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.

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.

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.

Adverse associations of sedentary behavior with cancer incidence and all-cause mortality:A prospective cohort study

Background:Inconsistent results have been reported in developed countries for relationships between sedentary behavior and cancer incidence and mortality,and evidence from the Chinese population is scarce.This study aimed to investigate such relationships in large Chinese population-based prospective cohorts and to explore the joint effect and interaction of sedentary behavior and moderate-to-vigorous physical activity(MVPA)on these relationships.Methods:We included 95,319 Chinese adults without cancer from 3 large cohorts and assessed their sedentary behavior and physical activity with a unified questionnaire.Cancer incidence and mortality were confirmed by interviewing participants or their proxies and checking hospital records and death certificates.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)for cancer and mortality were estimated using Cox proportional hazards regression models.Results:During 559,002 person-years of follow-up,2388 cancer events,1571 cancer deaths,and 4562 all-cause deaths were recorded.Sedentary behavior was associated with increased risk of developing cancer and deaths in a doseresponse manner.The multivariable-adjusted HRs(95%CIs)were the following:HR=1.16,95%CI:1.01-1.33;HR=1.24,95%CI:1.04-1.48;and HR=1.15,95%CI:1.04-1.28 for cancer incidence,cancer mortality,and all-cause mortality,respectively,for those having≥10 h/day of sedentary time compared with those having<6 h/day of sedentary time.Sedentary populations(≥10 h/day)developed cancer or died 4.09 years and 2.79 years earlier,respectively,at the index age of 50 years.Failure to achieve the recommended level of MVPA may further aggravate the adverse associations,with the highest cancer and mortality risks being observed among participants with both≥10 h/day of sedentary time and<150 min/week of MVPA.Limitations of this study include the fact that physical activity information was obtained via questionnaire instead of objective measurement and that there were insufficient incident cases for the analysis of associations between sedentary behavior and site-specific cancers.Conclusion:Sedentary behavior was associated with an increased risk of cancer and all-cause mortality among Chinese adults,especially for those with≥10 h/day of sedentary time.It is necessary to reduce sedentary time,in addition to increasing MVPA levels,for the prevention of cancer and premature death.

Association of Estimated Pulse Wave Velocity and the Dynamic Changes in Estimated Pulse Wave Velocity with All-Cause Mortality among Middle-Aged and Elderly Chinese

Objective We aimed to clarify the association between estimated pulse wave velocity(ePWV)and the changes in ePWV with all-cause mortality among middle-aged and elderly Chinese.Methods Data were obtained from the China Health and Retirement Longitudinal Study(CHARLS)from 2011-2018.The ePWV was calculated using an equation that included age and mean blood pressure(MBP).The ΔePWV was assessed as the difference in ePWV between the first two waves.Cox proportional hazard models were used to determine the association between ePWV and ΔePWV with all-cause mortality after adjustment for potential confounders.Results Of 13,116 participants during a median follow-up of 7.0 years,1,356 deaths occurred.An increased ePWV was independently associated with all-cause mortality.The hazard ratio[95% confidence interval(CI)]for participants from the 1^(st)-4^(th) quartile groups was 1.00,1.69(1.31-2.18),3.09(2.44-3.91),and 8.54(6.78-10.75),respectively.Each standard deviation(SD)increment of ePWV increased the risk of all-cause mortality by 132%.Furthermore,theΔePWV was significantly associated with a 1.28-fold(95%CI,1.18-1.38)risk of all-cause mortality per SD increment.Conclusion This cohort study provided novel evidence from a Chinese population that an increased ePWV or progression of the ePWV was independently associated with all-cause mortality,which highlighted the importance of mitigating ePWV progression in clinical practice.

Metabolomics signature of blood pressure salt sensitivity and its link to cardiovascular disease:A dietary salt-intervention trial

Individuals with a high degree of salt sensitivity(SS)have a greater risk of cardiovascular disease(CVD),but whether SS fosters CVD by influencing metabolomics homeostasis remains unclear.This study aimed to reveal the role of the SS-related metabolomics signature in the development of CVDs,based on the MetaSalt study,which was a dietary salt-intervention trial conducted at four centers in China in 2019.A total of 528 participants were recruited and underwent 3 days of baseline observations,a 10-day low-salt intervention,and a 10-day highsalt intervention.Plasma untargeted metabolomics,lipidomics,and BP measurements were scheduled at each stage.Participants were grouped into extreme SS,moderate SS,and salt-resistant(SR)individuals according to their BP responses to salt.Linear mixed models were used to identify SS-related metabolites and determine the relationship between the SS-related metabolomics signature and arterial stiffness.Mendelian randomization(MR)analyses were applied to establish the causal pathways among the SS-related metabolites,BP,and CVDs.Among the 713 metabolites,467 were significantly changed after the high-salt intervention.Among them,the changes in 30 metabolites from the low-salt to the high-salt intervention differed among the SS groups.Of the remaining nonsalt-related metabolites,the baseline levels of 11 metabolites were related to SS.These 41 metabolites explained 23%of the variance in SS.Moreover,SS and its metabolomics signature were positively correlated with arterial stiffness.MR analyses demonstrated that the SS-related metabolites may affect CVD risk by altering BP,indicating that the increase in BP was the consequence of the changes in SS-related metabolites rather than the cause.Our study revealed that the metabolomics signature of SS individuals differs from that of SR individuals and that the changes in SS-related metabolites may increase arterial stiffness and foster CVDs.This study provides insight into understanding the biology and targets of SS and its role in CVDs.

Changes on Stroke Burden Attributable to Ambient Fine Particulate Matter in China

Objective In recent decades,China has implemented a series of policies to address air pollution.We aimed to assess the health effects of these policies on stroke burden attributable to ambient fine particulate matter(PM_(2.5)).Methods Joinpoint regression was applied to explore the temporal tendency of stroke burden based on data from the Global Burden of Disease 2019 study.Results The age-standardized rates of disability-adjusted life year(DALY)for stroke attributable to ambient PM2.5 in China,increased dramatically during 1990-2012,subsequently decreased at an annual percentage change(APC)of-1.98[95% confidence interval(CI):-2.26,-1.71]during 2012-2019.For ischemic stroke(IS),the age-standardized DALY rates doubled from 1990 to 2014,and decreased at an APC of-0.83(95%CI:-1.33,-0.33)during 2014-2019.Intracerebral hemorrhage(ICH)showed a substantial increase in age-standardized DALY rates from 1990 to 2003,followed by declining trends,with APCs of-1.46(95%CI:-2.74,-0.16)during 2003-2007 and-3.33(95%CI:-3.61,-3.06)during 2011-2019,respectively.Conversely,the age-standardized DALY rates for subarachnoid hemorrhage(SAH)generally declined during 1990-2019.Conclusion Our results clarified the dynamic changes of the ambient PM_(2.5)-attributable stroke burden in China during 1990-2019,highlighting the health effects of air quality improvement policies.

Temporal trend in mortality of cardiovascular diseases and its contribution to life expectancy increase in China, 2013 to 2018

Backgrounds::Cardiovascular disease(CVD)remains the leading cause of deaths nationwide.However,little is understood about its temporal trend and corresponding influence on longevity improvements.We aimed to describe the updated tendency in CVD mortality and to quantify its impact on life expectancy(LE)increase in China.Methods::All-cause mortality rates were calculated with population sizes from the National Bureau of Statistics and death counts from the National Health Commission.We estimated CVD mortality rates by allocating age-and sex-based mortality envelopes to each CVD subtype based on its proportion derived from the Disease Surveillance Points system.The probability of CVD premature deaths and LE were calculated with life tables and we adopted Arriaga’s method to quantitate age-and cause-specific contributions to LE gains.Results::During 2013 to 2018,the age-standardized mortality rate of CVD decreased from 289.69(95%confidence interval[CI]:289.03,290.35)/100,000 to 272.37(95%CI:271.81,272.94)/100,000,along with a decline in probability of CVD premature deaths from 9.05%(95%CI:9.02%,9.09%)to 8.13%(95%CI:8.10%,8.16%).The gap in CVD mortality across sexes expanded with more remarkable declines in females,especially for those aged 15 to 64 years.Among major subtypes,the probability of premature deaths from hemorrhage stroke declined fastest,while improvements of ischemic stroke and ischemic heart disease were limited,and there was an increase in stroke sequelae.LE in China reached 77.04(95%CI:76.96,77.12)years in 2018 with an increase of 1.38 years from 2013.Of the total LE gains,21.15%(0.29 years)were attributed to reductions of CVD mortality in the overall population,mostly driven by those aged>65 years.Conclusions::The general process in reducing CVD mortality has contributed to longevity improvements in China.More attention should be paid to prevention and control of atherosclerotic CVD and stroke sequelae,especially for the elderly.Working-age males also deserve additional attention due to inadequate improvements.

Sedentary behavior and risk of incident cardiovascular disease among Chinese adults

Although emerging studies from high-income countries investigated the relationship between sedentary behavior(SB) and cardiovascular risk,little evidence came from developing countries.Moreover,the benefits of reallocating time from SB to physical activity(PA) on incident cardiovascular disease(CVD) are unknown.Using three cohorts from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project,we included 93 110 adults who were free from CVD at baseline.Cox proportional hazards models were used to calculate the hazard ratios(HRs) and 95% confidence intervals(CIs) for CVD,including stroke,coronary heart disease,and CVD death.Isotemporal substitution models were applied to estimate the per-hour effects of replacing SB with PA.After 5.8 years follow-up,3799 CVD cases were identified.A gradient positive association between sedentary time and incident CVD was observed.Relative to those with <5 h/d sedentary time,the multivariable-adjusted HRs(95% CIs) of CVD incidence were 1.07(0.96-1.20),1.27(1.13-1.43) and 1.51(1.34-1.70) for those having 5-<8,8-<10,and> 10 h/d sedentary time,respectively.When participants were cross-classified by SB and moderate to vigorous physical activity(MVPA) level,the CVD risk was highest in those with> 10 h/d SB and <150 min/week MVPA.Among those who reported> 5 h/d sedentary time,per-hour substitution of SB with light,moderate,and vigorous PA reduced incident CVD risk by 5%,6%,and 8%,respectively.The study first found that sedentary time was associated with increased incident CVD risk among Chinese adults and that substitution of SB with PA of any intensity could convey cardiovascular benefits among those with> 5 h/d SB.

Long-term exposure to fine particulate matter modifies the association between physical activity and hypertension incidence

Background:The trade-off between the benefits of regular physical activity(PA)and the potentially detrimental effects of augmented exposure to air pollution in highly polluted regions remains unclear.This study aimed to examine whether ambient fine particulate matter(PM_(2.5))exposure modified the impacts of PA volume and intensity on hypertension risk.Methods:We included 54,797 participants without hypertension at baseline in a nationwide cohort of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project.PA volume and intensitywere assessed by questionnaire,and high-resolution(1 km×1 km)PM_(2.5)estimates were generated using a satellite-based model.Results:During 413,516 person-years of follow-up,12,100 incident hypertension cases were identified.PM_(2.5)significantly modified the relationship between PA and hypertension incidence(p_(interaction)<0.001).Increased PA volume was negatively associated with incident hypertension in the low PM_(2.5)stratum(<59.8μg/m^(3),ptrend<0.001),with a hazard ratio of 0.81(95%confidence interval(95%CI):0.74-0.88)when comparing the fourth with the first quartile of PA volume.However,the health benefits were not observed in the high PM_(2.5)stratum(≥59.8μg/m^(3),p_(trend)=0.370).Moreover,compared with light PA intensity,vigorous intensity was related to a 20%(95%CI:9%-29%)decreased risk of hypertension for participants exposed to low PM_(2.5),but a 17%(95%CI:4%-33%)increased risk for those with high PM_(2.5)levels.Conclusion:PA was associated with a reduced risk of hypertension only among participants with low PM_(2.5)exposure.Our findings recommended regular PA to prevent hypertension in less polluted regions and reinforced the importance of air quality improvement.

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.

Cardiovascular risk assessment: The key path toward precision prevention

1 INTRODUCTION Cardiovascular disease(CVD)is the most common noncommunicable disease and the leading cause of death globally.l It has resulted in enormous economic and social burdens,while posing a ggreat challenge for the prevention and control of CvD worldwide,especially in China.Assessment and management of cardiovascular risk is the foundation of CvD prevention,and is strongly recommended by guidelines.Additionally,it can help screen the target population who would benefit most from the lower-cost intervention,while informing them the cardiovascular risk,which will help in promoting self-management.It can also guide doctors in making logical management decisions,and implement precision prevention and treatment strategies to reduce the CVD burden.2,4 Therefore,it is a key approach in achieving the goals of"Good Health and Well-being"in the United Nations and"Healthy China 2030"in China.

Longitudinal association of egg consumption habits with blood lipids among Chinese adults: results from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project

To the Editor:According to guidelines from western countries as well as China,dietary patterns with low intake of cholesterol have been widely recommended for maintaining ideal lipid levels.As one of the major sources of both high-quality protein and dietary cholesterol,eggs have always been the focus in terms of diet.Although increased lipid levels induced by high egg intake have been revealed by randomized controlled trials(RCTs),they may not be sufficient to reflect the impacts of habitual egg intake due to high doses of egg intake of more than 7 eggs/week or even 14 eggs/week.Further,RCTs typically have shorter intervention periods of about 3 months,which may not observe a stable association due to homeostasis in cholesterol metabolism of human beings.[1,2]Up to now,only three cohorts assessed the associations of egg intake with lipid levels or dyslipidemia,and the findings were still controversial.One recent cohort study has reported the non-significant association between higher egg intake(≥7 vs.1 eggs/week)and lipid profiles.On the other hand,another cohort from Spain found that compared with<1 egg/week,>4 eggs/week had no significant influence on total cholesterol(TC)and triglyceride(TG),but significantly decreased high-density lipoprotein cholesterol(HDL-C)levels.[4]However,none of these cohorts were from developing countries,and the association between moderate egg intake and lipid profiles has not been well illustrated.Egg consumption in China,a representative of developing countries,is relatively higher,and it may be possible to better explore the appropriate range of egg intake.

Fruit and vegetable consumption,cardiovascular disease,and all-cause mortality in China

Evidence about the response patterns of fruit and vegetable consumption with the risk of cardiovascular disease(CVD)and allcause mortality was inconsistent.These associations were examined using a large-scale,population-based Chinese cohort comprising 100,728 participants.A food-frequency questionnaire was used to assess fruit and vegetable consumption.Outcomes were ascertained by interviewing individuals or their proxies and checking hospital records or death certificates.Cox proportional hazards regression was used to calculate hazard ratios(HRs)with 95% confidence intervals(CIs).At the 736,668 person-years of follow-up,3,677 CVD cases and 5,466 deaths were identified.The multivariable-adjusted HRs for CVD across increasing quartiles of total fruit and vegetable consumption were 1(reference),0.94(95%CI=0.85-1.04),0.89(95%CI=0.80-0.98),and 0.85(95%CI=0.77-0.95).Moreover,participants in the highest quartile displayed a 13% lower risk of all-cause mortality(HR=0.87;95%CI=0.80-0.95).A nonlinear dose-response relation was found for CVD,without additional benefits beyond a consumption of600 g d-1,whereas the all-cause mortality risk decreased along with higher consumption,with a linear trend.These associations remained significant for fruit consumption but not for vegetable consumption.Our findings indicated that greater fruit and vegetable consumption was significantly associated with a lower risk of CVD and all-cause mortality.Increasing fruit and vegetable consumption,especially fruit,in the general population would prevent CVD and premature mortality.

Impacts of PM_(2.5) on Ambulatory Blood Pressure Monitoring Indicators Attenuated by Blood Pressure Control Status and Treatment-Two Cities and Two Municipalities,China,2017−2019

Summary What is already known about this topic?Short-term PM_(2.5) exposure has been associated with hourly,24-hour,daytime,and nighttime blood pressure(BP)levels,and further studies focusing whether and how the associations with other ambulatory BP monitoring indicators are warranted.

Changes in Mortality Rates of Major Chronic Diseases Among Populations Aged Over 60 Years and Their Contributions to Life Expectancy Increase-China,2005-2020

Summary What is already known about this topic?The impacts of population aging have appeared in China,leading to a marked shift in the major contributors to life expectancy.Longevity improvements are now mainly promoted by reductions in mortality rates of the aged.What is added by this report?This study systematically evaluates both changes in mortality rates of major chronic diseases among populations aged over 60 years as well as their contributions to life expectancy increases in China,from 2005 to 2020.What are the implications for public health practice?The results of this study demonstrate that more attention should be paid to health conditions of the elderly,especially for the prevention and control of major chronic diseases.

Prevalence of familial hypercholesterolemia and its association with coronary artery disease:A Chinese cohort study

Background:Familial hypercholesterolemia(FH)is underrecognized,and its association with coronary artery disease(CAD)remains limited,especially in China.We aimed to investigate the prevalence of FH and its relationship with CAD in a large Chinese cohort.Methods:FH was defined using the Make Early Diagnosis to Prevent Early Death(MEDPED)criteria.The crude and age-sex standardized prevalence of FH were calculated based on surveys of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project during 2007−2008.The associations of FH with incident CAD and its major subtypes were estimated with the cohort-stratified multivariate Cox proportional hazard models based on the data from the baseline to the last follow-up(2018−2020).Results:Among 98,885 included participants,190 participants were defined as FH.Crude and age−sex standardized prevalence and 95%confidence interval(CI)of FH were 0.19%(0.17%-0.22%)and 0.13%(0.10%-0.16%),respectively.The prevalence varied across age groups and peaked in the group of 60-<70 years(0.28%),and the peak prevalence(0.18%)in males was earlier,yet lower than the peak crude prevalence in females(0.41%).During a mean follow-up of 10.7 years,2493 cases of incident CAD were identified.After multivariate adjustment,FH patients had a 2.03-fold greater risk of developing CAD compared to non-FH participants.Conclusions:The prevalence of FH was estimated to be 0.19%in the participants,and it was associated with an elevated risk of incident CAD.Our study suggests that early screening of FH has certain public health significance for the prevention of CAD.

Fruit and vegetable intake and the risk of arterial hypertension in China:A prospective cohort study

Background:Population-based epidemiological evidence regarding the association between fruit and vegetable intake and the incidence of hypertension is inconsistent.This prospective cohort study aimed to investigate the association between fruit and vegetable intake and the risk of new-onset hypertension.Methods:Based on the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR),58,981 Chinese adults without hypertension at baseline were included.Information on fruit and vegetable intake was collected using a food-frequency questionnaire.Cox proportional hazards models were performed to estimate the hazard ratios(HRs)and 95%confidence intervals(CIs)of incident hypertension.Results:During 640,795 person-years of follow-up,21,008 new cases of hypertension were recorded.Compared with participants in the lowest quintile(Q1)of total fruit and vegetable(TFV)intake,the HRs(95%CIs)of incident hypertension were 0.90(0.86-0.95),0.85(0.81-0.90),0.82(0.78-0.86),and 0.83(0.78-0.88)for the Q2 to Q5 group(ptrend<0.001),respectively.In further analyses categorizing participants according to the recommended intake level(500 g/day),we found that increasing the intake of TFV,even though it was still insufficient for the recommendation,also had a protective effect against the incident hypertension.When considering the intake of fruit or vegetable separately,we found similar trends as the TFV intake.Conclusion:These results suggest that a higher intake of fruit and vegetable is beneficial for preventing hypertension in Chinese adults.

Hypertension and human health:Evidence and prospects

High blood pressure is a major public health issue and a leading risk factor for death worldwide,with the number of attributable deaths increased from 6.8 million in 1990 to 10.8 million in 2019.1,2 According to the World Health Organization,the age-standardized prevalence of hypertension was estimated to be 33%,affecting approximately 1.3 billion adults aged 30–79 years in 2019 worldwide,doubling from 1990.3 In addition to the heavy disease burden,the economic burden associated with hypertension is also substantial,accounting for approximately 10%of the global healthcare expenditure.4 Furthermore,despite improvements in diagnostic and treatment capacities,the status of hypertension care remains suboptimal,especially in low-and middle-income countries.For instance,in China,in 2019,the awareness,treatment,and control rates of hypertension were 38.3%,34.6%,and 12.0%,respectively.5 Accumulating evidence calls for more comprehensive and effective prevention and management of hypertension.

Physical activity, long-term fine particulate matter exposure and type 2 diabetes incidence: A prospective cohort study

Background: Despite the adverse effects of ambient fine particulate matter (PM_(2.5) ) on type 2 diabetes and the beneficial role of physical activity (PA), the influence of PM_(2.5) on the relationship between PA and type 2 diabetes remains unclear.Methods: In this prospective study with 71,689 participants, PA was assessed by a questionnaire and was categorized into quartiles for volume and three groups for intensity. Long-term PM_(2.5) exposure was calculated using 1-km resolution satellite-based PM_(2.5) estimates. PM_(2.5) exposure and PA's effect on type 2 diabetes were assessed by cohort-stratified Cox proportional hazards models, individually and in combination.Results: In 488,166 person-years of follow-up, 5487 incident type 2 diabetes cases were observed. The association between PA and type 2 diabetes was modified by PM_(2.5) . Compared with the lowest quartile of PA volume, the highest quartile was associated with reduced type 2 diabetes risk in low PM_(2.5) stratification (≤65.02 μg/m^(3)) other than in high PM_(2.5) stratification (>65.02 μg/m^(3)), with the hazard ratio (HR) of 0.75 (95% confidence interval [CI]: 0.66-0.85) and 1.10 (95% CI: 0.99-1.22), respectively. Similar results were observed for PA intensity. High PM_(2.5) exposure combined with the highest PA levels increased the risk of type 2 diabetes the most (HR= 1.79, 95% CI: 1.59-2.01 for PA volume;HR = 1.82, 95% CI: 1.64-2.02 for PA intensity).Conclusion: PA could reduce type 2 diabetes risk in low-pollution areas, but high PM_(2.5) exposure may weaken or even reverse the protective effects of PA. Safety and health benefits of PA should be thoroughly assessed for long-term polluted residents.