Zhaojun Yang

Prevalence of cardiovascular disease risk factor in the Chinese population: the 2007–2008 China National Diabetes and Metabolic Disorders Study

AIMS Cardiovascular disease (CVD) is now the most prevalent and debilitating disease affecting the Chinese population. The goal of the present manuscript was to analyse cardiovascular risk factors and the prevalence of non-fatal CVDs from data gathered from the 2007-2008 China National Diabetes and Metabolic Disorders Study. METHODS AND RESULTS A nationally representative sample of 46 239 adults, 20 years of age or older, was randomly recruited using a multistage stratified design method. Lifestyle factors, diagnosis of CVD, stroke, diabetes, and family history of each subject were collected, and an oral glucose tolerance test or a standard meal test was performed. Various non-fatal CVDs were reported by the subjects. SUDAAN software was used to perform all weighted statistical analyses, with P < 0.05 considered statistically significant. The prevalence of coronary heart disease, stroke, and CVDs was 0.74, 1.07, and 1.78% in males; and 0.51, 0.60, and 1.10% in females, respectively. The presence of CVDs increased with age in both males and females. The prevalence of being overweight or obese, hypertension, dyslipidaemia, or hyperglycaemia was 36.67, 30.09, 67.43, and 26.69% in males; and 29.77, 24.79, 63.98, and 23.62% in females, respectively. In the total sample of 46 239 patients, the prevalence of one subject having 1, 2, 3, or ≥4 of the 5 defined risk factors (i.e. smoking, overweight or obese, hypertension, dyslipidaemia, or hyperglycaemia) was 31.17, 27.38, 17.76, and 10.19%, respectively. Following adjustment for gender and age, the odds ratio of CVDs for those who had 1, 2, 3, or ≥4 risk factors was 2.36, 4.24, 4.88, and 7.22, respectively, when compared with patients with no risk factors. CONCLUSION Morbidity attributed to the five defined cardiovascular risk factors was high in the Chinese population, with multiple risk factors present in the same individual. Therefore, reasonable prevention strategies should be designed to attenuate the rapid rise in cardiovascular morbidity.

Impact of waist circumference and body mass index on risk of cardiometabolic disorder and cardiovascular disease in Chinese adults: a national diabetes and metabolic disorders survey.

Background We updated the prevalence of obesity and evaluated the clinical utility of separate and combined waist circumference (WC) or body mass index (BMI) category increments in identifying cardiometabolic disorder (CMD) and cardiovascular disease (CVD) risk in Chinese adults. Methods and Findings 46,024 participants aged ≥20 years, a nationally representative sample surveyed in 2007–2008, were included in this analysis. Taking the cutoffs recommended by the Chinese Joint Committee for Developing Chinese Guidelines (JCDCG) and the Working Group on Obesity in China (WGOC) into account, the participants were divided into four WC and four BMI groups in 0.5-SD increments around the mean, and 16 cross-tabulated combination groups of WC and BMI. 27.1%, 31.4%, and 12.2% of Chinese adults are centrally obese, overweight, or obese according to JCDCG and WGOC criteria. After adjustment for confounders, after a 1-SD increment, WC is associated with a 1.7-fold or 2.2-fold greater risk of having DM or DM plus dyslipidemia than BMI, while BMI was associated with a 2.3-fold or 1.7-fold higher hypertension or hypertension plus dyslipidemia risk than WC. The combination of WC and BMI categories had stronger association with CMD risk, i.e., the adjusted ORs (95% CI) of having DM, hypertension, and dyslipidemia for the combined and separate highest WC and BMI categories were 2.19 (1.96–2.44) vs 1.88 (1.67–2.12) and 1.12 (0.99–1.26); 5.70 (5.24–6.19) vs 1.51 (1.39–1.65) and 1.69 (1.57–1.82); and 3.73 (3.42–4.07) vs 2.16 (1.98–2.35) and 1.33 (1.25–1.40), respectively. The combination of WC and BMI categories was more likely to identify individuals with lower WC and lower BMI at CVD risk, even after the effects of CMD were controlled (all P<0.05). Conclusion Central obesity, overweight, and obesity are epidemic in Chinese adults. The combination of WC and BMI measures is superior to the separate indices in identifying CMD and CVD risk.

Serum Lipids and Lipoproteins in Chinese Men and Women

Background— Because of rapid change in lifestyle risk factors, cardiovascular disease has become the leading cause of death in China. We sought to estimate the national levels of serum lipids and lipoproteins among the Chinese adult population. Methods and Results— We conducted a cross-sectional study in a nationally representative sample of 46 239 adults aged ≥20 years. Fasting serum total, high-density lipoprotein, and low-density lipoprotein cholesterol and triglycerides were measured by standard methods. The age-standardized estimates of total, high-density lipoprotein, and low-density lipoprotein cholesterol and triglycerides were 4.72 (95% confidence interval, 4.70–4.73), 1.30 (1.29–1.30), 2.68 (2.67–2.70), and 1.57 (1.55–1.58) mmol/L, respectively, in the Chinese adult population. In addition, 22.5% (21.8–23.3%) or 220.4 million (212.1–228.8) Chinese adults had borderline high total cholesterol (5.18–6.21 mmol/L), and 9.0% (8.5–9.5%) or 88.1 million (83.4–92.8) had high total cholesterol (≥6.22 mmol/L). The population estimates for borderline high (3.37–4.13 mmol/L), high (4.14–4.91 mmol/L), and very high (≥4.92 mmol/L) low-density lipoprotein cholesterol were 13.9% (13.3–14.5%) or 133.5 million (127.0–140.1), 3.5% (3.3–3.8%) or 33.8 million (31.2–36.5), and 3.0% (2.8–3.3%) or 29.0 million (26.3–31.8) persons, respectively. In addition, 22.3% (21.6–23.1%) or 214.9 million (207.0–222.8) persons had low high-density lipoprotein cholesterol (<1.04 mmol/L). The awareness, treatment, and control of borderline high or high total cholesterol were 11.0%, 5.1%, and 2.8%, respectively, in the Chinese adult population. Conclusions— Serum total and low-density lipoprotein cholesterol levels were high and increasing in the Chinese population. Without effective intervention, atherosclerotic cardiovascular diseases may soar in the near future in China.

Acarbose compared with metformin as initial therapy in patients with newly diagnosed type 2 diabetes: an open-label, non-inferiority randomised trial

BACKGROUND Metformin is the only first-line oral hypoglycaemic drug for type 2 diabetes recommended by international guidelines with proven efficacy, safety, and cost-effectiveness. However, little information exists about its use in Asian populations. We aimed to ascertain the effectiveness of the α-glucosidase inhibitor acarbose, extensively adopted in China, compared with metformin as the alternative initial therapy for newly diagnosed type 2 diabetes. METHODS In this 48-week, randomised, open-label, non-inferiority trial, patients who were newly diagnosed with type 2 diabetes, with a mean HbA1c of 7·5%, were enrolled from 11 sites in China. After a 4-week lifestyle modification run-in, patients were assigned to 24 weeks of monotherapy with metformin or acarbose as the initial treatment, followed by a 24-week therapy phase during which add-on therapy was used if prespecified glucose targets were not achieved. Primary endpoints were to establish whether acarbose was non-inferior to metformin in HbA1c reduction at week 24 and week 48 timepoints. The non-inferiority margin was 0·3%, with an expected null difference in the change from baseline to week 48 in HbA1c. Analysis was done on a modified intention-to-treat population. This study was registered with Chinese Clinical Trial Registry, number ChiCTR-TRC-08000231. FINDINGS Of the 788 patients randomly assigned to treatment groups, 784 patients started the intended study drug. HbA1c reduction at week 24 was -1·17% in the acarbose group and -1·19% in the metformin group. At week 48, the HbA1c reduction was -1·11% (acarbose) and -1·12% (metformin) with difference 0·01% (95% CI -0·12 to 0·14, p=0·8999). Six (2%) patients in the acarbose group and seven (2%) patients in the metformin group had serious adverse events, and two (1%) and four (1%) had hypoglycaemic episodes. INTERPRETATION This study provides evidence that acarbose is similar to metformin in efficacy, and is therefore a viable choice for initial therapy in Chinese patients newly diagnosed with type 2 diabetes. FUNDING Bayer Healthcare (China) and Double Crane Phama.

Prevalence of cardiovascular disease and risk factors in the Chinese population with impaired glucose regulation: the 2007-2008 China national diabetes and metabolic disorders study.

Cardiovascular disease (CVD) is one of the most common chronic diseases in China. This aim of this study is to determine the prevalence of CVDs and risk factors in Chinese impaired glucose regulation subjects.We used a multistage, stratified sampling method to select subjects from the general Chinese population aged 20 years and older. Subjects underwent an oral glucose tolerance test to identify normal glucose tolerance (NGT) and impaired glucose regulation including isolated impaired fasting glucose (i-IFG), impaired glucose tolerance (i-IGT), and combined IFG/IGT and diabetic mellitus (DM). A logistic regression analysis was performed to examine the association between glucose abnormalities and CVD events.We identified that 34 293 subjects had NGT, 1 469 i-IFG, 4 571 i-IGT, 957 IFG/IGT and 4 949 DM. The age-sex standardized prevalence rate of cardiovascular disease was 1.06% (95% CI 0.87-1.28), 1.79% (95% CI 1.37-2.33) and 3.83% (95% CI 2.79-5.24) in NGT, impaired glucose regulation and DM, respectively. Among impaired glucose subjects, prevalence of defined CVD risk factors (smoking, overweight, obesity, hypertension and dyslipidemia) was 29.52% (95% CI: 27.8-31.21), 36.25% (95% CI: 34.29-38.26), 10.05% (95% CI: 8.86-11.37), 36.43% (95% CI: 34.53-38.36) and 69.96% (95% CI: 67.87-71.98), respectively. Compared to 1 risk factor, the odds ratios (ORs) of CVDs with 2, 3 or 4 risk factors were 1.94 (95% CI: 0.74-5.09), 2.76 (95% CI: 1.06-7.21) and 5.84 (95% CI: 1.68-20.26), respectively. Additionally, compared to i-IFGs, ORs of CVDs with i-IGT and IFG/IGT were 2.88 (95%CI 1.36-6.01) and 2.12 (95% CI 0.83-5.44), respectively.The prevalence of cardiovascular risk factors was high in the Chinese impaired glucose regulation population. The postprandial hyperglycemia is more associated with CVD than isolated fasting hyperglycemia.

BMI and waist circumference are associated with impaired glucose metabolism and type 2 diabetes in normal weight Chinese adults

AIMS To examine the associations of BMI and waist circumference with glucose metabolism and (pre)diabetes among adults with BMI < 25 kg/m². METHODS We conducted a cross-sectional study in a nationally representative sample (10,098 men and 17,454 women) of Chinese adults aged ≥ 20 years with BMI < 25 kg/m². Glucose levels after at least 10 hours of overnight fasting, at 30 minutes and at 120 minutes after a standard 75-g oral glucose load were measured. Associations of BMI and waist circumference with outcomes were examined by general linear models for continuous outcomes and by logistic regression models for dichotomous outcomes. RESULTS Among those with BMI < 25 kg/m², 18.8% of men and 17.1% of women had abnormal glucose metabolism, including 4.9% of men and 3.8% of women with undiagnosed type 2 diabetes. For each SD increase in BMI (2.1 kg/m²) and waist circumference (8.3 cm), fasting glucose levels increased by 0.128 and 0.170 mmol/L in men, and by 0.112 and 0.167 mmol/L in women, respectively; the corresponding increases for 2-hour post-load glucose levels were 0.121 and 0.217 mmol/L in men, and 0.241 and 0.362 mmol/L in women. When simultaneously included in the same model, these associations with waist circumference were stronger than with BMI. CONCLUSION Obesity measures are associated with abnormal glucose metabolism and diabetes, with central obesity playing a more prominent role than general obesity in Chinese population with BMI < 25 kg/m². Chinese diabetes prevention and treatment programs should incorporate targeting of normal weight adults with central obesity.

Worse Pancreatic β-cell Function and Better Insulin Sensitivity in Older Chinese Without Diabetes

BACKGROUND Whether insulin secretion and insulin sensitivity in older Chinese differ from younger persons without diabetes has not been examined and is unknown to us. METHODS Oral glucose tolerance test was performed in a total of 32,245 Chinese without diabetes history. Insulin sensitivity was estimated by Matsudas insulin sensitivity index (Matsuda ISI), and insulin secretion was measured by the insulinogenic index. The insulin secretion and sensitivity were compared among three age groups: 20-39 (the young), 40-59 (the middle), and greater than or equal to 60 years (the older). RESULTS A higher proportion of postchallenge hyperglycemia (PH), both in prediabetes and in diabetes stage, was associated with older age. In the young, middle, and older age groups, the insulinogenic index median was 10.64, 8.40, and 6.67, respectively, in individuals with normal glucose tolerance (NGT); it was 8.56, 6.12, and 4.98 in individuals with prediabetes, respectively (p < .001 vs the young group). In these three age groups, the Matsuda insulin sensitivity index was 8.20, 8.39, and 8.84 in individuals with normal glucose tolerance, and it was 5.23, 5.94, and 6.33 in individuals with prediabetes, respectively (p < .05 vs the young group). These differences were independent of body mass index and waist circumference. CONCLUSIONS Older Chinese without diabetes are characterized with worse insulin secretion and better insulin sensitivity. Insulin insufficiency and insulin resistance may contribute disproportionately to abnormal glucose tolerance in people of different age.

Sex-Specific Prevalence of Diabetes and Cardiovascular Risk Factors in the Middle-Aged Population of China: A Subgroup Analysis of the 2007–2008 China National Diabetes and Metabolic Disorders Study

The sex difference in the prevalence rates of diabetes and cardiovascular diseases (CVDs) among the middle-aged population in China remain largely unknown. Therefore, we analyzed differences in the prevalence of diabetes, self-reported CVDs, and some CVD risk factors among men and women in the middle-aged population (30–49 years) and in individuals aged 50 years and older using data from the China National Diabetes and Metabolic Disorders Study of 2007–2008. Middle-aged men appeared to have significantly a higher prevalence of diabetes and self-reported CVDs than middle-aged women (8.07% vs 5.06% for diabetes, P < 0.001; 0.64% vs 0.22% for CVDs, P < 0.001). Men also showed higher rates of central obesity, hypertension, and dyslipidemia than women (all P < 0.01). Compared with women, men were more likely to drink alcohol and smoke cigarettes but less likely to be under diet control. The sex-specific differences in prediabetes, CVD, and CVD risk factors between men and women were diminished or even reversed in the population aged 50 years and older. No sex-specific differences were found in the prevalences of a family history of diabetes, coronary heart disease, and hypertension (P > 0.05) in middle-aged population. Specific strategies to reduce modifiable risk factors for the prevention and control of diabetes and CVD may be warranted in this population.

Association between Family History Risk Categories and Prevalence of Diabetes in Chinese Population

Aim To investigate the association between different family history risk categories and prevalence of diabetes in the Chinese population. Methods The family history of diabetes was obtained from each subject, and an oral glucose tolerance test was performed for measuring the fasting and postload glucose and insulin levels based on a national representative cross-sectional survey of 46,239 individuals (age ≥ 20 years) in the 2007–2008 China National Diabetes and Metabolism Disorders Study. The family history risk categories of diabetes were high, moderate, and average (FH2 and FH1: at least two generations and one generation of first-degree relatives with diabetes, respectively; FH0: no first-degree relatives with diabetes). Results The age- and gender-adjusted prevalence rates of diabetes were 32.7% (95% confidence interval (CI): 26.4–39.7%) in FH2, 20.1% (95% CI: 18.2–22.1%) in FH1, and 8.4% (95% CI: 7.9–8.9%) in FH0 (P < 0.0001). The calculated homeostatic model assessment-estimated insulin resistance (HOMA-IR), Matsuda insulin sensitivity index (ISI), and insulinogenic index (ΔI30/ΔG30) values showed significant trending changes among the three risk categories, with the most negative effects in FH2. Multivariate logistic regression analysis showed that the odds ratios of having diabetes were 6.16 (95% CI: 4.46–8.50) and 2.86 (95% CI: 2.41–3.39) times higher in FH2 and FH1, respectively, than in FH0 after adjustment for classical risk factors for diabetes. Conclusions Family history risk categories of diabetes have a significant, independent, and graded association with the prevalence of this disease in the Chinese population.

Prevalence and associated factors of microalbuminuria in Chinese individuals without diabetes: cross-sectional study

Objective To investigate the prevalence of microalbuminuria (MAU) among Chinese individuals without diabetes and the relationship between MAU and metabolic factors, individual socioeconomic status (SES), and regional economic development level. Design Cross-sectional study of prevalence of MAU. Setting 152 urban street districts and 112 rural villages from northeast, north, east, south central, northwest and southwest China. Participants 46 239 participants were recruited using a multistage stratified sampling design from 2007 to 2008. A total of 41 290 participants without diabetes determined by oral glucose tolerance test were included in the present study. Urine albumin/creatinine ratio results of 35 430 individuals were available. Primary and secondary outcome measures Positive detection of MAU was determined using an ACR of 22.1–299.9 mg/g in men 30.9–299.9 mg/g in women. Results The prevalence of MAU in men was 22.4% and 24.5% in women. In developed, intermediate-developed and under-developed areas, the prevalence of MAU in men was 20.7%, 21.9% and 32.5%, respectively; in women the prevalence was 19.6%, 26.0% and 29.5%, respectively. The prevalence of MAU increased as the number of metabolic disorders present increased, and as the number of lower SES components increased (farmer, below university education level and low income). Prevalence of MAU in developed and intermediate developed areas had adjusted risk ratios of 0.52 (95% CI 0.42 to 0.60) and 0.65 (95% CI 0.57 to 0.76), respectively. Multivariate logistic analyses demonstrated MAU was strongly associated with older age, high-blood pressure, higher blood glucose low education level, low occupational level and residence in under-developed region. Conclusions Several factors had independent correlations to MAU in China: older age, metabolic abnormalities, lower SES level and living in economically under-developed areas, which encourage the development of strategies to lower the risk for MAU in these susceptible populations.