Life's essential 8 and risk of subclinical atherosclerosis progression: a prospective cohort study

BACKGROUND Previous studies have demonstrated the benefits of ideal cardiovascular health(CVH) in reducing cardiovascular risk.However,its role in subclinical atherosclerosis(SA) progression remains unclear.We aim to examine the association of CVH,estimated by the American Heart Association's new Life's Essential 8(LE8),with the progression of SA.METHODS This prospective cohort study was conducted among 972 asymptomatic Chinese participants and followed up for5.7 years.The LE8 score(range,0–100) consisted of blood pressure,lipids,glucose,body mass index,smoking status,diet health,physical activity and sleep health was evaluated in 1998 and 2008–2009.Progression of SA was determined by carotid plaque and coronary artery calcification(CAC) in 2008–2009 and 2013–2014.Log-binomial regression model was used to estimate the association of LE8 score with SA progression.RESULTS Each 10 points increment in LE8 score was associated with 15.2%(RR:0.848,95% CI:0.797–0.902),17.7%(RR:0.823,95% CI:0.766–0.884) and 12.0%(RR:0.880,95% CI:0.845–0.916) lower risks of carotid plaque,CAC and overall SA progression,respectively.Compared with participants with non-ideal CVH at both visits,the participants with ideal CVH at both visits had39.1%(RR:0.609,95% CI:0.494–0.752),41.0%(RR:0.590,95% CI:0.456–0.764) and 29.7%(RR:0.703,95% CI:0.598–0.825) lower risks of carotid plaque,CAC and overall SA progression,respectively.CONCLUSIONS Higher LE8 scores were associated with lower risks of SA progression.Besides,long-term maintenance of optimal CVH was more beneficial to prevent SA progression.

Beneficial effects of moderate to vigorous physical activity on cardiovascular disease among Chinese adults

Background In China,lack of evidence remains a significant challenge for the national initiative to promote physical activity(PA).We aimed to quantify the beneficial effects of meeting or maintaining the recommended PA level[150 minutes per week(min/wk)of moderate PA or 75 min/wk of vigorous PA or an equivalent combination]on incident cardiovascular disease(CVD)among Chinese population.Methods We included 100,560 participants without history of CVD from three cohorts in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project.Cox proportional hazards models were used to estimate hazard ratios(HRs)and 95%confidence intervals(CIs)for CVD events and its subtypes,including stroke,coronary heart disease,heart failure,and CVD death.Results During a median follow-up of 7.3 years(range:6–15 years),777,163 person-years and 4693 incident CVD events were observed.Compared with participants who were inactive at baseline,the multivariable adjusted HR(95%CI)of developing CVD was 0.74(0.69–0.79)for those who met recommended moderate to vigorous physical activity(MVPA)level at baseline.Furthermore,the risk of CVD incidence was reduced with increment of MVPA(Ptrend<0.001),and the HR(95%CI)of highly-active versus inactive category was 0.62(0.56–0.68).Compared with individuals who were inactive both at the baseline and follow-up,those keeping active over the period of follow-up had a substantial lower risk of incident CVD with the HR(95%CI)of 0.57(0.43–0.77).Conclusions The findings demonstrated that meeting and maintaining the recommended MVPA level could reduce the cardiovascular risk.Wider adoption of the PA recommendations would have considerable health impacts to the Chinese population.

Associations of tea consumption with blood pressure progression and hypertension incidence

BACKGROUND Association between tea consumption and incident hypertension remains uncertain.This study conducted to examine the health effects of tea consumption on blood pressure progression and hypertension incidence.METHODS A population-based cohort of 38,913 Chinese participants without hypertension at baseline were included in the current study.Information on tea consumption was collected through standardized questionnaires.Associations of tea consump-tion with blood pressure progression and incident hypertension were analyzed using logistic regression models and Cox propor-tional hazards regression models,respectively.RESULTS During a median follow-up of 5.9 years,17,657 individuals had experienced progression to a higher blood pressure stage and 5,935 individuals had developed hypertension.In multivariate analyses,habitual tea drinkers(≥3 times/week for at least six months)had a 17%lower risk for blood pressure progression[odds ratio(OR)=0.83,95%CI:0.79-0.88]and a 14%de-creased risk for incident hypertension[hazard ratio(HR)=0.86,95%CI:0.80-0.91]compared with non-habitual tea drinkers.In-dividuals in different baseline blood pressure groups could obtain similar benefit from habitual tea drinking.In terms of tea con-sumption amount,an inverse,linear dose-response relation between monthly consumption of tea leaves and risk of blood pres-sure progression was observed,while the risk of incident hypertension did not reduce further after consuming around 100 g of tea leaves per month.CONCLUSIONS Our study demonstrated that habitual tea consumption could provide preventive effect against blood pres-sure progression and hypertension incidence.

Associations of soybean products intake with blood pressure changes and hypertension incidence: the China-PAR project

Background The relationships between dietary intake of soybean products and incident hypertension were still uncertain.This study aimed to illustrate the associations between intake of soybean products with risks of incident hypertension and longitudinal changes of blood pressure in a prospective cohort study.Methods We included 67,499 general Chinese adults from the Project of Prediction for Atherosclerosis Cardiovascular Disease Risk in China(China-PAR).Information about soybean products consumption was collected by standardized questionnaires,and study participants were categorized into the ideal(≥125 g/day)or non-ideal(<125 g/day)group.Hazard ratios(HRs)and corresponding 95%confidence intervals(95%CIs)for incident hypertension were calculated using Cox proportional hazard models.Among participants with repeated measures of blood pressure,generalized linear models were used to examine the relationships between soybean products consumption and blood pressure changes.Results During a median follow-up of 7.4 years,compared with participants who consumed<125 g of soybean products per day,multivariable adjusted HR for those in the ideal group was 0.73(0.67-0.80).This inverse association remained robust across most subgroups while significant interactions were tested between soybean products intake and age,sex,urbanization and geographic region(P values for interaction<0.05).The mean systolic and diastolic blood pressure levels were 1.05(0.71-1.39)mmHg and 0.44(0.22-0.66)mmHg lower among participants in the ideal group than those in the non-ideal group.Conclusions Our study showed that intake of soybean products might reduce the long-term blood pressure levels and hypertension incidence among Chinese population,which has important public health implications for primary prevention of hypertension.

Effects of the total physical activity and its changes on incidence, progression, and remission of hypertension

OBJECTIVES Moderate to vigorous physical activity is recommended to prevent hypertension according to the current guidelines.However,the degree to which the total physical activity(TPA)and its changes benefit normotensives and hypertensives is uncertain.We aimed to examine the effects of TPA and its changes on the incidence,progression,and remission of hypertension in the large-scale prospective cohorts.METHODS A total of 73,077 participants(55,101 normotensives and 17,976 hypertensives)were eligible for TPA analyses.During a mean follow-up of 7.16 years(394,038 person-years),12,211 hypertension cases were identified.TPA was estimated as metabolic equivalents and categorized into quartiles.Cox proportional hazards regression and multivariable logistic regression were used to estimate associations of TPA and changes in TPA with incident hypertension and progression/remission of hypertension.RESULTS Compared with the lowest quartile of TPA,normotensives at the third and the highest quartile had a decreased risk of incident hypertension,with hazard ratios(HRs)of 0.86[95%confidence interval(CI):0.81−0.91]and 0.81(95%CI:0.77−0.86),respectively.Hypertensives at the highest quartile of TPA demonstrated a decreased risk of progression of hypertension[odds ratio(OR)=0.87,95%CI:0.79−0.95],and an increased probability of hypertension remission(OR=1.17,95%CI:1.05−1.29).Moreover,getting active from a sedentary lifestyle during the follow-up period could reduce 25%(HR=0.75,95%CI:0.58−0.96)risk of incident hypertension,whereas those becoming sedentary did not achieve benefit from initially being active.CONCLUSIONS Our findings indicated that increasing and maintaining TPA levels could benefit normotensives,whereas higher TPA levels were needed to effectively control progression and improve remission of hypertension.Physical activity played undoubtedly an essential role in both primary and secondary prevention of hypertension.

Lifestyle improvement and the reduced risk of cardiovascular disease:the China-PAR project

BACKGROUND The benefits of healthy lifestyles are well recognized. However, the extent to which improving unhealthy lifestyles reduces cardiovascular disease(CVD) risk needs to be discussed. We evaluated the impact of lifestyle improvement on CVD incidence using data from the China-PAR project(Prediction for Atherosclerotic Cardiovascular Disease Risk in China).METHODS A total of 12,588 participants free of CVD were followed up for three visits after the baseline examination. Changes in four lifestyle factors(LFs)(smoking, diet, physical activity, and alcohol consumption) were assessed through questionnaires from the baseline to the first follow-up visit. Cox proportional hazard models were used to estimate hazard ratios(HRs) and corresponding 95% confidence intervals(CIs). The risk advancement periods(RAPs: the age difference between exposed and unexposed participants reaching the same incident CVD risk) and population-attributable risk percentage(PAR%) were also calculated.RESULTS A total of 909 incident CVD cases occurred over a median follow-up of 11.14 years. Compared with maintaining 0-1healthy LFs, maintaining 3–4 healthy LFs was associated with a 40% risk reduction of incident CVD(HR = 0.60, 95% CI: 0.45–0.79)and delayed CVD risk by 6.31 years(RAP:-6.31 [-9.92,-2.70] years). The PAR% of maintaining 3–4 unhealthy LFs was 22.0%compared to maintaining 0-1 unhealthy LFs. Besides, compared with maintaining two healthy LFs, improving healthy LFs from 2to 3–4 was associated with a 23% lower risk of CVD(HR = 0.77, 95% CI: 0.60–0.98).CONCLUSIONS Long-term sustenance of healthy lifestyles or improving unhealthy lifestyles can reduce and delay CVD risk.

Risk stratification of atherosclerotic cardiovascular disease in Chinese adults

Objective: This study aims to determine the distribution of observed atherosclerotic cardiovascular disease (ASCVD) incidence in contemporary cohorts in China, and to identify cut-off points for ASCVD risk classification based on traditional criteria and new equations developed by Prediction for ASCVD Risk in China (China-PAR). Methods: The study populations included cohorts in the China-PAR project, with 34,757 participants eligible for the current analysis. Traditional risk stratification was assessed by using Chinese guidelines on prevention of CVD and hypertension, and 5 risk groups were classified based on these guidelines after slight modification for available risk factors. Kaplan-Meier analysis was conducted to obtain the cumulative incidence of observed ASCVD events for all subjects and sub-groups. The predicted 10-year ASCVD risk was obtained using the China-PAR equations. Results: A total of 1922 ASCVD events were identified during an average follow-up of 14.1 years. According to the group classification based on traditional risk stratification, the observed 10-year risks for ASCVD were 4.61%(95%confidence interval[CI]:4.11-5.10%) in the moderate-risk group and 8.74%(95%CI:7.82-9.66%) in the high-risk group. Based on the China-PAR equations for risk assessment of ASCVD, those with predicted risks of<5%, 5-10%, and≥10%could be classified into categories of low-, moderate-, and high-risk for ASCVD, respectively. Conclusion: The findings enable development of a simple method for classification of individuals into low-, moderate-, and high-risk groups, based on the China-PAR equations. The method will be useful for self-management and prevention of ASCVD in Chinese adults.

Diabetes awareness, treatment, control rates and associated risk factors among Beijing residents in 2011:A cross-sectional survey

Objective: To examine the awareness, treatment and control rates of diabetes and identify their associated risk factors among Beijing residents. Methods: A cross-sectional survey was conducted in 2011, using a stratified multistage cluster random sampling method to select a representative sample of 20,242 residents in Beijing aged 18e79 years. Diabetes was defined as fasting blood glucose (FBG)≥7.0 mmol/L and/or history of diabetes and/or using insulin or hypoglycemic agents. All estimates of awareness, treatment and control rates were weighted by the 2010 Beijing Population Census data and the sampling scheme. Multivariate Logistic regression was used to identify factors associated with awareness, treatment and control rates. Results: A total of 2061 (10.3%) participants were diagnosed as diabetes. The overall awareness, treatment and control rate among patients were 60.9%, 51.3% and 22.4%, respectively, while overall control rate among treated patients was 33.8%. These rates differed across subgroups. Women were more likely to be aware of diabetes status, receive treatment and have better glucose controlled than men (69.5%vs. 54.7%for awareness, 61.0%vs. 44.3%for treatment, and 27.6%vs. 18.6%for control, respectively). In addition, only 22.2%of treated patients had both FBG and hemoglobin A1c (HbA1c) controlled well. Multivariate Logistic regression suggested that old age, women, higher education and family history of diabetes were asso-ciated with higher awareness, treatment and control rates (All P<0.05). Treated individuals living in rural (OR ? 0.67(95%CI: 0.47e0.96)) or with dyslipidemia (OR ? 0.63 (95%CI: 0.44e0.91)) had a lower diabetic control rate. Conclusions: Awareness, treatment and control rates of diabetes in Beijing were still low. A comprehensive intervention strategy on diabetes management and control is warranted.

Association of cardiovascular diseases with milk intake among general Chinese adults

Background:The association of milk intake with cardiovascular disease(CVD)and cause-specific mortality remained controversial and evidence among the Chinese population was limited.We aimed to study the relationship between milk intake and CVDs among general Chinese adults.Methods::A total of 104,957 participants received questionnaire survey.Results of physical examination such as anthropometric measurements and biochemical tests during 2007 to 2008,demographic data and their information on milk intake were collected through standardized questionnaires.Cox proportional hazard regression models were used to calculate hazard ratios(HRs)and their corresponding 95%confidence intervals(CIs)of CVD incidence,cause-specific mortality and all-cause mortality related to milk intake.Restricted cubic splines(RCSs)were applied to examine dose-response associations.Results::Among the 91,757 participants with a median follow-up period of 5.8 years,we documented 3877 CVD cases and 4091 all-cause deaths.Compared with participants who never consumed milk,the multivariate-adjusted HRs(95%CIs)of CVD incidence for 1 to 150 g/day,151 to 299 g/day,and≥300 g/day were 0.94(0.86-1.03)(P>0.05),0.77(0.66-0.89)(P<0.05),and 0.59(0.40-0.89)(P<0.05),respectively;each 100 g increase of daily milk intake was associated with 11%lower risk of CVD incidence(HR,0.89;95%CI:0.85-0.94;P<0.001),and 11%lower risk of CVD mortality(HR,0.89;95%CI:0.82-0.97;P=0.008)after adjustment for age,sex,residential area,geographic region,education level,family history of CVD,smoking,alcohol drinking,physical activity level,body mass index,and healthy diet status(ideal or not).RCS analyses also showed a linear dose-response relationship with CVD(P for overall significance of the curve<0.001;P for non-linearity=0.979;P for linearity<0.001)and stroke(P for overall significance of the curve=0.010;P for non-linearity=0.998;P for linearity=0.002)incidence,and CVD mortality(P for overall significance of the curve=0.045;P for non-linearity=0.768;P for linearity=0.014)within the current range of daily milk intake.Conclusions::Daily milk intake was associated with lower risk of CVD incidence and mortality in a linear inverse relationship.The findings provide new evidence for dietary recommendations in CVD prevention among Chinese adults and people with similar dietary pattern in other countries.

Ethnic differences in the association between angiotensin-converting enzyme gene insertion/deletion polymorphism and peripheral vascular disease: A meta-analysis

Background: Several studies have investigated the association of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with peripheral vascular disease (PVD); however, the results remain controversial. Therefore, we conducted the current meta-analysis to evaluate this relationship in the general population of different ethnicities. Methods: We searched PubMed, Embase, Web of Science, Wanfang Database, and CNKI to identify eligible studies. Random-effect models were applied to estimate the pooled odds ratio (OR) with a 95％ confidence interval (CI), regardless of between-study heterogeneity. Results: A total of 13 studies with 1966 cases and 6129 controls were included in this meta-analysis. The pooled ORs for the association between ACE I/D polymorphism and PVD risk were not statistically significant in the overall population under all genetic models. In further ethnicity-stratified analyses, we found a statistically significant association of ACE I/D polymorphism with PVD susceptibility in Asians under most models. However, the association among Caucasians did not reach statistical significance. Conclusion: ACE I/D polymorphism might be associated with susceptibility to PVD in the Asian population, but there was no clear evidence indicating a similar significant relationship among Caucasians.

Corrigendum to'Ethnic differences in the association between angiotensin-converting enzyme gene insertion/deletion polymorphism and peripheral vascular disease:A meta-analysis' [CDTM 3/4 (2017) 230e241]

The editorial staff and authors would like to make a correction to the published paper.1 There were some mistakes in the original version of the article in Fig. 4. The editorial staff and authors havecorrected the errors as shown in the figure below. The figure legend does not need to be changed. The rest of themanuscript does not need to be changed.