Association of Glasgow Coma Scale with Total Homocysteine Levels in Patients with Hemorrhagic Stroke.

OBJECTIVES: We aimed to evaluate the association between Glasgow Coma Scale (GCS) and total homocysteine (tHcy) levels and examine the possible effect modifiers in patients with hemorrhagic stroke. METHODS: A total of 1,516 participants with hemorrhagic stroke and having the complete data on baseline GCS and tHcy measurements were included in the final analysis. RESULTS: The mean (SD) of age, tHcy, and GCS levels were 61.5 (11.3) years, 17.0 (10.3) µmol/L, and 13.9 (2.2), respectively. Compared with participants with severe damage (GCS <9), those with mild damage (GCS ≥13) had significantly lower transformed tHcy levels (ß = -2.46; 95% CI -4.80 to -0.12). Consistently, a significantly lower transformed tHcy levels were found in participants with mild damage (GCS ≥13; ß = -1.37; 95% CI -2.66 to -0.08) compared with those with moderate to severe damage (GCS <13). In the stratified analysis, a stronger inverse association between GCS categories (≥13 vs. <13) and tHcy concentrations was observed in ever smokers (vs. never; p for interaction = 0.045), and in participants with systolic blood pressure (SBP) ≥160 mm Hg (vs. <160 mm Hg; p for interaction = 0.031), or total cholesterol (TC) ≥5.2 mmol/L (vs. <5.2 mmol/L; p for interaction = 0.025). CONCLUSION: There was an inverse association between GCS level and tHcy concentration among patients with hemorrhagic stroke, especially in ever smokers or in participants with higher SBP or TC levels.

Community-based stroke system of care for Chinese rural areas.

BACKGROUND AND PURPOSE: Stroke system of care plays key roles both in providing effective therapies and in improving the overall outcome of patients with stroke. Our purpose was to develop and evaluate the system in Chinese rural areas. METHODS: A stroke system of care was developed from November 2009 to November 2010 in 3 townships in Ganyu County. An additional 3 matched townships were invited as controls. We first investigated stroke management in these townships and then implemented stroke system of care and an education campaign in the 3 intervention townships. The effectiveness of the system was then evaluated. RESULTS: There were 1036 patients with new stroke among 344 345 subjects in the 6 rural communities. The incidence of stroke in the rural areas was 301/100 000, and the mortality rate was 55/100 000. The proportions significantly increased in the intervention communities after the implementation of the stroke system of care and education campaign when compared with the control communities, including patients presenting at rural hospitals within 3 hours of symptom onset (13.6% versus 8.7%; P=0.017), diagnosed by computed tomographic scanning within 24 hours of admission (65.3% versus 58.5%; P=0.034), and received thrombolytic treatment (3.9% versus 1.7%; P=0.038). During the 1-year follow-up, 32 (6.5%) patients with stroke in the intervention communities and 48 (10.1%) in the control communities died. The disability rate of stroke was significantly reduced in the intervention communities at postintervention (38.4% versus 48.1%; P=0.001). CONCLUSIONS: A stroke system of care would be reliable and practical in Chinese rural areas. CLINICAL TRIAL REGISTRATION URL: http://www.chictr.org. Unique identifier: ChiCTR-RCH-13003408.

Methylenetetrahydrofolate reductase C677T polymorphism is associated with estimated glomerular filtration rate in hypertensive Chinese males.

BACKGROUND: Plasma level of total homocysteine (tHcy) is negatively correlated with kidney function in general population. However, the causal mechanism of this correlation is poorly understood. The purpose of this study is to investigate the association of methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism, which is a major genetic determinant of the plasma tHcy level, with estimated glomerular filtration rate (eGFR) in Chinese. METHODS: A total of 18 814 hypertensive patients (6,914 males, 11,900 females) were included in the study. RESULTS: Association between the eGFR and MTHFR C677T genotype was examined by sex-specific regression analyses. In males, TT genotype was associated with 1.37 ml/min/1.73 m(2) decrease in eGFR (p = 0.004) and with an increased risk (OR = 1.32, p = 0.008) for the lowest quintile of eGFR after adjusting for age, BMI, and blood pressures. However, such association was not observed in females (p > 0.05). This association suggests MTHFR C677T polymorphism may play a role in the regulation of eGFR in males. CONCLUSIONS: MTHFR 677 T is a risk allele for decreased kidney function in Chinese males, implicating this gene in the pathogenesis of chronic kidney disease (CKD).

Genetic and environmental influences on serum lipid tracking: a population-based, longitudinal Chinese twin study.

We conducted cross-sectional and longitudinal twin analysis to explore genetic and environmental contribution to serum lipid tracking during childhood and adolescence. The study sample was part of a population-based twin cohort that was recruited in the rural areas of the Anhui Province of China. The baseline recruitment of twins was carried out from 1998 through 2000 and the follow-up from 2005 through 2007. Serum lipids showed significant tracking during childhood and adolescence. Participants with lipids at the highest tertile at the baseline tended to remain high at follow-up across ages and Tanner stages, whereas subjects with lipids at the lowest tertile at the baseline tended to remain low at follow-up. Using twin modeling, we showed that genetic and environmental factors contributed to individual variations in lipid levels and tracking from the baseline to the follow-up visit. The estimated tracking correlations for total cholesterol, triglyceride, and LDL cholesterol were in the range of 0.25-0.53 and were predominantly influenced by genetic factors. In contrast, the phenotypic tracking of HDL cholesterol was influenced by both genetic and environmental factors. Our study underscores the importance of considering both environmental and genetic factors in studying the etiology of dyslipidemia.

Adiposity, serum lipid levels, and allergic sensitization in Chinese men and women.

BACKGROUND: Obesity and allergic diseases have increased dramatically in recent decades. Although adiposity has been associated with asthma, associations with allergic sensitization have been inconsistent. OBJECTIVE: To examine the association of adiposity and lipid profiles with allergic sensitization. METHODS: This study included 1187 rural Chinese twins (653 men) age 18 to 39 years, with skin prick tests, anthropometric and dual-energy x-ray absorptiometry-assessed adiposity measures, and lipid assessments. Allergic sensitization was defined as positive SPT to >/=1 allergen (9 foods and 5 aeroallergens tested). We applied sex-stratified generalized estimating equations to assess the association of adiposity and serum lipids with allergic sensitization, and structural equation models to estimate the genetic/environmental influences on any observed associations. RESULTS: Men had lower percent body fat (% BF) (13.9% vs. 28.8%) but higher rates of allergic sensitization (56.2% vs 36.7%) than women. Men in the highest %BF quartile were 2.1 times more likely to be sensitized than the lowest quartile (95% CI, 1.3-3.5; P trend = .003). In men, the risk of allergic sensitization increased with high-density lipoprotein (HDL) <40 mg/dL (odds ratio = 4.0; 95% CI, 1.8-9.2) and higher low-density lipoprotein quartiles (P trend = .007). This appeared to be partially explained by shared genetic factors between serum lipid levels and allergic sensitization. In females, lower HDL was associated with increased risk of allergic sensitization. CONCLUSION: In this relatively lean Chinese population, higher %BF, lower HDL and higher LDL were associated with greater risk of allergic sensitization, most notable in men. The observed associations among adiposity, serum lipids, and allergic sensitization in men appear to be partially explained by common genetic influences on these traits.

Sleep patterns among rural Chinese twin adolescents.

OBJECTIVE: To examine sleep patterns and influencing factors (age, gender, Tanner Stage, weekday vs. weekend, and pre-sleep activity) among rural Chinese adolescents. METHODS: This is a prospective study among 621 adolescents aged 11-20 years (341 males) using both a questionnaire and sleep diary to obtain bedtime, wake-up time, sleep latency, and total sleep time (TST). RESULTS: The median TST was 8.6h on weekdays and 9.4h on weekends. Despite absence of late night social pressure and computers, a U-shaped TST pattern was observed across age and Tanner Stage, with a nadir around age 15-16 years or Tanner IV. Bedtimes became progressively later with age and Tanner Stage, while wake-up time was considerably earlier for school students or up to Tanner IV. Later wake-up times and longer TST on weekends were seen in school students, but not in non-school adolescents (>17 years). Pre-sleep activity, like reading or studying, was related to later bedtime, earlier wake-up time, and shorter TST in both genders. CONCLUSIONS: Age, Tanner Stage, and pre-sleep activity affected sleep patterns in this sample of rural Chinese adolescents. Later bedtime coupled with earlier wake-up time associated with academic demand appear to be important contributors to sleep loss among school students.

Association of surrogate and direct measures of adiposity with risk of metabolic syndrome in rural Chinese women.

BACKGROUND: Most studies linking obesity and metabolic syndrome (MS) have used body mass index (BMI) and waist circumference (WC) to measure obesity. While BMI is correlated with direct measures of total and central adiposity, it is influenced by lean body and bone mass. We hypothesize that direct measures of adiposity may help develop further insight into the link between obesity and MS, thus more accurately identifying individuals at high risk for MS. AIM OF THE STUDY: We examined how surrogate and direct measures of adiposity were associated with MS risk and if direct adiposity measures enhanced BMI and WC identification of MS risk. METHODS: 3,734 Chinese female twins aged 20-39 years were studied. Percent body fat (%BF) and proportion of trunk fat to total BF (%TF) were assessed by DEXA. Graphic plots and generalized estimating equations were used to examine the associations of adiposity measures with MS and its components. Concordance of adiposity measures and MS abnormalities between monozygotic (MZ) and dizygotic (DZ) twin pairs were compared. RESULTS: The prevalence of MS increased for high BMI (>or=23 kg/m(2)), %BF (>or=32), WC (>or=80 cm), and (to a lesser degree) %TF (>or=50). Below those thresholds, the prevalence of MS was low (0-5.3%). %TF was independently associated with higher risk of MS and its components even after adjusting for BMI and WC. As a result, among women with normal BMI and WC, high %TF was associated with 1.3-2.0-fold elevated risk of MS components. In contrast, women with high BMI but normal WC and %TF neither have significantly increased risk of MS, nor for any component other than high BP. MZ twins showed higher concordance for MS and its components than DZ twins. CONCLUSIONS: In this lean Chinese rural female sample, BMI >or= 23 and WC >or= 80 were associated with a markedly increased risk of MS, which was further enhanced by elevated %TF. Even in women with a normal BMI and WC, %TF was independently associated with MS and its components. Twin analysis findings suggest that adiposity measurements and MS risk are influenced by genetics.

Dissociation between the prevalence of atopy and allergic disease in rural China among children and adults.

BACKGROUND: The prevalence of allergic diseases is increasing worldwide, but the reasons are not well understood. Previous studies suggest that this trend might be associated with lifestyle and urbanization. OBJECTIVE: We sought to describe patterns of sensitization and allergic disease in an unselected agricultural Chinese population. METHODS: The data were derived from a community-based twin study in Anqing, China. Skin prick tests were performed to foods and aeroallergens. Atopy was defined as sensitization to 1 or more allergens. Allergic disease was ascertained by means of self-report. The analysis was stratified by sex and age (children [11-17 years] and adults [>or=18 years]) and included 1059 same-sex twin pairs. RESULTS: Of 2118 subjects, 57.6% were male (n = 1220). Ages ranged from 11 to 71 years, and 43.3% were children (n = 918). Atopy was observed in 47.2% (n = 999) of participants. The most common sensitizing foods were shellfish (16.7%) and peanut (12.3%). The most common sensitizing aeroallergens were dust mite (30.6%) and cockroach (25.2%). Birth order and zygosity had no effect on sensitization rates. Multivariate logistic regression models revealed that risk factors for sensitization include age for foods and sex for aeroallergens. The rates of food allergy and asthma were estimated to be less than 1%. CONCLUSIONS: Atopic sensitization was common in this rural farming Chinese population, particularly to shellfish, peanut, dust mite, and cockroach. The prevalence of allergic disease, in contrast, was quite low.

A large-scale genome-wide linkage analysis to map loci linked to stature in Chinese population.

CONTEXT: A number of genome-wide scans of stature have been reported previously, but with inconsistent results. The inconsistency may be partly due to differential population characteristics and gender- and/or age-specific effects on this trait. OBJECTIVE: This study aimed to identify the quantitative trait loci (QTLs) underlying the variation of stature in Chinese population, and to evaluate age- and gender-specific linkage for stature. METHODS: We conducted a large-scale, genome-wide linkage scan using the data from three independent samples (a total of 7112 subjects from 1811 pedigrees) enrolled from the same geographical region in China. Linkage analyses were performed in the pooled samples and in subgroups defined by age (25 yr), gender, or both, using the model-free regression method implemented in MERLIN-REGRESS. RESULTS: The strongest linkage signal was obtained on 17q24 (LOD=3.82) in the pooled samples. Age-specific analysis revealed two additional significant QTLs on 13q34 and 18p11.3 among subjects 25 yr or younger. In gender-specific analyses, males showed suggestive QTLs on 12q21 (LOD=2.31) and 17q22 (LOD=2.60), and females showed a suggestive QTL on 13q31.1 (LOD=2.68). Age- and gender-specific linkage analyses suggested that males older than 25 yr contributed more signals to QTLs on 12q21 and 17q22, with a LOD score of 3.00 and 2.26, respectively, whereas females older than 25 yr presented a suggestive QTL on 8q24.3 (LOD=2.57). CONCLUSION: Our study identified a strong linkage of chromosome 17q24 to stature in this Chinese population, and indicated that it may be informative to consider differential age and gender effects in the genetic dissection of stature.

Efficacy of folic acid and enalapril combined therapy on reduction of blood pressure and plasma glucose: a multicenter, randomized, double-blind, parallel-controlled, clinical trial.

OBJECTIVE: We compared the efficacy of folic acid (FA) plus enalapril with enalapril alone on the reduction of blood pressure (BP) and fasting plasma glucose (FPG) in adult Chinese hypertensive patients. METHODS: Four hundred eighty subjects with mild to moderate BP were randomly assigned to one of three treatment groups: 1) 10 mg of enalapril (control group), 2) 10 mg of enalapril plus 0.4 mg of FA (low-FA group), or 3) 10 mg of enalapril plus 0.8 mg of FA (high-FA group) daily for 8 wk. Generalized linear mixed models were used to compare the reduction in BP and FPG level from baseline to week 8 of the treatment and the difference among the three treatment groups, adjusting for pertinent covariates. RESULTS: Four hundred forty-three subjects (57.3% women, 27-75 y of age) successfully completed the trial. After the 8-wk treatment, compared with baseline, all treatment groups showed significant reduction of BP but not of FPG. There was no significant difference in BP or FPG reduction among the three treatment groups. In subgroup analysis, we found that in subjects with hyperglycemia (FPG >or=6.1 mmol/L) at baseline, FPG reduction was significantly greater in the high-FA group (-0.80 +/- 1.20 mmol/L) than in the low-FA group (-0.39 +/- 1.44 mmol/L) and the control group (-0.23 +/- 1.30 mmol/L). Regression analysis further confirmed that FPG reduction in the high-FA group was -0.68 +/- 0.28 mmol/L greater than in the control group (P = 0.015), even after adjustment for important covariates. A dose-response trend was evident (P for trend = 0.025) and the test for an interaction between treatment group and baseline FPG was significant (P < 0.001). CONCLUSION: In this sample of adult Chinese hypertensive patients, FA combined with enalapril showed a greater beneficial effect on reduction of FPG in a dose-related fashion than did enalapril alone among subjects with hyperglycemia.

Strategy for early identification of prediabetes in lean populations: New insight from a prospective Chinese twin cohort of children and young adults.

AIMS: To identify certain subgroups in young and lean populations, who may be at a high risk of developing prediabetes/diabetes, which is not captured by current BMI-based screening algorithms. METHODS: Incidence of prediabetes/diabetes was assessed using oral glucose tolerance tests among 1859 children and 1073 young adults from a prospective Chinese twin cohort. RESULTS: Over a 6-year follow-up, 507 (27.3%) children and 293 (27.3%) adults developed prediabetes/diabetes. Of the 800 incidents, 737(92.1%) and 644(80.5%) were lean at baseline and follow-up, respectively. Baseline fasting glucose in the top tertile of the normal range was associated with an increased risk of prediabetes/diabetes: odds ratio, 1.85 (95% CI 1.32-2.59) and 3.29 (95%CI 2.10-5.17) among normal weight and underweight children, respectively, and 2.74 (95% CI 1.78-4.23) and 3.08 (95% CI 1.69-5.58) among normal weight and overweight/obese adults, respectively, compared with the low tertile of fasting glucose. CONCLUSIONS: We showed that majority incident cases of prediabetes/diabetes were not overweight/obese (at baseline), who would have been missed by traditional screening algorithm emphasizing overweight/obesity. Our findings revealed that an upper end of normal fasting glucose was a simple and robust predictor of future higher risk of prediabetes/diabetes in this young and lean population.

Short sleep duration and adiposity in Chinese adolescents.

OBJECTIVE: To investigate the relationship between sleep duration and adiposity measurements in rural Chinese adolescents. METHODS: This report is based on a cross-sectional analysis of 500 Chinese adolescent twins. Anthropometric measurements and direct adiposity measurements using dual-energy X-ray absorptiometry (DEXA) were taken for all subjects. Standard sleep questionnaires and a 7-day diary were administered to assess sleep duration. RESULTS: Sleep duration decreased with increasing age during adolescence, reaching a nadir at approximately 15 years of age. While BMI and body fat increased through the entire range of adolescence for both genders, after the age of 12, females had much higher amounts of total and truncal fat than males. Graphic plots showed that among females, both long and short sleepers tended to have higher adiposity measures than medium duration sleepers. The association of short sleep duration with higher adiposity measures was significant even after adjustment for covariates. This association was stronger for total and truncal fat and waist circumference (P < 0.05) than for BMI (P = 0.06). In contrast, consistent relationships between sleep duration and adiposity measures were not seen in males. CONCLUSION: Even in this relatively lean Chinese adolescent cohort, short sleep duration was significantly associated with higher adiposity measures and lower lean body mass in females. The results of this study indicate that the observed association between short sleep duration and higher BMI is most likely mediated by factors associated with total and central adiposity rather than lean body mass.

Association of sulfonylurea receptor 1 genotype with therapeutic response to gliclazide in type 2 diabetes.

To investigate the effects of sulfonylurea receptor 1 (SUR1) exon 33 (TCC-->GCC, S1369A) polymorphism on responsiveness to gliclazide. About 115 patients with type 2 diabetes were treated with gliclazide for 8 weeks. SUR1 genotypes were tested by Taqman-PCR. After gliclazide treatment, there was association between T/G polymorphism and decrease of HbA1c. G carriers were more sensitive to gliclazide and the decrease of HbA1c was more significant than TT genotype (TT, 0.76%+/-1.70%; TG+GG, 1.60%+/-1.39%, P=0.044). The polymorphism of SUR1S1369A was associated with the therapeutic efficacy of gliclazide.

Age and gender specific lung function predictive equations provide similar predictions for both a twin population and a general population from age 6 through adolescence.

BACKGROUND: There have been numerous studies of asthma in twins, but no study has evaluated whether lung function predictive models yield similar results between twin and general populations. We sought to evaluate this in late childhood and adolescent subjects. METHODS: We generated cross-sectional, sex- and age-specific regression models of FEV(1), and FVC, in a community-based cohort of 3140 healthy, non-smoking Chinese twins using generalized estimating equations to adjust for correlations within twin pairs. We applied the model to a healthy non-smoking general population cohort of 2187 subjects from the same region, and compared %predicted FEV(1) and FVC values between the two populations. RESULTS: Stratified by age and sex, the associations of height with FEV(1) or FVC varied by age group. During the adolescent growth spurt (age 13 for girls and ages 14-16 for boys), the associations of height with FEV(1) or FVC were nonlinear and greater than that seen at other ages. During adolescence, FEV(1) and FVC for a given height increased with age. The percent predicted values of FEV(1) and FVC in the twin population were similar to that of the general population. CONCLUSIONS: Twin and general populations have similar patterns of lung function change over middle childhood and adolescence. Similar equations may be used to estimate percent predicted values. Finally, a single prediction equation cannot completely describe patterns of lung function from childhood through adolescence due to puberty related changes.

[Distribution of serum folic acid level of patient suffered mild and moderate hypertension in six cities in China].

OBJECTIVE: To describe distribution of serum folic acid concentrations and differences among age, gender groups and geography in Chinese population with mild-to-moderate hypertension. METHODS: 455 subjects aged 28 to 75 years were randomly recruited from six cities in China. Serum folic acid concentrations were measured by electrochemiluminescence. RESULTS: (1)The mean of serum folic acid in male (12.39nmol/L) was lower than that in female (14.61nmol/L) (P <0.01). The folic acid deficiency rate and lower folic acid rate in male were also significantly higher than those in female (P < 0.05). (2) Subjects from Nanjing city could have relatively higher level in serum of folic acid (P < 0.05), when compared with those from other cities. Additionally, there were no differential distributions of folic acid levels among different age groups. CONCLUSION: Serum folic acid distribution in Chinese mild-to-moderate hypertensive patients could have gender and geography differences.

Interactive Effect of the KCNJ11 Ile337Val Polymorphism and Cigarette Smoking on the Antihypertensive Response to Irbesartan in Chinese Hypertensive Patients.

OBJECTIVE: This study was designed to detect the association of the potassium inwardly rectifying channel, subfamily J, member 11 (KCNJ11) gene polymorphism with antihypertensive therapeutic response to irbesartan in a large-scale Chinese hypertensive population. METHODS: A total of 1,099 patients with essential hypertension were enrolled to receive a daily dose of 150 mg irbesartan for 27 days. Pretreatment baseline blood pressure (BP) and posttreatment BP on the 28th day were measured. Plasma irbesartan concentrations were measured by high-performance liquid chromatography-fluorescence. The KCNJ11 I337V gene polymorphism was determined using high-throughput TaqMan technology. RESULTS: The HapMap data in the Han Chinese population showed that the I337V was used as a representative for 4 common functional polymorphisms. Our results showed that the association of antihypertensive response to irbesartan and the KCNJ11 genetic variant in the total sample was not significant. However, in nonsmokers, relative to the GG genotype, subjects with the homozygous AA genotype had a significantly higher therapeutic response to irbesartan (adjusted beta ± SE: 4.7±1.9 mm Hg, P = 0.015). In smokers, the subjects with the homozygous AA genotype had a significantly lower therapeutic response to irbesartan (adjusted beta ± SE: -5.6±2.5 mm Hg, P = 0.026). A multivariate linear regression model confirmed that there was a significant interactive effect between the KCNJ11 gene and smoking on irbesartan treatment (interaction P = 0.001). CONCLUSION: The interactive effect of smoking status and the KCNJ11 genotype may influence the antihypertensive effects of irbesartan, which indicates a consideration for future individualized antihypertensive drug treatment.

Association between Body Mass Index and All-Cause Mortality in Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT).

The association between elevated body mass index (BMI) and risk of death has been reported in many studies. However, the association between BMI and all-cause mortality for hypertensive Chinese adults remains unclear. We conducted a post-hoc analysis using data from the China Stroke Primary Prevention Trial (CSPPT). Cox regression analysis was performed to determine the significance of the association of BMI with all-cause mortality. During a mean follow-up duration of 4.5 years, 622 deaths (3.0%) occurred among the 20,694 participants aged 45-75 years. A reversed J-shaped relationship was observed between BMI and all-cause mortality. The hazard ratios (HRs) for underweight (<18.5 kg/m²), overweight (24.0-27.9 kg/m²), and obesity (≥28.0 kg/m²) were calculated relative to normal weight (18.5-23.9 kg/m²). The summary HRs were 1.56 (95% CI, 1.11-2.18) for underweight, 0.78 (95% CI 0.64-0.95) for overweight and 0.64 (95% CI, 0.48-0.85) for obesity. In sex-age-specific analyses, participants over 60 years of age had optimal BMI in the obesity classification and the results were consistent in both males and females. Relative to normal weight, underweight was associated with significantly higher mortality. Excessive weight was not associated with increased risk of mortality. Chinese hypertensive adults had the lowest mortality in grade 1 obesity.

Effect of environmental tobacco smoke on levels of urinary hormone markers.

Our recent study showed a dose-response relationship between environmental tobacco smoke (ETS) and the risk of early pregnancy loss. Smoking is known to affect female reproductive hormones. We explored whether ETS affects reproductive hormone profiles as characterized by urinary pregnanediol-3-glucuronide (PdG) and estrone conjugate (E1C) levels. We prospectively studied 371 healthy newly married nonsmoking women in China who intended to conceive and had stopped contraception. Daily records of vaginal bleeding, active and passive cigarette smoking, and daily first-morning urine specimens were collected for up to 1 year or until a clinical pregnancy was achieved. We determined the day of ovulation for each menstrual cycle. The effects of ETS exposure on daily urinary PdG and E1C levels in a +/-10 day window around the day of ovulation were analyzed for conception and nonconception cycles, respectively. Our analysis included 344 nonconception cycles and 329 conception cycles. In nonconception cycles, cycles with ETS exposure had significantly lower urinary E1C levels (beta = -0.43, SE = 0.08, p < 0.001 in log scale) compared with the cycles without ETS exposure. There was no significant difference in urinary PdG levels in cycles having ETS exposure (beta = -0.07, SE = 0.15, p = 0.637 in log scale) compared with no ETS exposure. Among conception cycles, there were no significant differences in E1C and PdG levels between ETS exposure and nonexposure. In conclusion, ETS exposure was associated with significantly lower urinary E1C levels among nonconception cycles, suggesting that the adverse reproductive effect of ETS may act partly through its antiestrogen effects.

Association of cigarette smoking with steady-state plasma concentration of irbesartan in male Chinese with hypertension.

Previous studies suggested that cigarette smoking, being highly prevalent in many countries, is an important environmental factor that contributes to interindividual variations in response to certain medications. To investigate the possible interactions between irbesartan (a commonly used angiotensin II type 1 receptor antagonist) and cigarette smoking, we recruited 491 male patients with essential hypertension from two rural districts of China. All subjects were treated with irbesartan (150 mg/day) for 28 days, and the steady-state plasma concentrations of irbesartan 24 h after the dose of day 27 (the trough level) and 6 h after the dose of day 28 were determined using prevalidated high-performance liquid chromatography (HPLC)-fluorescence method. Multiple linear regression was used to analyze the effect of smoking on the steady-state plasma concentrations of irbesartan, with potential confounding factors adjusted. The results showed that current smokers had significantly higher average steady-state trough plasma level of irbesartan than that of the nonsmokers and former smokers. The finding was still valid when subjects from the two different districts were separately analyzed. The stratified analysis according to age suggested that the effect of increasing irbesartan concentration by current cigarette smoking in the elderly patients was stronger than that in adults. The metabolism of irbesartan in current smokers was slower compared to that in nonsmokers and former smokers. In summary, the present study showed significant associations between current cigarette smoking and an increased steady-state trough plasma concentration of irbesartan in a male Chinese population with hypertension. The metabolic rate of irbesartan in current smokers was slower than those in nonsmokers and former smokers.

Metabolic syndrome, but not insulin resistance, is associated with an increased risk of renal function decline.

BACKGROUND & AIMS: The purpose of this study was to evaluate the effect of metabolic syndrome (Mets) and insulin resistance (IR) on the risk of renal function decline (RFD) in a rural Chinese cohort. METHODS: A total of 2696 subjects aged 40-71 years with normal renal function were followed-up for 7 years. RFD was defined using the Kidney Disease: Improving Global Outcome definition, i.e., a drop in estimated glomerular filtration rate (eGFR) category accompanied by a 25% or greater drop in eGFR from baseline or a sustained decline in eGFR of more than 5 mL/min/1.73 m(2)/year. RESULTS: During the 7-year follow-up, 9.0% of the subjects developed RFD. Subjects with Mets at baseline had an increased risk of RFD with an adjusted odds ratio (OR) of 1.77 (95%CI: 1.25-2.52), and there was a graded relationship between the numbers of Mets components and the risk for RFD. Exclusion of the subjects with hypertension (1.65; 0.99-2.75) or diabetes (1.86; 1.30-2.67) at baseline or further adjustment for IR (1.72; 1.15-2.57) did not substantially change the association between Mets and the risk of RFD. Moreover, the ORs of Mets status for RFD in the older group (≥55 years) were 2.14 (1.06-4.33) times of that in the younger group (<55 years) and 2.26 (1.07-4.78) times in hypercholesterolemia group (≥5.2 mmol/L) of that in the normal (<5.2 mmol/L) group. The baseline IR was not associated with the risk for RFD. CONCLUSIONS: Mets, but not IR, was associated with an increased risk for RFD. And there was a detrimental interaction of Mets with older age and hypercholesterolemia on the risk of RFD.