Outline of the report on cardiovascular disease in China, 2010.

Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens.

[Association of C602A and T1559C polymorphisms of E-selectin gene and essential hypertension].

OBJECTIVE: To investigate the possible genetic associations between the C602A and T1559C polymorphisms of E-selectin (SELE) and essential hypertension. METHODS: Essential hypertensive patients (n = 500) and healthy normotensive subjects (n = 930) were screened for the genotypes C602A and T1559C by real-time quantitative polymerase chain reaction after DNA extraction to identify representative variations in the SELE gene. RESULTS: Normotensive subjects and hypertensive patients were significantly different with respect to the genotypes CC, CA and AA, 26 (5.2%), 20 (4.0%) and 454 (90.8%) vs 14 (1.5%), 53 (5.7%) and 863 (92.8%) respectively of C602A. And the C-allele frequency was also significantly different between the NT and EH groups (C, A = 7.2%, 92.8% vs 4.4%, 95.6%). When subgrouped by gender, frequency of CC, CA, AA between normotensive and essential hypertensive males was 14 (4.7%), 11 (3.7%), 272 (91.6%) and 10 (1.7%), 34 (5.8%), 545 (92.5%), which differed significantly (P < 0.05), while in female groups, all the frequency of genotypes were significantly different (P < 0.01) except CC + CA. The additive model (TT, TC, CC) of the T1559C genotype was significantly different between essential hypertensive and normotensive groups overall, 57 (11.4%), 200 (40.0%), 43 (48.6%) and 66 (7.1%), 354 (38.1%), 510 (54.8%), respectively. The T-allele of hypertensive patients significantly differed from normotensive subjects (T, C = 31.4%, 68.6% vs 26.1%, 73.9% respectively). When subgrouped by gender, between the male NT and EH groups, the TT, TC and CC frequency of T1559C were 36 (5.9%), 117 (39.4%), 144 (48.5%) and 35 (5.9%), 230 (39.0%), 354 (55.0%), and the frequency of T vs C was 31.4% vs 68.6% and 26.1% vs 73.9%, which were significantly different (all P < 0.01). As in female NT and EH groups, there were not significant differences existed at all. CONCLUSION: C602A and T1559C of SELE are associated with essential hypertension in the Chinese population, and T1559C is closely related with male hypertension other than in females.

[Relationship between serum non-high-density lipoprotein cholesterol and incidence of cardiovascular disease].

OBJECTIVE: To evaluate the relationship between serum non-HDL-C and incidence of various cardiovascular disease (CVD) in Chinese population aged 35-64 years. METHODS: This prospective study was performed from 1992 to 2004 in 11 provinces of China and the association between baseline non-HDL-C level with the risk of various CVD events was analyzed in 29 937 subjects aged 35-64 years using Cox multivariate proportional hazards regression. CVD events in this study including acute coronary events (ACE), ischemic stroke, hemorrhagic stroke and ischemic cardiovascular disease (ICVD). RESULTS: (1) Adjusted for age, gender, smoking status, diabetes, body mass index and blood pressure, the relative risk of ACE, ischemic stroke and ICVD in groups of non-HDL-C 3.37 - 4.13 mmol/L (130 - 159 mg/dl), 4.14 - 4.91 mmol/L (160 - 189 mg/dl) and ≥ 4.92 mmol/L (190 mg/dl) was 1.24 (0.91 - 1.70), 1.78 (1.25 - 2.53), 2.23 (1.48 - 3.35); 1.34 (1.07 - 1.68), 1.38 (1.04 - 1.83), 1.38 (0.97 - 1.94) and 1.37 (1.12 - 1.63), 1.52 (1.22 - 1.90), 1.70 (1.30 - 2.22), respectively. The risk of hemorrhagic stroke was declined obviously in group > 4.92 mmol/L (190 mg/dl). (2) The correlation between VLDL-C and ACE was the strongest in four CVD events when VLDL-C and LDL-C were joint analyzed, ICVD events ranked the second. The risk for ischemic stroke also borderline increased with increasing VLDL-C and LDL-C (P > 0.05). CONCLUSION: Increased non-HDL-C is associated with increased risk of suffering ACE, ischemic stroke and ICVD and VLDL-C plays a critical role in the development of ICVD events, especially ACS, in middle aged Chinese population.

[Plasma proteomic analysis in male normotensive, prehypertensive and hypertensive subjects].

OBJECTIVE: To compare the plasma proteome among male normotensive, prehypertensive, and hypertensive subjects. METHODS: Plasma proteome was analyzed by two-dimensional electrophoresis combined with MALDI-TOF mass spectrometry in this case-control study among well matched male normotensive, prehypertensive and hypertensive subjects (n = 26 each). RESULTS: The results showed that there were 22 differentially expressed protein spots among the protein samples derived from the 3 groups which corresponded to 18 proteins associated with inflammation and immunity, lipid metabolism, transport, coagulation and fibrinolysis, cell proliferation and apoptosis, and antioxidation. CONCLUSION: Proteins were differentially expressed in male subjects with various blood pressure levels.

[Association between plasma fibrinogen concentration and ten-year change in blood pressure].

OBJECTIVE: To explore the association between plasma fibrinogen (FIB) concentration and ten-year change in blood pressure in Chinese population aged 35 - 64. METHODS: A prospective cohort comprising 2683 subjects was established in Beijing in 1992. Blood pressure (BP) and other traditional cardiovascular risk factors were assessed in 1992 and 2002 respectively, and plasma FIB concentration was measured in 1992. The association of plasma FIB with ten-year change in blood pressure was analyzed. RESULTS: (1) The median concentration of FIB among this population was 3.8 g/L (3.2 - 4.3 g/L), and the percentage of the people with abnormal FIB concentration (FIB > 4.0 g/L) was 33.4% in 1992. The FIB concentration of the females was higher than that of the males (P < 0.01) and the FIB concentration of the hypertensive subjects was significantly higher than that of the non-hypertensive subjects (P < 0.05), however, there was no significant difference in the abnormal FIB rate among different age groups. (2) Compared with the BP levels in 1992, the systolic BP and diastolic BP of this population increased by 10.0 mm Hg and 5.0 mm Hg respectively in 2002. The partial correlation coefficients of baseline FIB concentration with ten-year difference for systolic and diastolic BP were 0.125 (P < 0.01) and 0.047 (P < 0.05) respectively, and the absolute value of 10-year increase of systolic pressure in the subjects with abnormal FIB was significantly higher than that in those with normal FIB (P < 0.01). (3) The BP grade 2002 was higher than the baseline grade in 1992 in 49.6% of the study population. The BP grade increase rate of the subjects with abnormal FIB was 55.3%, significantly higher than that of the subjects with normal FIB (46.8%, P < 0.05). (4) In the population without baseline hypertension the risk of BP grade increase within 10 years in those with abnormal FIB was 1.46 times the risk in those with normal FIB, the multivariable OR (95% CI) was 1.457 (1.201 - 1.768) for those with normal BP and 2.082 (1.422 - 3.048) for those with hypertension. CONCLUSION: Plasma FIB concentration is associated with the BP change. Improvement of high coagulation and high adhesion help control BP, especially in people with hypertension.

[The association between white blood cell count and 10-year cardiovascular risk in a large Chinese cohort aged 35-64 years].

OBJECTIVE: To evaluate the association between white blood cell count and the risk of cardiovascular diseases (CVD) in subjects aged 35 - 64 years. METHODS: This prospective study was carried out in 11 provinces from 1992 to 2003. The association of baseline white blood cell count and cardiovascular disease occurrence was analyzed in 30 384 subjects aged 35 - 64 years using Cox multivariate proportional hazards regression. RESULTS: (1) Compared with the group of 4.0 - 4.9 x 10(9)/L, multivariate-adjusted relative risk of ischemic cardiovascular disease (ICVD, including coronary heart disease and ischemic stroke) increased continuously in proportion to increased white blood cell count. (2) White blood cell count had different impact on different types of CVD. Positive association was observed between white blood cell count and the risk of ischemic stroke, but the relationship between white blood cell count and the risk of hemorrhagic stroke was not significant. Compared with the referent group (4.0 - 4.9 x 10(9)/L), the risk of coronary heart disease of the group of white blood count > 9.0 x 10(9)/L increased by 70% (RR = 1.71, P < 0.05) and that of ischemic stroke increased by 80% (RR = 1.85, P < 0.01). CONCLUSION: The risk of ICVD and CVD increases continuously in proportion to increased white blood cell count, the white blood cell count might be used to predict future risk of CVD, especially risk for ICVD.

[Predictive value of combined measurements of body mass index and waist circumference for the risk of cardiovascular disease].

OBJECTIVE: To evaluate the predictive value of the combined measurements of body mass index (BMI) and waist circumference (WC) for the risk of cardiometabolic diseases (including diabetes, hypertension, and dyslipidemia) and ischemic cardiovascular disease. METHOD: A total of 30,378 Chinese people from 11 provinces were studied in this prospective study conducted from 1992 to 2003. Multivariable logistic and Cox regression were used respectively to determine the predictive value of WC for cardiometabolic diseases and ischemic cardiovascular disease within each BMI categories. RESULTS: (1) The prevalence of obesity were 10% defined by BMI. Among them, 76.4% had abdominal obesity defined by WC. The prevalence of abdominal obesity was 17.5% by WC categories, and 43.4% of them were classified as obesity by BMI. (2) The prevalence rates of cardiometabolic diseases were higher in individuals with elevated WC within each BMI category. (3) Compared with subjects with normal BMI and WC, the risk of ischemic cardiovascular disease increased by 38% (RR = 1.383, 95% CI 1.083 - 1.765) in overweight subjects with elevated WC and by 57% (RR = 1.570, 95% CI 1.226 - 2.010) in obese subjects with elevated WC. CONCLUSION: Combined measurements of BMI and WC provide a better prediction for the risk of cardiometabolic diseases and ischemic cardiovascular disease.

[Serum triglyceride is an independent risk factor for acute coronary heart disease events in 35 - 64 years old Chinese-Chinese Multi-provincial Cohort Study.].

OBJECTIVE: To evaluate the association between serum triglyceride (TG) and the cardiovascular diseases (CVD) risk in Chinese population. METHODS: A total of 30, 378 men and women aged 35 - 64 years old were recruited in the Chinese-Chinese Multi-provincial Cohort Study (CMCS). The serum TG and other CVD risk factors were measured. All subjects were followed up annually or biannually for acute CVD events from 1992 to 2004. A Cox regression model was established to identify the association between TG and risk of CVD events. RESULTS: The accumulative incidence rate of acute coronary heart disease (CHD) events increased from 62.6/100 000 in the low TG groups to 168.4/100 000 in the high TG group divided by the quartile. TG was identified as an independent risk factor for CHD after adjustment for the confounding risk factors by a Cox regression model. Compared subjects with TG < 0.81 mmol/L, CHD risk increased 81% and 59% in subjects with TG 1.15 - 1.59 mmol/L and TG >/= 1.60 mmol/L, respectively (all P < 0.05). There was no significant association between TG level and the risks of hemorrhagic and ischemic stroke events (P > 0.05). CONCLUSION: Serum TG is an independent risk factor for acute CHD events in Chinese population aged 35 - 64.

[Impact of new criterion of glucose level on the prevalence of impaired fasting glucose and risk of ischemic cardiovascular diseases].

OBJECTIVE: To evaluate the effect of lowering the fasting plasma glucose (FPG) cutoff point for the criterion of impaired fasting glucose (IFG) in the 2003 ADA guideline on the prevalence of IFG and risk of ischemic cardiovascular diseases (ICVD) associated with IFG in Chinese population. METHOD: A prospective study was carried out in 11 provinces from 1992 to 2003. The baseline survey was conducted according to the WHO-MONICA protocol for risk factor surveys. These subjects have been followed-up for coronary heart disease (CHD) and stroke since the baseline survey. The association between baseline FPG and ICVD (CHD and ischemic stroke) events in 30 378 subjects aged 35 - 64 years in the 10-year follow-up period was analyzed. RESULTS: (1) Lowering the criterion for diagnosing IFG to 5.55 mmol/L increased the prevalence of IFG from 6.9% to 21.6% in Chinese population aged 35 - 64 years. (2) As compared with the group of FPG less than 5.55 mmol/L, the prevalence of other traditional CVD risk factors increased in the FPG level of 5.55 - 6.05, 6.11 - 6.94 and 6.99 mmol/L or above. (3) Univariate analysis method showed that the 10-year accumulated incidence and relative risk for ICVD increased with the elevated baseline level of FPG. (4) After adjusting for age and other ICVD risk factors (including hypertension, lipid disorder, smoking and obesity) FPG level of 5.55 - 6.05 mmol/L showed an independently predictive value for ICVD in men (RR = 1.302, 95% CI = 1.021 - 1.660), but not in women (RR = 1.255, 95% CI = 0.887 - 1.776). Hypertension, low HDL-C, smoking (men) and central obesity (women) were more strongly associated with ICVD than glucose status. CONCLUSIONS: The newly defined IFG criterion (FPG 5.55 - 6.94 mmol/L) increased the prevalence of IFG by more than 2 times in Chinese population aged 35 - 64 years. The 10-year accumulated incidence and relative risk for ICVD increased with the elevated baseline level of FPG. The predictive value of hyperglycemia for ICVD was weaker than that of other traditional risk factors. Comprehensive intervention for multiple risk factors clustering should be strengthened to reduce the overall risk of CVD.

[Relationship between metabolic syndrome and 10-year risk for incident type 2 diabetes mellitus].

OBJECTIVE: To analyze the relationship of metabolic syndrome (MS) and its components at baseline to the 10-year incidence of diabetes mellitus. METHODS: An investigation on cardiovascular disease (CVD) risk factors, including questionnaire survey, physical examination, and laboratory examination, was carried out in the populations of 4154 subjects, aged 35 approximately 64, in 2 communities (Peking University and Capital Iron and Steel Company area) collected by cluster sampling in the year 1992, with a response rate of 82.0%, so as to obtain baseline data. In 2002 a follow-up survey was conducted among these same populations, aged 45 approximately 74 then with a response rate of 70.0%. Complete data were obtained from 2740 subjects during the 2 investigations. The data of 2659 subjects who were diagnosed as without diabetes mellitus type 2 (T2DM) during the baseline survey, 1177 males (44.3%) and 1482 females (55.7%), were analyzed. RESULTS: (1) 112 patients with T2DM were discovered during the follow-up survey with an incidence of 4.2%, the incidence being 5.0% in males and 3.6% in females. (2) The proportions of those with different MS components were higher among the T2DM patients than those without T2DM. The proportion of baseline high fasting glucose was 71.43% among those who were diagnosed as with T2DM during the follow-up survey. Of the MS components high fasting glucose had the highest proportion among the T2DM patients. (3) Adjusted for age and sex, the results using a logistic regression model showed that abdominal obesity, triglycerides and fasting glucose were the independent factors associated with T2DM in addition of blood pressure and HDL cholesterol. Among them, fasting glucose contributed mostly to T2DM with a relative risk (RR) of 7.14 (4.62, 11.03). (4) Compared with those without both MS and high fasting glucose, the relative risk of T2DM for persons with MS but without high fasting glucose was 2.91 times that for those without MS and with normal fasting glucose. CONCLUSION: MS is an independent indicator for incidence of T2DM. Among the MS components, high fasting glucose contributes mostly to T2DM; however, the prediction of MS for T2DM cannot be entirely explained by high fasting glucose. Those without high fasting glucose but with MS should take early intervention measures to prevent the incidence of T2DM.

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

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

[Increased plasma vasoactive substances and antioxidant enzymes levels in prehypertensive patients].

OBJECTIVE: This study investigates the plasma vasoactive substances and antioxidant enzymes levels in prehypertensive patients. METHODS: Patients were scruited according to JNC-7 and divided into three groups: 74 normotensive subjects (NT group, 38 males, mean age 47.15 +/- 7.77 years old); 51 prehypertensive patients (PH group, 29 males, mean age 47.82 +/- 5.16 years old) and 71 essential hypertensive patients (EH group, 37 males, mean age 48.25 +/- 7.97 years old). Serum lipids and plasma angiotensin II (Ang II), endothelin (ET), vasopressin (AVP), calcitonin gene-related peptide (CGRP), nitric oxide synthase (NOS), superoxide dismutase (SOD) and glutathione peroxidase (GPX) by radioimmunoassay and enzyme linked immunosorbent assay. RESULTS: Serum Lipids (TG, CHO and LDL) were significantly higher in the PH and EH groups compared to NT group (all P < 0.05). Ang II, AVP and ET were significantly increased while CGRP decreased in the EH group than that in NT group (all P < 0.05). SOD was significantly lower while GPX significantly higher. Further more, in the PH and EH groups than those in the NT group (all P < 0.05). CONCLUSION: SOD was reduced and GPX increased in prehypertensive patients.

[The changing trend of serum total cholesterol in Beijing population aged 25 - 64 years during 1984 - 1999].

OBJECTIVE: To describe the changing trend of serum total cholesterol (TC) in Beijing population aged 25 - 64 years old from 1984 to 1999 and to explore the distributions of hypercholesterolemia in different subgroups. METHODS: From 1984 to 1999, five independent cardiovascular diseases (CVD) risk factors surveys with the same protocol were conducted in Beijing population aged 25 - 64 years. Stratified-random sampling was used. RESULTS: (1) In the period from 1984 to 1999, the mean level of TC increased 1.058 mmol/L (25.1%) in Beijing population aged 25 - 64. The mean level of TC showed increase trends in different genders and age groups, with the greatest increase of 0.998 mmol/L (25.9%) being in the 25 - 34 age group. The mean level of TC was higher in urban subjects than in rural subjects, whereas the increment of TC level was higher in the rural subjects (32.8%) than in urban subjects (26.3%). (2) The prevalence of hypercholesterolemia increased from 6.1% in 1984 to 29.9% in 1999, with 23.8% of the increase during the 15 years. Among different subgroups, both the lowest prevalence of hypercholesterolemia and the greatest increase of hypercholesterolemia prevalence were shown in men aged 25 - 34 years old, with a 16.4 fold increase in 15 years. CONCLUSION: The increase trends of mean TC level and hypercholesterolemia prevalence were observed in Beijing population during 1984 - 1999, especially in rural subjects and men aged 25 - 34 years old.

[The association of cardiovascular risk factors and prevalence of carotid atherosclerosis at 10 years].

OBJECTIVE: To explore the association of cardiovascular disease (CVD) risk factors and its impact on the 10-year prevalence of carotid atherosclerosis. METHODS: Two surveys for CVD risk factors were carried out in a population consisting of 1323 subjects in Beijing in both 1992 and 2002 and a direct measurement of carotid arteries with B-mode ultrasound imaging were performed in 2002. Intima-media thickness (IMT) and plaque of carotid arteries were regarded as the indicators of carotid atherosclerosis and main CVD risk factors were treated as the impact factors. RESULTS: (1) 10-year prevalence of carotid atherosclerosis continually increased with elevated baseline risk factors levels. Age, smoking, hypertension and hypercholesterolemia were found to be independently associated with carotid atherosclerosis. (2) 10-year prevalence of carotid atherosclerosis increased with the elevated number of risk factors clustering in individuals. (3) The prevalence of IMT and plaque were 67.1% and 42.6% in subjects with CVD risk factors in both 1992 and 2002 surveys with Odds Ratios being 1.7 and 3.1 times as those without risk factors. CONCLUSION: Traditional CVD risk factors exert impact on CVD and carotid atherosclerosis with different degrees and carotid atherosclerosis can be regarded as an early evaluation indicator for risk of atherosclerotic diseases.

[Association of baseline cholesterol level and its 10-year change with carotid atherosclerosis in the population of Peking University community].

OBJECTIVE: To explore the association of baseline cholesterol level in 1992 and its 10-year change from 1992 to 2002 with the prevalence of carotid atherosclerosis. METHODS: In 1992, 1985 subjects of the community of Peking University, aged 35 - 64, underwent physical examination and blood-lipid test to study the cardio-vascular disease (CVD) risk factors. In 2002, the second survey on CVD risk factors was conducted among the existing 1932 subjects, now aged 45 - 74. In addition, B-mode ultrasonography of the carotid artery was performed too. The complete data of 1331 subjects were analyzed. RESULTS: (1) In 2002, the prevalence rates of intimal medial thickening (IMT) and carotid plaque in the study population were 47.8% and 29.9% respectively. (2) The post-10-year prevalence rate of carotid plaque was 19.7% in the subjects with the baseline cholesterol < 3.64 mmol/L, and was 46.8% in those with the baseline cholesterol 6.24 mmol/L, with a thickening rate 3.1 times that of the subjects with the baseline cholesterol < 3.64 mmol/L. The higher the baseline TV level, the higher the prevalence rates of carotid plaque and IMT. (3) The prevalence rate of carotid plaque was 32.0% in the subjects with normal TC in both 1992 and 2002, and 50.0% in those with hypercholesterolemia in both 1992 and 2002. CONCLUSION: Carotid atherosclerosis is a prevalent disorder in the people aged 45 - 74 in Beijing. The prevalence rates of carotid plaque and IMT increase with the elevation of baseline cholesterol level.

[Physiological characteristics and cardiac electrophysiology manifested in Minnesota coding of the "desert people" in Taklimakan Desert: study of 224 cases].

OBJECTIVE: To study the physiological characteristics and cardiac electrophysiology of the "desert people" in Taklimakan Desert, an isolated population of Uygurs. METHODS: Two hundred and twenty-four out of the 1030 "desert people", 133 males aged 37.8 +/- 17.5 (15-99) and 91 females aged 34.1 +/- 12.1 (27-85), underwent measurement of height, body weight, waist circumference, and blood pressure. Twelve-lead resting electrocardiogram was obtained and Minnesota coding was conducted. 150 Kariya Uygurs, 76 males aged 50.7 +/- 15.6 (27-85) and 75 females aged 46.6 +/- 11.7 (24-69) were used as controls. RESULTS: The abnormal Minnesota coding rate in the "desert people" as a whole was 46.0%, significantly higher than that of the controls (35.1%, P < 0.05). In the "desert people", the abnormal Minnesota coding rate was 54.9% in the males, significantly higher than that in the females (33.0%, P < 0.05). In the control group, the abnormal coding rate was 28.0% in the females and 42.1% in the males. The ECG high left R amplitude rate (code 3-1, 3-3) of the "desert people" as a whole was 32.6%, significantly higher than that of the controls (12.6%, P < 0.001). Within the "desert people" group, the ECG high left R amplitude rate of the females was 19.8%, significantly lower than that of the males (41.2%, P < 0.005). Within the control group, the ECG high left R amplitude rate of the females was 10.7%, not significantly different from that of the males (14.5%, P > 0.5). The hypertension rate of the "desert people" was 7.6%, significantly lower than that of the controls (36.4%, P < 0.005). The hypertension rate of the "desert people" coded as with left high R amplitude was 12.2%, significantly lower than that of the controls coded as with left high R amplitude (41.6%, P < 0.005). The overweight and obesity rate of the "desert people" was 9.6%, significantly lower than that of the controls (23%, P < 0.005). The arrhythmia (8-1 - 8-8) rate of the "desert people" was 8.92%, not significantly different from that of the controls (6.62%, P > 0.05). The incidence of conduction block (7-1 - 7-8) of the "desert people" was 3.12%, not significantly different from that of the controls (2.64%, P > 0.05). CONCLUSION: The higher incidence of ECG high left R amplitudes and low prevalence of hypertension in the "desert people" suggest that the high left R amplitude in "Desert people" may be related to their thin chest wall, low BMI, and physiological left ventricular hypertrophy. The "desert people" have more physical work, and less stress and pollution. They have low incidence of congenital heart disease, rheumatic heart disease and hypertension. All these may be associated with a low incidence of arrhythmia.

[Risk factors comparison in Chinese patients developing acute coronary syndrome, ischemic or hemorrhagic stroke: a multi-provincial cohort study].

OBJECTIVE: To observe the risk factors characteristic of patients developing acute coronary syndrome, ischemic or hemorrhagic stroke in a Chinese population aged 35 - 64 (n = 30 378). METHOD: This prospective study was carried out in 11 provinces in China from 1992 to 2003. The association between baseline risk factors and events in the 10-year follow-up period was analyzed. RESULTS: (1) A total of 809 events were recorded during the follow up period and 227 with acute coronary syndrome, 582 with stroke (ischemic 419, hemorrhagic 146, undefined 17) and the 10-year cumulative person-year incidence rates were 114/100,000, 209/100,000 and 73/100,000 for acute coronary syndrome, acute ischemic stroke and acute hemorrhagic stroke, respectively. (2) Rate of having > or = 1 modifiable risk factors was significantly higher in event group than that in subjects without events (89% vs. 64.7%, P < 0.01). (3) Sorted by intensity, the sequence of independently risk factors obtained from multivariate analysis for acute coronary syndrome were hypertension, smoking, hypercholesterolemia and low-HDL-C; for acute ischemic stroke event were hypertension, diabetes, low-HDL-C, smoking and obesity; for acute hemorrhagic stroke was hypertension. CONCLUSION: The morbidity for cardiovascular diseases is higher in Chinese population with various traditional risk factors than those without or having fewer traditional risk factors and there are various distinct independent risk factors pattern in patients with different cardiovascular diseases subtypes.

[Serum total cholesterol and 10-year cardiovascular risk in a Chinese cohort aged 35-64 years].

OBJECTIVE: To evaluate the association between serum total cholesterol (TC) and the risk of cardiovascular diseases (CVD) in subjects aged 35-64 years. METHODS: This prospective study was performed from 1992 to 2002 in 11 provinces of China and the association between baseline TC level and the development of cardiovascular diseases was analyzed in 30 384 subjects aged 35-64 years using Cox multivariate proportional hazards regression. RESULTS: (1) Compared with the group of TC < 3.64 mmol/L (140 mg/dl), multivariate-adjusted relative risk of ischemic cardiovascular disease (ICVD, including CHD and ischemic stroke) increased continuously with increasing TC level. (2) TC level was positively related to the occurrence of ischemic stroke, but not to hemorrhagic stroke. The risk of CHD increased by 74% (RR = 1.743) and the risk of ischemic stroke increased by 12% (RR = 1.119) in the group with TC > or = 5.72 mmol/L compared with the group with TC < 5.72 mmol/L (220 mg/dl). (3) High serum cholesterol was responsible to 5.9% of ICVD, 11.7% of the acute CHD and 2.9% of the acute stroke. (4) At each TC level, the 10-year risk of ICVD increased in the presence of other risk factors. CONCLUSION: Starting from TC of 3.64 mmol/L, the risk of ICVD increases continuously with increasing TC level. Multiple risk factor intervention should be strengthened to reduce the overall risk of CVD.

[The effect of lipoprotein lipase (LPL) polymorphism on plasma LPL concentration and triglyceride].

OBJECTIVE: To study the effect of lipoprotein lipase (LPL)-HindIII and PvuII polymorphisms on preheparin plasma LPL concentration and triglyceride. METHODS: A cross-sectional study was carried out in a general population of Beijing in 1999, using stratified-random sampling method. LPL-HindIII and PvuII polymorphism and preheparin plasma LPL concentration were determined in 670 individuals aged 45 - 64. RESULTS: (1) The frequencies of H1H1, H1H2, and H2H2 genotypes were 0.646, 0.322, and 0.031 respectively; and the frequencies of P1P1, P1P2, and P2P2 genotypes were 0.410, 0.472, and 0.118 respectively. The distribution of genotypes and that of alleles were homogeneous in both sexes. (2) The plasma LPL concentrations of the 12 type heterozygotes (H1H2 and P1P2) and those of the 22 type (H2H2 and P2P2) homozygotes were all higher than that of the 11 type homozygotes (H1H1 and P1P1) (all P < 0.01). And the LPL concentration varied greatly among different individuals of the same genotype. (3) Smoking, alcohol consumption, BMI, and waist level influenced LPL concentration more significantly in the H1H1 and P1P1 homozygotes and P1P2 heterozygotes. Multivariate analysis showed that smoking and obesity were independent influencing factors of serum LPL concentration (both P < 0.01). (4) The prevalence rate of hypertriglyceridemia was significantly different among different genotypes, the 11 type homozygotes having the highest rate, and the 22 type homozygotes having the lowest. In the same genotype, along with the increase of the serum LPL concentration the prevalence of hypertriglyceridemia decreased (P < 0.05). CONCLUSION: LPL-HindIII and PvuII polymorphisms are determinants of plasma LPL concentration. This genetic effect can be modified by some environmental factors, such as smoking and obesity.