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.

Effect of Long-term exposure to fine particulate matter air pollution on hypertension incidence:a systematic review and meta-analysis of cohort studies

Objective Studies of the association of hypertension with long-term exposure to particulate matter less than 2.5μm in diameter(PM2.5)have shown contradictory results and the magnitude of the association is still unclear.Hence,we conducted a meta-analysis of cohort studies to assess the effect of long-term exposure to PM2.5 on incident hypertension.

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.

Interactions of variants in the CACNA1C gene with smoking on blood pressure responses to potassium intervention:the GenSalt Study

Objective Calcium Voltage-Gated Channel Subunit Alpha1 C(CACNA1C)gene encodes an alpha-1 subunit of a voltage-dependent calcium channel.This subunit forms the pore through which calcium ions pass into the cell and plays an important role in regulating blood pressure.Smoking habit has been proven become the risk factor of hypertension.This study aimed to investigate the interaction of variants in CACNA1C gene with smoke in blood pressure(BP)responses to dietary sodium and potassium intervention.

MiR-320e inhibits proliferation in human umbilical vein endothelial cells

Objective MicroR NAs(miRs)are a class of small non-coding RNAs,and have been shown to be critical regulators in pathology of cardiovascular disease,such as atherosclerosis,hypertension.We aimed to identify certain miR from differentially expressed miRs in coronary artery disease(CAD)patients and healthy controls,and to investigate its role in the pathology of CAD.

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.

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.

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.

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.

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.

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 valida- tion, respectively. We evaluated both calibration and discrimination measures for model performance. Furthermore, we estimated ASCVD-ffee 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 Z2 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 well- performed 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.

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.

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.

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.

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.

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).