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Abstract Elaborating and understanding disparities in the burden of cardiovascular disease attributable to high fasting plasma glucose is important to improve diabetes prevention and promote cardiovascular health. In this study, we pool data on 791,373 people aged 25 years and older from three population-based surveys, and estimate the burden of cardiovascular disease attributable to high fasting plasma glucose between 2010 and 2018 in China by age, sex, region and socio-demographic index. In 2018, an estimated total of 498.61 thousand (95% uncertainty interval 463.93 to 534.12) cardiovascular disease-related deaths are attributable to high fasting plasma glucose in China. High fasting plasma glucose accounts for 1076.09 years of life lost per 100,000 people (95% uncertainty interval 1026.88–1129.04) due to cardiovascular disease in 2018, with substantial variation across provinces. In 2018, the higher age-standardised cardiovascular disease mortality rate attributable to high fasting plasma glucose is observed in the high-middle socio-demographic index region and the middle socio-demographic index region. Nationally, compared to 2010, exposure to high fasting plasma glucose and population aging in 2018 are the primary drivers of increased fasting plasma glucose-related deaths due to cardiovascular disease. Findings of this study emphasize the importance of developing population-specific tailored measures in China and other regions with similar condition.

Abstract Background Previous studies have investigated the association between cardiometabolic risk factors and cardiovascular disease (CVD), but evidence of the attributable burden of individual and combined cardiometabolic risk factors for CVD and mortality is limited. We aimed to investigate and quantify the associations and population attributable fraction (PAF) of cardiometabolic risk factors on CVD and all-cause mortality, and calculate the loss of CVD-free years and years of life lost in relation to the presence of cardiometabolic risk factors. Methods Twenty-two thousand five hundred ninety-six participants aged ≥ 35 without CVD at baseline were included between October 2012 and December 2015. The outcomes were the composite of fatal and nonfatal CVD events and all-cause mortality, which were followed up in 2018 and 2019 and ascertained by hospital records and death certificates. Cox regression was applied to evaluate the association of individual and combined cardiometabolic risk factors (including hypertension, diabetes and high low-density lipoprotein cholesterol (LDL-C)) with CVD risk and all-cause mortality. We also described the PAF for CVD and reductions in CVD-free years and life expectancy associated with different combination of cardiometabolic conditions. Results During the 4.92 years of follow-up, we detected 991 CVD events and 1126 deaths. Hazard ratio were 1.59 (95% confidential interval (CI) 1.37–1.85), 1.82 (95%CI 1.49–2.24) and 2.97 (95%CI 1.85–4.75) for CVD and 1.38 (95%CI 1.20–1.58), 1.66 (95%CI 1.37–2.02) and 2.97 (95%CI 1.88–4.69) for all-cause mortality, respectively, in participants with one, two or three cardiometabolic risk factors compared with participants without diabetes, hypertension, and high LDL-C. 21.48% of CVD and 15.38% of all-cause mortality were attributable to the combined effect of diabetes and hypertension. Participants aged between 40 and 60 years old, with three cardiometabolic disorders, had approximately 4.3-year reductions life expectancy compared with participants without any abnormalities of cardiometabolic disorders. Conclusions Cardiometabolic risk factors were associated with a multiplicative risk of CVD incidence and all-cause mortality, highlighting the importance of comprehensive management for hypertension, diabetes and dyslipidemia in the prevention of CVD.

Abstract Background Air pollution is a growing public health concern of global significance. Till date, few studies have explored the associations between air pollutants and cardiac imaging phenotypes. In this study, we aim to explore the association of ambient air pollution and abnormal left ventricular diastolic function (ALVDF) among a large-scale free-living population. Methods The participants were from a national representative large-scale cross-sectional study, i.e., the China Hypertension Survey (CHS), 2012–15. After exclusion, 25,983 participants from 14 provinces and 30 districts in China were included for the final analysis. The annual average ambient PM2.5, PM10 and NO2 concentrations were obtained from the chemical data assimilation system (ChemDAS). The clinical evaluation of left ventricular function was conducted in the survey field which was based on echocardiography. Grading diastolic dysfunction was based on Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009). Results The mean age of 25,983 participants was 56.8 years, 46.5% were male, and the crude prevalence of GradeI-III ALVDF were 48.1%, 1.6% and 1.1%, respectively. The ORs (95% CI) for ALVDF in the fully adjusted model were 1.31 (1.11–1.56), 1.11 (1.01–1.21) and 1.18 (0.90–1.54) for an increase of 10 μg/m3 of PM2.5, PM10 and NO2, respectively. And for different grades of ALVDF, elevated concentration of PM2.5 and PM10 exposures significantly increased the risk of gradeIinstead of gradeII ~ III ALVDF. There was a positive linear and “J” shape concentration–response association between annual average ambient PM2.5 and NO2 and the ALVDF risk assessed by the restricted cubic spline. The exposure level of most participants to PM10 was less than 130 μg/m3, and the risk of ALVDF increased significantly with the concentration rise. Conclusions This large-scale nationwide population study demonstrated a significantly positive association between ambient PM2.5, PM10 and NO2 with ALVDF, especially for mild ALVDF. The functional abnormality may partially explain the enhanced cardiovascular morbidity and mortality associated with air pollution, which highlights the importance of appropriate interventions to reduce ambient air pollution in China.

Abstract Background A workplace-based primary prevention intervention be an effective approach to reducing the incidence of hypertension (HTN). However, few studies to date have addressed the effect among the Chinese working population. We assessed the effect of a workplace-based multicomponent prevention interventions program for cardiovascular disease on reducing the occurrence of HTN through encouraging employees to adopt a healthy lifestyle. Methods In this post hoc analysis of cluster randomized controlled study, 60 workplaces across 20 urban regions in China were randomized to either the intervention group (n = 40) or control group (n = 20). All employees in each workplace were asked to complete a baseline survey after randomization for obtaining sociodemographic information, health status, lifestyle, etc. Employees in the intervention group were given a 2-year workplace-based primary prevention intervention program for improving their cardiovascular health, including (1) cardiovascular health education, (2) a reasonable diet, (3) tobacco cessation, (4) physical environment promotion, (5) physical activity, (6) stress management, and (7) health screening. The primary outcome was the incidence of HTN, and the secondary outcomes were improvements of blood pressure (BP) levels and lifestyle factors from baseline to 24 months. A mix effect model was used to assess the intervention effect at the end of the intervention in the two groups. Results Overall, 24,396 participants (18,170 in the intervention group and 6,226 in the control group) were included (mean [standard deviation] age, 39.3 [9.1] years; 14,727 men [60.4%]). After 24 months of the intervention, the incidence of HTN was 8.0% in the intervention groups and 9.6% in the control groups [relative risk (RR) = 0.66, 95% CI, 0.58 ~ 0.76, P

Summary: Background: Dementia has become a major public health concern worldwide, but comprehensive assessments of dementia burden attributable to high body mass index (BMI) in China have not been done. Methods: We used a temporal-spatial Bayesian hierarchical model to estimated BMI levels based on 1.25 million Chinese. We estimated dementia burden attributable to high BMI by age, sex, year, and socioeconomic development in terms of deaths and years of life lost (YLLs) and assessed the effect of population ageing. Findings: The average age-standardised BMI was 24.58 kg/m2 and 24.15 kg/m2 for men and women in 2018, respectively. 12,901 (95% UI, 10,617–15,420) dementia deaths were attributable to high BMI in China in 2018, with 5417 deaths from man and 7421 deaths from woman. The attributable age-standardised YLL rates for dementia increased 27% from 2005 to 2018. The attributable age-standardised mortality rates increased with human development index. People aged 80 years and older had the highest attributable mortality rate, and the rate decreased with decreasing age. Population ageing was an important component of the increase in dementia death. Interpretation: The rapid increase and large inequality highlighted the urgent need for evidence-based policies and interventions. We therefore call for establishing stronger anti-dementia strategies to promote the healthy ageing. Funding: China National Key Research and Development Program, China National Science & Technology Pillar Program, and National Health Commission of the People's Republic of China.

BackgroundAt present, the association between age at menarche and menopause, reproductive lifespan, and cardiovascular disease (CVD) risk among Chinese postmenopausal women is not clear, and some related researches are contradictory.MethodsA total of 6,198 Chinese postmenopausal women with a mean age of 63.6 years were enrolled at baseline in 2012–2015 and followed up for 5 years. A standardized questionnaire was used to collect relevant information by well-trained interviewers. Physical examination of the participants was performed by trained medical staff. CVD events were observed during follow-up. Cox proportional hazards models were used to estimate hazard ratios between reproductive characteristics and CVD events.ResultsAge at menarche was positively associated with CVD events (HR, 1.106; 95%CI, 1.047–1.167). There was a negative association between age at menopause and CVD risk in postmenopausal women with comorbidity (HR, 0.952; 95%CI, 0.909–0.996). Reproductive lifespan was negatively associated with CVD events (HR, 0.938; 95%CI, 0.880–0.999). The CVD risk increased by 10.6% for every 1-year increase in age at menarche. The CVD risk reduced by 6.2% for every 1-year increase in age at menopause in women with comorbidity. The CVD risk reduced by 3.8% for every 1-year increase in reproductive lifespan.ConclusionsBased on the large prospective study with a nationally representative sample, Chinese postmenopausal women with late age at menarche and shorter reproductive lifespan have higher risk of CVD events.

BackgroundThe association between reproductive lifespan and risk of hypertension among postmenopausal women is unclear.MethodsA total of 94,141 postmenopausal women with a mean age of 64.8 years from the China Hypertension Survey were enrolled at baseline from 2012 to 2015. A standardized questionnaire was used to collect relevant information by well-trained interviewers. Blood pressure and physical examination of the participants were performed by trained medical staff. Logistic regression was used to estimate the odds ratios for hypertension by years of reproductive lifespan.ResultsThe average years of reproductive lifespan in Chinese women was 34.0 years. Women who were longer in reproductive lifespan were more likely to have older age at recruitment, higher body mass index, larger waist circumference, lower mean systolic blood pressure, and higher mean diastolic blood pressure (p < 0.05). After adjustments, odds ratios (95% confidence interval) for hypertension were 1.035 (0.988–1.085), 1.007 (0.966–1.048), 1.000 (reference), 0.932 (0.899–0.967), and 0.953 (0.909–0.997) for those with reproductive lifespan at ≤ 28, 29–31, 32–34 (reference), 35–37, and ≥ 38 years, respectively, with a significantly inverse association was seen in those with reproductive lifespan at 35–37 and ≥ 38 years. The overall risk of hypertension declined with the increase in reproductive lifespan, and the risk of hypertension was reduced by 1.1% for every 1-year increase in the reproductive lifespan (odds ratio, 0.989; 95% confidence interval, 0985–0.994) per year. The negative association between reproductive lifespan and hypertension was evident among age at recruitment groups, body mass index categories, and education levels, with the strongest association among women aged ≥ 70 years. Positive associations between reproductive lifespan and risk of hypertension were evident among women aged < 60 years, and this association was stronger among current alcohol drinkers.ConclusionBased on the large nationally representative sample, Chinese postmenopausal women with a shorter reproductive lifespan have a higher risk of hypertension.

Previous studies have documented the associations between short-term diurnal temperature range (DTR) exposure and cardiovascular disease (CVD) via time-series analyses. However, the long-term impacts of DTR through a population-based prospective cohort have not been elucidated thoroughly. This study aimed to quantify the longitudinal association of DTR exposure with all-cause mortality and CVD in a nationwide prospective cohort and, by extension, project future DTR changes across China under climate change. We included 22,702 adults (median age 56.1 years, 53.7% women) free of CVD at baseline from a nationwide cross-sectional study in China during 2012–2015, and examined three health outcomes during a follow-up survey in 2018–2019. We estimated the chronic DTR exposure as baseline annual mean daily maximum minus minimum temperature. The Cox proportional hazards regression was adopted to assess the multivariable-adjusted hazard ratio and its corresponding 95% confidence interval (95% CI). We employed 31 downscaled global climate models under two shared socioeconomic pathways for future projection. During the median follow-up period of ~5 years, 1096 subjects died due to all causes while 993 and 597 individuals developed fatal or nonfatal CVD and fatal or nonfatal stroke, respectively. The cumulative incidence rates of all-cause mortality, CVD, and stroke were 10.49, 9.45, and 5.64 per 1000 person-years, respectively. In the fully adjusted models, the risks for all-cause mortality, CVD, and stroke would increase by 13% (95% CI: 8–18%), 12% (95% CI: 7–18%), and 9% (95% CI: 2–16%) per 1 °C increment in DTR, respectively. Moreover, linear positive associations for the concentration–response curves between DTR and mortality and CVD were observed. We also found significantly greater DTR-related mortality risks among rural residents than their urban counterparts. The DTR changes featured a dipole pattern across China under a warming climate. The southern (northern) China would experience increased (decreased) DTR exposure by the end of 21st century. The present study indicates that chronic DTR exposure can exert long-term impacts on mortality and CVD risks, which may inform future public health policies on DTR-related susceptible population and regions.