Cardiovascular Disease In Chinese Adults Research Articles

Relationship between carbohydrate intake and risk factors for cardiovascular disease in Chinese adults: data from the China Health and Nutrition Survey (CHNS).

It is well known that dietary factors affect the development of cardiovascular disease. We evaluated the associations between carbohydrate intake and cardiovascular disease risk factors using data from the China Health and Nutrition Survey, 2009. A total of 6,648 Chinese adults aged 18-60 were divided into five groups based on carbohydrate intake (% of energy). Mixed-effect linear regression models were used to estimate the risk factors in relation to carbohydrate intake, and mixed-effect logistic regression models were used to assess the risk of cardiovascular disease. When age was adjusted, carbohydrate intake was negatively correlated with total cholesterol and triglycerides in men and total cholesterol and low-density lipoprotein cholesterol in women. However, there were positive associations of carbohydrate intake with waist circumference, body mass index, and blood pressure in women. After additional adjustment for urbanicity index, income, physical activity, education, alcohol and smoking, and dietary intake, the 5th quintile of carbohydrate intake reduced the risk for high low-density lipoprotein cholesterol in women (OR=0.73, 95% CI: 0.53, 0.99) compared with the 1st quintile. However, the top quintile of carbohydrate intake increased the risk for impaired glucose tolerance in men (OR=2.08, 95% CI: 1.04, 4.16) compared with the lowest quintile after adjusting for all confounders. Higher-carbohydrate diets may associate with risk factors for cardiovascular disease. Moderate carbohydrate intake is recommended for daily consumption. These results suggest that improving dietary patterns may be an important approach to the prevention of cardiovascular disease in Chinese adults.

A18945 Dietary calcium and sodium intake and risk of cardiovascular disease in Chinese adults

A18945 Dietary calcium and sodium intake and risk of cardiovascular disease in Chinese adults

Lifestyle Interventions Lower Cardiovascular Disease in Chinese Adults with IGT—Thirty-Year Follow-Up of Da Qing Diabetes Prevention Study

Lifestyle interventions can prevent or delay type 2 diabetes (T2DM) but their long-term effect on cardiovascular disease (CVD) remains unclear. We assessed the effect of lifestyle interventions on the incidence of CVD events among Chinese adults with impaired glucose tolerance (IGT) who participated in the Da Qing Diabetes Prevention Study (DQDPS) and who were followed for up to 30 years after randomization. DQDPS was a 6-year clinical trial conducted in Da Qing, China from 1986 to 1992 in which 576 adults with IGT were randomized by clinic to a control group (138) or one of three lifestyle intervention groups (438) (diet or exercise or both). After the 6-year active intervention, participants were followed to assess their first CVD events until December 31st 2016. CVD was defined as fatal or nonfatal CVD, which included myocardial infarction, congestive heart failure, stroke, and amputation. The intervention effect on CVD was assessed using Cox proportional hazards analysis. 542 (94.1%) of the original participants had data for CVD events. 192 in the combined intervention group and 79 in the control group had a first CVD event during the follow-up. The 30-year cumulative incidence of CVD was 51.8% (95% CI 47.1-56.5) in the intervention group and 65.7% (95% CI 57.8-73.6) in the control group. CVD incidence per 1000 person-years was 21.8 (95% CI 18.8-25.1) in the intervention group compared to 29.0 (95% CI 23.0-36.2) in the control. After accounting for clinic cluster, the intervention reduced the risk of the first CVD event by 27% (HR 0.73, 95% CI 0.55-0.96; p=0.024).Our study is the first to show that a lifestyle intervention program in persons with IGT significantly reduces the incidence of CVD. Our results provide further justification to adopt lifestyle interventions as public health measures to prevent T2DM. Disclosure Q. Gong: None. P. Zhang: None. J. Ma: None. J. Wang: None. Y. An: None. Y.J. Cheng: None. B. Zhang: None. H. Li: None. Y. Chen: None. Y. Hu: None. E.W. Gregg: None. P.H. Bennett: None. G. Li: None.

Association of Random Plasma Glucose Levels With the Risk for Cardiovascular Disease Among Chinese Adults Without Known Diabetes.

Diabetes is a known risk factor for cardiovascular disease (CVD). Substantial uncertainty remains, however, about the relevance to CVD risk for blood glucose levels below the diabetes threshold. To examine the association of random plasma glucose (RPG) levels with the risk for major CVD in Chinese adults without known diabetes. This prospective cohort study included 467 508 men and women aged 30 to 79 years with no history of diabetes, ischemic heart disease (IHD), stroke, or transient ischemic attack. Participants were recruited from 5 urban and 5 rural diverse locations across China from June 25, 2004, to July 15, 2008, and followed up to January 1, 2014. Baseline and usual (longer-term average) RPG level. Cardiovascular deaths, major coronary events (MCE) (including fatal IHD and nonfatal myocardial infarction), ischemic stroke (IS), major occlusive vascular disease (MOVD) (including MCE or IS), and intracerebral hemorrhage. Preliminary validation of stroke and IHD events demonstrated positive predictive values of approximately 90% and 85%, respectively. Cox regression yielded adjusted hazard ratios (aHRs) for CVD associated with RPG levels. Among the 467 508 participants (41.0% men; 59.0% women; mean [SD] age, 51 [11] years), a significant positive association of baseline RPG levels with CVD risks continued to 4.0 mmol/L (72 mg/dL). After adjusting for regression dilution bias, each 1-mmol/L (18-mg/dL) higher usual RPG level above 5.9 mmol/L (106 mg/dL) was associated with an 11% higher risk for cardiovascular death (6645 deaths; aHR, 1.11; 95% CI, 1.10-1.13). Similarly strong positive associations were seen for MCE (3270 events; aHR, 1.10; 95% CI, 1.08-1.13), IS (19 153 events; aHR, 1.08; 95% CI, 1.07-1.09), and MOVD (22 023 events; aHR, 1.08; 95% CI, 1.07-1.09). For intracerebral hemorrhage, the association was weaker, but also significant (4326 events; aHR, 1.05; 95% CI, 1.02-1.07). These associations persisted after excluding participants who developed diabetes during follow-up. Among adult Chinese without diabetes, lower RPG levels are associated with lower risks for major CVDs, even within a normal range of blood glucose levels.

Reduced Kidney Function Is Associated With Cardiometabolic Risk Factors, Prevalent and Predicted Risk of Cardiovascular Disease in Chinese Adults: Results From the REACTION Study.

BackgroundChronic kidney disease (CKD) increases cardiovascular disease (CVD) risk. However, the association of mildly reduced kidney function with CVD risk is unclear.Methods and ResultsThis study investigated the association of estimated glomerular filtration rate (eGFR) with prevalent CVDs, 10‐year Framingham risk for coronary heart disease (CHD), and 10‐year risk of atherosclerotic cardiovascular diseases (ASCVD) in 239 832 participants from the baseline of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal study. With an interviewer‐assisted questionnaire, we collected information on CVD, including reported CHD, stroke, or myocardial infarction. Chronic Kidney Disease–Epidemiology Collaboration (CKD‐EPI) equation was used to calculate eGFR. Compared with individuals with normal eGFR (≥90 mL/min per 1.73 m2), those with decreased eGFR (75–89, 60–74, and <60 mL/min per 1.73 m2) had higher risk of prevalent obesity, diabetes mellitus, hypertension, and dyslipidemia in both men and women (P for trend all <0.001). Moreover, a significantly higher 10‐year Framingham risk for CHD and 10‐year risk for ASCVD was observed in both men and women with mildly decreased eGFR (60–89 mL/min per 1.73 m2).ConclusionsEven mildly reduced eGFR (under 90 mL/min per 1.73 m2) is associated with elevated 10‐year Framingham risk for CHD and 10‐year ASCVD risk among Chinese adults.

Risk stratification of atherosclerotic cardiovascular disease in Chinese adults

ObjectiveThis study aims to determine the distribution of observed atherosclerotic cardiovascular disease (ASCVD) incidence in contemporary cohorts in China, and to identify cut-off points for ASCVD risk classification based on traditional criteria and new equations developed by Prediction for ASCVD Risk in China (China-PAR). MethodsThe study populations included cohorts in the China-PAR project, with 34,757 participants eligible for the current analysis. Traditional risk stratification was assessed by using Chinese guidelines on prevention of CVD and hypertension, and 5 risk groups were classified based on these guidelines after slight modification for available risk factors. Kaplan–Meier analysis was conducted to obtain the cumulative incidence of observed ASCVD events for all subjects and sub-groups. The predicted 10-year ASCVD risk was obtained using the China-PAR equations. ResultsA total of 1922 ASCVD events were identified during an average follow-up of 14.1 years. According to the group classification based on traditional risk stratification, the observed 10-year risks for ASCVD were 4.61% (95% confidence interval [CI]: 4.11–5.10%) in the moderate-risk group and 8.74% (95% CI: 7.82–9.66%) in the high-risk group. Based on the China-PAR equations for risk assessment of ASCVD, those with predicted risks of <5%, 5–10%, and ≥10% could be classified into categories of low-, moderate-, and high-risk for ASCVD, respectively. ConclusionThe findings enable development of a simple method for classification of individuals into low-, moderate-, and high-risk groups, based on the China-PAR equations. The method will be useful for self-management and prevention of ASCVD in Chinese adults.

Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank.

To examine the relationship of self-reported diabetes, and of random blood glucose levels among individuals without known diabetes, with the prevalence of cardiovascular disease in Chinese adults. We examined cross-sectional data from the China Kadoorie Biobank of 0.5 million people aged 30-79 years recruited from 10 diverse regions of China in the period 2004-2008. Logistic regression was used to estimate the odds ratios of prevalent cardiovascular disease associated with self-reported diabetes, and with measured random blood glucose levels among participants with no history of diabetes, adjusting simultaneously for age, sex, area, education, smoking, alcohol, blood pressure and physical activity. A total of 3.2% of participants had self-reported diabetes (men 2.9%; women 3.3%) and 2.8% had screen-detected diabetes (men 2.6%; women 2.8%), i.e. they had no self-reported history of diabetes but a blood glucose level suggestive of a diagnosis of diabetes. Compared with individuals without a history of diabetes, the odds ratios associated with self-reported diabetes were 2.18 (95% CI 2.06-2.30) and 1.88 (95% CI 1.75-2.01) for prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively. Among participants without self-reported diabetes there was a positive association between random blood glucose and ischaemic heart disease and stroke/transient ischaemic attack prevalence (P for trend <0.0001). Below the diabetic threshold (<11.1 mmol/l) each additional 1 mmol/l of random blood glucose was associated with 4% (95% CI 2-5%) and 5% (95% CI 3-7%) higher odds of prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively. In this adult Chinese population, self-reported diabetes was associated with a doubling of the odds of prevalent cardiovascular disease. Below the threshold for diabetes there was still a modest, positive association between random blood glucose and prevalent cardiovascular disease.

Impact of Waist Circumference and Body Mass Index on Risk of Cardiometabolic Disorder and Cardiovascular Disease in Chinese Adults: A National Diabetes and Metabolic Disorders Survey

BackgroundWe updated the prevalence of obesity and evaluated the clinical utility of separate and combined waist circumference (WC) or body mass index (BMI) category increments in identifying cardiometabolic disorder (CMD) and cardiovascular disease (CVD) risk in Chinese adults.Methods and Findings46,024 participants aged ≥20 years, a nationally representative sample surveyed in 2007–2008, were included in this analysis. Taking the cutoffs recommended by the Chinese Joint Committee for Developing Chinese Guidelines (JCDCG) and the Working Group on Obesity in China (WGOC) into account, the participants were divided into four WC and four BMI groups in 0.5-SD increments around the mean, and 16 cross-tabulated combination groups of WC and BMI. 27.1%, 31.4%, and 12.2% of Chinese adults are centrally obese, overweight, or obese according to JCDCG and WGOC criteria. After adjustment for confounders, after a 1-SD increment, WC is associated with a 1.7-fold or 2.2-fold greater risk of having DM or DM plus dyslipidemia than BMI, while BMI was associated with a 2.3-fold or 1.7-fold higher hypertension or hypertension plus dyslipidemia risk than WC. The combination of WC and BMI categories had stronger association with CMD risk, i.e., the adjusted ORs (95% CI) of having DM, hypertension, and dyslipidemia for the combined and separate highest WC and BMI categories were 2.19 (1.96–2.44) vs 1.88 (1.67–2.12) and 1.12 (0.99–1.26); 5.70 (5.24–6.19) vs 1.51 (1.39–1.65) and 1.69 (1.57–1.82); and 3.73 (3.42–4.07) vs 2.16 (1.98–2.35) and 1.33 (1.25–1.40), respectively. The combination of WC and BMI categories was more likely to identify individuals with lower WC and lower BMI at CVD risk, even after the effects of CMD were controlled (all P<0.05).ConclusionCentral obesity, overweight, and obesity are epidemic in Chinese adults. The combination of WC and BMI measures is superior to the separate indices in identifying CMD and CVD risk.

Heart rate influence on incidence of cardiovascular disease among adults in China

Higher heart rate is associated with mortality, whereas its association with clinical cardiovascular events is much more challenged. A prospective study was conducted for 169,871 Chinese adults ≥40 years in 1991 and followed during 1999-2000 with a response rate of 93.4%. Hazard ratios (HRs) were estimated by Cox proportional hazard regression model. Cardiovascular disease (CVD) was defined as diagnosis of acute myocardial infarction or stroke or death due to CVD (International Classification of Diseases, Ninth Revision: 390.0-398.9, 401.0-429.9 and 430.0-438.9). After an average of 8.3 years' follow-up (836,811 person-years), 6837 participants (3932 men, 2905 women) developed CVD. Compared with the participants with heart rate 60-74 beats per minute (bpm), heart rate 75-89 and ≥90 bpm in men increased the risk of CVD after multivariate adjustment, with corresponding HRs [95% confidence intervals (CIs)] 1.12 (1.04-1.20) and 1.32 (1.18-1.47). Heart rate ≥90 bpm increased women's risk of CVD with HR (95% CI) 1.23 (1.09-1.38). Heart rate ≥75 bpm in men increased the risk of heart disease. Heart rate ≥90 bpm increased the risks of coronary heart disease (CHD) and stroke in men, and the risks of heart disease and CHD in women. Elevated heart rate was associated with high CVD incidence in Chinese adults. This suggests that higher heart rate might be a risk marker for CVD in Chinese adults.

Prehypertension and risk of incidence and mortality of cardiovascular disease in Chinese adults

Prehypertension and risk of incidence and mortality of cardiovascular disease in Chinese adults

Prehypertension and risk of cardiovascular disease in Chinese adults

To examine the excess risks associated with prehypertension and absolute benefit of treatment. We conducted a prospective cohort study in 169 871 Chinese adults aged 40 years and older. Data on blood pressure and covariables were obtained at a baseline examination in 1991 and follow-up evaluation was conducted in 1999-2000. Compared with normotension (<120/80 mmHg), prehypertension (120-139/80-89 mmHg) was significantly associated with an increased relative risk (95% confidence interval) of cardiovascular disease (CVD) incidence 1.34 (1.27, 1.42) and mortality 1.22 (1.15, 1.30), coronary disease incidence 1.32 (1.16, 1.50) and mortality 1.47 (1.23, 1.75), and stroke incidence 1.72 (1.59, 1.86) and mortality 1.67 (1.50, 1.86). The population-attributable risk associated with prehypertension was 10.6 and 7.1% for CVD incidence and mortality, 9.9 and 13.9% for coronary disease incidence and mortality, and 19.9 and 18.7% for stroke incidence and mortality. The optimal 5-year number-needed-to-treat to prevent a CVD event or death was 53 and 185, 17 and 51, and eight and 22 for prehypertension, stage 1 hypertension, and stage 2 hypertension, respectively. The optimal number-needed-to-treat to prevent a CVD event was significantly smaller in prehypertension patients with a history of CVD or diabetes (34 for incidence and 44 for mortality) compared with those without (115 for incidence and 352 for mortality). Prehypertension was related to an increased risk of CVD. Treatment of prehypertension among patients with a history of CVD or diabetes was as beneficial as treatment of stage 1 hypertensive patients without a history of CVD or diabetes.

Hypertension subtype and risk of cardiovascular disease in Chinese adults.

We examined the relationship between hypertension subtype and cardiovascular disease incidence and mortality in Chinese adults. We conducted a prospective cohort study in a nationally representative sample of 169 871 Chinese men and women aged >or=40 years. Data on systolic (SBP) and diastolic blood pressure (DBP) and other variables were obtained at a baseline examination in 1991 with the use of standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. Hypertension subtypes were defined as combined systolic and diastolic hypertension (SBP >or=140 and DBP >or=90 mm Hg), isolated systolic hypertension (SBP >or=140 and DBP <90 mm Hg), isolated diastolic hypertension (SBP <140 and DBP >or=90 mm Hg), and 2 categories of treated hypertension (SBP <140 and DBP <90 mm Hg or SBP >or=140 and/or DBP >or=90 mm Hg). After participants with missing BP values were excluded, 169 577 adults were included in the analyses. Compared with normotensives, relative risks (95% CIs) of cardiovascular disease incidence and mortality were 2.73 (2.60 to 2.86) and 2.53 (2.39 to 2.68) for combined systolic and diastolic hypertension, 1.78 (1.69 to 1.87) and 1.68 (1.58 to 1.78) for isolated systolic hypertension, 1.59 (1.43 to 1.76) and 1.45 (1.27 to 1.65) for isolated diastolic hypertension, 2.01 (1.64 to 2.48) and 1.61 (1.28 to 2.03) for treated hypertension with SBP <140 and DBP <90 mm Hg, and 3.37 (3.07 to 3.69) and 2.88 (2.60 to 3.19) for treated hypertension with SBP >or=140 and/or DBP >or=90 mm Hg, respectively, after adjustment for important covariables. Our results indicate that all hypertension subtypes are associated with significantly increased risk of cardiovascular disease in Chinese adults. Primary prevention of hypertension should be a public health priority in the Chinese population.

Blood Pressure and Risk of Cardiovascular Disease in Chinese Men and Women

We examined the relationship between systolic and diastolic blood pressure (BP) and the incidence of cardiovascular disease (CVD) in a nationally representative cohort of 169,871 men and women > or = 40 years of age in China. Data on BP and other variables were obtained at a baseline examination in 1991 using standard protocols. Follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. After adjustment for age, sex, cigarette smoking, alcohol consumption, physical activity, body mass index, education, geographic region, urbanization, and time-dependent history of diabetes, a strong and linear association between both systolic and diastolic BP and incidence of CVD, coronary heart disease and stroke were observed (all P < 0.0001). For example, the relative risks (95% confidence interval (CI)) of CVD incidence were 1.09 (1.00-1.18), 1.25 (1.16-1.35), 1.49 (1.38-1.62), 2.15 (1.99-2.31), 3.01 (2.78-3.27), and 4.16 (3.84-4.51) for those with systolic/diastolic BP of 110-119/75-79, 120-129/80-84, 130-139/85-89, 140-159/90-99, 160-179/100-109, and > or = 180/110 mm Hg compared to those with BP <110/75 mm Hg. Increases in systolic BP were associated with a greater risk of CVD compared to corresponding increases in diastolic BP. The linear trend for increased CVD risk being related to higher BP levels was observed in all subgroups of gender, age, body weight, and cigarette smoking. Our results indicate that there is a strong, linear, and independent relationship between BP levels and the risk of CVD in Chinese adults. Systolic BP is a stronger predictor of CVD risk compared to diastolic BP.

Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults

Recent data suggest that current overweight and central adiposity guidelines based on Western populations are not appropriate for Asian populations. The published data among Chinese are insufficient to address this issue. We aimed to identify cutoffs for body mass index (BMI; in kg/m(2)) and waist circumference that confer increased risk of cardiovascular disease in Chinese adults as would be consistent with overweight and central adiposity. A nationally representative, cross-sectional sample of 15 239 Chinese adults aged 35-74 y was studied. Mean blood pressure, total cholesterol, LDL-cholesterol, triacylglycerol, and glucose values were incrementally higher and mean HDL-cholesterol values were incrementally lower with each unit increase in BMI and waist circumference in both men and women. Both the point at which sensitivity equaled specificity and the shortest distance in the receiver operating characteristic curves for hypertension, dyslipidemia, diabetes, or >/=2 of these risk factors suggested a BMI cutoff of 24 and a waist circumference cutoff of 80 cm for both men and women. Lower cutoffs for BMI and waist circumference are needed in the identification of Chinese patients at high risk of cardiovascular disease.