Physicochemical, structural and functional properties of low methoxyl pectin­iron (III) complex and its effect on rats with iron deficiency anemia.

Iron deficiency anemia (IDA) is the most common nutritional disease worldwide. In this study, a low methoxyl pectin (LMP)­iron(III) complex was prepared. The physicochemical and structural properties were characterized by HPSEC, HPIC, CV, FTIR, 1H NMR, XRD, SEM and CD. The results showed that iron increased the molecular weight of the LMP­iron(III) from 11.50 ± 0.32 to 12.70 ± 0.45 kDa and improved its crystallinity. Moreover, the findings demonstrated that -OH and -COOH groups in LMP coordinate with Fe3+ to form ß-FeOOH. The water-holding capacity, emulsion stability, and antioxidant activities of the LMP­iron(III) were lower than those of LMP. Furthermore, the therapeutic effects of LMP­iron(III) on IDA were investigated in rats. Following LMP­iron(III) supplementation, compared with the model group, the administration of LMP­iron(III) significantly increased the body weight, hemoglobin concentration, and serum iron concentration as well as decreased free erythrocyte protoporphyrin concentration. Therefore, the LMP­iron(III) can potentially treat IDA in rats experiments, providing a theoretical basis for the development of a promising iron supplement.

Healthy lifestyle, statin, and mortality in people with high CVD risk: A nationwide population-based cohort study.

Objective: To examine the joint association of healthy lifestyles and statin use with all-cause and cardiovascular mortality in high-risk individuals, and evaluate the survival benefits by life expectancy. Methods: During 2015-2021, participants aged 35-75 years were recruited by the China Health Evaluation And risk Reduction through nationwide Teamwork. Based on number of healthy lifestyles related to smoking, alcohol drinking, physical activity, and diet, we categorized them into: very healthy (3-4), healthy (2), and unhealthy (0-1). Statin use was determined by self-report taking statin in last two weeks. Results: Among the 265,209 included participants at high risk, 6979 deaths were observed, including 3236 CVD deaths during a median 3.6 years of follow-up. Individuals taking statin and with a very healthy lifestyle had the lowest risk of all-cause (HR: 0.70; 95 %CI: 0.57-0.87) and cardiovascular mortality (0.56; 0.40-0.79), compared with statin non-users with an unhealthy lifestyle. High-risk participants taking statin and with a very healthy lifestyle had the highest years of life gained (5.90 years at 35-year-old [4.14-7.67; P < 0.001]) compared with statin non-users with an unhealthy lifestyle among high-risk people. And their life expectancy was comparable with those without high risk but with a very healthy lifestyle (4.49 vs. 4.68 years). Conclusion: The combination of preventive medication and multiple healthy lifestyles was associated with lower risk of all-cause and cardiovascular mortality and largest survival benefits. Integrated strategy to improve long-term health for high-risk people was urgently needed.

Association of high-density lipoprotein cholesterol with all-cause and cause-specific mortality in a Chinese population of 3.3 million adults: a prospective cohort study.

Background: High-density lipoprotein cholesterol (HDL-C) has been inversely associated with cardiovascular disease (CVD) risk, but recent evidence suggests that extremely high levels of HDL-C are paradoxically related to increased CVD incidence and mortality. This study aimed to comprehensively examine the associations of HDL-C with all-cause and cause-specific mortality in a Chinese population. Methods: The China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART) project included 3,397,547 participants aged 35-75 years with a median follow-up of 3.9 years. Baseline HDL-C levels were measured, and mortality data was ascertained from the National Mortality Surveillance System and Vital Registration of Chinese Center for Disease Control and Prevention. Findings: This study found U-shaped associations of HDL-C with all-cause, cardiovascular and cancer mortality. When compared with the groups with the lowest risk, the adjusted hazard ratios (95% CIs) for HDL-C <30 mg/dL was 1.23 (1.17-1.29), 1.33 (1.23-1.45) and 1.18 (1.09-1.28) for all-cause, CVD and cancer mortality, respectively. For HDL-C >90 mg/dL, the corresponding HR (95% CIs) was 1.10 (1.05-1.15), 1.09 (1.01-1.18) and 1.11 (1.03-1.19). Similar U-shaped patterns were also found in associations of HDL-C with ischemic heart disease, ischemic stroke, and liver cancer. About 3.25% of all-cause mortality could be attributed to abnormal levels of HDL-C. The major contributor to mortality was ischemic heart disease (16.06 deaths per 100,000 persons, 95% UI: 10.30-22.67) for HDL-C <40 mg/dL and esophageal cancer (2.29 deaths per 100,000 persons, 95% UI: 0.57-4.77) for HDL-C >70 mg/dL. Interpretation: Both low and high HDL-C were associated with increased mortality risk. We recommended 50-79 mg/dL as the optimal range of HDL-C among Chinese adults. Individuals with dyslipidemia might benefit from proper management of both low and high HDL-C. Funding: The CAMS Innovation Fund for Medical Science (2021-1-I2M-011), the National High Level Hospital Clinical Research Funding (2022-GSP-GG-4), the Ministry of Finance of China and National Health Commission of China, and the 111 Project from the Ministry of Education of China (B16005), the Program for Guangdong Introducing Innovative and Enterpreneurial Teams (2019ZT08Y481), Sanming Project of Medicine in Shenzhen (SZSM201811096), the Young Talent Program of the Academician Fund, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen (YS-2022-006) and Guangdong Basic and Applied Basic Research Foundation (2023A1515010076 & 2021A1515220173).

Associations between Chinese visceral adiposity index and risks of all-cause and cause-specific mortality: A population-based cohort study.

AIM: To determine the associations between the Chinese visceral adiposity index (CVAI) and the risks of all-cause and cause-specific mortality. MATERIALS AND METHODS: A total of 3 916 214 Chinese adults were enrolled in a nationwide population cohort covering all 31 provinces of mainland China. The CVAI was calculated based on age, body mass index, waist circumference, and triglyceride and high-density lipoprotein cholesterol concentrations. We used a Cox proportional hazards regression model to determine the hazard ratios and 95% confidence intervals (CIs) for risk of mortality associated with different CVAI levels. RESULTS: The median follow-up duration was 3.8 years. A total of 86 158 deaths (34 867 cardiovascular disease [CVD] deaths, 29 884 cancer deaths, and 21 407 deaths due to other causes) were identified. In general, after adjusting for potential confounding factors, a U-shaped relationship between CVAI and all-cause mortality was observed by restricted cubic spline (RCS). Compared with participants in CVAI quartile 1, those in CVAI quartile 4 had a 23.0% (95% CI 20.0%-25.0%) lower risk of cancer death, but a 23.0% (95% CI 19.0-27.0) higher risk of CVD death. In subgroup analysis, a J-shaped and inverted U-shaped relationship for all-cause mortality and cancer mortality was observed in the group aged < 60 years. CONCLUSIONS: The CVAI, an accessible indicator reflecting visceral obesity among Chinese adults, has predictive value for all-cause, CVD, and cancer mortality risks. Moreover, the CVAI carries significance in the field of health economics and secondary prevention. In the future, it could be used for early screening purposes.

Associations of remnant cholesterol with cardiovascular and cancer mortality in a nationwide cohort.

The health significance of triglyceride-rich lipoproteins, also known as remnant cholesterol, has been increasingly recognized. However, evidence of their associations with cause-specific mortality in the general population was previously insufficient. To explore these associations and their heterogeneities across subgroups, a prospective cohort study was conducted including 3,403,414 community-based participants from ChinaHEART, an ongoing government-funded public health program throughout China, from November 2014 through December 2022. The study assessed mortality risk of all-cause mortality, cardiovascular disease (CVD) mortality (including mortality from ischemic heart diseases (IHD), ischemic stroke (IS), and hemorrhagic stroke (HS), separately), and cancer mortality (including lung cancer, stomach cancer, and liver cancer, separately). During the 4-year follow-up, 23,646 individuals died from CVD (including 8807 from IHD, 3067 from IS, and 5190 from HS), and 20,318 from cancer (including 6208 from lung cancer, 3013 from liver cancer, and 2174 from stomach cancer). Compared with individuals with remnant cholesterol <17.9 mg/dL, multivariable-adjusted mortality hazard ratios (HRs) for individuals with remnant cholesterol ≥27.7 mg/dL were 1.03 (1.00-1.05) for all-cause mortality, 1.17 (1.12-1.21) for CVD (1.19 (1.12-1.27) for IHD mortality, and 1.22 (1.09-1.36) for IS mortality), and 0.90 (0.87-0.94) for all-cancer mortality (0.94 (0.87-1.02) for lung cancer, 0.59 (0.53-0.66) for liver cancer, and 0.73 (0.64-0.83) for stomach cancer). In summary, this study revealed a correlation between increased remnant cholesterol levels and an elevated risk of cardiovascular disease mortality, as well as a reduced risk of mortality for certain types of cancer.

Influence of Socioeconomic Gender Inequality on Sex Disparities in Prevention and Outcome of Cardiovascular Disease: Data From a Nationwide Population Cohort in China.

Background Knowledge gaps remain in how gender-related socioeconomic inequality affects sex disparities in cardiovascular diseases (CVD) prevention and outcome. Methods and Results Based on a nationwide population cohort, we enrolled 3 737 036 residents aged 35 to 75 years (2014-2021). Age-standardized sex differences and the effect of gender-related socioeconomic inequality (Gender Inequality Index) on sex disparities were explored in 9 CVD prevention indicators. Compared with men, women had seemingly better primary prevention (aspirin usage: relative risk [RR], 1.24 [95% CI, 1.18-1.31] and statin usage: RR, 1.48 [95% CI, 1.39-1.57]); however, women's status became insignificant or even worse when adjusted for metabolic factors. In secondary prevention, the sex disparities in usage of aspirin (RR, 0.65 [95% CI, 0.63-0.68]) and statin (RR, 0.63 [95% CI, 0.61-0.66]) were explicitly larger than disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR, 0.88 [95% CI, 0.84-0.91]) or ß blockers (RR, 0.67 [95% CI, 0.63-0.71]). Nevertheless, women had better hypertension awareness (RR, 1.09 [95% CI, 1.09-1.10]), similar hypertension control (RR, 1.01 [95% CI, 1.00-1.02]), and lower CVD mortality (hazard ratio, 0.46 [95% CI, 0.45-0.47]). Heterogeneities of sex disparities existed across all subgroups. Significant correlations existed between regional Gender Inequality Index values and sex disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (Spearman correlation coefficient, r=-0.57, P=0.0013), hypertension control (r=-0.62, P=0.0007), and CVD mortality (r=0.45, P=0.014), which remained significant after adjusting for economic factors. Conclusions Notable sex disparities remain in CVD prevention and outcomes, with large subgroup heterogeneities. Gendered socioeconomic factors could reinforce such disparities. A sex-specific perspective factoring in socioeconomic disadvantages could facilitate more targeted prevention policy making.

Educational inequalities in mortality and their mediators among generations across four decades: nationwide, population based, prospective cohort study based on the ChinaHEART project.

OBJECTIVES: To assess the different educational inequalities in mortality among generations born between 1940 and 1979 in China, and to investigate the role of socioeconomic, behavioural, and metabolic factors as potential contributors to the reduction of educational inequalities. DESIGN: Nationwide, population based, prospective cohort study. SETTING: The ChinaHEART (China Health Evaluation And risk Reduction through nationwide Teamwork) project in all 31 provinces in the mainland of China. PARTICIPANTS: 1 283 774 residents aged 35-75 years, divided into four separate cohorts born in 1940s, 1950s, 1960s, and 1970s. MAIN OUTCOME MEASURES: Relative index of inequality and all cause mortality. RESULTS: During a median follow-up of 3.5 years (interquartile range 2.1-4.7), 22 552 deaths were recorded. Among the four generations, lower education levels were found to be associated with a higher risk of all cause death: Compared with participants with college level education or above, the hazard ratio for people with primary school education and below was 1.4 (95% confidence interval 1.2 to 1.7) in the 1940s cohort, 1.8 (1.5 to 2.1) in the 1950s cohort, 2.0 (1.7 to 2.4) in the 1960s cohort, and 1.8 (1.4 to 2.4) in the 1970s cohort. Educational relative index of inequality in mortality increased from 2.1 (95% confidence interval 1.9 to 2.3) in the 1940s cohort to 2.6 (2.1 to 3.3) in the 1970s cohort. Overall, the mediation proportions were 37.5% (95% confidence interval 32.6% to 42.8%) for socioeconomic factors, 13.9% (12.0% to 16.0%) for behavioural factors, and 4.7% (3.7% to 5.8%) for metabolic factors. Except for socioeconomic measurements, the mediating effects by behavioural and metabolic factors decreased in younger generations. CONCLUSION: Educational inequalities in mortality increased over generations in China. Improving healthy lifestyles and metabolic risk control for less educated people, especially for younger generations, is essential to reduce health inequalities.

Primary care institutional characteristics associated with hypertension awareness, treatment, and control in the China PEACE-Million Persons Project and primary health-care survey: a cross-sectional study.

BACKGROUND: Since 2010, China has made vast financial investments and policy changes to the primary care system. We aimed to assess how hypertension awareness, treatment, and control might be used to assess quality of primary care systems, which reflect the outcomes of public health services and medical care. METHODS: We used The China Patient-centred Evaluative Assessment of Cardiac Events Million Persons Project, a government-funded public health project that focuses on cardiovascular disease risk in China. We linked primary care institution characteristics that were captured in the survey between 2016 and 2017 to the participant-level data gathered in baseline visits between 2014 and 2021. Participants were included if they had hypertension and lived in the towns or streets that took part in the primary care survey. Participants were excluded if they had missing data for blood pressure measurement, history of hypertension, sex, or age. Primary care institutions were excluded if the catchment area had fewer than 100 participants with hypertension. Hypertension awareness was defined as the proportion of participants with hypertension who self-reported a hypertension diagnosis. Hypertension treatment was defined as the proportion of participants who currently use antihypertensive medications among those who were aware. Hypertension control was defined as the proportion of participants with an average systolic blood pressure less than 140 mm Hg and an average diastolic blood pressure less than 90 mm Hg over two readings among those who were treated during the study. All patients were included in the analysis. This trial was registered at ClinicalTrials.gov, NCT02536456. FINDINGS: Between Sept 15, 2014, and March 16, 2021, we assessed 503 township-level primary care institutions for eligibility. 70 institutions were excluded as they could not be linked with individual data or because their catchment area had fewer than 100 participants with hypertension. We analysed 433 township-level primary care institutions across all 31 provinces of mainland China, including 660 565 individuals with hypertension in their catchment areas. Across townships, age-sex standardised hypertension awareness varied from 8·2% to 81·0%, treatment varied from 2·6% to 96·5%, and control proportions varied from 0% to 62·4%. Hypertension awareness, treatment, and control were significantly associated with the following institutional characteristics: government funding through balance allocation (ie, institutions have their human resources funded by local government, but need to be self-supporting in other aspects; awareness odds ratio 0·88, 95% CI 0·78-0·99; p=0·027), having financial problems that interrupted routine service delivery (awareness 0·81, 0·72-0·92; p=0·0007, control 0·84; 0·75-0·94, p=0·0034), setting performance-based bonus (treatment 1·39, 1·07-1·80; p=0·013), basic salary defined by number of patient visits (control 0·85, 0·76-0·95; p=0·0053), using electronic referrals (treatment 1·41, 1·14-1·73; p=0·0012, control 1·17; 1·03-1·33, p=0·014), implementing family physician contract services (awareness 1·13, 1·00-1·28; p=0·045, control 1·30; 1·15-1·46, p<0·0001), and proportion of physicians who are formally licensed (awareness per 10% increase 1·04, 1·01-1·08; p=0·019, treatment 1·08; 1·02-1·14, p=0·0077; control per 10% increase 1·07, 1·03-1·10; p=0·0006). INTERPRETATION: The role of primary care role in hypertension management might benefit from new strategies that promote best practices in institutional financing, performance appraisal, service delivery, and information technology. FUNDING: Chinese Academy of Medical Sciences Innovation Fund for Medical Science, and the National High Level Hospital Clinical Research Funding. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Cardiovascular disease prevention and mortality across 1 million urban populations in China: data from a nationwide population-based study.

BACKGROUND: China has been undergoing a rapid urbanisation. There are substantial disparities between old and new urban citizens in access to health care. We aimed to compare cardiovascular disease prevention and death risks among four distinct urban groups. METHODS: Urban residents aged 35-75 years living in 96 prefecture-level cities from 31 provinces in mainland China were enrolled in the national population-based cohort China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project. They were categorised into four groups by their former and current places of residence as follows: old-urban in situ residents (local residents in established urban areas since birth), new-urban in situ residents (local residents in newly urbanised areas established during urbanisation), urban-to-urban migrants (migrants from other urban areas), and rural-to-urban migrants (migrants from rural areas). We excluded participants with missing data for former and current places of residence, medical history, socioeconomic status, or lifestyle information. After adjusting for demographic and socioeconomic characteristics, relative risks (RRs) of cardiovascular disease prevention indicators and hazard ratios (HRs) of cardiovascular mortality and all-cause mortality of the other three population groups were estimated by modified log-Poisson models with robust standard error and Cox proportional hazard models, with old-urban in situ residents as the reference group. FINDINGS: From Sept 1, 2015, to Aug 17, 2020, 1 339 329 residents were enrolled, 270 606 were excluded for missing data in key variables, and 1 068 723 were subsequnetly included in the study. Compared with old-urban in situ residents, new-urban in situ residents were less likely to adhere to a healthy diet (RR 0·72 [95% CI 0·62-0·83]), while no significant results were observed in rural-to-urban migrants; new-urban in situ residents were less likely to use statins as primary prevention (RR 0·60 [0·46-0·79]), angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs; RR 0·78 [0·65-0·93]) and ß-blockers (RR 0·68 [0·53-0·88]) as secondary prevention; and rural-to-urban migrants were less likely to use aspirin as a primary (RR 0·67 [0·46-0·96]) and secondary (RR 0·71 [0·54-0·94]) prevention and statins (RR 0·70 [0·51-0·97]) and ACEIs or ARBs (RR 0·68 [0·50-0·93]) as secondary prevention. Furthermore, in people diagnosed with hypertension, new-urban in situ residents were less likely to have their blood pressure controlled (RR 0·79 [95% CI 0·72-0·87]), while no significant results were observed in rural-to-urban migrants. New-urban in situ residents had higher risk of cardiovascular mortality (HR 1·16 [95% CI 1·05-1·29]; p=0·005) than did old-urban in situ residents, after a median follow-up of 2·7 years (IQR 2·0-4·2). INTERPRETATION: New-urban in situ residents and rural-to-urban migrants both showed poorer utilisation of primary and secondary prevention medications than did old-urban in situ residents, while new-urban in situ residents also had lower adherence to healthy lifestyles and higher death risks. Comprehensive measures should be taken to strengthen the primary health-care system in newly urbanised areas, and promote interprovincial medical insurance reimbursement. FUNDING: Chinese Academy of Medical Sciences Innovation Fund for Medical Science and the National High Level Hospital Clinical Research Funding. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Prevalence, treatment, and attributed mortality of elevated blood pressure among a nationwide population-based cohort of stroke survivors in China.

Background: Elevated blood pressure (BP) is associated with substantial morbidity and mortality in stroke survivors. China has the highest prevalence of stroke survivors and accounts for one-third of stroke-related deaths worldwide. We aimed to describe the prevalence and treatment of elevated BP across age, sex, and region, and assess the mortality attributable to elevated BP among stroke survivors in China. Materials and methods: Based on 3,820,651 participants aged 35-75 years from all 31 provinces in mainland China recruited from September 2014 to September 2020, we assessed the prevalence and treatment of elevated BP (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) among those with self-reported stroke and stratified by age group, sex, and geographic region. We estimated the age- and sex-specific population attributable fractions of death from elevated BP. Results: Among 91,406 stroke survivors, the mean (SD) age was 62 (8) years, and 49.0% were male. The median interquartile range (IQR) stroke duration was 4 (2, 7) years. The prevalence of elevated BP was 61.3% overall, and increased with age (from 47.5% aged 35-44 years to 64.6% aged 65-75 years). The increment of prevalence was larger in female patients than male patients. Elevated BP was more prevalent in northeast (66.8%) and less in south (54.3%) China. Treatment rate among patients with elevated BP was 38.1%, and rates were low across all age groups, sexes, and regions. Elevated BP accounted for 33 and 21% of cardiovascular and all-cause mortality among stroke survivors, respectively. The proportion exceeded 50% for cardiovascular mortality among patients aged 35-54 years. Conclusion: In this nationwide cohort of stroke survivors from China, elevated BP and its non-treatment were highly prevalent across all age groups, sexes, and regions. Elevated BP accounted for nearly one-third cardiovascular mortality in stroke survivors, and particularly higher in young and middle-aged patients. National strategies targeting elevated BP are warranted to address the high stroke burden in China.

Association between clustering of cardiovascular risk factors and resting heart rate in Chinese population: a cross-sectional study.

BACKGROUND: Epidemiologic studies have explored the association between a single cardiovascular risk factor (CVRF) and resting heart rate (RHR), but the research on the relation of multiple risk factors with RHR remains scarce. This study aimed to explore the associations between CVRFs clustering and the risk of elevated RHR. METHODS: In this cross-sectional study, adults aged 35-75 years from 31 provinces were recruited by the China PEACE Million Persons Projects from September 2015 to August 2020. We focused on seven risk factors: hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, alcohol use, and low physical activity. Multivariate logistic regression was used to calculate odds ratios (OR) for elevated RHR (> 80 beats/min). RESULTS: Among 1,045,405 participants, the mean age was 55.67 ± 9.86 years, and 60.4% of participants were women. The OR (95% CI) for elevated RHR for the groups with 1, 2, 3, 4 and ≥ 5 risk factor were 1.11 (1.08-1.13), 1.36 (1.33-1.39), 1.68 (1.64-1.72), 2.01 (1.96-2.07) and 2.58 (2.50-2.67), respectively (P trend < 0.001). The association between the CVRFs clustering number and elevated RHR was much more pronounced in young males than in other age-sex subgroups. Clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR than those comprising more behavioral risk factors. CONCLUSIONS: There was a significant positive association between the CVRFs clustering number and the risk of elevated RHR, particularly in young males. Compared clusters comprising more behavioral risk factors, clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR. RHR may serve as an indicator of the cumulative effect of multiple risk factors.

Alcohol use disorder and its association with quality of life and mortality in Chinese male adults: a population-based cohort study.

AIMS: We aimed to demonstrate the distribution of alcohol use disorder (AUD) in China and assess its association with quality of life and mortality. METHODS: We studied 367 120 men aged 35-75 years from 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project. At baseline, AUD was assessed by alcohol use disorders identification test score, and EQ-5D-3L questionnaire was used to measure the quality of life. Mortality data was collected via National Mortality Surveillance System and Vital Registration. Mixed models were fitted to assess the associations of AUD with quality of life, and Cox proportional hazard models were fitted for the associations with all-cause and cause-specific mortality. RESULTS: We identified 39 163 men with AUD, which accounted for 10.7% of male participants and 25.8% of male drinkers. In the multivariable analysis, male drinkers who were aged 45-54 years, with higher education level, currently smoking, obese, with diagnosed hypertension, and without diagnosed cardiovascular diseases had higher rates of AUD. Male drinkers with AUD were less likely to have optimal QOL compared with those without AUD (OR: 0.63, 95% CI: 0.61-0.65, P < 0.001). Moreover, among male drinkers, AUD was prospectively associated with a 20% higher risk for all-cause mortality and a 30% higher risk for mortality from cancer. CONCLUSIONS: In China one fourth of men who drank alcohol had AUD, which was associated with lower QOL and higher risk of all-cause mortality. National policies or strategies are urgently needed to control alcohol-related harms.

Atherosclerotic Cardiovascular Disease Risk and Lipid-Lowering Therapy Requirement in China.

Background: Lipid-lowering therapy (LLT) is one of the key strategies for reducing the atherosclerotic cardiovascular disease (ASCVD) burden. However, little is known about the percentage of people in need of different LLT regimens to achieve optimal targets of low-density lipoprotein cholesterol (LDL-C), and the corresponding cost and benefit. Methods: We conducted a simulation study based on the data from the nationwide China PEACE MPP population cohort (2015-2020), from which we included 2,904,914 participants aged 35-75 years from all the 31 provinces in mainland China. Participants were grouped based on their 10-year ASCVD risks, then entered into a Monte Carlo model which was used to perform LLT intensification simulation scenarios to achieve corresponding LDL-C goals in each risk stratification. Results: After standardizing age and sex, the proportions of participants included at low, moderate, high, and very-high risk were 70.8%, 15.6%, 11.5%, and 2.1%, respectively. People who failed to achieve the corresponding LDL-C goals -8.1% at low risk, 19.6% at moderate risk, 53.2% at high risk, and 93.6% at very-high risk (either not achieving the goal or not receiving LLT)-would be in need of the LLT intensification simulation. After the use of atorvastatin 20 mg was simulated, over 99% of the population at low or moderate risk could achieve the LDL-C goals; while 11.3% at high and 24.5% at very-high risk would still require additional non-statin therapy. After the additional use of ezetimibe, there were still 4.8% at high risk and 11.3% at very-high risk in need of evolocumab; and 99% of these two groups could achieve the LDL-C goals after the use of evolocumab. Such LLT intensification with statin, ezetimibe, and evolocumab would annually cost $2.4 billion, $4.2 billion, and $24.5 billion, respectively, and prevent 264,170, 18,390, and 17,045 cardiovascular events, respectively. Conclusions: Moderate-intensity statin therapy is pivotal for the attainment of optimal LDL-C goals in China, and around 10-25% of high- or very-high-risk patients would require additional non-statin agents. There is an opportunity to reduce the rising ASCVD burden in China by optimizing LLT.

Healthy lifestyle behaviours and all-cause and cardiovascular mortality among 0.9 million Chinese adults.

BACKGROUND: Healthy lifestyle behaviours are effective means to reduce the burden of diseases. This study was aimed to fill the knowledge gaps on the distribution, associated factors, and potential health benefits on mortality of four healthy lifestyle behaviours in China. METHODS: During 2015-2019, participants aged 35-75 years from 31 provinces were recruited by the China PEACE Million Persons Project. Four healthy lifestyle behaviours were investigated in our study, including non-smoking, none or moderate alcohol use, sufficient leisure time physical activity (LTPA), and healthy diet. RESULTS: Among 903,499 participants, 74.1% were non-smokers, 96.0% had none or moderate alcohol use, 23.6% had sufficient LTPA, 11.1% had healthy diet, and only 2.8% had all the four healthy lifestyle behaviours. The adherence varied across seven regions; the highest median of county-level adherence to all the four healthy lifestyle behaviours was in North China (3.3%) while the lowest in the Southwest (0.8%) (p < 0.05). Participants who were female, elder, non-farmers, urban residents, with higher income or education, hypertensive or diabetic, or with a cardiovascular disease (CVD) history were more likely to adhere to all the four healthy lifestyle behaviours (p < 0.001). County-level per capital Gross Domestic Product (GDP) was positively associated with sufficient LTPA (p < 0.05 for both rural and urban areas) and healthy diet (p < 0.01 for urban areas), while negatively associated with none or moderate alcohol use (p < 0.01 for rural areas). Average annual temperature was negatively associated with none or moderate alcohol use (p < 0.05 for rural areas) and healthy diet (p < 0.001 for rural areas). Those adhering to all the four healthy lifestyle behaviours had lower risks of all-cause mortality (HR 0.64 [95% CI: 0.52, 0.79]) and cardiovascular mortality (HR 0.53 [0.37, 0.76]) after a median follow-up of 2.4 years. CONCLUSIONS: Adherence to healthy lifestyle behaviours in China was far from ideal. Targeted health promotion strategies were urgently needed.

Association Between Weight Gain From Young to Middle Adulthood and Metabolic Syndrome Across Different BMI Categories at Young Adulthood.

OBJECTIVES: We aimed to assess the dose-response association between weight gain from young to middle adulthood and odds of metabolic syndrome, across body mass index (BMI) categories at young adulthood. METHODS: Based on a national population-based screening project, middle-aged (35-64 years) participants who recalled weight at age 25 years and received standardized measurements were included. Multivariable adjusted restricted cubic splines and logistic regression models were applied. RESULTS: In total, 437,849 participants were included (62.1% women, 52.0 ± 7.6 years). Larger weight gains from young to middle adulthood were associated with higher odds of metabolic syndrome at middle adulthood, with odds of 2.01 (1.98-2.05), 1.93 (1.92-1.94), and 1.67 (1.64-1.7) per 5-kg weight gain across participants who were underweight, normal-weight, and overweight/obese at young adulthood, respectively. After further adjusting for current BMI, larger weight gains still correlated with higher odds of metabolic syndrome among underweight and normal-weight participants, while an inverted U-shaped association was observed in overweight/obese participants. CONCLUSIONS: Weight maintenance from young to middle adulthood could be effective to mitigate metabolic syndrome burden, especially among underweight and normal-weight people. Historical weight gain confers varied information about metabolic syndrome risk independent of attained BMI across BMI categories at young adulthood.

Facile fabrication of Cu(II) coordinated chitosan-based magnetic material for effective adsorption of reactive brilliant red from aqueous solution.

In order to effectively remove reactive brilliant red (RBR) in aqueous solution, a novel Cu(II) coordinated chitosan-based magnetic composite (CTS-Cu@SiO2@Fe3O4) was prepared. The physicochemical properties of the resultant adsorbent were characterized by Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), vibrating sample magnetometer (VSM) thermogravimetric (TG) analysis, scanning electron microscopy (SEM) and N2 adsorption-desorption. The adsorption capacity toward RBR was systematically investigated as a function of contact time, solution pH, initial concentration, ionic strength and temperature. Compared with CTS@SiO2@Fe3O4, CTS-Cu@SiO2@Fe3O4 showed better adsorption performance in removing RBR, reaching a maximum of 880.84 mg/g at pH 4, which confirmed that the coordination of Cu(II) can improve the adsorption capability. The adsorption kinetics of CTS-Cu@SiO2@Fe3O4 was found to follow the pseudo-second-order kinetic model, and the equilibrium adsorption data were well described by the Freundlich isotherm model. Thermodynamic studies indicated that the adsorption process was spontaneous and endothermic. XPS analysis confirmed that the adsorption was mainly controlled by electrostatic interaction between copper/amino cation and RBR anion. Furthermore, regeneration experiments demonstrated that CTS-Cu@SiO2@Fe3O4 can be used repeatedly. In a word, CTS-Cu@SiO2@Fe3O4 can be served as a promising adsorbent for dye wastewater scavenging.

Facile fabrication of chitosan-based adsorbents for effective removal of cationic and anionic dyes from aqueous solutions.

To develop chitosan-based adsorbents for the treatment of dye wastewater, poly acrylic acid (PAA) and poly acrylamide (PAM) were simultaneously grafted onto the chitosan (CTS) chain to obtain a grafted-crosslinked material g-CCTS, and then, Fe-g-CCTS was prepared via coordination of Fe(III) onto the prepared g-CCTS. Two adsorbents g-CCTS and Fe-g-CCTS were fully characterized by scanning electron microscopy (SEM), energy dispersive spectrometer (EDS), Nitrogen adsorption and desorption, X-ray diffraction (XRD), Fourier transform infrared (FT-IR) spectroscopy and thermogravimetric (TG) analysis. In adsorption experiment, g-CCTS exhibited effective adsorption towards cationic dye methylene blue (MB), and Fe-g-CCTS showed effective adsorption towards anionic dye reactive brilliant red (RBR). The effects of solution pH, salt concentration and temperature on the adsorption process were investigated. The maximum adsorption capacity of g-CCTS for MB was up to 79.09 mg/g at pH 12, and that of Fe-g-CCTS for RBR reached 918.53 mg/g at pH 2. It was observed that both adsorption processes were monolayer adsorption, and conformed to the pseudo-second-order model and the Langmuir isotherm model. This research provided a facile and accurate method for effective dyes removal from wastewater.

Preparation of a novel chitosan-based magnetic adsorbent CTS@SnO2@Fe3O4 for effective treatment of dye wastewater.

A novel chitosan-based magnetic composite CTS@SnO2@Fe3O4 was prepared by water-in-oil emulsification for adsorbing anionic dye RBR in aqueous solution. The physicochemical properties of the obtained material were characterized by FTIR, XRD, VSM, TGA, SEM and N2 adsorption-desorption. Effects of contact time, solution pH, ionic strength, initial dye concentration and temperature on the adsorption of reactive brilliant red (RBR) were investigated via batch adsorption experiments. Compared with CTS@Fe3O4, CTS@SnO2@Fe3O4 showed better adsorption performance for RBR, represented by the adsorption capacity reaching a maximum of 981.23 mg/g at pH 2, illustrating that the introduction of SnO2 was beneficial for adsorption. The kinetic data and equilibrium adsorption behaviors were well depicted by pesudo-second-order kinetic model and Langmuir isotherm model, respectively. Evaluation of the thermodynamic parameters revealed that the adsorption process was spontaneous and endothermic. XPS analysis confirmed a potential adsorption mechanism that the N atoms on composite chelated with RBR ions in solution. In addition, CTS@SnO2@Fe3O4 particles were easy to be magnetically separated and had outstanding reusability after five times recycling. All in all, CTS@SnO2@Fe3O4 was proven to be an efficient and promising adsorbent for the dye removal due to its higher adsorption capacity compared with other adsorbents.

Prevalence, Awareness, and Treatment of Isolated Diastolic Hypertension: Insights From the China PEACE Million Persons Project.

Background Characterizing and assessing the prevalence, awareness, and treatment patterns of patients with isolated diastolic hypertension (IDH) can generate new knowledge and highlight opportunities to improve their care. Methods and Results We used data from the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project, which screened 2 351 035 participants aged 35 to 75 years between 2014 and 2018. IDH was defined as systolic and diastolic blood pressure of <140 and ≥90 mm Hg; awareness as self-reported diagnosis of hypertension; and treatment as current use of antihypertensive medications. Of the 2 310 184 participants included (mean age 55.7 years; 59.5% women); 73 279 (3.2%) had IDH, of whom 63 112 (86.1%) were untreated, and only 6512 (10.3%) of the untreated were aware of having hypertension. When compared with normotensives, participants who were <60 years, men, at least college educated, had body mass index of >28 kg/m2, consumed alcohol, had diabetes mellitus, and prior cardiovascular events were more likely to have IDH (all P<0.01). Among those with IDH, higher likelihood of awareness was associated with increased age, women, college education, body mass index of >28 kg/m2, higher income, diabetes mellitus, prior cardiovascular events, and Central or Eastern region (all P<0.05). Most treated participants with IDH reported taking only 1 class of antihypertensive medication. Conclusions IDH affects a substantial number of people in China, however, few are aware of having hypertension and most treated participants are poorly managed, which suggests the need to improve the diagnosis and treatment of people with IDH.