Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen,China

BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

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.

China cardiovascular diseases report 2018: an updated summary

1 Introduction Rapid socioeconomic progress has greatly affected the lifestyle in China.Consequently,owing to lifestyle changes,urbanization,and accelerated population aging,the risk of cardiovascular diseases(CVD)has increased.The incidence of CVD has been increasing continuously and this upward trend is projected to continue in the next decade.The growing burden of CVD has become a major public health issue.

Common SNPs of APM1 Gene Are Not Associated With Hypertension or Obesity in Chinese Population

Objective To investigate whether the common variants 45T/G and 276G/T in APM1 gene were associated with hypertension combined with obesity （HO） and related clinical features in Chinese Han population. Methods A case-control study design was applied. Common polymorphisms of 45T/G and 276G/T were genotyped by PCR product sequencing in 484 cases with HO and 502 controls with normal blood presure and BMI 〈 25. Results The genotype and allele frequencies of 45T/G, 276G/T, and haplotype defined by the two variants in cases did not differ from those in controls. The means of blood pressure, BMI and waist-hip ratio did not differ among genotypes of the two polymorphisms and haplotypes. Among lipid profiles, only serum high-density lipoprotein cholesterol （HDL-C） levels were significantly lower in T allele carders than that in non-T carriers after adjusting possible confounding factors （1.21 vs 1.32 mmol/L, P=0.0001）. Condusion Polymorphisms of 45T/G and 276G/T in APM1 gene are not associated with hypertension or obesity, or their clinical features in Chinese Han population. Common polymorphism of 45T/G might be associated with serum HDL-C levels in Chinese.

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.

Association of the Apolipoprotein B Gene Polymorphisms With Essential Hypertension in Northern Chinese Han Population

Objective To study the association of the apolipoprotein B gene polymorphisms with essential hypertension in Northern Chinese Han population. Methods XbaI and EcoRl polymorphisms of the apolipoprotein B （APOB） gene were genotyped by polymerase chain reaction （PCR） and restriction fragment-length polymorphism （RFLP） method in 503 unrelated hypertensive patients and 490 healthy controls recruited from international collaborative study of cardiovascular disease in Asia （InterAsia）. Results The difference in the genotypic distributions could be neglected across the groups. The prevalence of X＋ allele in healthy controls （4.8%） was less frequent in Chinese, and there was no significant difference in the frequency of the X＋ allele between cases （5.7%） and controls （P=0.38）. The observed E- allele frequencies were closely similar among groups （5.9% in cases vs 5.0% in controls, P=0.39）. Logitstic regression analyses revealed that the lack of association still persisted after adjustment of other environmental factors. Haplotype analysis showed that X-E＋ was most frequent and no haplotype could significantly contribute to essential hypertension. Conclusion The APOB gene XbaI and EcoRI polymorphisms are not associated with essential hypertension in the Northern Chinese Han population. Future studies on single nucleotide polymorphisms in larger samples are needed to further investigate the possible contribution of the APOB gene to essential hypertension.

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.

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.

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.

Genetic variants in the ADD1 and GNB3 genes and bloodpressure response to potassium supplementation

Dietary potassium-supplementation has been associated with a decreased risk of hypertension and other cardiovascular outcomes.However,blood pressure(BP)responses to potassium supplementation vary among individuals.This study was designed to examine the association between 12 single nucleotide polymorphisms(SNPs)in the adducin 1 alpha(ADD1)and guanine nucleotide binding protein(G protein)beta polypeptide 3(GNB3)genes and systolic BP(SBP),diastolic BP(DBP),and mean arterial pressure(MAP)responses to potassium-supplementation.We conducted a 7-day high-sodium intervention(307.8 mmol sodium/day)followed by a 7-day high-sodium with potassium-supplementation(60 mmol potassium/day)among 1906 Han Chinese participants from rural north China.BP measurements were obtained at the end of each intervention period using a random-zero sphygmomanometer.We identified significant associations between ADD1 variant rs17833172 and SBP,DBP,and MAP responses to potassium-supplementation(all P<0.0001)that remained significant after adjustment for multiple comparisons.In participants that were heterozygous or homozygous for the G allele of this marker,SBP,DBP,and MAP response to potassium-supplementation were–3.52(–3.82,–3.21),–1.41(–1.66,–1.15)and–2.12(–2.37,–1.87),respectively,as compared to the corresponding responses of 1.99(0.25,3.73),–0.65(–0.10,–0.21),and–0.23(–0.37,0.83),respectively,for those who were homozygous for A allele.In addition,participants with at least one copy of the G allele of rs12503220 of the ADD1 gene had significantly increased DBP and MAP response to potassium-supplementation(P=0.0041 and 0.01,respectively),which was also significant after correction for multiple testing.DBP and MAP responses to potassiumsupplementation were–1.36(–1.63,–1.10)and–2.07(–2.32,–1.82)for those with at least G allele compared to corresponding responses of 0.86(–0.68,2.40)and–0.45(–1.74,0.84)for those who were homozygous for A allele.In summary,our study identified novel associations between genetic variants of the ADD1 gene and BP response to potassium-supplementation,which could have important clinical and public health implications.Future studies aimed at replicating these novel findings are warranted.