Haiyu Pang

Influence of Salt Intake on Association of Blood Uric Acid with Hypertension and Related Cardiovascular Risk.

Background A relationship of blood uric acid (UA) with hypertension and cardiovascular risk is under debate thus salt intake is hypothesized to contribute to such associations. Methods In this cross-sectional study, stratified cluster random sampling elicited a sample of 1805 Kazakhs with 92.4% compliance. Hypertension and moderate-or-high total cardiovascular risk (mTCR) were defined according to guidelines. Sodium intake was assessed by urinary sodium excretion. Prevalence ratios (PRs) were used to express associations of UA with hypertension and mTCR. Results In the highest tertile of sodium intake in women, the adjusted PRs (95% confidence intervals) of low to high quartiles compared with the lowest quartile of UA, were 1.22(0.78–1.91), 1.18(0.75–1.85), and 1.65(1.09–2.51) for hypertension and 1.19(0.74–1.90), 1.39(0.91–2.11), and 1.65(1.10–2.47) for mTCR (P for trend <0.05). However, these findings were not shown for other sodium intake levels. There were similar results in men. PRs markedly increased with a concomitant increase in UA and sodium intake and there was a significant interaction (P = 0.010) for mTCR with PRs of 1.69(1.10–2.60) for men and 3.70(2.09–6.52) for women in those with the highest compared with the lowest quartile of UA and tertile of sodium intake. Similar findings were shown for hypertension. Conclusions This study implied that a high salt intake may enhance the associations of UA with hypertension and cardiovascular risk.

Association between smoking and deaths due to colorectal malignant carcinoma: a national population-based case–control study in China

Background:This study explored the association between smoking and colorectal malignant carcinoma (CRC) in the Chinese population at the national level for the first time.Methods:In the China Nationwide Retrospective Mortality Survey conducted during 1989–1991, 12 942 CRC cases among 1 136 336 all-cause deaths aged ⩾30 years were randomly assigned 25 884 control interviews from 325 255 surviving spouses of all-cause deaths across 103 urban and rural areas.Results:Compared with non-smokers, smoking significantly increased the risk of CRC-specific mortality by 9.8% (odds ratio (OR)=1.098, 95% confidence interval (CI)=1.046–1.153) adjusted for sex, age, and residence. There were significant dose–response relationships between smoking and CRC, such as smoking years, cigarettes smoked daily, and age at onset of smoking. Long-term heavy smokers aged ⩾50 years with ⩾30 smoking years and ⩾20 cigarettes daily had an excess risk of CRC deaths of 30.2% (OR=1.302, 95% CI=1.214–1.397). The strongest association between these smoking variables, such as long-term heavy smokers (OR=1.604, 95% CI=1.341–1.919), and CRC was observed among rural men.Conclusions:Quitting smoking at any time would likely be beneficial to CRC prevention. Long-term heavy smokers and rural men should be viewed as special targets for smoking prevention and cessation programs.

Prevalence of conventional cardiovascular disease risk factors among Chinese Kazakh individuals of diverse occupational backgrounds in Xinjiang China.

Kazakh is a typical transnational ethnic group with the Eurasian lineage. It is the main ethnic group in Kazakhstan, and one of the ethnic minorities in China, Russia, Turkeymore than 40 other countries and regions. There are an approximately 1.25 million Kazak populations in China, of which 96.4% is located in northern Xinjiang [1]. For thousands of years, Chinas Kazakh people are mainly active in raising livestock on the prairie grasslands.With the development of the urbanization, Kazak people naturally formed three different subgroups with different occupation backgrounds (i.e., nomads, farmers, and urban residents). When cardiovascular disease (CVD) risk factors are more prevalent in urban China, little is known about the prevalence about this ethnic group. To investigate the prevalence of CVD conventional risk factors among Kazakh individuals of different occupational backgrounds the baseline data of The Xinjiang Altay Kazakh Heart Study (XAKHS) was used.

Multicentre evaluation of perioperative red blood cells transfusions in China

Multicentre evaluation of perioperative red blood cells transfusions in China Editor—China is facing a blood shortage. Approximately 60% of blood products are being transfused during clinical surgery. We aimed to assess the appropriateness of perioperative red blood cells (RBCs) transfusion in public tertiary general hospitals in China. This study was designed as a retrospective (January 2006– December 2009) multicentre survey involving three typical sample hospitals [The Peking Union Medical College Hospital (PUMC Hospital), the Second Affiliated Hospital of Zhejiang University School of Medicine (SAZU Hospital), and the Northern Jiangsu People’s Hospital (NJP Hospital)]. Using a yearstratified random sampling with a sampling proportion of 20% for every stratum, 6384 patients who had a history of RBCs transfusion were selected from three hospitals. Of them, 1274 patients, who had complete records of objective indication, were included in the appropriateness evaluation. A structural survey form was used to extract data from the medical records, which included the patients’ general information, surgical information, objective transfusion indication, and blood infusion information. The appropriateness evaluation consisted of two steps. First, a reasonableness evaluation was done by a composite criterion that was mainly based on Chinese blood transfusion guidance. – 6 Then, over-transfusion was further assessed among patients who were identified as reasonable transfusion based on the first step. During the study periods, the whole blood transfusion was almost replaced by blood component transfusion after the year 2007. The proportion of blood component transfusion increased from 92.3% in 2006 to 99.6% in 2009. Overall, the unreasonable RBCs transfusion rate significantly decreased from 41.5% [95% confidence interval (CI): 35.2– 47.9] to 30.2% (25.9–34.7) during the study periods. The downtrends were consistent in all subgroups (38.7–28.8%, 45.2–23.5%, and 41.9–38.9% at the PUMC, the SAZU, and the NJP Hospital, respectively, all P,0.05). Table 1 shows the distribution characteristics of patients who have undergone unreasonable RBCs transfusions. The unreasonable rate in thoracic surgery patients was highest [56.8% (46.3–67.0)], followed by heart/blood vessel surgery patients [47.7% (39.7–55.9)]. Patients without anaemia on admission had more than twice the unreasonable rate as did anaemia patients, especially at the SAZU (64.7% vs 17.9%, P,0.0001) and the NJP Hospital (68.7% vs 24.2%, P,0.0001). In fact, when surgical acute blood loss was replaced by crystalloid or colloid fluids to maintain normovolaemia, in most stable hospitalized patients with adequate preoperative haemoglobin, the loss could often be well tolerated due to normal compensatory responses that are invoked before a blood transfusion becomes necessary. 5 Overall, the over-transfusion rate was 10.1%. Nearly, half of the over-transfusion episodesoccurred inabdominal operations (consistently in three hospitals). Abdominal surgery accounted for the highest proportion ofall surgeries (37.6%)and consumed the largest number of RBCs transfusions (38.4%). Improved transfusion practices during abdomen surgery might conserve scarce blood resources largely because of its substantial operation quantity. After controlling for the hospital, the overtransfusion rate in patients without anaemia on admission was significantly higher than that in anaemic patients (16.9% vs 6.8%, P,0.0001). This study suggests that perioperative blood transfusion is gradually being standardized in China. However, rational blood usage still requires improvements. The low proportion of patients who have complete indication records indicated that an objective indication-guided blood transfusion needs to be further strengthened. Patients who had undergone thoracic, abdominal surgery, or without anaemia on admission were considered as potential populations for blood conservation. Our resultsare unlikely to beconclusive because of the typical sampling design. Nevertheless, these data have sounded alarm bells for perioperative blood conservation in China.

Prevalence, Awareness, Treatment, and Control of Hypertension among Kazakhs with high Salt Intake in Xinjiang, China: A Community-based Cross-sectional Study

Hypertension is a leading cause of death worldwide; data on hypertension among ethnic minorities in China are sparse. This study aimed to estimate hypertension prevalence, awareness, treatment, and control in a Kazakh population, and to assess the association between salt intake and the above measures. A cross-sectional survey was conducted among Kazakh adults (≥30 years old) in the town of Hongdun, Altay, Xinjiang. Survey procedures included a questionnaire, physical measurement, and laboratory tests. Of 1805 eligible individuals, 1668 (92.4%) were included in the analysis. After adjustment for gender, age, and occupation, prevalence of hypertension was 45.5%. The proportions with awareness, treatment, control, or medication-control were 61.0%, 28.8%, 2.9% and 10.1%, respectively. Higher prevalence was seen among nomads and farmers (50.7% and 44.6%, respectively). However, the proportions with treatment or control were lower than seen among urban citizens. Hypertension prevalence was higher in those with higher salt intake (p = 0.0008). In contrast, the proportions with awareness (p = 0.0389), treatment (p = 0.0010), control (p = 0.0503), and medication-control (p = 0.2012) reduced as salt intake increased. In conclusion, hypertension prevalence is high in this population, but the proportions with awareness, treatment, or control are sub-optimal. Public health interventions that improve hypertension prevention and control, particularly among nomads, is needed.

Passive smoking and stroke in men and women: a national population-based case-control study in China

An association between passive smoking and stroke is unclear in China, particularly the association with hemorrhagic stroke. This study included 16205 deaths due to stroke aged ≥30 years and 16205 non-stroke controls randomly selected and frequency-matched to cases on gender and age. Smoking of spouses, defined as ≥1 cigarette per day for up to 1 year, was taken as a measure of exposure to passive smoking of subjects that was retrospectively ascertained by interviewing surviving spouses. After adjustment for variables, passive smoking increased the risk of death by 10% (odds ratio (OR), 1.10; 95% confidence interval (CI), 1.05–1.16) for all strokes, by 10% (OR, 1.10; 95% CI, 1.04–1.16) for hemorrhagic stroke, and by 12% (OR, 1.12; 95% CI, 1.03–1.23) for ischemic stroke, compared with non-exposure. This finding was highly consistent in men or women and in smokers or non-smokers, and was generally consistent among zones of China despite geographic diversity. The risk significantly increased with exposure-years and quantity of cigarettes smoked daily by spouses. This study indicated that passive smoking is associated with deaths from all-type strokes. It is highly advisable for the government to promote strong tobacco prevention and cessation programs and smoke-free environments.

Smoking and adult glioma: a population-based case-control study in China

BACKGROUND Smoking increases the risk of numerous cancers; however, an association of smoking with adult gliomas has not been found in a population. METHODS This case-control study included 4556 glioma cases (ICD-9 code 191.0-191.9) aged ≥ 30 years and 9112 controls from a national survey of smoking and mortality in China in 1989-1991. Controls from 325 255 surviving spouses of all-cause deaths were randomly assigned to cases in each of 103 areas according to sex and age groups at a ratio of 2:1. Smoking information was ascertained retrospectively by interviewing surviving spouses. RESULTS After adjustment for confounders, smoking increased the risk of glioma deaths by 11% (odds ratio [OR] = 1.11; 95% confidence interval [CI]: 1.03-1.21). Compared with non-smokers; the increased risk was 9% (OR = 1.09; 95% CI: 0.99-1.20) in men and 16% (OR = 1.16; 95% CI: 1.00-1.36) in women. The risk increased with age and doses. For individuals aged ≥ 50 years, smoking was associated with higher risk of glioma death by 25% (OR = 1.25; 95% CI: 1.15-1.38); this increased risk for smokers who smoked ≥ 20 cigarettes daily for ≥ 30 years was 53% (OR = 1.53; 95% CI: 1.34-1.74). There were similar findings in both men and women and with either pathology-based or non-pathology-based comparisons. CONCLUSIONS This study indicates that smoking is associated with glioma deaths in the Chinese population. Long-term heavy smoking could be a factor for risk stratification in individuals attending brain tumor clinics.