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Objective As a risk indicator of hypertension, arterial stiffness is difficult to measure. Thus, we aimed to evaluate the association between estimated pulse wave velocity (ePWV) as a convenient indicator and the incidence of hypertension. Methods The Kailuan cohort was selected for statistical analysis and 54 849 individuals were included in the final cohort. Multiple linear regression was used to analyse the correlation between ePWV and mean SBP (SBP_m) measured at five time points over a 10-year period and between ePWV and mean DBP (DBP_m) measured at five time points over a 10-year period. Logistic regression was used to analyse the effect of estimated arterial stiffness on hypertension. Results The mean age of individuals was 48.44 ± 9.32 years, and 41 419 individuals (75.51%) were male. A multiple linear regression analysis showed that ePWV was positively correlated with both SBP_m and DBP_m. For every 1 cm/s increase in ePWV, SBP_m and DBP_m increased by 5.60 and 2.12 mmHg, respectively. A logistic regression analysis showed that in the total cohort, the incidence of hypertension in populations with moderate, moderate-high and high ePWV values was 3.03, 5.44 and 7.87-times higher, respectively, compared with individuals with low ePWV values. ePWV had a higher predictive value in female and middle age population compared with male and the eldly population grouped by sex and age respectively. Conclusion ePWV positively correlates with both SBP_m and DBP_m, and an increase in ePWV is associated with an increase in the incidence of hypertension.

Due to environmental health concerns, exposure to heavy metals and related adverse effects in electronic waste (e-waste) dismantling areas have attracted considerable interest in the recent years. However, little information is available about the Soil/Dust Ingestion Rates (SIR) of heavy metals for children living in such sites. This study estimated the soil ingestion of 66 children from e-waste disassembly areas by collecting and analyzing selected tracer elements in matched samples of their consumed food, feces, and urine, as well as soil samples from their play areas. The concentrations of tracer elements (including Al, Ba, Ce, Mn, Sc, Ti, Y, and V) in these samples were analyzed. The SIR was estimated to be 148.3 mg/day (median) and 383.3 mg/day (95th percentile) based on the Best Tracer Method (BTM). These values are somewhat higher than those observed in America, Canada, and other parts of China. Health risk assessments showed that Cr presented the greatest carcinogenic risk, at more than 10−6 in this typical polluted area, while As was second. These findings provide important insights into the exposure risks of heavy metals in e-waste dismantling sites and emphasize the health risk caused by Cr and As.

Following the restriction of bisphenol A (BPA) in certain products, a number of bisphenol analogues (BPs) have been used as BPA replacements in different applications, raising environmental and health concerns. The present study determined a total of 13 bisphenol analogues in house dust and children urine from South China families (n = 46). Among all BPs, BPA, bisphenol S (BPS) and bisphenol F (BPF) were frequently detected in house dust, with concentrations ranging from 0.54 to 26.2 μg/g (median: 2.60 μg/g), 0.07-11.5 μg/g (median: 0.32 μg/g) and 0.02-2.4 μg/g (median: 0.29 μg/g), respectively. BPA (median: 2.43 ng/mL) was also the dominant BP in children urine samples, accounting for 75.2 ± 27.4% of the total concentrations of urinary BPs, followed by BPS (0.23 ng/mL), whereas BPF was only detected in less than 30% of urine samples. Children's daily intake of bisphenols through dust ingestion and total daily intakes were estimated based on the dust and urine concentrations, respectively. The estimated intake of BPA, BPS and BPF via house dust ingestion accounted for 9%, 12% and 38% of the total intakes predicted based on urinary concentrations, respectively, and exhibited very low exposure risks.

Due to the development of the economy, electronic waste (e-waste) has become a new global problem and e-waste dismantling processes are an important source of air pollution. Among the pollutants emitted, polycyclic aromatic hydrocarbons (PAHs) are a severe concern because of their carcinogenic and mutagenic properties. However, few studies have investigated the atmospheric PAHs generated by e-waste dismantling in a specific region, especially the PAH levels throughout the year. Thus, we assessed the effects of PAHs on the local air quality by sampling the total suspended particulates (TSP), PM10, PM2.5, and gaseous phase from an e-waste dismantling area and a control site during four seasons. The TSP, PM10, and PM2.5 concentrations were measured as 84.8–414, 70.7–302, and 57.1–204 μg m−3, respectively, in this area, and those of three types of particulate bound-PAHs and gaseous phase PAHs were 2.6–16.1, 2.2–15.1, 1.9–14.6, and 20.1–72.8 ng m−3, respectively. The pollutant levels were higher in the spring and winter than those in the summer and autumn. The PAH sources were identified by diagnostic ratio approaches and principal component analysis. E-waste dismantling was identified as the major source of PAH pollution within this area, where approximately 82.4% of the PAHs was attributed to e-waste dismantling at an industrial park (EP site). Among the sites sampled, the pollutant levels and cancer risk were highest at the EP site, and they could pose a cancer risk for humans, although only the bioaccessible PAHs in human lungs were considered. In particular, infants had a higher health risk than adults, thereby suggesting that air pollution with PAHs is a concern in this area. This study provides clear evidence of the requirement for control measurements of e-waste dismantling processes.

Aims/Introduction A higher ratio of triglyceride to high‐density lipoprotein cholesterol (TG/HDL‐C) is considered as the independent risk index of cardiovascular (CV) events. However, cohort studies regarding this correlation are rarely reported, especially in the Chinese population. The aim of present study was to explore the relationship of the TG/HDL‐C ratio with CV risks among Chinese adults during 10‐year follow‐up period. Materials and Methods We carried out a prospective study using data obtained from 96,542 individuals in Kailuan, who were grouped through the median value (0.8533) of the TG/HDL‐C ratio. Adverse outcomes mainly referred to major CV events. We used the person‐years incidence and cumulative incidence to predict the morbidity. The risk of CV events was estimated through Cox proportional hazard models. Results The mean age of the cohort was 51.5 ± 12.6 years, and 79.6% of participants were men. During a median follow‐up period of 9.75 years, 5,422 major CV events occurred, including 1,312 myocardial infarction cases and 4,228 stroke cases. The cumulative incidence of myocardial infarction, stroke and total CV events was 1.36% (range 1.29–1.43%), 4.38% (range 4.25–4.51%) and 5.62% (range 5.47–5.76%), respectively. Compared with low the TG/HDL‐C ratio (≤0.8533) group, the high TG/HDL‐C ratio (>0.8533) group had higher morbidity of CV events. The hazard ratio of total CV events, stroke and myocardial infarction was 1.19 (95% CI 1.12–1.26), 1.11 (95% CI 1.03–1.18) and 1.50 (95% CI 1.33–1.70), respectively. Furthermore, the TG/HDL‐C ratio and major CV events had a line‐shaped relationship with each other. Conclusions Among the Chinese population, a higher TG/HDL‐C ratio is correlated with an increased risk of major CV events., This is the first large prospective cohort study regarding the association of the triglyceride to high‐density lipoprotein cholesterol (TG/HDL‐C) ratio with major cardiovascular events among Chinese individuals. Among the Chinese population, an elevated TG/HDL‐C ratio is associated with an increased risk of major cardiovascular events.

Since commercial polybrominated diphenyl ethers (PBDEs) have been globally banned or restricted in 2000s, alternative halogenated flame retardants (AHFRs) appear increasingly dominant over PBDEs in many countries/regions. In this study, low levels of AHFRs were unexpectedly observed in the indoor dust from Adelaide, South Australia. Anti-dechlorane plus (anti-DP) was the most frequently detected AHFR with a median concentration of 1.28 ng/g, while other AFHRs were less detected (detection frequency50%). The levels of ΣPBDEs (496 ng/g, median) and ΣAHFRs (160 ng/g) and the ratio of ΣAHFRs/ΣPBDEs (0.32) were much lower than those investigated in Australian indoor dust previously. The findings were different to the trend for PBDEs and AHFRs from other countries over the past two decades. No significant correlation was determined between DP and PBDE congeners, indicating their different sources in dust. The human exposure assessment suggested that dust ingestion was the predominant pathway of PBDEs and AHFRs exposure for toddlers, while dermal absorption may be the dominant pathway for adults. The estimated daily intake (EDI) suggested low health risks via dust ingestion and dermal contact for general populations in Adelaide. This study contributes to the knowledge on region-specific FR contamination in indoor environments and related human exposure risk.

On the basis of 45,092 participants (mean age of 54.04 ± 13.09 years) from the Kailuan study, this study was performed to explore the relationships among total cholesterol (TC), brachial-ankle pulse wave velocity (BaPWV), and systolic blood pressure (SBP) and quantify their separate effects. The correlations among TC, SBP, and BaPWV were analyzed using multivariate linear regression models. Mediation analysis was performed to determine whether the effect of TC on SBP can be explained by arterial stiffness. Multivariate linear regression analysis showed that for every one standard deviation increase in TC and BaPWV, SBP increased by 0.33 mmHg and 0.044 mmHg, respectively; for every one standard deviation increase in TC, BaPWV increased by 5.34 cm/s. Mediation analysis showed that the TC-induced SBP elevation was mediated by arterial stiffness in more than half of the whole cohort (indirect effect, 0.73; percent mediated, 54.5%). Furthermore, the TC-induced SBP elevation was mediated by arterial stiffness in less than half of the males (indirect effect, 0.70; percent mediated, 47.9%); however, the results were not statistically significant in females. In conclusion, TC and BaPWV are positively correlated with SBP, whereas TC is positively correlated with BaPWV. Almost half of the increase in SBP contributed to TC is mediated by arterial stiffness.

ObjectiveThis study was performed to explore the effects of visit-to-visit blood pressure variability (BPV) on cardiovascular events (CVEs) in people with various body mass indexes (BMIs).DesignProspective cohort study.SettingThe average real variability of systolic blood pressure (ARVSBP) was the indicator for visit-to-visit BPV. The participants were divided into three groups: normal weight, overweight and obesity. We further divided these groups into four subgroups based on the ARVSBP. A Cox regression model was used to calculate the HRs of the ARVSBP on CVEs in the same and different BMI groups. Additionally, a competitive risk model was used to calculate the HRs of the ARVSBP on CVEs in the same BMI group.ParticipantsIn total, 41 043 individuals met the inclusion criteria (no historical CVEs or tumours, no incidence of CVEs or tumours and no death during the four examinations) and had complete systolic blood pressure and BMI data.ResultsA total of 868 CVEs occurred. The cumulative incidence of CVEs increased as ARVSBP rose in both the normal weight and overweight groups. In same BMI groups, the risk of CVEs significantly increased as ARVSBP increased only in the normal weight group (highest quartiles of ARVSBP: HR (95% CI) 2.20 (1.46–3.31)). In the different BMI groups, the risk of CVEs in the ARVSBP subgroup in each BMI group was higher than that the least quintile of ARVSBP in the normal weight group (highest quartiles of ARVSBP in obesity: HR (95% CI) 2.28 (1.47–3.55)). The result of the competitive risk model did not change.ConclusionsAs BMI and ARVSBP increase, the risk of CVEs increases. However, the risk of visit-to-visit BPV on CVEs varies in different BMI groups, especially in people of normal weight.Trial registration numberCHiCTR-TNC1100 1489.

Objective. To study the application of an accelerometer in adjusting the parameters, setting the sensor indicated rate (SIR) and detecting characteristics in the pacemaker (PM) rate response. Approach. Three-axis (GT9X Link-type) accelerometers were positioned on the waist and chest in 33 participants implanted with rate responsive PMs while wearing an ambulatory ECG recorder (Holter). During the walking test, by collecting vertical axis (Axis-1) activity intensity counts, Axis-1’ metabolic equivalent of energy (METaxis-1) and its expected heart rate (HRmet-axis1) were calculated by the relevant equations, and on the basis of the HRmet-axis1 as the target heart rate, the SIR was set by programming the rate response slope parameter. During the following daily walking activity, the physical activity parameters and Holter ECG was recorded continuously. After the end of the whole test the analysis on these data recorded was performed retrospectively. Main results. After completing the SIR setting, in 24 participants with complete ventricular pacing the comparison between HRmet-axis1 (92.5 ± 7.8 BPM) and the HRvp-Holter (94.0 ± 10.5 BPM) showed no statistical difference (ΔHR: 1.25 ± 6.69 BPM, P: 0.568) during the last one walking test, and there was also no significant difference (ΔHR: 2.8 ± 7.1 BPM, P: 0.398) between the HRmet-axis1 (90.7 ± 7.1 BPM) and HRvp-Holter (93.4 ± 10.3 BPM) during daily walking activity. In addition, in the data of 108 time intervals selected during the daily walking activities in the abovementioned 24 participants, METaxis-1 and HRvp-Holter correlation analysis showed good correlation and the regression equation was HR = 12.4 × MET ± 43.1 ( P < 0.0001 ). Significance. An accelerometer can play an important role in adjusting parameters, setting the SIR and detecting characteristics in the PM rate response.

Aims/Introduction The prevalence of prediabetes has become a global epidemic, and prediabetes is often accompanied with metabolic syndrome (MS). However, the association between MS and cardiovascular (CV) risk among individuals with prediabetes in China remains unknown. The present study aimed to identify the relationship of MS with CV risk in Chinese adults with prediabetes. Materials and Methods Altogether, 19,464 participants with prediabetes were enrolled at baseline and were followed up prospectively. Prediabetes is defined as a fasting plasma glucose level between 5.6 and 6.9 mmol/L, and with neither a history of diabetes nor current use of hypoglycemic drugs. Participants were classified on the basis of the presence of MS, according to the definition of the International Diabetes Federation. Main outcomes include major CV events. Incidence rates were expressed in cumulative incidence and person‐years incidence. Cox proportional hazards analysis was used to estimate the risk of major CV events. Results At baseline, the mean age was 51.9 ± 11.4 years, and 85.6% (n = 16,663) were men. During a median follow‐up period of 10.0 years, a total of 1,169 major CV events occurred, including 921 strokes and 273 cases of myocardial infarction. The cumulative incidences were 9.0% (8.1–10.0%), 6.8% (6.0–7.6%) and 2.5% (2.0–3.0%) for total CV events, strokes and myocardial infarction. Regardless of the risk of total CV events, or the risk of stroke or myocardial infarction, the number of prediabetes individuals with MS was higher than those without, and the hazard ratio was 1.50 (95% confidence interval 1.31–1.73), 1.42 (95% confidence interval 1.21–1.67), 1.78 (95% confidence interval 1.34–2.36), respectively. Conclusions Among the Chinese population with prediabetes, the risk for major CV events was significantly higher in those with MS than those without.

Background Hyperlipidemia is associated with arterial stiffness. Herein, We examined the effect of prolonged exposure to hyperlipidemia on the risk of arterial stiffness in young adults. Methods A study cohort (35–55 years old) that received health check-ups in the Kailuan study (2014–2016) were assessed. Hyperlipidemia was defined as a low-density lipoprotein cholesterol ≥160 mg/dL according to the Chinese Guidelines for the Management of Dyslipidemia in Adults. Subjects were divided into three groups based on the number of years with hyperlipidemia: normal (0 years), low exposure (1–5 years), and high exposure (5–10 years) groups. Arterial stiffness was defined as brachial-ankle pulse wave velocity > 1400 cm/s. For all subjects and subjects that did not meet statin treatment criteria under guidelines, logistics regression was used to analyze the effect of prolonged hyperlipidemia exposure on arterial stiffness in different age groups. Results Among 12,431 subjects, the mean age was 46.42 ± 5.34 years with 9000 men (72.4%). Brachial-ankle pulse wave velocity gradually increased with increased exposure duration. Logistic regression analysis showed that hyperlipidemia exposure was a risk factor for arterial stiffness in the low (1.22 times) and high (1.49 times) exposure groups compared with the normal group. In the different age groups, the risk of arterial stiffness increased with the duration of hyperlipidemia exposure, apart for the 35–40-year-old population. The effect of hyperlipidemia exposure duration on arterial stiffness in young adults that did not meet statin treatment criteria under guidelines was similar to the general population. Conclusions Prolonged exposure to hyperlipidemia in young adults increases the risk of arterial stiffness. Young adults with this condition may benefit from more aggressive primary prevention. Trial registration Name of the registry: Risk factors and intervention for cardiology, cerebrovascular and related disease (Kailuan Study) Trial registration number: CHiCTR-TNC1100 1489 Date of registration: Aug 24, 2011 URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=8050

BACKGROUND The aim of this study was to investigate the association between body mass index (BMI) and brachial-ankle pulse wave velocity (baPWV) in hypertensive males. MATERIAL AND METHODS Altogether, 14 866 male hypertensive participants were included in the analysis. Participants were divided into 3 groups: low BMI group (BMI

Background Pre-hospital identification of acute ST-elevation myocardial infarction and activation of the catheterization laboratory can reduce first medical contact to wire-crossing times. We conducted a study on providing 24-hour tele-electrocardiography services via the WeChat group application, aiming to reduce the time taken for diagnosis and treatment of ST-elevation myocardial infarction. Methods A controlled before and after study was conducted on 140 ST-elevation myocardial infarction patients who were initially seen in non-percutaneous coronary intervention-capable hospital and transferred for primary percutaneous coronary intervention at our percutaneous coronary intervention centre from 1 February to 31 October 2018. The WeChat group had 70 patients with pre-hospital electrocardiography transmission via WeChat and the control group had 70 patients who did not transfer pre-hospital electrocardiography. The reperfusion time of the two groups was compared to evaluate the effect of the WeChat group intervention. Results In the WeChat group versus the control group, the median symptom onset to first medical contact time was similar (129 vs 150 min, p > 0.05), but the median first medical contact to wire, door to wire and first medical contact to catheterization laboratory activity were significantly shorter (132 vs 171 minutes, p Conclusions Pre-hospital electrocardiography transfer via a WeChat group resulted in earlier reperfusion of ST-elevation myocardial infarction patients who were transferred from the non-percutaneous coronary intervention centre.

Background Obesity and overweight are related to changes in blood pressure, but existing research has mainly focused on the impact of body mass index (BMI) on short-term blood pressure variability (BPV). The study aimed to examine the impact of BMI on long-term BPV. Methods Participants in the Kailuan study who attended all five annual physical examinations in 2006, 2008, 2010, 2012, and 2014 were selected as observation subjects. In total, 32,482 cases were included in the statistical analysis. According to the definition of obesity in China, BMI was divided into four groups: underweight (BMI