董莹
中国医学科学院阜外医院 社区防治部
OBJECTIVES:The study aimed to investigate the spatial variation of hypertension (HTN) and the associations between the risk of HTN and altitude, longitude, latitude in Chinese population.METHODS:The newest China Hypertension Survey (CHS) study, which used a nationally representative sample, was conducted between 2012 and 2015. A total of 451 755 participants aged at least 18 years from 262 county-level regions in 31 provinces were analyzed to explore the geographical variations of HTN prevalence at county-level. A total of 444 375 participants were included in two-level logistic regression model to examine the association between HTN risk and exposure to altitude, longitude, and latitude after adjusting for potential confounding variables at individual level.RESULTS:The findings of spatial analysis indicated that there were remarkably high and low HTN prevalence zones. High HTN prevalence zones extended from parts of the southeast to northern China and the northeast. The risk of HTN increased with increasing longitude, with adjusted odds ratios (aORs, 95% confidence interval [CI]) of 2.08 (1.04--4.18), 2.21 (1.15--4.22), 2.54 (1.31--4.93), 2.59 (1.32--5.08), and 2.81 (1.12--7.08) for longitudes of 90-100°E, 100-110°E, 110-120°E, 120-130°E, and at least 130°E, respectively, with a significant dose--response relationship that HTN risks increase as longitude rises from 90°E to ≥130°E(Ptrend <0.001), compared with the longitude group of less than 80°E, consistent with the conclusion that geographical variations of high HTN prevalence zones by spatial analysis.CONCLUSION:The findings of remarkably high HTN prevalence zones modified previous understandings about the regional difference of HTN distribution, and provide an important basis for future efforts to prevent and control HTN in different regions of China.
Journal of hypertension 2020
We estimated the prevalence of ideal cardiovascular health (CVH), and its relationship with cardiovascular disease (CVD) and all-cause mortality in a Chinese population. A cross-sectional survey of CVD risk factors was conducted among Chinese participants aged 35 to 64 years in 2009 to 2010. In 2017, 8965 participants completed follow-up assessments in which CVD and all-cause mortality were collected; 8754 participants were eligible for analysis. The percentage of meeting all 7 ideal CVH metrics was 0.10%. During a median follow-up of 6.3 years, the incidence of CVD and all-cause mortality were 6.02% and 4.85% per 1000 person-year in participants with 0 to 1 ideal CVH metrics, 3.33% and 3.57% in those with 2 to 5, 0.40% and 0.79% in those with 6 to 7, respectively. After adjusting for covariates, the risk of CVD was significantly lower in participants with 2 to 5 (hazard ratio [HR]: 0.67, 95% confidence interval [CI]: 0.45-0.98) and 6 to 7 (HR: 0.12, 95%CI: 0.02-0.87) ideal CVH metrics compared to those with 0 to 1 ideal CVH metrics. The risk of all-cause mortality was decreased as ideal CVH metrics increased (HR: 0.78, 95%CI: 0.70-0.88). A greater number of ideal CVH metrics was associated with a lower risk of CVD and all-cause mortality, but the prevalence of all 7 ideal CVH metrics was low in a Chinese population.
Angiology 2019
OBJECTIVE:This study aimed to examine the latest prevalence of abdominal obesity in China based on nationally representative data.METHODS:A stratified, multistage, random sampling method was used to obtain a nationally representative sample of residents aged ≥ 18 years from 31 provinces in mainland China from October 2012 to December 2015. Abdominal obesity was defined as a waist circumference ≥ 90 cm for men and a waist circumference ≥ 85 cm for women.RESULTS:The data of 441,306 participants were analyzed. The prevalence of abdominal obesity was 29.1% (28.6% in men and 29.6% in women); the number of adults with abdominal obesity was estimated to be 277.8 million (approximately 140.1 million in men and 137.7 million in women). The prevalence of abdominal obesity varied considerably among provinces. In general, the prevalence of abdominal obesity was higher in the northern, lower in the southern, higher in the western, and lower in the eastern areas of China. Besides the regional disparities, the prevalence of abdominal obesity varied greatly among different population subgroups.CONCLUSIONS:Abdominal obesity is highly prevalent among Chinese adults. National and provincial obesity control and prevention strategies should be public health priorities in China. To better control obesity, the underlying reasons for the regional disparities need to be addressed.
Obesity (Silver Spring, Md.) 2019
BACKGROUND:This study aimed to assess the association of high sensitivity C-reactive protein (hs-CRP) with cardiovascular disease (CVD) in middle-aged Chinese population.METHODS:The baseline was collected 2009-2010, and follow-up was conducted in 2016-2017. Data of hs-CRP were from baseline examination and re-examination in 2016-2017 using transmission turbidimetry with a measurement range of 0-42 000. The primary outcome was CVD including coronary heart disease events and stroke events.RESULTS:Among 8688 participants free from CVD (at baseline, mean age, 50.1 years, 3897 were males), there were 189 CVD events, occurred during a median follow-up of 6.34 years (54 685 person-years at risk). From the Kaplan-Meier curve, we found that there was a progressive increase in CVD event rates by hs-CRP tertiles (log-rank test, p<0.001). Baseline hs-CRP was linearly associated with CVD (p for trend=0.015) even after adjusting for known CVD risk factors. Furthermore, the net reclassification improvement when hs-CRP was added to a model based on traditional factors was 7.85% for CVD (p=0.003). In addition, the correlation between change of hs-CRP and CVD was conducted in a subgroup (n=4778). However, we did not find the correlation between hs-CRP change and CVD (correlation coefficient: -0.003, p=0.846).CONCLUSIONS:In the middle-aged Chinese population, hs-CRP was associated with increased risk of developing CVD. Although there was no correlation between hs-CRP change and CVD, the level of hs-CRP was higher at follow-up than baseline even among those with CVD. More attention should be given to those with higher level of hs-CRP for CVD prevention.
Journal of epidemiology and community health 2019
BACKGROUND:Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic vascular morbidity after coronary heart disease and stroke. Epidemiology data of PAD is very limited in low-income and middle-income countries. A national wide survey was conducted from October 2012 to December 2015 to assess the prevalence of PAD in China.METHODS:Data from the China Hypertension Survey (CHS). In total, 56,000 people aged 35 years or older were enrolled in this sub-survey for PAD, and 30,025 participants were eligible for analysis. Ankle-brachial index was measured using an automated ABI device (WatchBP Office device Microlife, China). PAD was defined by ABI and Edinburgh Claudication Questionnaire.RESULTS AND CONCLUSIONS:Overall, 6.6% (estimated 45.3 million) of the Chinese adult population age 35 years or older had PAD. The weighted prevalence of PAD increased significantly after aged ≥75 years. There were no significant differences in PAD prevalence between urban and rural residents, as well as between males and females. Among individuals with PAD, only 4.9% (95% CI: 0%-10.1%) were aware of their condition, 1.9% (95% CI: 0%-4.0%) received revascularization, and 0.2% (95% CI: 0%-0.4%) achieved ABI >0.9. Older age, Han population, current smokers, education level, hypertension, CAD, diabetes, dyslipidemia, and rural residences all were significantly associated with an increased risk of PAD. In China, there is an increasing prevalence of PAD, but the awareness, treatment, and control were very low. Special attention should be paid to prevent and control PAD in China.CLINICAL TRIAL REGISTRATION NUMBER:ChiCTR-ECS-14004641.
International journal of cardiology 2019
Background Data regarding the metabolic risk factors clustering on the risk of left ventricular diastolic dysfunction ( LVDD ) are lacking among people living at high altitude and under hypoxic conditions. In this study, we explored the association between metabolic risk factor clustering and LVDD among the Tibetan population of China. Methods and Results We conducted a cross-sectional survey in a representative sample of 1963 Tibetans in 2014 to 2016. Grading LVDD was based on recommendations for the evaluation of LV diastolic function by echocardiography (2009). The prevalence of LVDD among 1963 participants (mean age: 51.51 years, 41.11% male) was 34.39%. Odds ratios (95% CI ) of LVDD for the 1, 2, and 3 to 5 risk factors clustering were 1.45 (0.96-2.17), 2.68 (1.8-3.98), and 2.9 (1.9-4.43), respectively ( P for trend <0.001). The association between metabolic risk factors clustering and LVDD was much more pronounced in the middle-aged group than in the elderly ( P for interaction=0.0170). High altitude was one of the major independent risk factors for LVDD ; however, habitation altitude had no significant effect on the association between metabolic risk factors and LVDD ( P for interaction=0.1022). The multivariable dominance analysis indicated that abdominal obesity, hypertension, and elevated blood glucose were the significant contributors to LVDD . Conclusions There was a significant positive association between the metabolic risk factor clustering number and LVDD among a population living at high altitude, especially in middle-aged adults. However, habitation altitude itself has no significant effect on the association between metabolic risk factors and LVDD .
Journal of the American Heart Association 2019
BACKGROUND:Living at high altitude may have undesirable effects on the kidney. We explored the chronic kidney disease (CKD) prevalence and risk factors among the residents living at different altitude in Tibetan Plateau.METHODS:A cross-sectional study was carried out in 2014 to 2016 in Linzhi (2900 m altitude), Lhasa (3650 m) and Anduo (4700 m). Information on the cardiovascular risk factors was collected and blood and urine samples were measured.RESULTS:The data of 1707 subjects aged ≥35 y were analyzed. The age-standardized prevalence of CKD in Linzhi, Lhasa and Anduo was 27.7% (95% CI: 22.1-33.3%), 18.3% (12.7-24.0%) and 30.4% (23.5-37.3%) in men and 37.7% (31.8-43.6%), 29.5% (24.6-34.4%) and 36.7% (29.0-44.4%) in women, respectively. Multivariable logistic regression showed that age, female gender, systolic blood pressure, fasting serum glucose, with primary school education or lower were associated with higher risk of CKD and living in Lhasa was associated with lower risk of CKD.CONCLUSION:A higher prevalence of CKD was found in the residents living in the Tibetan Plateau. However, for the highlanders living at higher altitude does not mean higher risk. The CKD risk factors found in this study are similar to those in other studies.
Clinica chimica acta; international journal of clinical chemistry 2018
BACKGROUND:The aim of the study was to assess the association between chronic kidney disease (CKD) and obesity in predicting CKD among Chinese adults, distinguishing between 5 different adiposity indices: visceral fat index (VFI), percentage body fat (PBF), body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR).METHODS:A total of 29,516 participants aged 35 years or above were selected using a stratified multistage random sampling method across China during 2012-2015. CKD was defined as an estimated glomerular filtration (eGFR) < 60 ml/min/1.72m2.RESULTS:The overall weighted prevalence of CKD was 3.94% (3.62% in males and 4.25% in females). All five adiposity indices had significant negative correlations to eGFR (P < 0.05). The area under the ROC (receiver operating characteristic) curves (AUC) for PBF was almost significantly larger than the other adiposity indices (P < 0.001). In addition, PBF yielded the highest Youden index in identifying CKD (male: 0.15; female: 0.20). In the logistic analysis, PBF had the highest crude odds ratios (ORs) in both males (OR: 1.819, 95% CI 1.559-2.123) and females (OR: 2.268, 95% CI 1.980-2.597). After adjusted for age, smoking status, alcohol use, education level, marital status, rural vs. urban area, geographic regions, and diagnosis of hypertension, diabetes mellitus, myocardial infarction and stroke, the ORs on PBF remained significant for both genders (P < 0.05).CONCLUSIONS:Obesity is associated with an increased risk of CKD. Furthermore, PBF was a better predictor for identifying CKD than other adiposity indices (BMI, WC, WHtR, and VFI).
BMC nephrology 2018
Objective: To estimate the association between high-sensitivity C-reactive protein (hs-CRP) and cardiovascular events as well as all-cause mortality events. Methods: During 2009- 2010, out of the 11 623 individuals, 1 000 participants aged 35-64 years, were recruited and divided into 12 age-groups, to have received a study on CVD risk factors. Information on the risk factors of cardiovascular diseases was also collected. Fasting blood sample was gathered for all the participants, with hs-CRP tested. Participants in 7 out of the 12 sites were followed, with 6.21 years (36 075 person-years) as the median follow-up period. Cardiovascular and all-cause mortality events were collected. A total of 6 177 participants had been followed after excluding participants who had baseline infections, or did not take hs-CRP test/physical examination at the baseline. Finally, 5 984 participants were included for analysis. Participants were categorized into three groups based on the hs-CRP (mg/L) values: <1, 1-3 and >3, respectively. Cox proportional hazards regression model was used to analyze the relationships between hs-CRP with cardiovascular events or all-cause mortality events, after adjusting for confounding factors. Results: Mean age of the participants was 50.2 years. The incidence rates of cardiovascular disease events were 3.6/1 000 person-years, 7.1/1 000 person-years,and 10.4/1 000 person-years among three groups and 3.0/1 000 person-years, 5.7/1 000 person-years, 9.1/1 000 person-years for all-cause mortality events, respectively. After adjusting for confounding factors, the hazard risks (HR) for cardiovascular events were 1.33 (95%CI: 0.95-1.84) in the hs-CRP 1-3 mg/L group and 1.76 (95%CI: 1.20-2.60) in the hs-CRP>3 mg/L group when comparing with the hs-CRP<1 mg/L group (trend test P=0.003). The HRs for all-cause mortality events were 1.76 (95%CI: 1.23-2.54) and 2.64 (95%CI: 1.74-4.01) (trend test P<0.001), respectively. Conclusion: Hs-CRP appeared an independent predictor for cardiovascular events and all-cause mortality events.
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 2018
To evaluate the accuracy of the Omron HBP-1300, an automatic device for blood pressure (BP) measurement, compared with the standard auscultatory method with a mercury sphygmomanometer, we conducted a large population-based survey. From 2012 to 2015, a total of 500,000 participants were randomly selected from the 262 urban cities and rural counties in China, of them BP was measured three times simultaneously with mercury sphygmomanometer and Omron HBP-1300 in 37,816 participants. Bias was estimated as the average of the auscultatory measurements minus the average of the oscillometric measurements, with its corresponding 95% limits of agreement. The Association for the Advancement of Medical Instrumentation standards and British Hypertension Society protocols were used to evaluate the accuracy of the oscillometric device. The results showed that the Omron underestimated systolic BP by 1.0 mm Hg (95% limits of agreement: -9.2, 11.2) and underestimated diastolic BP by 0.2 mm Hg (95% limits of agreement: -8.5, 8.1). The bias in systolic BP values was related to heart rate, systolic BP, and pulse pressure level, while the bias in diastolic BP was related to the heart rate and pulse pressure level. Omron HBP-1300 passed the Association for the Advancement of Medical Instrumentation standards and British Hypertension Society protocol requirements. The sensitivity and specificity of the Omron HBP-1300 to detect hypertension were 86.2% and 98.0%, respectively. Our results showed that the Omron HBP-1300 could be used for measuring BP in large epidemiology studies. The bias of BP measurement was related to the age, systolic BP, and pulse pressure level.
Journal of the American Society of Hypertension : JASH 2017
