Ischemic Heart Disease In China Research Articles

Analysis of the Trend in the Burden of Ischemic Heart Disease in China from 1990 to 2021

Analysis of the Trend in the Burden of Ischemic Heart Disease in China from 1990 to 2021

Mortality trend analysis of ischemic heart disease in China between 2010 and 2019: a joinpoint analysis

BackgroundThis study presented the mortality trend of ischemic heart disease (IHD) in Chinese residents from 2010 to 2019 and provided a basis for further establishment of relevant interventions.MethodsData, such as sex, age, urban and rural areas, and death status, were extracted from the China Death Surveillance Dataset from 2010 to 2019, with mortality and age-adjusted death rates (AADRs) as the main indicators. The joinpoint regression model was used to analyze mortality and AADRs trends in IHD. A semi-structured expert interview was conducted to propose targeted intervention measures and countermeasures.ResultsWe observed an overall upward trend in IHD mortality rates and AADRs in China from 2010 to 2019 (average annual percentage change [AAPC] = 5.14%, AAPCAADRs = 1.60%, P < 0.001). Mortality rates and AADRs increased for both males (AAPC = 4.91%, AAPCAADRs = 1.09%, P < 0.05) and females (AAPC = 5.57%, AAPCAADRs = 1.84%, P < 0.001), with higher mortality rate for males than females but higher variation for females than males. Urban (AAPC = 4.80%, AAPCAADRs = 1.76%, P < 0.05) and rural (AAPC = 5.31%, P < 0.001; AAPCAADRs = 0.99%, P > 0.05) mortality rates increased, with the mortality rate higher in rural areas than in urban areas. In the age analysis, mortality rate was higher in middle-aged and older adults than in other age groups. The age-sex cross-analysis found the highest trend in mortality rates among females aged ≥ 75 years (annual percentage change [APC] = 2.43%, P < 0.05).ConclusionsThe upward trend in IHD mortality in China from 2010 to 2019, especially among female residents aged ≥ 75 years, poses continuing challenges to public health policies and actions.

Disease burden and risk factors of ischemic heart disease in China during 1990-2019 based on the Global Burden of Disease 2019 report: A systematic analysis.

The aim of this study was to identify the disease burden and risk factors of ischemic heart disease (IHD) in China, during 1990-2019, through a systematic analysis using the Global Burden of Disease (GBD) 2019 report in order to provide first-hand information for primary and secondary prevention of IHD in China. Data on the rates of incidence, death, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of IHD were obtained from GBD2019 to determine the disease burden and risk factors of IHD in China. The rates of incidence, death, YLLs, YLDs, and DALYs of IHD in China increased at different levels during 1990-2019. The annual rate of change in incidence, death, YLLs, YLDs, and DALYs of IHD were 1.31%, 1.57%, 0.93%, 1.14%, and 0.94%, respectively. In 2019, the YLDs of IHD in Chinese women were higher, while the rates of incidence and death, YLLs, and DALYs were lower in Chinese women than in Chinese men. The disease burden of IHD had significant age differences, and people aged ≥70 years had the highest disease burden. A total of 24 risk factors were associated with the rates of death and DALYs of IHD, and the five most significant risk factors were high systolic blood pressure, high LDL cholesterol (LDL-C), smoking, ambient particulate matter pollution, and intake of a high-sodium diet. From 1990 to 2019, a high annual rate of change in IHD-related deaths and DALYs was observed due to ambient particulate matter pollution, high body mass index (BMI), and intake of a diet high in processed meat. The results of the study revealed that the disease burden of IHD in China was on the rise, especially in people aged ≥70 years. The main disease burden of IHD in male patients was premature death and that in female patients was disability. Environmental, behavioral, and metabolic factors were considered the three main risks of the disease burden of IHD, with metabolic factors having the greatest impact. Therefore, periodic health check-ups and high-risk factor interventions for key populations should be strengthened from the grassroots level, which are conducive to further reducing the disease burden of IHD in China.

Notoginsenoside R1 Regulates Ischemic Myocardial Lipid Metabolism by Activating the AKT/mTOR Signaling Pathway.

Ischemic heart diseases are responsible for more than one-third of all deaths worldwide. Radix notoginseng is widely used to treat ischemic heart disease in China and other Asian countries, and notoginsenoside R1 (NGR1) is its characteristic and large-amount ingredient. However, the potential molecular mechanisms of NGR1 in improving ischemic heart diseases are unclear. In this study, we combined pharmacological evaluation with network pharmacology, myocardial proteomics, and conventional molecular dynamics (MD) simulation to explore the cardio-protection mechanisms of NGR1. Our results revealed that NGR1 improved the echocardiographic, tissue pathological, and serum biochemical perturbations in myocardial ischemic rats. The network pharmacology studies indicated that NGR1 mainly regulated smooth muscle cell proliferation, vasculature development, and lipid metabolism signaling, especially in the PI3K/AKT pathway. Myocardial proteomics revealed that the function of NGR1 was focused on regulating metabolic and energy supply processes. The research combined reverse-docked targets with differential proteins and demonstrated that NGR1 modulated lipid metabolism in ischemic myocardia by interacting with mTOR and AKT. Conventional MD simulation was applied to investigate the influence of NGR1 on the structural stabilization of the mTOR and AKT complex. The results suggested that NGR1 can strengthen the affinity stabilization of mTOR and AKT. Our study first revealed that NGR1 enhanced the affinity stabilization of mTOR and AKT, thus promoting the activation of the AKT/mTOR pathway and improving lipid metabolic abnormity in myocardial ischemic rats.

Association between genetic predisposition to childhood obesity and the risk of adult ischemic heart disease in China

Objective: To examine the associations of childhood obesity, assessed by genetic variations of childhood body mass index (BMI), with the risk of adult ischemic heart disease (IHD) and major coronary event (MCE). Methods: More than 69 000 participants from the China Kadoorie Biobank were genotyped. After excluding those with coronary heart disease, stroke, or cancer at baseline, a total of 64 454 participants were included in this study. Based on genome-wide significant single nucleotide polymorphisms (SNPs), childhood BMI genetic risk score were constructed for every participant and divided into quintiles, with the lowest quintile as the low genetic risk group and the highest quintile as the high genetic risk group. Cox proportional hazards regression models were used to estimate the association between genetic predisposition to childhood obesity and the risk of ischemic heart disease. Results: During a median of 10.7 years of follow-up, 7 073 incident cases of IHD and 1 845 cases of MCE were documented. After adjusting for sex, age, region, and the first ten genetic principal components, the HRs (95%CIs) for IHD and MCE in the high genetic risk group were 1.10 (1.02-1.18) and 1.10 (0.95-1.27), compared with the low genetic risk group. IHD risk increased by 4% (2%-6%) for each one standard deviation increase in genetic risk score (trend P=0.001). After further adjustment for baseline BMI, the differences between genetic risk groups were not statistically significant, but there was still a linear trend between genetic risk score and IHD risk (trend P=0.019). Conclusions: IHD risk increased with genetic predisposition to childhood obesity, suggesting that childhood obesity is an important risk factor for the development of IHD in China. As an easily identifiable feature, changes of childhood BMI should be monitored regularly to realize early intervention of IHD in adults.

Socioeconomic differences in health-care use and outcomes for stroke and ischaemic heart disease in China during 2009–16: a prospective cohort study of 0·5 million adults

SummaryBackgroundChina initiated major health-care reforms in 2009 aiming to provide universal health care for all by 2020. However, little is known about trends in health-care use and health outcomes across different socioeconomic groups in the past decade.MethodsWe used data from the China Kadoorie Biobank (CKB), a nationwide prospective cohort study of adults aged 30–79 years in 2004–08, in ten regions (five urban, five rural) in China. Individuals who were alive in 2009 were included in the present study. Data for all admissions were obtained by linkage to electronic hospital records from the health insurance system, and to region-specific disease and death registers. Generalised linear models were used to estimate trends in annual hospital admission rates, 28-day case fatality rates, and mean length of stay for stroke, ischaemic heart disease, and any cause in all relevant individuals.Findings512 715 participants were recruited to the CKB between June 25, 2004, and July 15, 2008, 505 995 of whom were still alive on Jan 1, 2009, and contributed to the present study. Among them, we recorded 794 824 hospital admissions (74 313 for stroke, 69 446 for ischaemic heart disease) between 2009 and 2016. After adjustment for demographic, socioeconomic, lifestyle, and morbidity factors, hospitalisation rates increased annually by 3·6% for stroke, 5·4% for ischaemic heart disease, and 4·2% for any cause, between 2009 and 2016. Higher socioeconomic groups had higher hospitalisation rates, but the annual proportional increases were higher in those with lower education or income levels, those enrolled in the urban or rural resident health insurance scheme, and for those in rural areas. Lower socioeconomic groups had higher case fatality rates for stroke and ischaemic heart disease, but greater reductions in case fatality rates than higher socioeconomic groups. By contrast, mean length of stay decreased by around 2% annually for stroke, ischaemic heart disease, and any cause, but decreased to a greater extent in higher than lower socioeconomic groups for stroke and ischaemic heart disease.InterpretationBetween 2009 and 2016, lower socioeconomic groups in China had greater increases in hospital admission rates and greater reductions in case fatality rates for stroke and ischaemic heart disease. Additional strategies are needed to further reduce socioeconomic differences in health-care use and disease outcomes.FundingWellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China Ministry of Science and Technology, and Chinese National Natural Science Foundation.

Declining socioeconomic inequalities in hospital care use and case fatality rates for stroke and ischaemic heart disease in China during 2009–16: a prospective study of 0·5 million adults

BackgroundChina initiated major health-care reforms in 2009 to provide health-care coverage for all by 2020. Little is known about their long-term effect on inequalities in health-care use and outcomes across socioeconomic groups. We aimed to examine trends in hospital care use and case fatality rates for stroke and ischaemic heart disease over 8 years during the implementation of the reforms, overall and by socioeconomic status. MethodsIn this prospective study, we enrolled adults (30–79 years) from ten regions in China, with linkage to mortality and hospitalisation records. We used generalised linear models to estimate trends in annual hospitalisation rates, 28-day case fatality rates, and average length of stay for stroke, ischaemic heart disease, and any cause. FindingsDuring 2009–16, 794 824 hospital admissions (74 313 for stroke, 69 446 for ischaemic heart disease) were recorded among 505 995 participants. After adjustment for socioeconomic, lifestyle, and previous disease factors, hospitalisation rates increased by about 5% annually for stroke, ischaemic heart disease, and any cause. Higher socioeconomic groups had higher hospitalisation rates, but the annual increases were 2-fold higher in lower socioeconomic groups. Annual increases were higher in rural than urban areas (6·7% vs 3·7% for stroke; 10·0% vs 3·9% for ischaemic heart disease; both p<0·0001), in lower than higher education groups (9·0% vs 3·5% for stroke; 8·6% vs 3·3% for ischaemic heart disease; both p<0·0001), and in lower than higher income groups (8·5% vs 3·3% for stroke; 9·7% vs 5·3% for ischaemic heart disease; both p<0·0001). The annual increases in hospitalisation rates were higher for individuals in the rural or urban resident medical insurance scheme than for those enrolled in the urban employee scheme (6·1% vs 2·8% for stroke, 8·9% vs 3·5% for ischaemic heart disease; both p<0·0001). The case fatality rates for stroke and ischaemic heart disease were higher in lower socioeconomic groups, but differences decreased over time. Average length of stay decreased by about 2% annually for stroke, ischaemic heart disease, and any cause in all socioeconomic groups. InterpretationDifferences in hospital admission rates for stroke and ischaemic heart disease between socioeconomic groups have decreased since the initiation of health-care reforms in China in 2009, but additional strategies are needed to further reduce socioeconomic inequalities in health-care use and outcomes. FundingWellcome Trust, UK Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China, Chinese Ministry of Science and Technology, and Chinese National Natural Science Foundation.

Trend analysis of the burden of ischemic heart disease in China, 1990 to 2015

Objective: The objective of this study is to analyze the trend of burden of ischemic heart disease (IHD) in China between 1990 and 2015. Methods: Data were collected from the results of 2015 Global Burden of Disease Study. We arranged and analyzed the mortality and disability-adjusted life year (DALY) for IHD by sexes, ages and provinces (excluding Taiwan, China) in China between 1990 and 2015. The age-standardized rates were determined using the average world population age structure in the period of 2010-2035 as a reference, and the changes of the related indicators were calculated. Results: In 2015, IHD caused 1 461 thousand deaths, and its age-standardized death rate was 114.8 per 100 000. Number of DALYs from IHD were 25 765 thousand in 2015, with the age-standardized DALY rate at 1 760.2 per 100 000. From 1990 to 2015, the age-standardized death rate for IHD in China increased by 13.3% but age-standardized DALY rate decreased by 3.9%. Number of IHD DALYs among male (16 664 thousand) was higher than it among female (9 101 thousand) in China in 2015, and 83.5% of total DALYs from IHD occurred among people aged over 50 years old. Province with highest age-standardized death rate was Heilongjiang, with rate at 187.4 per 100 000 in 2015. Qinghai (54.0%) increased most and Macao (-52.3%) decreased most from 1990 to 2015. Province with highest age-standardized DALY rate was Xinjiang, with rate at 3 040.8 per 100 000 in 2015. Qinghai (33.2%) increased most while Macao (-59.0%) decreased most between 1990 and 2015. Conclusion: Burden of IHD in China increased remarkably from 1990 to 2015, especially among males and people aged over 50 years old. The differences among provinces were obvious.

Mortality trends for ischemic heart disease in China: an analysis of 102 continuous disease surveillance points from 1991 to 2009

BackgroundIn the past 20 years, the trends of ischemic heart disease (IHD) mortality in China have been described in divergent claims. This research analyzes mortality trends for IHD by using the data from 102 continuous Disease Surveillance Points (DSP) from 1991 to 2009.MethodThe 102 continuous DSP covered 7.3 million people during the period 1991–2000, and then were expanded to a population of 52 million in the same areas for 2004–2009. The data were adjusted by using garbage code redistribution and underreporting rate, mapped from international classification of diseases ICD-9 to ICD-10. The mortality rates for IHD were further adjusted by the crude death proportion multiplied by the total number of deaths in the mortality envelope, which was calculated by using logrt = a + bt. Age-standard death rates (ASDRs) were computed using China’s 2010 census population structure. Trend in IHD was calculated from ASDRs by using a joinpoint regression model.ResultsThe IHD ASDRs increased in total in regions with an average annual percentage change (AAPC) 4.96%, especially for the Southwest (AAPC = 7.97%) and Northeast areas (AAPC = 7.10%), and for male and female subjects (with 5% AAPC) as well. In rural areas, the year 2000 was a cut-off point for mortality rate with annual percentage change increasing from 3.52% in 1991–2000 to 9.02% in 2000–2009, which was much higher than in urban areas (AAPC = 1.05%). And the proportion of deaths increased in older adults, and more male deaths occurred before age 60 compared to female deaths.ConclusionBy observing a wide range of areas across China from 1991 to 2009, this paper concludes that the ASDR trend for IHD increased. These trends reflect changes in the Chinese standard of living and lifestyle with diets higher in fat, higher blood lipids and increased body weight.

The Effects of Age, Period, and Cohort on Mortality from Ischemic Heart Disease in China

In contrast with most developed countries, mortality due to ischemic heart disease (IHD) continues to rise in China. We examined the effects of age, period, and cohort on IHD mortality in urban and rural populations from 1987 to 2013 to identify the drivers of this trend. Region-specific data on annual IHD mortality among adults aged 20 to 84 years and corresponding population statistics were collected. We then tested for age, period, and cohort effects using the Intrinsic Estimator approach. Our results indicated that IHD mortality in China increased significantly over the three decades studied. There was a log-linear increase in the age effect on IHD mortality as those aged 80–84 showed 277 and 161 times greater IHD mortality risk than those aged 20–24 in urban and rural populations, respectively. While there was an upward trend in the period effect in both populations, the influence of the cohort effect on mortality decreased over time for those born from 1904 to 1993. The age, period, and cohort effects on mortality in China were generally comparable between urban and rural populations. The results suggest that population aging is a major driver behind the rapid rise in IHD mortality. Increased exposure to air pollution may also have played a role in driving the period effect

Traditional Chinese medicine, Danlou tablets alleviate adverse left ventricular remodeling after myocardial infarction: results of a double-blind, randomized, placebo-controlled, pilot study.

BackgroundDanlou tablets, a patented Chinese Medicine, have been long approved for the treatment of ischemic heart disease in China. While numerous empirical observations suggested Danlou tablets could decrease frequency and duration of angina pectoris attacks, evidence supporting its efficacy on cardiac remodeling remains inadequate. Therefore, this pilot trial was designed to determine whether Danlou tablets would reduce adverse left ventricular (LV) remodeling in patients with myocardial infarction (MI).Methods and ResultsEligible patients with acute MI were enrolled and randomly assigned to Danlou tablets or placebo groups, superimposed on standard treatment for MI. Then, in addition to assessment of the clinical outcome, the changes in LV volumes were evaluated by a serial echocardiography. In total, 83 patients (Danlou tablets 42 and placebo 41) completed 90 days of treatment and had complete baseline and outcome data. Standard echocardiographic evaluations revealed significant differences in the change of LV end-diastolic volume index (LVEDVi) between group of patients treated with Danlou tablets and the placebo group (−4.49 ± 7.29 vs. −0.34 ± 9.01 mL/m2, P < 0.001). The reduction in LVEDVi was independent of beta-blocker, ACE inhibitors/ARBs use. Furthermore, treatment with Danlou tablets significantly reduced LV end-systolic volume index (−4.09 ± 5.85 vs. −0.54 ± 5.72 mL/m2, P < 0.001) and improved the LV ejection fraction (4.83 ± 9.23 vs. 0.23 ± 8.15 %, P < 0.001), as compared to placebo. Meaningfully, the incidence of the major adverse cardiovascular events was also lower in patients receiving Danlou tablets (P < 0.05).ConclusionSuperimposed on the standard pharmacologic treatment, Danlou tablets significantly reversed post-MI adverse LV remodeling, thereby contributed to the overall positive clinical outcome.Trial registrationclinicaltrials.gov identifier NCT02675322 (February 1, 2016).Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1406-4) contains supplementary material, which is available to authorized users.

Increasing mortality from ischaemic heart disease in China from 2004 to 2010: disproportionate rise in rural areas and elderly subjects. 438 million person-years follow-up.

We sought to ascertain the changes in mortality from ischaemic heart disease (IHD) from 2004 to 2010 in China as the sheer size of China's population makes disease patterns relevant globally. Data on IHD mortality were obtained from the Chinese Centre for Disease Control and Prevention National Disease Surveillance Point System, which includes 161 counties and a population of over 73 million-a representative sample of over 6% of the entire population of China. Both crude and World Health Organization (WHO)-standardized IHD mortality increased, in both men and women and in both urban and rural locations, during the study period, demonstrating the effect of urbanization, economic growth, and epidemiological transition on cardiovascular health. WHO-standardized IHD mortality increased for rural males by 9.2% per year (95% CI: 6.7-11.7%; P < 0.0001), and the trend was statistically significantly higher (P = 0.0001) than in urban males by 6.4% per year (95% CI: 3-10%; P = 0.02). WHO-standardized IHD mortality rate increased for rural females by 7.0% per year (95% CI: 4.6-9.4%; P < 0.0001); this was statistically significantly higher than urban females by 4.3% per year (95% CI: 1-8%; P = 0.02). The age group over 80 years showed the greatest increase in IHD mortality. Mortality from IHD is increasing in China, in contrast to decreasing in other countries. This is largely driven by increasing IHD mortality in rural areas and subjects over 80 years old. This needs urgent attention by public health workers and policymakers.

Increasing Mortality from Ischaemic Heart Disease in China from 2004 - 2010: 438 Million Person-Years Follow Up

Increasing Mortality from Ischaemic Heart Disease in China from 2004 - 2010: 438 Million Person-Years Follow Up

Dioscin improves heart function by increasing sodium influx via NCX in rat cardiomyocytes

ObjectiveDioscin (Dio) is widely used for the treatment of ischemic heart disease in China. The molecular mechanism underlying the inotropic effects of Dio, however, remains poorly understood.Methods and ResultsLeft ventricle contractile function was measured using the Langendorff non‐recirculating mode of isolated rat heart perfusion. Effects of Dio on cardiac function were assessed by measuring left ventricular systolic pressure (LVSP) and left ventricular end diastolic pressure (LVEDP) as well as the peak rate of rise/fall of left ventricular pressure (±dP/dtmax), in absence or presence of a sodium‐calcium exchanger inhibitor SEA0400. Our ex vivo data show that within the concentrations of 0.1–1μmol/L, Dio significantly increased the LVSP and +dP/dtmax, and these effects were significantly antagonized by 1 μmol·L−1 SEA0400. Furthermore, we investigated the effect of Dio on sodium current (INa) and L‐type calcium current (ICa,L). Intriguingly, the ICa,L was found to be inhibited by Dio, while the INa was augmented by Dio. The effect of Dio on contractile function and ICa,L appears to be contradictory. Therefore, we assessed the effect of Dio on the [Ca2+]i in H9c2 cells. Dio significantly increases the relative fluorescence intensity of intracellular calcium (n=8, P&lt;0.01 vs control), which was partially attenuated by either SEA0400 or calcium‐free or sodium‐free extracellular fluid. Mitochondrial membrane potential was further detected with multifunctional microplate reader in order to determine whether Dio causes mitochondrial injuries. Our data show that Dio barely affected the mitochondrial membrane potential at the concentration of 0.1–1 μmol·L−1, while 10 μmol·L−1 dioscin results in a slight decrease in the mitochondrial membrane potential.ConclusionOur results demonstrate that Dio exerts the positive inotropic effect through elevating [Ca2+]i and increasing sodium influx and sodium‐calcium exchange via the Na+/Ca2+ exchanger (NCX) in rat cardiomyocytes.Support or Funding InformationSupported by Youth Project of Tianjin Natural Fundation (14JCQNJC13700) to Yongqiang Yin

GW24-e3662 The comparative study on expression of SIRT1 signal transduction by Xuefuzhuyu capsule

ObjectivesThe Xuefuzhuyu capsule is used for the treatment of ischaemic heart disease in China. Evidences have demonstrated that Xuefuzhuyu capsule could protect cardiomyocytes from injury induced by ischaemia, but molecular...

Abstract P303: Panaxnotogensengsaponins Promotes Angiogenesis and Enhances the Buildup of Effective Coronary Collateral Circulation in Ischemic Myocardium

Background: Ischemic heart disease (IHD) is a condition that the blood vessels are narrowed or blocked due to the deposition of cholesterol plaques on the blood vessel walls. This affects the supply of blood to the heart and reduces the supply of oxygen and nutrients to the heart musculature, which has been regarded as the largest threat to the public health worldwide. PNS is a purified natural product extract that has been proved effective and widely used clinically in preventing and treating IHD in China. However, the detailed mechanisms of action of PNS remain to be addressed. The present study aims to explore the effect of PNS on modulating angiogenesis in vitro and in vivo to better understand its mechanism of action in treating IHD. Methods and Results: In this study, myocardial ischemia rat model and endothelial cell derived from human capillary blood vessel (ECV304) were utilized. Our data revealed that PNS significantly increased capillary blood vessel density in isoproterenol-induced rat ischemic myocardium model. It also decreased the pathological damage and ameliorated the ultrastructure of myocardial cells in rat ischemic myocardium as assessed by light microscopy, transmission electron microscopy and immunohistochemistry. At cellular level, PNS significantly decreased the number of apoptotic cells in rat ischemic myocardium model. Mechanistic study utilizing microarray and real-time PCR were further performed to examine the gene expression profile. The data revealed that PNS significantly upregulated the mRNA expression of a panel of angiogenic growth factors and their receptors such as VEGF, VEGFR2 and FGFR1. In vitro study revealed that PNS did not exhibit significant effect on the proliferation of ECV304 cells under normoxia culture condition; however, it facilitated the proliferation of ECV304 cells under hypoxia condition, suggesting the selective effect of PNS on angiogenesis under ischemic/hypoxic conditions. Conclusions: Our study demonstrated for the first time that PNS exerts its therapeutic effect on IHD through the mechanisms that in part involve regulating the expression of important angiogenic growth factor, which coordinately enhance the build-up of effective coronary collateral circulation in ischemic myocardium.

Body mass index and mortality from ischaemic heart disease in China: a 15-year prospective study on 220 000 adult men

To assess the relationship between body mass index (BMI) and ischaemic heart disease (IHD) mortality, especially in populations with low mean BMI levels. We examined the data from a population-based, prospective cohort study of 220 000 Chinese men aged 40 - 79, who were enrolled in 1990 - 1991, and followed up ever since to 1/1/2006. Relative risks of the deaths from IHD by the baseline BMI were calculated, after controlling age, smoking, and the other potential confounding factors. The mean baseline BMI was 21.7 kg/m(2), and 2763 IHD deaths were recorded during the 15-year follow-up (6.8% of all deaths) program. Among men without prior vascular diseases at baseline, there was a J-shaped association between BMI and IHD mortality. When baseline BMI was above 20 kg/m(2), there was a strongly positive association of BMI with IHD risk, with each 5 kg/m(2) higher in BMI associated with 21% (95%CI: 9% - 35%, P = 0.0004) higher IHD mortality. Below this BMI range, the association appeared to be reverse, with the risk ratios as 1.00, 1.11, and 1.14, respectively, for men with BMI 20 - 21.9, 18 - 19.9, and < 18 kg/m(2). The excess IHD risk observed at low BMI levels persisted after restricting analysis to never smokers or excluding the first 3 years of follow-up. Lower BMI was associated with lower IHD risk among people in the so-called 'normal range' of BMI values (20 - 25 kg/m(2)). However, below that range, the association might well be reversed.

Evolving Cardiovascular Disease Prevalence, Mortality, Risk Factors, and the Metabolic Syndrome in China

The rapid growth transformation of China from a rural agrarian society to an industrial society with increased wealth has impacted the cardiovascular health of the entire population. The increasing prevalence of cardiovascular disease (CVD) and CVD risk factors mirror in some regards the disease prevalence in western industrialized countries and in other areas present unique public health issues. This article reviewed recent population surveys, reports, and clinical trials conducted in China. It was found that the prevalence of CVD and many of the risk factors such as hypertension, obesity, and diabetes contributing to disease mortality are increasing in China. However, compared with the United States, disease mortality is lower. Also, cerebrovascular disease is far more common than ischemic heart disease in China. The low prevalence of disease may suggest a reduced role of diagnostic imaging studies as compared with the US, while the increased percentage of strokes may point to the need for widely available emergent computed tomography (CT) imaging in hospitals in China. This article also discusses the occurrence of metabolic syndrome, obesity, glucose intolerance, diabetes, and their unique features in the Chinese population. Of interest, compared with the Caucasian cohort of the same body mass index (BMI), the Chinese had a higher percentage of body fat. Metabolic syndrome was found to be associated with increased cardiovascular mortality rate. With one fifth of the world's population, China can anticipate a dramatic rise, in absolute numbers, of CVD. It is imperative that national and regional programs are initiated to detect and treat the disease.

Angiogenic Effects of the Extracts from Chinese Herbs: Angelica and ChuanXiong

Angelica and ChuanXiong are used to cure ischemic heart disease in China. Previous studies found that these two herbs could increase myocardial blood flow, oxygen-supply and keep myocardial oxygen balance, etc. However, the mechanisms of angiogenic effects of these two herbs are not well-known. The purpose of this study was to assess the effects of Angelica and ChuanXiong on vascular endothelial growth factor (VEGF) expression in rat myocardial infarction, on endothelial cell proliferation and quantity of vessels on chick embryo chorioallantoic membrane (CAM). In this study, rats were divided randomly into either pre-treatment or acute-treatment group and sacrificed at the end of the treatments. VEGF expression using Western blot analysis was significantly increased in the groups pre-treated with ChuanXiong and Angelica when compared to the control group (p < 0.05). There was significant increase in VEGF expression in the rats treated acutely with Angelica (p < 0.05). In the contrary, the rats treated with ChuanXiong showed a decrease in VEGF expression when compared to the acute-treatment control group (p < 0.05). Similar results were observed in immunohistochemistry of VEGF expression in the myocardia. Our study also demonstrated that these two herbs significantly enhanced endothelial cell proliferation (p < 0.05) and revascularity in CAM (p < 0.05). The data showed that Angelica and ChuanXiong could affect VEGF expression in rat myocardial infarction, promote endothelial cell proliferation and stimulate quantity of vessels on CAM model. The results suggest that Angelica and ChuanXiong have angiogenic effects, and may provide some mechanisms for the treatment of myocardial infarction and peripheral ischemia.

Cardiac effects of salvia miltiorrhiza/dalbergia odorifera mixture, an intravenously applicable Chinese medicine widely used for patients with ischemic heart disease in China.

Chronotropic, inotropic and coronary vasodilator actions of the clinically available ampoule preparation of Salvia miltiorrhiza/Dalbergia odorifera mixture were examined using canine isolated, blood-perfused heart preparations. The mixture slightly decreased the sinoatrial rate and significantly increased coronary blood flow, but hardly affected the developed tension of the papillary muscle. The effect on coronary blood flow was induced by at least a 10-fold smaller dose than that which induced the chronotropic effect. These results were quite similar to those of a typical calcium channel blocker, verapamil, used in a previous study, suggesting that the Salvia miltiorrhiza/Dalbergia odorifera mixture may have potential as an anti-anginal drug.