The effect of living environmental factors on cardiovascular diseases in Chinese adults: results from a cross-sectional and longitudinal study

Association between hygiene environment, care needs, and depression among Chinese older adults: A cohort analysis from the CHARLS

Limited research has explored the link between functional dependency, care needs, and depression among older adults. This study aims to explore the association between dependency levels and depression among Chinese older adults, as well as examine the relationship between hygiene environment and these two factors. Data were obtained from the CHARLS 2011-2018. A total of 4871 individuals aged 60 years and older were included. Generalized estimating equations were employed for the analysis. A conceptual framework was established to longitudinally illustrate the pathway from hygiene environment to dependency levels to depression. Findings indicated higher dependency levels and poorer hygiene environments were associated with an increased risk of depression, with dependency serving as a mediator between hygiene environment and depression. Policymakers should prioritize improvements in rural sanitation and long-term care policies, healthcare providers should enhance depression screening and caregiver training, and clinicians should provide personalized interventions to better address mental health challenges.

Exosomes derived from cardiac fibroblasts with Ang-II stimulation provoke myocardial hypertrophy via miR-15b-5p/PTEN-L axis

This study aimed to examine the impact of exosomes derived from Ang II-stimulated cardiac fibroblasts (CFs) on myocardial hypertrophy. Neonatal rat CFs were isolated and identified using Vimentin immunofluorescence. Following Ang II stimulation, exosomes were collected, characterized, and subjected to miRNA sequencing. Myocardial hypertrophy models were induced both in vitro and in vivo using Ang II. CFs were transfected with miR-15b-5p mimics or inhibitors, and their exosomes were co-cultured with rat cardiomyocytes (H9C2). Changes in cell viability, myocardial hypertrophy, and the expression levels of PTEN-L, PINK1, and Parkin proteins were assessed using the CCK-8 assay, cell surface area evaluation, and Western blot analysis. Cardiac tissue pathology and myocardial hypertrophy were evaluated through HE and WAG staining, respectively, while PTEN-L expression was detected by immunohistochemistry. The results demonstrated successful isolation of CFs and their exosomes, with miR-15b-5p significantly enriched in the exosomes derived from Ang II-stimulated CFs (Ang II-CFs-Exos). Ang II-CFs-Exos inhibited cell viability, exacerbated myocardial hypertrophy, and activated mitophagy via miR-15b-5p in the in vitro myocardial hypertrophy model. PTEN-L was identified as a downstream target of miR-15b-5p, with its overexpression reversed the effects of miR-15b-5p mimic on myocardial hypertrophy and mitophagy. Additionally, mitochondrial inhibitors also countered the effects of the miR-15b-5p mimic on myocardial hypertrophy. Furthermore, Ang II-CFs-Exos exacerbated myocardial hypertrophy in rats, while knockout of miR-15b-5p in Ang II-CFs-Exos mitigated this effect. To sum up, Ang II-CFs-Exos promote myocardial hypertrophy by modulating PINK1/Parkin signaling -mediated mitophagy through the miR-15b-5p/PTEN-L axis.

Association between residential environment quality with mild cognitive impairment among middle and elderly adults in China

BACKGROUND

Most studies have focused on the effects of individual environmental risk factors on cognitive function; however, none have evaluated the association between residential environmental quality and cognitive impairment.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) were used to include 12,801 participants in a cross-sectional study and 8781 participants in a cohort study. Residential environmental quality was assessed using indicators such as particulate matter, types of household fuel, water sources, indoor temperature, and building types. Based on the residential environment quality score, participants were classified into three groups: comfortable (0-1 points), moderate (2-3 points), and poor (4-6 points). To evaluate the association between residential environmental quality and cognitive scores in the cross-sectional study, as well as the development of mild cognitive impairment (MCI) in the cohort study, ordinary least squares (OLS) regression and logistic regression models were applied.

RESULTS

In the cross-sectional study, cognitive scores and performance across four dimensions-orientation, computation, memory, and drawing-showed a significant decline from the comfortable to the poor residential environment groups. In the fully adjusted OLS regression model, scores across these dimensions were significantly reduced in the moderate and poor groups compared to the comfortable group (P for trend <0.001). The incidence of MCI from 2011 to 2018 was 10.1 %, 16.8 %, and 18.8 % for participants living in comfortable, moderate, and poor environments, respectively, with statistically significant differences among groups (all P < 0.07). Logistic regression analysis revealed an odds ratio of 1.25 (95 % CI: 1.02-1.53) for the moderate group and 1.31 (95 % CI: 1.04-1.65) for the poor group, compared to the comfortable group (P for trend<0.05).

CONCLUSIONS

An inferior residential environment is associated with lower cognitive scores and a higher rik of developing MCI in middle-aged and older Chinese adults.

The impact of living environmental factors on cognitive function and mild cognitive impairment: evidence from the Chinese elderly population

OBJECTIVES

Mild cognitive impairment represents a pivotal stage in the cognitive decline of older adults, with a considerable risk of advancing to dementia. Recognizing how living environmental factors affect cognition is crucial for crafting effective prevention and intervention strategies. This study seeks to elucidate the relationship between various living environmental factors and cognitive function, with a specific focus on mild cognitive impairment, within a Chinese elderly population.

METHODS

This is a cross-section and longitudinal study. Utilizing data from CHARLS, our cross-sectional analysis included 4,401 participants, while the cohort study comprised 3,177 individuals. We assessed living environmental factors based on household fuel types, water sources, indoor temperatures, residential building types, and ambient PM2.5 levels. We employed multiple linear regression for cross-sectional analyses and Cox proportional hazards regression models for longitudinal assessments to determine the effects of living environments on cognitive function and MCI risk. Stratified analyses, interaction tests, and sensitivity analyses were conducted to further validate our findings.

RESULTS

The findings revealed that, compared to those in high-risk environments, participants in low-risk settings exhibited higher cognitive scores (β = 1.25, 95%CI: 0.85, 1.65), better mental status (β = 0.70, 95%CI: 0.48, 0.92), and improved episodic memory (β = 0.27, 95%CI: 0.13, 0.41). Over a 7-year follow-up, the use of low-risk living environments (HR = 0.67, 95%CI: 0.49, 0.91), including clean fuels (HR = 0.74, 95%CI: 0.57, 0.95) and tap water (HR = 0.84, 95%CI: 0.71, 1.00), demonstrated a protective effect against MCI development. This correlation remained significant regardless of age, gender, residence, education level, smoking, alcohol consumption, and depression.

CONCLUSION

This research provides substantial evidence that living environmental factors significantly affect cognitive function and MCI risk in Chinese older adults. Enhancing living conditions may be a key strategy for promoting cognitive health and preventing MCI in this demographic. Further research is necessary to explore the long-term impacts and potential intervention strategies to optimize living environments for better cognitive outcomes in aging populations.

Association between functional dependence and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study

BACKGROUND

The effect of different functional dependency types on cardiovascular disease (CVD) is largely unknown. Here, we aimed to investigate the association between functional dependence and CVD among middle-aged and older adults by conducting a cross-sectional and longitudinal study.

METHODS

The study sample comprised 16,459 individuals of ≥40 years (including 10,438 without CVD) who had participated in the 2011 China Health and Retirement Longitudinal Study (CHARLS). Functional dependence was categorized based on the "interval-of-need" method, while CVD was defined as physician-diagnosed heart disease or stroke. Cox proportional hazard regression was employed to assess the effects of functional dependence on CVD. Moreover, patients were grouped according to the functional status changes, and the impact of these changes on CVD was observed. Heterogeneity, subgroup, and interaction analyses were used to evaluate the consistency of the study findings. Finally, a mediation analysis was performed to estimate the potential mediation effects on the relationship between functional dependence and CVD risk.

RESULTS

CVD prevalence in the overall study population was 13.73 % (2260/16,459), while its prevalence among individuals with functional independence, low dependency, medium dependency, and high dependency was 9.60 % (1085/11,302), 14.25 % (119/835), 17.72 % (115/649), and 25.01 % (941/3763), respectively. Additionally, medium (odds ratio: 1.33, 95 % confidence interval: 1.06-1.68) and high functional dependency (1.55, 95 % CI: 1.38-1.75) were associated with CVD. A total of 2987 (28.62 %) participants with CVD were identified during the 9-year follow-up, with 4.85 % (145/2987) of the CVD cases being attributed to functional dependence. The individuals with medium (HR: 1.20, 95 % CI: 1.01-1.44) and high functional dependency (1.25, 95 % CI: 1.14-1.37) were more likely to develop CVD than their peers with functional independence. Furthermore, persistent functional dependence (HR: 1.72, 95 % CI: 1.52-1.94) and transition from functional independence to dependence (1.79, 95 % CI: 1.61-1.98) were associated with a higher CVD risk than continuous functional independence. Hypertension and diabetes may partially mediate CVD caused by functional dependence.

CONCLUSION

Functional dependence is associated with high CVD risk. Therefore, appropriate healthcare attention must be directed towards functionally dependent populations to protect their cardiovascular health.

Examining dynamic developmental trends: the interrelationship between age-friendly environments and healthy aging in the Chinese population-evidence from China Health and Retirement Longitudinal Study, 2011-2018

BACKGROUND

The objective of this research is to investigate the dynamic developmental trends between Age-Friendly Environments (AFE) and healthy aging in the Chinese population.

METHODS

This study focused on a sample of 11,770 participants from the CHARLS and utilized the ATHLOS Healthy Aging Index to assess the level of healthy aging among the Chinese population. Linear mixed model (LMM) was used to explore the relationship between AFE and healthy aging. Furthermore, a cross-lagged panel model (CLPM) and a random-intercept cross-lagged panel model (RI-CLPM) were used to examine the dynamic developmental trends of healthy aging, taking into account both Between-Person effects and Within-Person effects.

RESULTS

The results from LMM showed a positive correlation between AFE and healthy aging (β = 0.087, p < 0.001). There was a positive interaction between the geographic distribution and AFE (central region * AFE: β = 0.031, p = 0.038; eastern region * AFE: β = 0.048, p = 0.003). In CLPM and RI-CLPM, the positive effect of healthy aging on AFE is a type of Between-Person effects (β ranges from 0.147 to 0.159, p < 0.001), while the positive effect of AFE on healthy aging is Within-Person effects (β ranges from 0.021 to 0.024, p = 0.004).

CONCLUSION

Firstly, individuals with high levels of healthy aging are more inclined to actively participate in the development of appropriate AFE compared to those with low levels of healthy aging. Furthermore, by encouraging and guiding individuals to engage in activities that contribute to building appropriate AFE, can elevate their AFE levels beyond the previous average level, thereby improving their future healthy aging levels. Lastly, addressing vulnerable groups by reducing disparities and meeting their health needs effectively is crucial for fostering healthy aging in these populations.

Mediating effect of depressive symptoms on the relationship of chronic pain and cardiovascular diseases among Chinese population: Evidence from the CHARLS

OBJECTIVE

Few studies have examined the direct or indirect effect of chronic pain on cardiovascular diseases (CVD) within Chinese population. The objective aimed to investigate the mediating role of depressive symptoms between chronic pain and CVD.

METHODS

6522 participants from China Health and Retirement Longitudinal Study were included in this retrospective cohort study. The main endpoint was the occurrence of CVD. Weighted multivariate logistic regression was used to assess the association between chronic pain and depressive symptoms. Distribution-of-product method was employed to examine the mediation effect of depressive symptoms. Subgroup analyses were performed.

RESULTS

219 developed CVD at the end of follow-up period. After adjusting all confounding variables, chronic pain was associated with increased risk of depressive symptoms in total population [odds ratio (OR) = 3.85, 95%confidence interval (CI): 3.35-4.42]. Among total population, there was a positive association of chronic pain and CVD [risk ratio (RR)a = 2.00, 95% CI: 1.33-3.00] (total effect). After further adjusting depressive symptoms, the association between chronic pain and CVD was significant (RRb = 1.67, 95% CI: 1.16-2.41) (direct effect). According to the distribution-of-product test, we observed a mediating effect of depressive symptoms on the relationship between chronic pain and CVD with the percentage of mediation of 32.8%. The mediating effect of depression was observed in individuals of aged45-65 years old, female participants, participants who never drinking and not have hypertension.

CONCLUSION

Chronic pain was positively associated with CVD for Chinese population, and depressive symptoms was considered to mediate the association between chronic pain and CVD.

The association between long-term exposure to ambient PM2.5 and high-density lipoprotein cholesterol level among chinese middle-aged and older adults

BACKGROUND

Recently, the impact of PM2.5 on human health has been intensively studied, especially the respiratory system. High-density lipoprotein plays a crucial role in removing excess cholesterol from cells and transporting it to the liver for excretion. However, the effects of ambient PM2.5 on high-density lipoprotein (HDL) level have not been further studied. Our research aims to investigate the potential association between ambient PM2.5 concentrations and high-density lipoprotein (HDL) levels within the middle-aged and older adults in China.

METHODS

We employed data from individuals aged 45 years and above who were participants in Wave 3 of the China Health and Retirement Longitudinal Study (CHARLS). The high-quality, high-resolution PM2.5 exposure concentration data for each participant were obtained from the ChinaHighAirPollutants (CHAP) dataset, while the HDL levels were derived from blood samples collected during CHARLS Wave 3. This analysis constitutes a cross-sectional study involving a total of 12,519 participants. To investigate associations, we conducted multivariate linear regression analysis, supplemented by subgroup analysis.

RESULTS

In this cross-sectional investigation, we discerned a negative association between prolonged exposure to ambient PM2.5 constituents and high-density lipoprotein (HDL) levels. The observed correlation between ambient PM2.5 and HDL levels suggests that older individuals residing in areas with elevated PM2.5 concentrations exhibit a reduction in HDL levels (Beta: -0.045; 95% CI: -0.056, -0.035; P < 0.001). Upon adjusting for age in Model I, the Beta coefficient remained consistent at -0.046 (95% CI: -0.056, -0.035; p < 0.001). This association persisted even after accounting for various potential confounding factors (Beta = -0.031, 95% CI: -0.041, -0.021, p < 0.001).

CONCLUSIONS

Our study reveals a statistically significant negative correlation between sustained exposure to higher concentrations of ambient PM2.5 and high-density lipoprotein (HDL) levels among Chinese middle-aged and older individuals.

Loneliness status transitions and risk of cardiovascular disease among middle-aged and older adults

BACKGROUND AND AIMS

Loneliness is a risk factor for cardiovascular disease (CVD), and the levels at which individuals experience it can transition over time. However, the impact of increased loneliness or decreased loneliness on later CVD risk remains unexplored. We aimed to identify the age-specific association between loneliness status transitions and subsequent CVD incidences in middle-aged and older adults.

METHODS AND RESULTS

Data was extracted from the China Health and Retirement Longitudinal Study (CHARLS) on 8463 adults to evaluate how loneliness status transitions across two data collection points were associated with the subsequent CVD incidence at a five-year follow-up. Loneliness status transitions were divided into four categories: stable low loneliness, decreased loneliness, increased loneliness, and stable high loneliness. Data were analyzed using a Cox-proportional hazards model with age subgroups, accounting for covariates at baseline. During follow-up, the incidence rate of CVD per 1000 person-years was lower for the stable low loneliness group and decreased loneliness group compared to the increased loneliness and stable high loneliness group. Increased loneliness is associated with the highest risk of overall CVD and heart disease (HR 2.44, P < 0.001; HR 2.34, P < 0.001), while stable high loneliness is associated with the highest risk of stroke among the four loneliness categories (HR 4.29, P < 0.05). The age-specific analyses revealed no statistically significant interaction in terms of loneliness status transitions and age group.

CONCLUSION

Increased loneliness and stable high loneliness are associated with higher CVD risk. In clinical practice, it is important to monitor patients' loneliness status transitions to reduce CVD incidences.

Changes in frailty and incident cardiovascular disease in three prospective cohorts

BACKGROUND AND AIMS

Previous studies found that frailty was an important risk factor for cardiovascular disease (CVD). However, previous studies only focused on baseline frailty status, not taking into consideration the changes in frailty status during follow-up. The aim of this study was to investigate the associations of changes in frailty status with incident CVD.

METHODS

This study used data of three prospective cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS). Frailty status was evaluated by the Rockwood frailty index and classified as robust, pre-frail, or frail. Changes in frailty status were assessed by frailty status at baseline and the second survey which was two years after the baseline. Cardiovascular disease was ascertained by self-reported physician-diagnosed heart disease (including angina, heart attack, congestive heart failure, and other heart problems) or stroke. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders.

RESULTS

A total of 7116 participants from CHARLS (female: 48.6%, mean age: 57.4 years), 5303 from ELSA (female: 57.7%, mean age: 63.7 years), and 7266 from HRS (female: 64.9%, mean age: 65.1 years) were included according to inclusion and exclusion criteria. The median follow-up periods were 5.0 years in the CHARLS, 10.7 years in the ELSA, and 9.5 years in the HRS. Compared with stable robust participants, robust participants who progressed to pre-frail or frail status had increased risks of incident CVD (CHARLS, HR = 1.84, 95% CI: 1.54-2.21; ELSA, HR = 1.53, 95% CI: 1.25-1.86; HRS, HR = 1.59, 95% CI: 1.31-1.92). In contrast, frail participants who recovered to robust or pre-frail status presented decreased risks of incident CVD (CHARLS, HR = 0.62, 95% CI: 0.47-0.81; ELSA, HR = 0.49, 95% CI: 0.34-0.69; HRS, HR = 0.70, 95% CI: 0.55-0.89) when compared with stable frail participants. These decreased risks of incident CVD were also observed in pre-frail participants who recovered to robust status (CHARLS, HR = 0.66, 95% CI: 0.52-0.83; ELSA, HR = 0.65, 95% CI: 0.49-0.85; HRS, HR = 0.71, 95% CI: 0.56-0.91) when compared with stable pre-frail participants.

CONCLUSIONS

Different changes in frailty status are associated with different risks of incident CVD. Progression of frailty status increases incident CVD risks, while recovery of frailty status decreases incident CVD risks.

Association between living environmental quality and risk of arthritis in middle-aged and older adults: a national study in China

Background

The association between combined environmental factors and the risk of arthritis is still scarcely studied. The present study performed cross-sectional and cohort studies to explore the association between risk score of living environment quality and the risk of arthritis in middle-aged and older adults in China.

Methods

The study was based on China Health and Retirement Longitudinal Study (CHARLS), and it recruited 17,218 participants in the cross-sectional study and 11,242 participants in the seven-year follow-up study. The living environment quality was measured by household fuel types, household water sources, room temperature, residence types, and ambient concentration of PM2.5. Logistic regression and Cox proportional hazard regression models were utilized to examine the association between the living environment quality and the risk of arthritis. Competing risk models and stratified analyses were applied to further verify our results.

Results

Compared with individuals in the suitable environment group, people who lived in moderate (OR:1.28, 95%CI: 1.14-1.43) and unfavorable environments (OR:1.49, 95%CI:1.31-1.70) showed higher risks of arthritis when considering the multiple living environmental factors (P for trend <0.001) in the cross-sectional analysis. In the follow-up study, similar results (P for trend = 0.021), moderate environment group (HR:1.26, 95%CI:1.01-1.56) and unfavorable environment group (HR: 1.36, 95%CI: 1.07-1.74), were founded.

Conclusion

Inferior living environment might promote the development of arthritis. It is necessary for the public, especially old people, to improve the living environment, which may be the key to the primary prevention of arthritis.

The Bidirectional Association Between Cognitive Function and Gait Speed in Chinese Older Adults: Longitudinal Observational Study

BACKGROUND

Cognitive and gait speed decline are common conditions in older adults and are often associated with future adverse consequences. Although an association between cognitive function and gait speed has been demonstrated, its temporal sequence remains unclear, especially in older Chinese adults. Clarifying this could help identify interventions to improve public health in older adults.

OBJECTIVE

This study aims to examine the longitudinal reciprocal association between gait speed and cognitive function and the possible temporal sequence of changes in both factors in a national longitudinal cohort.

METHODS

Data were derived from 2 waves (2011 baseline and 2015 follow-up) of the China Health and Retirement Longitudinal Study (CHARLS). Participants 60 years or older, without dementia or Parkinson disease at baseline, and with completed data on gait speed and cognition at both baseline and follow-up were included. Usual gait speed was measured over two 2.5-m walks. Mental intactness and episodic memory were used to assess global cognitive function. Cross-lagged panel models and linear mixed-effects models were used to examine the association between cognition and gait speed over time. Standardized coefficients were reported.

RESULTS

A total of 3009 participants (mean age 66.4 years, SD 5.4 years; 1422/3009, 47.26%, female participants) were eligible for inclusion in our analyses. Cross-lagged panel analyses revealed that after accounting for baseline gait speed, cognition, and potential confounders, baseline global cognition (β=.117, 95% CI 0.082-0.152; P<.001), mental intactness (β=.082, 95% CI 0.047-0.118; P<.001), and episodic memory (β=.102, 95% CI 0.067-0.137; P<.001) were associated with subsequent gait speed. Simultaneously, baseline gait speed was also associated with subsequent global cognition (β=.056, 95% CI 0.024-0.087; P=.001), mental intactness (β=.039, 95% CI 0.008-0.069; P=.01), and episodic memory (β=.057, 95% CI 0.023-0.092; P=.001). The comparison of standardized cross-lagged coefficients suggested that the effect size of baseline global cognition on subsequent gait speed was significantly larger than the reverse effect (χ₁²=6.50, P for difference=.01). However, the effects of both mental intactness and episodic memory on subsequent gait speed were not significantly stronger than those of the reverse pathway (χ₁²=3.33, P for difference=.07 and χ₁²=3.21, P for difference=.07). Linear mixed-effects analyses further supported these bidirectional relationships, revealing that lower baseline cognitive scores predicted steeper declines in gait speed trajectory, and slower baseline gait speed predicted more declines in cognitive trajectory over time.

CONCLUSIONS

There is a longitudinal bidirectional association between usual gait speed and both global cognitive function and specific domains of mental intactness and episodic memory among Chinese older adults. Baseline global cognition is likely to have a stronger association with subsequent gait speed than the reverse pathway. This interlinkage is noteworthy and may have implications for public health. Maintaining normal cognitive function may be an important interventional strategy for mitigating age-related gait speed reduction.