The impact of bilateral brachial-ankle pulse wave velocity difference on cardiovascular disease and all-cause mortality.

Background: This study aims to investigate the association between an elevated bilateral pulse wave velocity difference (BPWVD) and cardiovascular diseases (CVDs) and all-cause mortality. Methods: This study included a total of 38,356 participants. A multivariable Cox proportional hazards regression was used to assess the association between high BPWVD and the increased risk of CVDs and all-cause mortality by calculating hazard ratios (HRs) with 95% confidence intervals. Results: A total of 1,213 cases of CVDs were identified over a mean duration of 6.19 years, including 886 cases of cerebral infarction (CI), 105 cases of intracerebral hemorrhage (ICH), and 222 cases of myocardial infarction (MI), along with 1,182 cases of all-cause mortality. The median BPWVD was 42 cm/s (19-80 cm/s). After adjusting for all confounders and baseline brachial-ankle PWV (baPWV), our analysis revealed a significant correlation between a higher risk of CVDs, MI, and all-cause mortality with an increase in BPWVD per standard deviation. HRs (95% confidence interval) were found to be 1.06 (1.01-1.11), 1.11 (1.02-1.21), and 1.07 (1.04-1.10), respectively. Among the participants with higher baPWV on the left side, the HRs (95% confidence interval) were 1.08 (1.02-1.14) for CVDs, 1.27 (1.10-1.46) for incident ICH, 1.16 (1.00-1.24) for incident MI, and 1.10 (1.07-1.15) for all-cause mortality, for per standard deviation increase in BPWVD. Conclusions: Our findings reveal a significant correlation between elevated BPWVD and the risks of developing CVDs and all-cause mortality. This highlights the importance of thoroughly evaluating BPWVD as a means of detecting individuals at risk for CVDs and mortality.

Arterial Stiffness Preceding Diabetes: A Longitudinal Study.

RATIONALE: Previous studies on the relationship between diabetes and arterial stiffness were mostly cross-sectional. A few longitudinal studies focused on one single direction. Whether the association between arterial stiffness and diabetes is bidirectional remains unclear to date. OBJECTIVE: To explore the temporal relationship between arterial stiffness and fasting blood glucose (FBG) status. METHODS AND RESULTS: Included were 14 159 participants of the Kailuan study with assessment of brachial-ankle pulse wave velocity (baPWV) from 2010 to 2015, and free of diabetes, cardiovascular and cerebrovascular diseases, and chronic kidney disease at baseline. FBG and baPWV were repeatedly measured at baseline and follow-ups. Cox proportional hazard regression model was used to estimate hazard ratios and 95% confidence intervals (CIs) of incident diabetes across baseline baPWV groups: <1400 cm/s (ref), 1400≤ baPWV <1800 cm/s, and ≥1800 cm/s. Path analysis was used to analyze the possible temporal causal relationship between baPWV and FBG, among 8956 participants with repeated assessment of baPWV and FBG twice in 2010 to 2017. The mean baseline age of the observed population was 48.3±12.0 years. During mean 3.72 years of follow-up, 979 incident diabetes cases were identified. After adjusting for potential confounders, the hazard ratio (95% CI) for risk of diabetes was 1.59 (1.34-1.88) for the borderline arterial stiffness group and 2.11 (1.71-2.61) for the elevated arterial stiffness group, compared with the normal ideal arterial stiffness group. In the path analysis, baseline baPWV was associated with follow-up FBG (the standard regression coefficient was 0.09 [95% CI, 0.05-0.10]). In contrast, the standard regression coefficient of baseline FBG for follow-up baPWV (ß=0.00 [95% CI, -0.02 to 0.02]) was not significant. CONCLUSIONS: Arterial stiffness, as measured by baPWV, was associated with risk of developing diabetes. Arterial stiffness appeared to precede the increase in FBG.

Effect of resting heart rate on the risk of all-cause death in Chinese patients with hypertension: analysis of the Kailuan follow-up study.

OBJECTIVE: Previous studies have shown that an elevated heart rate is associated with a higher risk of cardiovascular events. This study aimed to prospectively examine the relationship between resting heart rate (RHR) and all-cause mortality in Chinese patients with hypertension. DESIGN: An observational, prospective and population-based cohort study. SETTING: The Kailuan cohort study was conducted in Tangshan City in northern China. PARTICIPANTS: We enrolled 46 561 patients who did not receive beta-blocker treatment and were diagnosed with hypertension for the first time during an employee health examination in Kailuan Group in 2006 and 2008. OUTCOME: The primary outcome of this study was all-cause mortality. METHODS: The patients in this study were followed for 9.25±1.63 years. All patients were followed up face to face every 2 years. According to the distribution of RHR in the study population, RHR was categorised into five groups on the basis of quintiles: Q1: RHR ≤68 beats per minute (bpm); Q2: RHR >68 and ≤72 bpm; Q3: RHR >72 and ≤76 bpm; Q4: RHR >76 and ≤82 bpm; Q5: RHR >82 bpm. Cox proportional hazards model, which was adjusted for traditional risk factors, was used. RESULTS: During follow-up, 4751 deaths occurred. After adjustment for potential confounders, restricted cubic spline regression showed that the risk of all-cause mortality increased with heart rate. In multivariate Cox regression analyses adjusted for age, sex and major covariates, the HR for all-cause mortality was 1.31 (95% CI 1.27 to 1.33) in the highest quintile group (Q5) compared with the lowest quintile group (Q1). CONCLUSION: An increase in RHR is a long-term risk factor of all-cause mortality in Chinese patients with hypertension. TRIAL REGISTRATION NUMBER: ChiCTR-TNC-11001489.

Association between healthy vascular aging and the risk of the first stroke in a community-based Chinese cohort.

In this study we tested whether vascular aging is associated with the risk of first stroke in the Kailuan cohort, a community-based Chinese cohort. For participants aged ≥ 50 years, healthy vascular aging (HVA) was defined as an absence of hypertension and a brachial-ankle pulse wave velocity < the mean + 2 standard deviations, which was determined from a reference sample of healthy participants aged < 30 years. The primary outcome was first stroke (ischemic or hemorrhagic). In total, 11,474 participants were enrolled. The prevalence of HVA decreased from 36.0% in participants aged 50-59 years to 4.7% in those aged ≥ 70 years. During a median follow-up of 3.3 years, the incidence of first stroke was 0.5% in the HVA group but was 2.6% in the Non-HVA group. After adjusting for confounding variables, HVA was associated with a 0.32-fold lower risk of first stroke compared to the Non-HVA group (95% confidence interval, 0.18-0.56; p < 0.001). It thus appears that HVA reduced the risk of first stroke in a community-based Chinese population. This suggests that evaluation of vascular aging as part of public health screening may be useful for stroke risk assessment.

Cumulative alcohol consumption and stroke risk in men.

BACKGROUNDS: Views on the relationship between alcohol consumption and stroke risk remain controversial. Moreover, data on cumulative alcohol intake are limited. We examined the potential impact of cumulative alcohol consumption on the risk of total stroke and its subtypes in men. METHODS: This prospective study included 23,433 men from the Kailuan Study. Cumulative alcohol consumption was taken as the primary exposure by calculating self-reported alcohol consumption from three consecutive examinations (in 2006, 2008, and 2010). The first occurrence of stroke was confirmed by reviewing medical records from 2010 to 2016. We used Cox proportional hazards regression to analyze the data. RESULTS: During the 5.9 ± 0.8 years of follow-up, 678 total strokes were identified, including 595 ischemic stroke (IS), 90 intracerebral hemorrhage and 19 subarachnoid hemorrhage cases. The adjusted hazard ratios (95% confidence intervals) of total stroke for light, moderate and heavy cumulative alcohol consumption were 1.23 (1.01-1.51), 1.49 (1.13-1.97), and 1.50 (1.21-1.86), respectively, compared with those of nondrinkers. The results were similar for IS. Cumulative alcohol consumption was not associated with intracerebral hemorrhage risk (hazard ratio 1.46; 95% confidence interval, 0.74-2.08). CONCLUSIONS: Cumulative alcohol consumption is an independent risk factor of total stroke and IS in men in a community-based cohort. Even light alcohol intake increases the risk of total stroke and IS.

Cumulative mean arterial pressure and risks of adverse cardiac and cerebrovascular events: a prospective cohort study of 53,813 adults.

The association between cumulative mean arterial blood pressure (MAP) and risks of adverse cardiac and cerebrovascular events (CCVEs) has not been characterized. This prospective cohort study included 53,813 participants, free of prior myocardial infarction or stroke in or before 2010 (baseline) from a community-based cohort including 101,510 participants. Cumulative MAP was defined as the summed average MAP for each pair of consecutive examinations multiplied by the time interval with the data from previous surveys (2006- 2007, 2008 to 2009, 2010-2011). Incident adverse CCVEs were ascertained by both the information collection in biennial follow-up surveys (2012-2013, 2014-2015) and surveying each year's discharge lists from local hospitals and death certificates from state vital statistics offices by three experienced physicians blinded to the study design. The study population were stratified into quartiles based on cumulative MAP (<354.62 mmHg, n = 13,454; 354.62 to 392.82 mmHg, n = 13,452; 392.82 to 438.04 mmHg, n = 13 453; ≥ 438.04 mmHg, n = 13,454). We documented 1055 incident adverse CCVEs, including 271 myocardial infarction and 794 stroke (10 comorbid with myocardial infarction), which consisted of 673 ischemic stroke and 134 hemorrhagic stroke (13 comorbid with ischemic stroke). The incidence of adverse CCVEs increased with the increase of cumulative MAP with significant difference (p < 0.001). Cox proportional hazards regression models revealed the elevated cumulative MAP as an independent risk factor for adverse CCVEs, especially hemorrhagic stroke, after adjusting potential confounders. A J-shaped relationship between cumulative MAP and hemorrhagic stroke was also observed.

High SBP trajectories are associated with risk of all-cause death in general Chinese population.

OBJECTIVE: This study aimed to investigate whether long-term trajectories of high SBP can further predict risk of all-cause death in Chinese adults. METHODS: We used a community-based cohort of 84 363 participants without myocardial infarction, stroke, or cancer, in 2010. SBP trajectories used latent mixture modeling with data from 2006, 2008, and 2010. Cox proportional hazards models were used to examine the association between SBP trajectories and risk of all-cause death in 2010-2015. RESULTS: We identified five distinct SBP trajectory patterns based on the 2006 status and the pattern of change during 2006-2010. Each pattern was labeled according to the SBP levels and pattern over time: low-stable (n = 21 249), moderate-stable (n = 39 390), moderate-increasing (n = 9634), elevated-decreasing (n = 9094) and elevated-stable (n = 4996). During 5.24 ±â€Š1.04 years of follow-up, we documented 4131 deaths. After adjusting for potential confounding factors and using the low-stable group as a reference, hazard ratios [95% confidence interval (CI)] of all-cause death for the moderate-stable, moderate-increasing, elevated-decreasing, and elevated-stable groups were 1.32 (1.12-1.56), 1.60 (1.26-2.04), 1.69 (1.38-2.07), and 1.75 (1.33-2.32), respectively. Although the moderate-stable trajectory exhibited SBP ranges within the 'normal' range (126.90-130.09 mmHg) in 2006-2010, this group had higher all-cause death risk relative to the low-stable trajectory group (109.86-112.46 mmHg) (adjusted hazard ratio = 1.32, 95% CI 1.12-1.56). CONCLUSION: High SBP trajectories are independent risk factors for all-cause death. Our findings suggest increasing SBP trajectories within the currently designated 'normal' range may still increase risk of all-cause death.

Correlation between the trajectory of systolic blood pressure and new renal damage in a nonhypertensive population.

OBJECTIVE: This study aims to investigate the correlation between the trajectory of systolic blood pressure (SBP) and new renal damage in a nonhypertensive population. PATIENTS AND METHODS: This prospective cohort study included a total of 14 382 nonhypertensive individuals, employees of Kailuan Group of Companies, who took part in five healthy examinations in 2006-2007, 2008-2009, 2010-2011, 2012-2013, and 2014-2015, and had complete data. These individuals were divided into four groups according to the different trajectories of SBP: low-low, low-stable, middle-high, and high-high groups. The correlation between the trajectory of SBP and new renal damage in a nonhypertensive population was analyzed using a multivariate Cox's proportional hazard regression model. RESULTS: (a) A total of 14 382 individuals had complete data and the average age of these individuals was 44.6±10.8 years. Among these, 10 888 (75.7%) individuals were men and 3494 (24.3%) individuals were women. (b) These individuals were divided into four groups according to different trajectories of blood pressure: low-low group, accounting for 13.15% (blood pressure was <106 mmHg); low-stable group, accounting for 53.91% (blood pressure was between 115 and 116 mmHg); middle-high group, accounting for 28.77% (blood pressure was between 125 and 131 mmHg); and high-high group, accounting for 4.6% (blood pressure was between 126 and 151 mmHg). (c) With the increase in the trajectory of SBP, the detection rate of renal damage increased gradually. From the low-low group to the high-high group, the detection rates of estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m were 2.3, 2.4, 3.6, and 4.3%, respectively; the positive rates of urinary protein were 1.7, 2.9, 3.8, and 5.5%, respectively; and the detection rates of eGFR less than 60 ml/min/1.73 m or positive urinary protein were 4, 5.2, 7.3, and 9.3%, respectively (P<0.05). (d) After adjustment for other confounding factors, multivariate Cox's proportional hazard regression analysis showed that compared with the low-low group, the risk of eGFR less than 60 ml/min/1.73 m increased by nearly 1.5 times in the high-high group and in the low-stable, middle-high, and high-high groups, the risks of positive urinary protein, eGFR less than 60 ml/min/1.73 m, or positive urinary protein increased by 1.48-2.34 and 1.20-1.70 times, respectively. CONCLUSION: In a nonhypertensive population, the high trajectory of SBP is a risk factor for kidney damage.

Association of Cumulative Exposure to Resting Heart Rate with Risk of Stroke in General Population: The Kailuan Cohort Study.

BACKGROUND AND PURPOSE: It remains unclear whether resting heart rate (RHR), particularly cumulative exposure to resting heart rate (cumRHR), is associated with stroke. The aim of our study was to prospectively explore the relationship between cumRHR and stroke morbidity. MATERIALS AND METHODS: The Kailuan study is a prospective longitudinal cohort study on cerebrovascular events and cardiovascular factors. Hazard ratios (HRs) with 95% confidence interval (CI) were calculated using a Cox competing risk model. RESULTS: A total of 46,568 participants were included in the final analysis. In the observation population, we identified 851 stroke events and 1012 incident death cases in the 4.98 ± .51 year followed-up. Each 46.74 (beats/min) × year increase in heart rate was associated with a 12% increase in the risk of stroke (HR = 1.12, 95% CI = 1.05-1.20). In the categorical model, the highest quartile had an increased risk of stroke (HR = 1.43, 95% CI = 1.13-1.81), compared with the bottom quartile. Gender and age had no interaction with cumRHR for the risk of stroke. CONCLUSION: Increase of exposure to cumulative heart rate is independently associated with a higher risk of stroke in the general population.

Cumulative Resting Heart Rate Exposure and Risk of All-Cause Mortality: Results from the Kailuan Cohort Study.

The relationship between cumulative exposure to resting heart rate (cumRHR) and mortality remain unclear in the general population. In the Kailuan cohort study, resting heart rate (RHR) was repeatedly measured at baseline and at years 2 and 4 by electrocardiogram among 47,311 adults aged 48.70 ± 11.68. The cumRHR was defined as the summed average RHR between two consecutive examinations multiplied by the time interval between with two examinations [(beats/min) * year]. A higher RHR was defined as ≥80 beats/min, and the number of visits with a higher RHR was counted. During a median of 4.06 years of follow-up, a total of 1,025 participants died. After adjusting for major traditional cardiovascular risk factors and baseline RHR, the hazard ratio for the highest versus lowest quartile of cumRHR was 1.39 (95% CI: 1.07-1.81) for all-cause mortality. Each 1-SD increment in cumRHR was associated with a 37% (HR: 1.37, 95% CI: 1.23-1.52) increased risk of death and displayed a J-shaped relationship. Compared with no exposure, adults who had a higher RHR at all 3 study visits were associated with a 1.86-fold higher risk (95% CI: 1.33-2.61) of mortality. In summary, cumulative exposure to higher RHR is independently associated with an increased risk of mortality.