Predicted 10-year Cardiovascular Disease Risk and Its Association with Sleep Duration among Adults in Beijing-Tianjin-Hebei Region,China

Objective The study aims to predict 10-year cardiovascular disease (CVD) risk and explore its association with sleep duration among Chinese urban adults. Methods We analyzed part of the baseline data of a cohort that recruited adults for health screening by cluster sampling. The simplified Pittsburgh Sleep Quality Index (PSQI) and Framingham 10-year risk score (FRS) were used to measure sleep duration and CVD risk. Demographic characteristics, personal history of chronic diseases, lifestyle factors were collected using a questionnaire. Height, weight, total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) were also measured. Multiple logistic regression models were performed to explore the association of sleep duration with the predicted CVD risk. Results We included 31, 135 participants (median age 44 years, 53.02％ males) free of CVD, cerebral stroke, and not taking lipid-lowering agents. Overall, 14.05％, and 25.55％ of participants were at medium and high predicted CVD risk, respectively. Short sleep was independently associated with increased odds of medium to high risk of predicted 10-year CVD among males (OR = 1.10; 95％ CI:1.01–1.19) and increased odds of medium to high and high risk of predicted 10-year CVD among females (OR = 1.23; 95％ CI: 1.08–1.40; OR = 1.27; 95％ CI: 1.11–1.44). In contrast, long sleep had no association with cardiovascular risk. Conclusion A substantial number of adults free of CVD were at high 10-year CVD risk. Short sleep was associated with increased odds of predicted CVD risk.     

Association between dyslipidemia and chronic kidney disease: a cross-sectional study in the middle-aged and elderly Chinese population?

Background Dyslipidemia,a well-known risk factor for cardiovascular disease,is common in patients with kidney disease.Recent studies discerned that dyslipidemias play a critical role in renal damage pr...     

Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study

CONTEXT: Few studies have examined the interactive effects of smoking and serum cholesterol level on morbidity and mortality from cardiovascular dieseases. In East Asia, where the prevalence of smoking is among the highest in the world, morbidity and mortality from ischemic heart disease (IHD) is rapidly escalating. OBJECTIVES: To determine whether cigarette smoking is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the Republic of Korea (South Korea), a population that has relatively low levels of serum cholesterol, and to determine whether serum cholesterol levels modify the risk relationship between smoking and ASCVD. DESIGN: Prospective cohort study with a follow-up period of 6 years (1993-1998). SETTING AND SUBJECTS: A total of 106745 Korean men aged 35 to 59 years who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1990 and 1992. MAIN OUTCOME MEASURES: Hospital admissions and deaths from IHD, cerebrovascular disease (CVD), and total ASCVD. RESULTS: At baseline, 61389 (58%) were current cigarette smokers and 64482 (60%) had a total cholesterol level of less than 5.17 mmol/L (200 mg/dL). Between 1993 and 1998, 1006 IHD events (176 per 100000 person-years), 1364 CVD events (238 per 100000 person-years), and 716 other ASCVD events (125 per 100000 person-years) occurred. In multivariate Cox proportional hazard models controlling for age, hypertension, hypercholesterolemia, and diabetes, current smoking increased the risk of IHD (risk ratio [RR], 2.2; 95% confidence interval [CI], 1.8-2.8), CVD (RR, 1.6; 95% CI, 1.4-1.8), and total ASCVD (RR, 1.6; 95% CI, 1.5-1.8). For each outcome, there were significant dose-response relationships with amount and duration of smoking. Throughout the range of serum cholesterol levels, current smoking significantly increased the risk of IHD and CVD. In the lowest quartile of serum cholesterol levels (<4.42 mmol/L [171 mg/dL]), the RR from current smoking was 3.3 (95% CI, 1.7-6.2) for IHD and 1.6 (95% CI, 1.2-2.3) for CVD. There was no evidence of an interaction between smoking and serum cholesterol (P for interaction = .75, .87, and .92 for IHD, CVD, and total ASCVD, respectively). CONCLUSIONS: This study demonstrates that in Korea smoking is a major independent risk factor for IHD, CVD, and ASCVD and that a low cholesterol level confers no protective benefit against smoking-related ASCVD.     

2 926例2型糖尿病患者社区综合干预9年心血管风险的变化

背景　2型糖尿病与心血管疾病（CVD）和死亡率密切相关,不同心血管风险2型糖尿病人群CVD事件发生鲜有报道。目的　观察北京社区2型糖尿病患者长期综合干预后心血管风险的变化。方法　2008年从北京市15个社区纳入2 926例2型糖尿病患者。将入组的2型糖尿病患者分为单纯糖尿病组（DM组,n=824）,合并高血压组（HTN组,n=1 267）及合并CVD者（CVD组,n=835）。按改良FRS评分（I-FRS）将上述三组人群进一步分别分为低危组（I-FRS<10%）、中危组（10%≤I-FRS≤20%）及高危组（I-FRS>20%）。截至2017年,所有患者均接受9年规范化的管理,并进行随访评估。随访结束时,比较各组心血管风险的变化,包括临床特征、I-FRS评分及终点事件。采用Cox回归模型分析终点事件的影响因素。结果　基线时,I-FRS中危组,CVD组年龄、糖尿病病程高于DM组及HTN组;CVD组及HTN组收缩压高于DM组,空腹血糖（FPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）低于DM组（P<0.01）。基线时,I-FRS高危组,CVD组年龄高于DM组、HTN组;CVD组及HTN组的收缩压高于DM组;CVD组及HTN组的FPG、HbA1c、TC、LDL-C低于DM组（P<0.01）。9年随访结束时,I-FRS中危组,CVD组及HTN组血压、TC、LDL-C低于基线时,DM组舒张压、FPG、HbA1c、TC、LDL-C低于基线时;I-FRS高危组,CVD组及HTN组血压、FPG、TG、LDL-C低于基线时,DM组HbA1c、TC低于基线时;I-FRS中危组和高危组,CVD组、HTN组及DM组I-FRS均较基线明显下降（P<0.05）。9年随访结束时,CVD组及HTN组的累计全因死亡、CVD事件高于DM组（P<0.017）。Cox回归分析结果显示,校正年龄及性别的影响后,HTN组及CVD组发生终点事件的风险分别为DM组的1.542、1.923倍。结论　社区糖尿病合并CVD患者预后较差,综合干预CVD危险因素具有重要意义。应积极关注并干预I-FRS较高的糖尿病人群,即使是单纯糖尿病人群,从而实现个体化评估。     

我国五省市、自治区慢性肾脏病患者心血管疾病的危险因素调查

目的了解我国慢性肾脏病(CKD)患者心血管疾病(CVD)的危险因素。方法利用我国五个省市、自治区七家三级甲等医院2002至2003年收治的1239例慢性肾脏病病人有关心血管疾病的资料库,用多因素Logistic回归分析该组患者人口学资料、生活方式、疾病和用药史、体检及实验室参数与各类心血管疾病的关系;同时对主要危险因素的普遍性进行分析。结果(1)血清C反应蛋白(CRP)显著增高(>10mg/L)是慢性肾脏病患者发生冠状动脉疾病(CAD)的危险因素(OR2.13,95%可信区间[CI]1.32～3.43);本组慢性肾脏病患者CRP>10mg/L者占21.5%。(2)女性(OR2.99,CI2.09～4.26)、贫血(OR2.06,CI1.19～3.57)和收缩期高血压(OR1.016,CI1.00～1.02)是左心室肥厚(LVH)的主要危险因素;本组慢性肾脏病病人收缩压控制在140mmHg以下者占54.2%,血红蛋白维持≥110g/L者仅15%。(3)钙磷乘积增加与慢性肾脏病患者的充血性心力衰竭(CHF)有关(OR1.023,CI1.01～1.03);本组病人中25.9%钙磷乘积≥55。(4)低白蛋白血症(OR6.01,CI1.25～28.96)和舒张压增高(OR1.049,CI1.00～1.09)是慢性肾脏病合并脑卒中(CVA)的主要危险因素;低白蛋白血症的患病率为37.3%。(5)传统危险因素如糖尿病增加慢性肾脏病患者CAD(OR2.34)、CHF(OR1.97)和脑卒中(OR4.40)的危险性;年龄增加是CAD(OR1.04)和脑卒中(OR1.22)的危险因素;而高血压则与左心室肥厚(OR1.016)、CHF(OR1.02)和脑卒中(OR1.04)的发生有关。结论慢性肾脏病患者具有不同于一般人群的心血管疾病危险因素,探讨对微炎症和营养不良的干预方法,加强对贫血、高血压和钙磷代谢紊乱的控制是改善我国慢性肾脏病患者心血管疾病预后的关键。     

The effect of rheumatoid arthritis on the risk of cerebrovascular disease and coronary artery disease in young adults

Background

Only a few studies have investigated the affect of rheumatoid arthritis (RA) on the risk of cerebrovascular disease (CVD)/coronary artery disease (CAD) in young adults. This study, therefore, examined the association between RA and the risk of CVD/CAD in young adults and the interaction effects between cardiovascular risk factors and RA on the risk of CVD/CAD.

Relationship of Inflammation and Endothelial Dysfunction with Risks to Cardiovascular Disease among People in Inner Mongolia of China

Objective To explore the relationship of inflammation and endothelial dysfunction with risks to cardiovascular disease （CVD）. Methods Blood pressure, body weight, body height, waist circumference and lifestyle risk factors were measured and studied among 2589 participants in Inner Mongolia of China, and biomarkers of inflammation and endothelial dysfunction including high-sensitivity C-reactive protein （hsCRP）, soluble inter-cellular adhesion molecule-1 （slCAM-1）, soluble E-selectin （sE-selectin）, and angiotensin II were investigated. Results Subjects with metabolic risk factors for CVD had higher levels of hsCRP, sE-selectin and slCAM-1 than those without such risk factors （all P〈O.05）. Levels of all biomarkers positively and significantly increased with aggregation of the metabolic risk factors among the subjects （all P for trend 〈0.001）. Data from the multivariate analysis showed that participants with high levels of hsCRP [odds ratio （OR}： 1.96, 95% confidence interval （CI）： 1.52-2.53], sE-selectin （OR： 1.35, 95% Cl： 1.05-1.72）, and angiotensin II （OR： 1.81, 95% CI＂ 1.40-2.33） were more likely to develop hypertension; participants with high levels of hsCRP （OR： 2.33, 95% CI： 1.85-2.94）, sE-selectin （OR： 1.24, 95% CI： 1.00-1.54）, and slCAM-1 （OR： 1.70, 95% CI： 1.30-2.22） were more likely to develop dyslipidemia, and those with high levels of hsCRP （OR： 2.95, 95% CI： 2.27-3.83） and slCAM-I（OR： 2.80, 95% CI： 2.06-3.80） were more likely to develop hyperglycemia. Conclusion Biomarkers of inflammation and endothelial dysfunction were separately associated with relevant metabolic risk factors for CVD. And appropriate measures should be taken to control inflammation and improve endothelial function among individuals with different metabolic risk factors for CVD.     

Associations of Daytime Napping with Incident Cardiovascular Diseases and Hypertension in Chinese Adults: A Nationwide Cohort Study

Objective This study aimed to examine the associations of daytime napping with incident risks of cardiovascular diseases(CVDs)and hypertension(HTN).Methods Data for napping and CVD outcomes in 25 provinces were collected from baseline(2010)and three waves of follow-up(2012-2017)investigations of the China Family Panel Studies.Cox frailty models with random intercepts for the surveyed provinces were used to assess the longitudinal effects of daytime napping on CVD and HTN.Results Compared with non-nappers,30+min nappers had higher risks of CVD and HTN,while no significant associations were observed among<30 min nappers.Incident risks among 30-to<60-min nappers increased by 22%[hazard ratio(HR)1.22,95% confidence interval(CI)1.08-1.39]for CVD and 21%(1.21,1.04-1.41)for HTN,respectively,with corresponding HRs of CVD and HTN of 1.27(1.09-1.47)and 1.38(1.16-1.65)among≥60 min nappers.Nap-associated CVD risks varied by subgroups,with stronger associations in participants with lower body mass index(<24 kg/m²),physically inactive persons,smokers,and participants with longer nighttime sleep(≥7 h/night).Significant effects of daytime napping were observed on rural and northern residents only,highlighting great regional variations in CVD risks associated with napping habits.Conclusions This cohort study revealed strong evidence that long daytime napping(≥30 min)is associated with an increased incidence of cardiovascular events.     

Prevalence and risk factors for left ventricular hypertrophy and left ventricular geometric abnormality in the patients with hypertension among Han Chinese

Background  Left ventricular hypertrophy (LVH) and geometric abnormality are associated with morbidity and mortality of cardiovascular disease and stroke. Hypertension is the major cause of LVH. Yet the prevalence and other risk factors of LVH and geometric abnormality in Chinese hypertensive population are unknown. The objective of this study was to investigate the prevalence and risk factors of LVH and geometric abnormality in community-based Chinese hypertensive population.

Methods  The study was a community-based cross-sectional study, and comprised 4270 hypertension patients with integrated clinical and echocardiographic data. Left ventricular mass was measured by transthoracic echocardiography. LVH was diagnosed by using the criteria of over 49.2 g/m^2.7 for men and 46.7 g/m^2.7 for women. LV geometric patterns (normal, concentric remodeling, concentric or eccentric hypertrophy) were calculated according to LVH and relative wall thickness. Logistic regression model was used to determine the odds ratio (OR) and 95% confidence intervals (CI) of the risk factors of LVH.

Results  The prevalence of LVH was 42.7% in 4270 hypertensive patients, with 37.4% in males and 45.4% in females, respectively. The prevalence of concentric remodeling, concentric or eccentric hypertrophy was 24.7%, 20.2%, and 22.6%, respectively. In Logistic regression model, female (OR 1.3, 95%CI 1.1–1.5, P <0.01), age (OR 1.02, 95%CI 1.01–1.03, P <0.01), body mass index (OR 1.2, 95%CI 1.15–1.20, P <0.01), systolic blood pressure (OR 1.02, 95%CI 1.01–1.03, P <0.01), and serum triglyceride (OR 1.10, 95% CI 1.00–1.20, P <0.01) were risk factors of LVH. Female, age, body mass index, systolic blood pressure and serum triglyceride were also risk factors of left ventricular geometric abnormality.

Conclusions  The echocardiographic LVH is the major complication of patients with hypertension in rural area of China, especially for women. To effectively treat hypertension, weight loss and control of serum triglyceride may help to prevent LVH in hypertensive population.

     

老年高血压人群发生糖代谢异常风险的10年队列研究

目的 观察老年高血压(HT)及非高血压(NHT)人群糖代谢异常的发生情况及其危险因素.方法 采用前瞻性队列研究方法,研究对象为1999至2009年在解放军总医院体检的60岁以上老年人,除外基线时已确诊2型糖尿病(T2DM)及糖调节受损(IGR)者.观察在10年中发生DM及IGR的情况及影响因素,应用COX风险比例模型分析相关危险因素,Kaplan-Meier法分析累计发病率.结果 (1) 1999年调查人数为1 136人,纳入糖耐量正常582人,其中HT组384例,NHT组198人.随访10年后,HT组发生T2DM显著高于NHT组(27.6％比18.7％,P＜0.05),HR( 95％ CI)为1.48(1.07～2.04);两组DM发病密度分别为33.8‰和20.6‰.HT组与NHT组的IGR发生率差异无统计学意义(P＞0.05);新发HT组与NHT组相比,DM及IGR的发生率差异无统计学意义(P＞0.05).(2)血脂紊乱及HT是发生T2DM的独立危险因素,HR(95％CI)分别为1.459(1.027～2.072)及1.516(1.039～2.212);同时也是发生糖代谢异常的独立危险因素,HR (95％ CI)分别为1.545(1.087～2.195)及1.524(1.044 ～2.224);HT与NHT人群T2DM及糖代谢异常的累积发生率差异均有统计学意义(均P ＜0.05).结论 老年人群合并HT后其糖尿病风险增加,是非NHT人群的1.52倍.血脂紊乱也是T2DM及糖代谢异常的独立危险因素.     

Influence of socioeconomic status on acute myocardial infarction in the Chinese population: the INTERHEART China study

Background  Many researches report that low socioeconomic status (SES) is associated with a higher risk of coronary heart disease (CHD). This study aimed to determine whether levels of education, family income, and other SES were associated with acute myocardial infarction (AMI) in the Chinese population, and to compare the difference in this association between northern and southern regions in China.

Methods  We conducted a case-control study. Cases were first AMI (n=2909). Controls (n=2947) were randomly selected and frequency matched to cases on age and sex. SES was measured using education, family income, possessions in the household, and occupation.

Results  Low levels of education (8 years) were more common in cases compared to controls (53.4% and 44.1%; P=0.0001). After adjusting all risk factors, the level of education was associated with AMI risk in the Chinese population (P=0.0005). The odds ratio (OR) associated with education of 8 years or less, compared with more than 12 years (trade school/college/university) was 1.33 (95% CI 1.12–1.59), and for education of 9–12 years 1.04 (95% CI 0.88–1.33). The proportion of higher income population was more in controls than cases (39.4% and 35.3%). Number of possessions and non-professional occupation were only weakly or not at all independently related to AMI. The adjusted OR associated with the lower education was 2.38 (95% CI 1.67–3.39) in women, and 1.18 (95% CI 0.99–1.42) in men (P=0.0001, for heterogeneity). The interaction between levels of education and different regions was significant (P=0.0206, for interaction).

Conclusion  Several socioeconomic factors including levels of education and income were closely associated with increase of AMI risk in China, most markedly in northeast and southern area. The effect of education was stronger towards AMI in women than men.

     

Influence of dietary patterns on the risk of acute myocardial infarction in China population: the INTERHEART China study

Background Some dietary patterns are risk factors for acute myocardial infarction (AMI).Chinese traditional food and habits vary from other cultures.The present study determined whether different dieta...     

锯齿状息肉与传统腺瘤风险因素对比及结直肠癌适宜筛查年龄

目的 对锯齿状息肉(SPs)及传统腺瘤(CA)相关风险因素进行分析、对比,探讨两类息肉风险因素间异同.方法 收集南方医院消化内镜中心2012～2015行全结肠镜及息肉病理检查的病例.随机选取健康对照103例,SPs100例,CA 115例,采集各病例性别、年龄、身高、体质量等临床数据.运用SPSS软件,先对各因素进行组间多重比较,对具有显著性的因素再纳入多因素logistic回归分析,得到风险因素及其OR值.结果 SPs平均发病年龄48.87岁(95％CI 47.22-50.52),较CA更早(P=0.038).以青年组为参照,中年组发生SPs风险增加2.31倍(95％CI 1.46-3.65)、CA风险增加4.10倍(95％CI 2.50-6.72);老年组发生SPs风险增加2.77倍(95％CI 1.52-5.04)、CA风险增加6.00倍(95％CI 3.26-11.05).其中,年龄与CA的发生较SPs关系更为密切(老年组:OR=2.14,95％CI 1.21-3.78,P=0.009).男性较女性SPs发病风险增加2.75倍(95％CI 1.50-5.07)、CA增加2.19倍(95％CI1.22-3.95).BMI每增加1个单位,SPs发病风险增加1.18倍(95％CI 1.06-1.30)、CA增加1.20倍(95％CI 1.09-1.32).结论 两类息肉风险因素类别相同,可使用同一方案进行高危人群筛查.SPs平均发病年龄早于50岁且有可能快速进展为癌,提早CRC筛查年龄值得考虑.     

血尿酸水平与颈动脉内中膜厚度的研究

目的 探讨不同血尿酸水平与动脉硬化早期指标颈动脉内中膜厚度(cIMT)之间的关系. 方法 采用随机按年龄分层抽样方法,抽取≥40岁的某矿场工人5 440例,按照血尿酸水平进行分组,多因素分析血尿酸与cIMT的关系. 结果 (1)5 294例研究对象纳入统计分析,非高尿酸组4 739例(89.5％),高尿酸组555例(10.5％).(2)高尿酸组的年龄、cIMT、体质量指数(BMI)、收缩压(SBP)、对数转换后的甘油三酯(Log-TG)、总胆固醇(TC)、肌酐(Cr)的均值和饮酒、喜盐、锻炼比例均高于非高尿酸组,差别有统计学意义(P＜0.05).(3)多因素线性回归模型分析显示,校正相关因素后,血尿酸每增加1 mg/dL,cIMT增加分别为:总人群0.01 mm(95％CI:0.01～0.01,P＜0.05),女性0.03 mm(95％CI:0.02～0.04,P＜0.05),男性0 mm(95％ CI:0.00～0.01,P=0.072).(4)多因素Logistic回归分析结果显示,校正相关因素后,高尿酸组cIMT≥1 mm的风险是非高尿酸组的倍数分别为:总人群是1.27倍(95％CI:1.01～1.60,P＜0.05)、女性是1.99倍(95％CI:1.29～3.06,P＜0.05)、男性是1.06倍(95％CI:0.81～1.39,P=0.67). 结论 女性的血尿酸水平与cIMT增厚有关,高尿酸血症可能更易发生动脉硬化.     

北京社区居民不同年龄组冠心病主要危险因素流行特点

目的 调查北京市社区居民不同年龄水平冠心病(CHD)主要危险因素异常的流行病学特征,探讨北京市防治CHD的方向.方法 于2007年6月至2007年8月期间,分层整群随机抽样调在北京市社区居民10054名,根据年龄分为3个组,20～44岁组、45～59岁组及≥60岁组,采取问卷调查、体格检查和生化检测进行CHD主要危险因素的测定.结果 经标化后北京社区居民高胆固醇血症、高血压、糖尿病、吸烟及肥胖的发病率分别为9.30%,41.57%,10.18%,35.81%及22.89%.高胆固醇血症、高血压及糖尿病发病率随年龄增加均有增高趋势(趋势χ~2值依次为15.6,31.7和18.0,均P<0.001).吸烟及肥胖的发病率45～59岁组最高,分别是28.00%和25.27%(均P<0.01).在45～59岁组及≥60岁组,将近30%左右的人处于胆固醇边缘升高及血压边缘升高的状态之中,高于40%的人处于体重超重的状态下.经标化后10.4%北京社区居民处于理想水平.22.45%的居民伴有1项以上危险因素的边缘异常.67.15%的居民伴有1项以上的危险因素,其中伴有2项及3项以上危险因素聚集者占21.37%及8.50%.与20～44岁组相比,45～59岁组、≥60岁组发生CHD危险因素聚集的风险分别是2.63倍(95%CI 2.371～2.924)、4.3倍(95%CI3.764～4.913).男性与女性相比发生CHD危险因素聚集的风险是4.392(95%CI 3.938～4.899).结论 北京社区居民CHD主要危险因素发生率较高.45～59岁组及≥60岁组CHD主要危险因素发生率及聚集风险均较20～44岁组增高,是北京市人群防治的重点.     

倒班与不良生活方式的交互作用对钢铁工人高胆固醇血症的影响研究

背景　我国成人血脂异常患病率不断提高，血清总胆固醇升高是动脉粥样硬化性心血管疾病的重要危险因素。同时，我国倒班工人数量逐渐增加，目前对于倒班与血脂异常关系的研究结果并不相同，并且也较少有研究探讨倒班、不良生活方式与人群高胆固醇血症的关系。目的　探究倒班及不良生活方式对钢铁工人高胆固醇血症的联合作用。方法　采用整群抽样选择某钢厂2017年职业体检的员工，采用自行设计的《健康评估调查表》收集个人基本信息（性别、年龄、身高、体质量、家族史等）、倒班情况（倒班时间、倒班开始年龄等）、个人生活方式（饮食、体力活动、吸烟、饮酒等 ）；采用限制性立方样条（RCS）模型分析倒班年限与高胆固醇血症的剂量-反应关系；根据RCS结果，对倒班年限进行分组，使用多因素Logistic回归模型分析倒班和不良生活方式与高胆固醇血症的关系。通过计算超额相对危险度（RERI）、交互作用归因比（AP）来评价倒班与不良生活方式的相加交互作用。结果　根据RCS结果分为0 年、>0~年、23.8~年 3组，以是否患有高胆固醇血症为因变量，采用Logistic回归分析倒班与高胆固醇血症的关系，结果显示，在>0~年倒班年限中，倒班与高胆固醇血症呈正相关（P<0.05）。吸烟、饮酒、BMI均与高胆固醇血症呈正相关（P<0.05）。体力活动与DASH饮食评分在调整年龄、性别、高血压、糖尿病、家族史等变量后与高胆固醇血症无明显相关性（P>0.05）。当综合考虑时，不良生活方式评分3分及以上组合的工人患高胆固醇血症是不良生活方式评分1分及以下工人的1.703倍。倒班年限在23.8年内且不良生活方式评分3分及以上的工人发生高胆固醇血症的危险是从不倒班、不良生活方式评分1分及以下工人的2.527倍。仅研究倒班年限在23.8年以内的工人时，发现倒班与不良生活方式有明显的交互作用，其中RERI为1.559（0.186，2.928），AP为46.26（4.36，88.17）。结论　倒班与不良生活方式均会使工人患高胆固醇血症的风险增高，并且倒班与不良生活方式具有交互作用。     

Association of Visit-to-Visit Variabilities in Metabolic Factors with Chronic Kidney Disease in Chinese Adults Living in Shanghai

Objective This study aimed to examine the association of visit-to-visit variabilities in metabolic factors with chronic kidney disease (CKD) in Shanghai community residents. Methods We used data from a cohort study of community residents who participated in three examinations in 2008, 2009, and 2013, respectively. Fasting plasma glucose (FPG) level, blood pressure (BP), and lipid levels were determined in 2,109 participants at all three visits, and CKD was evaluated between the second and the third visits. Visit-to-visit variabilities in metabolic factors were described by coefficients of variation (CV) at three visits. A variability score was calculated by adding the numbers of metabolic factors with a high variability defined as the highest quartile of CV. CKD was defined as the estimated glomerular filtration rate < 60 mL/min per 1.73 m2 or urinary albumin-to-creatinine ratio≥ 30 mg/g. Results A total of 200 (9.5％) participants had CKD at the third visit. Compared with the lowest quartile of CV, the highest quartile was associated with a 70％ increased risk of CKD for FPG [odds ratio, OR =1.70; 95％ confidence interval (CI) 1.06–2.72], 62％ for systolic BP (OR = 1.62, 95％ CI 1.04–2.50), and 85％for low-density lipoprotein cholesterol (OR = 1.85, 95％ CI 1.23–2.80). Furthermore, the risk of CKD increased significantly with an increasing variability score. Compared with participants with score 0, participants with scores of 1, 2, and 3 were associated with 58％ (OR = 1.58, 95％ CI 1.08–2.32), 121％(OR = 2.21, 95％ CI 1.40–3.49), and 548％ (OR = 6.48, 95％ CI 3.18–13.21) higher risks of CKD, respectively. Conclusion The visit-to-visit variabilities in metabolic factors were significantly associated with the risks of CKD in Shanghai community residents.     

颈动脉不同部位斑块与冠心病的关联研究

目的 探讨颈动脉不同部位斑块与冠心病的关系,为预防冠心病提供科学依据.方法 采用横断面研究设计,对北京市石景山区古城社区和苹果园社区40岁及以上的社区居民进行一般人口学资料问卷调查、体格检查、生化指标检测以及颈动脉超声检查;采用非条件Logistic回归分析不同部位的颈动脉斑块与冠心病的关系.结果 共纳入3 840名研究对象,其中冠心病组481名(12.6％),非冠心病组3 349(87.4％).Logistic回归分析显示,调整年龄、性别、体质指数、文化程度、吸烟、饮酒、高血压、2型糖尿病、高血脂、血清总胆固醇、甘油三酯、高密度脂蛋白胆固醇、降压药物、降糖药物因素后,颈总动脉、颈动脉膨大部、颈内动脉,斑块检出者均比未检出者患冠心病风险高[(OR=1.486,95％ CI:1.122 ～1.968)、(OR=1.501,95％ CI:1.183 ～ 1.904)、(OR=1.566,95％ CI:1.213～2.022)];颈总动脉、颈动脉膨大部、颈内动脉每增加一个斑块,冠心病风险分别增加26.5％(OR=1.265,95％ CI:1.083～1.478)、24.7％(OR=1.247,95％ CI:1.120～1.390)、30.5％ (OR=1.305,95％ CI:1.102 ～1.546),颈内动脉斑块总面积每增加1mm2,冠心病患病风险增加1.6％,(OR=1.016,95％CI:1.005～1.027);斑块病变部位与冠心病的患病风险之间存在剂量-反应关系(线性趋势检验P＜O.001).结论 颈动脉不同部位的斑块与冠心病存在关联关系,且颈内动脉斑块与冠心病最具有关联性,颈动脉斑块病变部位数增加提示冠心病的患病风险增加.     

北方农村人群心血管病一级预防筛查策略的评价

目的：在中国北方农村人群的前瞻性队列中,评估不同的心血管病筛查策略可获得的健康收益。方法：研究对象为6 221名基线未患心血管病的40~74岁北京房山农村人群。本研究比较的筛查策略包括：策略1,在40~74岁人群中采用《中国心血管病预防指南（2017）》推荐的筛查策略;策略2,采用中国动脉粥样硬化性心血管病风险预测研究（prediction for atherosclerotic cardiovascular disease risk in China,China PAR）风险评估模型的定量筛查策略在40~74岁人群中进行筛查;策略3,采用China PAR定量评估后在50~74岁人群中进行筛查。利用马尔科夫模型模拟将该人群根据上述不同的筛查策略进行心血管病危险分层,并根据指南中的推荐,对中危及以上人群采用生活方式干预,对高危人群额外进行药物治疗干预。比较不同筛查策略的健康收益,包括增额质量调整生命年（quality adjusted life year,QALY）、可预防的心血管病发病和死亡例数、每增加1个QALY（每预防1例心血管病发病或死亡）需筛查人数等。模型所需参数来源于本队列研究、公开发表的中国人群研究数据、Meta分析和系统综述。针对一般人群心血管病发病率的不确定性进行单因素敏感性分析,并针对风险比参数的不确定性进行概率敏感性分析。结果：与不筛查相比,采用策略1、2、3产生的增额QALY分别为498年（95%CI：103~894）、691年（95%CI：233~1 149）和654年（95%CI：199~1 108）,可预防的心血管病发病例数分别为298例（95%CI：155~441）、374例（95%CI：181~567）和346例（95%CI：154~538）。同时,采用China PAR定量评估的策略（策略2和策略3）较《中国心血管病预防指南（2017）》策略有显著的增额QALY（P<0.05）,可预防更多的心血管病发病和死亡（P<0.05）,且需筛查人数较少（策略3筛查50~74岁人群,3个指标P均<0.05;策略2筛查40~74岁人群,预防1例心血管病死亡需筛查人数这一指标P＜0.05）。采用China PAR定量的筛查策略在40~74岁人群和50~74岁人群筛查的健康收益相似。单因素敏感性分析和概率敏感性分析的结果与主要分析结果一致。结论：在北方农村人群中开展心血管病一级预防的筛查及干预是必要的,基于China PAR定量筛查的策略较《中国心血管病预防指南（2017）》推荐的筛查策略获得的健康收益更高,50岁起利用China PAR进行心血管病筛查较40岁起进行筛查可以减少筛查人数,获得相似的健康收益,适用于经济不发达地区开展筛查项目。     

绝经与心血管疾病及相关代谢紊乱的关联

目的：在45~59岁中国女性人群中,探索绝经与心血管疾病及相关代谢紊乱的关联关系。方法： 将中国健康与养老追踪调查（China health and retirement longitudinal study,CHARLS）2013年第1次随访调查具有全国代表性的横断面调查样本中4 702名45~59岁围绝经期女性选出作为研究对象,其中未绝经女性1 769人,已绝经女性2 933人。主要研究变量来自于健康状况和功能问卷以及体格测量结果,采用广义线性模型计算并比较未绝经和已绝经两组人群心血管危险因素经过年龄等因素调整后的均值;采用多变量Logistic回归模型调整年龄等混杂因素,计算绝经与心血管疾病及其危险因素之间的OR值及95%可信区间。结果： 调整年龄和其他混杂因素后,发现绝经与心血管疾病有正向关联（OR=1.34,95%CI：1.04~1.74）;绝经与高血压（OR=1.42,95%CI：1.10~1.84）、绝经与同时具有2种及以上心血管危险因素（OR=1.31,95%CI：1.02~1.68）的关联也具有统计学意义;此外,已绝经女性人群的腰围平均水平（87.11 cm,95%CI： 86.81~87.42 cm）高于未绝经人群（86.41 cm,95%CI： 85.99~86.84 cm）;研究未发现绝经与糖尿病及血糖升高、血脂异常、肥胖的统计学关联。结论： 中国女性绝经后更可能具备一种或多种心血管危险因素,从而具备更高的心血管疾病发病风险,绝经可能在老龄化的影响之外进一步加剧中老年女性人群的心血管相关疾病负担。