Relationship of sleep duration with incident cardiovascular outcomes: a prospective study of 33,883 adults in a general population.

BACKGROUND: Studies on the effect of sleep duration on cardiovascular health have contradictory findings. Underlying health issues may have led to inconsistent results and warrant consideration. We aim to assess the relationship of night sleep duration with incident cardiovascular disease (CVD) in a general population, taking into consideration underlying chronic diseases. METHODS: Data from Shanghai Suburban Adult Cohort and Biobank with a median follow-up of 5.1 years was used, including 33,883 adults aged 20-74 years old. Incident CVD cases were reported and recorded by the Center for Disease Prevention and Control in Songjiang, Shanghai. We used Cox proportional hazard regression models and restricted cubic spline (RCS) analysis to explore the relationship between different sleep groups and sleep duration with incident CVD outcomes, through stratification by gender and age, as well as different health conditions, with adjustments for potential confounders. RESULTS: Long sleep duration (> 9 h) compared to > 7 to ≤ 8 h was associated with overall incident CVD in participants aged ≥ 50 years old: HR(95%CI) = 2.07 (1.15, 3.74) for 50-59y and 1.43 (1.04, 1.93) for 60-74y. RCS analysis showed a J-shaped relationship between sleep and CVD risk in those ≥ 50y, which was confirmed only in those with a chronic health condition. Non-linear relationships between sleep and CVD risk factors, such as BMI, blood glucose and glycated haemoglobin, were observed. CONCLUSIONS: Long sleep duration is associated with increased risk of CVD in people ≥ 50y. However, CVD risk factors and underlying health conditions such as hypertension, and diabetes, may play a driving role in the relationship.

Lipoprotein Particle Profiles Compared With Standard Lipids in the Association With Subclinical Aortic Valve Calcification in Apparently Healthy Japanese Men.

BACKGROUND: Risk factors for atherosclerotic disease including dyslipidemia have been shown to be associated with aortic valve calcification (AVC). Nuclear magnetic resonance (NMR)-measured lipoprotein particles, low-density and high-density lipoprotein particles (LDL-p, HDL-p) in particular, have emerged as novel markers of atherosclerotic disease; however, whether NMR-measured particles are associated with AVC remains to be determined. This study aimed to examine the association between NMR-based lipoprotein particle measurements and standard lipids with AVC. The primary variables of interest were LDL-p (nmol/L), HDL-p (µmol/L), LDL-cholesterol, and HDL-cholesterol (both in mg/dL).Methods and Results:A community-based random sample of Japanese men aged 40-79 years examined in 2006-2008, in Shiga, Japan was studied. Presence of AVC was defined as an Agatston score >0. Lipoprotein particles were measured using NMR spectroscopy. In the main analysis, multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for the prevalence of AVC across the higher quartiles of lipids in reference to the lowest ones were obtained. Of 874 participants analyzed, 153 men had AVC. Multivariable-adjusted ORs of prevalent AVC for the highest vs. the lowest quartile were significantly elevated for LDL-p (OR, 2.20; 95% CI: 1.23-3.93) and LDL-cholesterol (OR, 2.16; 95% CI: 1.23-3.78). In contrast, neither HDL-p nor HDL-cholesterol was associated with AVC. CONCLUSIONS: The association of prevalent AVC with NMR-based LDL-p was comparable to that with LDL-cholesterol.

Elevated Fasting Blood Glucose Levels Are Associated With Lower Cognitive Function, With a Threshold in Non-Diabetic Individuals: A Population-Based Study.

BACKGROUND: Cognitive dysfunction has been recognized as a diabetes-related complication. Whether hyperglycemia or elevated fasting glucose are associated with cognitive decline remains controversial. We aimed to investigate the relationship between fasting glucose levels and cognitive function in diabetic and non-diabetic individuals. METHODS: Participants were Japanese diabetic (n = 191) and non-diabetic (n = 616) men, aged 46-81 years, from 2010-2014. Blood samples were taken after a 12 h fast. The Cognitive Ability Screening Instrument (CASI), with a maximum score of 100, was used for cognitive assessment. Cognitive domains of CASI were also investigated. Fractional logit regression with covariate adjustment for potential confounders was used to model cross-sectional relationships between fasting blood glucose and CASI score. RESULTS: For diabetic individuals, CASI score was 0.38 (95% confidence interval: 0.66-0.12) lower per 1 mmol/L higher fasting glucose level. Short-term memory domain also exhibited an inverse association. For non-diabetic individuals, a reverse U-shaped relationship was observed between fasting glucose and cognitive function, identifying a threshold for highest cognitive performance of 91.8 CASI score at 3.97-6.20 mmol/L (71.5-111.6 mg/dL) fasting glucose. Language ability domain displayed a similar relationship with fasting glucose. CONCLUSIONS: Elevated fasting glucose levels in diabetic men were associated with lower cognitive function, in which short-term memory was the main associated domain. Interestingly, in non-diabetic men, we identified a threshold for the inverse relationship of elevated fasting glucose with cognitive function. Contrastingly to diabetic men, language ability was the main associated cognitive domain among non-diabetic men.

Association of Alcohol Consumption With Fat Deposition in a Community-Based Sample of Japanese Men: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA).

BACKGROUND: Excessive alcohol intake has been shown to be associated with cardiovascular disease via metabolic pathways. However, the relationship between alcohol intake and obesity has not been fully elucidated. We aimed to examine the association of alcohol consumption with fat deposition and anthropometric measures. METHODS: From 2006-2008, we conducted a cross-sectional study in a population-based sample of Japanese men aged 40 through 79 years. Areas of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were calculated using computed tomography imaging. Based on a questionnaire, we classified participants into five groups according to weekly alcohol consumption, excluding former drinkers: non-drinkers (0 g/week), 0.1-160.9, 161-321.9, 322-482.9, and ≥483 g/week. Multivariable linear regression was used to estimate adjusted means of obesity indices for each group. RESULTS: We analyzed 998 men (mean age and body mass index [BMI], 63.8 years and 23.6 kg/m2, respectively). Higher weekly alcohol consumption was strongly and significantly associated with higher abdominal VAT area, percentage of VAT, and VAT-to-SAT ratio (all P for trend <0.001), and also with waist circumferences and waist-to-hip ratio (P for trend = 0.042 and 0.007, respectively). These associations remained significant after further adjustment for BMI, whereas alcohol consumption had no significant association with abdominal SAT area. CONCLUSIONS: Higher alcohol consumption was associated with higher VAT area, VAT%, and VAT-to-SAT ratio, independent of confounders, including BMI, in general Japanese men. These results suggest that alcohol consumption may have a potential adverse effect on visceral fat deposition.

Associations of High-Density Lipoprotein Particle and High-Density Lipoprotein Cholesterol With Alcohol Intake, Smoking, and Body Mass Index　- The INTERLIPID Study.

BACKGROUND: Recently, high-density lipoprotein particles (HDL-P) have been found to be more strongly inversely associated with coronary artery disease (CAD) risk than their counterpart, HDL cholesterol (HDL-C). Given that lifestyle is among the first targets in CAD prevention, we compared the associations of HDL-P and HDL-C with selected lifestyle factors. Methods and Results: We examined 789 Japanese participants of the INTERLIPID Study: men (n=386) and women (n=403) aged 40-59 years in 1996-1998. Participants treated for dyslipidemias were excluded. Lifestyle factors included alcohol intake, smoking amount, and body mass index (BMI). Multivariable linear regression was used for cross-sectional analyses of these factors with HDL-P, HDL-C, HDL-P size subclasses (small, medium and large) and mean HDL-P size. In men, higher alcohol intake was associated with higher HDL-P and higher HDL-C. The associations of alcohol, however, were strongest with HDL-P. A higher smoking amount tended to be associated with lower HDL-P and HDL-C. In contrast, BMI was not associated with HDL-P, but was strongly inversely associated with HDL-C. While alcohol intake favored larger mean HDL-P size, smoking and BMI favored a lipid profile with smaller HDL-P subclasses and overall smaller mean HDL-P size. Similar, but generally weaker results were observed in women. CONCLUSIONS: Although both HDL-P and HDL-C are parameters of HDL, they have different associations with alcohol, smoking and BMI.

Relationship of Insulin Resistance to Prevalence and Progression of Coronary Artery Calcification Beyond Metabolic Syndrome Components: Shiga Epidemiological Study of Subclinical Atherosclerosis.

OBJECTIVE: The association between insulin resistance (IR) and coronary artery calcification (CAC) has been uncertain after adjustment for metabolic syndrome components. We aimed to evaluate whether IR is associated with CAC prevalence or progression independently of metabolic syndrome components. APPROACH AND RESULTS: We conducted a population-based study in a random sample of Japanese men aged 40 to 79 years and determined IR using the homeostasis model assessment of insulin resistance (HOMA-IR). The associations of HOMA-IR and other diabetic parameters per 1-SD increase with CAC prevalence and progression were evaluated using multivariable logistic regression. Of 1006 total participants at baseline (mean age, 64±10 years), CAC prevalence was observed in 646 (64.2%), and of 789 participants at follow-up (mean duration, 4.9±1.3 years), CAC progression was observed in 365 (46.3%). After adjustment for covariates including metabolic syndrome components, higher HOMA-IR was independently associated with CAC prevalence (adjusted odds ratio 1.34, 95% confidence interval 1.10-1.63; P=0.003) and progression (odds ratio 1.32, 95% confidence interval 1.09-1.60; P=0.004). In participants without diabetes mellitus, positive associations were similarly observed (prevalence: odds ratio 1.29, 95% confidence interval 1.04-1.60; P=0.022; and progression: odds ratio 1.25, 95% confidence interval 1.01-1.55; P=0.042), whereas glucose and hemoglobin A1c were not associated with CAC prevalence and progression. CONCLUSIONS: Higher IR was associated with CAC prevalence and progression independently of metabolic syndrome components in Japanese men and also in those without diabetes mellitus. Among diabetic measures, IR and fasting insulin, but not glucose and hemoglobin A1c, predicted CAC progression in men without diabetes mellitus.

Significant inverse association of equol-producer status with coronary artery calcification but not dietary isoflavones in healthy Japanese men.

Equol, a metabolite of the dietary isoflavone daidzein, is produced by the action of gut bacteria in some individuals who are termed as equol-producers. It is proposed to have stronger atheroprotective properties than dietary isoflavones. We examined a cross-sectional association of dietary isoflavones and equol-producer status with coronary artery calcification (CAC), a biomarker of coronary atherosclerosis, among men in Japan. A population-based sample of 272 Japanese men aged 40-49 years recruited from 2004 to 2007 was examined for serum isoflavones, serum equol, CAC and other factors. Equol-producers were classified as individuals having a serum level of equol >83 nm. The presence of CAC was defined as a coronary Ca score ≥10 Agatston units. The associations of dietary isoflavones and equol-producers with CAC were analysed using multiple logistic regression. The median of dietary isoflavones, equol and CAC were 512·7 (interquartile range (IQR) 194·1, 1170·0), 9·1 (IQR 0·10, 33·1) and 0·0 (IQR 0·0, 1·0) nm, respectively. Prevalence of CAC and equol-producers was 9·6 and 16·0 %, respectively. Dietary isoflavones were not significantly associated with CAC. After multivariable adjustment, the OR for the presence of CAC in equol-producers compared with equol non-producers was 0·10 (95 % CI 0·01, 0·90, P<0·04). Equol-producers had significantly lower CAC than equol non-producers, but there was no significant association between dietary isoflavones and CAC, suggesting that equol may be a key factor for atheroprotective properties of isoflavones in Japanese men. This finding must be confirmed in larger studies or clinical trials of equol that is now available as a dietary supplement.

Cross-sectional comparison of coronary artery calcium scores between Caucasian men in the United States and Japanese men in Japan: the multi-ethnic study of atherosclerosis and the Shiga epidemiological study of subclinical atherosclerosis.

The incidence of coronary heart disease in the United States has declined, and prevalences of several coronary disease risk factors have become comparable to those in Japan. Therefore, the burden of coronary atherosclerosis may be closer among younger persons in the 2 countries. We aimed to compare prevalences of coronary atherosclerosis, measured with coronary artery calcium scores, between men in the 2 countries by age group (45-54, 55-64, or 65-74 years). We used community-based samples of Caucasian men in the United States (2000-2002; n = 1,067) and Japanese men in Japan (2006-2008; n = 832) aged 45-74 years, stratifying them into groups with 0, 1, 2, or ≥3 of the following risk factors: current smoking, overweight, diabetes, dyslipidemia, and hypertension. We calculated adjusted odds ratios of US Caucasian men's having Agatston scores of ≥10, ≥100, and ≥400 with reference to Japanese men. Overall, the odds of Caucasian men having each Agatston cutoff point were greater. The ethnic difference, however, became smaller in younger age groups. For example, adjusted odds ratios for Caucasian men's having an Agatston score of ≥100 were 2.05, 2.43, and 3.86 among those aged 45-54, 55-64, and 65-74 years, respectively. Caucasian men in the United States had a higher burden of coronary atherosclerosis than Japanese men, but the ethnic difference was smaller in younger age groups.

Associations of Sedentary Behavior with Risks of Cardiovascular Disease Events among Chinese Adults.

AIMS: Evidence regarding the modification effects of age, sex, ethnicity, socioeconomic status, or weight status on the associations of sedentary behavior (SB) with cardiovascular diseases (CVDs) is limited. Moreover, the mechanisms for the associations also remain unclear. We aimed to investigate the possible influence of these factors on the associations of SB with CVD events and whether the associations are mediated by metabolic phenotypes. METHODS: This study included 42,619 participants aged 20-74 years, recruited from the Shanghai Suburban Adult Cohort and Biobank study. SB was assessed at baseline and integrated with health information systems to predict future CVD events. Cox proportional hazards models, interaction analyses, restricted cubic splines and causal mediation analyses were used for assessments. RESULTS: Compared to those with ＜3 h/d sedentary time, participants having SB ≥ 5 h/d had significantly higher risks of CVD (HR[95%CI]: 1.27[1.12-1.44]), coronary heart disease (CHD, 1.35[1.14-1.60]), and ischemic stroke (IS, 1.30[1.06-1.60]). The association of CHD was more pronounced in the retired individuals than their counterparts (1.45[1.20-1.76] versus 1.06[0.74-1.52], pinteraction=0.046). When SB was expressed as a continuous variable, a 1 h/d increment in SB was positively associated with risks of CVD (1.03[1.01-1.05]), CHD (1.04[1.01-1.07]), and IS (1.05[1.01-1.08]). High-density lipoprotein cholesterol (HDL-C, proportion mediated: 12.54%, 12.23%, and 11.36%, all p＜0.001), followed by triglyceride (TG, 5.28%, 4.77%, and 4.86%, all p＜0.01) and serum uric acid (SUA, 3.64%, 4.24%, and 2.29%, all p＜0.05) were major mediators through metabolic phenotypes. CONCLUSIONS: Higher SB was associated with elevated risks of CVD events. The detrimental effect of SB on CHD risk was more pronounced among retired individuals. Moreover, HDL-C, TG and SUA partially mediated the relationships between SB and CVD events. Our findings may have implications for preventing and controlling CVD associated with SB.

ABCA1 protein enhances Toll-like receptor 4 (TLR4)-stimulated interleukin-10 (IL-10) secretion through protein kinase A (PKA) activation.

BACKGROUND: ABCA1 is known to suppress proinflammatory cytokines. RESULTS: ABCA1 activates PKA and up-regulates anti-inflammatory cytokine IL-10. Elevated PKA transforms macrophages to M2-like phenotype. Disrupting lipid rafts by statins MCD, and filipin recuperates ABCA1 phenotype and likely functions downstream of ABCA1. CONCLUSION: By modulating cholesterol, ABCA1 activates PKA. This generates M2-like macrophages. SIGNIFICANCE: ABCA1 does not simply suppress inflammatory response. It promotes M2-like activation and facilitates resolution. Nonresolving inflammatory response from macrophages is a major characteristic of atherosclerosis. Macrophage ABCA1 has been previously shown to suppress the secretion of proinflammatory cytokine. In the present study, we demonstrate that ABCA1 also promotes the secretion of IL-10, an anti-inflammatory cytokine critical for inflammation resolution. ABCA1(+/+) bone marrow-derived macrophages secrete more IL-10 but less proinflammatory cytokines than ABCA1(-/-) bone marrow-derived macrophages, similar to alternatively activated (M2) macrophages. We present evidence that ABCA1 activates PKA and that this elevated PKA activity contributes to M2-like inflammatory response from ABCA1(+/+) bone marrow-derived macrophages. Furthermore, cholesterol lowering by statins, methyl-ß-cyclodextrin, or filipin also activates PKA and, consequently, transforms macrophages toward M2-like phenotype. Conversely, cholesterol enrichment suppresses PKA activity and promotes M1-like inflammatory response. As the primary function of ABCA1 is cholesterol removal, our results suggest that ABCA1 activates PKA by regulating cholesterol. Indeed, forced cholesterol enrichment in ABCA1-expressing macrophages suppresses PKA activation and elicits M1-like response. Collectively, these findings reveal a novel protective process by ABCA1-activated PKA in macrophages. They also suggest cholesterol lowering in extra-hepatic tissues by statins as an anti-inflammation strategy.

Association of Ambient Temperature With the Prevalence of Intimate Partner Violence Among Partnered Women in Low- and Middle-Income South Asian Countries.

Importance: Intimate partner violence (IPV), including physical, sexual, and emotional violence, constitutes a critical public health problem, particularly in low- and middle-income countries. While climate change could escalate violent events, data quantifying its possible association with IPV are scant. Objective: To evaluate the association of ambient temperature with the prevalence of IPV among partnered women in low- and middle-income countries in South Asia, and to estimate the association of future climate warming with IPV. Design, Setting, and Participants: This cross-sectional study used data from the Demographic and Health Survey and included 194 871 ever-partnered women aged 15 to 49 years from 3 South Asian countries (India, Nepal, and Pakistan). The study applied the mixed-effect multivariable logistic regression model to investigate the association of ambient temperature with IPV prevalence. The study further modeled the change in IPV prevalence under various future climate change scenarios. The data included in the analyses were collected from October 1, 2010, to April 30, 2018, and the current analyses were performed from January 2, 2022, to July 11, 2022. Exposure: Annual ambient temperature exposure for each woman, estimated based on an atmospheric reanalysis model of the global climate. Main Outcomes and Measures: The prevalence of IPV and its types (physical, sexual, and emotional violence) were assessed based on self-reported questionnaires from October 1, 2010, to April 30, 2018, and the changes in the prevalence with climate changes were estimated through the 2090s. Results: The study included 194 871 ever-partnered women aged 15 to 49 years (mean [SD] age, 35.4 [7.6] years; overall IPV prevalence, 27.0%) from 3 South Asian countries. The prevalence of physical violence was highest (23.0%), followed by emotional (12.5%), and sexual violence (9.5%). The annual temperature ranges were mostly between 20 °C and 30 °C. A significant association was found between high ambient temperature and the prevalence of IPV against women, with each 1 °C increase in the annual mean temperature associated with a mean increase in IPV prevalence of 4.49% (95% CI, 4.20%-4.78%). According to the study's projections under the unlimited emissions scenarios (SSPs [shared socioeconomic pathways], as defined by the Intergovernmental Panel on Climate Change] 5-8.5), IPV prevalence would increase by 21.0% by the end of the 21st century, while it would only moderately increase under increasingly stricter scenarios (SSP2-4.5 [9.8%] and SSP1-2.6 [5.8%]). In addition, the projected increases in the prevalence of physical (28.3%) and sexual (26.1%) violence were greater than that of emotional violence (8.9%). In the 2090s, India was estimated to experience the highest IPV prevalence increase (23.5%) among the 3 countries, compared with Nepal (14.8%) and Pakistan (5.9%). Conclusions and Relevance: This cross-sectional, multicountry study provides ample epidemiological evidence to support that high ambient temperature may be associated with the risk of IPV against women. These findings highlight the vulnerabilities and inequalities of women experiencing IPV in low- and middle-income countries in the context of global climate warming.

Association of triglyceride-glucose index with cardiovascular disease among a general population: a prospective cohort study.

BACKGROUND: The impact of triglyceride-glucose (TyG) index, a surrogate marker for insulin resistance, on the risk of cardiovascular disease (CVD) in general populations remains controversial. We aimed to comprehensively study the relationship between TyG index with the risk of incident CVD events in the general population in Shanghai. METHODS: A total of 42,651 participants without previous history of CVD events from Shanghai Suburban Adult Cohort and Biobank (SSACB) were included. SSACB was a community-based natural population cohort study using multistage cluster sampling method. TyG index was calculated as Ln [fasting serum triglyceride (mg/dL) * fasting blood glucose (mg/dL)/2]. Kaplan-Meier curves, log-rank test and cox proportional hazards model were used to calculate the association between TyG index and incident CVD, including stroke and coronary heart disease (CHD). Restricted cubic spline analyses were used to determine whether there was a non-linear relationship between TyG index and CVD events. RESULTS: During a median follow-up of 4.7 years, 1,422 (3.3%) individuals developed CVD, including 674 (1.6%) cases of stroke and 732 (1.7%) cases of CHD. A one unit increment higher TyG index was associated with [HR(95%CI)] 1.16(1.04-1.29) in CVD and with 1.39(1.19-1.61) in stroke. Only linear relationships between TyG and CVD/stroke were observed, while no relationship was observed with CHD after adjustments for confounders. In subgroup analyses, younger (< 50y) and diabetic participants had higher risk of CVD than their counterpart groups, while hypertensive and dyslipidemic participants depicted lower risks than their counterparts. CONCLUSION: Elevated TyG index was associated with a higher risk of incident CVD and stroke. TyG index may help in the early stage of identifying people at high risk of CVD.

Synergistic Effects of Gentamicin, Cefepime, and Ciprofloxacin on Biofilm of Pseudomonas aeruginosa.

Background: Pseudomonas aeruginosa is an opportunistic pathogen involved in number of hospital-acquired infections such as catheter-associated urinary tract infections, bacteremia, septicemia, skin infections, and ventilator-associated pneumoniae. Biofilm formation is an important trait implicated in chronic infections, such as cystic fibrosis and chronic pulmonary obstruction. We evaluated effects of gentamicin, cefepime, and ciprofloxacin on biofilm of P. aeruginosa. Materials and Methods: A total of 266 isolates were collected from the Armed Forces Institute of Pathology (AFIP). Antibiotic susceptibility was assessed by double disk synergy testing. ESBL and carbapenemase detection was performed by phenotypic testing. Molecular screening of the genes was done by PCR. Micro-dilution broth method was used to determine minimum inhibitory concentrations of antibiotics. Biofilm formation was done by micro-titer plate assay. Results: Overall, 20% of the P. aeruginosa isolates were extensively drug-resistant (XDR-PA), and 25% were multi-drug-resistant (MDR-PA). Likewise, 43% of the isolates were ESBL producers, and carbapenemase production was detected in 40% of the isolates. Molecular analysis confirmed occurrence of different resistant factors in ESBL-positive isolates; 67% carried blaTEM, 62% blaCTXM-15, 41% blaSHV, 34% blaCTXM-14, and 33% blaOXA-1. In addition, 68% of the carbapenem-resistant isolates were positive for blaNDM-1, 25% for blaOXA-48, and 22% for blaKPC-2. Biofilm formation was assessed for 234 isolates, out of which 28% were strong biofilm formers. Moderate and weak biofilm formers constituted 46% and 23%, respectively. Overall, ciprofloxacin, levofloxacin, and cefepime showed inhibitory effects on P. aeruginosa biofilms. Antibiotics in combination showed strong synergistic effects (ciprofloxacin and cefepime), while gentamicin and cefepime resulted in complete eradication of P. aeruginosa biofilm. Conclusion: We confirm strong synergistic effects of gentamicin and cefepime that completely eradicated P. aeruginosa biofilm. We further confirm inhibitory effects of ciprofloxacin, levofloxacin, and cefepime on P. aeruginosa biofilms. Hence, combination therapy can be more effective against biofilm-associated infections.

Varying Definitions of Carotid Intima-Media Thickness and Future Cardiovascular Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Carotid intima-media thickness (cIMT) has been widely used as a predictor of future cardiovascular disease (CVD); however, various definitions of cIMT exist. This study provides a systematic review and meta-analysis of the associations between different cIMT definitions and CVD. METHODS AND RESULTS: A systematic review of the different cIMT definitions used in prospective cohort studies was performed. The relationships between cIMT of different definitions (common carotid artery IMT [CCA-IMT], internal carotid artery IMT [ICA-IMT], combined segments [combined-IMT], mean CCA-IMT, and maximum CCA-IMT) with future stroke, myocardial infarction (MI), and CVD events were analyzed using random effects models. Among 2287 articles, 18 articles (14 studies) with >10 different cIMT definitions were identified and included in our meta-analysis. After adjusting for age and sex, a 1-SD increase in CCA-IMT was associated with future stroke (hazard ratio [HR], 1.32 [95% CI, 1.27-1.38]), MI (HR, 1.27 [95% CI, 1.22-1.33]), and CVD events (HR, 1.28 [95% CI, 1.19-1.37]). A 1-SD increase in ICA-IMT was related to future stroke (HR, 1.25 [95% CI, 1.11-1.42]) and CVD events (HR, 1.25 [95% CI, 1.04-1.50]) but not MI (HR, 1.26 [95% CI, 0.98-1.61]). A 1-SD increase in combined-IMT was associated with future stroke (HR, 1.30 [95% CI, 1.08-1.57]) and CVD events (HR, 1.36 [95% CI, 1.23-1.49]). Maximum CCA-IMT was more strongly related than mean CCA-IMT with risk of MI, and both measures were similarly associated with stroke and CVD events. CONCLUSIONS: Combined-IMT is more strongly associated with CVD events compared with single-segment cIMT definitions. Maximum CCA-IMT shows a stronger association with MI than mean CCA-IMT. Further research is warranted to validate our findings and to standardize the cIMT measurement protocol, as well as to explore underlying mechanisms.

ADHD Symptoms and Obesity in Chinese Children and Adolescents: A Longitudinal Study With Abnormal Eating Behaviors as Moderating Factors.

BACKGROUND: Emerging studies have explored the possibility of ADHD and associated abnormal eating behaviors as catalysts for obesity in children and adolescents. However, results were largely inconsistent. This study aims to explore the effects of ADHD and abnormal eating behaviors (including eating disorders, emotional eating, and bedtime eating) on obesity, and to assess the moderating role of abnormal eating behaviors between ADHD symptoms and BMI in Chinese children and adolescents. METHODS: We recruited 546 grade 3 to 11 students and their parents by stratified random sampling from three primary schools and four middle schools in Shanghai, China. This study used parent-reported versions of the ADHD Rating Scale-IV to assess ADHD symptoms, the Eating Attitudes Test and the Children's Eating Attitude Test to assess eating disorder (ED) symptoms, and the Child Eating Behavior Questionnaire to collect information about other abnormal eating behaviors at baseline and at a follow-up survey 1 year later. RESULTS: Hierarchical linear regression analysis revealed that ED played a moderating role in the relationship between ADHD symptoms and BMI in addition to age (ß = .003, p = .008). The simple slope test showed that ADHD symptoms positively correlated with BMI ofs in the older age group with a high level of ED symptoms (ß = .16, p < .001). Moreover, the baseline ED symptoms (ß = .03, p = .032) and ADHD symptoms (ß = .12, p = .015) increased the students' BMI one year later after controlling for confounding factors. CONCLUSION: Findings of this study suggest that ADHD and ED symptoms raised the students' BMI separately. Moreover, ADHD and ED symptoms raised the students' BMI separately. Moreover, a combined high level of ADHD and ED symptoms is correlated with students' high BMI in the older age group.

Association between Metabolic Phenotypes of Body Fatness and Incident Stroke: A Prospective Cohort Study of Chinese Community Residents.

This study aimed to assess the association of body mass index (BMI)-based and waist circumference (WC)-based metabolic phenotypes with the risk of stroke among Chinese community residents. A total of 34,294 participants (mean ± standard deviation age: 56.05 ± 11.26 years) with no previous stroke diagnosis history were included in this cohort study. BMI-based metabolic phenotypes were classified into eight groups: metabolically healthy and normal weight (MHNW), metabolically healthy and underweight (MHUW), metabolically healthy and overweight (MHOW), metabolically healthy and obese (MHO), metabolically unhealthy and normal weight (MUNW), metabolically unhealthy and underweight (MUUW), metabolically unhealthy and overweight (MUOW), and metabolically unhealthy and obese (MUO). WC-based metabolic phenotypes were classified into four groups: metabolically healthy and normal WC (MHNWC), metabolically healthy and oversized WC (MHOWC), metabolically unhealthy and normal WC (MUNWC), and metabolically unhealthy and oversized WC (MUOWC). The association of these phenotypes with developing stroke events was examined using proportional hazards models. A total of 546 cases of first-stroke onset were recorded over a median follow-up time of 4.97 years. Compared with the reference group, the obesity phenotypes showed higher risks for stroke. The adjusted HRs (95% CIs) of MHUW, MHOW, MHO, MUNW, MUUW, MUOW, and MUO phenotypes were 1.01 (0.41, 2.49), 1.47 (1.09, 2.00), 1.33 (0.80, 2.22), 2.49 (1.87, 3.30), 3.92 (1.44, 10.72), 2.14 (1.64, 2.79), and 2.60 (1.91, 3.55), respectively. The adjusted HRs (95% CIs) of MHOWC, MUNWC, and MUOWC were 1.41 (1.02, 1.94), 2.25 (1.76, 2.87), and 2.16 (1.63, 2.87), respectively. The metabolic phenotypes defined by an alternative definition all showed significant positive associations (except for MHUW), with the adjusted HR ranging from 1.51 to 3.08 based on BMI and from 1.68 to 2.24 based on WC. The risk of stroke increased with the increase in metabolic abnormality numbers in different BMI and WC groups (all p trend < 0.001). The present study suggests that maintaining normal body weight or WC and improving metabolic health are of great significance in preventing cerebrovascular diseases.

A Comparison of Segment-Specific and Composite Measures of Carotid Intima-Media Thickness and their Relationships with Coronary Calcium.

AIMS: The utility of carotid intima-media thickness (cIMT) as a marker for coronary heart disease is under heavy debate. This is predominantly due to the lack of a standard definition of cIMT, leading to inconsistent results. We investigated and compared the relationships of five different measures of cIMT with coronary calcium. METHODS: Japanese men aged 40-79y ( n=869) from Shiga Epidemiological Study of Subclinical Atherosclerosis were examined. Mean cIMT was measured in three segments of the carotid arteries: common carotid artery (CCAmean), internal carotid artery (ICAmean) and bifurcation (Bifmean). Mean cIMT of average values (Mean cIMT) and mean cIMT of maximum values (Mean-Max cIMT) of all segments combined were assessed. Coronary calcium was assessed as coronary artery calcification (CAC). Ordinal logistic regression was used to determine the odds ratio (OR) of higher CAC per 1 standard deviation higher cIMT measure. Analyses were adjusted for cardiovascular covariates and stratified by age quartiles. RESULTS: All cIMT measures had positive associations with CAC (p＜0.001): [OR, 95% Confidence Interval]: ICAmean [1.23, 1.07-1.42], CCAmean [1.27, 1.08-1.49], Bifmean [1.33, 1.15-1.53], Mean cIMT [1.42, 1.22-1.66], and Mean-Max [1.50, 1.28-1.75]. In age-stratified analyses, only Mean-Max cIMT maintained a significant relationship with CAC in every age quartile (p＜0.05), while CCAmean had some of the weakest associations among age quartiles. CONCLUSIONS: Mean-Max cIMT had consistently stronger associations with coronary calcium, independent of important confounders, such as age. The most oft-used measure, CCAmean, was no longer associated with coronary calcium after age-adjustment and stratification.

Association between Reproductive Factors and Type 2 Diabetes: A Cross-Sectional Study.

(1) Introduction: The available studies on the association between type 2 diabetes mellitus (T2DM) and menopause report conflicting results. (2) Objective: This study aimed to investigate the association of menopausal status, age at menopause, and length of the reproductive period with T2DM. (3) Methods: This cross-sectional study is part of the 'China Eastern Cohort Study', which is a community-based cohort study. Multistage, stratified, clustered sampling was used to recruit the study participants in Shanghai, China. Age at menarche and menopause was recorded, and reproductive period was calculated. Weighted logistic regression was used to calculate the prevalence ratios (PRs) with 95% confidence intervals (CIs) of T2DM. Restricted cubic splines were used to assess the relationship between age at menopause, reproductive period, and T2DM. (4) Results: A total of 20,128 women were included. The prevalence of T2DM was 13.7%. Postmenopausal women exhibited a higher prevalence of T2DM than premenopausal women (p < 0.001) and an unfavorable metabolic profile, including higher body mass index, hypertension, and hyperlipidemia. A higher risk of T2DM was observed in postmenopausal women (PR2.12, 95%CI: 1.79-2.51, p < 0.001) compared with premenopausal women, independently of confounding factors. After adjustment for confounding factors, age at menopause and reproductive period were not significantly associated with T2DM. (5) Conclusions: Postmenopausal status is associated with T2DM, while menopausal age and reproductive period are not associated with T2DM. Menopausal status should be considered during T2DM screening.

Fish Consumption and Risk of Stroke in Chinese Adults: A Prospective Cohort Study in Shanghai, China.

Present studies on the association of fish consumption with risk of stroke have shown controversial results, and this association within the Chinese population remains unknown. We aimed to investigate the association between fish consumption and incidence of total stroke, ischemic stroke and hemorrhagic stroke among adults in China. We analyzed the data of 57,701 adults aged 20-74 years, with no history of stroke, in a prospective cohort study in Shanghai. Fish consumption was calculated from a food frequency questionnaire at baseline and divided into four categories (less than 300, 300-450, 450-600 and more than 600 g/week). Participant information was linked to health information systems in which stroke event information was collected up until 31 December 2021. The hazard ratios (HR) and 95% confidence intervals (CI) of the associations of fish consumption with risk of total stroke, ischemic stroke and hemorrhagic stroke were estimated using cox proportional hazards regression models. Dose-response relationships were estimated using restricted cubic spline analyses. During a median follow-up of 4.56 years, 807 newly developed stroke events were ascertained, including 664 ischemic stroke events and 113 hemorrhagic stroke events. Fish consumption of 300-450 g/week was associated with a reduced risk of total stroke (HR: 0.78, 95% CI: 0.64-0.94) and ischemic stroke (0.70 (0.57-0.88)) compared with fish consumption of less than 300 g/week, after adjustment for comprehensive covariates including sociodemographic characteristics, lifestyle, dietary patterns and disease histories. No significant association was found between fish consumption and hemorrhagic stroke. The findings of our study support the consumption level of fish recommended in the dietary guidelines.