Association of stage 1 hypertension defined by the 2017 ACC/AHA guideline with cardiovascular events and mortality in Chinese adults / 中华医学杂志(英文版)

BACKGROUND@#The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the threshold defining hypertension to 130/80 mmHg. However, how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear. This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population.@*METHODS@#Participants with stage 1 hypertension ( n = 69,509) or normal BP ( n = 34,142) were followed in this study from 2006/2007 to 2020. Stage 1 hypertension was defined as a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg. None were taking antihypertensive medication or had a history of myocardial infarction (MI), stroke, or cancer at baseline. The primary outcome was a composite of MI, stroke, and all-cause mortality. The secondary outcomes were individual components of the primary outcome. Cox proportional hazards models were used for the analysis.@*RESULTS@#During a median follow-up of 11.09 years, we observed 10,479 events (MI, n = 995; stroke, n = 3408; all-cause mortality, n = 7094). After multivariable adjustment, the hazard ratios for stage 1 hypertension vs. normal BP were 1.20 (95% confidence interval [CI], 1.13-1.25) for primary outcome, 1.24 (95% CI, 1.05-1.46) for MI, 1.45 (95% CI, 1.33-1.59) for stroke, and 1.11 (95% CI, 1.04-1.17) for all-cause mortality. The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90 (95% CI, 0.85-0.96).@*CONCLUSIONS@#Using the new definition, Chinese adults with untreated stage 1 hypertension are at higher risk for MI, stroke, and all-cause mortality. This finding may help to validate the new BP classification system in China.

Changes of fasting plasma glucose level before and after menopause: Research based on Kailuan health checkup cohort / 中华内分泌代谢杂志

Objective:To analyze the changes of fasting plasma glucose(FPG)level before and after menopause.Methods:Kailuan health checkup cohort was used to extract data of women aged≥18 years who participated in the first physical examination of Kailuan physical examination cohort and had menopausal age at the end of the seventh physical examination. A total of 3 749 women with 22 057 physical examination records were included in the analysis. Natural logarithmic transformation was applied to FPG, and a segmented linear mixed-effects model was used to analyze the changes in ln-transformed FPG before and after menopause. Additionally, an interaction analysis was performed to assess the multiplicative effect of baseline age and baseline body mass index(BMI)on ln-transformed FPG concerning pre- and post-menopausal periods.Results:The average age of the first physical examination for women in this study was (45.63±4.52)years, the median menopausal age was 51(50~53)years, and the median number of physical examinations was 6(5~7)times. The results of the piecewise linear mixed effect model showed that lnFPG increased from 1 year before menopause, with an average annual increase of 0.021 mmol/L, and continued to increase from menopause to 5 years after menopause, with an average annual increase of 0.007 mmol/L. LnFPG tended to be stable after 5 years of menopause. Baseline age could affect the changes of lnFPG before and after menopause, and there was a negative multiplicative interaction between baseline age ≥45 years and the time period from 6 years to 1 year before menopause( P=0.032). Women with baseline age ≥45 years had a higher average annual increase in lnFPG from 1 year before menopause to 5 years after menopause than women with baseline age <45 years( P<0.05). On lnFPG, there was a positive multiplicative interaction between baseline BMI and time segments around menopause. Compared to women with BMI <24.0 kg/m 2, obese women displayed more annual increase in lnFPG from 6 years to 1 year before menopause as well as from menopause to 5 years after menopause( P<0.05). Conclusions:Menopause has an adverse impact on FPG, with the most significant changes occurring within the period of one year before menopause and up to five years after menopause. Age and BMI significantly influence the changes in FPG before and after menopause.

Impact of Baseline Non-high-density Lipoprotein Cholesterol Level on New-onset Cardiovascular Disease Among Postmenopausal Women / 中国循环杂志

Objectives:To investigate the impact of baseline non-high-density lipoprotein cholesterol(non-HDL-C)levels on new-onset cardiovascular disease(CVD)in postmenopausal women. Methods:This prospective cohort study selected 8 893 postmenopausal women who participated from 2006 to 2018 employee health examination of Kailuan Group and had complete total cholesterol(TC)and HDL-C data and no history of CVD.Participants were followed up to 31 December,2021.The primary endpoint was the occurrence of CVD or death.According to the Chinese Lipid Management Guidelines(2023),the participants were divided into non-HDL-C<4.1 mmol/L group(n=6 079),4.1 mmol/L≤non-HDL-C<4.9 mmol/L group(n=1 824)and non-HDL-C≥4.9 mmol/L group(n=990).The cumulative incidence of CVD in different groups of non-HDL-C levels was calculated using the Kaplan-Meier method and tested by log-rank analysis.Multivariate Cox regression model was used to analyze the effects of different non-HDL-C levels on CVD. Results:The mean follow-up time was(10.78±4.48)years,the cumulative incidence of CVD in different non-HDL-C level groups was 1.82%,3.24%and 2.89%,respectively.Kaplan-Meier survival curve showed a statistically significant difference in cumulative incidence among the three groups(log-rank P<0.0001).The results of Cox regression analysis showed that after adjusting for confounding factors such as age and sex,the HR(95%CI)values for CVD in the 4.1≤non-HDL-C<4.9 mmol/L group and the non-HDL-C≥4.9 mmol/L group were 1.40(1.13-1.74)and 1.35(1.03-1.78),respectively. Conclusions:High non-HDL-C levels are an independent risk factor for new-onset CVD in postmenopausal women.

Impact of Resting Heart Rate on All-cause Mortality in Ultra-high Risk Atherosclerotic Cardiovascular Disease Patients / 中国循环杂志

Objectives:To investigate the impact of resting heart rate on the risk of all-cause mortality in ultra-high risk atherosclerotic cardiovascular disease(ASCVD)patients. Methods:A total of 3 645 patients with ultra-high risk ASCVD(as defined in the 2023 Chinese Lipid Management Guidelines)were screened from the 2006 to 2020 Kailuan Study cohort,and after excluding 602 patients with missing resting heart rate,3 043 patients were included in the final analysis.Patients were divided into＜68 beats/min group(n=744),68-74 beats/min group(n=786),75-80 beats/min group(n=760),and≥81 beats/min group(n=753)according to the resting heart rate.Cox proportional regression model was used to estimate the hazard ratios(HRs)and 95%CI for all-cause mortality associated with the different resting heart rate groups and every 10 beats/min increase of resting heart rate.The dose-effect relationship of resting heart rate level and all-cause mortality was assessed by a restricted cubic spline regression model.The Kaplan-Meier method was applied to calculate the cumulative all-cause mortality in different groups,and the differences were compared using log-rank test. Results:The median follow-up time was 5.81(3.46,9.64)years,there were 772(25.37%)all-cause deaths during follow up.After adjusting major confounding factors,the results showed that compared with＜68 beats/min group,the risk of all-cause mortality in 75-80 beats/min group and≥81 beats/min group increased by 24%(HR=1.24,95%CI:1.01-1.52,P=0.047)and 47%(HR=1.47,95%CI:1.20-1.81,P＜0.001),respectively;the risk of all-cause mortality in 68-74 beats/min group was similar(HR=1.06,95%CI:0.86-1.31,P=0.625).In addition,an increase of 10 beats/min in resting heart rate was associated with a 13%increase in the risk of all-cause mortality(HR=1.13,95%CI:1.07-1.19,P＜0.001).In stratified analyses,it was found that for every 10 beats/min increase in resting heart rate,women faced a higher risk of all-cause mortality than men,and patients＜65 years old faced a higher risk of all-cause mortality than patients≥65 years old.The restricted cubic spline analysis also showed that resting heart rate was linearly associated with the risk of all-cause mortality(Poverall＜0.001,Pnon-linear=0.933),and the risk increased significantly with resting heart rate＞70 beats/min. Conclusions:Increased resting heart rate is linearly associated with increased risk of all-cause mortality in patients with ultra-high risk ASCVD.The appropriate intervention cut-off point of resting heart rate for ultra-high risk ASCVD patients may be＞75 beats/min.

Influencing Factors of Inter-arm Systolic Blood Pressure Differences in Hypertensive Population Aged 40 Years and Younger / 中国循环杂志

Objectives:To explore the influencing factors of inter-arm systolic blood pressure difference(sIAD)in young hypertensive population. Methods:A total of 12 895 young Kailuan employees aged≤40 years,who participated in the physical examination from 2010 to 2020,were enrolled in this study.All of them underwent blood pressure measurements of four limbs in supine position.Young hypertensive group(n=3 584)and young non-hypertensive group(n=3 584)were 1∶1 matched by sex and age(±1 year),and participants were further divided into sIAD＜10 mmHg(1 mmHg=0.133 kPa)and sIAD≥10 mmHg subgroups.A stepwise multivariate logistic regression model was established to analyze the determinants of sIAD≥10 mmHg. Results:The detection rate of sIAD≥10 mmHg was significantly higher in the young hypertensive group than in the young non-hypertensive group(31.72%vs.27.76%,P＜0.001).Stepwise multivariate logistic regression analysis showed that in young hypertensive population,ankle-brachial index(ABI)＜0.9,male,obesity,overweight,elevated low density lipoprotein cholesterol(LDL-C)level,and systolic blood pressure were positively associated with sIAD≥10 mmHg,while college education or above,physical exercise were negatively correlated with sIAD≥10 mmHg(all P＜0.05).In the young non-hypertensive population,ABI＜0.9,systolic blood pressure were positively correlated with sIAD≥10 mmHg,while age was negatively associated with sIAD≥10 mmHg(all P＜0.05). Conclusions:The detection rate of sIAD≥10 mmHg is higher in young hypertensive population than in young non-hypertensive population.Decreased ABI,male sex,obesity,overweight,increased LDL-C level,systolic blood pressure,college education and above,and physical exercise are the influencing factors of sIAD≥10 mmHg in young hypertensive population.

Ideal cardiovascular health and mortality: pooled results of three prospective cohorts in Chinese adults / 中华医学杂志(英文版)

BACKGROUND@#Evidence on the relations of the American Heart Association's ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps.@*METHODS@#A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis.@*RESULTS@#During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed.@*CONCLUSIONS@#ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.

Severity of non-alcoholic fatty liver disease is a risk factor for developing hypertension from prehypertension / 中华医学杂志(英文版)

BACKGROUND@#There is little published evidence about the role of non-alcoholic fatty liver disease (NAFLD) in the progression from prehypertension to hypertension. This study was conducted to investigate the association of NAFLD and its severity with the risk of hypertension developing from prehypertension.@*METHODS@#The study cohort comprised 25,433 participants from the Kailuan study with prehypertension at baseline; those with excessive alcohol consumption and other liver diseases were excluded. NAFLD was diagnosed by ultrasonography and stratified as mild, moderate, or severe. Univariable and multivariable Cox proportional hazard regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident hypertension according to the presence and 3 categories of severity of NAFLD.@*RESULTS@#During a median of 12.6 years of follow-up, 10,638 participants progressed to hypertension from prehypertension. After adjusting for multiple risk factors, patients with prehypertension and NAFLD had a 15% higher risk of incident hypertension than those without NAFLD (HR = 1.15, 95% CI 1.10-1.21). Moreover, the severity of NAFLD was associated with the incidence of hypertension, which was higher in patients with more severe NAFLD (HR = 1.15 [95% CI 1.10-1.21] in the mild NAFLD group; HR = 1.15 [95% CI 1.07-1.24] in the moderate NAFLD group; and HR = 1.20 [95% CI 1.03-1.41] in the severe NAFLD group). Subgroup analysis indicated that age and baseline systolic blood pressure may modify this association.@*CONCLUSIONS@#NAFLD is an independent risk factor for hypertension in patients with prehypertension. The risk of incident hypertension increases with the severity of NAFLD.

Case-control study on fragility fractures in coal miners: A comparison between surface and underground workers / 环境与职业医学

Background The prevalence of osteoporosis and osteopenia is higher among underground coal miners than surface workers. The special underground work environment and unhealthy habits such as smoking, drinking, and a high-salt diet may lead to changes in bone metabolism, increasing the risk of fragility fractures and placing a heavy economic burden on individuals and society. Objective To identify potential factors influencing fragility fractures among coal miners in different working environments and to provide a basis for targeted preventive measures to reduce the occurrence of fragility fractures. Methods Male participants who attended at least one of the physical examinations in Kailuan Group between June 2006 and December 2020 were included in the study. The participants were divided into two groups based on their working environment: surface or underground. A case-control study was conducted, where patients with new fragility fractures served as the case group and participants without fragility fractures served as the control group. The two groups were matched with a case:control ratio of 1:4 by age (±1 year) and the same year of physical examination. The matching process was repeated twice, once for the surface working population and once for the underground working population. The analysis of risk factors was conducted using conditional logistic regression models. Results Among a total of 113138 employees in Kailuan Group, 82631 surface workers and 30507 underground workers were included, respectively. The number of individuals who suffered fragility fractures was 1375, accounting for 1.22% of the total population. The incidence of fragility fractures in underground workers was significantly higher than that in surface workers (1.63%>1.07%, P<0.001). The results of conditional logistic regression model showed that current smoking (OR=1.26, 95%CI: 1.05, 1.51), manual labor (OR=1.37, 95%CI: 1.06, 1.78), diabetes (OR=1.26, 95%CI: 1.04, 1.54), sinus tachycardia (OR=1.81, 95%CI: 1.23, 2.66), history of stroke (OR=1.51, 95%CI: 1.09, 2.09), education at college and above (OR=0.65, 95%CI: 0.45, 0.95), high income level (OR=0.69, 95%CI: 0.54, 0.90), elevated hemoglobin (OR=0.91, 95%CI: 0.85, 0.98), and elevated total cholesterol (OR=0.90, 95%CI: 0.82, 0.99) were associated with fragility fractures in the surface working population of coal mines; current smoking (OR=1.48, 95%CI: 1.17, 1.87), current drinking (OR=1.26, 95%CI: 1.01, 1.56), manual labor (OR=2.64, 95%CI: 1.41, 4.94), history of dust exposure (OR=1.28, 95%CI: 1.03, 1.58), and obesity (OR=0.72, 95%CI: 0.52, 0.96) were associated with fragility fractures in the underground working population of coal mines. Conclusion In preventing fragility fractures, special attention should be paid to the bone health of underground workers engaged in manual labor or having a history of dust exposure. It is important to correct their unhealthy behaviors in a timely manner, such as smoking and drinking, and to appropriately increase body weight to prevent fragility fractures. For surface workers, particular attention should be given to the high-risk group for fragility fractures, such as low family income per capita, manual labor, and having a history of stroke or diabetes; in addition, close monitoring of their resting heart rate, hemoglobin levels, and total cholesterol levels may help prevent fragility fractures.

Association Between Different Blood Pressure Levels at Baseline and Early-onset Heart Disease Among Young Population Under 40 Years Old / 中国循环杂志

Objectives:To explore the association between different blood pressure levels at baseline and early-onset heart disease among young adults under 40 years in China. Methods:This prospective cohort study included 35 993 subjects who participated in the physical examination of the employees of Kailuan Group for the first time from 2006 to 2012 and were younger than 40 years,with complete blood pressure data and had no history of heart disease.Participants were followed up to the end of 2021.The primary endpoint was early-onset heart disease(including coronary heart disease,atrial fibrillation,and heart failure).According to 2018 Chinese guidelines for the management of hypertension,the participants were divided into four groups:normal blood pressure group(n=13 208),elevated blood pressure group(n=16 576),stage 1 hypertension group(n=4 357),and stage 2-3 hypertension group(n=1 852).The cumulative incidence of heart disease among participants with different blood pressure levels at baseline was compared using log-rank test.Multivariate Cox proportional hazard regression model was used to analyze the impact of different blood pressure levels at baseline on early-onset heart disease in this cohort. Results:After a mean follow-up of(12.5±2.6)years,the cumulative incidence of early-onset heart disease in normal blood pressure group,elevated blood pressure group,stage 1 hypertension group,stage 2-3 hypertension group were 0.47%,0.97%,3.56%and 4.42%respectively(log-rank P<0.01).After adjusting for confounding factors such as age and sex,Cox regression analysis showed that the HR(95%CI)of heart disease in the elevated blood pressure group,hypertension grade 1 group and hypertension grade 2-3 group were 1.59(1.12-2.24),2.08(1.41-3.08)and 3.20(2.11-4.85)(all P<0.01),respectively,compared with the normal blood pressure group. Conclusions:Elevated blood pressure is a risk factor for early-onset heart disease among young Chinese population.

The relationship between cumulative fasting blood glucose exposure and all-cause mortality / 中华内分泌代谢杂志

Objective:To investigate the relationship between cumulative fasting blood glucose(cumFPG)exposure and all-cause mortality.Methods:The prospective cohort study included 56 845 subjects of Kailuan Group who participated in physical examinations from 2006 to 2007, 2008 to 2009, and 2010 to 2011 with complete data and a median of 7.77 years of follow up. The end point event was all-cause mortality. The incidence of all-cause mortality was compared in various groups divided by four quartile of cumFPG. The Cox proportional hazards model and natural spline were used to analyze the effect of cumFPG on all-cause mortality.Results:During the average(7.77±1.05)years of follow-up, the incidence density of all-cause mortality was on the rise with the increase of cumFPG(4.93, 5.87, 8.48, and 14.02 per 1 000 person-years), with statistically significant difference by Log- rank test( P<0.001). Cox proportional hazards model showed that after adjusting for potential confounding factors(age, sex, body mass index, hypertension, baseline fasting plasma glucose), the HR value(95% CI)of all-cause mortality in the fourth quartile group was 1.28(1.15-1.42)compared to the first quartile. When cumFPG increased every standard deviation, the risk of all-cause mortality increased by 17%. Natural spline analysis exhibited a similar J curve relationship between cumFPG and all-cause mortality. Conclusion:High cumFPG is a risk factor of all-cause mortality.

Effects of pre- and post-diagnosis of malignant neoplasms total cholesterol difference on all-cause death in the Kailuan study population / 肿瘤研究与临床

Objective:To explore the effects of pre- and post-diagnosis of malignant neoplasms total cholesterol difference on all-cause death in the Kailuan study population.Methods:A prospective cohort study method was used to observe on the job and retired workers who were diagnosed with malignant neoplasms during the healthy physical examination and had the complete data of total cholesterol pre- and post-diagnosis of malignant neoplasms at Kailuan (Group) Limited Liability Corporation from June 2006 to December 2015. Medical insurance system and medical records case management system of Kailuan General Hospital were used to retrieve the confirmed diagnosis time of participants with malignant neoplasms. SAS 9.4 software was used to extract the physical examination data of participants diagnosed as malignant neoplasms before and after 2 years. The whole participants were divided into 4 groups according to the quartile of the total cholesterol difference pre- and post-diagnosis of cancer. The first quartile group: the total cholesterol difference <-0.93 mmol/L (823 cases), the second quartile group: the total cholesterol difference≥-0.93 mmol/L and <-0.21 mmol/L (811 cases), the third quartile group: the total cholesterol difference≥-0.21 mmol/L and <0.49 mmol/L (832 cases), the forth quartile group: the total cholesterol difference≥0.49 mmol/L (833 cases). The incidence density was used to calculate the mortality of different total cholesterol difference quartile groups, and the Cox proportional hazards model was used to analyze the influencing factors of all-cause death of all quartile groups.Results:Totally, 1 564 cases had all-cause death during median 2.46 years of follow-up time. There were 481, 440, 333, 310 death cases respectively of 4 quartile groups. The death rates of all quartile groups were 230.10/1 000 person-years, 163.90/1 000 person-years, 115.34/1 000 person-years, and 83.44/1 000 person-years respectively ( χ2 = 604.62, P < 0.001). After adjusting for confounding factors, the Cox proportional hazards model analysis showed that compared with the first quartile group, the hazard ratio with the 95% confidence interval of all-cause death in the second, third, and fourth quartile groups was 0.86 (0.76-0.98), 0.62(0.54-0.72) and 0.58 (0.50-0.67) respectively (all Ptrend < 0.001). After adjusting for confounding factors of patients with cancer in different location, the forth quartile group except for cancer in thyroid, breast, prostate, testis and urinary system, all Ptrend was less than 0.05 compared with that of the first quartile group. Conclusion:Among Kailuan study population, the smaller decline or even rise in total cholesterol level of post-diagnosis compared with that of pre-diagnosis is a protective factor of all-cause death.

Relationship of hyperuricemia with all-cause mortality in patients with atrial fibrillation / 中国综合临床

Objective:To explore whether hyperuricemia was an independent risk factor for all-cause mortality in patients with atrial fibrillation.Methods:Patients with atrial fibrillation who were confirmed by 12-lead electrocardiogram in 11 hospitals of Kailuan Group from 2006 to 2007 were selected as the research objects.All patients were followed up by prospective cohort study, and all-cause deaths were observed.The last follow-up time was December 31, 2013.Kaplan-Meier curve and Cox proportional hazards model were used to analyze and compare the risk of all-cause mortality in patients with atrial fibrillation in the hyperuricemia group compared with the normal uric acid group.Results:A total of 388 community-based patients with atrial fibrillation were included in the final statistical analysis, with 136 all-cause deaths occurred during an average follow-up period of 6.93 years.The incidence of all-cause mortality was 9.24% per year(36/390)in the hyperuricemia group, whereas 5.16% per year(100/1 937) in the normal uric acid group.In the univariate Cox proportional risk model analysis, the risk ratio (95% CI) of all-cause death in patients with atrial fibrillation in the hyperuricemia group (95% CI) was 1.84(1.26-2.69) times that in the normal uric acid group ( P<0.01). After adjusting for potential confounding variables, the adjusted risk ratio (95% CI) of all-cause death in patients with atrial fibrillation in hyperuricemia group was still 1.94(1.32-2.85) times of that in normal uric acid group ( P<0.01). After adjustment for potential confounding variables, for each 0.01 g/L increase in uric acid (1 g/L=5 950 μmol/L), the risk of all-cause death in patients with atrial fibrillation increased by 1.15 (1.05-1.26) times ( P<0.01). Conclusion:Hyperuricemia was an independent risk factor for all-cause death in patients with atrial fibrillation in community.

Correlation between serum high sensitivity C-reactive protein and carotid intima-media thickness / 中国综合临床

Objective:To investigate the correlation between serum high sensitivity C-reactive protein and carotid intima-media thickness.Methods:A total of 5 136 health examination subjects, aged ≥40 years old, who met the inclusion criteria and had complete data, were selected as the research objects.A unified questionnaire survey, blood biochemistry and carotid artery color doppler ultrasound examination were performed.According to the diagnostic criteria of hs-CRP published by American Heart Association (AHA), the subjects were divided into three groups: 0.05 mg/L<hs-CRP<1.00 mg/L, 1.00 mg/L≤ hs-CRP<3.00 mg/L, and hs-CRP≥ 3.00-10.00 mg/L.Stepwise linear regression, χ 2 trend test and stepwise regression analysis were used to explore the correlation between hs-CRP and CIMT. Results:(1)Five thousand one hundred and thirty-six patients were enrolled, including 3 048 males and 2 088 females, aged (54.87±11.65) years.(2) Taking CIMT as the dependent variable and hs-CRP (converted by Lg)as the independent variable, the stepwise linear regression analysis using the entry method showed that there was a linear correlation between hs-CRP and CIMT, and the standard regression coefficient was 1.107( P<0.01). (3) According to this study, CIMT was divided into two groups, CIMT≤ 0.84 mm group and CIMT>0.84 mm group.The results showed that when the concentration of hs-CRP was high, CIMT increased with the increase of hs-CRP( OR(95% CI) 1.24 (1.01~1.52), P<0.05). Conclusion:There was a positive correlation between hs-CRP and CIMT.Patients with higher levels of hs-CRP are more likely to develop CIMT thickening and increase the risk of arteriosclerotic disease.

Association between pulse pressure and new-onset diabetes in overweight and obese people / 中华内分泌代谢杂志

Objective:To investigate the association between pulse pressure(PP) and new-onset diabetes in overweight and obese people.Methods:A prospective cohort study was conducted in overweight or obese participants selected from Kailuan Study who underwent 2006-2007 annual checkup and met the inclusion and exclusion criteria. PP was calculated by blood pressure and participants were divided into 4 groups according to PP quartile. The cumulative incidence of new-onset diabetes of different PP groups was calculated by Kaplan- Meier method and compare by Log- Rank test. The multivariate Cox proportional hazards model was used to analyze the association between different PP groups and new-onset diabetes. Results:During an average follow-up of 8.45 years, 8 922 diabetes was identified. The cumulative incidence rate of the Q1, Q2, Q3, and Q4 groups were 22.12%, 24.48%, 27.97%, and 33.44% respectively, which were statistically different( χ2=368.16, P<0.01). Cox proportional hazards regression analysis showed that after adjusting for multiple confounding factors, compared with Q1 group, the hazard ratio for diabetes in Q2, Q3, and Q4 groups were 1.07(1.00-1.14), 1.13(1.05-1.21), and 1.17(1.09-1.27) respectively. And the HR of diabetes event in pulse pressure(per 1 SD increase) was 1.04(1.02-1.07). Similar results were found in participants who were over-weight, obese, with normal blood pressure or hypertensive without drugs use. Conclusion:PP is positively correlated with the new-onset diabetes. High PP is one of the risk factors for developing diabetes in overweight and obese people.

Impact of change of ideal cardiovascular behavior and related factors on healthy vascular aging / 中华心血管病杂志

Objective@#To investigate the impact of change of ideal cardiovascular behavior and related factors on healthy vascular aging(HVA).@*Methods@#This study was a multi-center cross-sectional survey. Six thousand three hundred and sixteen participants who underwent at least 2 healthy examinations from 2006 to 2015 at 11 hospitals, including Kailuan Hospital and so on, and examined brachial-ankle pulse wave velocity (baPWV) during 2010 and 2016, with available information about cardiovascular behavior and factors were included. The cardiovascular health score (CHS) was calculated. Basic CHS was collected from the first examination. The second CHS derived from the healthy examination in the same year of baPWV examination. Change of cardiovascular health score (ΔCHS) was calculated. Participants were defined into 5 groups according to ΔCHS, namely ΔCHS≤-2 (n=2 166), ΔCHS=-1 (n=1 284), ΔCHS=0 (n=1 187), ΔCHS=1 (n=860), and ΔCHS≥2 (n=819). Participants′ characteristics, value of baPWV and proportion of HVA were compared among different groups. Multiple logistic regression analysis was used to investigate the association between ΔCHS and HVA. The ΔCHS was recalculated and included in multiple logistic regression analysis model again after each component of the cardiovascular health metrics was removed separately in order to investigate effects of removal factors on HVA by observing changes in effect values.@*Results@#The percentage of the participants with HVA in the group of ΔCHS≤-2, ΔCHS=-1, ΔCHS=0, ΔCHS=1 and ΔCHS≥2 were 23.3%(505/2 166), 27.8%(357/1 284), 28.7%(341/1 187),31.9%(274/860) and 33.9%(278/819), respectively. After adjustment for age, sex, income, education, alcohol consumption and the basic CHS, a significant positive association between ΔCHS and proportion of participants with HVA was observed (OR=1.50, 95%CI 1.44-1.56). Multiple regression analysis after removing each single cardiovascular behavior or factor showed that the OR value decreased as follow systolic blood pressure (OR=1.04, 95%CI 1.00-1.09), fasting blood glucose (OR=1.14, 95%CI 1.09-1.18), physical exercise (OR=1.16, 95%CI 1.11-1.21), salt intake (OR=1.17, 95%CI 1.12-1.22), body mass index (OR=1.18, 95%CI 1.13-1.23), smoking(OR=1.18, 95%CI 1.13-1.23) and total cholesterol (OR=1.20, 95%CI 1.16-1.24).@*Conclusion@#The improvement of every ideal cardiovascular behavior and factor is associated with the increase of the proportion of HVA population.

Study on the health literacy and related factors of the cancer prevention consciousness among urban residents in China from 2015 to 2017 / 中华预防医学杂志

Objective@#To understand the health literacy and relevant factors of cancer prevention consciousness in Chinese urban residents from 2015 to 2017.@*Methods@#A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The self-designed questionnaire was used to collect the information of demographic characteristics and cancer prevention consciousness focusing on nine common risk factors, including smoking, alcohol, fiber food, food in hot temperature or pickled food, chewing betel nut, helicobacter pylori, moldy food, hepatitis B infection, estrogen, and exercise. The logistic regression model was adopted to identify the influencing factors.@*Results@#The overall health literacy of the cancer prevention consciousness was 77.4% (24 980 participants), with 77.4% (12 018 participants), 79.9% (6 406 participants), 77.2% (1 766 participants) and 74.5% (4 709 participants) in each group (P<0.001). The correct response rates for nine risk factors ranged from 55.2% to 93.0%. The multivariate logistic regression analysis showed that compared with community residents, people with primary school level education or below, and the number of people living together in the family <3, the cancer risk assessment/screening intervention population, cancer patients, those with junior high school level educationor above and the number of people living in the family ≥3 had better health literacy of the cancer prevention consciousness (all P values <0.05). Compared with females, 39 years old and below, government-affiliated institutions or civil servants, from the eastern region, males, older than 40 years, company or enterprise employees, and from the middle or western region had worse health literacy of the cancer prevention consciousness (all P values <0.05).@*Conclusion@#The health literacy of the cancer prevention consciousness in Chinese urban residents should be improved. The cancer screening intervention, gender, age, education, occupation, the number of people co-living in the family, and residential region were associated with the health literacy of the cancer prevention consciousness.

Analysis on the consciousness of the cancer early detection and its influencing factors among urban residents in China from 2015 to 2017 / 中华预防医学杂志

Objective@#To understand the consciousness of the cancer early detection among urban residents and identify the influencing factors from 2015 to 2017.@*Methods@#A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. Self-designed questionnaires were used to collect population, socioeconomic indicators, self-cancer risk assessment, regular participation in physical examination and other information. The multivariate logistic regression model was used to identify the factors of people who had not regularly participated in the regular physical examination in the past five years.@*Results@#The self-assessment results of 32 357 residents showed that there were 27.54% (8 882) of total study population with self-reported cancer risk, 45.48% (14 671) without cancer risk and 26.98% (8 704) with unclear judgement on their own cancer risk. Among population with cancer risk, 79.84% (7 091) considered physical examination accounted. In the past five years, there were 21 105 (65.43%) residents participated in regular physical examination and 11 148 (34.56%) participated in non-scheduled one, respectively. The multivariate logistic regression analysis showed that compared with unmarried and western region residents, divorced, middle and eastern region residents had a stronger consciousness to participate in the regular physical examination (P<0.05). Compare with residents with annual household income less than 20 000 CNY in 2014, cancer risk assessment/screening intervention population, and self-assessment with cancer risk, residents with annual household income between 20 000 CNY and 59 000 CNY in 2014, occupational population, community residents, cancer patients, self-reported cancer-free risk, and self-assessment with unclear judgement of cancer risk were less likely to participate in the regular physical examination (all P values <0.05).@*Conclusion@#From 2015 to 2017, the Chinese urban residents had a acceptable consciousness of the cancer early detection. The marital status, annual household income, population group and self-assessment of cancer risk were related to the consciousness of the cancer early detection of people who had not participated in the regular physical examination in the past five years.

Analysis on the consciousness of the early cancer diagnosis and its related factors among urban residents in China from 2015 to 2017 / 中华预防医学杂志

Objective@#To understand the consciousness of the cancer early diagnosis among urban residents and identify the related factors from 2015 to 2017.@*Methods@#A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The general demographic characteristics, the consciousness of the cancer early diagnosis (whether people would have a willingness or encourage their relatives/friends to confirm the abnormal results once which were detected from the physical examination) and other information were collected by using the self-designed questionnaire. The non-conditional logistic regression model was used to identify the relateol factors related to the consciousness of the cancer early diagnosis.@*Results@#As for residents with abnormal result from the physical examination, 89.29% (28 802) of residents would choose to seek medical treatment for further diagnosis. If their relatives/friends had abnormal results from the physical examination, 89.55% (28 886) of residents would encourage their relatives/friends to confirm the diagnosis in time. The non-conditional logistic regression model analysis showed that compared with the public institution staff/civil servants, annual household income less than 20 000 CNY, the western region and the cancer risk assessment/screening intervention population, the company staff, annual household income about 40 000 CNY and more, and the residents from the middle and eastern region had a stronger consciousness to seek further diagnosis; while the unemployed residents and community residents were less likely to seek further diagnosis (P<0.05).@*Conclusions@#From 2015 to 2017, the Chinese urban residents had a good consciousness of the cancer early diagnosis. Occupation, annual household income, residential region and population group were related to the consciousness of the cancer early diagnosis.

Analysis on the consciousness of the early cancer treatment and its influencing factors among urban residents in China from 2015 to 2017 / 中华预防医学杂志

Objective@#To understand the consciousness of the cancer early treatment and its demographic and socioeconomic factors.@*Methods@#A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China (CanSPUC) from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The questionnaire collected personal information, the consciousness of the cancer early treatment and relevant factors. The Chi square test was used to compare the difference between the consciousness of the cancer early treatment and relevant factors among the four groups. The logistic regression model was used to analyze the influencing factors related to the consciousness of the cancer early treatment.@*Results@#With the assumption of being diagnosed as precancer or cancer, 89.97% of community residents, 91.84% of cancer risk assessment/screening population, 93.00% of cancer patients and 91.52% of occupational population would accept active treatments (P<0.001). If the immediate family members were diagnosed as precancer or cancer, people who would encourage their family members to receive early treatment in the four groups accounted for 91.96%, 91.94%, 92.44% and 91.55%, respectively (P<0.001). The company employees, annual household income with 40 000 yuan and more and other three groups had a relatively better consciousness of the cancer early treatment (P<0.05). Male, widowed, unemployed and from the central and western regions had a relatively worse consciousness of the cancer early treatment (P<0.05).@*Conclusion@#Residents in urban China participants had a good consciousness of the cancer early treatment. The marital status, occupation, annual household income and residential regions were major factors related to the consciousness of the cancer early treatment.

Analysis on the health literacy of the cancer prevention and treatment and its related factors among urban residents in China from 2015 to 2017 / 中华预防医学杂志

Objective@#To understand the health literacy of the cancer prevention and treatment among urban residents of China, and explore the related factors.@*Methods@#A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China (CanSPUC) from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The health literacy of the cancer prevention, early discovery, early diagnosis, early treatment and the demands of cancer prevention and treatment knowledge was analyzed. The level of health literacy among different groups were calculated and compared. The binary logistic regression model was used to analyze the influencing factors of the health literacy of the cancer prevention and treatment.@*Results@#The level of health literacy of the cancer prevention and treatment was 56.97% among all study population; in each group it was 55.01% for community residents, 59.08% for cancer risk assessment/screening population, 61.99% for cancer patients and 57.31% for occupational population, respectively (P<0.001). The level of health literacy of the cancer prevention and treatment of residents aged 50 to 69 years old, other occupational groups, unmarried, the central and western region residents and the group with unclear self-assessment of cancer risk was significantly lower than that of residents younger than 40 years old, personnel of public institutions/civil servants, married, the eastern region residents and the group whose self-assessment without cancer risk (P<0.05) . The level of health literacy of cancer prevention and treatment of females, people who went to high school or over, cancer risk assessment/screening population, cancer patients and occupational population was significantly higher than that of males, people who had an education level of primary school or below and community residents (P<0.05) .@*Conclusion@#The health literacy of the cancer prevention and treatment of urban residents in China was relatively high, but there was still room for improvement. Gender, age, educational level, occupation, region, marital status, self-assessment of cancer risk, and type of respondents were the key influencing factors of the health literacy of the cancer prevention and treatment. Male, 50-69 years old, lower educational level, central and western regions, unclear cancer risk self-assessment, and without specific environmental exposure to cancer prevention and treatment knowledge or related risk factors were the characteristics of the key intervention group of the health literacy of the cancer prevention and treatment.