Association between proprotein convertase subtilisin/kexin type 9 and late saphenous vein graft disease after coronary artery bypass grafting: a cross-sectional study.

OBJECTIVE: The study aims to explore the association between serum proprotein convertase subtilisin/kexin type 9 (PCSK9) level and saphenous vein grafts disease (SVGD) after coronary artery bypass grafting (CABG). DESIGN: A cross-sectional study. SETTING: A secondary hospital in Tianjin City, China. PARTICIPANTS: A total of 231 participants were included in the study. Inclusion criteria were as follows: age ≥18 years, previous CABG surgery at least 12 months ago, at least one SVG for bypass during CABG, abnormal non-invasive test results or recurrent stable angina pectoris by coronary angiography indications, and willing to participate and sign informed consent. Participants with any of the following were excluded from the study: congenital valvular disease, decompensated heart failure, anaemia defined as a haemoglobin level of <12 g/dL in women or <13 g/dL in men, malignant neoplasms, renal failure, severe hepatic disease, thyroid disease, acute or chronic inflammatory disease and chronic obstructive lung disease. PRIMARY OUTCOME MEASURE: SVGD was defined as at least one SVG with significant stenosis (≥50%). Circulating PCSK9 levels were measured using commercial ELISA kits according to the manufacturer's instructions. RESULTS: The mean PCSK9 level in the SVGD group was significantly higher than that in the patent group (275.2±38.6 vs 249.3±37.7, p<0.01). The multivariate logistic regression model revealed a significant association between serum PCSK9 and SVGD (OR 2.08, 95% CI 1.46-2.95) per 1 SD increase in serum PCSK9. CONCLUSIONS: The present study is the first to identify an independent association between PCSK9 and late SVGD after adjustment for established cardiovascular risk factors. A multicentre prospective cohort study with large sample size should be conducted in the future to further research this relationship.

Leisure-time physical activity and risk of type 2 diabetes: a meta-analysis of prospective cohort studies.

Published articles reported controversial results about the association between leisure-time physical activity (LTPA) and risk of type 2 diabetes. A meta-analysis of prospective cohort studies was conducted to explore the effect of LTPA on the incidence of type 2 diabetes. PubMed and Embase databases were searched from its inception to June 13, 2014. Fixed or random effects models were used to calculate the pooled effect sizes based on between-study heterogeneity that was examined by the Q test and I (2) statistic. A total of eight studies, including 296,395 participants and 10,815 incident cases, were included in this study. Both high-level LTPA [high vs. low: hazard ratio (HR) 0.69, 95 % confidence interval (CI) 0.61-0.78] and moderate-level LTPA (moderate vs. low: HR 0.79, 95 % CI 0.70-0.89) were associated with decreased incidence of type 2 diabetes. In conclusion, LTPA was significantly associated with decreased risk of diabetes; high-level LTPA is more beneficial in decreasing the incidence of type 2 diabetes than moderate-level LTPA.

Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis.

A number of prospective cohort studies have investigated the associations between consumption of sugar-sweetened beverages (SSB) and the risk of hypertension, CHD and stroke, but revealed mixed results. In the present study, we aimed to perform a dose-response meta-analysis of these prospective studies to clarify these associations. A systematic literature search was conducted using the PubMed and Embase databases up to 5 May 2014. Random- or fixed-effects models were used to calculate the pooled relative risks (RR) with 95 % CI for the highest compared with the lowest category of SSB consumption, and to conduct a dose-response analysis. A total of six prospective studies (240 726 participants and 80 411 incident cases of hypertension) from four publications on hypertension were identified. A total of four prospective studies (194 664 participants and 7396 incident cases of CHD) from four publications on CHD were identified. A total of four prospective studies (259 176 participants and 10 011 incident cases of stroke) from four publications on stroke were identified. The summary RR for incident hypertension was 1·08 (95 % CI 1·04, 1·12) for every additional one serving/d increase in SSB consumption. The summary RR for incident CHD was 1·17 (95 % CI 1·10, 1·24) for every serving/d increase in SSB consumption. There was no significant association between SSB consumption and total stroke (summary RR 1·06, 95 % CI 0·97, 1·15) for every serving/d increase in SSB consumption. The present meta-analysis suggested that a higher consumption of SSB was associated with a higher risk of hypertension and CHD, but not with a higher risk of stroke.

The proportion and trend of human immunodeficiency virus infections associated with men who have sex with men from Chinese voluntary blood donors: a systematic review and meta-analysis.

BACKGROUND: Human immunodeficiency virus (HIV)-positive cases associated with men who have sex with men (MSM) have rapidly increased over the past years. The objective of this study is to comprehensively evaluate the proportions, changing trends, and geographical distribution of MSM-associated HIV cases from Chinese voluntary blood donors by systematically reviewing the available literature. STUDY DESIGN AND METHODS: Major English and Chinese research databases were searched for studies reporting study locations, study years, the number of HIV infections among blood donors, and the number of HIV-positive donations associated with MSM in China. The proportion estimates were calculated; subgroup analyses and test for time trend were performed using software of comprehensive meta-analysis. RESULTS: Thirty-four studies met eligibility criteria. The pooled proportion of HIV-positive donations associated with MSM from 2001 to 2012 was 36.5% (95% confidence interval, 29.6%-44.1%). The epidemic was found to be more severe in northeast and north China compared to south China (59.6%; 55.0% vs. 3.8%, respectively). The proportion showed a significantly increasing trend over the study period (10.3% in 2001-2005; 38.6% in 2006-2009; and 47.6% in 2010-2012; trend test chi-square = 16.42, p < 0.001). CONCLUSION: The relatively high proportion of MSM- associated HIV-positive donors is of concern. Efficient and effective measures focused on public education and improving knowledge of blood safety are needed to prevent this at-risk population from seeking HIV testing through blood donation. It is also imperative to expand the scope of postdonation nucleic acid testing to shorten the window period to improve blood supply safety in China.

Sexual Risk Behaviors and HIV Infection among Men Who Have Sex with Men and Women in China: Evidence from a Systematic Review and Meta-Analysis.

OBJECTIVES: To understand the current risk of HIV infection and transmission and further elucidate the underlying risk factors among men who have sex with men and women (MSMW) in China. METHODS: Following PRISMA guidelines, we conducted a systematic review and meta-analysis of searching through Chinese and English available literature databases between January 2000 and June 2014 to identify articles. RESULTS: Thirty-six articles (including 19,730 MSMW and 53,536 MSMO) met the selection criteria and the aggregated results found that MSMW have significantly higher HIV prevalence than MSMO (6.6% versus 5.4%, OR = 1.27, 95% CI = 1.01-1.58). A higher proportion of MSMW had commercial male partners in the past 6 months (18.3% versus 12.2%, OR = 1.56, 95% CI = 1.01-2.42). Additionally, substance use in the past 6 months was significantly more frequent among MSMW than MSMO (alcohol use: 27.1% versus 13.1%, OR = 2.53, 95% CI = 2.14-2.99; illicit drug use: 5.3% versus 2.5%, OR = 2.09, 95% CI = 1.48-2.95). CONCLUSION: A higher proportion of commercial sex and substance use among MSMW may be a potentially indicative factor for significantly higher HIV prevalence compared to MSMO. Targeted interventions should aim at increasing the frequency of HIV/STIs screening and preventing high risk commercial sex and substance use among MSMW to decrease their HIV transmission to the general population.

Nut consumption in relation to cardiovascular disease risk and type 2 diabetes: a systematic review and meta-analysis of prospective studies.

BACKGROUND: Many prospective cohort studies have investigated the association between nut consumption and risk of coronary artery disease (CAD), stroke, hypertension, and type 2 diabetes (T2D). However, results have been inconsistent. OBJECTIVE: We aimed to investigate the association between nut consumption and risk of CAD, stroke, hypertension, and T2D. DESIGN: PubMed and EMBASE databases were searched up to October 2013. All prospective cohort studies of nut consumption and risk of CAD, stroke, hypertension, and T2D were included. Summary RRs with 95% CIs were estimated by using a fixed- or random-effects model. RESULTS: A total of 23 prospective studies (9 studies for CAD, 4 studies for stroke, 4 studies for hypertension, and 6 studies for T2D) from 19 publications were included in the meta-analysis. There were 179,885 participants and 7236 CAD cases, 182,730 participants and 5669 stroke cases, 40,102 participants and 12,814 hypertension cases, and 342,213 participants and 14,400 T2D cases. The consumption of each 1 serving of nuts/d was significantly associated with incident CAD (RR: 0.81; 95% CI: 0.72, 0.91; P < 0.001) and hypertension (RR: 0.66; 95% CI: 0.44, 1.00; P = 0.049). However, there was no association between the consumption of each 1 serving of nuts/d and risk of stroke (RR: 0.90; 95% CI: 0.71, 1.14) or T2D (RR: 0.80; 95% CI: 0.57, 1.14). CONCLUSIONS: A higher consumption of nuts was associated with reduced risk of CAD and hypertension but not stroke or T2D. Large randomized controlled trials are warranted to confirm the observed associations.

HIV related high risk behaviors and willingness to participate in HIV vaccine trials among China MSM by computer assisted self-interviewing survey.

BACKGROUND: The number of new HIV infections among MSM of China is rapidly increasing in recent years and behavioral interventions have had limited effectiveness. To control the HIV pandemic may lie in an HIV vaccine. This study examined the factors associated with willingness to participate (WTP) in HIV vaccine clinical trials among China MSM. METHODS: A cross-sectional survey was carried out among MSM from three cities in northeast China. Questionnaires pertaining to MSM risk behavior and WTP in HIV vaccine trials were administered through computer assisted self-interviewing (CASI). RESULTS: A total of 626 MSM participated in this survey. 54.8% had occasional male partners and 52.2% always used condoms with male sex partners. HIV prevalence was 5.0%. 76.7% were WTP in a preventive HIV vaccine clinical trial. Results showed that HIV vaccination is a means of protection for spouses and family; family support to participate in vaccine trials and desire for economic incentives were significantly associated with WTP. CONCLUSIONS: There was a high proportion of WTP in HIV vaccine trials among Chinese MSM. The high HIV prevalence and high proportion of risky sexual behavior indicate that Liaoning MSM are potential candidates for HIV vaccine trials.

Physical activity and risk of hypertension: a meta-analysis of prospective cohort studies.

Published literature reports controversial results about the association of physical activity (PA) with risk of hypertension. A meta-analysis of prospective cohort studies was performed to investigate the effect of PA on hypertension risk. PubMed and Embase databases were searched to identify all related prospective cohort studies. The Q test and I(2) statistic were used to examine between-study heterogeneity. Fixed or random effects models were selected based on study heterogeneity. A funnel plot and modified Egger linear regression test were used to estimate publication bias. Thirteen prospective cohort studies were identified, including 136,846 persons who were initially free of hypertension, and 15,607 persons developed hypertension during follow-up. The pooled relative risk (RR) of main results from these studies suggests that both high and moderate levels of recreational PA were associated with decreased risk of hypertension (high versus low: RR, 0.81; 95% confidence interval, 0.76-0.85 and moderate versus low: RR, 0.89; 95% confidence interval, 0.85-0.94). The association of high or moderate occupational PA with decreased hypertension risk was not significant (high versus low: RR, 0.93; 95% confidence interval, 0.81-1.08 and moderate versus low: RR, 0.96; 95% confidence interval, 0.87-1.06). No publication bias was observed. The results of this meta-analysis suggested that there was an inverse dose-response association between levels of recreational PA and risk of hypertension, whereas there was no significant association between occupational PA and hypertension.

Recapitulation of four hypertension susceptibility genes (CSK, CYP17A1, MTHFR, and FGF5) in East Asians.

OBJECTIVE: A recent genome wide association study identified eight hypertension susceptibility loci in Europeans. Subsequently, several studies have investigated these associations in East Asian populations. The results of these studies, however, have been inconsistent. A meta-analysis was performed to assess the associations of the most published polymorphisms, including CSK rs1378942, CYP17A1 rs11191548, MTHFR rs17367504, and FGF5 rs16998073 polymorphisms with hypertension. METHODS: Published literature from PubMed and Embase databases was retrieved. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects model. RESULTS: Seven studies (16,368 cases /19,707 controls) for CSK rs1378942 polymorphism, seven studies (15,688 cases /18,784 controls) for CYP17A1 rs11191548 polymorphism, four studies (7994 cases / 12,844 controls) for MTHFR rs17367504 polymorphism, and three studies (6026 cases / 8393 controls) for FGF5 rs16998073 polymorphism were included in the meta-analysis. The results suggested that both CYP17A1 rs11191548 and FGF5 rs16998073 polymorphisms were significantly associated with hypertension risk in East Asians (CYP17A1 rs11191548 (random effect model): OR=1.16, 95% CI 1.07-1.25, p=3.59×10(-4), I(2)=78.2%, p (heterogeneity)=1.14×10(-4); FGF5 rs16998073 (random effect model): OR=1.30, 95% CI 1.23-1.37, p=6.29×10(-21), I(2)=65.0%, p (heterogeneity)=0.009); whereas no significant association was observed for CSK rs1378942 (fix effect model: OR=1.09, 95% CI 0.98-1.22, p=0.128, I(2)=0.0%, p (heterogeneity)=0.820), or MTHFR rs17367504 (fix effect model: OR=1.06, 95% CI 0.98-1.14, p=0.126, I(2)=0.0%, p (heterogeneity)=0.822). CONCLUSION: The present meta-analysis indicated significant associations of both CYP17A1 rs11191548 and FGF5 rs16998073 polymorphisms with hypertension susceptibility in East Asians.

Sex-dependent associations of genetic variants identified by GWAS with indices of adiposity and obesity risk in a Chinese children population.

OBJECTIVE: Recent genome-wide association studies have identified a few single nucleotide polymorphisms (SNPs), which are associated with body mass index (BMI)/obesity. This study aimed to examine the identified associations among a population of Chinese children. RESEARCH DESIGN AND METHODS: Five SNPs (SEC16B rs10913469, SH2B1 rs4788102, PCSK1rs6235, KCTD15 rs29941, BAT2 rs2844479) were genotyped for a group of Chinese children (N = 2849, age range 6-18 years). A total of 1230 obese cases and 1619 controls with normal weight were identified based on the Chinese age- and sex-specific BMI references. RESULTS: Of five studied variants, only two (SEC16B rs10913469, SH2B1 rs4788102) were nominally associated with indices of adiposity and obesity risk in girls and only SEC16B rs10913469 in children at puberty (p < 0·05), while no statistical associations was found for three other variants (PCSK1rs6235, KCTD15 rs29941, BAT2 rs2844479). After false discovery rate (FDR) adjustment for multiple testing, none were statistically significant. Further analysis indicated that the genetic risk score (GRS) was associated with BMI, waist circumference and risk of obesity (defined by BMI) in girls, even after FDR adjustment for multiple testing. However, there was no statistical association of GRS with indices of adiposity and risk of obesity in children at puberty after multiple comparison correction. CONCLUSIONS: This study confirmed the synthetic effect of SNPs on the indices of adiposity and risk of obesity in Chinese girls, but failed to replicate the effect of five separate variants. We also did not found cumulative effect of SNPs in children at puberty.

Quantitative assessment of the associations between four polymorphisms (FokI, ApaI, BsmI, TaqI) of vitamin D receptor gene and risk of diabetes mellitus.

The vitamin D receptor (VDR) gene polymorphisms have been suggested to be involved in the development of diabetes mellitus, including type 1 diabetes (T1DM) and type 2 diabetes (T2DM). However, the results have been inconsistent. In this study, we performed a meta-analysis to investigate the associations. Literature was retrieved from PubMed, ISI Web of Science and Chinese databases. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated using a random or fixed effect model. 79 studies (FokI: 22 studies; BsmI: 25 studies; ApaI: 17 studies; TaqI: 15 studies) on T1DM and 44 studies (FokI: 10 studies; BsmI: 10 studies; ApaI: 14 studies; TaqI: 10 studies) on T2DM were included. The results indicated that BsmI polymorphism was associated with an increased risk of T1DM (B vs. b: OR 1.31, 95 % CI 1.10-1.55, P = 0.002), especially in East Asians (B vs. b: OR 2.57, 95 % CI: 1.55-4.24, P < 0.001); FokI polymorphism was associated with an increased risk of T2DM (f vs. F: OR 1.30, 95 % CI: 1.17-1.45, P < 0.001), especially in East Asians (f vs. F: OR 1.36, 95 % CI: 1.21-1.54, P < 0.001). However, no significant association was observed between ApaI or TaqI polymorphism and diabetes risk with the exception of significant association between ApaI polymorphism and T1DM risk in East Asians. Thus, the authors found BsmI polymorphism in the VDR gene may increase the risk of T1DM in East Asians and the FokI polymorphism may increase the risk of T2DM in East Asians.

Size, composition, and strength of ties of personal social support networks among adult people living with HIV/AIDS in Henan and Beijing, China.

To characterize the level of personal support available to people living with HIV/AIDS (PLWHA) in Henan and Beijing, China, face-to-face interviews were conducted to collect information on network size, composition, and strength of ties. The number of people as sources of support for participants in Henan varied from 1 to 13 and 1 to 16 in Beijing. In Henan, family members were more likely to provide support than non-relatives and they provided support more frequently; in Beijing non-relatives were more likely to provide support than family members. Family members were closer to PLWHA than non-relatives in both sites, but the closest type of relative and non-relative supporters were different between Henan and Beijing. PLWHA in Henan and Beijing receive considerable social support, but there is still opportunity for additional social support. Efforts should be made to mobilize civil society to provide support for PLWHA in China.

Estimation and projection of the HIV epidemic trend among the migrant population in China.

OBJECTIVE: The migrant population is a vulnerable group for HIV infection in China. Understanding potential epidemic trends among migrants is critical for developing HIV preventative measures in this population. METHODS: The Estimation and Projection Package (EPP) model was used to process prefecture and county-level surveillance data to generate HIV prevalence and epidemic trends for migrant populations in China. RESULTS: The prevalence of HIV among migrants in 2009 was estimated at 0.075% (95% CI: 0.042%, 0.108%) in China. The HIV epidemic among migrants is likely to increase over the next 5 years, with the prevalence expected to reach 0.110% (95% CI: 0.070%, 0.150%) by 2015. CONCLUSION: Although the 2009 estimates for the HIV/AIDS epidemic in China indicate a slower rate of increase compared with the national HIV/AIDS epidemic, it is estimated to persistently increase among migrants over the next 5 years. Migrants will have a strong impact on the overall future of the HIV epidemic trend in China and evidence-based prevention and monitoring efforts should be expanded for this vulnerable population.

Heterosexual risk of HIV infection in China: systematic review and meta-analysis.

BACKGROUND: Heterosexual sex has become the dominant transmission route in China. Recently studies reported high heterogeneity in heterosexual transmission risk in resource-limited countries. The aim of this study was to summarize the risk of HIV transmission among Chinese serodiscordant couples. METHODS: A systematic review and meta-analysis of observational studies of heterosexual HIV transmission among serodiscordant couples in China was conducted. Two reviewers conducted a literature search using the China National Knowledge Infrastructure (CNKI), Chinese Medical Current Contents (CMCC), and Medline databases. Pooled transmission estimates per 100 person-years (PY) were calculated using a random-effects model. Meta-regression analysis and subgroup analysis stratified by study design, transmission direction and period of antiretroviral therapy (ART) availability were conducted to assess the factors associated with transmission. RESULTS: Eleven eligible studies were identified reporting on 11 984 couples and 405 HIV transmission events. HIV transmission risk from HIV-positive individuals to heterosexual partners was 1.68 (95%CI 0.74 - 2.62) per 100 PY. Study design did not reach statistical significance in meta-regression analysis. The pooled female-to-male transmission estimate was 1.11 (95%CI 0.09 - 2.14) per 100 PY and male-to-female transmission estimate was 1.43 (95%CI 0.19 - 2.68) per 100 PY. The pooled estimate for those before the availability of the Chinese National Free Antiretroviral Therapy Program (2.13 (95%CI 0.00 - 4.63) per 100 PY) was higher than that for those after the implementation of this program (1.44 (95%CI 0.62 - 2.26) per 100 PY). CONCLUSIONS: Transmission estimates in China were lower than other developing countries, but higher than developed countries. Research that better defines HIV secondary transmission rates and the associated behavioral, treatment adherence, and health-related risk factors among heterosexual serodiscordant couples in China is needed.

A cross-sectional study of HIV and syphilis infections among male students who have sex with men (MSM) in northeast China: implications for implementing HIV screening and intervention programs.

BACKGROUND: China has 76.2 million high school and college students, in which the number of reported HIV/AIDS cases is increasing rapidly. Most of these cases are attributed to male-to-male sexual contact. Few studies have explored HIV prevalence and behavioural characteristics of Chinese male students who have sex with men (MSM). METHODS: A cross-sectional study of MSM high school and college students in Liaoning Province was conducted. Data were collected through face-to-face interviews and blood specimens were obtained and tested for HIV and syphilis. RESULTS: There were 436 eligible participants. HIV and syphilis prevalence was 3.0% and 5.0%, respectively. In multivariate analysis, sexual orientation known by family members (OR: 7.3; 95% CI: 1.5-34.6), HIV/AIDS information obtained from clinical doctors (OR: 6.7; 95% CI: 1.7-25.9), HIV/AIDS information obtained through free educational services and materials such as voluntary counseling and testing (VCT) and condom distribution services (OR: 0.2; 95% CI: 0.4-1.0), inconsistent condom use (OR: 5.7; 95%: 1.3-25.3), sexual partner experienced anal bleeding after insertive anal intercourse (OR: 6.8; 95% CI: 1.6-28.4), and history of illegal drug use (OR: 18.9; 95% CI: 2.2-165.3) were found to be significantly associated with HIV infection. CONCLUSIONS: Greater effort should be made towards stemming the HIV and syphilis epidemics among Chinese student MSM. Immediate screening and comprehensive interventions towards student MSM should be implemented in order to curb the spread of HIV. Family and school-based interventions should be considered to target this educated, yet vulnerable, population.

Dynamic characteristic analysis of HIV mother to child transmission in China.

OBJECTIVE: To explore dynamic characteristics of the HIV mother to child transmission (MTCT) epidemic in China. METHODS: A deterministic dynamic transmission model was used to determine the effect of key parameters on the likely long-term trends of the HIV MTCT epidemic in China. Matlab 7.0 was used to develop the model. RESULTS: The number of the susceptibles (S), the transmission rate (ß), and the screening proportion (α) of HIV positive pregnant women have the greatest impact on the HIV MTCT epidemic in China. The growth of the MTCT epidemic in China could not be controlled only by decreasing the MTCT transmission rate. The prevalence of HIV positive women should be reduced and more pregnant women should be tested for HIV. CONCLUSION: Prevention of MTCT (PMTCT) should focus not only on the reduction of HIV transmission rates and incidences of HIV among women but also on the increase of HIV testing for pregnant women. The most cost-effective PMTCT means for China should be investigated in future studies.