Objective Evidence suggests that depleted gut microbialα-diversity is associated with hypertension;however,whether metabolic markers affect this relationship remains unknown.We aimed to determine the potential metabo...Objective Evidence suggests that depleted gut microbialα-diversity is associated with hypertension;however,whether metabolic markers affect this relationship remains unknown.We aimed to determine the potential metabolites mediating the associations ofα-diversity with blood pressure(BP)and BP variability(BPV).Methods Metagenomics and plasma targeted metabolomics were conducted on 523 Chinese participants from the MetaSalt study.The 24-hour,daytime,and nighttime BP and BPV were calculated based on ambulatory BP measurements.Linear mixed models were used to characterize the relationships betweenα-diversity(Shannon and Chao1 index)and BP indices.Mediation analyses were performed to assess the contribution of metabolites to the observed associations.The influence of key metabolites on hypertension was further evaluated in a prospective cohort of 2,169 participants.Results Gut microbial richness(Chao1)was negatively associated with 24-hour systolic BP,daytime systolic BP,daytime diastolic BP,24-hour systolic BPV,and nighttime systolic BPV(P<0.05).Moreover,26 metabolites were strongly associated with richness(Bonferroni P<0.05).Among them,four key metabolites(imidazole propionate,2-hydroxy-3-methylbutyric acid,homovanillic acid,and hydrocinnamic acid)mediated the associations between richness and BP indices(proportions of mediating effects:14.1%–67.4%).These key metabolites were also associated with hypertension in the prospective cohort.For example,each 1-standard deviation unit increase in hydrocinnamic acid significantly reduced the risk of prevalent(OR[95%CI]=0.90[0.82,0.99];P=0.03)and incident hypertension(HR[95%CI]=0.83[0.71,0.96];P=0.01).Conclusion Our results suggest that gut microbial richness correlates with lower BP and BPV,and that certain metabolites mediate these associations.These findings provide novel insights into the pathogenesis and prevention of hypertension.展开更多
Objective The relationship between fish consumption and stroke is inconsistent,and it is uncertain whether this association varies across predicted stroke risks.Methods A cohort study comprising 95,800 participants fr...Objective The relationship between fish consumption and stroke is inconsistent,and it is uncertain whether this association varies across predicted stroke risks.Methods A cohort study comprising 95,800 participants from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project was conducted.A standardized questionnaire was used to collect data on fish consumption.Participants were stratified into low-and moderate-to-high-risk categories based on their 10-year stroke risk prediction scores.Hazard ratios(HRs)and 95%confidence intervals(CIs)were estimated using Cox proportional hazard models and additive interaction by relative excess risk due to interaction(RERI),attributable proportion(AP),and synergy index(SI).Results During 703,869 person-years of follow-up,2,773 incident stroke events were identified.Higher fish consumption was associated with a lower risk of stroke,particularly among moderate-to-high-risk individuals(HR=0.53,95%CI:0.47-0.60)than among low-risk individuals(HR=0.64,95%CI:0.49-0.85).A significant additive interaction between fish consumption and predicted stroke risk was observed(RERI=4.08,95%CI:2.80-5.36;SI=1.64,95%CI:1.42-1.89;AP=0.36,95%CI:0.28-0.43).Conclusion Higher fish consumption was associated with a lower risk of stroke,and this beneficial association was more pronounced in individuals with moderate-to-high stroke risk.展开更多
Background:It remains unclear whether the cardiovascular benefits of physical activity(PA)vary across populations with different predicted atherosclerotic cardiovascular disease(ASCVD)risks.This study aimed to determi...Background:It remains unclear whether the cardiovascular benefits of physical activity(PA)vary across populations with different predicted atherosclerotic cardiovascular disease(ASCVD)risks.This study aimed to determine the modification of predicted cardiovascular risk on the association between PA and ASCVD incidence.Methods:A total of 94,734 participants without ASCVD in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project were included,with a median follow-up of 6.0 years.PA volume(metabolic equivalent of task(MET)-h/day)and intensity(%,percentage of moderate-to-vigorous PA(MVPA))were assessed by questionnaires.Based on the ASCVD 10-year and lifetime risk prediction scores,participants were classified into low-to-medium-risk and high-risk groups.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)for ASCVD were calculated using Cox proportional hazards models.Results:During 679,438 person-years of follow-up,3470 ASCVD events occurred.Higher PA volume was associated with lower ASCVD incidence,which was more pronounced among high-predicted-risk individuals than their low-to-medium-risk counterparts,with HRs(95%CIs)of0.58(0.50-0.67)and 0.62(0.53-0.71)for the highest vs.lowest quartiles of PA volume,respectively.Additionally,analyses for PA intensity showed similar results.Compared with inactive individuals,there was a 32%(95%CI:25%-38%)and 23%(95%CI:13%-32%)risk reduction in high-and low-to-medium-risk groups,respectively,when over half of the PA volume was from MVPA.Furthermore,the additive interactions between PA and predicted risk indicated a further risk reduction by increasing PA,especially MVPA,in high-risk individuals.Conclusion:Engaging in more PA,especially MVPA,reduced the risk of ASCVD incidence,with greater benefits among high-risk individuals.These findings emphasize the imperative for personalized PA recommendations tailored to distinct risk populations—in particular,reinforcing PA guidance for high-risk individuals.展开更多
Background:The trade-off between the benefits of regular physical activity(PA)and the potentially detrimental effects of augmented exposure to air pollution in highly polluted regions remains unclear.This study aimed ...Background:The trade-off between the benefits of regular physical activity(PA)and the potentially detrimental effects of augmented exposure to air pollution in highly polluted regions remains unclear.This study aimed to examine whether ambient fine particulate matter(PM_(2.5))exposure modified the impacts of PA volume and intensity on hypertension risk.Methods:We included 54,797 participants without hypertension at baseline in a nationwide cohort of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project.PA volume and intensitywere assessed by questionnaire,and high-resolution(1 km×1 km)PM_(2.5)estimates were generated using a satellite-based model.Results:During 413,516 person-years of follow-up,12,100 incident hypertension cases were identified.PM_(2.5)significantly modified the relationship between PA and hypertension incidence(p_(interaction)<0.001).Increased PA volume was negatively associated with incident hypertension in the low PM_(2.5)stratum(<59.8μg/m^(3),ptrend<0.001),with a hazard ratio of 0.81(95%confidence interval(95%CI):0.74-0.88)when comparing the fourth with the first quartile of PA volume.However,the health benefits were not observed in the high PM_(2.5)stratum(≥59.8μg/m^(3),p_(trend)=0.370).Moreover,compared with light PA intensity,vigorous intensity was related to a 20%(95%CI:9%-29%)decreased risk of hypertension for participants exposed to low PM_(2.5),but a 17%(95%CI:4%-33%)increased risk for those with high PM_(2.5)levels.Conclusion:PA was associated with a reduced risk of hypertension only among participants with low PM_(2.5)exposure.Our findings recommended regular PA to prevent hypertension in less polluted regions and reinforced the importance of air quality improvement.展开更多
Background:Inconsistent results have been reported in developed countries for relationships between sedentary behavior and cancer incidence and mortality,and evidence from the Chinese population is scarce.This study a...Background:Inconsistent results have been reported in developed countries for relationships between sedentary behavior and cancer incidence and mortality,and evidence from the Chinese population is scarce.This study aimed to investigate such relationships in large Chinese population-based prospective cohorts and to explore the joint effect and interaction of sedentary behavior and moderate-to-vigorous physical activity(MVPA)on these relationships.Methods:We included 95,319 Chinese adults without cancer from 3 large cohorts and assessed their sedentary behavior and physical activity with a unified questionnaire.Cancer incidence and mortality were confirmed by interviewing participants or their proxies and checking hospital records and death certificates.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)for cancer and mortality were estimated using Cox proportional hazards regression models.Results:During 559,002 person-years of follow-up,2388 cancer events,1571 cancer deaths,and 4562 all-cause deaths were recorded.Sedentary behavior was associated with increased risk of developing cancer and deaths in a doseresponse manner.The multivariable-adjusted HRs(95%CIs)were the following:HR=1.16,95%CI:1.01-1.33;HR=1.24,95%CI:1.04-1.48;and HR=1.15,95%CI:1.04-1.28 for cancer incidence,cancer mortality,and all-cause mortality,respectively,for those having≥10 h/day of sedentary time compared with those having<6 h/day of sedentary time.Sedentary populations(≥10 h/day)developed cancer or died 4.09 years and 2.79 years earlier,respectively,at the index age of 50 years.Failure to achieve the recommended level of MVPA may further aggravate the adverse associations,with the highest cancer and mortality risks being observed among participants with both≥10 h/day of sedentary time and<150 min/week of MVPA.Limitations of this study include the fact that physical activity information was obtained via questionnaire instead of objective measurement and that there were insufficient incident cases for the analysis of associations between sedentary behavior and site-specific cancers.Conclusion:Sedentary behavior was associated with an increased risk of cancer and all-cause mortality among Chinese adults,especially for those with≥10 h/day of sedentary time.It is necessary to reduce sedentary time,in addition to increasing MVPA levels,for the prevention of cancer and premature death.展开更多
Objective In recent decades,China has implemented a series of policies to address air pollution.We aimed to assess the health effects of these policies on stroke burden attributable to ambient fine particulate matter(...Objective In recent decades,China has implemented a series of policies to address air pollution.We aimed to assess the health effects of these policies on stroke burden attributable to ambient fine particulate matter(PM_(2.5)).Methods Joinpoint regression was applied to explore the temporal tendency of stroke burden based on data from the Global Burden of Disease 2019 study.Results The age-standardized rates of disability-adjusted life year(DALY)for stroke attributable to ambient PM2.5 in China,increased dramatically during 1990-2012,subsequently decreased at an annual percentage change(APC)of-1.98[95% confidence interval(CI):-2.26,-1.71]during 2012-2019.For ischemic stroke(IS),the age-standardized DALY rates doubled from 1990 to 2014,and decreased at an APC of-0.83(95%CI:-1.33,-0.33)during 2014-2019.Intracerebral hemorrhage(ICH)showed a substantial increase in age-standardized DALY rates from 1990 to 2003,followed by declining trends,with APCs of-1.46(95%CI:-2.74,-0.16)during 2003-2007 and-3.33(95%CI:-3.61,-3.06)during 2011-2019,respectively.Conversely,the age-standardized DALY rates for subarachnoid hemorrhage(SAH)generally declined during 1990-2019.Conclusion Our results clarified the dynamic changes of the ambient PM_(2.5)-attributable stroke burden in China during 1990-2019,highlighting the health effects of air quality improvement policies.展开更多
Background:Statins are the first line of treatment for dyslipidemia,but their side effects often reduce medication compliance.Natto and red yeast rice are natural ingredients with lipid-lowering effects.However,the ef...Background:Statins are the first line of treatment for dyslipidemia,but their side effects often reduce medication compliance.Natto and red yeast rice are natural ingredients with lipid-lowering effects.However,the efficacy of Natto Red Yeast Rice(NRYR)supplement in combination with statins in regulating blood lipid levels has not been fully evaluated.Methods:Amulticenter,double-blinded,randomized-controlled trial was conducted among individuals with low-density lipoprotein cholesterol(LDL-C)of 3.4 to 5.0mmol/L at six sites in China,of those at moderate risk of cardiovascular disease(CVD)are prioritized.Participants are enrolled and randomly assigned into four groups by a combination of NRYR(or its placebo)and Simvastatin(or its placebo)in a ratio of 1:1:1:1.After examination at baseline,all participants underwent intervention for 3 months and two follow-up visits at 1 month and 3 months after the intervention.The primary outcome is the change in LDL-C level at 3 months,and secondary outcomes include changes in levels of other lipid profiles and biomarkers,as well as calculated 10-year CVD risk.A total of 1136 participants were randomly assigned,of whom 1110 received the intervention.Discussion:This study may provide new evidence for the efficacy of NRYR supplement in combination with statins to regulate lipid levels and optimize lipid management.Trial Registration:Chinese Clinical Trial Registry database:registration nos.ChiCTR2200064214,ChiCTR2200064215.展开更多
Evidence about the response patterns of fruit and vegetable consumption with the risk of cardiovascular disease(CVD)and allcause mortality was inconsistent.These associations were examined using a large-scale,populati...Evidence about the response patterns of fruit and vegetable consumption with the risk of cardiovascular disease(CVD)and allcause mortality was inconsistent.These associations were examined using a large-scale,population-based Chinese cohort comprising 100,728 participants.A food-frequency questionnaire was used to assess fruit and vegetable consumption.Outcomes were ascertained by interviewing individuals or their proxies and checking hospital records or death certificates.Cox proportional hazards regression was used to calculate hazard ratios(HRs)with 95% confidence intervals(CIs).At the 736,668 person-years of follow-up,3,677 CVD cases and 5,466 deaths were identified.The multivariable-adjusted HRs for CVD across increasing quartiles of total fruit and vegetable consumption were 1(reference),0.94(95%CI=0.85-1.04),0.89(95%CI=0.80-0.98),and 0.85(95%CI=0.77-0.95).Moreover,participants in the highest quartile displayed a 13% lower risk of all-cause mortality(HR=0.87;95%CI=0.80-0.95).A nonlinear dose-response relation was found for CVD,without additional benefits beyond a consumption of600 g d-1,whereas the all-cause mortality risk decreased along with higher consumption,with a linear trend.These associations remained significant for fruit consumption but not for vegetable consumption.Our findings indicated that greater fruit and vegetable consumption was significantly associated with a lower risk of CVD and all-cause mortality.Increasing fruit and vegetable consumption,especially fruit,in the general population would prevent CVD and premature mortality.展开更多
Backgrounds::Cardiovascular disease(CVD)remains the leading cause of deaths nationwide.However,little is understood about its temporal trend and corresponding influence on longevity improvements.We aimed to describe t...Backgrounds::Cardiovascular disease(CVD)remains the leading cause of deaths nationwide.However,little is understood about its temporal trend and corresponding influence on longevity improvements.We aimed to describe the updated tendency in CVD mortality and to quantify its impact on life expectancy(LE)increase in China.Methods::All-cause mortality rates were calculated with population sizes from the National Bureau of Statistics and death counts from the National Health Commission.We estimated CVD mortality rates by allocating age-and sex-based mortality envelopes to each CVD subtype based on its proportion derived from the Disease Surveillance Points system.The probability of CVD premature deaths and LE were calculated with life tables and we adopted Arriaga’s method to quantitate age-and cause-specific contributions to LE gains.Results::During 2013 to 2018,the age-standardized mortality rate of CVD decreased from 289.69(95%confidence interval[CI]:289.03,290.35)/100,000 to 272.37(95%CI:271.81,272.94)/100,000,along with a decline in probability of CVD premature deaths from 9.05%(95%CI:9.02%,9.09%)to 8.13%(95%CI:8.10%,8.16%).The gap in CVD mortality across sexes expanded with more remarkable declines in females,especially for those aged 15 to 64 years.Among major subtypes,the probability of premature deaths from hemorrhage stroke declined fastest,while improvements of ischemic stroke and ischemic heart disease were limited,and there was an increase in stroke sequelae.LE in China reached 77.04(95%CI:76.96,77.12)years in 2018 with an increase of 1.38 years from 2013.Of the total LE gains,21.15%(0.29 years)were attributed to reductions of CVD mortality in the overall population,mostly driven by those aged>65 years.Conclusions::The general process in reducing CVD mortality has contributed to longevity improvements in China.More attention should be paid to prevention and control of atherosclerotic CVD and stroke sequelae,especially for the elderly.Working-age males also deserve additional attention due to inadequate improvements.展开更多
Although emerging studies from high-income countries investigated the relationship between sedentary behavior(SB) and cardiovascular risk,little evidence came from developing countries.Moreover,the benefits of realloc...Although emerging studies from high-income countries investigated the relationship between sedentary behavior(SB) and cardiovascular risk,little evidence came from developing countries.Moreover,the benefits of reallocating time from SB to physical activity(PA) on incident cardiovascular disease(CVD) are unknown.Using three cohorts from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project,we included 93 110 adults who were free from CVD at baseline.Cox proportional hazards models were used to calculate the hazard ratios(HRs) and 95% confidence intervals(CIs) for CVD,including stroke,coronary heart disease,and CVD death.Isotemporal substitution models were applied to estimate the per-hour effects of replacing SB with PA.After 5.8 years follow-up,3799 CVD cases were identified.A gradient positive association between sedentary time and incident CVD was observed.Relative to those with <5 h/d sedentary time,the multivariable-adjusted HRs(95% CIs) of CVD incidence were 1.07(0.96-1.20),1.27(1.13-1.43) and 1.51(1.34-1.70) for those having 5-<8,8-<10,and> 10 h/d sedentary time,respectively.When participants were cross-classified by SB and moderate to vigorous physical activity(MVPA) level,the CVD risk was highest in those with> 10 h/d SB and <150 min/week MVPA.Among those who reported> 5 h/d sedentary time,per-hour substitution of SB with light,moderate,and vigorous PA reduced incident CVD risk by 5%,6%,and 8%,respectively.The study first found that sedentary time was associated with increased incident CVD risk among Chinese adults and that substitution of SB with PA of any intensity could convey cardiovascular benefits among those with> 5 h/d SB.展开更多
Individuals with a high degree of salt sensitivity(SS)have a greater risk of cardiovascular disease(CVD),but whether SS fosters CVD by influencing metabolomics homeostasis remains unclear.This study aimed to reveal th...Individuals with a high degree of salt sensitivity(SS)have a greater risk of cardiovascular disease(CVD),but whether SS fosters CVD by influencing metabolomics homeostasis remains unclear.This study aimed to reveal the role of the SS-related metabolomics signature in the development of CVDs,based on the MetaSalt study,which was a dietary salt-intervention trial conducted at four centers in China in 2019.A total of 528 participants were recruited and underwent 3 days of baseline observations,a 10-day low-salt intervention,and a 10-day highsalt intervention.Plasma untargeted metabolomics,lipidomics,and BP measurements were scheduled at each stage.Participants were grouped into extreme SS,moderate SS,and salt-resistant(SR)individuals according to their BP responses to salt.Linear mixed models were used to identify SS-related metabolites and determine the relationship between the SS-related metabolomics signature and arterial stiffness.Mendelian randomization(MR)analyses were applied to establish the causal pathways among the SS-related metabolites,BP,and CVDs.Among the 713 metabolites,467 were significantly changed after the high-salt intervention.Among them,the changes in 30 metabolites from the low-salt to the high-salt intervention differed among the SS groups.Of the remaining nonsalt-related metabolites,the baseline levels of 11 metabolites were related to SS.These 41 metabolites explained 23%of the variance in SS.Moreover,SS and its metabolomics signature were positively correlated with arterial stiffness.MR analyses demonstrated that the SS-related metabolites may affect CVD risk by altering BP,indicating that the increase in BP was the consequence of the changes in SS-related metabolites rather than the cause.Our study revealed that the metabolomics signature of SS individuals differs from that of SR individuals and that the changes in SS-related metabolites may increase arterial stiffness and foster CVDs.This study provides insight into understanding the biology and targets of SS and its role in CVDs.展开更多
Background:High sodium intake is an important risk factor for hypertension and cardiovascular disease.However,the association between gut microbiota composition and metabolomic profiles with dietary sodium intake and ...Background:High sodium intake is an important risk factor for hypertension and cardiovascular disease.However,the association between gut microbiota composition and metabolomic profiles with dietary sodium intake and blood pressure(BP)is not well-understood.The metabolome,microbiome,and dietary salt intervention(MetaSalt)study aimed to investigate microbial and metabolomic profiles related to dietary sodium intake and BP regulation.Methods:This family-based intervention study was conducted in four communities across three provinces in rural northern China in 2019.Probands with untreated prehypertension or stage-1 hypertension were identified through community-based BP screening,and family members including siblings,offspring,spouses,and parents were subsequently included.All participants participated in a 3-day baseline examination with usual diet consumption,followed by a 10-day low-salt diet(3 g/d of salt or 51.3 mmol/d of sodium)and a 10-day high-salt diet(18 g/d of salt or 307.8 mmol/d of sodium).Differences in mean BP levels were compared according to the intervention phases using a paired Student’s t-test.Results:A total of 528 participants were included in this study,with a mean age of 48.1 years,36.7%of whom were male,76.8%had a middle school(69.7%)or higher(7.1%)diploma,23.4%had a history of smoking,and 24.4%were current drinkers.The mean arterial pressure at baseline was 97.2±10.5 mm Hg for all participants,and significantly decreased during the low-salt intervention(93.8±9.3,P<0.0001)and subsequently increased during the high-salt intervention(96.4±10.0,P<0.0001).Conclusions:Our dietary salt intervention study has successfully recruited participants and will facilitate to evaluate the effects of gut microbiota and metabolites on BP regulation in response to sodium burden,which will provide important evidence for investigating the underlying mechanisms in the development of hypertension and subsequent cardiovascular diseases.Trial registration:The study was registered in the Chinese Clinical Trial Registry database(ChiCTR1900025171).展开更多
Background:Familial hypercholesterolemia(FH)is underrecognized,and its association with coronary artery disease(CAD)remains limited,especially in China.We aimed to investigate the prevalence of FH and its relationship...Background:Familial hypercholesterolemia(FH)is underrecognized,and its association with coronary artery disease(CAD)remains limited,especially in China.We aimed to investigate the prevalence of FH and its relationship with CAD in a large Chinese cohort.Methods:FH was defined using the Make Early Diagnosis to Prevent Early Death(MEDPED)criteria.The crude and age-sex standardized prevalence of FH were calculated based on surveys of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project during 2007−2008.The associations of FH with incident CAD and its major subtypes were estimated with the cohort-stratified multivariate Cox proportional hazard models based on the data from the baseline to the last follow-up(2018−2020).Results:Among 98,885 included participants,190 participants were defined as FH.Crude and age−sex standardized prevalence and 95%confidence interval(CI)of FH were 0.19%(0.17%-0.22%)and 0.13%(0.10%-0.16%),respectively.The prevalence varied across age groups and peaked in the group of 60-<70 years(0.28%),and the peak prevalence(0.18%)in males was earlier,yet lower than the peak crude prevalence in females(0.41%).During a mean follow-up of 10.7 years,2493 cases of incident CAD were identified.After multivariate adjustment,FH patients had a 2.03-fold greater risk of developing CAD compared to non-FH participants.Conclusions:The prevalence of FH was estimated to be 0.19%in the participants,and it was associated with an elevated risk of incident CAD.Our study suggests that early screening of FH has certain public health significance for the prevention of CAD.展开更多
Summary What is already known about this topic?Short-term PM_(2.5) exposure has been associated with hourly,24-hour,daytime,and nighttime blood pressure(BP)levels,and further studies focusing whether and how the assoc...Summary What is already known about this topic?Short-term PM_(2.5) exposure has been associated with hourly,24-hour,daytime,and nighttime blood pressure(BP)levels,and further studies focusing whether and how the associations with other ambulatory BP monitoring indicators are warranted.展开更多
The utility of the polygenic risk score(PRS)to identify individuals at higher risk of stroke beyond clinical risk remains unclear,and we clarified this using Chinese population-based prospective cohorts.Cox proportion...The utility of the polygenic risk score(PRS)to identify individuals at higher risk of stroke beyond clinical risk remains unclear,and we clarified this using Chinese population-based prospective cohorts.Cox proportional hazards models were used to estimate the 10-year risk,and Fine and Gray’s models were used for hazard ratios(HRs),their 95%confidence intervals(CIs),and the lifetime risk according to PRS and clinical risk categories.A total of 41,006 individuals aged 30–75 years with a mean follow-up of 9.0 years were included.Comparing the top versus bottom 5%of the PRS,the HR was 3.01(95%CI 2.03–4.45)in the total population,and similar findings were observed within clinical risk strata.Marked gradients in the 10-year and lifetime risk across PRS categories were also found within clinical risk categories.Notably,among individuals with intermediate clinical risk,the 10-year risk for those in the top 5%of the PRS(7.3%,95%CI 7.1%–7.5%)reached the threshold of high clinical risk(≥7.0%)for initiating preventive treatment,and this effect of the PRS on refining risk stratification was evident for ischemic stroke.Even among those in the top 10%and 20%of the PRS,the 10-year risk would also exceed this level when aged≥50 and≥60 years,respectively.Overall,the combination of the PRS with the clinical risk score improved the risk stratification within clinical risk strata and distinguished actual high-risk individuals with intermediate clinical risk.展开更多
To the Editor:According to guidelines from western countries as well as China,dietary patterns with low intake of cholesterol have been widely recommended for maintaining ideal lipid levels.As one of the major sources...To the Editor:According to guidelines from western countries as well as China,dietary patterns with low intake of cholesterol have been widely recommended for maintaining ideal lipid levels.As one of the major sources of both high-quality protein and dietary cholesterol,eggs have always been the focus in terms of diet.Although increased lipid levels induced by high egg intake have been revealed by randomized controlled trials(RCTs),they may not be sufficient to reflect the impacts of habitual egg intake due to high doses of egg intake of more than 7 eggs/week or even 14 eggs/week.Further,RCTs typically have shorter intervention periods of about 3 months,which may not observe a stable association due to homeostasis in cholesterol metabolism of human beings.[1,2]Up to now,only three cohorts assessed the associations of egg intake with lipid levels or dyslipidemia,and the findings were still controversial.One recent cohort study has reported the non-significant association between higher egg intake(≥7 vs.1 eggs/week)and lipid profiles.On the other hand,another cohort from Spain found that compared with<1 egg/week,>4 eggs/week had no significant influence on total cholesterol(TC)and triglyceride(TG),but significantly decreased high-density lipoprotein cholesterol(HDL-C)levels.[4]However,none of these cohorts were from developing countries,and the association between moderate egg intake and lipid profiles has not been well illustrated.Egg consumption in China,a representative of developing countries,is relatively higher,and it may be possible to better explore the appropriate range of egg intake.展开更多
Background: Despite the adverse effects of ambient fine particulate matter (PM_(2.5) ) on type 2 diabetes and the beneficial role of physical activity (PA), the influence of PM_(2.5) on the relationship between PA and...Background: Despite the adverse effects of ambient fine particulate matter (PM_(2.5) ) on type 2 diabetes and the beneficial role of physical activity (PA), the influence of PM_(2.5) on the relationship between PA and type 2 diabetes remains unclear.Methods: In this prospective study with 71,689 participants, PA was assessed by a questionnaire and was categorized into quartiles for volume and three groups for intensity. Long-term PM_(2.5) exposure was calculated using 1-km resolution satellite-based PM_(2.5) estimates. PM_(2.5) exposure and PA's effect on type 2 diabetes were assessed by cohort-stratified Cox proportional hazards models, individually and in combination.Results: In 488,166 person-years of follow-up, 5487 incident type 2 diabetes cases were observed. The association between PA and type 2 diabetes was modified by PM_(2.5) . Compared with the lowest quartile of PA volume, the highest quartile was associated with reduced type 2 diabetes risk in low PM_(2.5) stratification (≤65.02 μg/m^(3)) other than in high PM_(2.5) stratification (>65.02 μg/m^(3)), with the hazard ratio (HR) of 0.75 (95% confidence interval [CI]: 0.66-0.85) and 1.10 (95% CI: 0.99-1.22), respectively. Similar results were observed for PA intensity. High PM_(2.5) exposure combined with the highest PA levels increased the risk of type 2 diabetes the most (HR= 1.79, 95% CI: 1.59-2.01 for PA volume;HR = 1.82, 95% CI: 1.64-2.02 for PA intensity).Conclusion: PA could reduce type 2 diabetes risk in low-pollution areas, but high PM_(2.5) exposure may weaken or even reverse the protective effects of PA. Safety and health benefits of PA should be thoroughly assessed for long-term polluted residents.展开更多
基金supported by the National Science and Technology Major Program for Noncommunicable Chronic Diseases(2023ZD0503500)the National Natural Science Foundation of China(82030102,12126602,91857118)+1 种基金the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2021-I2M-1-010,2019-I2M-2-003)the National High Level Hospital Clinical Research Funding(2022-GSP-GG-1,2022-GSP-GG-2)。
文摘Objective Evidence suggests that depleted gut microbialα-diversity is associated with hypertension;however,whether metabolic markers affect this relationship remains unknown.We aimed to determine the potential metabolites mediating the associations ofα-diversity with blood pressure(BP)and BP variability(BPV).Methods Metagenomics and plasma targeted metabolomics were conducted on 523 Chinese participants from the MetaSalt study.The 24-hour,daytime,and nighttime BP and BPV were calculated based on ambulatory BP measurements.Linear mixed models were used to characterize the relationships betweenα-diversity(Shannon and Chao1 index)and BP indices.Mediation analyses were performed to assess the contribution of metabolites to the observed associations.The influence of key metabolites on hypertension was further evaluated in a prospective cohort of 2,169 participants.Results Gut microbial richness(Chao1)was negatively associated with 24-hour systolic BP,daytime systolic BP,daytime diastolic BP,24-hour systolic BPV,and nighttime systolic BPV(P<0.05).Moreover,26 metabolites were strongly associated with richness(Bonferroni P<0.05).Among them,four key metabolites(imidazole propionate,2-hydroxy-3-methylbutyric acid,homovanillic acid,and hydrocinnamic acid)mediated the associations between richness and BP indices(proportions of mediating effects:14.1%–67.4%).These key metabolites were also associated with hypertension in the prospective cohort.For example,each 1-standard deviation unit increase in hydrocinnamic acid significantly reduced the risk of prevalent(OR[95%CI]=0.90[0.82,0.99];P=0.03)and incident hypertension(HR[95%CI]=0.83[0.71,0.96];P=0.01).Conclusion Our results suggest that gut microbial richness correlates with lower BP and BPV,and that certain metabolites mediate these associations.These findings provide novel insights into the pathogenesis and prevention of hypertension.
基金supported by the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(2021-I2M-1-010,2019-I2M-2-003,and 2017-I2M-1-004)the National High Level Hospital Clinical Research Funding(2022-GSPGG-1,2022-GSP-GG-2)+2 种基金the Research Unit of Prospective Cohort of Cardiovascular Diseases and Cancers,CAMS(2019RU038)the National Key Research and Development Program of China(2018YFE0115300 and 2017YFC0211700)the National Natural Science Foundation of China(82030102,12126602).
文摘Objective The relationship between fish consumption and stroke is inconsistent,and it is uncertain whether this association varies across predicted stroke risks.Methods A cohort study comprising 95,800 participants from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project was conducted.A standardized questionnaire was used to collect data on fish consumption.Participants were stratified into low-and moderate-to-high-risk categories based on their 10-year stroke risk prediction scores.Hazard ratios(HRs)and 95%confidence intervals(CIs)were estimated using Cox proportional hazard models and additive interaction by relative excess risk due to interaction(RERI),attributable proportion(AP),and synergy index(SI).Results During 703,869 person-years of follow-up,2,773 incident stroke events were identified.Higher fish consumption was associated with a lower risk of stroke,particularly among moderate-to-high-risk individuals(HR=0.53,95%CI:0.47-0.60)than among low-risk individuals(HR=0.64,95%CI:0.49-0.85).A significant additive interaction between fish consumption and predicted stroke risk was observed(RERI=4.08,95%CI:2.80-5.36;SI=1.64,95%CI:1.42-1.89;AP=0.36,95%CI:0.28-0.43).Conclusion Higher fish consumption was associated with a lower risk of stroke,and this beneficial association was more pronounced in individuals with moderate-to-high stroke risk.
基金supported by the National Natural Science Foundation of China(Grant No.:82322059(FL))Noncommunicable Chronic Diseases-National Science and Technology Major Project(Grant No.:2023ZD0503500(XFL))+1 种基金Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Grant No.:2021-I2M-1-010(FL))National High-Level Hospital Clinical Research Funding(Grant No.:2022-GSP-GG-1(DG),2022-GSP-GG-2(XFL),and 2023GSP-RC-19(FL))。
文摘Background:It remains unclear whether the cardiovascular benefits of physical activity(PA)vary across populations with different predicted atherosclerotic cardiovascular disease(ASCVD)risks.This study aimed to determine the modification of predicted cardiovascular risk on the association between PA and ASCVD incidence.Methods:A total of 94,734 participants without ASCVD in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project were included,with a median follow-up of 6.0 years.PA volume(metabolic equivalent of task(MET)-h/day)and intensity(%,percentage of moderate-to-vigorous PA(MVPA))were assessed by questionnaires.Based on the ASCVD 10-year and lifetime risk prediction scores,participants were classified into low-to-medium-risk and high-risk groups.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)for ASCVD were calculated using Cox proportional hazards models.Results:During 679,438 person-years of follow-up,3470 ASCVD events occurred.Higher PA volume was associated with lower ASCVD incidence,which was more pronounced among high-predicted-risk individuals than their low-to-medium-risk counterparts,with HRs(95%CIs)of0.58(0.50-0.67)and 0.62(0.53-0.71)for the highest vs.lowest quartiles of PA volume,respectively.Additionally,analyses for PA intensity showed similar results.Compared with inactive individuals,there was a 32%(95%CI:25%-38%)and 23%(95%CI:13%-32%)risk reduction in high-and low-to-medium-risk groups,respectively,when over half of the PA volume was from MVPA.Furthermore,the additive interactions between PA and predicted risk indicated a further risk reduction by increasing PA,especially MVPA,in high-risk individuals.Conclusion:Engaging in more PA,especially MVPA,reduced the risk of ASCVD incidence,with greater benefits among high-risk individuals.These findings emphasize the imperative for personalized PA recommendations tailored to distinct risk populations—in particular,reinforcing PA guidance for high-risk individuals.
基金supported by the National Key Research and Development Program of China(2018YFE0115300 and 2017YFC0211703)the National Natural Science Foundation of China(91643208,82073658,and 91843302)+3 种基金the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2021-I2M-1-010,2017-I2M-1-004,and 2019-I2M-2-003)Research Unit of Prospective Cohort of Cardiovascular Diseases and Cancers,Chinese Academy of Medical Sciences(2019RU038)the China Medical Board(15-220)supported by the National Institute of Environmental Health Sciences of the National Institutes of Health(Award#1R01ES032140).
文摘Background:The trade-off between the benefits of regular physical activity(PA)and the potentially detrimental effects of augmented exposure to air pollution in highly polluted regions remains unclear.This study aimed to examine whether ambient fine particulate matter(PM_(2.5))exposure modified the impacts of PA volume and intensity on hypertension risk.Methods:We included 54,797 participants without hypertension at baseline in a nationwide cohort of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project.PA volume and intensitywere assessed by questionnaire,and high-resolution(1 km×1 km)PM_(2.5)estimates were generated using a satellite-based model.Results:During 413,516 person-years of follow-up,12,100 incident hypertension cases were identified.PM_(2.5)significantly modified the relationship between PA and hypertension incidence(p_(interaction)<0.001).Increased PA volume was negatively associated with incident hypertension in the low PM_(2.5)stratum(<59.8μg/m^(3),ptrend<0.001),with a hazard ratio of 0.81(95%confidence interval(95%CI):0.74-0.88)when comparing the fourth with the first quartile of PA volume.However,the health benefits were not observed in the high PM_(2.5)stratum(≥59.8μg/m^(3),p_(trend)=0.370).Moreover,compared with light PA intensity,vigorous intensity was related to a 20%(95%CI:9%-29%)decreased risk of hypertension for participants exposed to low PM_(2.5),but a 17%(95%CI:4%-33%)increased risk for those with high PM_(2.5)levels.Conclusion:PA was associated with a reduced risk of hypertension only among participants with low PM_(2.5)exposure.Our findings recommended regular PA to prevent hypertension in less polluted regions and reinforced the importance of air quality improvement.
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2019-I2M-2-003,2017-I2M-1-004)National Key R&D Program of China(2017YFC0211700,2018YFE0115300)the National Natural Science Foundation of China(91643208).
文摘Background:Inconsistent results have been reported in developed countries for relationships between sedentary behavior and cancer incidence and mortality,and evidence from the Chinese population is scarce.This study aimed to investigate such relationships in large Chinese population-based prospective cohorts and to explore the joint effect and interaction of sedentary behavior and moderate-to-vigorous physical activity(MVPA)on these relationships.Methods:We included 95,319 Chinese adults without cancer from 3 large cohorts and assessed their sedentary behavior and physical activity with a unified questionnaire.Cancer incidence and mortality were confirmed by interviewing participants or their proxies and checking hospital records and death certificates.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)for cancer and mortality were estimated using Cox proportional hazards regression models.Results:During 559,002 person-years of follow-up,2388 cancer events,1571 cancer deaths,and 4562 all-cause deaths were recorded.Sedentary behavior was associated with increased risk of developing cancer and deaths in a doseresponse manner.The multivariable-adjusted HRs(95%CIs)were the following:HR=1.16,95%CI:1.01-1.33;HR=1.24,95%CI:1.04-1.48;and HR=1.15,95%CI:1.04-1.28 for cancer incidence,cancer mortality,and all-cause mortality,respectively,for those having≥10 h/day of sedentary time compared with those having<6 h/day of sedentary time.Sedentary populations(≥10 h/day)developed cancer or died 4.09 years and 2.79 years earlier,respectively,at the index age of 50 years.Failure to achieve the recommended level of MVPA may further aggravate the adverse associations,with the highest cancer and mortality risks being observed among participants with both≥10 h/day of sedentary time and<150 min/week of MVPA.Limitations of this study include the fact that physical activity information was obtained via questionnaire instead of objective measurement and that there were insufficient incident cases for the analysis of associations between sedentary behavior and site-specific cancers.Conclusion:Sedentary behavior was associated with an increased risk of cancer and all-cause mortality among Chinese adults,especially for those with≥10 h/day of sedentary time.It is necessary to reduce sedentary time,in addition to increasing MVPA levels,for the prevention of cancer and premature death.
基金supported by National Key Research and Development Program of China(2018YFE0115300,2022YFC3600800,2017YFC0211706)Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(2021-I2M-1-010)+3 种基金National Natural Science Foundation of China(82073658,82070473)National High Level Hospital Clinical Research Funding(2022-GSP-GG-1,2022-GSP-GG-2)Research Unit of Prospective Cohort of Cardiovascular Diseases and Cancers,CAMS(2019RU038)National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,CAMS(NCRC2020006)。
文摘Objective In recent decades,China has implemented a series of policies to address air pollution.We aimed to assess the health effects of these policies on stroke burden attributable to ambient fine particulate matter(PM_(2.5)).Methods Joinpoint regression was applied to explore the temporal tendency of stroke burden based on data from the Global Burden of Disease 2019 study.Results The age-standardized rates of disability-adjusted life year(DALY)for stroke attributable to ambient PM2.5 in China,increased dramatically during 1990-2012,subsequently decreased at an annual percentage change(APC)of-1.98[95% confidence interval(CI):-2.26,-1.71]during 2012-2019.For ischemic stroke(IS),the age-standardized DALY rates doubled from 1990 to 2014,and decreased at an APC of-0.83(95%CI:-1.33,-0.33)during 2014-2019.Intracerebral hemorrhage(ICH)showed a substantial increase in age-standardized DALY rates from 1990 to 2003,followed by declining trends,with APCs of-1.46(95%CI:-2.74,-0.16)during 2003-2007 and-3.33(95%CI:-3.61,-3.06)during 2011-2019,respectively.Conversely,the age-standardized DALY rates for subarachnoid hemorrhage(SAH)generally declined during 1990-2019.Conclusion Our results clarified the dynamic changes of the ambient PM_(2.5)-attributable stroke burden in China during 1990-2019,highlighting the health effects of air quality improvement policies.
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2021-I2M-1-010)the BYHEALTH Nutrition and Health Research Foundation(No.TY202104003).
文摘Background:Statins are the first line of treatment for dyslipidemia,but their side effects often reduce medication compliance.Natto and red yeast rice are natural ingredients with lipid-lowering effects.However,the efficacy of Natto Red Yeast Rice(NRYR)supplement in combination with statins in regulating blood lipid levels has not been fully evaluated.Methods:Amulticenter,double-blinded,randomized-controlled trial was conducted among individuals with low-density lipoprotein cholesterol(LDL-C)of 3.4 to 5.0mmol/L at six sites in China,of those at moderate risk of cardiovascular disease(CVD)are prioritized.Participants are enrolled and randomly assigned into four groups by a combination of NRYR(or its placebo)and Simvastatin(or its placebo)in a ratio of 1:1:1:1.After examination at baseline,all participants underwent intervention for 3 months and two follow-up visits at 1 month and 3 months after the intervention.The primary outcome is the change in LDL-C level at 3 months,and secondary outcomes include changes in levels of other lipid profiles and biomarkers,as well as calculated 10-year CVD risk.A total of 1136 participants were randomly assigned,of whom 1110 received the intervention.Discussion:This study may provide new evidence for the efficacy of NRYR supplement in combination with statins to regulate lipid levels and optimize lipid management.Trial Registration:Chinese Clinical Trial Registry database:registration nos.ChiCTR2200064214,ChiCTR2200064215.
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2017-I2M-1-004,2019-I2M-2-003)National Key Research and Development Program of China(2017YFC0211700,2018YFE0115300)the National Natural Science Foundation of China(91643208)。
文摘Evidence about the response patterns of fruit and vegetable consumption with the risk of cardiovascular disease(CVD)and allcause mortality was inconsistent.These associations were examined using a large-scale,population-based Chinese cohort comprising 100,728 participants.A food-frequency questionnaire was used to assess fruit and vegetable consumption.Outcomes were ascertained by interviewing individuals or their proxies and checking hospital records or death certificates.Cox proportional hazards regression was used to calculate hazard ratios(HRs)with 95% confidence intervals(CIs).At the 736,668 person-years of follow-up,3,677 CVD cases and 5,466 deaths were identified.The multivariable-adjusted HRs for CVD across increasing quartiles of total fruit and vegetable consumption were 1(reference),0.94(95%CI=0.85-1.04),0.89(95%CI=0.80-0.98),and 0.85(95%CI=0.77-0.95).Moreover,participants in the highest quartile displayed a 13% lower risk of all-cause mortality(HR=0.87;95%CI=0.80-0.95).A nonlinear dose-response relation was found for CVD,without additional benefits beyond a consumption of600 g d-1,whereas the all-cause mortality risk decreased along with higher consumption,with a linear trend.These associations remained significant for fruit consumption but not for vegetable consumption.Our findings indicated that greater fruit and vegetable consumption was significantly associated with a lower risk of CVD and all-cause mortality.Increasing fruit and vegetable consumption,especially fruit,in the general population would prevent CVD and premature mortality.
基金This study was supported by grants from the Chinese Academyof MedicalSciences(CAMS)Innovation Fund for Medical Sciences(No.2021-I2M-1-010,No.2017-I2M-1-004)the National Natural Science Foundation of China(No.12126602,No.82030102)the National Key R&D Program of China(No.2017YFC0211700).
文摘Backgrounds::Cardiovascular disease(CVD)remains the leading cause of deaths nationwide.However,little is understood about its temporal trend and corresponding influence on longevity improvements.We aimed to describe the updated tendency in CVD mortality and to quantify its impact on life expectancy(LE)increase in China.Methods::All-cause mortality rates were calculated with population sizes from the National Bureau of Statistics and death counts from the National Health Commission.We estimated CVD mortality rates by allocating age-and sex-based mortality envelopes to each CVD subtype based on its proportion derived from the Disease Surveillance Points system.The probability of CVD premature deaths and LE were calculated with life tables and we adopted Arriaga’s method to quantitate age-and cause-specific contributions to LE gains.Results::During 2013 to 2018,the age-standardized mortality rate of CVD decreased from 289.69(95%confidence interval[CI]:289.03,290.35)/100,000 to 272.37(95%CI:271.81,272.94)/100,000,along with a decline in probability of CVD premature deaths from 9.05%(95%CI:9.02%,9.09%)to 8.13%(95%CI:8.10%,8.16%).The gap in CVD mortality across sexes expanded with more remarkable declines in females,especially for those aged 15 to 64 years.Among major subtypes,the probability of premature deaths from hemorrhage stroke declined fastest,while improvements of ischemic stroke and ischemic heart disease were limited,and there was an increase in stroke sequelae.LE in China reached 77.04(95%CI:76.96,77.12)years in 2018 with an increase of 1.38 years from 2013.Of the total LE gains,21.15%(0.29 years)were attributed to reductions of CVD mortality in the overall population,mostly driven by those aged>65 years.Conclusions::The general process in reducing CVD mortality has contributed to longevity improvements in China.More attention should be paid to prevention and control of atherosclerotic CVD and stroke sequelae,especially for the elderly.Working-age males also deserve additional attention due to inadequate improvements.
基金supported by the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2019-I2M-2-003, 2017-I2M-1-004)National Key R&D Program of China (2017YFC0211700 and 2018YFE0115300)the National Natural Science Foundation of China (91643208)。
文摘Although emerging studies from high-income countries investigated the relationship between sedentary behavior(SB) and cardiovascular risk,little evidence came from developing countries.Moreover,the benefits of reallocating time from SB to physical activity(PA) on incident cardiovascular disease(CVD) are unknown.Using three cohorts from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project,we included 93 110 adults who were free from CVD at baseline.Cox proportional hazards models were used to calculate the hazard ratios(HRs) and 95% confidence intervals(CIs) for CVD,including stroke,coronary heart disease,and CVD death.Isotemporal substitution models were applied to estimate the per-hour effects of replacing SB with PA.After 5.8 years follow-up,3799 CVD cases were identified.A gradient positive association between sedentary time and incident CVD was observed.Relative to those with <5 h/d sedentary time,the multivariable-adjusted HRs(95% CIs) of CVD incidence were 1.07(0.96-1.20),1.27(1.13-1.43) and 1.51(1.34-1.70) for those having 5-<8,8-<10,and> 10 h/d sedentary time,respectively.When participants were cross-classified by SB and moderate to vigorous physical activity(MVPA) level,the CVD risk was highest in those with> 10 h/d SB and <150 min/week MVPA.Among those who reported> 5 h/d sedentary time,per-hour substitution of SB with light,moderate,and vigorous PA reduced incident CVD risk by 5%,6%,and 8%,respectively.The study first found that sedentary time was associated with increased incident CVD risk among Chinese adults and that substitution of SB with PA of any intensity could convey cardiovascular benefits among those with> 5 h/d SB.
文摘Individuals with a high degree of salt sensitivity(SS)have a greater risk of cardiovascular disease(CVD),but whether SS fosters CVD by influencing metabolomics homeostasis remains unclear.This study aimed to reveal the role of the SS-related metabolomics signature in the development of CVDs,based on the MetaSalt study,which was a dietary salt-intervention trial conducted at four centers in China in 2019.A total of 528 participants were recruited and underwent 3 days of baseline observations,a 10-day low-salt intervention,and a 10-day highsalt intervention.Plasma untargeted metabolomics,lipidomics,and BP measurements were scheduled at each stage.Participants were grouped into extreme SS,moderate SS,and salt-resistant(SR)individuals according to their BP responses to salt.Linear mixed models were used to identify SS-related metabolites and determine the relationship between the SS-related metabolomics signature and arterial stiffness.Mendelian randomization(MR)analyses were applied to establish the causal pathways among the SS-related metabolites,BP,and CVDs.Among the 713 metabolites,467 were significantly changed after the high-salt intervention.Among them,the changes in 30 metabolites from the low-salt to the high-salt intervention differed among the SS groups.Of the remaining nonsalt-related metabolites,the baseline levels of 11 metabolites were related to SS.These 41 metabolites explained 23%of the variance in SS.Moreover,SS and its metabolomics signature were positively correlated with arterial stiffness.MR analyses demonstrated that the SS-related metabolites may affect CVD risk by altering BP,indicating that the increase in BP was the consequence of the changes in SS-related metabolites rather than the cause.Our study revealed that the metabolomics signature of SS individuals differs from that of SR individuals and that the changes in SS-related metabolites may increase arterial stiffness and foster CVDs.This study provides insight into understanding the biology and targets of SS and its role in CVDs.
基金supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2019-I2M-2-003,2017-I2M-1-004)。
文摘Background:High sodium intake is an important risk factor for hypertension and cardiovascular disease.However,the association between gut microbiota composition and metabolomic profiles with dietary sodium intake and blood pressure(BP)is not well-understood.The metabolome,microbiome,and dietary salt intervention(MetaSalt)study aimed to investigate microbial and metabolomic profiles related to dietary sodium intake and BP regulation.Methods:This family-based intervention study was conducted in four communities across three provinces in rural northern China in 2019.Probands with untreated prehypertension or stage-1 hypertension were identified through community-based BP screening,and family members including siblings,offspring,spouses,and parents were subsequently included.All participants participated in a 3-day baseline examination with usual diet consumption,followed by a 10-day low-salt diet(3 g/d of salt or 51.3 mmol/d of sodium)and a 10-day high-salt diet(18 g/d of salt or 307.8 mmol/d of sodium).Differences in mean BP levels were compared according to the intervention phases using a paired Student’s t-test.Results:A total of 528 participants were included in this study,with a mean age of 48.1 years,36.7%of whom were male,76.8%had a middle school(69.7%)or higher(7.1%)diploma,23.4%had a history of smoking,and 24.4%were current drinkers.The mean arterial pressure at baseline was 97.2±10.5 mm Hg for all participants,and significantly decreased during the low-salt intervention(93.8±9.3,P<0.0001)and subsequently increased during the high-salt intervention(96.4±10.0,P<0.0001).Conclusions:Our dietary salt intervention study has successfully recruited participants and will facilitate to evaluate the effects of gut microbiota and metabolites on BP regulation in response to sodium burden,which will provide important evidence for investigating the underlying mechanisms in the development of hypertension and subsequent cardiovascular diseases.Trial registration:The study was registered in the Chinese Clinical Trial Registry database(ChiCTR1900025171).
基金National High Level Hospital Clinical Research Funding,Grant/Award Numbers:2022-GSP-GG-1,2022-GSP-GG-2National Natural Science Foundation of China,Grant/Award Numbers:12126602,82030102,91857118+1 种基金National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences,Grant/Award Number:NCRC2020006Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences,Grant/Award Numbers:2019-I2M-2-003,2021-I2M-1-010。
文摘Background:Familial hypercholesterolemia(FH)is underrecognized,and its association with coronary artery disease(CAD)remains limited,especially in China.We aimed to investigate the prevalence of FH and its relationship with CAD in a large Chinese cohort.Methods:FH was defined using the Make Early Diagnosis to Prevent Early Death(MEDPED)criteria.The crude and age-sex standardized prevalence of FH were calculated based on surveys of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China(China-PAR)project during 2007−2008.The associations of FH with incident CAD and its major subtypes were estimated with the cohort-stratified multivariate Cox proportional hazard models based on the data from the baseline to the last follow-up(2018−2020).Results:Among 98,885 included participants,190 participants were defined as FH.Crude and age−sex standardized prevalence and 95%confidence interval(CI)of FH were 0.19%(0.17%-0.22%)and 0.13%(0.10%-0.16%),respectively.The prevalence varied across age groups and peaked in the group of 60-<70 years(0.28%),and the peak prevalence(0.18%)in males was earlier,yet lower than the peak crude prevalence in females(0.41%).During a mean follow-up of 10.7 years,2493 cases of incident CAD were identified.After multivariate adjustment,FH patients had a 2.03-fold greater risk of developing CAD compared to non-FH participants.Conclusions:The prevalence of FH was estimated to be 0.19%in the participants,and it was associated with an elevated risk of incident CAD.Our study suggests that early screening of FH has certain public health significance for the prevention of CAD.
基金The National Key Research and Development Program of China(2016YFC0206503).
文摘Summary What is already known about this topic?Short-term PM_(2.5) exposure has been associated with hourly,24-hour,daytime,and nighttime blood pressure(BP)levels,and further studies focusing whether and how the associations with other ambulatory BP monitoring indicators are warranted.
基金supported by the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(2021-I2M-1-010,2019-I2M-2-003,and 2017-I2M-1-004)the National High Level Hospital Clinical Research Funding(2022-GSP-GG-1,2022-GSPGG-2)+5 种基金Research Unit of Prospective Cohort of Cardiovascular Diseases and Cancers,CAMS(2019RU038)the National Key Research and Development Program of China(2018YFE0115300 and 2017YFC0211700)the National Natural Science Foundation of China(82030102,1212660291857118)Taikang Yicai Public Health and Epidemic Control Fund(TKYC-GW-2020)the National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences(NCRC2020006)。
文摘The utility of the polygenic risk score(PRS)to identify individuals at higher risk of stroke beyond clinical risk remains unclear,and we clarified this using Chinese population-based prospective cohorts.Cox proportional hazards models were used to estimate the 10-year risk,and Fine and Gray’s models were used for hazard ratios(HRs),their 95%confidence intervals(CIs),and the lifetime risk according to PRS and clinical risk categories.A total of 41,006 individuals aged 30–75 years with a mean follow-up of 9.0 years were included.Comparing the top versus bottom 5%of the PRS,the HR was 3.01(95%CI 2.03–4.45)in the total population,and similar findings were observed within clinical risk strata.Marked gradients in the 10-year and lifetime risk across PRS categories were also found within clinical risk categories.Notably,among individuals with intermediate clinical risk,the 10-year risk for those in the top 5%of the PRS(7.3%,95%CI 7.1%–7.5%)reached the threshold of high clinical risk(≥7.0%)for initiating preventive treatment,and this effect of the PRS on refining risk stratification was evident for ischemic stroke.Even among those in the top 10%and 20%of the PRS,the 10-year risk would also exceed this level when aged≥50 and≥60 years,respectively.Overall,the combination of the PRS with the clinical risk score improved the risk stratification within clinical risk strata and distinguished actual high-risk individuals with intermediate clinical risk.
基金supported by grants from the Chinese Academy of Medical Science Innovation Fund for Medical Sciences(Nos.2017-I2M-1-004,2019-I2M-2-003)the National Key Research and Development Program of China(Nos.2017YFC0211703,2018YFE0115300)the National Natural Science Foundation of China(No.91643208)。
文摘To the Editor:According to guidelines from western countries as well as China,dietary patterns with low intake of cholesterol have been widely recommended for maintaining ideal lipid levels.As one of the major sources of both high-quality protein and dietary cholesterol,eggs have always been the focus in terms of diet.Although increased lipid levels induced by high egg intake have been revealed by randomized controlled trials(RCTs),they may not be sufficient to reflect the impacts of habitual egg intake due to high doses of egg intake of more than 7 eggs/week or even 14 eggs/week.Further,RCTs typically have shorter intervention periods of about 3 months,which may not observe a stable association due to homeostasis in cholesterol metabolism of human beings.[1,2]Up to now,only three cohorts assessed the associations of egg intake with lipid levels or dyslipidemia,and the findings were still controversial.One recent cohort study has reported the non-significant association between higher egg intake(≥7 vs.1 eggs/week)and lipid profiles.On the other hand,another cohort from Spain found that compared with<1 egg/week,>4 eggs/week had no significant influence on total cholesterol(TC)and triglyceride(TG),but significantly decreased high-density lipoprotein cholesterol(HDL-C)levels.[4]However,none of these cohorts were from developing countries,and the association between moderate egg intake and lipid profiles has not been well illustrated.Egg consumption in China,a representative of developing countries,is relatively higher,and it may be possible to better explore the appropriate range of egg intake.
基金National Natural Science Foundation of China(Grant/Award Numbers: 82030102, 82373676)National High Level Hospital Clinical Research Funding(Grant/Award Numbers: 2022-GSP-GG-1, 2022-GSP-GG-2)+2 种基金National Key Research and Development Program of China(Grant/Award Numbers: 2017YFC0211700, 2018YFE0115300)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Grant/Award Numbers: 2017-I2M-1-004, 2019-I2M-2-003, 2021-I2M-1-010)Research Unit of Prospective Cohort of Cardiovascular Diseases and Cancers, Chinese Academy of Medical Sciences(Grant/Award Number: 2019RU038)。
文摘Background: Despite the adverse effects of ambient fine particulate matter (PM_(2.5) ) on type 2 diabetes and the beneficial role of physical activity (PA), the influence of PM_(2.5) on the relationship between PA and type 2 diabetes remains unclear.Methods: In this prospective study with 71,689 participants, PA was assessed by a questionnaire and was categorized into quartiles for volume and three groups for intensity. Long-term PM_(2.5) exposure was calculated using 1-km resolution satellite-based PM_(2.5) estimates. PM_(2.5) exposure and PA's effect on type 2 diabetes were assessed by cohort-stratified Cox proportional hazards models, individually and in combination.Results: In 488,166 person-years of follow-up, 5487 incident type 2 diabetes cases were observed. The association between PA and type 2 diabetes was modified by PM_(2.5) . Compared with the lowest quartile of PA volume, the highest quartile was associated with reduced type 2 diabetes risk in low PM_(2.5) stratification (≤65.02 μg/m^(3)) other than in high PM_(2.5) stratification (>65.02 μg/m^(3)), with the hazard ratio (HR) of 0.75 (95% confidence interval [CI]: 0.66-0.85) and 1.10 (95% CI: 0.99-1.22), respectively. Similar results were observed for PA intensity. High PM_(2.5) exposure combined with the highest PA levels increased the risk of type 2 diabetes the most (HR= 1.79, 95% CI: 1.59-2.01 for PA volume;HR = 1.82, 95% CI: 1.64-2.02 for PA intensity).Conclusion: PA could reduce type 2 diabetes risk in low-pollution areas, but high PM_(2.5) exposure may weaken or even reverse the protective effects of PA. Safety and health benefits of PA should be thoroughly assessed for long-term polluted residents.
