Yinghua Lin

Associations Between Age at Menarche and Menopause With Cardiovascular Disease, Diabetes, and Osteoporosis in Chinese Women

CONTEXT Ages at menarche and menopause are associated with cardiovascular disease (CVD), diabetes, and osteoporosis in Caucasian women, but associations remain unexplored in Chinese women. OBJECTIVE The purpose of this study was to assess associations between age at menarche and menopause with CVD, diabetes, and osteoporosis in Chinese women. DESIGN AND SETTING A cross-sectional, population-based study was conducted in Fujian, China, from June 2011 to January 2012. PARTICIPANTS Among 6242 women aged 21 to 92 years, 3304 postmenopausal women were enrolled, excluding premenopausal women (n = 2527), those with unreported ages at menarche and menopause (n = 138), those with unrecorded physical measurements (n = 203), and those with menarche age <8 years or >20 years (n = 70). MAIN OUTCOME MEASURES An oral glucose tolerance test, a 12-lead resting electrocardiogram, and calcaneus quantitative ultrasound were performed. RESULTS No significant associations were found between menarche age, diabetes, and osteoporosis (both P > .05); later menarche (>18 years) was significantly associated with lower CVD risk (odds ratio = 0.71, 95% confidence interval, 0.57-0.89; P = .002). Menopause age was not associated with diabetes; higher menopause age was associated with decreasing CVD risk (P for trend = .020) and earlier menopause (≤46 years) with significantly higher osteoporosis risk (odds ratio = 1.59, 95% confidence interval, 1.07-2.36; P = .023). CONCLUSIONS In China, ages at menarche and menopause are not associated with diabetes. Later menarche and menopause are associated with decreasing CVD risk and earlier menopause with higher osteoporosis risk. Menarche and menopause history may help identify women with increased risk of developing CVD and osteoporosis.

Genetic variations in CYP17A1, CACNB2 and PLEKHA7 are associated with blood pressure and/or hypertension in she ethnic minority of China

OBJECTIVES Two large-scale genome-wide association studies (GWAs) have identified multiple variants associated with blood pressure (BP) or hypertension. The present study was to investigate whether some variations were associated with BP traits and hypertension or even prehypertension in adult She ethnic minority of China. METHODS The population of the present study comprised 4460 (1979 males and 2481 females, respectively) unrelated she ethnic minority based on a cross-sectional study from Ningde City in Fujian province of China. There were 1692 hypertensives, 1600 prehypertensives and 1168 normotensive controls, respectively. We genotyped 7 variants in CYP17A1, PLEKHA7, CACNB2, ATP2B1, TBX3-TBX5, CSK-ULK3 and SH2B3 reported by the previous GWAs on Europeans. All analyses were performed in an additive genetic model. RESULTS As the minor allele of rs653178 in/near SH2B3 was very rare with the frequency of 0.018, we excluded this single nucleotide polymorphism (SNP) in the further analyses. Of the other 6 loci, linear regression analyses revealed that rs11191548 in CYP17A1 and rs11014166 in CACNB2 were significantly associated with systolic BP (β = -1.17, P = 0.002 and β = -0.50, P = 0.006, respectively), while only SNP rs11191548 was significantly associated with diastolic BP (β = -0.56, P=0.002) after adjusted by age, sex and BMI. Two variants in CACNB2 and PLEKHA7 were found to be significantly related to hypertension (odds ratios [OR] and (95% confidence interval [CI]): 0.79 (0.65-0.97) and 1.19 (1.01-1.41), respectively) in logistic regression analyses after adjusted by age, sex and BMI. In addition, we found that combined risk alleles of the 6 SNPs increased risk of hypertension in a stepwise fashion (P for trend < 0.001). However, none of the 6 SNPs was significantly associated with BMI or prehypertension status. While logistic analysis showed that subjects with cumulative risk alleles more than 9 had significantly higher risk for prehypertension (adjusted OR: 3.10, P < 0.001) compared with those with risk alleles less than 4. CONCLUSIONS We replicated that variations in CYP17A1, CACNB2 and PLEKHA7 were related to BP traits and/or hypertension in She population. In addition, although we failed to observe single gene associated with prehypertension, we first found that conjoint effect of multiple risk alleles on BP might increase the risk of progressing to prehypertension.

Association study of genetic variants of 17 diabetes-related genes/loci and cardiovascular risk and diabetic nephropathy in the Chinese She population.

Genetic determinations are important in type 2 diabetes (T2DM) pathology. We investigated associations between genetic variants of 17 diabetes‐related genes/loci, T2DM and diabetic complications in Chinese She subjects.

Association study of genetic variants of 17 diabetes-related genes/loci and cardiovascular risk and diabetic nephropathy in the Chinese She population (中国畲族人群17个糖尿病相关基因位点的遗传变异与心血管风险和糖尿病肾病的相关性)

Genetic determinations are important in type 2 diabetes (T2DM) pathology. We investigated associations between genetic variants of 17 diabetes‐related genes/loci, T2DM and diabetic complications in Chinese She subjects.

Diabetes and its chronic complications in the She ethnic minority group of China.

OBJECTIVE According to recent reports, the development of type 2 diabetes in China has soared at an alarming rate. However, most of the investigations were based on Han people, who account for the majority of people in China. Little is known about the prevalence of diabetes its chronic complications in the She people, who have their own traditional lifestyle and hereditable background, different from other Asian population. The present study investigated the prevalence of type 2 diabetes and associated risk factors in the adult population of She nationals. SUBJECTS AND METHODS A total of 5,385 participants entered into the analysis eventually, including 2,308 men and 3,077 women. An oral glucose tolerance test was performed in subjects without diagnosed diabetes. Liver function, cardiovascular risk (brachial-ankle pulse wave velocity, estimated glomerular filtration rate, and abnormal Minnesota codes findings), uric acid, and neuropathy were tested to assess the profiles of associated risks. RESULTS In general, the self-reported diabetes rate was 9.5%. After age and sex standardization, the prevalence of diabetes was 6.1% (6.7% for men and 5.7% for women) in She Chinese people. In logistic regression models, age, family history of diabetes, alcohol use, total cholesterol, and triglycerides were all significantly associated with the risk of diabetes in this cross-sectional study (all P<0.05). In all, 47.4% had cardiovascular risks, 19.4% had liver dysfunction, and 6.2% had hyperuricemia. For women, compared with the first quartile, log-transformed homeostasis model assessment for insulin resistance of the fourth quartile was significantly higher (P<0.05), and log-transformed homeostasis model assessment for β cells was also higher in the second, third, and fourth quartiles (all P<0.05). The prevalences of polyneuropathy in impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG/IGT, and diabetes mellitus (DM) were 16.1%, 13.1%, 18.6%, and 28.4% separately, which was higher than that in normal glucose tolerance. The prevalences of polyneuropathy in IFG/IGT and DM were higher than that in IGT. CONCLUSIONS The present study revealed that a total of 6.1% She people suffered from type 2 diabetes, which was lower than the average level of China, but the standardized prevalence of prediabetes was higher, 20.6%. Early peripheral neuropathy screening should be performed in the prediabetes population. The Toronto Clinical Neuropathy Scoring System is convenient to assess diabetic polyneuropathy in clinical practice and should be tested regularly for people in prediabetes. Liver dysfunction, headache, and insomnia, appearing before type 2 diabetes, should be assessed regularly to avoid deterioration.

Associations between cardiovascular risk, insulin resistance, β-cell function and thyroid dysfunction: a cross-sectional study in She ethnic minority group of Fujian Province in China

OBJECTIVE To investigate the associations between cardiovascular risk, insulin resistance (IR), β-cell function and thyroid dysfunction in She ethnic minority group in China. METHODS We enrolled 5080 participants of She ethnicity in this analysis eventually. We measured serum TSH and thyroid peroxidase antibody (TPOAb) concentrations, blood glucose and insulin levels in both fasting and 2-h postprandial states, serum lipid levels, blood pressure (BP), brachial-ankle pulse wave velocity (baPWV), electrophysiological parameters, including T(peak)-T(end) interval (T(p-e)), QT interval and height of the R wave in lead aVL (RaVL), and anthropometric parameters. RESULTS The total prevalence of thyroid dysfunction in this population is 12.1%. Hyperthyroid subjects had shorter T(p-e) interval and QT interval in electrocardiogram (ECG), while hypothyroid subjects had shorter T(p-e) interval and longer QT interval in ECG than euthyroid subjects. Neither hyperthyroid nor hypothyroid subjects showed significant difference in BP, pulse pressure, and baPWV compared with euthyroid subjects. RaVL was slightly higher in hyperthyroid subjects, though the difference did not reach statistical significance (P=0.08). Subjects with TSH<0.3  mIU/l had higher blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and β-cell function (HOMA-β), whereas subjects with TSH>10 mIU/l had lower insulin, HOMA-IR, and HOMA-β than the reference group. There was a significant negative correlation, albeit weak, between TSH and HOMA-IR, HOMA-β after adjustment for confounding factors. CONCLUSIONS Hypothyroid subjects may carry higher cardiovascular risk than euthyroid subjects. Moreover, IR and β-cell function are inversely correlated with TSH, which may be explained by the decreasing insulin-antagonistic effects of thyroid hormones along with increasing TSH.

Prevalence and Risk Factors Associated with Prehypertension and Hypertension in the Chinese She Population

Background: Little is known about the prevalence and cardiovascular risk factors for prehypertension and hypertension in the She ethnic minority population of Fujian province in China. Methods and Results: Between April 2009 and September 2009, 5,523 participants of She nationality aged between 20 and 80 years participated in this survey and 5,357 were eventually enrolled in analyses. The survey was carried out to assess blood pressure and cardiovascular risk factors. The prevalence of prehypertension and hypertension was 35.87 and 38.42%, respectively, in all participants. Only 26.63% of the subjects with hypertension were aware of their diagnosis. Multivariate logistic regression showed that age, gender, overweight/obesity, dyslipidemia and alcohol use were risk factors for prehypertension, and age, overweight/obesity, dyslipidemia, alcohol use, family history of hypertension and hyperuricemia were risk factors for hypertension. The clustering of 2 and ≥3 risk factors was in higher proportion for subjects with hypertension and prehypertension when compared with those with prehypertension and normotension, respectively. After adjusting for other confounding factors, multivariable logistic regression showed that the greater the number of clustering cardiovascular risk factors, the greater the odds ratios for prehypertension and hypertension are. Conclusion: Hypertension and prehypertension were common in the She population of Fujian province. Cardiovascular risk factors cluster during prehypertension and awareness of hypertension was minimal. Early lifestyle modifications could be advocated to prevent the transition from prehypertension to hypertension and cardiovascular disease.

Association among serum uric acid, cardiovascular risk, and arterial stiffness: A cross-sectional study in She ethnic minority group of Fujian Province in China

Objectives: To investigate the association between serum uric acid levels, cardiovascular risk, and arterial stiffness in She ethnic minority in South China’s Fujian Province. Methods: 5109 participants aged 20–79 yr were enrolled in analysis. Tpeak-Tend interval (Tp-e), QT interval, and height of the R wave in lead aVL (aVLR) were measured on 12-lead electrocardiogram (ECG), and Minnesota code-indicated major abnormal ECG MA-ECG was used as a risk indicator of cardiovascular disease. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV). Results: Longer Tp-e interval, greater Tp-e/QT ratio, and higher aVLR were observed in the highest quartile of uric acid level. The incidence of MA-ECG was gradually increased from lowest to highest quartile of serum uric acid in males (p for trend <0.01). After adjusting traditional cardiovascular risk factors, multivariate analysis revealed that the fourth quartile of serum uric acid level was independently associated with MA-ECG in males [odds ratios (OR) (95% confidence interval): 2.129 (1.376-3.295)] but not in females. Serum uric acid was also associated with abnormal baPWV, when adjusted for atherogenic confounders. Compared with the lowest serum uric acid quartile, the OR (95% confidence interval) of the second, third, and fourth quartile were 1.920 (1.246-2.957), 1.650 (1.064-2.558), and 2.501 (1.600-3.908) in males. Conclusion: Among China’s She ethnic minority, uric acid level was independently related to arterial stiffness assessed by baPWV in both genders. The evaluation of uric acid level was related to higher cardiovascular risk in males but not in females.

Effect of type 2 diabetes mellitus on pulmonary function.

BACKGROUND Type 2 diabetes mellitus (T2DM) is a metabolic disease with debilitating effects on multiple organs. The alveolar-capillary network in the lung is a large microvascular unit which may be affected by T2DM-associated microangiopathy. METHODS This retrospective study investigated whether type 2 diabetes mellitus (T2DM) affected pulmonary function. Of the 584 patients enrolled in the study, 292 had T2DM and 292 did not. Forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), maximum voluntary ventilation (MVV) and total lung capacity (TLC) are values as percent of predicted, as well as FEV₁/FVC ratio which were values measured. RESULTS FEV₁, FVC, FEV₁/FVC ratio, MVV, and TLC were significantly lower in T2DM than in non-T2DM (P-values < 0.010). Multiple linear regression analysis found that for the entire study population fasting plasma glucose levels was negatively associated with FEV₁, FVC, FEV₁/FVC ratio and maximum voluntary ventilation (P-values < 0.030). Patients with T2DM were negatively associated with total lung capacity (P-values = 0.025). Multiple linear regression analysis found for patients with T2DM that fasting plasma glucose was negatively associated with FEV₁, FVC, FEV₁/FVC ratio and maximum voluntary ventilation (P-values < 0.020). In T2DM patient, height was negatively correlated with FEV₁ and FVC (all P-values < 0.020), triglycerides were negatively correlated with FEV₁/FVC ratio (P-values = 0.048), and creatinine was negatively correlated with total lung capacity (P-values = 0.017). CONCLUSIONS In summary, T2DM is associated with impaired pulmonary function consistent with obstructive ventilation pattern and fasting plasma glucose is an independent risk factor of reduced pulmonary function.

Glycated hemoglobin, diabetes mellitus, and cardiovascular risk in a cross-sectional study among She Chinese population

Objective: To determine whether glycated hemoglobin (HbA1c) could be used to diagnose Type 2 diabetes mellitus in She Chinese People and to assess the role of HbA1c in the development of cardiovascular disease. Research design and methods: An ethnically representative sample of 687 (277 males and 410 females) adults, 20 yr of age or older participated in the study, and 75-g oral glucose tolerance test was administrated. Based on receiver operating characteristic curves, various cut-off values of HbA1c were used to stratify glucose tolerance. Several indexes were used to assess the cardiovascular risk, including estimated glomerular filtration rate (eGFR), Tpeak-end, Tp-e dispersion, aVL R wave, and QTc. Results: Using World Health Organization as gold standard, the HbA1c value of 6.9% was optimal to diagnose diabetes mellitus with a sensitivity of 35.3% and specificity of 94.0%. And for impaired fasting glucose, impaired glucose tolerance, and impaired glucose regulation, the cut-off points were all 6.1%. Assessed by logistic regression model, HbA1c was an independent risk factor for the decline in eGFR; R wave in lead aVL increased significantly (p<0.05) with the increase of HbA1c values. Other indexes reflecting the cardiovascular risks were not meaningful in our study. Conclusions: HbA1c may be not a preferred method to diagnose Type2 diabetes in She Chinese people. However, more attention should be paid to subjects with HbA1c>6.1%, and their blood glucose should be tightly measured in clinical practice. In addition, we suggest that HbA1c is a predictor of cardiovascular disease.