Urban climate and cardiovascular health: Focused on seasonal variation of urban temperature, relative humidity, and PM2.5 air pollution.

Seasonal effects on subclinical cardiovascular functions (CVFs) are an important emerging health issue for people living in urban environment. The objectives of this study were to demonstrate the effects of seasonal variations of temperature, relative humidity, and PM2.5 air pollution on CVFs. A total of 86 office workers in Taipei City were recruited, their arterial pressure waveform was recorded by cuff sphygmomanometer using an oscillometric blood pressure (BP) device for CVFs assessment. Results of paried t-test with Bonferroni correction showed significantly increased systolic and diastolic BP (SBP, DBP), central end-systolic and diastolic BP (cSBP, cDBP) and systemic vascular resistance, but decreased heart rate (HR), stroke volume (SV), cardio output (CO), and cardiac index in winter compared with other seasons. After controlling for related confounding factors, SBP, DBP, cSBP, cDBP, LV dp/dt max, and brachial-ankle pulse wave velocity (baPWV) were negatively associated with, and SV was positively associated with seasonal temperature changes. Seasonal changes of air pollution in terms of PM2.5 were significantly positively associated with DBP and cDBP, as well as negatively associated with HR and CO. Seasonal changes of relative humidity were significantly negatively associated with DBP, and cDBP, as well as positively associated with HR, CO, and baPWV. This study provides evidence of greater susceptibility to cardiovascular events in winter compared with other seasons, with ambient temperature, relative humidity, and PM2.5 as the major factors of seasonal variation of CVFs.

Recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 patients: A comparison of international guidelines.

This mini-review provides the practice guideline recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 Patients. Remodeled "quasi-negative-pressure" isolation wards had been proved a feasible, inexpensive, safe, and effective measure to contain nosocomial outbreaks. We should first determine the minimum required ventilation volume of an isolation ward based on the severity of COVID-19 patients. Mechanical ventilation remains the mainstay for achieving the requirement, while the assistance of recirculation is also helpful. Beyond adequate ventilation volume, the "clean to less-clean" directional airflow remains the golden rule for the solution of indoor ventilation. The virus-laden exhaust should be treated with HEPA/UV device or be kept away from living organisms, buildings, and air inlets.

Epidemiological Characteristics and Meteorological Factors of Sudden Death among General Population of Ethnic Chinese in Taiwan: An Eighteen-Year Follow-Up Report in a Community.

Background: The epidemiological characteristics of sudden death may vary according to ethnicity and country. This study aimed to analyze the distribution of sudden deaths in Taiwan, as well as their epidemiological characteristics and the associated meteorological factors. Methods: The Chin-Shan Community Cardiovascular Cohort is a longitudinal study conducted in a community in Taipei County since July 1990. A total of 3,602 individuals aged 35 years and older were included in the study. Sudden deaths were prospectively recorded and analyzed. Results: Eighty-two (68.3% men) sudden deaths (8.56% of all deaths) were reported from July 1990 to December 2008, of which 87.8% were caused by cardiovascular disease. However, only 36.6% were attributed to coronary artery disease. There was a higher incidence of sudden death in the winter [incidence rate ratio (IRR): 1.91, 95% confidence interval (CI): 1.42-2.56], compared to fall, and the highest peak of sudden death occurred between 16:00-20:00 (IRR: 3.00, 95% CI: 1.72-5.22) compared to 00:00-04:00 as the reference group. Additionally, a relatively higher mean temperature was associated with a lower risk of sudden death (IRR: 0.96, 95% CI: 0.93-0.98). On the other hand, higher humidity (IRR: 1.09, 95% CI: 1.02-1.16) and discomfort index (IRR: 1.03, 95% CI: 1.003-1.05) were associated with increased risks of sudden death. Conclusions: Meteorological factors and circadian patterns were associated with sudden death among our Taiwanese cohort. Our study findings may support potential protective behavior for sudden death via weather forecasting.

2023 Guidelines of the Taiwan Society of Cardiology on the Diagnosis and Management of Chronic Coronary Syndrome.

Coronary artery disease (CAD) covers a wide spectrum from persons who are asymptomatic to those presenting with acute coronary syndromes (ACS) and sudden cardiac death. Coronary atherosclerotic disease is a chronic, progressive process that leads to atherosclerotic plaque development and progression within the epicardial coronary arteries. Being a dynamic process, CAD generally presents with a prolonged stable phase, which may then suddenly become unstable and lead to an acute coronary event. Thus, the concept of "stable CAD" may be misleading, as the risk for acute events continues to exist, despite the use of pharmacological therapies and revascularization. Many advances in coronary care have been made, and guidelines from other international societies have been updated. The 2023 guidelines of the Taiwan Society of Cardiology for CAD introduce a new concept that categorizes the disease entity according to its clinical presentation into acute or chronic coronary syndromes (ACS and CCS, respectively). Previously defined as stable CAD, CCS include a heterogeneous population with or without chest pain, with or without prior ACS, and with or without previous coronary revascularization procedures. As cardiologists, we now face the complexity of CAD, which involves not only the epicardial but also the microcirculatory domains of the coronary circulation and the myocardium. New findings about the development and progression of coronary atherosclerosis have changed the clinical landscape. After a nearly 50-year ischemia-centric paradigm of coronary stenosis, growing evidence indicates that coronary atherosclerosis and its features are both diagnostic and therapeutic targets beyond obstructive CAD. Taken together, these factors have shifted the clinicians' focus from the functional evaluation of coronary ischemia to the anatomic burden of disease. Research over the past decades has strengthened the case for prevention and optimal medical therapy as central interventions in patients with CCS. Even though functional capacity has clear prognostic implications, it does not include the evaluation of non-obstructive lesions, plaque burden or additional risk-modifying factors beyond epicardial coronary stenosis-driven ischemia. The recommended first-line diagnostic tests for CCS now include coronary computed tomographic angiography, an increasingly used anatomic imaging modality capable of detecting not only obstructive but also non-obstructive coronary plaques that may be missed with stress testing. This non-invasive anatomical modality improves risk assessment and potentially allows for the appropriate allocation of preventive therapies. Initial invasive strategies cannot improve mortality or the risk of myocardial infarction. Emphasis should be placed on optimizing the control of risk factors through preventive measures, and invasive strategies should be reserved for highly selected patients with refractory symptoms, high ischemic burden, high-risk anatomies, and hemodynamically significant lesions. These guidelines provide current evidence-based diagnosis and treatment recommendations. However, the guidelines are not mandatory, and members of the Task Force fully realize that the treatment of CCS should be individualized to address each patient's circumstances. Ultimately, the decision of healthcare professionals is most important in clinical practice.

Urinary sodium excretion and the risk of CVD: a community-based cohort study in Taiwan.

Urinary Na excretion is a potential risk factor for CVD. However, the underlying biological mechanisms and effects of salt sensitivity are unclear. The purpose of this study was to characterise the relative contribution of biological factors to the Na-CVD association. A total of 2112 participants were enrolled in this study. Structured questionnaires and blood and urine samples were obtained. Twenty-four-hour Na excretion was estimated using a single overnight urine sample. Hypertension, the metabolic syndrome and overweight status were considered to indicate salt sensitivity. Cox proportional hazard models were used to investigate the effects of salt sensitivity on urinary Na excretion and CVD risk. The traditional mediation approach was used to calculate the proportion of mediation. The mean age (sd) of the 2112 participants was 54·5 (sd 12·2) years, and they were followed up for a mean of 14·1 (sd 8·1) years. Compared with those in the lowest quartile, the highest baseline urinary Na excretion (>4·2 g/24 h) was associated with a 43 % higher CVD risk (hazard ratio, 1·43; 95 % CI 1·02, 1·99). Participants with high urinary Na excretion, hypertension or the metabolic syndrome had a significantly high risk of CVD. The carotid intima-media thickness had the largest mediating effect (accounting for 35 % of the Na-CVD association), followed by systolic blood pressure (BP) (33 %), left ventricular mass (28 %) and diastolic BP (14 %). Higher urinary Na excretion increased the risk of CVD, which was explained largely by carotid media-thickness and systolic BP.

Urban Fine Particulate Matter and Elements Associated with Subclinical Atherosclerosis in Adolescents and Young Adults.

The relationships between the elemental constituents of PM2.5 and atherosclerosis remain limited, especially in young populations. This study included 755 subjects aged 12-30 years in the Taipei metropolis. A land use regression model was used to estimate residential annual mean concentrations of PM2.5 and eight elemental constituents. We evaluated the percent differences in carotid intima-media thickness (CIMT) with PM2.5 and elemental constituent exposures by linear regressions. Interquartile range increments for PM2.5 (4.5 µg/m3), sulfur (108.6 ng/m3), manganese (2.0 ng/m3), iron (34.5 ng/m3), copper (3.6 ng/m3), and zinc (20.7 ng/m3) were found to associate with 0.92% (95% confidence interval (CI): 0.17-1.66), 0.51% (0.02-1.00), 0.36% (0.05-0.67), 0.98% (0.15-1.82), 0.74% (0.01-1.48), and 1.20% (0.33-2.08) higher CIMTs, respectively. Factor analysis identified four air pollution source-related factors, and the factors interpreted as traffic and industry sources were associated with higher CIMTs. Stratified analyses showed the estimates were more evident in subjects who were ≥18 years old, females, or who had lower household income. Our study results provide new insight into the impacts of source-specific air pollution, and future research on source-specific air pollution effects in young populations, especially in vulnerable subpopulations, is warranted.

Association between serum per- and polyfluoroalkyl substances and thrombograms in young and middle-aged Taiwanese populations.

PURPOSE: Per- and polyfluoroalkyl substances (PFAS) are a class of man-made chemicals used in many products. Recent in vitro and epidemiological reports have found that PFAS exposure can modify the function of platelets. Platelet size has been shown to affect platelet activity, and thrombograms are a simple method of indirect assessment of platelet function. However, there has been no large-scale research investigating the association between PFAS levels and complete thrombograms in humans. APPROACH AND RESULTS: In the current cross-sectional study, we enrolled 1779 Taiwanese subjects (aged between 12 and 63 years) to study the associations between serum PFAS concentrations and thrombograms. There were 1175 men and 604 women with a mean age of 34.5 years. When all four PFAS were fitted by the multiple linear models at the same time, platelet counts decreased significantly with increasing quartiles of perfluorooctanoate acid (PFOA) and perfluorooctane sulfonate (PFOS), while platelet distribution width (PDW), mean platelet volume (MPV), and platelet-large cell ratio (PLCR) also increased significantly with increasing quartiles of PFOS. The mean platelet count was the lowest (264.02 k/µL [95% CI 256.00-272.04]; P < 0.001) when both PFOA and PFOS concentrations were above the 50th percentile. CONCLUSIONS: We report that serum PFAS levels were correlated with thrombograms. If the association is etiologic, PFOA/PFOS may decrease the number of platelets, while PFOS may also increase the variation and the average size of platelets in the subjects of the study. Interestingly, PFOA and PFOS may have synergistic effects on the decrease in platelet counts. Further research is needed to study the effect of PFAS on platelets in humans.

Global DNA methylation mediates the association between serum perfluorooctane sulfonate and carotid intima-media thickness in young and middle-aged Taiwanese populations.

PURPOSE: Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are a group of synthetic chemicals used in the manufacture of many everyday products. Previous reports have shown PFAS exposure may contribute to cardiovascular diseases (CVD). Recent studies have also identified a critical role for DNA methylation, a model of epigenetic regulation, in the pathogenesis of CVD. Additionally, PFAS has been shown to affect DNA methylation. Our previous study reported the positive association between serum perfluorooctane sulfonate (PFOS) levels and mean carotid intima-media thickness (CIMT), a biomarker of arteriosclerosis, in a cohort composed of adolescent and young adult Taiwanese. However, the contribution of DNA methylation in the mechanism of PFOS-induced arteriosclerosis has never been explored in previous literature. APPROACH AND RESULTS: In this cross-sectional study, we included 1425 young and middle-aged Taiwanese individuals (12-63 years) to investigate the correlation between serum PFOS levels, 5mdC/dG (a global DNA methylation marker) and the mean CIMT. We showed that the positive association between serum PFOS levels, 5mdC/dG, and mean CIMT. The regression coefficients of mean CIMT with a one-unit increase in ln-PFOS concentration were higher when the levels of 5mdC/dG were above the 50th percentile in the multiple regression analysis. In the structural equation model (SEM), the results showed that serum PFOS levels were directly correlated with mean CIMT and indirectly correlated with CIMT through 5mdC/dG. CONCLUSIONS: Our results showed that PFOS exposure has direct associations on arteriosclerosis and indirect direct associations on arteriosclerosis through DNA methylation. The results suggest that DNA methylation might regulate the relationship between PFOS and arteriosclerosis in the study subjects. Additional works are required to understand the causal inference between PFOS, DNA methylation, and arteriosclerosis.

Apoptotic microparticles mediate the association between bisphenol A and subclinical atherosclerosis in a young population: A population-based study.

Bisphenol A (BPA) exposure is associated with atherosclerotic cardiovascular diseases. The interactions between BPA, extracellular microparticles (MPs), and atherosclerosis are unknown. A total of 103,756 young students participated in the mass urine-screening program in Taiwan between 1992 and 2000 were analyzed. After exclusion, 886 subjects were recruited to test the relationships between serum level of BPA, endothelial and platelet MPs as well as subclinical atherosclerosis represented by carotid artery intima-media thickness (CIMT). We found that an increment of one unit of log-BPA could lead to significant association between thicker CIMT and concentrations of endothelial microparticles and platelet microparticles in the cohort (odds ratio (OR) 1.23, P < 0.001). CD31 + /CD42a- (> 50%, OR 1.229, P = 0.001) and CD31 + /CD42a+ (≦ 50%, OR 1.262, P = 0.017 and > 50%, OR 1.212, P = 0.006) were significantly associated with thicker CIMT in the presence of elevated BPA. When considering the interactions between CD31 + /CD42a- and CD31 + /CD42a+ , we observed increased OR as CD31 + /CD42a- was greater than 50% (CD31 +/CD42a- > 50% and CD31 +/CD42a+ ≦ 50%, OR 1.356, P = 0.029; CD31 +/CD42a- > 50% and CD31 +/CD42a+ > 50%, OR 1.204, P = 0.014). Our study identified a higher risk of thicker CIMT associated with altered MPs in the presence of elevated BPA levels. BPA exposure is associated with endothelial dysfunction and subclinical atherosclerosis in a young population.

Association between the total plasma isomers of per- and polyfluoroalkyl substances and erythrograms in young and middle-aged Taiwanese populations.

PURPOSE: Per- and polyfluoroalkyl substances (PFAS) are human-made chemicals used in daily use products. Recent studies have shown that different perfluorooctanoic acid (PFOA) and/or perfluorooctane sulfonate (PFOS) isomers may have different biological effects. In vitro studies have also reported that PFAS exposure can alter the structure of hemoglobin (Hb). In epidemiology, however, few studies have investigated the relationship between PFAS exposure and erythrocytes. Additionally, the correlation between PFOA/PFOS isomers and full erythrograms has never been explored. APPROACH AND RESULTS: In cohorts comprising young and middle-aged Taiwanese populations, we enrolled 1483 participants (aged between 12 and 63 years) to analyze the correlations between the plasma levels of PFOA/PFOS isomers and whole-blood erythrograms. The study comprised 868 men and 615 women with a mean age of 31.2 years. When all PFOA/PFOS isomers were entered into the multiple linear regression model, the linear PFOA (L-PFOA) levels were positively correlated with the Hb, hematocrit (HCT), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) levels while the branched PFOS (B-PFOS) levels were positively associated with the Hb, HCT, and mean corpuscular hemoglobin concentration (MCHC). The mean value of Hb was the highest (14.66 mg/dL (95% CI =14.52-14.80); P for trend <0.001) when both the L-PFOA and B-PFOS levels were above the 50th percentile. CONCLUSIONS: The results imply that PFOA/PFOS isomers may increase the weight and volume of Hb/RBC and that L-PFOA/B-PFOS may have an additive effect on the Hb levels. However, it is also possible PFAS detected at a higher concentration may due to its binding to higher levels of Hb. Further studies are needed to investigate the effects of PFOA/PFOS isomers on RBCs in humans.

Association between urinary manganese and pulmonary function in young adults: A cross-sectional design with a longitudinal cohort validation.

BACKGROUND: The impact of heavy metals on pulmonary function among young adults has been scarcely studied, especially by a longitudinal cohort study. METHODS: We prospectively enrolled 974 young adults (aged 20-45 years) during 2017-2019 and measured pulmonary function and urinary heavy metals, including manganese, copper, chromium, iron, nickel, zinc, cadmium, and lead. Among them, 461 participants had examination of the same urinary heavy metals during 2006-2008, which could be used as a cohort for long-term effect of urinary metals on pulmonary function. RESULTS: In the 974 enrolled participants, urinary heavy metals were within normal range. The urinary manganese level was the only significant factor for the observed/predicted ratios of forced vital capacity (FVC %)(ß coefficient: -1.217, p = 0.030), forced expiratory volume in one second (FEV1%)(ß: -1.664, p < 0.001), and FEV1/FVC% of predicted (ß: -0.598, p = 0.047) in multivariable linear regression under cross sectional design. In cohort analysis, the urinary manganese level was also negatively associated with the FEV1% (ß: -1.920, p = 0.021). There was no significance between other urinary heavy metals and pulmonary function for all participants. The urinary manganese significantly negatively correlated with FVC%, FEV1% and FEV1/FVC% in female subgroup whereas copper and iron were significantly negatively correlated with FVC% in male subgroup. CONCLUSIONS: Among urinary heavy metals, urinary manganese level was associated with pulmonary function negatively, even the level was within normal range. In addition, women might be more susceptible to manganese. There is emergent need to conduct further investigation to confirm the respiratory hazardous effects of manganese.

The association between total serum isomers of per- and polyfluoroalkyl substances, lipid profiles, and the DNA oxidative/nitrative stress biomarkers in middle-aged Taiwanese adults.

Per- and polyfluoroalkyl substances (PFAS) have been widely used in consumer products. In vitro and animal studies have demonstrated that exposure to perfluorooctanoic acid (PFOA) and/or perfluorooctane sulfonate (PFOS) increases oxidative/nitrative stress. Recent studies have also found that isomers of PFOA/PFOS may have unique biological effects on clinical parameters. However, the correlation between PFOA/PFOS isomers and markers of oxidative/nitrative stress has never been investigated in the general population. In the current study, 597 adult subjects (ages between 22 and 63 years old) were enrolled from a control group of a case-control study entitled "Work-related risk factors and coronary heart disease". We investigated the correlation between the serum isomers of PFOA/PFOS, lipid profiles, and the urine compounds 8-hydroxy-2-deoxyguanosine (8-OHdG) and 8-nitroguanine (8-NO2Gua) in these participants. There were 519 men and 78 women with a mean age of 45.8 years. Linear PFOA levels were positively correlated with serum low density lipoprotein cholesterol (LDL-C), small dense LDL, and triglyceride, and linear PFOS levels were positively correlated with LDL-C and HDL-C in multiple linear regression analyses. After controlling for potential confounders, the mean levels of 8-OHdG and 8-NO2Gua significantly increased across the quartiles of linear PFOS in multiple linear regression analyses. When both the 8-OHdG and 8-NO2Gua levels were above the 50th percentile, the odds ratio (OR) of higher levels of LDL-C (>75th percentile) with one unit increase in ln linear PFOS level was the highest (OR 3.15 (95% CI = 1.45-6.64), P = 0.003) in logistic regression models. In conclusion, serum linear PFOA/PFOS were correlated with lipid profiles, and linear PFOS was associated with urine oxidative/nitrative stress biomarkers. The positive correlation between linear PFOS and LDL-C was more marked when concentrations of urine oxidative/nitrative stress biomarkers were elevated. Further studies are needed to elucidate the causal relationships among PFAS isomers, lipid profiles, and oxidative/nitrative stress.

Urinary heavy metals, DNA methylation, and subclinical atherosclerosis.

PURPOSE: Lead (Pb) or cadmium (Cd) exposure has been linked to atherosclerosis. Co-exposure of these two heavy metals often occurs in humans. Recent evidence has indicated a crucial role of DNA methylation in atherosclerosis, while Pb or Cd exposure has also been shown to alter DNA methylation. However, it is still unknown whether DNA methylation plays a role in the pathological mechanism of these two heavy metals in atherosclerosis. APPROACH AND RESULTS: We enrolled 738 participants (12-30 years) to investigate the association among concentrations of urine Pb or Cd, the 5mdC/dG value (a global DNA methylation marker) and the carotid intima-media thickness (CIMT). When each heavy metal was modeled separately, the results showed urine Pb and Cd concentrations were positively associated with the 5mdC/dG value and CIMT, respectively. When the two heavy metals were analyzed in the same model, urinary Pb concentrations were positively associated with the 5mdC/dG value and CIMT, while urinary Cd concentrations were only positively associated with the CIMT. When Pb and Cd are simultaneously considered in the same logistic regression model, the odds ratios (OR) of thicker CIMT (greater than 75th percentile) with one unit increase in ln-Pb level was 1.67 (95% C.I. = 1.17-2.46, P = 0.005) when levels of 5mdC/dG were above 50th percentile, which is higher than 5mdC/dG bellow the 50th percentile (OR = 1.50 (95% C.I. = 0.96-2.35), P = 0.076). In structural equation model (SEM), Pb or Cd levels are directly associated with CIMT. Moreover, Pb or Cd had an indirect association with CIMT through the 5mdC/dG. When we considered Pb and Cd together, Pb levels had a direct association with CIMT and an indirect association with CIMT through the 5mdC/dG value, while Cd only had a direct association with CIMT. CONCLUSIONS: Our findings imply that Pb and Cd exposure might be associated with subclinical atherosclerosis, and global DNA methylation might mediate Pb-associated subclinical atherosclerosis in this young population. Future effort is necessary to elucidate the causal relationship.

The selective peroxisome proliferator-activated receptor alpha modulator (SPPARMα) paradigm: conceptual framework and therapeutic potential : A consensus statement from the International Atherosclerosis Society (IAS) and the Residual Risk Reduction Initiative (R3i) Foundation.

In the era of precision medicine, treatments that target specific modifiable characteristics of high-risk patients have the potential to lower further the residual risk of atherosclerotic cardiovascular events. Correction of atherogenic dyslipidemia, however, remains a major unmet clinical need. Elevated plasma triglycerides, with or without low levels of high-density lipoprotein cholesterol (HDL-C), offer a key modifiable component of this common dyslipidemia, especially in insulin resistant conditions such as type 2 diabetes mellitus. The development of selective peroxisome proliferator-activated receptor alpha modulators (SPPARMα) offers an approach to address this treatment gap. This Joint Consensus Panel appraised evidence for the first SPPARMα agonist and concluded that this agent represents a novel therapeutic class, distinct from fibrates, based on pharmacological activity, and, importantly, a safe hepatic and renal profile. The ongoing PROMINENT cardiovascular outcomes trial is testing in 10,000 patients with type 2 diabetes mellitus, elevated triglycerides, and low levels of HDL-C whether treatment with this SPPARMα agonist safely reduces residual cardiovascular risk.

Urinary phthalate metabolites, coronary heart disease, and atherothrombotic markers.

Cross-sectional studies have described an association between exposure to phthalate esters and cardiovascular risk factors. However, the association with coronary heart disease (CHD) is still unclear. A total of 180 subjects randomly selected from 336 CHD patients, and 360 age- and sex-matched non-CHD controls were included from 2008 to 2011. Urinary metabolites of phthalate esters were measured by liquid chromatography-tandem mass spectrometry. The geometric means of urinary phthalates metabolites were significantly higher for the three Di-(2-ethylhexyl)-phthalate (DEHP) metabolites, mono-2-ethylhexyl phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate, and mono-(2-ethyl-5-oxohexyl) phthalate among CHD patients in-hospital than those of being discharged. Excluding 89 CHD patients of in-hospital and hospital discharge within 2 days, we found the urinary concentrations of MEHP, mono-n-butyl phthalate (MnBP), and mono-isobutyl phthalate (MiBP) of 91 CHD patients discharged ≥ 3 days were higher than those of controls. Among 451 participants, those with higher tertile levels of urinary MEHP, MnBP, and MiBP showed an increased risk for CHD compared to those with lowest tertile levels; the corresponding odds ratios (95% CI) were 2.77 (1.22-6.28), 2.90 (1.32-6.4), and 3.19 (1.41-7.21), respectively, after adjustment for confounders. Higher levels of hs-CRP, fibrinogen, and D-dimer were linked with increased levels of all DEHP metabolites in CHD patients. In conclusion, exposure to DEHP and dibutyl phthalates was positively associated with CHD and this relationship may be probably mediated via atherothrombosis.

Comparing the Consistency and Performance of Various Coronary Heart Disease Prediction Models for Primary Prevention Using a National Representative Cohort in Taiwan.

BACKGROUND: Predicting future coronary artery disease (CAD) risk by model-based approaches can facilitate identification of high-risk individuals for prevention and management. Therefore, we compared the consistency and performance of various CAD models for primary prevention using 1 external validation dataset from a national representative cohort in Taiwan.Methods and Results:The 10 CAD prediction models were assessed in a validation cohort of 3559 participants (≥35 years old, 53.5% women) from a Taiwanese national representative cohort that was followed up for a median 9.70 (interquartile range, 9.63-9.74) years; 63 cases were documented as developing CAD events. The overall κ value was 0.51 for all 10 models, with a higher value for women than for men (0.53 for women, 0.40 for men). In addition, the areas under the receiver operating characteristics curves ranged from 0.804 (95% confidence interval, 0.758-0.851) to 0.847 (95% confidence interval, 0.805-0.889). All non-significant chi-square values indicated good calibration ability. CONCLUSIONS: Our study demonstrated these 10 CAD prediction models for primary prevention were feasible and validated for use in Taiwanese subjects. Further studies of screening and management are warranted.

Association Between Long-term Exposure to Traffic-related Air Pollution and Inflammatory and Thrombotic Markers in Middle-aged Adults.

BACKGROUND: Studies evaluating possible associations between long-term exposure to air pollution and inflammatory and thrombotic markers are limited. METHODS: From 2009 to 2011, we monitored hematologic parameters and thrombotic markers in 402 volunteers 35-65 years of age who were recruited as the non-coronary heart disease (CHD) controls in a study of work-related factors and CHD in Taipei. We applied land-use regression models developed by the European Study of Cohorts for Air Pollution Effects to estimate the mean annual exposure of each participant to five air pollutants at their residence in Taipei, namely particulate matter (PM) of diameter <10 µm (PM10) and 2.5 µm (PM2.5), the absorbance of PM2.5 (PM2.5 abs), nitrogen dioxide (NO2), and nitrogen oxide (NOx). RESULTS: The mean annual exposures were 47.82 ± 4.78 µg/m for PM10, 29.08 ± 5.10 µg/m for PM2.5, and 2.04 ± 0.37 (10 m) for PM2.5 abs. Multivariate linear regression analyses showed that the mean percentage (95% confidence interval) of blood monocyte counts increased by 9.08% (1.61%, 16.54%) per 10 µg/m increase in PM10, by 16.28% (6.66%, 25.89%) per 1.0 × 10 m increase in PM2.5 abs, by 8.28% (2.08%, 14.48%) per 20 µg/m increase in NO2, and by 2.84% (1.22%, 4.46%) per 10 µg/m increase in NOx. In addition, each 5 µg/m increase in PM2.5 was associated with 1.97% (0.02%, 3.92%) increases in fibrinogen. CONCLUSIONS: Long-term exposure to traffic-related air pollution is positively associated with subclinical inflammatory and thrombotic markers in middle-aged workers in Taipei.

Association between measurements of thyroid function and the acrylamide metabolite N-Acetyl-S-(propionamide)-cysteine in adolescents and young adults.

Acrylamide is present in mainstream cigarette smoke and in some foods prepared at high temperatures. Animal studies have shown that acrylamide exposure alters thyroid function; however, it is not known if this also occurs in humans. The study examined the association between the urinary levels of the acrylamide metabolite and serum thyroid measures in adolescents and young adults. We recruited 793 subjects (mean age, 21.3 years; range, 12-30 years) from a population-based sample of Taiwanese adolescents and young adults to determine if the urinary levels of the acrylamide metabolite N-acetyl-S-(propionamide)-cysteine (AAMA) and the 6 serum thyroid measures are associated. The mean (SD) AAMA were 76.54 (76.42) µg/L. Linear regression analyzes showed a 1-unit increase in natural log AAMA was significantly associated with a decrease in serum free thyroxine (T4) (ng/dL) (ß=-0.041, SE=0.013, p=0.001) after controlling for covariates. Subpopulation analyzes showed AAMA and free T4 were significantly associated with females, age 20-30 years, non-current smokers, and non-alcohol consumers. In conclusion, higher urinary AAMA concentrations were associated with decreased levels of free T4 in this cohort. Further studies are warranted to determine if there is a causal relationship between acrylamide exposure and thyroid function.

Sex differences in trends of incidence and mortality of first-ever stroke in rural Tianjin, China, from 1992 to 2012.

BACKGROUND AND PURPOSE: Sex differences in secular trends of stroke incidence are rarely reported. We aimed to explore sex differences in incidence and mortality of stroke in rural China from 1992 to 2012. METHODS: In 1992, 14 920 residents were recruited to participate in the Tianjin Brain Study, a population-based study on stroke surveillance. Stroke events and all deaths were annually registered. RESULTS: We observed 908 incident strokes (366 in women) from 1992 to 2012. Women were significantly younger than men (64±12 versus 68±11 years) in 1992 to 1998 (P=0.024). The incidence of first-ever stroke per 100 000 person-years for men was 166 in 1992 to 1998, 227 in 1999 to 2005, and 376 in 2006 to 2012; for women, the rates were 86 (1992-1998), 148 (1999-2005), and 264 (2006-2012). From 1992 to 2012, the incidence grew annually by 5.8% in men and 8.0% in women. The male/female incidence ratio declined significantly: 1.9 in 1992 to 1998, 1.5 in 1999 to 2005, and 1.4 in 2006 to 2012. There were no significant sex differences in mortality. The prevalence of obesity and diabetes mellitus, the levels of total cholesterol and triglycerides, and the age of menopause and reproductive years in women concurrently increased in 2011. CONCLUSIONS: There was a significant increase in the incidence of first-ever stroke in women annually and a declining trend in the male/female rate ratio in rural China during the past 21 years. These results suggest that stroke will become one of the major diseases affecting women in future decades in China.