Zhe Huang

The ideal cardiovascular health metrics associated inversely with mortality from all causes and from cardiovascular diseases among adults in a Northern Chinese industrial city.

Background and Aims The American Heart Association has recently established seven ideal cardiovascular health metrics for cardiovascular health promotion and disease reduction (i.e., non-smoking, normal body mass index, physically active, healthy diet, and normal levels of cholesterol, blood pressure and fasting blood glucose). The present study seeks to evaluate how well these metrics predict mortality from all causes and cardiovascular diseases in adult Chinese living in a northern industrial city. Methods and Results Data of 95,429 adults who participated in the Kailuan cohort study from June 2006 to October 2007 was analyzed. All participants underwent questionnaire assessment, clinical examination, laboratory assessments and were followed up biannually. During a median follow-up of 4.02 years, 1,843 deaths occurred, with 597 deaths resulting from cardiovascular diseases. Lower mortality rates from all causes and cardiovascular diseases were observed among the subjects who met a higher number of the ideal health metrics. Compared to the participants who met none or one ideal health metric, those meeting ≥5 ideal health metrics had a lower risk of all-cause mortality by 30% (adjusted hazard ratio, 0.70; 95% confidence interval, 0.56–0.88) and a lower risk of mortality from cardiovascular diseases by 39% (adjusted hazard ratio, 0.61; 95% confidence interval, 0.41–0.89) . Four metrics (smoking status, physical activity, blood pressure and fasting blood glucose) were significantly associated with all-cause mortality. Three metrics (physical activity, blood pressure and fasting blood glucose) were significantly associated with mortality from cardiovascular diseases. Conclusion The number of ideal health metrics is negatively associated with mortality rates from all causes and cardiovascular diseases among adults in a Northern Chinese industrial city. The data supports the AHA recommendation of ideal health metrics for adults from Northern China.

Resting heart rate and risk of hypertension: results of the Kailuan cohort study.

Objective: Resting heart rate (RHR) is a predictive risk factor of the development of cardiovascular diseases, but its association with arterial hypertension has remained unclear. This study investigated the relationship between RHR and new-onset hypertension (NOH) in an Asian population. Methods: The Kailuan study is a prospective longitudinal cohort study on cardiovascular risk factors and cardiovascular or cerebrovascular events. Hazard ratios with 95% confidence intervals (CIs) were calculated using Cox regression modelling. Results: Out of 101 510 individuals originally included into the Kailuan study, 31 507 participants (mean age: 46.3 ± 11.5 years) were selected with no previous arterial hypertension or cardiac arrhythmias. After a mean follow-up period of 3.5 ± 0.9 years, 12 565 (39.88%) individuals developed arterial hypertension. Incidence of hypertension was 104.4, 109.7, 114.2 and 124.6 per 1000 person-years for each RHR quartile. In multivariate analysis with adjustment for blood pressure, blood lipids, diabetes mellitus and other parameters, hazard ratios for NOH increased significantly (P < 0.0001) with increasing RHR quartile. Increase in RHR by 10 beats/minute was associated with an 8% increase in NOH. Individuals in the highest RHR quartile as compared with participants in the lowest quartile demonstrated a 16% greater risk of developing NOH [hazard ratio 1.16; 95% confidence interval (CI) 1.11–1.23]. There were no significant interactions between RHR and prehypertension, diabetes mellitus, age and BMI in terms of NOH risk, respectively. Conclusion: Independently of other baseline parameters such as blood pressure, blood lipids and diabetes mellitus, elevated RHR significantly increases the risk of incident hypertension. Measuring RHR is helpful in predicting the risk of eventual arterial hypertension.

Resting Heart Rate and Risk of Cardiovascular Diseases and All-Cause Death: The Kailuan Study

Background Resting heart rate (RHR) predicts both cardiovascular and noncardiovascular death in different populations. However, the results of the association between RHR and cardiovascular diseases (CVDs) are inconsistent, especially for each subtype of CVDs. Objective The aim of this study was to prospectively explore the relationship between RHR and CVDs including myocardial infarction (MI), ischemic stroke, and hemorrhagic stroke and all-cause death in a general population. Methods The Kailuan study is a prospective longitudinal cohort study on cardiovascular risk factors and cardiovascular or cerebrovascular events. Hazard ratio (HR) with 95% confidence intervals (CI) were calculated using Cox regression modeling. Results We analyzed 92,562 participants (18–98 years old) in the Kailuan Study. CVDs were developed in 1,903 people during follow-ups. In multivariate analysis with adjustment for major traditional cardiovascular risk factors, HRs of the highest quintile group compared with the lowest quintile group of RHR for all-cause CVDs, MI, any stroke, ischemic stroke, hemorrhagic stroke, and all-cause death were 1.03 (95% CI, 0.98–1.07), 1.10 (95% CI, 1.01–1.20), 1.01 (95% CI, 0.97–1.06), 1.02 (95% CI, 0.96–1.07), 1.01 (95% CI, 0.92–1.11) and 1.18, (95% CI, 1.13–1.23), respectively. Conclusions The elevated RHR was independently associated with the increased risk for MI and all-cause death, but not for all-cause CVDs, any stroke, ischemic stroke, nor hemorrhagic stroke. This indicates that the elevated RHR might be a risk marker for MI and all-cause death in general populations.

Longitudinal Patterns of Blood Pressure, Incident Cardiovascular Events, and All-Cause Mortality in Normotensive Diabetic People

Lower blood pressure (BP) within the normotensive range has been suggested to be deleterious in diabetic people using antihypertensive drugs. We hypothesized that BP <120/80 mm Hg and BP trajectories may predict further risk of all-cause mortality or cardiovascular events in normotensive diabetic individuals. We included 3159 diabetic adults, free of hypertension, atherosclerotic cardiovascular diseases, or cancer in 2006 (baseline), from a community-based cohort including 101 510 participants. A total of 831 participants with BP <120/80 mm Hg and 2328 participants with BP of 120 to 139/80 to 89 mm Hg were included. BP and other clinical covariates were repeatedly measured every 2 years. During 7 years of follow-up, we documented 247 deaths and 177 cardiovascular events. Diabetic people with BP <120/80 mm Hg had a 46% increased risk of all-cause mortality (95% confidence interval, 10%–93%) compared with those with BP of 120 to 139/80 to 89 mm Hg at baseline. We then estimated the association between BP trajectories from 2006 to 2008 and adverse events among 2311 diabetic people who had both BP measures at 2006 and 2008. Relative to stable BP of 120 to 139/80 to 89 mm Hg, having persistently BP <120/80 mm Hg (hazard ratio: 2.35; 95% confidence interval, 1.10–5.01) or a spontaneous decrease in BP from 120 to 139/80 to 89 to <120/80 mm Hg (hazard ratio: 3.04; 95% confidence interval, 1.56–5.92) was significantly associated with an increased risk of all-cause mortality during 2008 to 2014. A rise in BP from 120 to 139/80 to 89 to ≥140/90 mm Hg conferred a high risk of cardiovascular events (hazard ratio: 1.98; 95% confidence interval, 1.24–3.17). In normotensive diabetic people having a low BP or a decline in BP was both associated with an increased risk of all-cause mortality, whereas development of incident hypertension increased the risk of cardiovascular events.

The product of resting heart rate times blood pressure is associated with high brachial-ankle pulse wave velocity.

Objective To investigate potential associations between resting heart rate, blood pressure and the product of both, and the brachial-ankle pulse wave velocity (baPWV) as a maker of arterial stiffness. Methods The community-based “Asymptomatic Polyvascular Abnormalities in Community (APAC) Study” examined asymptomatic polyvascular abnormalities in a general Chinese population and included participants with an age of 40+ years without history of stroke and coronary heart disease. Arterial stiffness was defined as baPWV≥1400 cm/s. We measured and calculated the product of resting heart rate and systolic blood pressure (RHR-SBP) and the product of resting heart rate and mean arterial pressure (RHR-MAP). Results The study included 5153 participants with a mean age of 55.1±11.8 years. Mean baPWV was 1586±400 cm/s. Significant (P<0.0001) linear relationships were found between higher baPWV and higher resting heart rate or higher arterial blood pressure, with the highest baPWV observed in individuals from the highest quartiles of resting heart rate and blood pressure. After adjusting for confounding parameters such as age, sex, educational level, body mass index, fasting blood concentrations of glucose, blood lipids and high-sensitive C-reactive protein, smoking status and alcohol consumption, prevalence of arterial stiffness increased significantly (P<0.0001) with increasing RHR-SBP quartile (Odds Ratio (OR): 2.72;95%Confidence interval (CI):1.46,5.08) and increasing RHR-MAP (OR:2.10;95%CI:1.18,3.72). Similar results were obtained in multivariate linear regression analyses with baPWV as continuous variable. Conclusions Higher baPWV as a marker of arterial stiffness was associated with a higher product of RHR-SBP and RHR-MAP in multivariate analysis. In addition to other vascular risk factors, higher resting heart rate in combination with higher blood pressure are risk factors for arterial stiffness.

Ideal Cardiovascular Health Metrics and Incident Hyperuricemia

Hyperuricemia has been shown to be associated with increased risks of gout and cardiovascular diseases. We prospectively investigated the association between the American Heart Association (AHA) ideal cardiovascular health metrics, including smoking, body mass index, dietary intake, physical activity, blood pressure, total cholesterol, and fasting blood glucose, and the risk of developing hyperuricemia.

Body mass index and mortality in patients with type 2 diabetes mellitus: A prospective cohort study of 11,449 participants

AIMS To investigate the association between body-mass index and mortality in Chinese adults T2DM. METHODS 11,449 participants of Kailuan Study with T2DM were included in this prospective cohort study. All-cause mortality was calculated using Kaplan-Meier analysis. Cox proportional hazards analysis was used to estimate the association between BMI and mortality. RESULTS During a mean follow-up period of 7.25±1.42years, 1254 deaths occurred. The number of deaths of the underweight, normal weight, overweight, and obese group was 23, 389, 557, and 285; the corresponding mortality was 25.0%, 13.4%, 10.3%, and 9.4%, respectively. The obese group had the lowest all-cause mortality rate (log-rank chi-square=48.430, P<0.001). After adjusting for age, sex, fasting blood glucose, smoking status, systolic blood pressure, history of hypertension, stroke, cancer and myocardial infarction, compared with the normal weight group, Multivariate Cox proportional hazard regression analysis showed that HR (95% CI) of all-cause mortality in the underweight, overweight, and obese group was 1.497 (0.962, 2.330), 0.833 (0.728, 0.952), and 0.809 (0.690, 0.949). After stratifying for age tertiles, this trend remained. CONCLUSIONS In T2DM patients in north China, the risk for all-cause mortality was lower in the overweight and the obese groups than those in the normal weight and the underweight groups.

Sleep and CKD in Chinese Adults: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES To assess the association between self-reported sleep duration and quality and odds of having CKD in Chinese adults on the basis of a community study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this cross-sectional study, we included 11,040 Chinese adults who participated in an ongoing prospective study, the Kailuan cohort. Survey questionnaire items addressed insomnia, daytime sleepiness, snoring, and sleep duration during their 2012 interview. Overall sleep quality was evaluated by summarizing these four sleep parameters. Fasting blood samples and single random midstream morning urine samples were collected in 2012 and analyzed for serum creatinine and proteinuria. CKD was defined by eGFR<60 ml/min per 1.73 m2 or proteinuria >300 mg/dl. We also examined those at high or very high risk of having CKD, on the basis of the Kidney Disease Improving Global Outcomes recommendations. The association between sleep quality and CKD was assessed using logistic regression model. RESULTS Worse overall sleep quality was associated with higher likelihood of being high or very high risk for CKD (multiadjusted odds ratio, 2.69; 95% confidence interval, 1.30 to 5.59 comparing two extreme categories; P trend <0.01), but not overall CKD (multiadjusted odds ratio, 1.58; 95% confidence interval, 0.89 to 2.80 comparing two extreme categories; P trend =0.46), after adjusting for potential confounders. Specifically, individuals with worse sleep quality were more likely to have proteinuria (multiadjusted odds ratio, 1.95; 95% confidence interval, 1.03 to 3.67 comparing two extreme categories; P trend =0.02), rather than lower eGFR level (multiadjusted mean eGFR levels were 96.4 and 93.6 ml/min per 1.73 m2 in the two extreme sleep categories, respectively; P trend =0.13). However, there was no statistically significant association between individual sleep parameters and CKD status. CONCLUSIONS Worse overall sleep quality was associated with higher odds of being high or very high risk for CKD and proteinuria in Chinese adults.

Peripheral Inflammatory Biomarkers for Myocardial Infarction Risk: A Prospective Community-Based Study.

BACKGROUND Most previous studies regarding chronic inflammation and risk of myocardial infarction (MI) have lacked repeated measures of high-sensitivity C-reactive protein (hs-CRP) and/or white blood cell (WBC) count over time. We examined whether cumulative average and longitudinal changes in these biomarkers were associated with subsequent MI risk. METHODS In this prospective, community-based study, we included 82544 Chinese participants [66796 men and 15748 women; mean (SD) age 55.1 (9.86) y] without prior cardiovascular diseases or cancer at baseline (2006-2007). hs-CRP, WBC and other clinical covariates were assessed at baseline and every 2 years during follow-up. RESULTS During 6 years of follow-up (2006-2012), we documented 714 incident MI cases. Higher baseline and cumulative average concentrations of hs-CRP and/or WBC were consistently associated with increased risk of MI (Ptrend <0.001 for both). Longitudinal increase in hs-CRP (Ptrend <0.001), but not WBC, was also associated with a higher future risk of MI, after adjustment for their baseline values and other covariates. Each 1-mg/L increment per year in hs-CRP was associated with a 9.3% increase in risk for future MI [hazard ratio (HR) = 1.09, 95% CI, 1.03; 1.17]. Participants with high-grade inflammatory status (hs-CRP ≥10 mg/L and WBC ≥10 × 109/L) had a higher risk of MI occurring <3 months after hs-CRP/WBC assessments vs those with hs-CRP <0.5 mg/L and WBC <5 × 109/L (HR = 6.64; 95% CI, 1.49-29.6), as compared with MI occurring ≥4 years (HR = 2.95; 95% CI, 0.90, 9.65). CONCLUSIONS Plasma hs-CRP concentration and WBC predicted MI risk. Longitudinal increase in hs-CRP was also associated with a higher risk of MI.

Smell and Taste Dysfunction Is Associated with Higher Serum Total Cholesterol Concentrations in Chinese Adults

Background: Several lipid-related hormones and peptides, such as glucagon-like peptide-1 and leptin, are involved in the regulation of taste and smell function. However, to our knowledge, it remains unknown whether these chemosensory functions are associated with lipid profiles.Objective: We examined the cross-sectional association between taste and smell dysfunction and blood cholesterol concentrations.Methods: With the use of a questionnaire, we assessed chronic smell and taste dysfunction in 12,627 Chinese participants (10,418 men and 2209 women; mean age: 54.4 y) who did not take hypolipidemic agents. Participants were categorized into 3 groups based on the number of smell and taste dysfunctions, ranging from 0 (best) to 2 (worst). A general linear model was used to test differences in serum concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides (TGs) across groups with different smell and taste status after adjusting for age, sex, education, occupation, smoking, drinking, obesity, and history of cardiovascular disease, cancer, and head injury.Results: The prevalence of smell and taste dysfunction was 2.4% and 1.2%, respectively. Worse smell and taste dysfunction was associated with higher total cholesterol concentrations (P-trend = 0.005). No significant differences were observed in LDL cholesterol, HDL cholesterol, and TG concentrations across groups with different numbers of chemosensory dysfunctions (P-trend > 0.1 for all). The associations between chemosensory dysfunction and total cholesterol concentrations were more pronounced in participants aged ≤60 y and in those who were nonsmokers relative to their counterparts (P-interaction < 0.05 for all).Conclusions: In this large cross-sectional study, chemosensory dysfunction was associated with higher serum total cholesterol concentrations among Chinese adults. Prospective studies are needed to investigate the temporal relation between these chemosensory dysfunctions and hypercholesterolemia.