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.

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.

Integrating polygenic and clinical risks to improve stroke risk stratification in prospective Chinese cohorts

The utility of the polygenic risk score(PRS)to identify individuals at higher risk of stroke beyond clinical risk remains unclear,and we clarified this using Chinese population-based prospective cohorts.Cox proportional hazards models were used to estimate the 10-year risk,and Fine and Gray’s models were used for hazard ratios(HRs),their 95%confidence intervals(CIs),and the lifetime risk according to PRS and clinical risk categories.A total of 41,006 individuals aged 30–75 years with a mean follow-up of 9.0 years were included.Comparing the top versus bottom 5%of the PRS,the HR was 3.01(95%CI 2.03–4.45)in the total population,and similar findings were observed within clinical risk strata.Marked gradients in the 10-year and lifetime risk across PRS categories were also found within clinical risk categories.Notably,among individuals with intermediate clinical risk,the 10-year risk for those in the top 5%of the PRS(7.3%,95%CI 7.1%–7.5%)reached the threshold of high clinical risk(≥7.0%)for initiating preventive treatment,and this effect of the PRS on refining risk stratification was evident for ischemic stroke.Even among those in the top 10%and 20%of the PRS,the 10-year risk would also exceed this level when aged≥50 and≥60 years,respectively.Overall,the combination of the PRS with the clinical risk score improved the risk stratification within clinical risk strata and distinguished actual high-risk individuals with intermediate clinical risk.

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.

Ideal cardiovascular health and incidence of atherosclerotic cardiovascular disease among Chinese adults:the China-PAR project

Existing evidence on the relationship between cardiovascular health(CVH) metrics and cardiovascular disease(CVD) was primarily derived from western populations. We aimed to evaluate the benefits of ideal CVH metrics on preventing incident atherosclerotic CVD(ASCVD) in Chinese population. This study was conducted among 93,987 adults from the China-PAR project(Prediction for ASCVD Risk in China) who were followed up until 2015. Cox proportional hazard regression models were used to estimate the hazard ratios(HRs) and their corresponding 95% confidence intervals(CIs) of CVH metrics for the risk of ASCVD, including coronary heart disease(CHD), stroke and ASCVD death. We further estimated the population-attributable risk percentage(PAR%) of these metrics in relation to each outcome. We observed gradient inverse associations between the number of ideal CVH metrics and ASCVD incidence. Compared with participants having ≤2 ideal CVH metrics, the multivariable-adjusted HRs(95% CIs) of ASCVD for those with 3, 4, 5, 6 and 7 ideal CVH metrics were 0.83(0.74–0.93), 0.66(0.59–0.74), 0.55(0.48–0.61), 0.44(0.38–0.50) and 0.24(0.18–0.31), respectively(P for trend <0.0001). Approximately 62.1% of total ASCVD, 38.7% of CHD, 66.4% of stroke, and 60.5% of ASCVD death were attributable to not achieving all the seven ideal CVH metrics. After adjusting effects of ideal health factors, having four ideal health behaviors could independently bring adults health benefits in preventing 17.4% of ASCVD, 18.0% of CHD, 16.7% of stroke, and 10.1% of ASCVD death. Among all the seven CVH metrics, to keep with ideal blood pressure(BP) implied the largest public health gains against various ASCVD events(PAR% between 33.0% and 47.2%), while ideal diet was the metric most difficult to be achieved in the long term. Our study indicates that the more ideal CVH metrics adults have, the less ASCVD burden there is in China. Special efforts of health education and behavior modification should be made on keeping ideal BP and dietary habits in general Chinese population to prevent the epidemic of ASCVD.

Predicting lifetime risk for developing atherosclerotic cardiovascular disease in Chinese population:the China-PAR project

Evidence on the lifetime risk for atherosclerotic cardiovascular disease(ASCVD) is insufficient;yet,estimating an individual's lifetime risk allows for a comprehensive assessment of ASCVD burden.We developed and validated lifetime risk prediction equations for ASCVD using four large and ongoing prospective cohorts of Chinese,the China-PAR project(Prediction for ASCVD Risk in China).Sexspecific equations were developed using two cohorts(as the derivation cohort) of 21,320 participants.Two other independent cohorts with 14,123 and 70,838 participants were used for their external validation,respectively.We evaluated both calibration and discrimination measures for model performance.Furthermore,we estimated ASCVD-free years lost or excess absolute risk attributable to high 10-year risk(!10.0%) and/or high lifetime risk(!32.8%).After 12.3 years' follow-up of the derivation cohort,1048 ASCVD events and 1304 non-ASCVD deaths were identified.Our sex-specific equations had good internal validation,with discriminant C statistics of 0.776(95% confidence interval [CI]:0.757–0.794) and 0.801(95% CI:0.778–0.825),and calibration χ~2 of 9.2(P = 0.418) and 5.6(P = 0.777) for men and women,respectively.Good external validation was also demonstrated with predicted rates closely matched to the observed ones.Compared with men having both low 10-year and low lifetime risk,men would develop ASCVD 3.0,4.6 and 8.6 years earlier if they had high 10-year risk alone,high lifetime risk alone,or both high 10-year and high lifetime risk at the index age of 35 years,respectively.We developed wellperformed lifetime risk prediction equations that will help to identify those with the greatest potential to avert ASCVD burden after implementation of innovative clinical and public health interventions in China.

久坐行为增加心血管疾病发病风险

西方发达国家的研究提示久坐行为增加心血管病发病风险,但是尚无来自中国等发展中国家的证据.此外,久坐行为替换为身体活动的心血管健康获益尚不明确.本研究的三项队列均来自于中国动脉粥样硬化性心血管病风险预测研究(China-PAR),共纳入基线无心血管病的研究对象93,110人.采用Cox比例风险模型计算心血管疾病的风险比和95%置信区间,采用等时替换模型计算替换久坐行为的健康效应.经过平均5.8年的随访,共发生心血管事件3799例.与久坐<5小时/天者相比,久坐5~<83 8~<10,≥10小时/天者发生心血管病的风险分别增加7%,27%和51%;其中,久坐≥10小时/天且中重度身体活动<150分钟/周者心血管病发病风险最高.对于久坐≥5小时/天者,将1小时的久坐替换为轻、中、高强度身体活动可以分别降低5%,6%,8%的心血管病发病风险.本研究首次报道久坐行为增加中国人群心血管病发病风险,并且发现将久坐行为替换为不同强度身体活动均可降低心血管病发病风险,为"少坐多动"健康生活方式的预防策略提供了中国证据.

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.

Associations of egg consumption with incident cardiovascular disease and all-cause mortality

Eggs are nutrient-dense while also loaded with abundant cholesterol, thus making the public hesitant about their consumption.We conducted the study to investigate if egg consumption is associated with incident cardiovascular disease(CVD) and all-cause mortality. Using the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China, we included 102,136 adults free of CVD and assessed their egg consumption with food-frequency questionnaires. CVD endpoints and all-cause mortality were confirmed during follow-ups by interviewing participants or their proxies and checking hospital records/death certificates.The HRs(95% CIs) were calculated using the cohort-stratified Cox regression models. During 777,163 person-years of followup, we identified 4,848 incident CVD and 5,511 deaths. U-shaped associations of egg consumption with incident CVD and allcause mortality were observed. Compared with consumption of 3–<6/week, the multivariable-adjusted HRs(95% CIs) of <1/week and ≥10/week for incident CVD were 1.22(1.11 to 1.35) and 1.39(1.28 to 1.52), respectively. The corresponding HRs(95% CIs) for all-cause mortality were 1.29(1.18 to 1.41) and 1.13(1.04 to 1.24). Our findings identified that both low and high consumption were associated with increased risk of incident CVD and all-cause mortality, highlighting that moderate egg consumption of 3–<6/week should be recommended for CVD prevention in China.

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.

Study design,general characteristics of participants,and preliminary findings from the metabolome,microbiome,and dietary salt intervention study(MetaSalt)

Background:High sodium intake is an important risk factor for hypertension and cardiovascular disease.However,the association between gut microbiota composition and metabolomic profiles with dietary sodium intake and blood pressure(BP)is not well-understood.The metabolome,microbiome,and dietary salt intervention(MetaSalt)study aimed to investigate microbial and metabolomic profiles related to dietary sodium intake and BP regulation.Methods:This family-based intervention study was conducted in four communities across three provinces in rural northern China in 2019.Probands with untreated prehypertension or stage-1 hypertension were identified through community-based BP screening,and family members including siblings,offspring,spouses,and parents were subsequently included.All participants participated in a 3-day baseline examination with usual diet consumption,followed by a 10-day low-salt diet(3 g/d of salt or 51.3 mmol/d of sodium)and a 10-day high-salt diet(18 g/d of salt or 307.8 mmol/d of sodium).Differences in mean BP levels were compared according to the intervention phases using a paired Student’s t-test.Results:A total of 528 participants were included in this study,with a mean age of 48.1 years,36.7%of whom were male,76.8%had a middle school(69.7%)or higher(7.1%)diploma,23.4%had a history of smoking,and 24.4%were current drinkers.The mean arterial pressure at baseline was 97.2±10.5 mm Hg for all participants,and significantly decreased during the low-salt intervention(93.8±9.3,P<0.0001)and subsequently increased during the high-salt intervention(96.4±10.0,P<0.0001).Conclusions:Our dietary salt intervention study has successfully recruited participants and will facilitate to evaluate the effects of gut microbiota and metabolites on BP regulation in response to sodium burden,which will provide important evidence for investigating the underlying mechanisms in the development of hypertension and subsequent cardiovascular diseases.Trial registration:The study was registered in the Chinese Clinical Trial Registry database(ChiCTR1900025171).

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.

内皮系统基因与血压改变和高血压发病的关系:盐敏感遗传流行病学研究

研究者在一个纵向家庭研究中以单标记和新基因为基础的方法探讨内皮系统基因与血压改变和高血压发病率的关系。方法：盐敏感性的遗传流行病学随访研究共纳入633个汉族家庭的1768位成员。使用随机零点血压计,获取基线和随访调查的共9次血压值。

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.