Life's essential 8 and risk of subclinical atherosclerosis progression: a prospective cohort study.

BACKGROUND: Previous studies have demonstrated the benefits of ideal cardiovascular health (CVH) in reducing cardiovascular risk. However, its role in subclinical atherosclerosis (SA) progression remains unclear. We aim to examine the association of CVH, estimated by the American Heart Association's new Life's Essential 8 (LE8), with the progression of SA. METHODS: This prospective cohort study was conducted among 972 asymptomatic Chinese participants and followed up for 5.7 years. The LE8 score (range, 0-100) consisted of blood pressure, lipids, glucose, body mass index, smoking status, diet health, physical activity and sleep health was evaluated in 1998 and 2008-2009. Progression of SA was determined by carotid plaque and coronary artery calcification (CAC) in 2008-2009 and 2013-2014. Log-binomial regression model was used to estimate the association of LE8 score with SA progression. RESULTS: Each 10 points increment in LE8 score was associated with 15.2% (RR: 0.848, 95% CI: 0.797-0.902), 17.7% (RR: 0.823, 95% CI: 0.766-0.884) and 12.0% (RR: 0.880, 95% CI: 0.845-0.916) lower risks of carotid plaque, CAC and overall SA progression, respectively. Compared with participants with non-ideal CVH at both visits, the participants with ideal CVH at both visits had 39.1% (RR: 0.609, 95% CI: 0.494-0.752), 41.0% (RR: 0.590, 95% CI: 0.456-0.764) and 29.7% (RR: 0.703, 95% CI: 0.598-0.825) lower risks of carotid plaque, CAC and overall SA progression, respectively. CONCLUSIONS: Higher LE8 scores were associated with lower risks of SA progression. Besides, long-term maintenance of optimal CVH was more beneficial to prevent SA progression.

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.

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.

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.

[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.

[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.

[A community-based study on relations between metabolic syndrome and carotid atherosclerosis in a middle-aged population].

OBJECTIVE: To explore the association between metabolic syndromes (MS) and carotid atherosclerosis and to estimate the predictive effects of MS under 3 different definitions. METHODS: A cross-sectional study was conducted in 2 community-based populations in Beijing, in 2008. 1266 subjects (598 men, 668 women), aged 45 - 69, were included in the analyses. MS was defined by the criteria of International Diabetes Federation (IDF), the revised NCEP ATP III (ATPIII-R) and "The Guidelines of Dyslipidemia Control for Chinese Adult" ("Guidelines") in 2007. RESULTS: The prevalence rates of MS by the 3 criteria were 39.0%, 43.3% and 30.9% respectively. The Kappa value for the measure of the agreement between each pair of the 3 definitions were 0.911, 0.719 and 0.730 respectively. The intima-media thickness in common carotid artery (CCA-IMT) was significantly higher (P < 0.001) in all MS groups than in non-MS groups, diagnosed with the 3 criteria independent of age, gender, LDL-C, and current smoking status. After adjustment of age, gender, LDL-C, and current smoking status, the classification of MS significantly increased the risk of prevalence of carotid atherosclerotic plaques, compared to the non-MS group. OR value were 1.499 (95%CI: 1.157 - 1.942) for IDF, 1.696 (95%CI: 1.314 - 2.189) for NCEP-R, 1.763 (95%CI: 1.344 - 2.312) for "Guideline" respectively. CONCLUSION: Our research findings indicated that, when MS were defined with the 3 definitions, prediction on the risk of sub-clinical atherosclerosis would work beyond some of the conventional cardiovascular risk factors such as smoking, LDL-C. There might exist some differences in gender issue on the strength of association between MS when diagnosed by different criteria and carotid plaque.

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.

[A cohort study on parental history and risk factors of stroke in Chinese population].

OBJECTIVE: To assess the relationship between parental history and the incidence of stroke 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. Information on the parental history of stroke of the participants was collected at baseline study under face to face interview. Individuals were divided into three groups according to their parental history of hypertension: those with no parental history of hypertension (Group 1), those with only one parent having the history of hypertension (Group 2) and those with both parents having the history of hypertension (Group 3). The hazard ratio and its 95% confidence interval were calculated using the Cox proportional hazard model. RESULTS: There were 370 stroke events during 163 858 person-years of observation. After adjusting for age and sex, the hazard ratioon stroke for group 1, group 2 and group 3 were 1.00, 1.74 (1.33-2.29), 3.61 (1.86-7.01), respectively. After adjusting for age, sex, smoking, drinking, 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 stroke of those three groups were 1.00, 1.34 (1.02-1.77), 2.50 (1.29-4.87), respectively. CONCLUSION: Individuals with parental history of stroke had a higher risk of stroke, and this was especially true for those with both parents having the history of stroke.

[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.

[Trends in prevalence, awareness, treatment and control of hypertension in middle-aged Chinese population].

OBJECTIVE: To analyze the trends in prevalence, awareness, treatment, control of hypertension among middle-aged Chinese. METHODS: The study comprised two cross-sectional surveys including urban and rural residents, manual workers, farmers and fishermen in different southern and northern parts of China. There were 13 populations under research with comparable data. 18 746 (in 1992 - 1994) and 13 504 (in 1998) participants, aged 35 through 59 years, equal number of men and women, were examined in each of the surveys, on blood pressure measurement, in 1992 - 1994 and in 1998. Hypertension was defined as systolic pressure >/= 140 mm Hg, and/or diastolic pressure >/= 90 mm Hg, and/or reported treatment with antihypertensive medications. Awareness and treatment on hypertension were assessed with standardized questions. Hypertension control was defined as measured blood pressure of less than 140/90 mm Hg. Awareness, treatment and control of hypertension were standardized according to the WHO world standard population. RESULTS: In 1998, 24.0% of participants had hypertension, an increase of 2.3% from 1992 - 1994. Prevalence of hypertension was higher in urban area (25.4%), increasing with age, and higher in men among the younger groups and lower in women among the older groups. Overall, in 1998, 42.6% were aware of their hypertensive status (increase of 5.3%), 31.3% were treated (increase of 3.8%), and the rate under control was 6.0% (increase of 2.6%). The rates of awareness, treatment and control, which tended to increase with age except those aged above 55 years, which were higher in urban areas and women compared with rural areas and men. For people with treated hypertension, the rates of those under control were ranged from 12.7% in 1992 - 1994, to 19.9% in 1998. CONCLUSION: Prevalence of hypertension was increasing in China, while the rates of control, although improving, continued to be low. This implied that effective public measures needed to be developed to enhance the awareness and rates of treatment.

[Inter-population and inter-individual effect of education attainment on men's behavior of smoking: China multi-center study of cardiovascular epidemiology].

OBJECTIVE: To study the inter-population and inter-individual effect of education attainment on men's behavior of smoking in China. METHOD: A cross-sectional study of 7,415 men, aged 35-59 years, from 15 population samples was carried out in 1998. Information on education attainment and smoking was collected by standardized questionnaires. The population samples were divided into 2 groups according to the proportion of men with college or above education attainment: group I had an average 25.8% of men with college or above education attainment, and group II had an average 2.0% of men with college or above education attainment. RESULTS: (1) In group I, the percent of ever smokers, current smokers, deeper smoker, and ever smokers with cessation due to disease and the average number of cigarettes per day for the smokers were significantly lower than in group II (66.2%, 56.4%, 34.4%, 47.8%, 17.2 cigarettes/day vs 75.8%, 64.4%, 40.3%, 58.4%, 20.4 cigarettes/day, respectively). (2) The percent of current smokers and the number of cigarettes decreased with increased education attainment in both groups. Taking the men with college or above education attainment in group I as reference, the odd ratio of smoking for those with high school education in group I was 1.8 (95% CI: 1.5-2.1), for those with middle school or lower education in group I was 2.0(95% CI: 1.7-2.5), for those with college or above education in group II was 1.4(95% CI: 0.9-2.1), for those with high school education in group II was 1.7(95% CI: 1.4-2.1), and for those with middle school or lower education in group II was 2.4 (95% CI: 2.1-2.8). CONCLUSION: Smoking behavior was affected by both individual education attainment and population education level. Smoking cessation measures should be focused on the development of better anti-smoking environment, such as education development, health promotion, etc.