ASSOCIATION OF INSULIN RESISTANCE AND C-REACTIVE PROTEIN WITH CORONARY ARTERY DISEASE IN PATIENTS WITH NORMAL GLUCOSE TOLERANCE

Objective To examine insulin resistance and high sensitivity C-reactive protein （hsCRP） association with clinical and angiographic severity of coronary artery disease （CAD） in patients with normal glucose tolerance. Methods In 638 consecutive patients with normal glucose tolerance, 221 had atypical chest pain and normal coronary artery （control group）, 279 had stable angina and CAD （SAP group ）, and 138 suffered acute myocardial infarction （ MI group）. The degree of CAD was further divided into borderline lesion （ lumen diameter narrowing 50% - 69% ）, significant 1-, 2- or 3-vessel disease （ luminal diameter narrowing 〉I 70% ）. Fasting serum glucose, insulin and hsCRP levels and lipid profiles were measured, and homeostasis model assessment for insulin resistance （ HOMA-IR ） was calculated. Multivariate analysis was performed to assess risk factors for 3-vessel disease or acute MI. Results Serum hsCRP, lipoprotein （a） levels, and insulin resistance index （IRI） were higher in AMI group than those in SAP and control groups. Serum hsCRP level and IRI were also higher in 3-vessel disease than those in other groups. Multivariate regression analysis revealed that insulin resistance, cigarette smoking, serum hsCRP, and lipoprotein （a） levels were independent risk factors for acute MI. Lipoprotein （ a ） elevation was an independent risk factor for 3-vessel disease. Conclusion Insulin resistance and high serum hsCRP level were associated with occurrence of acute MI and angiographic severity of coronary disease in patients with normal glucose tolerance.

Temperature change between neighboring days and hospital admissions in China

The short-term temperature fluctuation caused by global climate change is one of the risk factors affecting public health.Exploring the association between temperature fluctuation and diseases,which has received relatively limited research attention,can contribute to enhancing awareness of health risks and taking timely measures for health risk alert and management.Therefore,this study aims to investigate the relationship between temperature change between neighboring days(TCN)and hospitalizations,identify diseases sensitive to extreme TCN,and evaluate the related disease burden.We collected meteorological and hospitalization data from 2014 to 2019 in 23 sites of China to explore the impact of TCN on hospitalizations.We first quantified site-specific associations between TCN and hospitalizations and then conducted meta-analysis to pool the results,to assess the relative risk of extreme TCN for susceptible diseases,and to estimate the related disease burden attributed to TCN.Stratified analyses were undertaken by age,sex,and disease type.Results showed that all-cause hospital admission was significantly linked to TCN.A negative TCN(below-1.9℃)in the cool season and a positive TCN(above 1.0℃)in the warm season increased the risk of hospitalization.People aged 15-64 years,men,and patients with musculoskeletal system or connective tissue diseases were more sensitive to extremely negative TCN during the cool season.People aged over 65 years,men,and patients with respiratory diseases were more sensitive to extremely positive TCN during the warm season.The attributable fraction to all-cause hospitalization from negative TCN in the cool season was 2.05%(95%CI:-0.90%,4.53%)and from positive TCN in the warm season was 5.79%(95%CI:2.98%,8.31%).Circulatory diseases in the cool season and respiratory diseases in the warm season had the highest disease burden.Our findings indicate that awareness of TCN and its health risks should be promoted and evidence-informed policies are needed to reduce the risk of TCN.

Total and cause-specific mortality attributable to cold spells in China:A multicity and multicounty study

Climate change has resulted in an increase in the frequency and intensity of extreme cold weather events,but few multicity or multicounty researches have explored the association between cold spells and mortality risk and burden.We collected daily data on climate,sociodemo-graphic factors and mortality in 18 cities/counties across 11 geographical regions for the period of November to March 2014-2018.A distributed lag nonlinear model was used to examine the association between cold spells and mortality after adjustment for confounding factors.Twelve definitions of cold spells were used.Multi-meta regression analysis was applied to pool the impacts over different regions.Cold spells were significantly associated with all-cause mortality at lag 0-21(CRR:1.38,95%CI:1.21,1.57).In addition to respiratory diseases and cir-culatory system diseases,digestive,endocrine and nervous system diseases and injury were also affected by cold spells.The magnitude of the impacts of cold spells on mortality varied among the diseases investigated,with the highest risk estimate found for influenza and pneumonia(CRR:2.00,95%CI:1.45,2.76)and the lowest estimate found for injury(CRR:1.26,95%CI:1.09,1.46).The fraction of all-cause mortality attributable to cold spells was 2.31%(95%CI:0.90%,3.46%).Among the regional differences,the attributable burden of all-cause mortality was higher in rural areas and subtropical monsoon climate zone,with attributable fractions of 2.85%(95%CI:1.23%,4.11%)and 3.36%(95%CI:0.55%,5.35%),respectively.Cold spells increased mortality from a range of diseases.Women,older adults and residents of rural areas and subtropical monsoon climate zone were more vulnerable to cold spells impacts.The findings may help to formulate preventive strategies and early warning response plans to reduce mortality burden of extreme cold events.

Health risks from non-optimal temperatures in different populations and regions in China:Tailored intervention strategies are needed

Identifying temperature-sensitive diseases,vulnerable populations and attributable disease burden is crucial for the development and implementation of tailored climate change adaptation strategies in the context of climate change,especially through both mortality and morbidity analysis by using the data from same regions and populations.We re-analyzed and outlined the whole picture of the impacts of extreme temperatures on both mortality and morbidity among various populations and regions,based on the researches from a well-planned national project of Scientific Survey of Regional Meteorological Sensitive Diseases(SRMSD)with consistent methodology in China.The twenty-four representative regions of the SRMSD project cover all eleven geographical meteorological divisions in the country,including urban and rural areas.In addition to circulatory and respiratory diseases,we found that neurological diseases,injuries,digestive diseases,endocrine diseases,genitourinary diseases,skin and subcutaneous tissue diseases were sensitive to extreme heat,while digestive diseases were sensitive to extreme cold.The extreme temperature-sensitive diseases and the attributable disease burden varied by region.Females and the elderly people(65 years old and above)were more vulnerable to extreme heat when using mortality as a health outcome,whereas males and the young and middle-aged adults were more vulnerable to morbidity risk from heat.Our findings provide important scientific evidence for regional distribution of temperature-sensitive diseases and identification of vulnerable populations in China.It provides evidence and implications of developing regional heat/cold-exposure intervention policies,especially for hospital emergency departments and ambulance services during hot seasons.