A Comparison of Oscillometrically Measured Ankle-to-Brachial Mean Arterial Pressure Ratio and Ankle-Brachial Index in Predicting Cardiovascular Events and All-Cause Mortality.

BACKGROUND: The oscillometrically measured ankle-brachial index (omABI), which is determined by the ratio of ankle to brachial systolic blood pressure measured through oscillography, has been demonstrated as a robust predictor of cardiovascular events. However, the reliability of mean arterial pressure measured by oscillography may be higher than that of systolic blood pressure based on the principle of oscillographic oscillation. We aimed to compare the predictive value of oscillometrically measured ankle-tobrachial mean arterial pressure ratio (omMAPR) and omABI for cardiovascular events and all-cause mortality. METHODS: The observation cohort consisted of a total of 37 803 employees from the Chinese Kailuan Group who underwent limb blood pressure measurements during their participation in physical examination between 2010 and 2017. RESULTS: After an average follow-up period of 3 years, a total of 589 cardiovascular events and 570 cases of all-cause mortality were observed. The predictive performance of omMAPR was found to be slightly superior to omABI in terms of cardiovascular events (C-statistics: 0.55 vs. 0.51, P < .001) and all-cause mortality (C-statistics: 0.60 vs. 0.55, P <.001). After adjusting for confounders, within a specific range (omMAPR ≤ 1.06 or omABI ≤ 1.12), each 0.1-unit increase in omMAPR was associated with reductions of 14% (HR = 0.86, 95% CI: 0.77-0.96) and 23% (HR = 0.77, 95% CI: 0.70-0.84) in cardiovascular events and all cause mortality, respectively, while each 0.1-unit increase in omABI was associated with reductions of 12% (HR = 0.88, 95% CI: 0.79-0.97) and 22% (HR = 0.78, 95% CI: 0.72-0.85) in cardiovascular events and all-cause mortality, respectively. However, once out of that range (omMAPR > 1.06 or omABI > 1.12), neither omMAPR nor omABI was significantly associated with cardiovascular events or all-cause mortality. CONCLUSION: Both omMAPR and omABI within specific ranges (omMAPR ≤ 1.06 or omABI ≤ 1.12) were independent predictors for cardiovascular events and all-cause mortality. Moreover, omMAPR exhibited a slightly superior predictive ability compared to omABI in relation to cardiovascular events and all-cause mortality. The trial registration number is ChiCTR-TNRC-11001489.

Estimated pulse wave velocity and risk of new-onset heart failure.

AIMS: As a potential surrogate of carotid-femoral pulse wave velocity, estimated pulse wave velocity (ePWV) has been confirmed to independently predict the cardiovascular events, but the association between ePWV and heart failure has not been well confirmed. Therefore, we performed this cohort study to evaluate the association between ePWV and risk of new-onset heart failure. METHODS AND RESULTS: A total of 98 269 employees (mean age: 51.77 ± 12.56 years, male accounted for 79.9%) without prior heart failure who participated in the 2006-2007 health examination were selected as the observation cohort, with an average follow-up of 13.85 ± 1.40 years. Area under the receiver operator characteristic curve (AUC) of ePWV was calculated in prediction of heart failure. The adjusted Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals. The category-free net reclassification index (NRI) was calculated to evaluate the reclassification performance of cardiovascular risk models after adding ePWV. The AUC of ePWV was 0.74 in prediction of heart failure. After adjusting for the traditional cardiovascular risk factors except for age and blood pressure, the risk of new-onset heart failure increased by 35% [hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.33-1.37] for each 1 m/s increase in ePWV. Subgroup analysis showed that ePWV was significantly associated with incident heart failure regardless of THE presence (HR: 1.33, 95% CI: 1.31-1.36, P < 0.01) or absence (HR: 1.59, 95% CI: 1.46-1.73, P < 0.01) of cardiovascular risk factors, male (HR: 1.33, 95% CI: 1.31-1.36, P < 0.01) or female (HR: 1.44, 95% CI: 1.38-1.51, P < 0.01), young and middle-aged (<52 years) (HR: 1.50, 95% CI: 1.41-1.58, P < 0.01), or middle-aged and elderly (≥52 years) (HR: 1.23, 95% CI: 1.21-1.26, P < 0.01). The addition of ePWV to the traditional cardiovascular risk model including age and mean arterial pressure could significantly improve the reclassification ability by 31.1% (category-free NRI = 0.311, P < 0.01). CONCLUSIONS: ePWV was an independent predictor for new-onset heart failure.

Association of Cumulative Exposure to Cardiovascular Health Behaviors and Factors with the Onset and Progression of Arterial Stiffness.

AIM: This study aims to explore the association of cumulative exposure to cardiovascular health behaviors and factors with the onset and progression of arterial stiffness. METHODS: In this study, 24,110 participants were examined from the Kailuan cohort, of which 11,527 had undergone at least two brachial-ankle pulse wave velocity (baPWV) measurements. The cumulative exposure to cardiovascular health behaviors and factors (cumCVH) was calculated as the sum of the cumCVH scores between two consecutive physical examinations, multiplied by the time interval between the two. A logistic regression model was constructed to evaluate the association of cumCVH with arterial stiffness. Generalized linear regression models were used to analyze how cumCVH affects baPWV progression. Moreover, a Cox proportional hazards regression model was used to analyze the effect of cumCVH on the risk of arterial stiffness. RESULTS: In this study, participants were divided into four groups, according to quartiles of cumCVH exposure levels, namely, quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4). Logistic regression analysis showed that compared with the Q1 group, the incidence of arterial stiffness in terms of cumCVH among Q2, Q3, and Q4 groups decreased by 16%, 30%, and 39%, respectively. The results of generalized linear regression showed that compared with the Q1 group, the incidence of arterial stiffness in the Q3 and Q4 groups increased by -25.54 and -29.83, respectively. The results of Cox proportional hazards regression showed that compared with the Q1 group, the incidence of arterial stiffness in cumCVH among Q2, Q3, and Q4 groups decreased by 11%, 19%, and 22%, respectively. Sensitivity analyses showed consistency with the main results. CONCLUSIONS: High cumCVH can delay the progression of arterial stiffness and reduce the risk of developing arterial stiffness.

Level of systolic blood pressure within the normal range and risk of cardiovascular events in the absence of risk factors in Chinese.

The risk of cardiovascular disease (CVD) at currently defined normal systolic blood pressure (SBP) levels in individuals without CVD risk factors is not well examined. We evaluated whether higher systolic blood pressure within the range considered normal is associated with a higher CVD risk in Chinese without traditional CVD risk factors. The community-based study included 25,529 individuals (mean age:47.3 ± 12.3 years;range:18-95 years) with a baseline SBP of 90-129 mmHg, who were free of CVD and traditional CVD risk factors, and who were re-examined in biennial intervals. During a mean follow-up of 10.6 ± 1.49 years (maximum. 11.5 years), 847 CVD events occurred. CVD incidence per 1000 person-years increased with higher baseline SBP levels (SBP,90-99 mmHg:1.45;100-109 mmHg:2.15;110-119 mmHg:3.06; and 120-129 mmHg:3.80). After adjusting for CVD risk factors, the categorical Cox regression suggested that the CVD risk was not statistically significant for study participants with a baseline SBP level of 100-109 mmHg, 110-119 mmHg, and 120-129 mmHg compared with those with a baseline SBP level of 90-99 mmHg. If CVD risk factors including blood pressure categories which developed during follow-up were included in a time-dependent Cox regression analysis, the normal baseline SBP was still not associated with incident CVDs. A SBP between 90 and 129 mmHg was not associated with an increased CVD risk in a healthy population.

Blood pressure control and progression of arteriosclerosis in hypertension.

OBJECTIVE: Using the brachial--ankle pulse wave velocity (baPWV) as a biomarker for arteriosclerosis, we studied the effect of blood pressure (BP) and BP control on arteriosclerosis progression. METHODS AND RESULTS: The community-based longitudinal Kailuan study included 6552 participants [4938 (75.37%) men] with a mean follow-up of 4.62 ±â€Š2.21 years. Hypertension was defined based on the Joint National Committee (JNC7) criteria and the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. All study participants had hypertension and were stratified as follows according to BP at baseline and follow-up: the normal--normal [normal BP (under therapy) at baseline and final follow-up], normal--hypertensive, hypertensive--normal, and hypertensive--hypertensive groups. Using the JNC7-based hypertension definition, the annual baPWV increase was the highest (P < 0.001) in the hypertensive--hypertensive group [17.32 cm/s; 95% confidence interval [CI]:9.7--24.9], followed by the normal--hypertensive group (14.44 cm/s; 95% CI:5.5--23.4), and the hypertensive--normal group (0.88 cm/s; 95% CI: -7.84 to 9.60), with the normal--normal group as the reference group in a multivariable model. The model additionally included parameters, such as age, baseline baPWV, heart rate, BMI, serum glucose concentration, prevalence of antihypertensive treatment and alcohol consumption, heart rate, and estimated glomerular filtration rate. Applying the ACC/AHA guidelines and the same multivariable model, the annual baPWV increase was the highest (P < 0.001) in the hypertensive--hypertensive group (43.54 cm/s; 95% CI: 22.54--64.55), followed by the normal--hypertensive group (34.01 cm/s; 95% CI: 10.39--57.62) and the hypertensive--normal group (24.12 cm/s; 95% CI: 1.24--47.00). CONCLUSION: Lower BP and medical reduction in increased BP were associated with a reduction in the baPWV increase and may delay the progression of arteriosclerosis in hypertensive patients.

Isolated diastolic hypertension as defined by the 2017 American College of Cardiology/American Heart Association blood pressure guideline and incident cardiovascular events in Chinese.

OBJECTIVE: The new arterial hypertension guidelines by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) changed the definition of isolated diastolic hypertension (IDH). We assessed and compared in a Chinese population the IDH prevalence, newly defined by the 2017 ACC/AHA guidelines versus the former definition by the Joint National Committee 7 (JNC7) criteria, and examined longitudinal associations of IDH with cardiovascular disease (CVD) outcomes. METHODS: The prospective community-based Kailuan Study included participants aged 18-98 years who underwent a detailed medical examination at baseline in 2006/2007 and who were biennially re-examined till 2017. History of antihypertensive medication at baseline was an exclusion criterion. RESULTS: The study population consisted of 87 346 individuals (mean age: 50.9 years; range: 18-98 years). Prevalence of IDH was 7.79% [95% confidence interval (CI): 7.62, 7.97] by JNC7 guidelines and 24.72% (95% CI: 24.43, 25.01) by 2017 ACC/AHA criteria [difference: 19.93% (95% CI: 16.81, 17.04)]. Applying the 2017 ACC/AHA guidelines, the prevalence of IDH-recommended antihypertensive therapy was 7.73% (95% CI: 7.55, 7.90). In multivariable analysis, IDH by JNC7 criteria was significantly associated with incident myocardial infarction [n = 93 events; hazard ratio: 1.30 (95 CI: 1.02, 1.66)], cerebral hemorrhage [n = 73 events; hazard ratio: 1.79 (95% CI: 1.35, 2.38)], and total CVD [n = 373 events; hazard ratio: 1.15 (95% CI: 1.02, 1.30)], when compared with normotension. IDH based on 2017 ACC/AHA guidelines was associated with incident cerebral hemorrhage [n = 129 events; hazard ratio: 1.47 (95% CI: 1.12, 1.94)] and total CVD [n = 828 events; hazard ratio: 1.13 (95% CI: 1.02, 1.26)]. CONCLUSION: In this adult Chinese community, 2017 ACC/AHA-defined IDH was associated with the incidence of cerebral hemorrhage and total CVD, and as compared with JNC7-defined IDH, it was more prevalent.

A comparison between pylorus-preserving and distal gastrectomy in surgical safety and functional benefit with gastric cancer: a systematic review and meta-analysis.

BACKGROUND: Due to better functional outcomes, pylorus-preserving gastrectomy (PPG) has been widely applied for early gastric cancer (EGC) patients as an alternative to distal gastrectomy (DG). However, controversies still persist regarding the surgical efficacy and oncological safety of PPG. METHODS: Original studies comparing PPG and DG for EGC were searched in PubMed, Embase, and the Cochrane Register of Controlled Trials up to December 2019. The weight mean difference, standardized mean difference, or odds risk was used to calculate the short-term and long-term outcomes between the two groups. RESULTS: Twenty-one comparative studies comprising 4871 patients (1955 in the PPG group and 2916 in the DG group) were enrolled in this systematic review and meta-analysis. PPG showed longer hospital day, decreased harvested lymph nodes, and more delayed gastric emptying. However, PPG had the benefits of lower incidence of anastomosis leakage, early dumping syndrome, gastritis and bile reflux, and better recovery of total protein, albumin, hemoglobin, and weight. No difference was found in operative time, blood loss, and overall complications. Moreover, the long-term survival and recurrence rate were similar in two groups. CONCLUSION: Owing to the non-inferiority of surgery and oncology outcomes and the superiority of function outcomes in PPG, we revealed that PPG can be clinically applicable instead of DG in EGC. However, more high-quality comparative studies and randomized clinical trials would be required for further confirmation.

Baseline CHADS2 Score and Risk of Cardiovascular Events in the Population Without Atrial Fibrillation.

The association between CHADS2 score and stroke has been confirmed in patients with atrial fibrillation. But the majority of cardiovascular events occurred primarily in population without atrial fibrillation. Therefore, we performed this cohort study to evaluate the association between baseline CHADS2 score and cardiovascular events in the population without atrial fibrillation. A total of 99,755 Chinese adults with complete baseline data were followed for up to 10 years. The primary outcomes were cardiovascular event (a composite endpoint of myocardial infarction, cerebral infarction, and cerebral hemorrhage) and all-cause death. The area under the receiver operating characteristic curve was calculated for each kind of outcome. The adjusted cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals. The results showed the incidence of cardiovascular events and all-cause death increased with CHADS2 score. The area under the receiver operating characteristic curve for myocardial infarction, cerebral infarction, cerebral hemorrhage, cardiovascular events and all-cause death was 0.66, 0.67, 0.66, 0.67, and 0.69, respectively in participants without atrial fibrillation. Each 1 point increase in CHADS2 score was associated with the risk of all the outcomes in participants without atrial fibrillation after adjusting for age, sex, and other conventional cardiovascular confounders, the hazard ratio (95% confidence interval) for cardiovascular event and all-cause death was 1.17 (1.13 to 1.22) and 1.12 (1.08 to 1.15), respectively. In conclusion, baseline CHADS2 score is an independent risk factor for cardiovascular events and all-cause death in the population without atrial fibrillation.

Estimated pulse wave velocity and cardiovascular events in Chinese.

The estimated pulse-wave velocity (ePWV) as measure for arterial wall stiffness is associated with an increased risk of cardiovascular disease (CVDs) and all-cause death in Western populations. We investigated the association between ePWV and the incidence of CVDs (myocardial infarction, cerebral infarction, cerebral hemorrhage) and all-cause death in Chinese. The community-based longitudinal Kailuan Study included 98,348 participants undergoing biennial clinical examinations. During a mean follow-up of 10.32 ± 2.14 years, 6967 CVD events (myocardial infarction, n = 1610; cerebral infarction, n = 4634; cerebral hemorrhage, n = 1071) and 9780 all-cause deaths occurred. Stratified by age, sex and presence of cardiovascular risk factors, the incidence of CVDs and all-cause death were higher (P < 0.01) in individuals with ePWV values ≥ 10 m/s than in those with ePWV values < 10 m/s. After adjusting for age, age squared and other conventional cardiovascular risk factors, an ePWV value of ≥10 m/s or each ePWV increase by 1 m/s increased (P < 0.01) the risk for CVDs by 32% (Hazard ratio (HR):1.32; 95% confidence interval (CI):1.23-1.42) and 22% (HR:1.22; 95%CI:1.18-1.27), respectively, and increased the risk for all-cause death significantly (P < 0.01) by 28% (HR:1.28; 95%CI:1.20-1.37) and 10% (HR:1.10; 95%CI:1.07-1.13), respectively. The mean brachial-ankle PWV, measured in 43,208 individuals, was 15.30 ± 3.51 cm/s, with a mean difference of 6.45 m/s (95% limits of agreement:1.24-11.7) to the ePWV. Independently of cardiovascular risk factors, ePWV was associated with CVDs and all-cause mortality in Chinese.

Stage 1 hypertension defined by the 2017 ACC/AHA Hypertension Guidelines and Risk of Cardiovascular Events: a Cohort Study from Northern China.

To examine the association between stage 1 hypertension (at baseline and longitudinal change) defined by the 2017 ACC/AHA hypertension guidelines and risk of cardiovascular events in a Chinese Kailuan Cohort. A total of 97,126 active and retired workers aged 18 to 98 years free of cardiovascular disease at baseline were followed for up to 10 years in the Chinese Kailuan Cohort Study. Adjusted Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals of cardiovascular events among different blood pressure categories. Participants with stage 1 hypertension at baseline accounted for 31.1% of the cohort. Compared with normal blood pressure (<120/80 mmHg), stage 1 hypertension had a significantly higher risk of cardiovascular events, cerebral infarction and cerebral hemorrhage, and the hazard ratios (95% confidence intervals) were 1.25 (1.11-1.40), 1.31 (1.13-1.52), and 1.45 (1.07-1.97), respectively. Over a four-year period, 43.1% of participants maintained stage 1 hypertension. Compared with the decreased blood pressure from stage 1 hypertension to normal blood pressure, the maintained stage 1 hypertension had a significantly higher risk of cardiovascular events and cerebral infarction, and the hazard ratios (95% confidence intervals) were 1.78 (1.16-2.72) and 1.94 (1.14-3.30), respectively. People with stage 1 hypertension defined by the 2017 ACC/AHA hypertension guidelines have a relatively high risk for cardiovascular events in northern China; they should be given appropriate antihypertensive interventions.

Association of the ideal cardiovascular behaviors and factors with the incidence of nonalcoholic fatty liver disease: a prospective study.

OBJECTIVE: This study aimed to investigate the association of ideal cardiovascular behaviors and factors with the incidence of nonalcoholic fatty liver disease (NAFLD) prospectively. PATIENTS AND METHODS: We analyzed 25 278 (21 433 men and 11 895 women) participants in the study. Participants were divided into four categories according to the number of ideal cardiovascular behaviors and factors: 0-2, 3, 4, and 5-7 groups. Multivariate logistic regression was used to calculate the odds ratios with 95% confidence intervals (CIs). RESULTS: After adjustment for confounding factors, the multivariate logistic regression model showed that the risk of NAFLD among the groups with 3, 4, 5-7 ideal factors was lower than the 0-2 group; after adjustment for age, sex, income, education level, and other confounders, the odds ratios were 0.74 (95% CI: 0.68-0.80), 0.49 (95% CI: 0.45-0.53), and 0.37 (95% CI: 0.33-0.41), respectively. CONCLUSION: The incidence of NAFLD decreased gradually with increasing ideal cardiovascular health behaviors and factors.

Long-term effects of earthquake experience of young persons on cardiovascular disease risk factors.

INTRODUCTION: The aim of the study was to study the long-term effect on cardiovascular disease risk factors of stress from direct experience of an earthquake as a young person. MATERIAL AND METHODS: We selected workers born between July 1, 1958 and July 1, 1976 who were examined at Kailuan General Hospital between May and October of 2013. Data on cardiovascular events were taken during the workers' annual health examination conducted between 2006 and 2007. All subjects were divided into three groups according to their experience of the Tangshan earthquake of July 28, 1976, as follows: control group; exposed group 1 and exposed group 2. We compared cardiovascular disease risk factors between the three groups as well as by gender and age. RESULTS: One thousand one hundred and ninety-six workers were included in the final statistical analysis. Among all subjects, resting heart rate (p = 0.003), total cholesterol (p < 0.001), and fasting blood glucose (p < 0.001) were significantly higher among those who experienced the earthquake compared with unexposed controls, but were unrelated to loss of relatives. No significant difference in triglyceride levels was observed between the three groups (p = 0.900). Further refinement showed that the effects were restricted to males 40 years of age or older at the time of analysis, but were due primarily to age at the time of earthquake exposure (p = 0.002, p < 0.001 and p = 0.002). CONCLUSIONS: Earthquake experience in the early years of life has long-term effects on adult resting heart rate, total cholesterol, and fasting plasma glucose, especially among men.

Prenatal Earthquake Exposure and Midlife Uric Acid Levels Among Chinese Adults.

OBJECTIVE: To test whether prenatal exposure to earthquake (as a surrogate for acute prenatal stress) could have unfavorable effects on uric acid levels later in life. METHODS: We included 536 individuals who had been prenatally exposed to the Tangshan earthquake in 1976, and 536 sex- and age-matched individuals without that exposure. Serum uric acid concentrations were measured based on fasting blood samples, which were repeatedly collected in 2006, 2008, and 2010. Mean uric acid concentrations in 2010 and the increasing rate from 2006 to 2010 were compared between the 2 groups, after adjustment for age, sex, body mass index, serum concentrations of glucose, triglycerides, C-reactive protein level, estimated glomerular filtration rate, and other potential confounders. We also used multiple logistic regression to estimate the risk of hyperuricemia (>416 µmole/liter in men or >357 µmole/liter in women) in 2010 by calculating the odds ratios (ORs) and 95% confidence intervals (95% CIs) after adjustment for the previously mentioned covariates. RESULTS: Participants with prenatal exposure to the earthquake had higher concentrations of serum uric acid (adjusted means 315 µmole/liter versus 296 µmole/liter; P = 0.001) and a higher likelihood of having hyperuricemia (multivariate adjusted OR 1.70 [95% CI 1.09-2.66]) in 2010 relative to those without the exposure. Prenatal exposure to the earthquake was consistently significantly associated with a faster increase in uric acid concentration from 2006 to 2010 (P < 0.001). CONCLUSION: Prenatal exposure to the earthquake was associated with higher serum uric acid and higher odds of hyperuricemia in early adulthood.

Body mass index and mortality in patients with type 2 diabetes mellitus: A prospective cohort study of 11,449 participants.

AIMS: To investigate the association between body-mass index and mortality in Chinese adults T2DM. METHODS: 11,449 participants of Kailuan Study with T2DM were included in this prospective cohort study. All-cause mortality was calculated using Kaplan-Meier analysis. Cox proportional hazards analysis was used to estimate the association between BMI and mortality. RESULTS: During a mean follow-up period of 7.25±1.42years, 1254 deaths occurred. The number of deaths of the underweight, normal weight, overweight, and obese group was 23, 389, 557, and 285; the corresponding mortality was 25.0%, 13.4%, 10.3%, and 9.4%, respectively. The obese group had the lowest all-cause mortality rate (log-rank chi-square=48.430, P<0.001). After adjusting for age, sex, fasting blood glucose, smoking status, systolic blood pressure, history of hypertension, stroke, cancer and myocardial infarction, compared with the normal weight group, Multivariate Cox proportional hazard regression analysis showed that HR (95% CI) of all-cause mortality in the underweight, overweight, and obese group was 1.497 (0.962, 2.330), 0.833 (0.728, 0.952), and 0.809 (0.690, 0.949). After stratifying for age tertiles, this trend remained. CONCLUSIONS: In T2DM patients in north China, the risk for all-cause mortality was lower in the overweight and the obese groups than those in the normal weight and the underweight groups.

Cumulative Exposure to Ideal Cardiovascular Health and Incident Diabetes in a Chinese Population: The Kailuan Study.

BACKGROUND: It is unclear whether ideal cardiovascular health (CVH), and particularly cumulative exposure to ideal CVH (cumCVH), is associated with incident diabetes. We aimed to fill this research gap. METHODS AND RESULTS: The Kailuan Study is a prospective cohort of 101 510 adults aged 18 to 98 years recruited in 2006-2007 and who were subsequently followed up at 2- (Exam 2), 4- (Exam 3), and 6 (Exam 4)-year intervals after baseline. The main analysis is restricted to those individuals with complete follow-up at all 4 examinations and who had no history of diabetes until Exam 3. Cumulative exposure to ideal CVH (cumCVH) was calculated as the summed CVH score for each examination multiplied by the time between the 2 examinations (score×year). Logistic regression models were used to assess the association between cumCVH and incident diabetes. In fully adjusted models, compared with the lowest quintile of cumCVH, individuals in the highest quintile had ~68% (95% confidence interval [CI] 60-75) lower risk for incident diabetes (compared with 61% [95% CI 52-69] lower risk when using baseline CVH). Every additional year lived with a 1-unit increase in ideal CVH was associated with a 24% (95% CI 21-28) reduction in incident diabetes. CONCLUSIONS: Ideal CVH is associated with a reduced incidence of diabetes, but the association is likely to be underestimated if baseline measures of CVH exposure are used. Measures of cumulative exposure to ideal CVH are more likely to reflect lifetime risk of diabetes and possibly other health outcomes. CLINICAL TRIAL REGISTRATION: URL: https://www.chictr.org. Unique identifier: ChiCTRTNC-11001489.

[The effects of exposure to the famine during early life with elevated resting heart rate in the adult].

OBJECTIVE: To investigate the association between exposure to the famine during early life and elevated resting heart rate (RHR) in adulthood. METHOD: From June 2006 to October 2007, the employees of kailuan group who took part in the health examination were selected. Of those, 18 619 cases who was born during October 1, 1956 to September 30, 1964 in Hebei province were finally included in the analysis based on the inclusion and exclusion criteria. All the subjects were received questionnaire survey, smoking and drinking, physical examination, Lab examination and the measurement of RHR. The subjects of famine exposure group (3 190 cases) were born from October 1, 1959 to September 30, 1961, semi-exposure group (3 851 cases) were born from October 1, 1958 to September 30, 1959 and from October 1, 1961 to September 30, 1962, control group (11 578 cases) were born from October 1, 1956 to September 30, 1958 and from October 1, 1962 to September 30, 1964. The RHR and the detection rate of elevated RHR were compared among the three groups. The Multivariate logistic regression model was used to analyze the association between of exposure to famine during early life and elevated RHR in adulthood. RESULTS: The RHR level was higher in famine exposure group and semi-exposed group than control group, which were (74.34 ± 9.71), (74.41 ± 9.48) and (73.90 ± 9.45) beat per minute (bpm) (P values were 0.003 and 0.020, respectively). In all of the subjects. The results of multivariate logistic regression showed that exposure of famine during early life increased the risk of elevated RHR in adulthood after adjustment for age, gender and other confounders (OR = 1.10, 95% CI: 1.01-1.21). In men, exposure of famine during early life also increased the risk of elevated RHR in adulthood (OR = 1.15, 95% CI: 1.04-1.28); In women, there was no association between the famine exposure and elevated RHR (OR = 0.92, 95% CI: 0.74-1.14). CONCLUSION: Exposure of famine during early life increases the risk of elevated RHR in adulthood. This negative effect existed mainly in the male.

[Relationship between ideal cardiovascular behaviors/factors and the prevalence of nonalcoholic fatty liver disease].

OBJECTIVE: To investigate the relationship between ideal cardiovascular behaviors/factors and nonalcoholic fatty liver disease. METHODS: In our study, 54 303 workers who had participated in the 2006-2007 Kailuan health examination with complete data and without history of drinking, myocardial infarction, stroke or cancer, were recruited. All workers were under observation and their prevalence of nonalcoholic fatty liver disease recorded. According to the American Heart Association definition of ideal cardiovascular health behaviors and factors, multiple logistic regression method was used to calculate the OR and 95% CI for baseline behaviors and factors. RESULTS: The prevalence of nonalcoholic fatty liver disease according to 0-1, 2, 3, 4, 5-7 ideal cardiovascular health behaviors/factors were 62.6% , 48.9% , 33.3% , 16.1% and 7.5% , respectively. Results from the logistic model showed that after adjustment for age, gender, income, education level and other confounders, the ideal cardiovascular health behaviors/factors were associated with nonalcoholic fatty liver disease and the ORs (95% CI) were reduced gradually with the increase of ideal cardiovascular health behaviors/factors, which were 1,0.61(0.56-0.66), 0.37(0.34-0.40), 0.17(0.15-0.18) and 0.08 (0.07-0.09), respectively, in the 2, 3, 4, 5-7 ideal behaviors/factors groups. CONCLUSION: Ideal cardiovascular health behaviors and factors were associated with nonalcoholic fatty liver disease.

[Impact of resting heart rate on the progression to hypertension in prehypertension patients].

OBJECTIVE: To observe the effect of resting heart rate (RHR) on the progression to hypertension in patients with prehypertension. METHODS: People who participated the physical examination between 2006 and 2007 at Kailuan medical group and diagnosed as prehypentension were selected as the observation cohort. The second and the third physical examination were conducted between 2008 and 2009 and between 2010 and 2011. The observation population was divided into five groups according to the different levels of RHR at baseline: the first group ( ≤69 beats/min), the second group (70-74 beats/min), the third group (75-79 beats/min), the fourth group (80-84 beats/min) and the fifth group ( ≥85 beats/min). The rate of the progression to hypertension was compared among five groups, and the relationship between RHR and the progression to hypertension was estimated using Cox proportional hazard analysis. RESULTS: A total of 34 512 patients with prehypentension were recruited and 25 392 patients were involved in the final statistics after excluding patients who died or were lost to follow-up. A total of 13 228 (52.1%) patients with prehypentension developed hypertension during follow-up. The rate of the progression to hypertension increased with the RHR (first group: 51.2%, second group: 50.1%, third group: 52.9%, fourth group: 53.5%, fifth group: 57.5%). Multiple Cox regression models showed that the risk of the progression to hypertension increased with the RHR levels. Patients in the fifth group carried 1.25 times higher risk for developing hypertension than patients in the second group after adjustment for age, gender, systolic blood pressure, diastolic blood pressure, waist circumference, body mass index, triglyceride, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, fasting blood glucose, serum uric acid, C-reactive protein, smoking, drinking, physical exercise and family history of hypertension at baseline. CONCLUSION: Elevated RHR is an independent risk factor for the progression to hypertension in patients with prehypertension.

[Impact of isolated diastolic hypertension on new-onset cardiovascular and cerebro-vascular diseases].

OBJECTIVE: To explore the impact of isolated diastolic hypertension (IDH) on new-onset cardio-cerebral vascular diseases (CVD). METHODS: This cohort study involved 101 510 participants who were employees of the Kailuan Group-a state-run coal mining company, in 2006 and 2007. Among them, 6 780 subjects were diagnosed with IDH, 35 448 subjects were diagnosed with high-normal blood pressure and 19 460 subjects were diagnosed with normal tension. However, none of them had the history of either cardio-cerebral vascular disease or malignant cancer. Cardio-cerebral vascular events including cerebral infarction, cerebral hemorrhage, acute myocardial infarction were recorded every 6 months during the follow-up (47.1 ± 4.8) period. Multivariable Cox proportional hazards regression models were used to analyze the risk factors of first-ever CVD events. RESULTS: 1) There were 675 CVD events occurred during the follow-up period. The incidence rates of CVD events (1.7% vs. 0.9%), cerebral infarction (1.0% vs. 0.6%) and cerebral hemorrhage (0.4% vs. 0.1%) were significantly higher in IDH group than that in the normal tension group (all P < 0.05). 2) After adjustment for other established CVD risk factors, the hazards ratios became 1.67 (95% CI: 1.28-2.17) for total CVD events and 1.59 (95% CI: 1.12-2.27) for cerebral infarction and 2.67 (95% CI: 1.54-4.65) for cerebral hemorrhage in the IDH group. 3). In stratified analysis on age, after adjustment for other established CVD risk factors, the hazards ratio was 2.22 (95% CI: 1.41-3.50) for cerebral infarction in lower 60 years old group, while the it was 7.27 (95% CI: 2.58-20.42) for cerebral hemorrhage in groups older than 60 years of age. CONCLUSION: IDH was the independent risk factor for the total cardio-cerebral vascular events, on both cerebral infarction and cerebral hemorrhage. The predicted values of IDH for different CVD events were diverse on different age groups.

[Impact of premature birth on long term cardio-cerebral vascular events of puerpera].

OBJECTIVE: To investigate the impact of premature birth on long term cardio-cerebral vascular events of puerpera. METHODS: Ambispective cohort study method was used and 3 659 pregnant women giving birth during October 1976 to December 2008 at Kailuan medical group were included and divided into premature birth (PTB) group (n = 226) and non-PTB (NPTB) group (n = 3 433) by the history of PTB. Incidence of cardio-cerebral vascular events (myocardial infarction, cerebral infarction and cerebral hemorrhage) was obtained during follow-up. Multivariable Cox proportional hazards regression models was used to assess the relative risk of cardio-cerebral vascular events. RESULTS: (1) The childbearing age, proportion of pregnancy-induced hypertension, systolic blood pressure and diastolic blood pressure before delivery were significantly higher while weight and height of newborn were significantly less in PTB group than in NPTB group (P < 0.05 or 0.01). (2) There were 71 cardio-cerebral vascular events during the follow-up of (15.19 ± 7.75) years. In PTB group, the incidence of cardio-cerebral vascular events and myocardial infarction was 3.23/1 000 person-years and 2.05/1 000 person-years, respectively, while the corresponding incidence was 1.15/1 000 person-years and 0.42/1 000 person-years, respectively in NPTB group (all P < 0.05). After adjustment for other traditional cardiovascular risk factors, the risk of total cardio-cerebral vascular events, myocardial infarction in PTB group was 2.03 fold (95% CI: 1.02-4.04, P = 0.002) and 3.11 fold (95% CI: 1.18-8.18, P < 0.001) higher than in NPTB group. CONCLUSION: PTB is an independent risk factor for total cardio-cerebral vascular events, especially myocardial infarction of puerpera.