Multi-provincial Cohort Study Research Articles

Disentangling the Inverse LDL-C-hemorrhagic Stroke Association in Chinese Adults with Hypertension: Findings from the Chinese Multi-Provincial Cohort Study.

Why lower low-density lipoprotein cholesterol (LDL-C) was associated with a decreased atherosclerotic cardiovascular disease (ASCVD) risk but an increased hemorrhagic stroke (HS) risk in hypertensive adults remains unclear. We examined whether the inverse LDL-C-HS association partly arises from its effect on ASCVD. We estimated separable effects of LDL-C on HS outside (i.e., separable direct effect) or only through its effect on ASCVD (i.e., separable indirect effect) in hypertensive adults from the Chinese Multi-provincial Cohort Study. We quantified such effects using numbers needed to treat (NNT) to prevent or cause an extra HS based on the restricted mean event-free time till a 25-year follow-up. LDL-C $<$ 70 mg/dL was not associated with an increased HS risk compared to LDL-C $\ge$ 70 mg/dL regarding total and separable direct effects. However, a small separable indirect effect (i.e., NNT to harm: 9722 participants) was noted and validated via a series of sensitivity analyses. Moreover, modified effects were observed, particularly in the 35-49-year age group, men, and those with SBP $\ge$ 140 mm Hg. These results suggest the inverse LDL-C-HS association in hypertensive adults is partly due to its effect on ASCVD. A better understanding of such associations would provide more enlightening into stroke prevention.

Study on the 5-year trend and influencing factors of lipoprotein (a) concentration in community-based population

Objective: To explore the trend and influencing factors of serum lipoprotein (a) (Lp(a)) concentration over time in Chinese community populations. Methods: This study is a prospective cohort study. The participants were enrolled from Chinese Multi-provincial Cohort Study- Beijing projects, completed the cardiovascular disease risk factor surveys in 2002 and 2007, and the serum Lp (a) concentration were measured. Based on the Lp(a) concentration at baseline (2002) and follow-up (2007), the participants were classified into subgroups of <30.0 mg/dl (1 mg/dl=0.01 g/L) group, 30.0 to 49.9 mg/dl group, and ≥50.0 mg/dl group, respectively. Multivariable logistic regression analysis was used to identify influencing factors associated with Lp (a) absolute change (≥20 mg/dl) and relative change (≥20%) within 5 years. Results: Among 1 955 participants with age of (56.5±8.0) years old and 821 male (42.0%) at baseline, there were 1 657 (84.8%), 184 (9.4%) and 114 (5.8%) participants in Lp(a)<30.0 mg/dl group, 30.0 to 49.9 mg/dl group and ≥50.0 mg/dl group, respectively. Among the baseline Lp(a) concentration of 30.0-49.9 mg/dl group, 68 (37.0%) participants progressed to Lp(a) ≥50.0 mg/dl after 5 years follow-up, and 102 (55.4%) remained at this level. Participants with baseline Lp(a)<30.0 mg/dl (92%, 1 524/1 657) or Lp(a)≥50.0 mg/dl (94.7%, 108/114) tended to be maintained at their respective levels. The results of the multivariate logistic regression analysis showed that, in addition to the high level of baseline Lp(a) concentration, family history of cardiovascular disease, elevated fasting blood glucose and usage of oral lipid-lowering drugs were the influencing factors of Lp(a) changes over time (P<0.05). Conclusions: Adults with borderline-high Lp(a) concentrations (30.0 to 49.9 mg/dl) could be considered for repeated testing, especially for those with a family history of cardiovascular disease, elevated fasting blood glucose and usage of statins.

Association of neighborhood physical activity facilities with incident cardiovascular disease

BackgroundThe availability of physical activity (PA) facilities in neighborhoods is hypothesized to influence cardiovascular disease (CVD), but evidence from individual-level long-term cohort studies is limited. We aimed to assess the association between neighborhood exposure to PA facilities and CVD incidence.MethodsA total of 4658 participants from the Chinese Multi-provincial Cohort Study without CVD at baseline (2007–2008) were followed for the incidence of CVD, coronary heart disease (CHD), and stroke. Availability of PA facilities was defined as both the presence and the density of PA facilities within a 500-m buffer zone around the participants’ residential addresses. Time-dependent Cox regression models were performed to estimate the associations between the availability of PA facilities and risks of incident CVD, CHD, and stroke.ResultsDuring a median follow-up of 12.1 years, there were 518 CVD events, 188 CHD events, and 355 stroke events. Analyses with the presence indicator revealed significantly lower risks of CVD (hazard ratio [HR] 0.80, 95% confidence interval ([CI] 0.65–0.99) and stroke (HR 0.76, 95% CI 0.60–0.97) in participants with PA facilities in the 500-m buffer zone compared with participants with no nearby facilities in fully adjusted models. In analyses with the density indicator, exposure to 2 and ≥ 3 PA facilities was associated with 35% (HR 0.65, 95% CI 0.47–0.91) and 28% (HR 0.72, 95% CI 0.56–0.92) lower risks of CVD and 40% (HR 0.60, 95% CI 0.40–0.90) and 38% (HR 0.62, 95% CI 0.46–0.84) lower risks of stroke compared with those without any PA facilities in 500-m buffer, respectively. Effect modifications between presence of PA facilities and a history of hypertension for incident stroke (P = 0.049), and a history of diabetes for incident CVD (P = 0.013) and stroke (P = 0.009) were noted.ConclusionsResiding in neighborhoods with better availability of PA facilities was associated with a lower risk of incident CVD. Urban planning intervention policies that increase the availability of PA facilities could contribute to CVD prevention.

Lipoprotein(a) Is Associated With the Progression and Vulnerability of New-Onset Carotid Atherosclerotic Plaque.

Although important progress has been made in understanding Lp(a) (lipoprotein[a])-mediated stroke risk, the contribution of Lp(a) to the progression of vulnerable plaque features associated with stroke risk remains unclear. This study aims to evaluate whether Lp(a) is associated with carotid plaque progression, new-onset plaque features, and plaque vulnerability in a prospective community-based cohort study. Baseline Lp(a) levels were measured using latex-enhanced turbidimetric immunoassay among 804 participants aged 45 to 74 years and free of cardiovascular disease in the Chinese Multi-provincial Cohort Study-Beijing project. Carotid atherosclerosis was measured twice by B-mode ultrasonography over a 10-year interval during the 2002 and 2012 surveys to assess the progression of total, vulnerable and stable plaques, and plaque vulnerability. The total plaque area and plaque vulnerability score were calculated. The median baseline Lp(a) level was 10.20 mg/dL (interquartile range, 6.20 to 17.18 mg/dL). Modified Poisson regression analysis showed that Lp(a) ≥50 mg/dL was significantly associated with 10-year progression of total carotid plaque (relative risk [RR], 1.41 [95% CI, 1.21-1.64]; E-value=2.17), vulnerable plaque (RR, 1.93 [95% CI, 1.54-2.41]), and stable plaque (RR, 1.51 [95% CI, 1.11-2.07]) compared with Lp(a) <50 mg/dL. Moreover, among participants without plaque at baseline, Lp(a) ≥50 mg/dL was related to an increased total plaque area (β=0.36 [95% CI, 0.06-0.65]; P=0.018) and increased plaque vulnerability score (β=0.30 [95% CI, 0.01-0.60]; P=0.045) in multivariable linear regression. Elevated Lp(a) levels were associated with 10-year carotid plaque progression and plaque vulnerability, providing a basis for Lp(a) as a treatment target for stroke prevention.

Addition of Risk-enhancing Factors Improves Risk Assessment of Atherosclerotic Cardiovascular Disease in Middle-aged and Older Chinese Adults: Findings from the Chinese Multi-provincial Cohort Study

Objective: This study aimed to examine whether integrating risk-enhancing factors into the Chinese Society of Cardiology-recommended clinical risk assessment tool (i.e., the CSC model) for atherosclerotic cardiovascular disease (ASCVD) might improve 10-year ASCVD risk stratification in Chinese adults. Methods: A total of 4910 Chinese participants who were 50–79 years of age and free of cardiovascular disease in the 2007–2008 Survey from the Chinese Multi-provincial Cohort Study were included. We assessed the updated model’s clinical utility (i.e., Harrell’s C-index and net reclassification improvement [NRI]) by adding risk-enhancing factors individually or the number of risk-enhancing factors to the CSC model, for all individuals or those at intermediate risk. Risk-enhancing factors, including a family history of CVD, triglycerides ≥2.3 mmol/L, high-sensitivity C-reactive protein ≥2 mg/L, Lipoprotein (a) ≥50 mg/dL, non-high-density lipoprotein cholesterol ≥4.9 mmol/L, overweight/obesity, and central obesity, were evaluated. ASCVD events were defined as a composite endpoint comprising ischemic stroke and acute coronary heart disease events (including nonfatal acute myocardial infarction and all coronary deaths). Results: During a median 10-year follow-up, 449 (9.1%) ASCVD events were recorded. Addition of ≥2 risk-enhancing factors to the CSC model yielded a significant improvement in the C-index (1.0%, 95% confidence interval [CI]: 0.2–1.7%) and a modest improvement in the NRI (2.0%, 95% CI: −1.2–5.4%) in the total population. For intermediate-risk individuals, particularly individuals at high risk of developing ASCVD, significant improvements in NRI were observed after adding ≥2 risk-enhancing factors (17.4%, 95% CI: 5.6–28.5%) to the CSC model. Conclusions: Addition of ≥2 risk-enhancing factors refined 10-year ASCVD risk stratification, particularly for intermediate-risk individuals, supporting their potential in helping tailor targeted interventions in clinical practice.

Reduced serum calcium is associated with a higher risk of retinopathy in non-diabetic individuals: The Chinese Multi-provincial Cohort Study.

As a common micro-vascular disease, retinopathy can also present in non-diabetic individuals and increase the risk of clinical cardiovascular disease. Understanding the relationship between serum calcium and retinopathy would contribute to etiological study and disease prevention. A total of 1836 participants (aged 55-84 years and diabetes-free) from the Chinese Multi-Provincial Cohort Study-Beijing Project in 2012 were included for analyzing the relation between serum calcium level and retinopathy prevalence. Of these, 1407 non-diabetic participants with data on serum calcium in both the 2007 and 2012 surveys were included for analyzing the association of five-year changes in serum calcium with retinopathy risk. The retinopathy was determined from retinal images by ophthalmologists and a computer-aided system using convolutional neural network (CNN). The association between serum calcium and retinopathy risk was assessed by multivariate logistic regression. Among the 1836 participants (male, 42.5%), 330 (18.0%) had retinopathy determined by CNN. After multivariate adjustment, the odds ratio (OR) comparing the lowest quartiles (serum calcium < 2.38 mmol/L) to the highest quartiles (serum calcium ≥ 2.50 mmol/L) for the prevalence of retinopathy determined by CNN was 1.58 (95% confidence interval [CI]: 1.10- 2.27). The findings were consistent with the result discerned by ophthalmologists, and either by CNN or ophthalmologists. These relationships are preserved even in those without metabolic risk factors, including hypertension, high hemoglobin A1c, high fasting blood glucose, or high low-density lipoprotein cholesterol. Over 5 years, participants with the sustainably low levels of serum calcium (OR: 1.58; 95%CI: 1.05 - 2.39) and those who experienced a decrease in serum calcium (OR: 1.56; 95%CI: 1.04 - 2.35) had an increased risk of retinopathy than those with the sustainably high level of serum calcium. Reduced serum calcium was independently associated with an increased risk of retinopathy in non-diabetic individuals. Moreover, reduction of serum calcium could further increase the risk of retinopathy even in the absence of hypertension, high glucose, or high cholesterol. This study suggested that maintaining a high level of serum calcium may be recommended for reducing the growing burden of retinopathy. Further large prospective studies will allow more detailed information.

Accurate Prediction of Stroke for Hypertensive Patients Based on Medical Big Data and Machine Learning Algorithms: Retrospective Study.

BackgroundStroke risk assessment is an important means of primary prevention, but the applicability of existing stroke risk assessment scales in the Chinese population has always been controversial. A prospective study is a common method of medical research, but it is time-consuming and labor-intensive. Medical big data has been demonstrated to promote disease risk factor discovery and prognosis, attracting broad research interest.ObjectiveWe aimed to establish a high-precision stroke risk prediction model for hypertensive patients based on historical electronic medical record data and machine learning algorithms.MethodsBased on the Shenzhen Health Information Big Data Platform, a total of 57,671 patients were screened from 250,788 registered patients with hypertension, of whom 9421 had stroke onset during the 3-year follow-up. In addition to baseline characteristics and historical symptoms, we constructed some trend characteristics from multitemporal medical records. Stratified sampling according to gender ratio and age stratification was implemented to balance the positive and negative cases, and the final 19,953 samples were randomly divided into a training set and test set according to a ratio of 7:3. We used 4 machine learning algorithms for modeling, and the risk prediction performance was compared with the traditional risk scales. We also analyzed the nonlinear effect of continuous characteristics on stroke onset.ResultsThe tree-based integration algorithm extreme gradient boosting achieved the optimal performance with an area under the receiver operating characteristic curve of 0.9220, surpassing the other 3 traditional machine learning algorithms. Compared with 2 traditional risk scales, the Framingham stroke risk profiles and the Chinese Multiprovincial Cohort Study, our proposed model achieved better performance on the independent validation set, and the area under the receiver operating characteristic value increased by 0.17. Further nonlinear effect analysis revealed the importance of multitemporal trend characteristics in stroke risk prediction, which will benefit the standardized management of hypertensive patients.ConclusionsA high-precision 3-year stroke risk prediction model for hypertensive patients was established, and the model's performance was verified by comparing it with the traditional risk scales. Multitemporal trend characteristics played an important role in stroke onset, and thus the model could be deployed to electronic health record systems to assist in more pervasive, preemptive stroke risk screening, enabling higher efficiency of early disease prevention and intervention.

Association of apolipoprotein Cs with new-onset type 2 diabetes mellitus: findings from the Chinese multi-provincial cohort study

ObjectivesApolipoprotein Cs (apoCs), especially apoC-II and apoC-III, as the components of triglyceride-rich lipoproteins, play a key role in the pathophysiology of diabetes. However, prospective studies examining direct associations between apoCs...

Association of Serum Potassium Levels with Mortality and Cardiovascular Events: Findings from the Chinese Multi-provincial Cohort Study.

Dyskalemia involves critical electrolyte abnormalities and increases mortality risk in patients with acute clinical conditions. However, the association between dyskalemia and adverse outcomes in the general population is less well established. To investigate the association of serum potassium levels with mortality and cardiovascular events in the general population and to explore the characteristics of individuals at high risk. A prospective cohort study. A total of 5220 participants aged 50-79 years in the Chinese Multi-provincial Cohort Study. Serum potassium levels were measured by the ion-selective electrode method. The outcomes were incident cardiovascular disease (CVD), CVD death, non-CVD death, and total death. Of the 5220 participants, 48.2% were men, and the mean age was 62.3 (SD 7.6) years. Hyperkalemia was found in 8.7% of the participants and was significantly associated with total death (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.18-2.23) and CVD death (HR, 2.12; 95% CI, 1.25-3.61) after adjustment. Furthermore, the HRs (95% CIs) of hyperkalemia combined with 2 and ≥ 3 risk factors were 2.37 (1.50-3.74) and 4.06 (2.37-6.95) for total death and 3.26 (1.56-6.80) and 8.42 (4.06-17.50) for CVD death, respectively. The 10-year cumulative incidence of total death was 17.4% for participants with 2 or more risk factors. Hyperkalemia is associated with an increased risk of all-cause and CVD death, and this risk is more pronounced in patients with multiple risk factors. Our findings suggest that early identification and management of hyperkalemia in the general population are warranted.

Combined effect of menopause and cardiovascular risk factors on death and cardiovascular disease: a cohort study

BackgroundObservational studies suggest that early menopause is associated with increased risk of death and cardiovascular disease (CVD); however, the results of these studies have been inconsistently. We aimed to assess the association of menopause with death and CVD and whether this association was modified by cardiovascular risk factors.MethodsThe study population was women age 35–64 years living in two communities of Beijing who were enrolled in the Chinese Multi-provincial Cohort Study in 1992. Participants were followed until first cardiovascular event, death, or the end of follow-up (2018). Self-reported age at menopause was recorded. Multivariate Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of death and CVD after adjusting for baseline covariates of age, family history of CVD, and white blood cell count, as well as time-varying covariates of menopause, use of oral estrogen, and conventional risk factors. Additionally, we assessed the combined effect of age at menopause and risk factors on the primary endpoint.ResultsOf 2104 eligible women, 124 died and 196 had a first CVD event (33 fatal CVD and 163 non-fatal CVD). Compared with women who experienced menopause at age 50–51 years, the risk of death was higher in women with menopause at age 45–49 years (HR 1.99, 95% CI 1.24–3.21; P = 0.005), and the risk of ischemic stroke was higher in women with menopause at age < 45 years (HR 2.16, 95% CI 1.04–4.51; P = 0.04) and at age 45–49 years (HR 2.05, 95% CI 1.15–3.63; P = 0.01). Women who had menopause before age 50 years and at least one elevated risk factor at baseline had a higher risk of death (HR 11.10, 95% CI 1.51–81.41; P = 0.02), CVD (HR 3.98, 95% CI 1.58–10.01; P = 0.003), ischemic CVD (HR 4.53, 95% CI 1.63–12.62; P = 0.004), coronary heart disease (HR 8.63, 95% CI 1.15–64.50; P = 0.04), and stroke (HR 2.92, 95% CI 1.03–8.29; P = 0.04) than those with menopause at age 50–51 years and optimal levels of all risk factors.ConclusionsEarlier menopause may predict death and ischemic stroke. Furthermore, there is a combined effect of earlier menopause and elevated risk factors on death and CVD.

Association between apolipoprotein E-containing HDL-C and coronary heart disease risk: a community-based cohort study

Objective: To assess whether apolipoprotein E-containing HDL-C (APOE-HDL-C) is causally associated with coronary heart disease (CHD) risk. Methods: In total, 5 417 cardiovascular disease-free participants at baseline were followed up for up to 10 years in the Chinese Multi-provincial Cohort Study. APOE-HDL-C and HDL-C were measured in all participants. APOE-HDL-C/total HDL-C ratio was calculated. Multivariate Cox regression was employed to assess the association between HDL-C related biomarkers and 10-year CHD incident risk. Results: A total of 100 incident CHD events occurred during a mean 6.8 years follow-up. High levels of baseline HDL-C related biomarkers were significantly negatively associated with incident CHD risk. Comparison with participant with lowest level of APOE-HDL-C/total HDL-C ratio, those with highest level of APOE-HDL-C/total HDL-C ratio had 74% decreased risk of CHD (HR=0.26, 95%CI: 0.12-0.71). The individual with the highest level of APOE-HDL-C/total HDL-C ratio had the lowest absolute risk[0.48% (0.44%-0.52%)] of CHD, which was significantly lower than that [0.83% (0.78%-0.88%)] of the individual with the highest level of HDL-C. Conclusions: Our findings revealed that the APOE-HDL-C/total HDL-C ratio was significantly related to a 10-year increased risk of incident CHD, even beyond HDL-C. It seemed that APOE-HDL-C could serve as a new indicator of the anti-atherosclerotic function of HDL.

Association of menopause with risk of carotid artery atherosclerosis

ObjectivesObservational studies suggest that the risk of cardiovascular disease increases during menopause; however, the menopause-related risk of subclinical atherosclerosis is unclear. The aim of the current study is to evaluate menopause and the risk of subclinical carotid atherosclerosis through a retrospective analysis of data from a population-based prospective cohort study. Study designThe study sample comprised 879 women in the Beijing community enrolled in the Chinese Multi-provincial Cohort Study at baseline study in 1992 and followed up to at least one carotid ultrasound examination at three on-site follow-up surveys. Age at menopause was categorized as <40 years (premature menopause), 40-44 years (early menopause), 45-49 years (relatively early menopause), 50-51 years (reference), and >51 years (relatively late menopause). Menopause staging at baseline was categorized as: reproductive, menopausal transition/perimenopause, early postmenopause, and late postmenopause. Menopause as a time-varying covariate was calculated using waiting time to menopause and menopause status at the last follow-up (2012). Main outcome measuresThe main outcome measures included carotid plaque and intima-media thickening. Gray's test was performed to assess the equality of cumulative incidence functions between age groups at menopause and between menopause stages. Multivariate Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) associated with menopause. ResultsOf the 879 women included (mean [SD] age at baseline, 48.6 [8.1] years), 573 (65.2%) developed carotid plaques and 430 (48.9%) developed intima-media thickening during follow-up. Menopause was significantly associated with risk of developing carotid plaques (HR 1.93, 95% CI 1.05-3.54; P = 0.03) after adjustment for age at baseline, age at menopause, use of oral estrogen due to menopause, and traditional cardiovascular risk factors at baseline. No significant association was found between age at menopause and risk of carotid atherosclerosis. ConclusionMenopausal women, irrespective of age at menopause, had an increased risk of carotid plaque.

Impact of China's Low Centralized Medicine Procurement Prices on the Cost-Effectiveness of Statins for the Primary Prevention of Atherosclerotic Cardiovascular Disease.

Background:Statin medications reduce the risk of atherosclerotic cardiovascular disease (ASCVD). China’s new central government medicine procurement policy lowered statin prices by five-fold or more, which may impact the cost-effectiveness of statin therapy.Objective:To explore the impact of China’s 2019 centralized medicine procurement policy on the cost-effectiveness of statins treatment for primary ASCVD prevention.Methods:A microsimulation decision tree analytic model was built using individual participant data from ASCVD-free adults aged 35–64 years (n = 21,265) in the China Multi-provincial Cohort Study. ASCVD incidence, costs (2019 Int$), and quality-adjusted life years (QALYs) over a 10-year period from health-care sector and societal perspectives were estimated. Effect and cost-effectiveness of low-dose statins (equivalent potency regimens of simvastatin 20 mg/day, atorvastatin 10 mg/day, or rosuvastatin 5 mg/day) and moderate-dose (double low dose) statins therapy were simulated. The incremental cost-effectiveness ratio (ICER) of statin treatment was compared with no treatment by category of 10-year ASCVD risk. New lower prices of statins were from the centralized procurement policy bid-winning announcement file. One-way and probabilistic sensitivity analyses quantified model uncertainty.Results:Low-dose statins interventions reduced 10-year ASCVD incidence by 4.1%, 9.7%, and 15.5% among people with low, moderate, and high risk comparing to no treatment. Lowering statin prices to the 2019 central government procurement policy level could lower the ICER of low-dose statins treatment for high-risk people from Int$ 141,000 to Int$ 51,300 per QALY gained from health-care sector perspective. Moderate-dose statin treatment lowered the ICER compared with the low-dose statins treatment in each ASCVD risk category (Int$ 43,100 vs. Int$ 51,300 per QALY gained from the health-care sector perspective for high risk people). Cost-effectiveness improved progressively with increased baseline ASCVD risk.Conclusion:Implementing low central government prices will substantially improve the cost-effectiveness of statins for primary ASCVD prevention in 35–64-year-old Chinese adults.

Household Transitions to Clean Energy in a Multi-Provincial Cohort Study in China.

Household solid fuel (biomass, coal) burning contributes to climate change and is a leading health risk factor. How and why households stop using solid fuel stoves after adopting clean fuels has not been studied. We assessed trends in the uptake, use, and suspension of household stoves and fuels in a multi-provincial cohort study of 753 Chinese adults and evaluated determinants of clean fuel uptake and solid fuel suspension. Over one-third (35%) and one-fifth (17%) of participants suspended use of solid fuel for cooking and heating, respectively, during the past 20 years. Determinants of solid fuel suspension (younger age, widowed) and of earlier suspension (younger age, higher education, and poor self-reported health status) differed from the determinants of clean fuel uptake (younger age, higher income, smaller households, and retired) and of earlier adoption (higher income). Clean fuel adoption and solid fuel suspension warrant joint consideration as indicators of household energy transition. Household energy research and planning efforts that more closely examine solid fuel suspension may accelerate household energy transitions that benefit climate and human health.

High sdLDL Cholesterol can be Used to Reclassify Individuals with Low Cardiovascular Risk for Early Intervention: Findings from the Chinese Multi-Provincial Cohort Study.

Aim: A high-risk strategy has been implemented for lipid-lowering therapy in the primary prevention of cardiovascular disease. However, atherosclerosis and cardiovascular events are common among individuals with low cardiovascular risk. This study aimed to determine whether the small dense low-density lipoprotein cholesterol (sdLDLC) level can predict carotid atherosclerosis progression and identify high-risk individuals.Methods: Baseline sdLDLC and low-density lipoprotein cholesterol (LDLC) were measured in 808 particip ants from the Chinese Multi-provincial Cohort Study, aged 45–74 years. Adjusted relative risk was calculated using a modified Poisson regression model to assess the relationship between sdLDLC and 5-year atherosclerosis progression, as indicated by the progression, incidence, and multi-territorial extent of carotid plaque.Results: The 5-year atherosclerosis progression increased significantly with increased sdLDLC. Baseline sdLDLC was significantly associated with the short-term risk of plaque progression after multivariable adjustment, even in participants with low LDLC or a 10-year estimated cardiovascular risk. sdLDLC predicted plaque progression (relative risk 2.05; 95% confidence interval 1.43–2.93) in participants with LDLC < 130 mg/dL. Furthermore, participants with the highest sdLDLC but intermediate or low cardiovascular risk (accounting for 16% of the cohort) had double the risk of plaque progression, which was comparable to those with the same sdLDLC and high cardiovascular risk, relative to those with the lowest sdLDLC levels and low cardiovascular risk.Conclusions: sdLDLC is independently associated with the progression of carotid atherosclerosis, which may provide a basis for clinicians to reclassify individuals believed to be at low cardiovascular risk into the high-risk category, and those with high sdLDLC may benefit from more aggressive cholesterol-lowering treatment.

The association between plasma levels of 20 amino acids and risk of diabetes

Objective: To investigate the association between the plasma levels of 20 amino acids and the risk of diabetes in middle-aged and elderly population. Methods: This study was a part of the Chinese multi-provincial cohort study conducted in communities of Shougang. In 2007 and 2012, the population was investigated for diabetes and other risk factors. Blood samples collected from 475 people were tested for various amino acid levels by liquid chromatography-tandem mass spectrometry. A multivariate logistic regression analysis was used to analyze the association between plasma amino acid levels and diabetes risk. Results: The age of the selected population at baseline was (58.7±6.3) years, and the blood glucose level at baseline was (5.68±1.34) mmol/L. Among them, 56 (11.79%) subjects were diabetes. Multivariate logistic regression analyses showed that after adjusting for age, gender, body mass index, systolic blood pressure and dyslipidemia, individuals with plasma branched-chain amino acid (valine, leucine and isoleucine) and cysteine in the highest tertile levels were at high risk of diabetes with the ORs of 3.61 (95% CI 1.48-8.80), 3.27 (95% CI 1.34-7.99), 2.46 (95% CI 1.04-5.84) and 2.09 (95% CI 1.02-4.27), respectively. After 5 years' followed up, 5.73% (24/419) subjects developed diabetes. Compared with those in the lowest tertile, individuals with plasma branched-chain amino acid (total concentration), phenylalanine, and tyrosine levels at baseline in the highest tertile had 3.69 times, 3.61 times and 4.14 times higher risk to develop new diabetes, respectively. In contrast, individuals with plasma glycine level in the highest tertile had only 76% (OR 0.24, 95% CI 0.06-0.91) risk for the development of diabetes compared with those with plasma glycine level in the lowest tertile. Conclusions: The increase in plasma branched-chain amino acid and cysteine levels is significantly associated with an increase in incident diabetes. Subjects with higher levels of branched-chain amino acids and aromatic amino acids (phenylalanine, tyrosine) had a significantly higher risk of developing new-onset diabetes, while those with higher glycine levels had a significantly lower risk of developing diabetes in 5 years.

A14885 Tracking of Blood Pressure over a 20-year Period in the Chinese Multi-Provincial Cohort Study—Beijing Project, 1992–2012

Objectives: To assess the tracking of blood pressure (BP) from middle age to old age. Methods: The Chinese Multi-Provincial Cohort Study—Beijing Project included 4,149 participants aged 35–64 years at baseline in 1992 and followed up till 2012. Repeated BP measurements recorded in either two examinations in 1992, 2002, 2007, or 2012 were used in this analysis. Pearson correlation was used to measure the strength of association between BP measurements at different ages, and cross-tabulated quintiles of BP levels with advancing age was used to quantify the likelihood of maintaining BP in either the top or bottom quintile at later measurements. Results: The correlation coefficients decreased in magnitude with increasing length of time between readings from the same age. The greatest tracking coefficients for systolic BP and diastolic BP over 10 years was in men aged 45–54 years and in women aged 65–74 years. At the same time interval between measurements, the correlation coefficients in women were greater than in men for systolic BP and diastolic BP, though were smaller than men for pulse pressure among those older than 55 years. The relative likelihood of tracking was greater for systolic BP than diastolic BP and decreased in magnitude with increasing length of time between readings from the same age. Compared with men, women in the top or bottom of systolic BP quintile were more likely to maintain their position up to 20 years, except that women aged 45–64 years were less likely to remain at the top quintile in a 15-year interval. Conclusion: Tracking of BP is noted from middle age to old age, and it is more evidenced for systolic BP than diastolic BP and greater for women than for men.

GW29-e0548 Effect and cost-effectiveness of promoting statins use in primary prevention of atherosclerotic cardiovascular disease control in China: A predictive study base on Chinese multi-provincial cohort study

To explore the effect and cost-effectiveness of promoting statins use in people with different risk of atherosclerotic cardiovascular disease (ASCVD) according to the recommendation from Chinese guidelines for the management of dyslipidemia in primary prevention. A microsimulation model was build

GW29-e1204 Tracking of Blood Pressure over a 20-year Period in the Chinese Multi-Provincial Cohort Study—Beijing Project, 1992-2012

GW29-e1204 Tracking of Blood Pressure over a 20-year Period in the Chinese Multi-Provincial Cohort Study—Beijing Project, 1992-2012

GW29-e1397 Association between resting heart rate and cardiovascular risk in different levels of blood pressure: findings from the Chinese Multi-provincial Cohort Study

GW29-e1397 Association between resting heart rate and cardiovascular risk in different levels of blood pressure: findings from the Chinese Multi-provincial Cohort Study