Primary Prevention Trial Research Articles

Abstract MP42: Association of Taste Perception for Sweet, Salt, Sour, Bitter and Umami With Fruit and Vegetable Intake Among Community-dwelling Men and Women in the PREDIMED-PLUS Trial

Introduction: Emerging evidence suggests that differences in the ability to perceive individual tastes; sweet, salt, sour, bitter and umami, may influence food intake - amount and variety, thereby influencing diet quality, energy balance and cardiometabolic disorders. Objective: To explore the relationship between perception of each taste and intake of different categories of fruits and vegetables. We hypothesized that greater perception of each taste will be inversely associated with amount consumed. Methods: A cross-sectional analysis was performed on baseline data from participants (N=379) in the University of Valencia center of the PREDIMED-PLUS Clinical Trial; a multi-center weight-loss primary prevention trial of cardiovascular disease, among community-dwelling adults in Spain aged 55-75y diagnosed with metabolic syndrome. Taste perception was determined by challenging subjects with solutions of standard tastants representing sweet, salt, sour, bitter, and umami (400 mM sucrose, 200 mM NaCl, 34 mM citric acid, 5.6 mM phenylthiocarbamide [PTC], 200 mM monopotassium glutamate, respectively). Taste perception intensities were evaluated on a 0-5 scale. Food intake was assessed using a validated food frequency questionnaire. Outcomes included fruit and vegetable intake (servings/week), total and sub-groups (citrus and non-citrus fruits; cruciferous and non-cruciferous vegetables). Multivariable linear regression models were used to assess relationships between perception of each tastant and number of servings/week consumed, for total and square root-transformed sub-groups. Results: In the fully-adjusted models, controlling for sex, age, diabetes, smoking status, daily physical activity and weekly energy intake, there were inverse associations between sweet perception and intake of citrus fruit (β=-0.5; p<0.01) and total vegetables (β=-1.1; 95% CI [-2.0, -0.2]), particularly non-cruciferous vegetables (β=-1.0; p=0.02); and positive associations between salt perception and intake of total fruit (β=0.9; 95% CI [0.02, 1.7]), particularly non-citrus fruit (β=0.6; p=0.03), sour perception and intake of cruciferous vegetables (β=0.1; p=0.04) and umami perception and intake of non-cruciferous vegetables (β=0.7; p=0.04). No significant associations were observed between bitter taste perception and fruit or vegetable intake. Conclusion: This marks the first exploration of taste perception as a determinant of fruit and vegetable intake among community-dwelling adults. Perception for each tastant differentially affected the amount and type of fruits and vegetables consumed, with sweet, salt, sour and umami perception emerging as significant predictors. These findings support a role of taste perception in guiding the amount and type of foods consumed, albeit in a more complex manner than originally hypothesized.

Abstract 035: Comparative Effectiveness of Long-term Lifestyle and Pharmacological Interventions for Primary Prevention of Type 2 Diabetes: a Network Meta-analysis of Randomized Controlled Trials

Background: Lifestyle modification and some pharmacological interventions have been proven effective in preventing type 2 diabetes (T2D) in previous primary prevention trials. However, there is controversy regarding their comparative effectiveness because of the lack of head-to-head trials for all possible comparisons among different interventions. Network meta-analysis enables us to simultaneously evaluate the relative effectiveness among all interventions by synthesizing both direct evidence from head-to-head trials and indirect evidence through more than one common comparator while maintaining randomization. Objective: We performed a network meta-analysis of randomized controlled trials (RCTs) to directly and indirectly compare lifestyle modification and five commonly prescribed medications (insulin sensitizers, insulin secretagogues, alpha-glucosidase inhibitors, weight-loss drugs, and renin-angiotensin system blockade), and to rank their relative effectiveness for primary prevention of T2D among adults with prediabetes at enrollment. Methods: We systematically searched PubMed, Embase, and CENTRAL from inception to October 2018 and identified long-term RCTs (follow-up ≥ 1year) that evaluated the interventions for T2D prevention in adults with prediabetes (e.g. impaired fasting glucose and impaired glucose tolerance). A network meta-analysis using the frequentist approaches was conducted to calculate the summary odds ratio (OR) and 95% confidence interval (CI) for each active intervention in comparison with controls (i.e. usual care alone or with placebo or control pills) and rank the effectiveness of these interventions by the surface under the cumulative ranking curve probabilities. Results: Thirty-three RCTs involving 54,910 individuals with prediabetes and 13,189 diabetic cases were included. Network meta-analysis showed that lifestyle modification (OR, 0.53; 95% CI, 0.42 to 0.66), insulin sensitizers (0.44; 0.31 to 0.62), alpha-glucosidase inhibitors (0.60; 0.42 to 0.87), and weight-loss drugs (0.39; 0.23 to 0.66) were significantly associated with decreased risk of incident T2D as compared with the controls. Neither insulin secretagogues (0.80; 0.51 to 1.26) nor renin-angiotensin system blockade (0.93; 0.62 to 1.38) were significantly associated with lower risk of developing T2D. Ranking of these interventions revealed weight-loss drugs being the optimal intervention for preventing T2D (89.5%), followed by insulin sensitizers (84.1%), lifestyle modification (66.7%), and alpha-glucosidase inhibitors (54.4%). Conclusions: Among the four interventions (lifestyle modification, insulin sensitizers, alpha-glucosidase inhibitors, and weight-loss drugs) which showed significant benefits on the primary prevention of T2D, weight-loss drugs seem to be the most effective.

U-shaped association between serum albumin and development of chronic kidney disease in general hypertensive patients

We aimed to examine the association between serum albumin (SAlb) and the development of chronic kidney disease (CKD), and examine any possible effect modifiers in general hypertensive patients with normal renal function and with no previous cardiovascular diseases (CVD). This is a post-hoc analysis (performed at May, 2018) of 12,621 hypertensive adults with estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m2 and SAlb ≥35.0g/L from the renal sub-study of the China Stroke Primary Prevention Trial (CSPPT), conducted from May 2008 to August 2013. The primary outcome was development of CKD, defined as a decrease in eGFR of ≥30% and to a level of <60mL/min/1.73m2; or end stage renal disease. The median follow-up duration was 4.4 years. Overall, the association between SAlb levels and risk of the primary outcome followed a U-shape. The risk of CKD development significantly decreased with the increment of SAlb (per g/L: OR=0.92; 95% CI: 0.88-0.96) in participants with SAlb <51.4g/L, and increased with the increment of SAlb (per g/L: OR=1.06; 95%CI: 1.01-1.11) in participants with SAlb ≥51.4g/L. Moreover, in participants with SAlb <51.4g/L, the association between SAlb and CKD development remained significant in participants without proteinuria (per g/L: OR=0.93; 95% CI: 0.88-0.99). The association between SAlb and CKD development was not significantly modified by age, sex, folic acid treatment, proteinuria, systolic blood pressure (SBP) at baseline and time-averaged SBP during the treatment period (all P-interactions>0.05). There was a U-shaped association between SAlb levels and risk of CKD development among general hypertensive patients with normal renal function and without CVD, with a turning point at about 51.4g/L.

Aspirin for primary prevention of cardiovascular disease in diabetes.

Aspirin for primary prevention of cardiovascular disease in diabetes.

Plasma retinol and the risk of first stroke in hypertensive adults: a nested case-control study

Identification of novel risk factors is needed to further lower stroke risk. Data concerning the association between plasma retinol concentrations and the risk of stroke are limited. We aimed to evaluate the effect of plasma retinol on the risk of first stroke and to examine any possible effect modifiers in hypertensive patients. The study sample population was drawn from the China Stroke Primary Prevention Trial (CSPPT), using a nested case-control design, including 620 cases with first stroke and 620 matched controls. In the CSPPT, a total of 20,702 hypertensive patients were randomly assigned to a double-blind, daily treatment with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. The median treatment duration was 4.5 y. There was a significant inverse association between plasma retinol and the risk of first stroke (per 10-μg/dL increment; OR: 0.92; 95% CI: 0.86, 0.97) and first ischemic stroke (OR: 0.92; 95% CI: 0.86, 0.98). When retinol was assessed as quartiles, significantly lower risks of first stroke (OR: 0.64; 95% CI: 0.46, 0.88) and first ischemic stroke (OR: 0.67; 95% CI: 0.46, 0.96) were found in participants in quartiles 2-4 compared with those in quartile 1. Furthermore, a stronger inverse association between plasma retinol and first stroke was observed in participants with baseline total homocysteine (<10 compared with ≥10 μmol/L; P-interaction=0.049). However, plasma retinol had no significant effect on first hemorrhagic stroke (per 10-μg/dL increment; OR: 0.98; 95% CI: 0.79, 1.18). Our data showed a significant inverse association between plasma retinol and the risk of first stroke among Chinese hypertensive adults. This study was registered at clinicaltrials.gov as NCT00794885.

A Nested Case–Control Study on Plasma Vitamin E and Risk of Cancer: Evidence of Effect Modification by Selenium

BackgroundEvidence from epidemiologic studies has been inconsistent regarding the role of vitamin E in cancer incidence risk. ObjectiveThe aim of this study was to evaluate the prospective association between baseline plasma vitamin E levels and subsequent cancer risk in Chinese adults with hypertension, and to identify effect modifiers. DesignA nested, case–control study was conducted from 20,702 hypertensive participants in the China Stroke Primary Prevention Trial, a randomized, double-blind, controlled trial, conducted from May 2008 to August 2013. ParticipantsThe current study included 229 new cancer cases and 229 controls matched for age (±1 year), sex, treatment group, and study site. Main outcome measuresPlasma vitamin E was measured by liquid chromatography with tandem quadrupole mass spectrometers and plasma selenium was measured by inductively coupled plasma mass spectrometry using Thermo Fisher iCAP Q ICP-MS. Statistical analysesOdds ratios (OR) of cancer in relation to plasma concentrations of vitamin E were calculated using conditional logistic regression models. ResultsMedian follow-up duration was 4.5 years. Overall, vitamin E was not associated with subsequent risk of total cancer (per 1-mg/L [2.3 μmol/L] increase: OR 1.01, 95% CI 0.93 to 1.09) and non-gastrointestinal cancer (OR 1.10, 95% CI 0.98 to 1.24). However, there was a significant, inverse association between vitamin E and gastrointestinal cancer (OR 0.86, 95% CI 0.75 to 0.99), particularly esophageal cancer (OR 0.67, 95% CI 0.48 to 0.95). Moreover, high vitamin E decreased the risk of total cancer (OR 0.91, 95% CI 0.84 to 0.99) and gastrointestinal cancer (OR 0.83, 95% CI 0.73 to 0.95) among patients with high selenium levels (median≥83.7 μg/L [1.1 μmol/L]), and increased the risk of total cancer (OR 1.13, 95% CI 1.00 to 1.26) and non-gastrointestinal cancer (OR 1.25, 95% CI 1.03 to 1.50) among those with low selenium levels (<83.7 μg/L [1.1 μmol/L]). ConclusionsThis study suggests that higher levels of plasma vitamin E are associated with reduced risk of gastrointestinal cancer. High vitamin E decreased the risk of total cancer among patients with high selenium levels, but increased the risk of total cancer among those with low selenium levels.

Underutilization of Aspirin in Patients With Advanced Colorectal Polyps

BackgroundColorectal cancer is the third-most common cause of cancer deaths in the United States, and advanced colorectal polyps are a major risk factor. Although there are no large-scale individual trials designed a priori to test the hypothesis, in meta-analyses of trials in primary prevention of cardiovascular disease, aspirin reduces risk of colorectal cancer. The US Preventive Services Task Force used a microsimulation model, including baseline risk factors, and concluded that aspirin reduces risk of colorectal cancer by 40%. Their guidelines suggest that without a specific contraindication, clinicians should routinely prescribe aspirin to patients with advanced colorectal polyps. MethodsWritten informed consent was obtained, and brief telephone interviews were conducted by trained interviewers for 84 men and women with biopsy-proven advanced colorectal polyps from 55 clinical practices. ResultsOf the 84, 39 (46.4%) were men. The mean age was 66 with a range from 41 to 91 years. Among the 84, 36 (42.9%) reported taking aspirin. ConclusionsThese data suggest underutilization of aspirin by patients with advanced colorectal polyps. These data pose major challenges that require multifactorial approaches by clinicians and their patients, which include therapeutic lifestyle changes, adjunctive drug therapies, and screening. Lifestyle changes include treating overweight status and obesity and engaging in regular physical activity; adjunctive drug therapies include aspirin. These multifactorial approaches will be necessary to achieve the most good for the most patients with regard to prevention, as well as, early diagnosis and treatment of colorectal cancer in patients with advanced colorectal polyps.

Association Between Lipid Profiles and Arterial Stiffness in Chinese Patients With Hypertension: Insights From the CSPPT.

Arterial stiffness plays a key role in the pathogenesis of cardiovascular disease. However, the relationship between lipid levels and arterial stiffness is controversial. We aimed to investigate the association between lipid parameters and brachial-ankle pulse-wave velocity (baPWV) in Chinese patients with hypertension. A total of 14 071 participants with hypertension in the China Stroke Primary Prevention Trial (CSPPT) were enrolled in the present study. Patients were assigned to 4 equal groups according to their baPWV. Participants in the highest baPWV group were older with a higher prevalence of stroke and diabetes mellitus as well as higher body mass index (BMI), blood pressure, fasting plasma glucose, uric acid, total cholesterol (TC), triglycerides (TG), homocysteine (Hcy), and vitamin B12 levels ( P < .001). After adjusting for age, sex, BMI, and other cardiovascular risks, high-density lipoprotein cholesterol (HDL-C) was negatively related to baPWV (β = -0.22, P = .012), TC (β = 0.08, P = 0.001), TG (β = 0.14, P = .001); non-HDL-C (β = 0.12, P = .001) and positively related to baPWV. The effect was not observed for low-density lipoprotein cholesterol (LDL-C; β = 0.12, P = .335).These results suggested that non-HDL-C, TG, and TC were associated with arterial stiffness in a Chinese population with hypertension. HDL-C was inversely associated with arterial stiffness.

Serum Lipids and Risk of Rapid Renal Function Decline in Treated Hypertensive Adults With Normal Renal Function.

We aim to evaluate the effect of different lipids parameters, including triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), the TG to HDL-C (TG:HDL-C) ratio, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), on the risk of rapid renal function decline and examine any possible effect modifiers in general hypertensive patients with normal renal function. A total of 12,549 hypertensive patients with estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2 in the renal sub-study of the China Stroke Primary Prevention Trial were included in the analyses. The primary outcome was rapid renal function decline, defined as an average decline in eGFR ≥ 5 ml/min/1.73 m2 per year. The median treatment duration was 4.4 years. After the full adjustment for TC, TG, HDL-C, and other major covariates, a significantly higher risk of rapid renal function decline was found in participants with higher TG [≥150 vs. <150 mg/dl, 7.7% vs. 5.5%; odds ratios (OR): 1.27; 95% confidence interval (CI): 1.06-1.51], higher TG:HDL-C ratio [≥2.7 (median) vs. <2.7, 7.7% vs. 5.0%; OR: 1.39; 95% CI: 1.14-1.71), lower TC (≥200 vs. <200 mg/dl, 6.0% vs. 7.0%; OR: 0.79; 95% CI: 0.67-0.93), or lower LDL-C levels (≥130 vs. <130 mg/dl, 6.1% vs. 7.0%; OR: 0.79; 95% CI: 0.67-0.94). Moreover, the increased risk of the primary outcome associated with elevated TG was particularly evident among individuals with lower total homocysteine levels [<12.4 (median) vs. ≥ 12.4 μmol/l, P interaction = 0.036]. Higher TG and TG:HDL-C ratio were independent risk factors for rapid renal function decline in hypertensive adults with normal renal function.

More Intensive LDL-C Lowering Reduces Major Vascular Events Beyond Current Recommendations: Systematic Review and Meta-Analysis

Aims: To determine the relationship between more intensive low-density lipoprotein (LDL-C) lowering therapy and relative risk of major vascular events (MVEs) across different LDL-C levels. Methods: Randomised trials of statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors that reported rates of MVEs were included. Random-effects and network meta-analyses evaluated associations between baseline LDL-C, achieved LDL-C, degree of LDL-C lowering and 10-year risk of cardiovascular (CVD) death with the relative risk (RR) of MVEs. Results: Fifty studies, totalling 316,605 patients with mean follow-up 3.6 ± 1.6 years were included. Although more intensive LDL-C lowering was associated with greater reductions in MVEs in patients with higher baseline LDL-C (p < 0.001), there was benefit in further lowering LDL-C amongst subgroups of patients with all baseline LDL-C <2.07 mmol/l (RR, 0.89; 95% CI, 0.82–0.96). In a network meta-analysis, patients with achieved LDL-C <1.50 mmol/l were most likely free from MVEs (surface under the cumulative ranking curve, 0.98), followed by 1.50–1.79, 1.80–2.59, 2.60–3.39, 3.40–4.09 and ≥4.10 mmol/l respectively. In meta-regression of primary prevention trials, LDL-C lowering therapy provided greater RR reductions in MVEs in populations with lower 10-year risk of CVD death (p = 0.030). Patients aged >75 years who received intensive LDL-C lowering therapy had significantly less MVEs. There was significantly more adverse drug reactions in the intensive LDL-C lowering arm (RR, 1.18; 95% CI, 1.10–1.27), but no significant difference in serious adverse effects. Conclusions: This meta-analysis provides new evidence that further lowering LDL-C is associated with greater reductions in MVEs beyond current recommendations.

The modifying effect of the MTHFR genotype on the association between folic acid supplementation and pulse wave velocity: Findings from the CSPPT

In a subgroup analysis of the China Stroke Primary Prevention Trial, we aimed to explore the impact of folic acid supplementation on arterial stiffness and assess the modifying effect of the methylenetetrahydrofolate reductase (MTHFR) gene in Chinese patients with hypertension. This prospective study enrolled 2529 hypertensive Chinese patients. Participants were randomized to receive treatment with either a combination of enalapril and folic acid or enalapril. Brachial-ankle pulse wave velocity (PWV) was measured by trained medical staff using PWV instruments at both baseline and exit visits, approximately 5years after enrollment. This trial was registered with clinicaltrials.gov (NCT00794885). During the follow-up, change in folate was significantly and independently correlated with change in ba-PWV in study patients (β=-1.31, P<0.001). Individuals with CC genotype had a significantly greater PWV response to folic acid supplementation than did carriers of the T allele (β=-2.79, P<0.001 for CC homozygotes compared with β=-0.56, P=0.464 for TT homozygotes). The positive effect of folic acid on improved PWV was modified by the MTHFR genotype (P for interaction=0.034). In a subgroup of Chinese hypertensive patients who had received 5-year antihypertensive therapy, increases in folate status were associated with higher reductions in PWV, and individuals with the CC genotype showed greatest PWV response to folic acid supplementation.

Vitamin D Supplementation — Results from the VITAL Study

VITAL (Vitamin D and Omega-3 Trial) is a large U.S. primary prevention trial designed to examine whether two widely used supplements lower the

Effect of long-term low-dose folic acid supplementation on degree of total homocysteine-lowering: major effect modifiers.

We sought to examine the potential modifiers in the association between long-term low-dose folic acid supplementation and the reduction of serum total homocysteine (tHcy) among hypertensive patients, using data from the China Stroke Primary Prevention Trial (CSPPT). This analysis included 16 867 participants who had complete data on tHcy measurements at both the baseline and exit visit. After a median treatment period of 4·5 years, folic acid treatment significantly reduced the tHcy levels by 1·6 μmol/l (95 % CI 1·4, 1·8). More importantly, after adjustment for baseline tHcy and other important covariates, a greater degree of tHcy reduction was observed in certain subgroups: males, the methylenetetrahydrofolate reductase (MTHFR) 677TT genotype, higher baseline tHcy levels (≥12·5 (median) v. <12·5 μmol/l), lower folate levels (<8·0 (median) v. ≥8·0 ng/ml), estimated glomerular filtration rate (eGFR) <60 ml/min per 1·73 m2 (v. 60-<90 and ≥90 ml/min per 1·73 m2), ever smokers and concomitant use of diuretics (P for all interactions <0·05). The degree of tHcy reduction associated with long-term folic acid supplementation can be significantly affected by sex, MTHFR C677T genotypes, baseline folate, tHcy, eGFR levels and smoking status.

Plasma 25-hydroxyvitamin D concentrations and risk of incident cancer in adults with hypertension: A nested case–control study

Evidence from epidemiologic studies on the association of circulating 25-hydroxyvitamin D [25(OH)D] concentrations with the incident risk of cancer has been inconsistent. We aimed to investigate the prospective relationship of baseline plasma 25(OH)D concentrations with the risk of cancer, and to examine possible effect modifiers. We employed a nested case-control study design, including 231 patients with incident cancer during a median 4.5 years of follow up, and 231 matched controls from the China Stroke Primary Prevention Trial (CSPPT). The prevalence of plasma 25(OH)D<15, <20 and <30ng/mL was 23.6%, 47.4% and 85.5%, respectively. Overall, there was an inverse relation between risk of cancer and plasma 25(OH)D. The Odds ratios (95% CI) for participants in the second (15.1 to <20.6ng/mL), third (20.6 to <26.4ng/mL) and fourth quartiles (≥26.4ng/mL) were 0.45 (95% CI: 0.25-0.80), 0.53 (95% CI: 0.27-1.06) and 0.55 (95% CI: 0.27-1.10), respectively, compared with those in quartile 1. Conversely, low 25(OH)D (<15.1ng/mL) concentrations were associated with increased risk of cancer (OR, 2.08; 95% CI: 1.20-3.59) compared to higher concentrations. These associations were consistent across subtypes of cancer. Several potential effect modifiers were identified, including plasma vitamin E concentrations and alcohol intake. Low plasma 25(OH)D concentrations (<15.1ng/mL) were associated with increased total cancer risk among Chinese hypertensive adults, compared to higher 25(OH)D concentrations. This finding and the possible effect modifiers warrant additional investigation.

Value of electrocardiographic left ventricular hypertrophy as a predictor of poor blood pressure control: Evidence from the China stroke primary prevention trial.

Recent studies have shown that hypertension is poorly controlled in many populations worldwide. Electrocardiographic left ventricular hypertrophy is a common manifestation of preclinical cardiovascular disease that strongly predicts cardiovascular disease morbidity and mortality. However, little information is available regarding the role of left ventricular hypertrophy in blood pressure (BP) control. We aimed to assess the relationship between electrocardiographic left ventricular hypertrophy and BP control in the China Stroke Primary Prevention Trial. The study population included 17,312 hypertensive patients who were selected from a group of 20,702 adults who had participated in the China Stroke Primary Prevention Trial and had undergone electrocardiography at baseline visit. Multivariate analysis identified left ventricular hypertrophy as a predictor of unsatisfactory BP control. The results revealed that 8.1% of hypertensive adults exhibit left ventricular hypertrophy and that the disease is more prevalent in males (12.8%) than in females. Multivariate regression analysis showed that the electrocardiographic left ventricular hypertrophy group had a significantly higher rate of unsatisfactory BP control [odds ratio (OR) 1.42, 95% confidence interval (95% CI) 1.26–1.61, P < .001) than the nonleft ventricular hypertrophy group.Notable differences in BP control were also observed among males (OR 1.37, 95% CI 1.17–1.60, P < .001) and females (OR 1.45, 95% CI 1.18–1.77, P < .001) and especially among patients with comorbid diabetes (OR 2.32, 95% CI 1.31–4.12, P = .004). In conclusion, the results of this study indicate that electrocardiographic left ventricular hypertrophy appears to be an independent predictive factor for poor BP control, especially in females and patients with comorbid diabetes.

Association Between Folic Acid Supplementation and Retinal Atherosclerosis in Chinese Adults With Hypertension Complicated by Diabetes Mellitus.

Background: This cross-section investigation included 2,199 participants with hypertension complicated by diabetes mellitus, a cohort of the China Stroke Primary Prevention Trial in which 20,702 patients with essential hypertension were given enalapril with folic acid or enalapril-only double-blind treatment for 5 years. This study aimed to explore the correlation between folic acid supplementation and retinal atherosclerosis (RA) in adults with hypertension complicated by diabetes mellitus.Methods: The diagnosis of RA was determined by non-mydriatic fundus photography and classified by the Keith-Wagener-Barker system. The statistical correlation of folic acid supplementation with RA prevalence and severity was assessed.Results: Of our cohort, 1,698 (77.6%) participants were diagnosed with RA, and the prevalence in males and females was 78.0 and 75.6%, respectively. Participants in the enalapril group had higher total homocysteine (tHcy) levels than those in enalapril–folic acid group. Compared with the enalapril group in the tHcy > 15 μmol/L group of females, the odds ratio for the enalapril–folic acid group was 0.28 (95% confidence interval, 0.11–0.67, P = 0.0061).Conclusions: The prevalence of RA was high (77.6%) in our cohort of adults with hypertension complicated by diabetes mellitus. Folic acid supplementation was significantly associated with reduced risk of RA in females with hyperhomocysteinemia. No significant association were seen in males.

BMI is associated with the development of chronic kidney diseases in hypertensive patients with normal renal function.

We aimed to investigate the relationship of BMI and waist circumference with the development of chronic kidney disease (CKD). A total of 12 672 hypertensive patients with estimated glomerular filtration rate (eGFR) at least 60 ml/min per 1.73 m from the renal sub-study of the China Stroke Primary Prevention Trial (CSPPT) were included. The primary outcome was the development of CKD, defined as a decrease in eGFR of at least 30% and to a level of less than 60 ml/min per 1.73 m at the exit visit, or end-stage renal disease. A secondary outcome was rapid renal function decline, defined as an average decline in eGFR of at least 5 ml/min/1.73 m per year. Over a median follow-up of 4.4 years, the risk of the primary event (per 1 kg/m increment; OR = 1.07, 95% CI 1.02-1.14) or rapid renal function decline (per 1 kg/m increment; OR = 1.05, 95% CI 1.01-1.08) increased with each increment of BMI. Consistently, compared with those with normal weight (BMI <24.0 kg/m), participants with obesity (BMI ≥28.0 kg/m) had an increased risk of the primary event (OR = 1.82; 95% CI 1.15-2.90) and rapid renal function decline (OR = 1.26; 95% CI 0.95-1.67). However, waist circumference had no obvious effect on the risk of the primary event (per 5 cm increment: OR = 0.94, 95% CI 0.85-1.04) or rapid renal function decline (OR = 0.96, 95% CI 0.90-1.03). Higher BMI, but not waist circumference, was significantly associated with an increased risk of CKD development in hypertensive patients with normal kidney function.

A5216 Association between Blood Pressure Components and Brachial–ankle Pulse Wave Velocity in Chinese Hypertensive Adults

Objectives: Uncertainty remains regarding the correlations between blood pressure (BP) components [systolic BP (SBP), diastolic (DBP), pulse pressure (PP), mean arterial pressure (MAP)] and brachial–ankle pulse wave velocity (baPWV) because of limited and inconsistent data. We aimed to provide insights into the relationship between BP components and baPWV. Methods: The study included 14,598 hypertensive patients, who were selected from 20,702 participants in the China Stroke Primary Prevention Trial (CSPPT) at the exit visit of the trial. Results: Continuous SBP, DBP, PP and MAP were positively correlated with baPWV (β = 0.081, 0.084, 0.078 and 0.115, respectively). When BP components were classified into categorical variables, compared to normal MAP levels (70–105 mmHg), high MAP levels (≥105 mmHg) were positively correlated with baPWV (β = 2.080; 95%CI: 1.973–2.187), while low MAP levels (<70 mmHg) were negatively associated with baPWV (β = −3.224; 95%CI: −4.235 – −2.212). Furthermore, we observed a significant and progressive increase in baPWV with all BP components quartiles, suggesting a dose-dependent increase in baPWV with BP components. Meanwhile, in participants with SBP ≥145.3 mmHg, the coefficient reached the maximum [β = 3.447, P < 0.001]. Still, the effect of BP components on baPWV also showed differences within the different subgroups. Conclusion: In conclusion, among hypertensive patients, SBP, DBP, PP and MAP levels were independently and significantly positively associated with baPWV. Nonetheless, continuous MAP and categorical SBP ≥145.3 mmHg were strongly associated with baPWV, indicating that they might be more powerful predictors of arterial stiffness.

Legacy effects of statins on cardiovascular and all-cause mortality: a meta-analysis

ObjectivesTo assess evidence for ‘legacy’ (post-trial) effects on cardiovascular disease (CVD) mortality and all-cause mortality among adult participants of placebo-controlled randomised controlled trials (RCTs) of statins.DesignMeta-analysis of aggregate data.Setting/ParticipantsPlacebo-controlled statin...

Aspirin Was Not Beneficial in a Primary Prevention Trial

The effectiveness of aspirin for primary prevention of adverse cardiovascular (CV) events in contemporary patient populations remains unsettled. In the