蒋琳琳
中国医学科学院阜外医院 社区防治部
BACKGROUND:The epidemiology of valvular heart disease (VHD) has changed markedly over the last 50 years worldwide, and the prevalence and features of VHD in China are unknown. The objective of this study was to investigate the current status and etiology of VHD in China.METHODS:We used a cross-sectional national survey with stratified multistage random sampling from the general Chinese population to estimate the VHD burden. Data on demographic characteristics, medical history, physical examination, blood tests, and potential etiology were collected. Echocardiography was used to detect VHD.RESULTS:The national survey enrolled 34,994 people aged 35 years or older across China. Overall, 31,499 people were included in the final analysis, and 1309 participants were diagnosed with VHD. The weighted prevalence was 3.8%, with an estimated 25 million patients in China. The prevalence of VHD increased with age and was higher in participants with hypertension or chronic kidney disease than in their counterparts. Among participants with VHD, 55.1% were rheumatic and 21.3% were degenerative. The proportion of rheumatic decreased with age, and the proportion of degenerative rose with age. However, the prevalence of rheumatic disease was still higher in the elderly population than in the younger population. Logistic regression revealed that age and hypertension were correlated with VHD.CONCLUSIONS:In China, rheumatic heart disease was still the major cause of the VHD, with a significant increase in degenerative heart disease. Age and hypertension are important and easily identifiable markers of VHD.
BMC cardiovascular disorders 2021
Background Although numerous studies have been published evaluating the positive or negative effects of altitude on cardiovascular disease, many of them are conflicting. Methods and Results Data come from 2 cross-sectional surveys using a similar method in China; and a total of 34 215 residents, aged ≥35 years, were eligible and recruited in the study. Left ventricular diastolic dysfunction (LVDD), according to the 2009 American Society of Echocardiography guidelines, was defined and evaluated. Altitude was divided into low (<1500 m), middle (1500-3500 m), and high (≥3500 m) level groups. Among the 34 215 participants (aged 55.87 years; men, 45.92%; altitude ranging from 3.1 ~ 4507 m), 15 099 (crude prevalence, 44.13%), 517 (crude prevalence, 1.51%), and 272 (crude prevalence, 0.79%) were diagnosed as having grades I, II, and LVDD, respectively. Compared with low-level group, the odds ratios (ORs) (95% CIs) of LVDD for middle- and high-level groups were 1.65 (1.49-1.82) and 1.89 (1.63-2.19), respectively (Ptrend<0.001). The ORs (95% CI) were 1.43 (1.31-1.56) and 2.03 (1.67-2.47) per 500-m increment for middle- and high-level groups. There was a nonlinear relationship (upward-sloping "W" shape) between altitude and the risk of LVDD, assessed by the restricted cubic spline. For each LVDD grade, ORs (95% CIs) of grade I LVDD for middle- and high-level groups were 1.75 (1.59-1.92) and 1.95 (1.69-2.25), respectively; for grade II, ORs (95% CIs) for middle- and high-level groups were 6.19 (3.67-10.42) and 5.27 (2.18-12.74), respectively. The stratified analyses indicated that LVDD was much more remarkably influenced by elevated altitude in men (Pinteraction=0.0019). Conclusions Higher altitude is associated with increased risk of LVDD among people living over 1500 m, especially for men.
Journal of the American Heart Association 2021
To explore the association between unbalanced social determinants status and hypertension (HTN) in China, we conducted a cross-sectional survey in a sample of 299 220 Chinese in 2012 to 2015. Social determinants status were measured with: (a) district-level:Per capita GDP (Per_GDP), the number of hospital beds per 1000 residents (Per 1000_bed) and tertiary industry added value (TIAV); (b) individual-level: education and employment conditions. Compared with the poorest level of Per_GDP, the middle and richest group had higher risk of HTN [OR, 95%CI: 1.12 (1.09-1.14) and 0.99 (0.96-1.02)] and higher possibility of HTN awareness, treatment, and control. Higher risk of HTN and lower possibility of awareness, treatment, and control were associated with elevated Per 1000_bed in rural area. Higher possibility of HTN control was associated with the higher TIAV (Ptrend < .001). Those with middle (OR, 95%CI: 0.86, 0.84-0.88) and senior (OR, 95%CI: 0.72, 0.69-0.76) education had a decreased risk of HTN and higher HTN control possibility compared to primary. And participants in retirement/unemployment conditions had a higher risk of HTN and higher possibility of HTN awareness, treatment, and control compared with the job-holders. This study provides evidence from China that social determinants status has a detectable association with HTN. People with a higher economic area living, lower level of education, or retirement/ unemployment conditions has a higher risk of HTN, especially for male or rural residents. And lower possibility of HTN awareness, treatment, and control were associated with worse economic development and social circumstances environment, lower education level, and employment/student conditions.
Journal of clinical hypertension (Greenwich, Conn.) 2020
BACKGROUND:Along with global climate change, the relationship between temperature variability (TV) and cardiovascular hospitalization and deaths have been well established. However, limited studies were conducted to reveal the underlying mechanism for TV-related cardiovascular diseases.OBJECTIVES:In the current study, a novel TV calculation, taking account for both interday and intraday TV as well as lag effects, was used to investigate the effect of short-term TV on the level of high-sensitivity C reactive protein (hs-CRP), which is a crucial preclinical predictor for cardiovascular disease (CVD).RESULTS:Among the 11,623 Chinese population (46.0% male; mean age 49.8 years), the average hs-CRP was 1.4 mg/ L (standard deviation 1.6 mg/L). Statistical significance between TV and hs-CRP was observed for different TV exposure days (TV01-TV07) in adjusted model, with highest effect for TV06. Specifically, per 1 °C increase in TV06 led to 2.241% (95%CI: 1.552%-2.935%) increase in hs-CRP. Female, obesity and elderly population were more susceptible to TV. The largest mediator for the association of TV and hs-CRP was lipoprotein(a), accounting for 8.68%, followed by smoking status (4.78%), alcohol use (3.95%) and systolic BP (3.20%).CONCLUSION:Short-term TV will significantly increase the level of hs-CRP, suggesting hs-CRP to be the potential biologic mechanisms underlying the cardiovascular effects of TV. And more attention should be paid to unstable weather in the global climate change context. Further developing efficient public health policies on climate change may benefit for global heath.
The Science of the total environment 2020
BACKGROUND:Limited evidence is available regarding the potential heterogeneity of ambient temperature on blood pressure (BP) in various climate zones.OBJECTIVES:To explore the effect of daily ambient temperature on BP in various climate zones across 31 provinces in China.METHODS:A representative population sample (n = 451,770) were obtained from the China Hypertension Survey study (CHS) from October 2012 to December 2015. Survey seasons were divided into warm and cold seasons. Survey sites were divided into three climate zones as subtropical, temperate monsoon and temperate continental zones.RESULTS:After adjustment for confounders, an overall 10 °C decrease in ambient temperature was statistically associated 0.74 mmHg (95% CI: 0.69, 0.79) and 0.60 mmHg (95% CI: -0.63, -0.57) rise for SBP and DBP, respectively. In the warm season, U-shaped exposure-response curves were observed between ambient temperature and BP in temperate monsoon and continental zones, and liner curves in other zones. A greater SBP change due to a lower temperature was observed in subtropical zones, so did DBP in temperate continental zones, especially for cold season. Female, rural and elderly populations were more susceptible to cold weather than their counterparts.DISCUSSION:There is a geographical disparity between temperature and BP across different climate zones, which should been taken into consideration when maintaining stable blood pressure levels.
The Science of the total environment 2020
Results from recent studies on associations between blood pressure (BP) and short-term exposure to fine particulate matter (PM2.5) have been inconsistent. Most studies have been evaluations of small geographic areas, with no national study in China. This study aimed to examine the acute BP responses to ambient PM2.5 among the general population of Chinese adults. During 2012-2015, systolic and diastolic BP levels were obtained from a large national representative sample, the China Hypertension Survey database (n = 479,842). Daily PM2.5 average exposures with a spatial resolution of 0.1° were estimated using a data assimilation that combines satellite measurements, air model simulations, and monitoring values. Overall, a 10-μg/m3 increase in daily PM2.5 was associated with a 0.035 (95% confidence interval: 0.020, 0.049) mmHg change in systolic BP and 0.001 (-0.008, 0.011) mmHg in diastolic BP after adjustments. Stratified by geographic regions, the systolic and diastolic BP levels varied from -0.050 (-0.109, 0.010) to 0.242 (0.176, 0.307) mmHg, and from -0.026 (-0.053, 0.001) to 0.051 (0.020, 0.082) mmHg, respectively. Statistically significant positive BP-PM2.5 associations were only found in South and North China for systolic levels and in Southwest China for diastolic levels. We further explored the regional study population characteristics and exposure-response curves, and found that the geographic variations in BP-PM2.5 associations were probably due to different population compositions or different PM2.5 exposure levels. Our study provided national-level evidence on the associations between ambient PM2.5 exposure and elevated BP levels. The magnitude of the estimated associations varied substantially by geographic location in China. CLINICAL TRIAL REGISTRATION: The Clinical trial registration name was Survey on prevalence of hypertension in China; the registration number was ChiCTR-ECS-14004641. http://www.chictr.org.cn/showproj.aspx?proj=4932.
The Science of the total environment 2020
Importance:A workplace-based intervention could be an effective approach to managing high blood pressure (BP). However, few studies to date have addressed hypertension control among the Chinese working population.Objective:To assess the effect of a workplace-based, multicomponent intervention strategy on improving BP control.Design, Setting, and Participants:A cluster randomized clinical trial of a hypertension management program was conducted from January 2013 to December 2014 in 60 workplaces across 20 urban regions in China. Workplaces were randomized to either the intervention group (n = 40) or control group (n = 20). Employee participants in each workplace were asked to complete a cross-sectional survey. Data analysis on an evaluable population was conducted from January 2016 to January 2017.Interventions:The 2-year intervention included 2 components: (1) a workplace wellness program for improving employees' cardiovascular health and (2) a guidelines-oriented hypertension management protocol with a community health center intervention accompanied by monthly visits for achieving BP control over a period of 24 months.Main Outcomes and Measures:The primary outcome was the change in BP control rate from baseline to 24 months among employees with hypertension in the intervention and control groups. The secondary outcomes were the changes in BP level and lifestyle factors by the end of the trial.Results:Overall, 4166 participants (3178 in the intervention group and 988 in the control group) were included (mean [SD] age, 46.3 [7.6] years; 3451 men [82.8%]). Blood pressure control rate at baseline was 19.5% in the intervention group and 20.1% in the control group. After 24 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (66.2% vs 44.0%; odds ratio, 1.77; 95% CI, 1.58-2.00; P < .001). The intervention effect on systolic BP level was -5.8 mm Hg (95% CI, -6.8 to -4.9 mm Hg; P < .001) and on diastolic BP level was -3.6 mm Hg (95% CI, -4.4 to -2.9 mm Hg; P < .001). The BP control rate showed a gradual increment throughout the whole duration in the intervention group. Moreover, greater reduction was reported in the rates of drinking (-18.4%; 95% CI, -20.6% to -16.2%; P < .001), perceived stress (-22.9%; 95% CI, -24.8% to -21.1%; P < .001), and excessive use of salt (-32.0%; 95% CI, -33.7% to -30.4%; P < .001).Conclusions and Relevance:This trial found that a workplace-based, multicomponent intervention appeared to be more effective than usual care, leading to measurable benefits such as lower blood pressure, improved hypertension control, and adoption of healthy lifestyle habits. The intervention can therefore be considered for large-scale use or inclusion in hypertension control programs in workplaces in China and other countries.Trial Registration:Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641.
JAMA cardiology 2020
BACKGROUND:Circulating microRNAs (miRNA) are potential prognostic biomarkers for cardiovascular disease. We aimed to identify serum miRNA as an effective predictor for coronary artery disease (CAD) events in a general population cohort.Methods and Results:Serum miRNAs associated with CAD were determined by small RNA sequencing and quantitative RT-PCR. Further, the predictive ability of identified serum miRNAs was measured in a general population of 2,812 people. As a main outcome measure, CAD events were collected for 6 years and included acute myocardial infarction and subsequent myocardial infarction. Out of the 48 miRNA candidates, 5 miRNAs (miR-10a-5p, miR-126-3p, miR-210-3p, miR-423-3p and miR-92a-3p) showed better reliability and repeatability in serum. Then, the association of serum levels of the 5 miRNAs with CAD was validated. Furthermore, miR-10a-5p and miR-423-3p, which showed better performance, were tested in the large cohort, with a median follow up of 6.0 years. In multivariable Cox regression analysis, only miR-423-3p (P for trend<0.001) was able to precisely predict CAD events. Moreover, the addition of circulating miR-423-3p with the traditional risk factors together markedly improved the various model performance measures, including the area under the operating characteristics curve (0.782 vs. 0.806), Akaike Information Criterion (965.845 vs. 943.113) and net reclassification improvement (19.18%).CONCLUSIONS:Circulating miR-423-3p can improve the prediction of primary CAD outcomes on the basis of a traditional risk factor model in general population.
Circulation journal : official journal of the Japanese Circulation Society 2020
The purpose of this study was to assess the association of blood pressure (BP) measurements with the risk of cardiovascular disease (CVD) and examine whether central systolic BP (CSBP) predicts CVD better than brachial BP measurements (SBP and pulse pressure [PP]). Based on a cross-sectional study conducted in 2009-2010 with follow-up in 2016-2017 among 35- to 64-year-old subjects in China, we evaluated the performance of non-invasively predicted CSBP over brachial BP measurements on the first CVD events. Each BP measurement, individually and jointly with another BP measurement, was entered into the multivariate Cox proportional-hazards models, to examine the predictability of central and brachial BP measurements. Mean age of participants (n = 8710) was 50.1 years at baseline. After a median follow-up of 6.36 years, 187 CVD events occurred. CSBP was a stronger predictor for CVD than brachial BP measurements (CSBP, 1-standard deviation increment HR = 1.49, 95%CI: 1.31-1.70). With CSBP and SBP entering into models jointly, the HR for CSBP and SBP was 1.28 (1.04-1.58) and 1.22 (0.98-1.50), respectively. With CSBP and PP entering into models jointly, the HR for CSBP and PP was 1.51 (1.28-1.78) and 0.98 (0.83-1.15), respectively. For subgroup analysis, the association of CSBP with CVD was stronger than brachial BP measurements in women, those with hypertension and obesity. In the middle-aged Chinese population, noninvasively estimated CSBP may offer advantages over brachial BP measurements to predict CVD events, especially for participants with higher risk. These findings suggest prospective assessment of CSBP as a prevention and treatment target in further trials.
Journal of clinical hypertension (Greenwich, Conn.) 2020
BACKGROUND:Heart failure (HF) is a major health burden worldwide. However, there is no nationwide epidemiological data on HF in China after 2000. The aims of this study are (i) to determine the prevalence of left ventricular (LV) dysfunction and HF (with reduced, mid-range, and preserved ejection fraction) in a nationally representative Chinese population, and (ii) to investigate the treatment and control of hypertension in HF patients.METHODS AND RESULTS:Data from the China Hypertension Survey (CHS) and 22 158 participants were eligible for analysis in this study. For each participant, a self-reported history of HF and any other cardiovascular diseases was acquired. Two-dimensional and Doppler echocardiography was used to assess LV dysfunction. Overall, 1.3% (estimated 13.7 million) of the Chinese adult population aged ≥35 years had HF, 1.4% of participants had LV systolic dysfunction (ejection fraction <50%), and 2.7% were graded as having 'moderate' or 'severe' LV diastolic dysfunction. The weighted prevalence of HF was similar between urban and rural residents (1.6% vs. 1.1%, P = 0.266), and between men and women (1.4% vs. 1.2%, P = 0.632). In addition, among HF patients with hypertension, 57.7% received antihypertensive medication, and 14.5% had their blood pressure controlled <140/90 mmHg.CONCLUSIONS:In summary, there was an increase in the prevalence of HF, and LV dysfunction was very common in China. However, treatment and control of hypertension in participants with HF were low.CLINICAL TRIAL REGISTRATION NUMBER:ChiCTR-ECS-14004641.
European journal of heart failure 2019
