Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

Translate and psychometric evaluation of the scale of knowledge of cardiovascular risk factors and lifestyle after coronary event

BACKGROUND

Coronary heart disease (CHD) is a leading cause of morbidity and mortality worldwide. The level of self-care after coronary events is closely linked to understanding cardiovascular risk factors and adopting healthier lifestyle behaviors. An appropriate scale can help healthcare providers measure patients' understanding of cardiovascular risk factors and provide educational interventions. This study aimed to translate and conduct a psychometric evaluation of the scale of knowledge of cardiovascular risk factors and lifestyle after coronary events.

METHODS

A standardized guideline was followed for translating and culturally adapting the English version of the Scale of Knowledge of Cardiovascular Risk Factors and Lifestyle after Coronary Events. The study included 300 patients with CHD aged 23 to 90. Exploratory factor analysis (EFA) was used to analyze construct validity. Internal consistency was estimated with Cronbach's alpha (0.98), and the intra-class correlation coefficient (ICC) was used to assess scale stability (0.84).

RESULTS

A total of 300 patients with an average age of 56.6 ± 12.7 were evaluated. Exploratory factor analysis confirmed construct validity, resulting in a 4-factor model comprising knowledge of cardiovascular risks (7 items), knowledge of lifestyle recommendations (6 items), knowledge of cholesterol and blood pressure control (5 items), and knowledge of diabetes (3 items). Together, these factors explained 67.34% of the total variance. The Cronbach's alpha for internal consistency of the scale was 0.851. Additionally, scale stability, as measured by the test-retest method, was 0.84, which is acceptable according to the minimum value of 0.70.

CONCLUSION

The translated Scale of Knowledge of Cardiovascular Risk Factors and Lifestyle after Coronary Events demonstrated strong psychometric properties among patients with CHD. The scale is both reliable and valid, providing healthcare providers with a practical tool to evaluate patient understanding and guide educational efforts aimed at enhancing post-coronary event self-care.

CLINICAL TRIAL NUMBER

Not applicable.

Estimated Glucose Disposal Rate Associated With Risk of Frailty and Likelihood of Reversion

BACKGROUND

Estimated glucose disposal rate (eGDR) is a simple and effective measure for insulin resistance, which is associated with higher risk of frailty. We aim to analyse the associations of eGDR with frailty risk and its reversibility.

METHODS

A population-based longitudinal study was conducted of 11 670 participants from the China Health and Retirement Longitudinal Study and 19 355 participants from the Health and Retirement Study. Frailty was assessed by the frailty index and reversibility was measured by transitions from frailty at baseline to non-frailty during follow-up. The eGDR was divided into Q1, Q2, Q3 and Q4 according to the quartiles. Multi-state Markov model was performed to evaluate the effects of eGDR on transitions among non-frailty, frailty and death. Cox regression model was used to estimate eGDR associated with the risk of frailty and the likelihood of reversion.

RESULTS

In Chinese population characterized by a median age of 60 years (IQR: 54-66) with 6119 women (52.43%), compared with the Q1 level of eGDR, participants exposure to Q3 and Q4 level decreased the probability of transitioning from non-frailty to frailty by 22% (HR = 0.78, 95% CI: 0.69-0.88) and 25% (HR = 0.75, 95% CI: 0.66-0.86), respectively. But its Q2, Q3 and Q4 levels increased the probability of transitioning from frailty to non-frailty by 24% (HR = 1.24, 95% CI: 1.06-1.44), 39% (HR = 1.39, 95% CI: 1.19-1.64) and 33% (HR = 1.33, 95% CI: 1.13-1.58). In American population with a median age of 63 years (IQR: 56-72) and 11 189 women (57.81%), its Q2, Q3 and Q4 levels decreased the probability of transitioning from non-frailty to frailty by 17% (HR = 0.83, 95% CI: 0.77-0.89), 24% (HR = 0.76, 95% CI: 0.70-0.82) and 46% (HR = 0.54, 95% CI: 0.49-0.59), respectively. The probability of revising frailty increased by 25% (HR = 1.25, 95% CI: 1.13-1.38), 36% (HR = 1.36, 95% CI: 1.22-1.51) and 48% (HR = 1.48, 95% CI: 1.30-1.69) for levels Q2, Q3 and Q4. As shown in the prospective analysis, increased eGDR levels from Q2 to Q4 were associated with decreased frailty risk and higher likelihood of reversion, as evidenced by the dose-response relationship revealed by restricted cubic spline analysis.

CONCLUSIONS

Higher levels of eGDR were associated with a reduced risk of frailty, delayed transition from non-frailty to frailty and an increased likelihood of reversion. eGDR emerges as a promising predictor for early frailty detection, prognosis assessment and a potential therapeutic target for intervention strategies.

Effects of Chenpi Jiaosu on serum metabolites and intestinal microflora in a dyslipidemia population: a randomized controlled pilot trial

Introduction

Dyslipidemia is a critical risk factor for atherosclerosis and cardiovascular/cerebrovascular events, necessitating effective long-term management. However, conventional lipid-lowering drugs such as statins and fibrates are limited by adverse effects, including hepatotoxicity and myopathy, which restrict their prolonged use. Traditional Chinese medicine (TCM) and natural health products offer potential alternatives with multi-target mechanisms and improved safety profiles. Tangerine Peel Enzyme Drink (CPJS), a fermented health product derived from tangerine peel, has demonstrated lipid-modulating properties. This study aimed to evaluate the efficacy and safety of CPJS in improving dyslipidemia and explore its underlying metabolic and microbiological mechanisms.

Methods

A randomized, double-blind, parallel-controlled clinical trial was conducted with 72 participants (55 completers). Participants were divided into CPJS and control groups, receiving an 8-week intervention. Primary outcomes included changes in body weight and serum triglycerides (TG), while safety was assessed via liver/kidney function, creatine kinase, blood, and urine tests. Serum metabolomics (93 differential metabolites identified) and intestinal microbiota analysis were performed to elucidate metabolic pathways and microbial shifts. KEGG enrichment analysis mapped metabolites to biological pathways, such as lipid and amino acid metabolism.

Results

The CPJS group exhibited significant reductions in body weight and TG levels post-intervention (p < 0.05), with no adverse effects observed in safety biomarkers. Metabolomic profiling revealed alterations in fatty acyl, glycerophospholipid, and organic acid metabolites, indicating CPJS modulates lipid metabolism and energy homeostasis. KEGG analysis linked these changes to pathways including triglyceride degradation and amino acid metabolism. Additionally, CPJS increased specific gut microbial taxa associated with lipid regulation, suggesting a microbiome-mediated mechanism.

Discussion

CPJS demonstrates efficacy in improving dyslipidemia through dual mechanisms: direct modulation of triglyceride metabolism and indirect regulation via gut microbiota. Its safety profile aligns with findings from natural products like Cyclocarya paliurus and tempeh, which mitigate lipid abnormalities without hepatotoxicity. The multi-target action of CPJS mirrors TCM principles, where compounds like quercetin and flavonoids in CPJS may synergistically inhibit cholesterol synthesis and enhance lipid clearance. However, further research is needed to isolate active components and validate microbial contributions. Compared to synthetic drugs, CPJS offers a safer adjunct therapy, addressing limitations of current pharmacotherapies. Future studies should explore dose-response relationships and long-term outcomes in diverse populations.

Prevalence, awareness, treatment and control of hypertension in the Brazilian population and sociodemographic associated factors: data from National Health Survey

BACKGROUND

Hypertension is the main risk factor for cardiovascular diseases and more recent studies that estimated the prevalence of this condition considering aspects such as awareness of diagnosis, treatment, and control, revealing alarming results in the global scenario.

OBJECTIVE

To estimate the prevalence and assess the factors associated with hypertension prevalence, awareness, treatment, and control.

METHODS

This is a cross-sectional study based on data from the 2013 National Health Survey in Brazil. A total of 59,226 individuals of both sexes took part in this study. Exposure were defined based on blood pressure measurements, self-reported diagnosis of hypertension and use of antihypertensive medication. We estimated the prevalence of the dependent variables and the associations were subsequently tested by calculating prevalence ratios using Poisson regression.

RESULTS

The study population was composed mostly of women (52.3%), aged 36 to 59 years (42.6%), of white race/color (47.5%), with low schooling between 0 and 8 years (49.1%), having a partner (55.7%), in the urban area of the country (86.2%), mainly in the Southeast region (43.9%) and without health insurance (69.7%). The prevalence of hypertension in the Brazilian population was 32.3%. 60.8% were aware of the diagnosis, 90.6% were taking medication treatment and, of these, 54.4% had controlled blood pressure. Female gender and older age were associated with greater awareness (PR 1,34; 95% CI 1,28 - 1,40 / PR 2,40; 95% CI 2,15 - 2,69; respectively), treatment (PR 1,10; 95% CI 1,07 - 1,12 / PR 1,25; 95% CI 1,17 - 1,35; respectively) and control (PR 1,10; 95% CI 1,02 - 1,17 / PR 0,83; 95% CI 0,73 - 0,96; respectively). Other factors such as having a partner, health insurance, living in the urban area, race/color and schooling were also associated with dependent variables.

CONCLUSION

This study reveals that although a high percentage of hypertensive patients are taking medication, there are still substantial gaps in awareness and control, particularly among certain sociodemographic groups. Men, those with less schooling, black and brown people, those living in rural areas and those without health insurance have lower levels of awareness and control of hypertension.

Association between the cumulative estimated glucose disposal rate and incident cardiovascular disease in individuals over the age of 50 years and without diabetes: data from two large cohorts in China and the United States

BACKGROUND

The estimated glucose disposal rate (eGDR) has been linked to incident cardiovascular disease (CVD) in individuals without diabetes. However, few studies have accounted for long-term cumulative eGDR exposure.

OBJECTIVE

The aim of this study was to explore whether long-term cumulative eGDR was independently associated with incident CVD in individuals over the age of 50 years and without diabetes.

METHODS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS) and Health and Retirement Study (HRS). The cumulative eGDR was calculated as the summation of the average eGDR for each pair of consecutive examinations multiplied by the time between these two consecutive visits, in years. The outcome was incident CVD. Cox proportional hazards regression models and restricted cubic spline (RCS) regression models were used to evaluate the association between cumulative eGDR and incident CVD.

RESULTS

A total of 2430 participants from CHARLS and 2008 participants from HRS were included in the analysis. The median age of the participants in CHARLS at baseline was 59 years [IQR: 55-65 years], and 1205 (49.59%) were men. The median age of the participants in HRS at baseline was 64 years [IQR: 57-70 years], and 705 (35.11%) were men. The RCS regression model showed a negative and linear association between the cumulative eGDR and incidence of CVD (CHARLS: P < 0.001, P for nonlinearity = 0.248; HRS: P = 0.013, P for nonlinearity = 0.121). After multivariate adjustment, the higher levels of cumulative eGDR were independently associated with a lower risk of CVD (per SD, CHARLS: HR: 0.802, 95% CI: 0.716-0.898, HRS: HR: 0.791, 95% CI: 0.665-0.940, pooled analysis: HR: 0.799, 95% CI: 0.726-0.878).

CONCLUSIONS

A lower level of cumulative eGDR was associated with an increased risk of incident CVD in individuals over the age of 50 years and without diabetes. Continuous monitoring of cumulative eGDR exposure over time, based on consideration of traditional risk factors, may prove beneficial for the early identification and intervention of individuals at high risk of CVD. In regions with limited healthcare resources, among individuals with limited ability to access, process, and understand health information and services, cumulative eGDR may offer improved clinical applicability.

Automated process assessment of primary healthcare for hyperlipidemia: preliminary findings and implications form Anhui, China

BACKGROUND

Primary healthcare (PHC) plays a key role in hyperlipidemia (HL) management yet lacks adequate monitoring and feedback. This study aims at identifying pragmatic measures out from routinely collected electronic records to enable automatic monitoring and inform continuous optimization of HL-management at PHC settings.

METHODS

The study used randomly selected electronic records of PHC (from the province-wide data center of Anhui-province, China) as the main data source and generated both procedure-based and encounter-based measures for assessing HL-management. The procedure-based measures were derived from specific quality-facts of 21 stages/procedures (e.g., lipid lowering medication prescription) using self-designed algorithms. While the encounter-based measures included number or rate of visits for HL, currently-noticed hyperlipidemia (CNHL, or HL noticed during the current consultation), and ever-diagnosed hyperlipidemia (EDHL). Analysis of these measures employed mainly simple descriptives and linear regression modeling.

RESULTS

The study revealed interesting findings including: low and varied rates of visits for HL(from 0.01 to 1.43%) and visits by patients with EDHL/CNHL(from 0.13 to 20.54% or from 0.02 to 2.99%) between regions; large differences (5.14 to 22.20 times) between the mean or cumulative proportions of visits by patients with EDHL versus CNHL among clinician groups; consistent increase in the ratio of visits for HL in all cause visits over the study period (from 0.087 to 1.000%) accompanied with relatively stable proportions of patients with CNHL/EDHL; Relatively low scores in the procedure-based measures (ranged from 0.00 to 36.08% for specific procedures by seasons).

CONCLUSIONS

The measures identified are not only feasible from real-world PHC records but also give some useful metrics about how well current HL-management is going and what future actions are needed.

Prevalence and determinants of ideal cardiovascular health by sex and region-a population-based study in Peru

Introduction

Attaining what the American Heart Association terms Ideal Cardiovascular Health (ICVH) is viewed as an essential objective for preventing cardiovascular diseases (CVD).

Objective

To determine the prevalence of ICVH, stratified by sex and region and its associated factors in the adult population of Peru.

Materials and methods

Analytical cross-sectional study. Data were obtained from the Life Stage Food and Nutrition Surveillance Survey (VIANEV). ICVH can be depicted vis-a-vis the seven metrics of the AHA: blood pressure levels, total cholesterol and glucose levels, smoking status, body mass index, physical activity levels, and dietary intake through the consumption of fruits and vegetables. The variable was categorized as deficient/moderate vs. ideal for regression analysis.

Results

Of the 863 participants examined, findings demonstrated that 38.01% had ICVH. The prevalence is trending lower in correlation with rising age and educational attainment levels and for those inhabitants residing at higher elevations. Likewise, statistically significant variations were observable concerning the prevalence of ICVH contingent on the region of residence and marital status, in particular amongst the feminine inhabitants.

Conclusions

These results demonstrate that the frequency of ICVH in the grown-up inhabitants of Peru is comparatively tiny. Things linked to a lesser frequency of ICVH involve increased age, a higher level of education, living at higher altitudes, and staying married to a woman. These discoveries underscore the need to implement prevention and treatment strategies for CVD distinct for each inhabitant team.

The effect of low birthweight on physical activity engagement and markers of chronic disease in the Framingham cohort

While physical activity reduces the risk for chronic disease development, evidence suggests those experiencing early life growth-restriction do not express positive adaptations in response to physical activity. The purpose of this study was to examine the effects of low birthweight (LBW) on markers of chronic disease, adult physical activity, and the response to physical activity engagement in a longitudinal human cohort study. Data from the Framingham Offspring Cohort were organized to include participants with birthweight, physical activity, and chronic disease biomarker/treatment data available at two timepoints (exam 5 and exam 9, 19-year difference). A two-way ANCOVA was performed to determine the association of LBW and sex on physical activity engagement (63.0% female, 10.4% LBW). A multinomial logistic regression was performed to examine the associations of low birthweight and sex on chronic disease development while adjusting for physical activity. LBW was associated with elevated blood glucose and triglycerides (Exam 9). Though not statistically significant (p = 0.08), LBW females potentially spent more time in sedentary activity at exam 5 than LBW males and normal birthweight (NBW) females. LBW males spent significantly more time (p = 0.03) sedentary at exam 9 compared to NBW males and LBW females. There were no differences in the likelihood of chronic disease treatment between groups. Chronic disease biomarkers remained elevated when adjusted for total physical activity. In conclusion, LBW participants in the Framingham Offspring Cohort were not more likely to be treated for chronic diseases when controlling for physical activity engagement, though biomarkers of chronic disease remained elevated.

The comparison of the prevalence, awareness, treatment and control of hypertension among adults along the three provinces of the Lancang-Mekong River countries-China, Laos and Cambodia

BACKGROUND

Under the background of similar geography and culture in Lancang-Mekong countries and rapid changes in the regional economy and lifestyle, this study aimed to describe and compare the prevalence, awareness, treatment, and control of hypertension and assess the hypertension care cascade in three provinces of China, Laos, and Cambodia.

METHODS

A cross-sectional study was conducted between 2021 and 2023 in the three provinces of Lancang-Mekong River countries using consistent investigative procedures. We included 11,005 participants aged ≥ 18 years from three provinces, and data were collected through questionnaires, physical examinations, and biochemical tests. We analyzed the cascade of hypertension care and compared the prevalence, awareness, treatment, and control of hypertension.

RESULTS

The hypertension care cascade indicated that 46.3%, 51.6%, and 63.1% of patients in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), respectively, were not diagnosed, and 10.7%, 12.8% and 21.1% of patients, respectively, did not receive treatment. After sex-age standardization, the prevalence rates of hypertension in the three provinces were 33.4%, 34.5%, and 23.6%, respectively. Higher awareness rate in Yunnan Province (53.4%) and Oudomxay Province (46.5%) than in Ratanakiri Province of Cambodia (39.7%). The treatment rate of hypertension in Yunnan Province (42.4%) was higher than that in Oudomxay Province (34.5%), and Ratanakiri Province (16.9%). In addition, less than 20% of the patients in the three provinces had their blood pressure under control. The factors associated with hypertension differed across the three provinces.

CONCLUSIONS

In the three provinces of the Lancang-Mekong River Basin countries, there is a high burden of hypertension and a significant unmet need for hypertension care. Targeted and precise intervention strategies are urgently needed to improve the awareness, treatment, and control of hypertension in low- and middle-income regions.

Awareness of risk factors for cerebrovascular diseases among acute ischemic stroke patients in Shenzhen, China

BACKGROUND AND PURPOSE

Unawareness of the risk factors is one of the most important issues that need to be settled for stroke prevention. We aimed to evaluate the awareness of risk factors for cerebrovascular diseases (CVDs) among acute ischemic stroke patients and to investigate the characteristics of patients who were unaware of their risk factors in Shenzhen, China.

METHODS

Registered data on awareness of CVD risk factors of patients with confirmed acute ischemic stroke (AIS) from June 2020 to December 2022 were analyzed in May 2023. The data were extracted from the database of Shenzhen Quality Control Center for Management of Cerebrovascular Diseases.

RESULTS

Totally, there were 5147 AIS patients with complete data eligible for this study. AIS patients' awareness regarding existing hypertension, diabetes, dyslipidemia, and atrial fibrillation (AF) was 76.1%, 76.2%, 24.2%, and 53.4%, respectively. Patients who were lack of awareness of the CVD risk factors were more likely to be males, individuals with younger ages, and those without medical insurance or a CVD history.

CONCLUSIONS

The overall awareness of the CVD risk factors was suboptimal among AIS patients in Shenzhen, especially for the existing dyslipidemia. The health education of AIS should be further improved in males as well as individuals without medical insurance or any CVD histories. Age was an independent factor associated with the lack of awareness of the CVD risk factors. The stroke screening program should be extended to younger people.

A systematic, updated review of Xuezhikang, a domestically developed lipid-lowering drug, in the application of cardiovascular diseases

Cardiovascular diseases (CVDs) are a major threat to public health globally. A large proportion of people with dyslipidaemia have poorly controlled lipid levels, emphasizing the need for alternative lipid-lowering treatments that are both effective and safe. Xuezhikang, a red yeast rice (RYR) extract, containing 13 kinds of monacolins and other bioactive components, emerges as one such promising option. Its discovery was built on a long history of RYR use as a functional food supplement and traditional Chinese medicine. Several randomized, controlled clinical trials have substantiated its lipid-lowering effects and its potential to protect against CVDs. Safety concerns with statins did not arise during decades of experience with Xuezhikang treatment in clinical practice. The approval of Xuezhikang in multiple regions of Asia marked a conceptual shift in CVD management, moving from single agents to polypills and from synthetic medicines to natural extracts. This review comprehensively addresses important topics related to this medicinal natural extract, including the ancient utilization of RYR, the development of Xuezhikang, its mechanisms of action, pleiotropic effects, clinical studies, challenges, and future perspectives to enhance our understanding regarding the role of Xuezhikang, a representative, domestic lipid-lowering drug of RYR, in prevention and treatment of CVD.

[Comparison of initiation of antihypertensive therapy strategies for primary prevention of cardiovascular diseases in Chinese population: A decision-analytic Markov modelling study]

OBJECTIVE

To evaluate the health benefits and intervention efficiency of different strategies of initiating antihypertensive therapy for the primary prevention of cardiovascular diseases in a community-based Chinese population from the Chinese electronic health records research in Yinzhou (CHERRY) study.

METHODS

A decision-analytic Markov model was used to simulate and compare different antihypertensive initiation strategies, including: Strategy 1, initiation of antihypertensive therapy for Chinese adults with systolic blood pressure (SBP) ≥140 mmHg (2020 Chinese guideline on the primary prevention of cardiovascular diseases); Strategy 2, initiation of antihypertensive therapy for Chinese adults with SBP ≥130 mmHg; Strategy 3, initiation of antihypertensive therapy for Chinese adults with SBP≥140 mmHg, or with SBP between 130 and 140 mmHg and at high risk of cardiovascular diseases (2017 American College of Cardiology/American Heart Association guideline for the prevention, detection, evaluation, and management of high blood pressure in adults); Strategy 4, initiation of antihypertensive therapy for Chinese adults with SBP≥160 mmHg, or with SBP between 140 and 160 mmHg and at high risk of cardiovascular diseases (2019 United Kingdom National Institute for Health and Care Excellence guideline for the hypertension in adults: Diagnosis and management). The high 10-year cardiovascular risk was defined as the predicted risk over 10% based on the 2019 World Health Organization cardiovascular disease risk charts. Different strategies were simulated by the Markov model for ten years (cycles), with parameters mainly from the CHERRY study or published literature. After ten cycles of simulation, the numbers of quality-adjusted life years (QALY), cardiovascular events and all-cause deaths were calculated to evaluate the health benefits of each strategy, and the numbers needed to treat (NNT) for each cardiovascular event or all-cause death could be prevented were calculated to assess the intervention efficiency. One-way sensitivity analysis on the uncertainty of incidence rates of cardiovascular disease and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted.

RESULTS

A total of 213 987 Chinese adults aged 35-79 years without cardiovascular diseases were included. Compared with strategy 1, the number of cardiovascular events that could be prevented in strategy 2 increased by 666 (95% UI: 334-975), while the NNT per cardiovascular event prevented increased by 10 (95% UI: 7-20). In contrast to strategy 1, the number of cardiovascular events that could be prevented in strategy 3 increased by 388 (95% UI: 194-569), and the NNT per cardiovascular event prevented decreased by 6 (95% UI: 4-12), suggesting that strategy 3 had better health benefits and intervention efficiency. Compared to strategy 1, although the number of cardiovascular events that could be prevented decreased by 193 (95% UI: 98-281) in strategy 4, the NNT per cardiovascular event prevented decreased by 18 (95% UI: 13-37) with better efficiency. The results were consistent in the sensitivity analyses.

CONCLUSION

When initiating antihypertensive therapy in an economically developed area of China, the strategy combined with cardiovascular risk assessment is more efficient than those purely based on the SBP threshold. The cardiovascular risk assessment strategy with different SBP thresholds is suggested to balance health benefits and intervention efficiency in diverse populations.

Management of Hypertension in the Asia-Pacific Region: A Structured Review

This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin-angiotensin-aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential.

The trend of hypertension-related chronic kidney disease from 1990 to 2019 and its predictions over 25 years: an analysis of the Global Burden of Disease Study 2019

BACKGROUND

High blood pressure is a key pathogenetic factor that contributes to the deterioration of kidney function. However, the incidence trend of hypertension-related chronic kidney disease (CKD) has rarely been studied; therefore, we aimed to analyze the global, regional, and national patterns, temporal trends as well as burden of hypertension-related CKD.

METHODS

We extracted data on hypertension-related CKD from the Global Burden of Disease (GBD) study database, including the incidence, prevalence, disability-adjusted life years (DALYs), and mortality numbers and rates (per 100,000 population) and further described according to year, location, sex, age, and socio-demographic index (SDI). The estimated annual percentage changes (EAPCs) were calculated to assess the variation in incidence, DALYs, and mortality. We used an age-period-cohort (APC) model framework to analyze the underlying trends in prevalence by age, period, and birth cohort. Nordpred APC analysis was performed to predict the future morbidity and mortality of hypertension-related CKD.

RESULTS

In 2019, a total of over 1.57 million new hypertension-related CKD cases were reported worldwide, a 161.97% increase from 1990. Compared to 1990, the age-standardized incidence rates (ASIR) increased in all 21 regions in 2019. In all countries and territories except Iceland, the EAPC in ASIR and the lower boundary of its 95% confidence interval (CI) were higher than 0. ASIR, age-standardized prevalence rates (ASPR), age-standardized DALYs rates (ASDR), and age-standardized mortality rates (ASMR) were not identical among countries with different SDI regions in 2019; additionally, ASIR and ASMR were significantly different among sexes in all SDI regions in 2019. The predicted incidence and mortality counts globally continue to increase to 2044, and there is an upward trend in ASIR for both men and women.

CONCLUSIONS

Between 1990 and 2019, the ASIR of hypertension-related CKD demonstrated an ascending trend, and according to our projections, it would remain on the rise for the next 25 years. With remarkable global population growth, aging, and an increasing number of patients with hypertension, the burden of disease caused by hypertension-related CKD continues to increase.

Adherence Behaviors and Related Factors Among Elderly Hypertensive Patients in China: Evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

Non-adherence or partial adherence is the main reason for poor therapeutic effect of hypertension. This paper aims to assess adherence behaviors and related factors among elderly hypertensive patients in China.

METHODS

Participants aged ≥60 years, with hypertension, and with complete data in 2018 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. The adherence behaviors included medication, blood pressure monitoring and the combined adherence behaviors. Referring to the social-ecological theory, correlates of adherence behaviors were divided into three layers, namely demographic characteristics, health behaviors, living environment and retirement. Univariate and multivariable logistic regression models were performed to identify factors of adherence behaviors.

RESULTS

The prevalence of medication adherence (76.58%) was higher than that of blood pressure monitoring adherence (20.08%), and the full adherence rate was 18.53%. Self-rated health status, smoking status, living area, and health education status were detected to be associated with medication adherence and blood pressure monitoring adherence (all p < 0.05). Gender, sleep duration, health examination, and physical exercise were also detected to be associated with blood pressure monitoring adherence (all p < 0.05). Self-rated health status and health education status were detected to be associated with partially and fully adherence, while age, living area, and life satisfaction were detected to be associated with partially adherence, smoking status, sleep duration, health examination, and pension reliance were detected to be associated with fully adherence (all p < 0.05).

CONCLUSION

Our study reveals the poor adherence behaviors of elderly hypertensive patients in China. This is most evident among those who were male, 60-69 years old, living in rural areas, self-reported being healthier, those without health examination and health education. Targeting these vulnerable populations, we suggest to strengthen health education, increase the publicity of basic public health services and enhance the self-management ability of hypertensive patients.

Trend, regional variation and socioeconomic inequality in cardiovascular disease among the elderly population in China: evidence from a nationwide longitudinal study during 2011-2018

INTRODUCTION

Cardiovascular disease (CVD) continues to pose a significant burden among the elderly population in China. There is a knowledge gap in the temporal trends, regional variations and socioeconomic inequalities among this vulnerable population.

METHODS

This study conducted cross-sectional and cohort analyses based on four survey waves of the China Health and Retirement Longitudinal Study among adults aged ≥60 years spanning 2011-2018 across 28 provinces. Cross-sectional analyses examined temporal trends, regional variations and socioeconomic inequalities in CVD prevalence. Cohort analyses identified individuals without CVD in 2011 and followed them up until 2018 to calculate CVD incidence. Generalised estimating equations (GEE) were employed to identify associated factors.

RESULTS

A total of 5451, 7258, 8820 and 11 393 participants were eligible for cross-sectional analyses, and 4392 and 5396 participants were included in cohort analyses of CVD and comorbid CVD. In 2018, the age-adjusted and sex-adjusted prevalence of CVD and comorbid CVD was 31.21% (95% CI 27.25% to 35.17%) and 3.83% (95% CI 2.85% to 4.81%), respectively. Trend analyses revealed a significant increase in the adjusted prevalence from 2011 to 2018 (p for trend <0.001). There were substantial provincial variations in the adjusted prevalence of CVD and comorbid CVD. Higher socioeconomic status (SES) participants exhibited higher prevalence, and the concentration curves and concentration indices suggested persistent but narrowing inequalities in CVD and comorbid CVD across survey waves. Cohort analyses from 2011 to 2018 yielded overall CVD and comorbid CVD incidence densities of 17.96 and 2.65 per 1000 person-years, respectively. GEE results indicated increased CVD risks among older individuals, women, higher SES participants and northern residents.

CONCLUSION

More efforts should be taken to optimise strategies for high-quality CVD prevention and management in China's elderly population. Future interventions and policies should address age-specific and gender-specific, geographical, and socioeconomic disparities to ensure equitable access and outcomes for all.

Percentiles of predicted 10-year cardiovascular disease risk by sex and age in Brazil and their association with estimated risk of long-term atherosclerotic events

OBJECTIVE

Expressing the cardiovascular disease (CVD) risk in relation to peers may complement the estimation of absolute CVD risk. We aimed to determine 10-year CVD risk percentiles by sex and age in the Brazilian population and evaluate their association with estimated long-term atherosclerotic CVD (ASCVD) risk.

METHODS

A cross-sectional analysis of baseline data from the ELSA-Brasil study was conducted in individuals aged 40-74 years without prior ASCVD. Ten-year CVD risk and long-term ASCVD risk were estimated by the WHO risk score and the Multinational Cardiovascular Risk Consortium tool, respectively. Ten-year risk percentiles were determined by ranking the calculated risks within each sex and age group.

RESULTS

Ten-year CVD risk versus percentile plots were constructed for each sex and age group using data from 13,364 participants (55% females; median age, 52 [IQR, 46-59] years). Long-term ASCVD risk was calculated in 12,973 (97.1%) participants. Compared to individuals at the <25th risk percentile, those at the ≥75th percentile had a greater risk of being in the highest quartile of long-term risk (ORs [95% CIs] 6.57 [5.18-8.30] in females and 11.59 [8.42-15.96] in males) in regression models adjusted for age, race, education, and 10-year CVD risk. In both sexes, the association between risk percentile and long-term risk weakened after age 50. A tool for calculating 10-year CVD risk and the corresponding percentile is available at https://bit.ly/3CzPUi6.

CONCLUSIONS

We established percentiles of predicted 10-year CVD risk by sex and age in the Brazilian population, which independently reflect the estimated long-term ASCVD risk in younger individuals.

Prevalence, pattern, and correlates of dyslipidemia in Bangladeshi individuals

BACKGROUND

The burden of dyslipidemia in Bangladesh remains inadequately characterized.

OBJECTIVES

To determine and describe the prevalence and pattern of dyslipidemia and its associated risk factors among an adult Bangladeshi population.

DESIGN

Population-based, cross-sectional study. Participants were adults living in all eight administrative divisions of Bangladesh. The total sample size was 7084 (53.1 % women, 46.9% urban residents). Primary outcome measures were triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and the use of lipid lowering medication. In addition, control of LDL-C and control of non high-density lipoprotein cholesterol (non-HDL-C) were investigated.

RESULTS

The overall dyslipidemia prevalence was 76.7%, with 35.7% showing a high TG level, 18.5% showing a high LDL-C level, 63.8% showing a low HDL-C level, and 7.2% of the participants showing all three lipid abnormalities. Sylhet division had the highest prevalence (83.8%) of overall dyslipidemia, while Rangpur had the lowest prevalence (69.3%). The control of LDL-C (<50 mg/dL) and non-HDL-C (<80 mg/dL) among adults with a previous history of atherosclerotic cardiovascular diseases (ASCVD) were 5.1% and 6.9% respectively. The regression models showed that male sex and age 45-59 years were significant predictors of overall dyslipidemia. Both smokers and smokeless tobacco users were significant factors for overall dyslipidemia and high TG. A high waist-hip ratio was associated with overall dyslipidemia and all other subtypes of dyslipidemia.

CONCLUSION

The high prevalence of dyslipidemia in Bangladesh necessitates lifestyle interventions to prevent and control this cardiovascular risk factor.

The China Kadoorie Biobank Collaborative Group, Sun Q, Hu Y, Yu C, Guo Y, Pei P, Yang L, Chen Y, Du H, Sun D, Pang Y, Burgess S, Sansome S, Ning F, Chen J, Chen Z, Li L, Lv J. Healthy lifestyle and life expectancy free of major chronic diseases at age 40 in China

Whether a healthy lifestyle helps achieve gains in life expectancy (LE) free of major non-communicable diseases and its share of total LE in Chinese adults remains unknown. We considered five low-risk lifestyle factors: never smoking or quitting for reasons other than illness, no excessive alcohol use, being physically active, healthy eating habits and healthy body fat levels. Here we show that after a median follow-up of 11.1 years for 451,233 Chinese adults, the LE free of cardiovascular diseases, cancer and chronic respiratory diseases (95% confidence interval) at age 40 years for individuals with all five low-risk factors was on average 6.3 (5.1-7.5) years (men) and 4.2 (3.6-5.4) years (women) longer than those with 0-1 low-risk factors. Correspondingly, the proportion of disease-free LE to total LE increased from 73.1% to 76.3% for men and from 67.6% to 68.4% for women. Our findings suggest that promoting healthy lifestyles could be associated with gains in disease-free LE in the Chinese population.

Effect of Gut Microbiota on the Pharmacokinetics of Nifedipine in Spontaneously Hypertensive Rats

The pharmacokinetic variability of nifedipine widely observed in the clinic cannot be fully explained by pharmacogenomics. As a new factor affecting drug metabolism, how the gut microbiota affects the pharmacokinetics of nifedipine needs to be explored. Spontaneously hypertensive rats (SHRs) have been commonly used in hypertension-related research and served as the experimental groups; Wistar rats were used as control groups. In this study, the bioavailability of nifedipine decreased by 18.62% (p < 0.05) in the SHRs compared with the Wistar rats. Changes in microbiota were associated with the difference in pharmacokinetics. The relative abundance of Bacteroides dorei was negatively correlated with AUC0-t (r = -0.881, p = 0.004) and Cmax (r = -0.714, p = 0.047). Analysis of serum bile acid (BA) profiles indicated that glycoursodeoxycholic acid (GUDCA) and glycochenodeoxycholic acid (GCDCA) were significantly increased in the SHRs. Compared with the Wistar rats, the expressions of CYP3A1 and PXR were upregulated and the enzyme activity of CYP3A1 increased in the SHRs. Spearman's rank correlation revealed that Bacteroides stercoris was negatively correlated with GUDCA (r = -0.7126, p = 0.0264) and GCDCA (r = -0.6878, p = 0.0339). Moreover, GUDCA was negatively correlated with Cmax (r = -0.556, p = 0.025). In primary rat hepatocytes, GUDCA could induce the expressions of PXR target genes CYP3A1 and Mdr1a. Furthermore, antibiotic treatments in SHRs verified the impact of microbiota on the pharmacokinetics of nifedipine. Generally, gut microbiota affects the pharmacokinetics of nifedipine through microbial biotransformation or by regulating the enzyme activity of CYP3A1.

Prevalence, awareness, treatment, and control of dyslipidemia in Chinese adults: a systematic review and meta-analysis

Background

Researchers have conducted a considerable number of epidemiological studies on dyslipidemia in China over recent years. Nevertheless, a representative study to comprehensively appraise for the epidemiological status of dyslipidemia is still lacked. This meta-analysis is intended to explore the pooled prevalence, rates of awareness, treatment, and control of dyslipidemia among adults in Chinese Mainland.

Materials and methods

A systematic review was performed on relevant cross-sectional studies published since January 2012 by searching six authoritative literature databases. Meta-analyses were conducted in included studies based on a random-effect model to summarize the epidemiological status of dyslipidemia in China. A potential source of heterogeneity was detected by subgroup analysis and meta-regression. Publication bias was assessed by Egger's test and funnel plots. A sensitivity analysis was conducted to examine the study quality's influence on the pooled estimate of prevalence and rates of awareness, treatment, and control.

Results

Forty-one original researches with a total of 1,310,402 Chinese participants were finally included in the meta-analysis. The prevalence, rates of awareness, treatment, and control of dyslipidemia were 42.1%, 18.2%, 11.6%, and 5.4%, respectively. With a pooled prevalence estimate at 24.5%, low HDL-C was the most prevalent among various dyslipidemia types, followed by hypertriglyceridemia (TG) (15.4%), hypercholesterolemia (TC) (8.3%), and high LDL-C (7.1%). The pooled prevalence of elevated serum lipoprotein(a) [Lp(a)] was 19.4%. By gender, the prevalence of dyslipidemia was 47.3% in males and 38.8% in females. Subgroup analyses revealed that the prevalence in southern and urban areas were higher than their counterparts. Females and population in urban areas tended to possess higher rates of awareness, treatment, and control. Meta-regression analyses suggested that the year of screening influenced prevalence estimates for dyslipidemia. The impact of the study's quality on the pooled estimates is insignificant.

Conclusion

Our study suggested a severe epidemic situation of dyslipidemia among adults in Chinese Mainland. More importantly, the awareness, treatment, and control rates were extremely low, revealing that dyslipidemia is a grave health issue. Consequently, we should attach more importance to the management of dyslipidemia, especially in economically underdeveloped areas.

Systematic review registration

PROSPERO [CRD42022366456].

Relationship of Missed Statin Therapy and 10-Year Atherosclerotic Cardiovascular Disease Risk Score to Retear Rate After Arthroscopic Rotator Cuff Repair

BACKGROUND

There is no practical consensus on managing cholesterol in patients with rotator cuff repair despite hyperlipidemia and statin therapy being well-known factors in rotator cuff healing. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk score is a commonly used guideline to determine statin administration for hyperlipidemia.

PURPOSE

To identify the relationship between retear and preoperative factors, including 10-year ASCVD risk score and statin administration status, and to compare clinical outcomes and retear rates between patients who are taking and not taking statins.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

This study enrolled 182 patients with a symptomatic full-thickness rotator cuff tear who underwent arthroscopic repair. Serum lipid profile, 10-year ASCVD risk score, statin eligibility, and statin administration status were assessed. Patients were categorized into 2 groups based on magnetic resonance imaging to evaluate cuff integrity at postoperative 6 months: a healed group and a retear group. Radiographic and intraoperative factors related to retear were analyzed. Multiple regression analysis was performed to evaluate factors related to rotator cuff retear. For the subgroup analysis, patients eligible for statin therapy were divided into 2 subgroups according to administration status.

RESULTS

There were 149 (81.9%) patients in the healed group and 33 (18.1%) in the retear group. In the multiple regression analysis, missed statin therapy, 10-year ASCVD risk score, and fatty infiltration of the infraspinatus muscle were the independent factors related to retear. The cutoff value for 10-year ASCVD risk score was 11.85%, with a sensitivity of 0.75 and a specificity of 0.62. In the subgroup analysis of 104 patients eligible for statin therapy, 66 (63.5%; group 1) received statin therapy and 38 (36.5%; group 2) missed it. Group 2 showed a significantly higher retear rate than group 1 (36.8% vs 13.6%; P = .006).

CONCLUSION

Missed statin therapy, 10-year ASCVD risk score, and fatty infiltration of the infraspinatus were the independent factors associated with rotator cuff retear. Patients who missed statin therapy showed a higher retear rate than patients receiving statin therapy. Optimal statin therapy for patients who undergo arthroscopic rotator cuff repair might improve repair integrity.

Circadian rhythm sleep-wake disorders and the risk of dyslipidemia among railway workers in southwest China: A cross-sectional study

Railway workers are more likely to have an irregular work schedule, which had an effect on their circadian rhythm of sleep, and may lead to circadian rhythm sleep-wake disorders (CRSWDs). The association between CRSWDs and dyslipidemia in railway workers is poorly understood. The objective of this research is to study the association between CRSWDs and the risk of dyslipidemia. This cross-sectional study was conducted among railway workers in Southwest China. CRSWDs were assessed by the morningness-eveningness questionnaire self-assessment version (MEQ-SA). The blood samples were collected in the morning and the lipids of participants were measured. Associations of CRSWDs with dyslipidemia and its components were analyzed. A total of 8079 participants were enrolled in this study, and the results revealed that shift work sleep disorder (SWD) and advanced sleep-wake phase disorder (ASWPD) were associated with a higher risk of dyslipidemia (OR 1.17, 95%CI 1.06-1.29, P < 0.01; OR 1.68, 95%CI 1.09-2.64, P < 0.05) after adjusting for sociodemographic characteristics and lifestyles, in comparison with the control group. As for its components, the SWD group was associated with a higher risk of elevated total cholesterol, triglycerides, and low-density lipoprotein than the control group, while the ASWPD group was associated with a higher risk of elevated total cholesterol, and low-density lipoprotein (P < 0.05). In summary, SWD and ASWPD participants were associated with a higher risk of dyslipidemia in railway workers in Southwest China.Abbreviation: TG: triglyceride; TC: Total cholesterol; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; FPG: fasting plasma glucose. MEQ-SA: morningness-eveningness questionnaire self-assessment version; IPW: inverse-probability weighting; HDS: healthy diet scores; FFQ: food frequency; PA: physical activity; IQAP-SF: international physical activity questionnaire short form; MET-min/wk: metabolic equivalent task minutes per week; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; HBP: hypertension; DM: diabetes; CVD: cerebrovascular disease; OR: odds ratios; CI: confidence intervals.

Effect and mechanism of Tangzhiqing in improving cardiac function in mice with hyperlipidaemia complicated with myocardial ischaemia

Purpose

Tangzhiqing formula (TZQ) is a traditional Chinese medicine prescribed to treat lipid metabolism disorders, atherosclerosis, diabetes and diabetic cardiomyopathy. However, some challenges and hurdles remain. TZQ showed promising results in treating diabetes and hyperlipidaemia. However, its effect on and mechanism of action in hyperlipidaemia complicated with myocardial ischaemia (HL-MI) remain unknown.

Methods

In this study, a network pharmacology-based strategy integrating target prediction was adopted to predict the targets of TZQ relevant to the treatment of HL-MI and to further explore the involved pharmacological mechanisms.

Results

A total of 104 potential therapeutic targets were obtained, including MMP9, Bcl-2, and Bax, which may be related to the apoptosis and PI3K/AKT signalling pathways. Then, we confirmed these potential targets and pathways with animal experimentation. TZQ reduced lipid levels, increased the expression levels of Bcl-2, decreased Bax, caspase-3 and caspase-9 expression levels, and activated the PI3K/AKT signalling pathway.

Conclusion

In conclusion, this study provides new insights into the protective mechanisms of TZQ against HL-MI through network pharmacology and pharmacological approaches.

Glomerular filtration rate estimated by differing measures and risk of all-cause mortality among Chinese individuals without or with diabetes: A nationwide prospective study

BACKGROUND

Whether estimated glomerular filtration rates (eGFRs) by differing biomarkers are differentially associated with mortality or whether the associations differ by diabetes status remains unclear, especially in Chinese population.

METHODS

We included 6995 participants without diabetes (mean age: 60.4 years) and 1543 with diabetes (mean age: 61.8 years). Each eGFR measure was divided into normal (≥90 mL/min/1.73 m² ), modestly declined (60 to <90 mL/min/1.73 m² ), and chronic kidney disease (CKD) (<60 mL/min/1.73 m² ) groups. Cox proportional hazards models were used to estimate hazard ratio (HR) of all-cause mortality associated with each eGFR.

RESULTS

Over a follow-up of 7 years, 677 and 215 deaths occurred among individuals without or with diabetes, respectively. Among those without diabetes, all measures of modestly declined eGFR were not associated with mortality, whereas CKD defined by eGFR cystatin C (eGFRcys) and eGFR creatinine (eGFRcr)-cys (HRs were 1.71 and 1.55, respectively) but not by eGFRcr were associated with higher risk of mortality. Among diabetes, all measures of modestly declined eGFR (HRs: 1.53, 1.56, and 2.09 for eGFRcr, eGFRcys, and eGFRcr-cys, respectively) and CKD (HRs: 2.57, 2.99, and 3.92 for eGFRcr, eGFRcys, and eGFRcr-cys, respectively) were associated with higher risk of mortality. Regardless of diabetes status, an addition of eGFRcys or eGFRcr-cys to traditional risk factors lead to a larger improvement in the prediction of all-cause mortality risk than adding eGFRcr.

CONCLUSIONS

The association of eGFR with mortality risk appeared to be varied by its measures and by diabetes status among middle-aged and older Chinese, which needs to be considered in clinical practice.

Factors associated with lipid control in outpatients with heart failure

Background

Dyslipidemia is common among patients with heart failure, and it negatively impacts clinical outcomes. Limited data regarding the factors associated with poor lipid control in patients with HF patients. Therefore, this study aimed to evaluate lipid control and to explore the factors associated with poor lipid control in patients with HF.

Methods

The current cross-sectional study was conducted at outpatient cardiology clinics at two major hospitals in Jordan. Variables including socio-demographics, biomedical variables, in addition to disease and medication characteristics were collected using medical records and custom-designed questionnaire. Medication adherence was assessed using the validated 4-item Medication Adherence Scale. Binary logistic regression analysis was conducted to explore significant and independent predictors of poor lipid control among the study participants.

Results

A total of 428 HF patients participated in the study. Results showed that 78% of the participants had poor lipid control. The predictors that were associated with poor lipid control included uncontrolled BP (OR = 0.552; 95% CI: 0.330-0.923; P < 0.05), higher Hb levels (OR = 1.178; 95% CI: 1.013-1.369; P < 0.05), and higher WBC (OR = 1.133; 95% CI: 1.031-1.246; P < 0.05).

Conclusions

This study revealed poor lipid control among patients with HF. Future intervention programs should focus on blood pressure control in order to improve health outcomes among HF patients with dyslipidemia.

Person-centered and measured life's simple 7 cardiovascular health concordance and association with incident cardiovascular disease

Person-centered cardiovascular health (CVH) may facilitate cardiovascular disease primordial prevention in low resources settings. The study aims to assess the validity of person-centered CVH compared to gold standard measured CVH by examining the concordance between person-centered vs. measured CVH together with their respective association with incident cardiovascular disease events (CVD). Life's Simple 7 (LS7) CVH metrics, including non-smoking, Body Mass Index, diet, physical activity, blood glycemia, blood pressure, and blood cholesterol were collected from 19,473 adults participating in the e-cohort NutriNet-Santé study from 2011 to 2014 and were followed until September 2020. Clinical examinations and blood analyses defined the measured biological metrics, while diagnoses, medication, or treatment for type 2 diabetes, hypertension, and hypercholesterolemia defined person-centered biological metrics. Declared behavioral metrics were common for both measured and person-centered CVH. The study included 18,714 CVD-free participants (mean age 51 years, 73% women), among whom 16.52% and 38.75% had 5-7 ideal LS7 metrics according to measured and person-centered CVH, respectively. Weighted concordance of person-centered and measured CVH was 0.87 [0.86; 0.88]. Over median follow-up of 8.05 years, 749 CVD events occurred. There was a 7% (HR 0.93 [0.88; 0.99]) and 13% (HR 0.87 [0.83; 0.92]) risk reduction of CVD risk by additional measured and person-centered ideal metrics, respectively. In conclusion, person-centered CVH may represent a reliable alternative to measured CVH.

Understanding influencing attributes of COVID-19 vaccine preference and willingness-to-pay among Chinese and American middle-aged and elderly adults: A discrete choice experiment and propensity score matching study

Background and objective

COVID-19 has imposed burdens on public health systems globally. Owing to the urgency of vaccination, this study aimed at comparing the differences in preference and willingness to pay of COVID-19 vaccine among Chinese and American middle-aged and elderly adults.

Methods

A cross-sectional survey containing demographic questions, rating their acceptance of COVID-19 vaccination with and without recommendations from friends, family members or employers (the social cues referred to in our study), and a discrete choice experiment understanding COVID-19 vaccine preference and willingness to pay was conducted to collect data. Propensity score matching was utilized to adjust confounding factors of baseline characteristics and the relative importance of respondents' preference for each attribute and its level was estimated using a conditional logit model. Then, willingness to pay was calculated.

Results

In total, 3,494 (2,311 and 1,183 from China and the United States, respectively) completed the questionnaire, among which 3,444 questionnaires were effective. After propensity score matching, 1,604 respondents with 802 from the US and 802 from China were included. Under the influence of the social cues, Chinese respondents' vaccine acceptance decreased from 71.70 to 70.70%, while American respondents' vaccine acceptance increased from 74.69 to 75.81%. The discrete choice experiment showed that American respondents regarded the efficacy of COVID-19 vaccine as the most important attribute, whereas Chinese respondents attached the highest importance to the cost of vaccination. But overall, the COVID-19 vaccine with the higher efficacy, the milder adverse effect, the lower cost, and the longer duration will promote the preference of the public in both countries. Additionally, the public were willing to spend the most money for a reduction in COVID-19 vaccine adverse effect from moderate to very mild (37.476USD for the United States, 140.503USD for China), followed by paying for the 1% improvement in its efficacy and paying for the one-month extension of its duration.

Conclusion

Given the impact of social cues on vaccine acceptance, Chinese government should promote reasonable vaccine-related information to improve national vaccination acceptance. Meanwhile, considering the influence of COVID-19 attributes on public preference and willingness to pay, regulating the vaccine pricing, improving the efficacy of the vaccine, reducing its adverse effect, and prolonging the duration of the vaccine works will contribute to vaccine uptake.

Development and Validation of a Nomogram to Predict the Future Risk of Cardiovascular Disease

Background

Early identification of individuals at a high risk of cardiovascular disease (CVD) is crucial. This study aimed to construct a nomogram for CVD risk prediction in the general population.

Methods

This retrospective study analyzed the data between January 2012 and September 2020 at the Physical Examination Center of the Second Affiliated Hospital of Nanjing Medical University (randomized 7:3 to the training and validation cohorts). The outcome was the occurrence of CVD events, which were defined as sudden cardiac death or any death related to myocardial infarction, acute exacerbation of heart failure, or stroke. The least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression were applied to screen the significant variables related to CVD.

Results

Among the 537 patients, 54 had CVD (10.1%). The median cardiac myosin-binding protein-C (cMyBP-C) level in the CVD group was higher than in the no-CVD group (42.25 pg/mL VS 25.00 pg/mL, p = 0.001). After LASSO selection and multivariable analysis, cMyBP-C (Odds ratio [OR] = 1.004, 95% CI [CI, confidence interval]: 1.000-1.008, p = 0.035), age (OR = 1.023, 95% CI: 0.999-1.048, p = 0.062), diastolic blood pressure (OR = 1.025, 95% CI: 0.995-1.058, p = 0.103), cigarettes per day (OR = 1.066, 95% CI: 1.021-1.113, p = 0.003), and family history of CVD (OR = 2.219, 95% CI: 1.003-4.893, p = 0.047) were associated with future CVD events (p < 0.200). The model, including cMyBP-C, age, diastolic blood pressure, cigarettes per day, and family history of CVD, displayed a high predictive ability with an area under the curve (AUC) of 0.816 (95% CI: 0.714-0.918) in the training cohort (specificity and negative predictive value of 0.92 and 0.96) and 0.774 (95% CI: 0.703-0.845) in the validation cohort.

Conclusions

A nomogram based on cMyBP-C, age, diastolic blood pressure, cigarettes per day, and family history of CVD was constructed. The model displayed a high predictive ability.

Inflection Points in Blood Pressure Trajectories Preceding Hypertension Onset in Different Age Groups

Background Understanding the natural history of elevated blood pressure (BP) is important to determine the window for primary prevention of hypertension. The authors aimed to investigate the natural history of elevated BP and examine whether there were inflection points in BP trajectories preceding hypertension onset in Chinese adults. Methods and Results A total of 8688 participants with an average of 5 BP measurements were included from the CHNS (China Health and Nutrition Survey). In each wave, triplicate measurements on the same arm were taken, and the mean systolic BP (SBP) and diastolic BP (DBP) were used in the analysis. Hypertension onset was defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg or diagnosed by physician or currently under antihypertensive treatment. The median follow-up time was 13.0 years. Overall, BP elevation with age prior to the onset of hypertension showed a nonlinear trajectory. The increased rates in both SBP and DBP were obviously faster after the inflection point than before. According to hypertension onset at age 30 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years, at the inflection point, patients were ≈29, 38, 48, 57, and 67 years, SBP levels were 112.6, 114.8, 116.8, 117.4, and 118.0 mm Hg, and DBP levels were 73.4, 75.7, 76.9, 76.2, and 73.8 mm Hg, respectively. Conclusions There was a nonlinear trajectory of BP elevation preceding hypertension onset. The inflection points for SBP and DBP were in the range of 112 to 118 mm Hg and 73 to 77 mm Hg, respectively. Once BP levels exceeded the changing points, the level of SBP and DBP increased more rapidly.

Prevalence and management of hypertension in Central China: a cross-sectional survey

OBJECTIVE

We aimed to assess hypertension prevalence and management in Central China.

METHODS

In this cross-sectional study conducted from February 2019 to February 2020, we applied stratified multistage random sampling to investigate residents aged 35 to 75 years in Dancheng county of Zhoukou city and Xincai county of Zhumadian city, both in Central China.

RESULTS

We enrolled 63,940 participants in this survey. A total of 43.6% (95% confidence interval [CI]: 43.2-44.0) of participants had hypertension. Of these, 49.3% (95% CI: 48.7-49.9) were aware of their diagnosis, 36.5% (95% CI: 35.9-37.1) took antihypertensive medication, and 14.3% (95% CI: 13.9-14.7) had their blood pressure under control. Only 31.4% of hypertensive people receiving antihypertensive treatment had achieved control. The hypertension prevalence was lower in urban areas than in rural areas, with higher rates of awareness, treatment, and control. Among subgroups, rural men had the highest prevalence of hypertension. Prevalence, awareness, and treatment rates all increased with age, except for control rates, which declined in the 65- to 75-year-old group.

CONCLUSIONS

People in Central China have a high hypertension prevalence but low rates of awareness, treatment, and control. Great effort is needed to improve the prevention and management of hypertension in this region.

The Association Between Chronological Age and Dyslipidemia: A Cross-Sectional Study in Chinese Aged Population

Background and Aims

Dyslipidemia is obviously an important risk factor for cardiovascular diseases, which might further lead to disability and death in aged population. We thus performed the current study to evaluate the association between chronological age and dyslipidemia.

Subjects and Methods

A total number of 59,716 Chinese aged population (31,174 men and 28,542 women, average age 67.8y) were included in the current study. Age and sex were abstracted from medical records. Height, body weight, and blood pressure were measured by trained nurses. Serum concentration of total cholesterol (TC) and total triglycerides were performed by enzyme-linked immunosorbent method after at least 8-h fast. Dyslipidemia was defined if total cholesterol≥5.7 mmol/L, or total triglycerides≥1.7 mmol/L, or self-reported history of dyslipidemia.

Results

The prevalence of dyslipidemia was 50.4% in the current study population. Compared to the youngest age group (60-64y), the adjusted odds ratio was 0.88 (95% CI: 0.84, 0.92), 0.77 (95% CI: 0.73, 0.81), 0.66 (95% CI: 0.61, 0.70), 0.55 (95% CI: 0.50, 0.59) for the participants who were 65 to 69, 70-74, 75-79, and ≥80 years old (p trend <0.001). Excluding participants with low body weight and with overweight and obesity, with high blood pressure and history of hypertension, with high fasting blood glucose and history of diabetes, generated similar results with main analysis.

Conclusion

Chronological age was closely associated with the risk of dyslipidemia in Chinese aged population.

Correlation between dietary selenium intake and stroke in the National Health and Nutrition Examination Survey 2003-2018

BACKGROUND

Epidemiologic evidence of the effect of dietary selenium intake on stroke risk remains controversial. This study aimed to examine the cross-sectional correlation between dietary selenium intake and the risk of stroke in adults.

MATERIALS AND METHODS

We retrospectively analysed 39,438 participants from the National Health and Nutrition Examination Survey 2003-2018, aged 20-85 years. Participants were divided into quartiles depending on daily dietary selenium intake: quartile 1 (0-77 μg), quartile 2 (77-108 μg), quartile 3 (108-148 μg), and quartile 4 (148-400 μg). The dose-response relationship was assessed using the restricted cubic spline function.

RESULTS

The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of stroke were 0.70 (0.55, 0.88) for participants in quartile 2, 0.71 (0.53, 0.93) for quartile 3, and 0.61 (0.43, 0.85) for quartile 4 compared with that in quartile 1. p-Value for trend through quartiles was .007. A non-linear negative correlation between dietary selenium intake and stroke was observed in the threshold effect analysis and restricted cubic spline function (p-value for non-linearity < .001). An initial decrease in odds of stroke lower than 105 μg/day selenium intake (0.61 [0.44, 0.85], p = .004) was followed by a platform beyond 105 μg/day (0.97 [0.81, 1.16], p = .723). In the subgroup analysis, adjusted ORs (95% CIs) of stroke were 0.51 (0.36, 0.70) for female participants, 0.63 (0.40, 0.99) for participants with age <60 years, 0.63 (0.47, 0.85) for participants with poverty-income ratio < 2.14, 0.66 (0.50, 0.87) for participants with overweight and obesity, 0.66 (0.52, 0.84) for participants with hypertension, 0.72 (0.53, 0.97) for participants without diabetes, and 0.72 (0.56, 0.92) for non-anaemic participants.

CONCLUSIONS

Dietary selenium had a negative and non-linear correlation with the risk of stroke in adults. The correlation varied across different population subgroups.KEY MESSAGESDietary selenium had a negative and non-linear correlation with the risk of stroke in adults.Non-linear negative correlation trends were observed in subpopulations of females, age <60 years, poverty-income ratio <2.14, overweight and obesity, hypertension, non-diabetes, and non-anaemia.Dietary selenium intake of approximately 105 μg per day has an optimum effect on stroke.

Trends and Comparisons of Blood Pressure and Fasting Plasma Glucose in Patients with Hypertension, Diabetes, and Comorbidity: 4-Year Follow-Up Data

BACKGROUND

Patients with both diabetes and hypertension could face more health risks than those with either condition alone, and less attention has been paid to their management outcomes, so this study may be the first to specifically address this problem. We aimed to examine the management outcomes of blood pressure (BP) in hypertensive patients with/without diabetes and fasting plasma glucose (FPG) in diabetic patients with/without hypertension.

METHODS

Follow-up data were obtained from the National Basic Public Health Service Project in Sanming (2017-2021). A total of 25,795 adults with hypertension only, 4111 adults with diabetes only, and 5729 comorbid adults (namely, hypertensive patients with diabetes) were included. Generalized estimating equations were applied.

RESULTS

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with hypertension only both dropped significantly (Coef. = -0.00088, P < 0.001; Coef. = -0.00081, P < 0.001). DBP in comorbid patients decreased considerably (Coef. = -0.00033, P < 0.001). Pulse pressure in comorbid patients grew rapidly (Coef. = 0.00044, P < 0.001). BP control rate in patients with hypertension only increased significantly (OR = 1.00039, P < 0.001). FPG control rates in diabetic patients with/without hypertension grew markedly (OR = 1.00013, P < 0.001; OR = 1.00020, P < 0.001). Comorbid patients had lower baseline SBP and DBP but higher latest SBP than patients with hypertension only (Coef. = -1.18872, P < 0.001; Coef. = -1.16049, P < 0.001; Coef. = 1.0634, P < 0.001). Comorbid patients had lower baseline BP and FPG control rates than those with either condition alone, and differences were greater at the latest follow-up (OR = 0.28086, P < 0.001; OR = 0.91012, P = 0.049; OR = 0.04020, P < 0.001; OR = 0.69465, P < 0.001).

CONCLUSION

BP and FPG management outcomes have achieved progress. Comorbid patients have poorer performance than patients with either disease alone in BP levels especially the SBP level and control rates of SBP, DBP, and FPG. Future studies should be conducted using national data and include more confounding factors.

Sex differences in the association between the change in triglyceride‑glucose index and cognitive decline: A population-based cohort study

BACKGROUND

Previous studies indicated that insulin resistance (IR) was related to cognitive decline. This study aimed to investigate whether triglyceride-glucose (TyG) as a surrogate marker of IR can detect the association between IR and cognitive decline, and explore sex-specific association between the longitudinal change in TyG index and cognitive decline in the middle-aged and elderly population in China.

METHODS

Data from the China Health and Retirement Longitudinal Study, which include 2358 females and 2062 males, were used. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting blood glucose [mg/dL] / 2). Cognitive score was measured by word recall test and mental status test. Logistic regression was used to assess the association between change in TyG index and cognitive decline in men and women from 2011 to 2015, respectively. Subgroup analysis by age was also performed.

RESULTS

The fourth quartile of change in TyG index was significantly associated with the increased risk of decline in global cognition compared with the first quartile in men [odds ratio (OR) 1.32, 95 % CI 1.03 to 1.71]. Stratified by age groups, the significant association between TyG index and cognitive decline was only found in men aged under 60 years old (OR 1.51, 95 % CI 1.07 to 2.13).

LIMITATIONS

We only observed the association between TyG index and cognitive decline, but not the severity of the decline.

CONCLUSIONS

The increased TyG index is related to the risk of cognitive decline in men. This study provided new evidence for formulating sex-specific prevention and treatment strategies for cognitive decline.

Global Trends in the Epidemiology and Management of Dyslipidemia

Dyslipidemia, especially a circulating non-optimal level of cholesterol, is one of the most important risk factors for atherosclerotic cardiovascular disease (ASCVD), which accounts for the most deaths worldwide. Maintaining a healthy level of blood cholesterol is an important prevention strategy for ASCVD, through lifestyle intervention or cholesterol-lowering therapy. Over the past three decades, the epidemiology and management of dyslipidemia has changed greatly in many countries. Therefore, it is necessary to understand the current epidemiologic features of dyslipidemia and challenges from a global perspective.

Prevalence of prediabetes, diabetes, diabetes awareness, treatment, and its socioeconomic inequality in west of Iran

We aim to estimate the prevalence of prediabetes, and diabetes mellitus (DM). We estimated awareness, treatment, plasma glucose control, and associated factors in diabetes, as well as, socioeconomic-related inequality in the prevalence of diabetes and prediabetes. Data for adults aged 35-70 years were obtained from the baseline phase of the Dehgolan prospective cohort study (DehPCS). Diabetes status was determined as fasting plasma glucose (FPG) of ≥ 126 mg/dl and/or taking glucose lowering medication confirmed by a medical practitioner. Prediabetes was considered as 100 ≤ FPG ≤ 125 mg/dl. The relative concentration index (RCI) was used to exhibit socioeconomic inequality in the prevalence of prediabetes and DM. Prevalence of prediabetes and DM, diabetes awareness and treatment, and glycemic control of DM 18.22%, 10.00%, 78.50%, 68.91% and, 28.50%, respectively. Increasing age (p < 0.001), Increasing body mass index (BMI) (p < 0.05), ex-smoker (p < 0.01), family history of diabetes (FHD) (p < 0.001), and comorbidity (p < 0.001) were independent risk factors for DM. Age group of 46-60 (p < 0.05), ex-smoker (p < 0.05), FHD (p < 0.05) were increased chance of awareness. Current smokers (p < 0.05), and higher education increase the chance of glycemic control in DM. Both DM (RCI =  - 0.234) and prediabetes (RCI =  - 0.122) were concentrated significantly among less-educated participants. DM was concentrated significantly among poor (RCI =  - 0.094) people. A significant proportion of DM awareness and treatment can be due to the integration of diabetes into the primary health care system. The high prevalence of prediabetes and diabetes, which is affected by socioeconomic inequality and combined with low levels of glycemic control may place a greater burden on the health system. Therefore, awareness, receiving treatment, and glycemic control in people with diabetes, and the socioeconomic status of people have become increasingly important in the near future.

Disparities in cardiovascular disease prevalence among middle-aged and older adults: Roles of socioeconomic position, social connection, and behavioral and physiological risk factors

Introduction

Cardiovascular disease (CVD) remains the leading cause of premature death globally and a major contributor to decreasing quality of life. In the present study, we investigated the contribution of social, behavioral, and physiological determinants of CVD and their different patterns among middle-aged and older adults.

Methods

We used harmonized data from 6 nationally representative individual-level longitudinal studies across 25 countries. We restricted the age to ≥50 years and defined cases as a self-reported history of CVD. The exposure variables were the demographic status (age and sex), socioeconomic position (education level, employment, and household income level), social connections (marital status and family size), behavioral factors (smoking, alcohol drinking, and frequency of moderate to vigorous physical activity), and physiological risk factors (obesity, presence of hypertension, and presence of diabetes). Mixed logistic regression models were fitted to investigate the associations, and dominance analysis was conducted to examine the relative contributions.

Results

In total, 413,203 observations were included in the final analysis, with the CVD prevalence ranging from 10.4% in Mexico to 28.8% in the United States. Physiological risk factors were the main driver of CVD prevalence with the highest dominance proportion, which was higher in developing countries (China, 57.5%; Mexico, 72.8%) than in developed regions (United States, England, 10 European countries, and South Korea). Socioeconomic position and behavioral factors also highly contributed but were less significant in developing countries than in developed regions. The relative contribution of socioeconomic position ranged from 9.4% in Mexico to 23.4% in the United States, and that of behavioral factors ranged from 5.7% in Mexico to 26.1% in England.

Conclusion

The present study demonstrated the different patterns of determinant contributions to CVD prevalence across developing and developed countries. With the challenges produced by different risk factors, the implementation of tailored prevention and control strategies will likely narrow disparities in the CVD prevalence by promoting health management and enhancing the capacity of health systems across different countries.

Improvement in cardiometabolic risk markers following an oatmeal diet is associated with gut microbiota in mildly hypercholesterolemic individuals

Cardiovascular diseases have been the leading cause of death worldwide for decades. Some animal studies have indicated that oatmeal could improve gut microbiota and cardiometabolic risk markers. However, vivo evidence remained limited, especially in individuals with mild hypercholesterolemia. Our purpose was to explore the beneficial effects of oatmeal on serum lipids, oxidative stress and inflammation levels, and their correlations with gut microbiota and short-chain fatty acids (SCFAs) in mildly hypercholesterolemic individuals. The study was a randomized, single-blind, placebo-controlled trial. A total of 62 qualified participants were randomly divided into control group and oatmeal group with a 45-day follow-up. 16S rDNA and Gas-Chromatography Mass Spectrometry were employed respectively to measure the changes in gut microbiota and SCFAs at the start and the end of the intervention period. Cardiometabolic risk markers were assayed via commercial kits. The results suggested that oatmeal could significantly decrease serum total cholesterol (TC) (-8.59 %, p = 0.013), low density lipoprotein cholesterol (LDL-c) (-12.97 %, p = 0.004) and non-high density lipoprotein cholesterol (non-HDL-c) (-10.98 %, p = 0.040) level. In terms of oxidative stress, oatmeal significantly increased serum total antioxidant capacity (T-AOC) (21.98 %, p < 0.001), superoxide dismutase (SOD) (15.53 %, p = 0.044) levels and decreased concentration of malondialdehyde (MDA) (-19.11 %, p = 0.033) compared with control group. While no significant effect was observed in inflammatory factors. SCFAs results indicated that oatmeal could significantly increase serum acetic acid, propionic acid and valeric acid. The results of 16S rDNA showed that there was a significant difference in the alteration of β-diversity between groups throughout the whole trial. Oatmeal resulted in the increases of Akkermansia, Dialister, Faecalibacterium, Barnesiella, Agathobacter, Lactobacillus and the decrease of Ruminococcaceae-MK4A214-group. Correlation analysis further suggested that the lipids regulation effect of oatmeal may be mainly mediated by Lactobacillus and Dialister, as well as some SCFAs (e.g., acetic acid and propionic acid), while Barnesiella and Akkermansia may play a crucial role in ameliorating oxidative stress level. In conclusion, despite of its small sample size, the present study is the first clinical trial performed in Chinese individuals with mild hypercholesterolemia to explore the effects of oatmeal on serum lipids, oxidative stress, inflammation levels, and gut microbiota. The results demonstrated that oatmeal could induce some beneficial changes in serum lipids, oxidative stress, gut microbiota composition and SCFAs. Correlation analysis further extended our understanding of the role of gut microbiota and SCFAs in improving cardiometabolic risk markers.

Implications of the heterogeneity between guideline recommendations for the use of low dose aspirin in primary prevention of cardiovascular disease

The most recent primary cardiovascular disease (CVD) prevention clinical guidelines used in Europe, Italy, the USA, China, and South Korea differ in aspects of their approach to CVD risk assessment and reduction. Low dose aspirin use is recommended in certain high-risk patients by most but not all the countries. Assessment of traditional risk factors and which prediction models are commonly used differ between countries. The assessments and tools may not, however, identify all patients at high risk but without manifest CVD. The use of coronary artery calcium (CAC) score to guide decisions regarding primary prevention aspirin therapy is recommended only by the US primary prevention guidelines and the 2021 European Society of Cardiology guidelines. A more consistent and comprehensive global approach to CVD risk estimation in individual patients could help to personalize primary CVD prevention. Wider detection of subclinical atherosclerosis, together with structured assessment and effective mitigation of bleeding risk, may appropriately target patients likely to gain net benefit from low dose aspirin therapy.

Associations of typical antibiotic residues with elderly blood lipids and dyslipidemia in West Anhui, China

Growing evidence has indicated the association of clinical antibiotic use with abnormal blood lipid levels; however, no epidemiological study has examined the relationship of antibiotic exposure, probably derived from food chains, with blood lipid levels. This study investigated the relationships of urinary antibiotic levels with blood lipid levels and dyslipidemias in the older population. Baseline data of 960 participants from the Cohort of Elderly Health and Environment Controllable Factors were used in the present study. High-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) was performed to detect antibiotic residues in the urine samples of the participants. Our findings revealed that each 1 μg/g increase in enrofloxacin and ciprofloxacin levels was associated with an increase of 0.084 (95 % confidence interval (CI): 0.030, 0.139) and 0.049 (95 % CI: 0.012, 0.086) in triglyceride levels, respectively. Enrofloxacin was associated with an increased risk of hypertriglyceridemia. Each 1 μg/g increase in the enrofloxacin level corresponded to an increase of 0.052 (95 % CI: 0.006, 0.098) in the low-density lipoprotein cholesterol level. Furthermore, florfenicol exposure increased the risks of both hyperbetalipoproteinemia and hypoalphalipoproteinemia. By contrast, each 1 μg/g increase in sulfaclozine and doxycycline levels was associated with a - 0.062 (95 % CI: -0.111, -0.020), and - 0.083 (95 % CI: -0.160, -0.007) decrease in total cholesterol levels, respectively. Sulfaclozine was closely related to a decreased risk of hypercholesterolemia. Stratification analysis revealed specific differences in the correlation between antibiotic exposure and lipid levels based on the waist circumference (WC) values of the participants. Except for sulfaclozine and doxycycline, other antibiotics exerted adverse effects on lipid levels and increased dyslipidemia prevalence. The older participants with higher WC values were vulnerable to antibiotic exposure. Therefore, an appropriate understanding of the epidemiological attributes of antibiotic residues is indispensable to prevent abdominal obesity in the older population.

Recurrence prediction of Essen Stroke Risk and Stroke Prognostic Instrument-II scores in ischemic stroke: A study of 5-year follow-up

OBJECTIVE

To evaluate the predictive accuracy of the Essen Stroke Risk Score and the Stroke Prognostic Instrument II score on the long-term recurrence in Chinese patients with acute ischemic stroke.

METHODS

Patients with acute ischemic stroke were enrolled and had completed ESRS and SPI-II scores. Patients were stratified according to the Essen Stroke Risk Score and Stroke Prognostic Instrument II score and were followed until stroke recurrence or composite endpoint event (stroke recurrence, myocardial infarction or cardiovascular death). We estimated stratified incidence rates and calculated the cumulative risks at 5 years using Kaplan-Meier estimates. We used receiver operating characteristic (ROC) curves to compare the predictive ability of the Essen Stroke Risk Score and Stroke Prognostic Instrument II score.

RESULTS

A total of 578 patients completed the follow-up. The cumulative 5-year event rates were 32.3% (95% CI, 28.2% to 36.4%) for recurrent stroke and 37.9% (95% CI: 33.8%-42.0%) for composite endpoint event. The cumulative risk of all outcomes increased with increasing risk scores. AUC for ESRS and SPI-II risk scores were 0.613 (95% CI: 0.565-0.661) and 0.613 (95% CI: 0.564-0.662) for 5-year stroke recurrence respectively and correspondingly 0.622 (95% CI: 0.576-0.668) and 0.627 (95% CI: 0.581-0.674) for composite endpoint events.

CONCLUSION

In Chinese patients with acute ischemic stroke, both Essen Stroke Risk Score and Stroke Prognostic Instrument II scores could equally stratify the risk of 5-year recurrent stroke and combined vascular events.

Persistence of drug therapy is associated with ischemic stroke and other vascular events in high-risk stroke population

The high-risk stroke populations are significantly associated with an increased risk of stroke or other vascular events. Although proven primary and secondary stroke prevention medications are available, persistent use is required to be effective. However, the persistence of drug therapy and its association with outcomes in the high-risk stroke population have received limited study in China. Hence, according to the China National Stroke Screening Survey (CNSSS) program in 2015, we performed this multicenter population-based cross-sectional survey and prospective cohort study in Sichuan of southwestern China. The residents aged ≥ 40 years volunteered to participate in a face-to-face survey in 8 communities. Subjects with at least three of eight stroke-related risk factors or a history of stroke were defined as high-risk stroke population. The interviewers recorded individuals' medications at a face-to-face survey, and all the high-risk stroke population was followed up for 4.7 years. The persistence of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics for stroke was evaluated. The primary outcome was new stroke. Secondary outcomes included new composite vascular events of stroke, myocardial infarction, and death during follow-up periods. Among 16,892 participants, 2,893 (17.1%) participants were high-risk stroke population and 2,698 (93.3%) participants completed to follow-up. The 4.7-year persistence of therapy rate of antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 38.0%, 39.9%, 43.9%, and 59.8%, respectively. The total persistence of therapy rate for antihypertensives, hypoglycemics, lipid-lowering medications, and antithrombotics was 47.6% (136/286) in patients with hypertension, diabetes, dyslipidemia, and stroke at the same time. During the 4.7-year follow-up, there were 118 (4.4%) new ischemic stroke, 24 (0.9%) hemorrhagic stroke, 53 (2.0%) myocardial infarctions, and 33 (1.2%) deaths. After adjusting for the covariates, 4.7-year persistence of antihypertensives, hypoglycemics, lipid-lowering therapy, antithrombotics, and total persistence was independently associated with less new ischemic stroke and less new composite vascular events. Thus, more effective public education and efforts to understand and enhance the persistence of drug therapy are crucial to improve population health and decrease stroke and other vascular events for the high-risk stroke population.

Dyslipidaemia Is Associated with Severe Disease Activity and Poor Prognosis in Ulcerative Colitis: A Retrospective Cohort Study in China

Background: Clinical data on the correlation of dyslipidaemia with the long-term outcomes of ulcerative colitis (UC) are limited. This study aimed to evaluate the impact of lipid levels on disease activity and prognosis in UC. Methods: The retrospective data of UC patients who had detailed lipid profiles were collected from January 2003 to September 2020. All patients were followed-up to 30 September 2021. The long-term outcomes were UC-related surgery and tumorigenesis. Results: In total, 497 patients were included in the analysis. Compared to patients with normal lipid levels, those with dyslipidaemia commonly presented with more serious disease activity. Low high-density lipoprotein cholesterol (p < 0.05) levels were associated with higher risks of severe disease activity in UC. Regarding the long-term outcomes, patients with persistent dyslipidaemia were at higher risks of UC-related surgery (HR: 3.27, 95% CI: 1.86−5.75, p < 0.001) and tumorigenesis (HR: 7.92, 95% CI: 3.97−15.78, p < 0.001) and had shorter surgery- and tumour-free survival (p < 0.001) than patients with transient dyslipidaemia and normal lipid levels. Low levels of high-density lipoprotein cholesterol (p < 0.001) and apolipoprotein A1 (p < 0.05) were associated with higher risks of surgery and tumorigenesis. Conclusion: Persistent dyslipidaemia was associated with a higher risk of serious disease activity and worse long-term outcomes among patients with UC. Lipid patterns should be assessed to improve the management of high-risk patients with UC in the early phase.

Corrected Serum Ionized Calcium as a Risk Factor Related to Adult Dyslipidemia

Background

Dyslipidemia is a significant threat to global public health due to its pivotal role as a cardiovascular disease (CVD) risk factor. Calcium is a critical nutritional element required for electrical signal transduction and muscle and heart function, and calcium supplementation is widespread in the general population. However, associations between serum calcium and serum lipid profiles remain conflicting. Considering ionized calcium [Ca(2+)] is the best measure of active serum calcium and the lack of Ca(2+) analyzers, we aimed to examine the independent and joint associations between serum ionized calcium corrected by albumin ([Ca2+]corr) and the known modifiable risk factors and dyslipidemia.

Methods

We collected physical examination records, including demographic, anthropometric, laboratory tests, and clinical characteristics from individuals who had health checkups in 2019 at the health examination center of the First Affiliated Hospital of China Medical University. Subjects were categorized into Q1–Q4 groups using [Ca2+]corr quartiles, and odds ratios (ORs) with 95% confidence intervals (CIs) for dyslipidemia and associated components were calculated using logistic regression. We also performed non-linear and threshold effect analyses of [Ca2+]corr and triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (Non-HDL-C) levels.

Findings

Of 5,416 individuals aged 18–92 years, multivariable-adjusted models showed that ORs for dyslipidemia increased gradually with elevated [Ca2+]corr levels. Logistic regression analyses demonstrated that [Ca2+]corr levels were associated with the increased odds of dyslipidemia (per 1 mmol/L increase: OR = 3.53, 95% CI: 1.56–8.00, P < 0.001). When compared with individuals in the Q1 group, those in groups Q3 and Q4 had significantly higher dyslipidemia odds (OR_{Q3 vs. Q1} = 1.20, 95% CI: 1.01–1.42; OR_{Q4 vs. Q1} = 1.31, 95% CI: 1.10–1.56, all P < 0.05). Furthermore, a linear, positive relationship between [Ca2+]corr levels and dyslipidemia odds was observed (P for non-linear trend = 0.506), and the optimal cut-off point of [Ca2+]corr for dyslipidemia management was 2.26 mmol/L. A modifiable effect of albumin on the relationship between [Ca2+]corr and dyslipidemia odds was also found (P for interaction = 0.014). High [Ca2+]corr levels were positively associated with elevated TC, LDL-C, and Non-HDL-C but inversely associated with decreased HDL-C odds. Moreover, Locally weighted regression (Loess) analyses showed a non-linear, positive relationship between [Ca2+]corr and TG, TC, HDL-C, LDL-C, and Non-HDL-C levels.

Interpretation

Corrected serum ionized calcium was positively associated with increased odds of dyslipidemia and elevated TC, LDL-C, and Non-HDL-C, but inversely associated with the odds of decreased HDL-C.

Associations of Socioeconomic Status and Healthy Lifestyle With Incidence of Dyslipidemia: A Prospective Chinese Governmental Employee Cohort Study

Objective

The purpose of the study was to test whether primary lifestyles mediate associations of SES with incidence of dyslipidemia and to explore interaction relations of lifestyles and SES with incidence of dyslipidemia.

Methods

We included 9,901 individuals at baseline from January 2018 to November 2019, and incidence data were updated to 31 December 2020. Dyslipidemia was defined as total cholesterol (TC) 6.2 mmol/L TC ≥ or triglycerides (TG) ≥2.3 mmol/L or low-density lipoprotein cholesterol (LDL-C) ≥4.1 mmol/L or high-density lipoprotein cholesterol (HDL-C) <1.0 mmol/L; or physician diagnosed dyslipidemia or lipid-lowering drugs use. Lifestyles, socioeconomic factors, and personal characteristics were collected by a questionnaire. A latent class analysis based on education, family income, and occupational position was used to assess the SES. Lifestyle score was calculated using cigarette smoking, alcohol consumption, physical activity, and diet. Cox proportional hazard models and multivariate analyses were used to explore the associations. The mediation effect was evaluated using bootstrap method.

Results

Participant mean age was 36.5 years (SD = 0.11). The cumulative incidence of dyslipidemia was 11.0% over a mean follow-up of 13.4 months. Compared with participants of high SES, those with low SES had higher risk of incidence of dyslipidemia [hazard ratio 1.32, 95% confidence interval (CI): 1.01–1.73], after adjusting for lifestyle scores and other covariates. The proportion mediated by lifestyles was 5.41% (95%CI: 4.17–7.11). A significant additive interaction was found between lifestyles and SES, whereas association between lifestyle and incidence of dyslipidemia was stronger among those of high SES. Additionally, individuals with low SES and no or one healthy lifestyle behavior had a higher risk of developing dyslipidemia than those with high SES and 3 or 4 healthy lifestyles.

Conclusion

Unhealthy lifestyles play a small moderating role in socioeconomic inequity in incidence of dyslipidemia among Chinese governmental employees, suggesting that promoting healthy lifestyles alone may not significantly reduce socioeconomic inequalities in health, and measures to address other social determinants of health should also be considered alongside.

Landscape of cardiometabolic risk factors in Chinese population: a narrative review

With rapid economic growth and changes at all levels (including environmental, social, individual), China is facing a cardiovascular disease (CVD) crisis. In China, more than 40% of deaths are attributable to CVDs, and the number of CVD deaths has almost doubled in the past decades, in contrast to a decline in high-income countries. The increasing prevalence of cardiometabolic risk factors underlies the rise of CVDs, and thus curbing the rising cardiometabolic pandemic is imperative. Few articles have addressed this topic and provided an updated review of the epidemiology of cardiometabolic risk factors in China.In this narrative review, we describe the temporal changes in the prevalence of cardiometabolic risk factors in the past decades and their management in China, including both the well-recognized risk factors (general obesity, central obesity, diabetes, prediabetes, dyslipidemia, hypertension) and the less recognized ones (hyperhomocysteinemia, hyperuricemia, and high C-reactive protein). We also summarize findings from landmark clinical trials regarding effective interventions and treatments for cardiometabolic risk factors. Finally, we propose strategies and approaches to tackle the rising pandemic of cardiometabolic risk factors in China. We hope that this review will raise awareness of cardiometabolic risk factors not only in Chinese population but also global visibility, which may help to prevent cardiovascular risk.