Individual and Combined Cardiometabolic Morbidities and the Subsequent Risk of Cardiovascular Events in Chinese Adults: The China Cardiometabolic Disease and Cancer Cohort Study

Abstract Background The data regarding the association between main cardiometabolic morbidities such as diabetes, hypertension, and dyslipidemia and the subsequent risk of CVD events in Chinese adults are still limited. Therefore, we investigated the associations between individual and combined cardiometabolic morbidities and incident cardiovascular events in Chinese adults.Methods The China Cardiometabolic Disease and Cancer Cohort Study was a prospective, nationwide, and population-based cohort study of 20 Chinese communities from various geographic regions. A comprehensive set of questionnaires, clinical measurements, oral glucose tolerance tests (OGTTs), and laboratory examinations were carried out at baseline (2011-2012) and follow-up visits (2014-2016). 133572 participants aged ≥ 40 years who were free from cardiovascular disease (CVD) at baseline were included in the study.Results Compared with participants without diabetes, hypertension and dyslipidemia, participants with only diabetes (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.32-1.90) or only hypertension (2.04; 1.82-2.28) exhibited significantly higher risk for CVD events, while participants with only dyslipidemia (0.97; 0.84-1.12) exhibited no significantly higher risk for CVD events. When analyzed collectively, participants with diabetes plus hypertension (HR, 2.67; 95%CI, 2.33-3.06), diabetes plus dyslipidemia (1.57; 1.32-1.87), and hypertension plus dyslipidemia (2.12; 1.88-2.39) exhibited significantly higher risk for CVD events. Moreover, participants with the combination of diabetes, hypertension and dyslipidemia exhibited the highest risk for CVD events (HR, 3.06; 95%CI, 2.71-3.46). Multivariable-adjusted HRs (95% CIs) for CVD associated with diabetes based on fasting glucose ≥7.0 mmol/L, OGTT-2h glucose ≥11.1 mmol/L, and hemoglobin A1c ≥6.5% were 1.64 (1.51-1.78), 1.57 (1.45-1.69), and 1.54 (1.42-1.66), respectively; associated with hypertension based on systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg were 1.89 (1.76-2.03) and 1.74 (1.60-1.88), respectively; associated with dyslipidemia based on total cholesterol ≥6.22 mmol/L, low-density lipoprotein cholesterol ≥4.14 mmol/L, high-density lipoprotein cholesterol <1.04 mmol/L, and triglycerides ≥2.26 mmol/L were 1.18 (1.08-1.30), 1.30 (1.17-1.44), 1.00 (0.92-1.09), and 1.10 (1.01-1.20), respectively. ConclusionsDiabetes, hypertension and dyslipidemia showed additive associations with the risk of CVD events in middle-aged and elderly Chinese adults.

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Individual and combined cardiometabolic morbidities and the subsequent risk of cardiovascular events in Chinese adults

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab609 ◽

2021 ◽

Author(s):

Jiao Wang ◽

Zhimin Wang ◽

Feng Guo ◽

Yinghui Zhang ◽

Hongfei Ji ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Events ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Tolerance Test ◽

Population Based ◽

Lipoprotein Cholesterol ◽

Oral Glucose ◽

Chinese Adults ◽

Elderly Chinese

Abstract Objectives To investigate the associations between individual and combined cardiometabolic morbidities and incident cardiovascular events in Chinese adults. Design A prospective, nationwide, and population-based cohort study. Participants 133572 participants aged ≥ 40 years were included in the study. Main Outcome Measures Cardiovascular disease (CVD) events. Results Compared with participants without diabetes, hypertension and dyslipidemia, participants with only diabetes (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.32-1.90) or only hypertension (2.04; 1.82-2.28) exhibited significantly higher risk for CVD events, while participants with only dyslipidemia (0.97; 0.84-1.12) exhibited no significantly higher risk for CVD events. When analyzed collectively, participants with diabetes plus hypertension (HR, 2.67; 95%CI, 2.33-3.06), diabetes plus dyslipidemia (1.57; 1.32-1.87), and hypertension plus dyslipidemia (2.12; 1.88-2.39) exhibited significantly higher risk for CVD. Moreover, participants with the combination of diabetes, hypertension and dyslipidemia exhibited the highest risk for CVD events (HR, 3.06; 95%CI, 2.71-3.46). Multivariable-adjusted HRs (95% CIs) for CVD associated with diabetes based on fasting glucose ≥7.0 mmol/L, oral glucose tolerance test-2h glucose ≥11.1 mmol/L, and hemoglobin A1c ≥6.5% were 1.64 (1.51-1.78), 1.57 (1.45-1.69), and 1.54 (1.42-1.66), respectively; associated with hypertension based on systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg were 1.89 (1.76-2.03) and 1.74 (1.60-1.88), respectively; associated with dyslipidemia based on total cholesterol ≥6.22 mmol/L, low-density lipoprotein cholesterol ≥4.14 mmol/L, high-density lipoprotein cholesterol <1.04 mmol/L, and triglycerides ≥2.26 mmol/L were 1.18 (1.08-1.30), 1.30 (1.17-1.44), 1.00 (0.92-1.09), and 1.10 (1.01-1.20), respectively. Conclusions Diabetes, hypertension and dyslipidemia showed additive associations with the risk of CVD events in middle-aged and elderly Chinese adults.

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Risk prediction for subclinical carotid atherosclerosis in rotational shift workers in the arctic

European Heart Journal ◽

10.1093/ehjci/ehaa946.2711 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Shurkevich ◽

A Vetoshkin ◽

L Gapon ◽

A Simonyan ◽

V Kuznetsov

Keyword(s):

Blood Pressure ◽

Early Diagnosis ◽

Cardiovascular Events ◽

Carotid Arteries ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

The Arctic ◽

Lipid Lowering ◽

Correct Prediction ◽

Shift Workers

Abstract Introduction High prevalence of cardiovascular events at northern latitudes determines the necessity of studying mechanisms of formation and early diagnosis of atherosclerotic process. Purpose To determine the most unfavorable prognostic factors that provide the percentage of correct prediction and high accuracy in detection of atherosclerotic plaque (ASP) in common carotid arteries (CCA) in rotational shift workers in the Arctic. Methods Within 2010–2012 a study of 424 males aged 30–59 years at the medical unit “Gazprom dobycha Yamburg” (Yamburg settlement, 68°N) was performed. Patients were randomized into 2 groups according to blood pressure (BP). Gr.I included 294 people with BP more than 140/90 mmHg, arterial hypertension (AH) of 1,2 stage and Gr.II included 130 people with BP less than 140/90 mmHg. Groups did not differ in age (46.9±5.8 years, p=0.435); total work experience in the Arctic: 16.5±6.8 years (p=0.512) and rotational shiftwork duration: 12.5±4.6 years (p=0.597). Office BP was 149.4±13.3/97.1±7.3 mmHg in Gr.I and 123.4±7.5/80.5±5.5 mmHg in Gr.II. Ultrasound examination of carotid arteries with determination of presence or absence of ASP in CCA and estimation of stenosis using NASCET method were performed; ambulatory blood pressure monitoring was conducted; blood glucose levels, total cholesterol, high-density lipoprotein cholesterol, low density lipoprotein cholesterol were determined. Statistical analysis was carried out using R (v. 3.6.1) programming language for statistical data processing of R Studio application package (v. 1.2.1335). Results Signs of CCA atherosclerosis were revealed in 56% of patients with AH and in 25% of those without AH. According to multivariate analysis, three variables with the most significant set of predictors, associated with ASP in CCA with the percentage of correct prediction of 75.9% were selected by step-by-step method: diastolic BP24 (<0.0001), glucose (0.0167) and cholesterol (0.0439). Based on the obtained model, it was concluded that 1 mmHg increase in diastolic BP24 increases the risk for developing ASP by 5.9%, Exp. (Beta) = 1.059, 1 mmol/l increase in glucose and cholesterol escalates the risk by 44.1% and 25.2%, respectively: Exp. (Beta) = 1.441 and Exp. (Beta) = 1.252. Conclusion The data obtained will improve accuracy for the early diagnosis of subclinical atherosclerosis of CCA, allow to prescribe lipid-lowering therapy timely and reduce the risk of adverse cardiovascular events in rotational shift workers in the Arctic. Funding Acknowledgement Type of funding source: None

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Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood in a prospective British birth cohort: associations and potential explanations

BMJ Open ◽

10.1136/bmjopen-2018-024079 ◽

2019 ◽

Vol 9 (3) ◽

pp. e024079 ◽

Cited By ~ 6

Author(s):

Leah Li ◽

Snehal M Pinto Pereira ◽

Christine Power

Keyword(s):

Blood Pressure ◽

Child Maltreatment ◽

Physical Abuse ◽

Birth Cohort ◽

Childhood Maltreatment ◽

Early Life ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Cardiometabolic Disease ◽

Cardiometabolic Markers

ObjectivesResearch on associations between childhood maltreatment and adult cardiometabolic disease risk is sparse. We aimed to investigate associations between different forms of child maltreatment and mid-adult cardiometabolic markers and whether potential intermediaries could account for the associations observed.Setting1958 British birth cohort.ParticipantsApproximately 9000 cohort members with data on cardiometabolic markers.OutcomesAdult (45y) cardiometabolic markers (blood pressure, lipids and glycated haemoglobin [HbA1c]).ResultsSeventeen per cent of participants were identified as neglected; 6.1%, 1.6% and 10.0% were identified as experiencing physical, sexual and psychological abuse, respectively. Childhood neglect and physical abuse were associated with high body mass index (BMI) and large waist circumference when adjusting for early-life covariates. For neglect, the adjusted odds ratio (AOR) was 1.16 (95% CI: 1.02 to 1.32) and 1.15 (1.02 to 1.30) for general and central obesity, respectively, and for physical abuse, the respective AOR was 1.36 (1.13 to 1.64) and 1.38 (1.16 to 1.65). Neglect was also associated with raised triglycerides by 3.9 (0.3 to 7.5)% and HbA1c by 1.2 (0.4 to 2.0)%, and among females, lower high-density lipoprotein cholesterol (HDL-c) by 0.05 (0.01 to 0.08)mmol/L after adjustment. For physical abuse, the AOR was 1.25 (1.00 to 1.56) for high low-density lipoprotein cholesterol, HbA1c was raised by 2.5 (0.7 to 4.3)% (in males) and HDL-c was lower by 0.06 (0.01 to 0.12)mmol/L (in females). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. For psychological abuse, the AOR for elevated triglycerides was 1.21 (1.02 to 1.44) and HDL-c was lower by 0.04 (0.01 to 0.07)mmol/L. Maltreatments were not associated with raised blood pressure. In analyses of potential intermediary factors, several associations attenuated after adjustment for adult lifestyles (mainly smoking and alcohol consumption rather than physical activity) and child-to-adult BMI.ConclusionsChildhood maltreatments, particularly neglect and physical abuse, were associated with greater adiposity and poorer lipid and HbA1c profiles decades later in adulthood. Associations were modest but independent of early-life factors linked to these outcomes. Findings implicate adult lifestyles as an important intermediary between child maltreatment and outcomes.

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Triglycerides to high-density lipoprotein cholesterol ratio is an independent predictor of incident fatty liver; a population-based cohort study

Liver International ◽

10.1111/liv.12977 ◽

2015 ◽

Vol 36 (5) ◽

pp. 713-720 ◽

Cited By ~ 35

Author(s):

Yukiko Fukuda ◽

Yoshitaka Hashimoto ◽

Masahide Hamaguchi ◽

Takuya Fukuda ◽

Naoto Nakamura ◽

...

Keyword(s):

Cohort Study ◽

High Density Lipoprotein ◽

Fatty Liver ◽

High Density Lipoprotein Cholesterol ◽

Independent Predictor ◽

Density Lipoprotein ◽

Population Based ◽

High Density ◽

Lipoprotein Cholesterol ◽

Cholesterol Ratio

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Immediate Risk for Cardiovascular Events in Hip Fracture Patients: A Population-Based Cohort Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab336 ◽

2021 ◽

Author(s):

Warrington W Q Hsu ◽

Chor-Wing Sing ◽

Gloria H Y Li ◽

Kathryn C B Tan ◽

Bernard M Y Cheung ◽

...

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Cardiovascular Events ◽

Population Based ◽

Competing Risk ◽

Major Adverse Cardiovascular Events ◽

Early Management ◽

Risk Of Death ◽

One Year ◽

Subsequent Risk

Abstract Background Emerging evidence showed that bone metabolism and cardiovascular diseases (CVD) are closely related. We previously observed a potential immediate risk of cardiovascular mortality after hip fracture. However, whether there is an immediate risk of cardiovascular events after hip fracture is unclear. The aim of this study was to evaluate the risk for major adverse cardiovascular events (MACEs) between patients having experienced falls with and without hip fracture. Methods This retrospective population-based cohort study used data from a centralized electronic health record database managed by Hong Kong Hospital Authority. Patients having experienced falls with and without hip fracture were matched by propensity score (PS) at a 1:1 ratio. Adjusted associations between hip fracture and risk of MACEs were evaluated using competing risk regression after accounting for competing risk of death. Results Competing risk regression showed that hip fracture was associated with increased one-year risk of MACEs (hazard ratio [HR], 1.27; 95% CI, 1.21 to 1.33; p<0.001), with a 1-year cumulative incidence difference of 2.40% (1.94% to 2.87%). The HR was the highest in the first 90-day after hip fracture (HR of 1.32), and such an estimate was continuously reduced in 180-day, 270-day, and 1-year after hip fracture. Conclusions Hip fracture was associated with increased immediate risk of MACEs. This study suggested that a prompt evaluation of MACE among older adults aged 65 years and older who are diagnosed with hip fracture irrespectively of cardiovascular risk factors may be important, as early management may reduce subsequent risk of MACE.

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THE CORRELATION BETWEEN METABOLIC DISORDERS AND TPOAB/TGAB: A CROSS-SECTIONAL POPULATION-BASED STUDY

Endocrine Practice ◽

10.4158/ep-2020-0008 ◽

2020 ◽

Vol 26 (8) ◽

pp. 869-882 ◽

Cited By ~ 2

Author(s):

Ying Wu ◽

Xiaoguang Shi ◽

Xulei Tang ◽

Yongze Li ◽

Nanwei Tong ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Disorders ◽

Density Lipoprotein ◽

Thyroid Stimulating Hormone ◽

Lipoprotein Cholesterol ◽

Oral Glucose ◽

Thyroid Peroxidase ◽

Dependent Manner ◽

Free Triiodothyronine ◽

Cross Sectional

Objective: Studies have shown that metabolic abnormalities influence the immune system. Because the prevalence of metabolic and autoimmune thyroid diseases has increased synchronously, the correlation between them was worth exploring. The study objective was to investigate the relationship between metabolic disorders and thyroid auto-antibodies in euthyroid subjects. Methods: Data were obtained from the Thyroid Diseases and Diabetes Mellitus project survey of 55,891 subjects from 31 provinces in China. The body mass index (BMI), waist circumference (WC), blood pressure, thyroid peroxidase antibodies (TPOAbs), thyroglobulin antibodies (TgAbs), thyroid-stimulating hormone (TSH), urinary iodine concentration, blood glucose, lipid profile, and uric acid levels were evaluated. Free thyroxine and free triiodothyronine levels were measured in patients with abnormal serum TSH levels. Results: In males, the BMI, WC, systolic blood pressure (SBP), diastolic blood pressure (DBP), and 2-hour post-glucose oral glucose tolerance test results of the TPOAb-/TgAb-positive group were significantly higher than those of the TPOAb-/TgAb-negative group. In females, the BMI, WC, SBP, DBP, total cholesterol, and low-density-lipoprotein cholesterol (LDL-C) in the TPOAb-/TgAb-positive group were significantly increased compared to the TPOAb-/TgAb-negative group. Multivariate analysis showed that in males, the odds ratio (OR) of positive TgAbs in the abdominal obesity group was 1.175 (95% confidence interval [CI], 1.016 to 1.359; P = .03), and the OR of positive TPOAbs in the hyperuricemia group was 1.195 (95% CI, 1.041 to 1.372; P = .011). In females, the OR of positive TgAbs was 1.19 (95% CI, 1.068 to 1.326; P = .002) in the high LDL-C group. Conclusion: Obesity, high LDL-C, and hyperuricemia were positively correlated with the prevalence of positive thyroid autoantibodies in euthyroid subjects in a gender-dependent manner. This cross-sectional survey showed that metabolic disorders are associated with increased positive thyroid autoantibody levels in euthyroid subjects in a gender-dependent manner. Abbreviations: AIT = autoimmune thyroiditis; BMI = body mass index; CI = confidence interval; DBP = diastolic blood pressure; FPG = fasting plasma glucose; FT3 = free triiodothyronine; FT4 = free thyroxine; HbA1c = glycated hemoglobin; HDL-C = high-density-lipoprotein cholesterol; LDL-C = low-density-lipoprotein cholesterol; OGTT2hPG = oral glucose tolerance test 2-hours post-glucose; OR = odds ratio; SBP = systolic blood pressure; TC = total cholesterol; TG = triglycerides; TgAb = thyroglobulin antibody; TPOAb = thyroid peroxidase antibody; TSH = thyroid-stimulating hormone; UA = uric acid; WC = waist circumference

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