total cholesterol (TC), high density lipid cholesterol (HDL-C), fasting glucose, body mass index (BMI) and systolic blood pressure (SBP) in the model, the hazard ratio for cardiovascular disease for those three groups were 1.00, 1.01 (0.76 - 1.35), 1.72 (1.07 - 2.75) in men respectively and 1.00, 1.31 (0.94 - 1.84), 1.76 (0.98 - 3.15) in women respectively. CONCLUSION: The individuals with parental history of hypertension have a higher risk of cardiovascular disease, especially for those with both parents history of hypertension.