Chung-Shiuan Chen

Future Cardiovascular Disease in China Markov Model and Risk Factor Scenario Projections From the Coronary Heart Disease Policy Model–China

Background—The relative effects of individual and combined risk factor trends on future cardiovascular disease in China have not been quantified in detail. Methods and Results—Future risk factor trends in China were projected based on prior trends. Cardiovascular disease (coronary heart disease and stroke) in adults ages 35 to 84 years was projected from 2010 to 2030 using the Coronary Heart Disease Policy Model–China, a Markov computer simulation model. With risk factor levels held constant, projected annual cardiovascular events increased by >50% between 2010 and 2030 based on population aging and growth alone. Projected trends in blood pressure, total cholesterol, diabetes (increases), and active smoking (decline) would increase annual cardiovascular disease events by an additional 23%, an increase of approximately 21.3 million cardiovascular events and 7.7 million cardiovascular deaths over 2010 to 2030. Aggressively reducing active smoking in Chinese men to 20% prevalence in 2020 and 10% prevalence in 2030 or reducing mean systolic blood pressure by 3.8 mm Hg in men and women would counteract adverse trends in other risk factors by preventing cardiovascular events and 2.9 to 5.7 million total deaths over 2 decades. Conclusions—Aging and population growth will increase cardiovascular disease by more than a half over the coming 20 years, and projected unfavorable trends in blood pressure, total cholesterol, diabetes, and body mass index may accelerate the epidemic. National policy aimed at controlling blood pressure, smoking, and other risk factors would counteract the expected future cardiovascular disease epidemic in China.

A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010

Chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, cardiovascular disease and premature death. Here we estimated the global prevalence and absolute burden of CKD in 2010 by pooling data from population-based studies. We searched MEDLINE (January 1990 to December 2014), International Society of Nephrology Global Outreach Program funded projects, and bibliographies of retrieved articles and selected 33 studies reporting gender- and age-specific prevalence of CKD in representative population samples. The age standardized global prevalence of CKD stages 1–5 in adults aged 20 and older was 10.4% in men (95% confidence interval 9.3–11.9%) and 11.8% in women (11.2–12.6%). This consisted of 8.6% men (7.3–9.8%) and 9.6% women (7.7–11.1%) in high-income countries, and 10.6% men (9.4–13.1%) and 12.5% women (11.8–14.0%) in low- and middle-income countries. The total number of adults with CKD was 225.7 million (205.7–257.4 million) men and 271.8 million (258.0–293.7 million) women. This consisted of 48.3 million (42.3–53.3 million) men and 61.7 million (50.4–69.9 million) women in high-income countries, and 177.4 million (159.2–215.9 million) men and 210.1 million (200.8–231.7 million) women in low- and middle-income countries. Thus, CKD is an important global-health challenge, especially in low- and middle-income countries. National and international efforts for prevention, detection, and treatment of CKD are needed to reduce its morbidity and mortality worldwide.

Body Mass Index and Risk of Stroke among Chinese Men and Women

The relationship between body mass index (BMI) and stroke incidence and mortality remains controversial, particularly in Asian populations.

Blood pressure and clinical outcome among patients with acute stroke in Inner Mongolia, China.

Objectives The association between blood pressure and short-term clinical outcome of acute stroke is inconclusive. We studied the association between admission blood pressure and in-hospital death or disability among acute stroke patients in Inner Mongolia, China. Methods A total of 2178 acute ischemic stroke and 1760 hemorrhagic stroke patients confirmed by a computed tomography scan or magnetic resonance imaging were included in the present study. Blood pressure and other study variables were collected within the first 24 h of hospital admission. Clinical outcomes were evaluated by trained neurologists during hospitalization. Results The in-hospital case-fatality rate was higher for acute hemorrhagic stroke (5.9%) than it was for acute ischemic stroke (1.8%), whereas the disability rate was higher for those with acute ischemic stroke (41.3%) than those with acute hemorrhagic stroke (34.4%) at discharge. Blood pressure at admission was not significantly associated with clinical outcome in acute ischemic stroke. On the contrary, systolic and diastolic blood pressures were significantly and positively associated with odds of death or disability in acute hemorrhagic stroke. For example, compared to those with a systolic blood pressure less than 140 mmHg, multiple-adjusted odds ratio (95% confidence interval) of death/disability was 1.38 (0.96, 1.99), 1.42 (1.00, 2.03), 1.84 (1.28, 2.64), and 1.91 (1.35, 2.70) among participants with systolic blood pressure 140–159, 160–179, 180–199, and at least 200 mmHg, respectively (P < 0.0001 for linear trend). Conclusion Increased systolic and diastolic blood pressure were significantly and positively associated with death and disability among patients with acute hemorrhagic stroke, but not acute ischemic stroke, in Inner Mongolia, China.

Cigarette Smoking and Risk of Stroke in the Chinese Adult Population

Background and Purpose— We studied the relationship between cigarette smoking and stroke incidence and mortality in the Chinese adult population. Methods— We conducted a prospective cohort study in a nationally representative sample of 169 871 Chinese men and women aged 40 years and older. Data on cigarette smoking and other covariables were collected at a baseline examination in 1991 using a standard protocol. Follow-up evaluation was conducted in 1999 to 2000, with a response rate of 93.4%. Results— During an average of 8.3 years follow-up, a total of 6780 stroke events (3979 fatal strokes) were observed. The multivariate-adjusted relative risks (95% confidence interval) of stroke incidence and mortality associated with present cigarette smoking were 1.28 (1.19 to 1.37) and 1.13 (1.03 to 1.25) in men and 1.25 (1.13 to 1.37) and 1.19 (1.04 to 1.36) in women, respectively. The corresponding population attributable risks were 14.2% and 7.1% in men and 3.1% and 2.4% in women. Compared to never-smokers, the multivariate-adjusted relative risks of stroke incidence (95% confidence interval) were 1.21 (1.12 to 1.31), 1.21 (1.11 to 1.32), and 1.36 (1.25 to 1.47) for those who smoked 1 to 9, 10 to 19, and ≥20 cigarettes per day; and 1.18 (1.09 to 1.28), 1.25 (1.15 to 1.35), and 1.34 (1.24 to 1.44) for those who smoked 1 to 11, 12 to 26, and >26 pack-years, respectively (both P<0.0001 for linear trends). Conclusions— Our study identified a positive and dose-response relationship between cigarette smoking and risk of stroke. Smoking prevention and cessation programs should be an important strategy for reducing the burden of stroke in Chinese adults.

Increasing prevalence and low awareness, treatment and control of diabetes mellitus among Chinese adults: the InterASIA study.

AIMS To estimate the prevalence rates of impaired fasting glucose (IFG) and diabetes mellitus (DM) and to evaluate the awareness, treatment, and control of DM in the Chinese adult population. METHODS The International Collaborative Study of Cardiovascular Disease in ASIA (InterASIA), a cross-sectional study, was conducted in 2000-2001. A nationally representative sample of 15,236 Chinese adults between 35 and 74 years old who had fasting plasma glucose measured were used for the present research. Awareness, treatment, and control of DM were defined by subjects self-reporting a DM diagnosis and the use of a prescription medication or nonpharmacological intervention for DM, and had a fasting plasma glucose <126mg/dl, respectively. RESULTS The prevalence rates of IFG and DM in Chinese adults aged 35-74 years were 7.33 and 5.49%, respectively, with the age-standardized prevalence also 7.33 and 5.49%, respectively. Among patients with DM, 23.66% were aware of their DM, 20.33% were taking prescribed medication or nonpharmacological interventions, and 8.28% had fasting plasma glucose <126mg/dl. Among diabetics who reported a prior diagnosis of DM, 85.22% were taking prescription medication or nonpharmacological interventions and 35% had fasting plasma glucose <126mg/dl. CONCLUSIONS The prevalence rate of DM among Chinese adults has been increasing in recent years. The rates of awareness, treatment and control of DM are relatively low. Improving the awareness, treatment, and control is urgently needed for the intervention of DM in the Chinese adult population.

Trends in overweight and obesity in Chinese adults: between 1991 and 1999-2000.

Objective: The aim of this study was to evaluate trends in BMI and the prevalence of overweight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) between 1991 and 1999–2000 among Chinese adults.

Incidence and predictors of hypertension over 8 years among Chinese men and women.

Objective To determine the 8-year incidence of hypertension and its risk factors among Chinese adults. Methods A population-based sample of 10 525 Chinese adults aged ≥40 years and free from hypertension at baseline was followed up from 1991 to 1999–2000. Incident hypertension was defined as systolic pressure ≥140 mmHg, diastolic pressure ≥90 mmHg, or current use of antihypertensive medication. Results Over a mean of 8.2 years of follow-up, 28.9% of men and 26.9% of women developed hypertension. Among men, independent predictors of incident hypertension were baseline age [relative risk (RR) per 5 years: 1.10; 95% confidence interval (CI): 1.07, 1.13], living in urban regions versus rural regions (RR: 0.74; 95% CI: 0.64, 0.85), alcohol drinking versus non-drinking (RR: 1.13; 95% CI: 1.02, 1.24), prehypertension versus normotension (RR: 1.70; 95% CI: 1.53, 1.88), heart rate (RR of third versus first tertile: 1.27; 95% CI: 1.13, 1.44), body mass index (RR of third versus first tertile: 1.28; 95% CI: 1.12, 1.46) and low versus high physical activity (RR: 1.27; 95% CI: 1.10, 1.47). Results were similar for women, with current smoking in place of alcohol drinking and opposite results for region. The population-attributable risk of modifiable risk factors was between 25 and 50%. Conclusions These data indicate that the incidence of hypertension is high among these Chinese adults, and suggest that 25–50% of new hypertension cases could be prevented with risk factor modification. Given the excess cardiovascular mortality associated with hypertension, these data call for urgent improvements in hypertension prevention and control programs in China.

Prehypertension and risk of cardiovascular disease in Chinese adults.

Objective To examine the excess risks associated with prehypertension and absolute benefit of treatment. Methods We conducted a prospective cohort study in 169 871 Chinese adults aged 40 years and older. Data on blood pressure and covariables were obtained at a baseline examination in 1991 and follow-up evaluation was conducted in 1999–2000. Results Compared with normotension (<120/80 mmHg), prehypertension (120–139/80–89 mmHg) was significantly associated with an increased relative risk (95% confidence interval) of cardiovascular disease (CVD) incidence 1.34 (1.27, 1.42) and mortality 1.22 (1.15, 1.30), coronary disease incidence 1.32 (1.16, 1.50) and mortality 1.47 (1.23, 1.75), and stroke incidence 1.72 (1.59, 1.86) and mortality 1.67 (1.50, 1.86). The population-attributable risk associated with prehypertension was 10.6 and 7.1% for CVD incidence and mortality, 9.9 and 13.9% for coronary disease incidence and mortality, and 19.9 and 18.7% for stroke incidence and mortality. The optimal 5-year number-needed-to-treat to prevent a CVD event or death was 53 and 185, 17 and 51, and eight and 22 for prehypertension, stage 1 hypertension, and stage 2 hypertension, respectively. The optimal number-needed-to-treat to prevent a CVD event was significantly smaller in prehypertension patients with a history of CVD or diabetes (34 for incidence and 44 for mortality) compared with those without (115 for incidence and 352 for mortality). Conclusion Prehypertension was related to an increased risk of CVD. Treatment of prehypertension among patients with a history of CVD or diabetes was as beneficial as treatment of stage 1 hypertensive patients without a history of CVD or diabetes.

Effect of Dietary Protein Supplementation on Blood Pressure

BACKGROUND Observational studies have reported an inverse association between dietary protein intake and blood pressure (BP). We compared the effect of soy protein, milk protein, and carbohydrate supplementation on BP among healthy adults. METHODS AND RESULTS We conducted a randomized, double-blind crossover trial with 3 intervention phases among 352 adults with prehypertension or stage 1 hypertension in New Orleans, LA, and Jackson, MS, from September 2003 to April 2008. The trial participants were assigned to take 40 g/d soy protein, milk protein, or carbohydrate supplementation each for 8 weeks in a random order. A 3-week washout period was implemented between the interventions. Three BPs were measured at 2 baseline and 2 termination visits during each of 3 intervention phases with a random-zero sphygmomanometer. Compared with carbohydrate controls, soy protein and milk protein supplementations were significantly associated with -2.0 mm Hg (95% confidence interval -3.2 to -0.7 mm Hg, P=0.002) and -2.3 mm Hg (-3.7 to -1.0 mm Hg, P=0.0007) net changes in systolic BP, respectively. Diastolic BP was also reduced, but this change did not reach statistical significance. There was no significant difference in the BP reductions achieved between soy or milk protein supplementation. CONCLUSIONS The results from this randomized, controlled trial indicate that both soy and milk protein intake reduce systolic BP compared with a high-glycemic-index refined carbohydrate among patients with prehypertension and stage 1 hypertension. Furthermore, these findings suggest that partially replacing carbohydrate with soy or milk protein might be an important component of nutrition intervention strategies for the prevention and treatment of hypertension. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00107744.