Search

Background & Aims: Mediterranean diets reduce the risk of cardiovascular disease (CVD). However, the effect is unknown in people living with HIV, who have an increased risk potentially due to the additional burdens of infection, inflammation and antiretroviral treatment (ART). We examined the feasibility of a 6-month dietary intervention in adults with HIV dyslipidemia using a sample size adequate to detect differences in LDL-cholesterol., Methods: Sixty adults with stable HIV infection on ART and LDL-cholesterol >3 mmol/l were recruited. Participants were randomized (1:1) to receive dietary advice to reduce saturated fat intake to <10% of energy intake (Diet1), or supported to adopt the Mediterranean Portfolio Diet (Diet2) with additional cholesterol-lowering foods (nuts, stanols, soya, oats, beans) for 6 months. Recruitment, retention and intervention fidelity were monitored. Measurements were conducted at baseline, 6 and 12 months. A secondary analysis examined between group differences in CVD risk factors at month 6 adjusted for baseline values and potential confounders., Results: Rates of recruitment, participation and attrition were 35%, 91%, and 12% respectively. Reported dietary adherence was 68% to Mediterranean foods and 59% to Portfolio components. At 6 months Diet2 participants (n = 29) had a significantly lower LDL-cholesterol (mean difference adjusted for baseline -0.4 mmol/l, 95%CI -0.7 to -0.1, P = 0.01), and systolic blood pressure (-7 mmHg, 95%CI -2 to -12, P = 0.008) compared to those in Diet1 (n = 31). These effects were not sustained at 1 year (LDL-cholesterol -0.05 mmol/l, 95%CI -0.33 to 0.23, P = 0.7; systolic blood pressure -3.5 mmHg, 95%CI -9.4 to 2.5, P = 0.2)., Conclusion: We showed the feasibility of adopting a Mediterranean Portfolio diet in people living with HIV. Our findings suggest this intervention might equate to short term improvements in diet quality, blood pressure, and LDL-cholesterol. Further definitive evaluations are required to determine if this is a viable strategy to facilitate cardiovascular risk reduction., Clinical Trial Registry: ISRCTN32090191 Best Foods For your heart trial., Competing Interests: Conflict of Interest No potential conflicts of interest., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: To develop and validate a prediction model for airflow obstruction (AO) in older Chinese., Design: Multivariable logistic regression analysis in large population cohort of Chinese aged ≥50 years., Participants: Model development: 8762 Chinese aged ≥50 years were selected from the early phase recruits to the Guangzhou Biobank Cohort Study (GBCS) (recruited from September 2003 to May 2006). Internal validation: 100 bootstrap samples drawn with replacement from the development sample. External validation: 8395 Chinese aged ≥50 years from later phase GBCS (recruited from September 2006 to January 2008)., Outcomes: AO was defined by a forced expiratory volume in 1 s/forced vital capacity ratio < lower limits of normal., Results: 839 (9.6%) and 764 (9.1%) individuals had AO in the development and temporal validation samples respectively. The predictors in the prediction model included sex, age, body mass index groups, smoking status, presence of respiratory symptoms, and history of asthma. Model development and validation was stratified by sex. Model performance including calibration (calibration-in-the-large -0.017 vs. -0.157; and calibration slope 0.88 vs. 1.02), discrimination (C-statistic 0.72 vs. 0.63 with 95% confidence interval 0.69-0.75 vs. 0.62-0.73) and clinical usefulness (decision curve analysis) in the external temporal validation sample were more satisfactory in men than that in women. Prediction models with risk thresholds (13% in men and 7% in women) and easy-to-use nomograms were developed to assess the probability of AO., Conclusion: The diagnostic models based on readily available epidemiologic and clinical information with satisfactory performance can assist physicians to identify older individuals at high risk of AO and may improve the efficiency of spirometry for active case finding. Further validation beyond the Chinese population is warranted., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To study whether abnormal spirometric patterns were associated with differential mortality in Chinese adults with and without dyspnea., Methods: Guangzhou Biobank Cohort Study (GBCS) participants were classified by spirometric patterns and presence of dyspnea into 6 groups: normal spirometry (NS), restriction on spirometry (ROS) and airflow obstruction (AO), each with and without dyspnea. Adjusted hazard ratios (aHRs) were calculated for mortality using Cox models., Results: Among 16777 subjects, 1595 (9.5%) had ROS, 1036 (6.2%) had AO and 1009 (6.0%) had dyspnea. A total of 1993 deaths (11.9%) occurred during 11-year follow-up. Using NS without dyspnea as reference, NS with dyspnea was significantly associated with increased cardiovascular mortality risk (aHRs 1.61 (95% confidence interval (CI) 1.18-2.19); ROS with and without dyspnea were associated with increased risks of all-cause (aHRs 1.46 (95% CI 1.28-1.66) and 1.81 (95% CI 1.33-2.47)) and cardiovascular mortality (aHRs 1.89 (95% CI 1.55-2.31) and 1.85 (95% CI 1.12-3.03)), but not of lung cancer mortality (aHRs 1.33 (95% CI 0.91-1.94) and 1.35 (95% CI 0.49-3.70)); AO with and without dyspnea were associated with increased risks of all-cause (aHRs 1.59 (95% CI 1.36-1.86) and 2.36 (95% CI 1.77-3.15)), cardiovascular (aHRs 1.43 (95% CI 1.08-1.90) and 1.61 (95% CI 0.91-2.82)) and lung cancer mortality (aHRs 1.91 (95% CI 1.29-2.84) and 3.01 (95% CI 1.46-6.23)). These associations did not vary by sex or smoking status (all P-values for interaction >0.05)., Conclusion: Both ROS and AO, with and without dyspnea, were associated with increased all-cause and cardiovascular disease mortality. The increased risk of all-cause was greater and that of cardiovascular mortality was lower for AO than ROS. AO showed significantly increased risk of lung cancer but ROS did not. (272 words)., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: We examined the association between different adiposity indices and pulmonary function in Chinese adults in the Guangzhou Biobank Cohort Study (GBCS)., Methods: Participants with body mass index (BMI) < 18.5 (underweight) were excluded. Adiposity indices including BMI, waist circumference (WC), waist hip ratio, waist height ratio and body fat percentage were measured. Lung function was assessed by spirometry using a turbine flowmeter. We analyzed percent predicted for forced expiratory volume in 1 s (FEV 1 %), forced vital capacity (FVC %) and restrictive respiratory defect (FEV 1 /FVC ratio > low limits of normal and FVC % <0.80)., Results: Of 16186 participants (mean age 61.4 ± 7.2 years; 74.0% women), 116 (0.7%) had only general obesity (BMI ≥28 kg/m 2 ), 4079 (25.2%) had only central obesity (WC: ≥90 cm in men, ≥80 cm in women) and 1591 (9.8%) had both central obesity and general obesity. Comparing to those with neither central nor general obesity, those with only central adiposity and with both central and general obesity had lower pulmonary function (adjusted β range from -2.85 to -6.02 for FEV 1 % and FVC%, adjusted OR range from 1.14 to 1.70, all P < 0.05). But those with only general obesity had better but non-significant pulmonary function. (Crude β range from 1.46 to 2.92 for FEV 1 % and FVC%, crude OR range from 0.68 to 0.93, all P > 0.05). Both FEV 1 % and FVC% decreased per standard deviation increase in obesity indices (adjusted β from -0.46 to -3.17, all P < 0.002). A positive association of central or general obesity with restrictive respiratory defect was observed (adjusted odds ratio (AOR) from 1.50 to 2.04, all P < 0.002). Further adjustment for WC reversed the inverse association between BMI and pulmonary function (adjusted β from 1.93 to 6.22, all P < 0.001) and restrictive respiratory defect (adjusted AOR from 0.72 to 0.80, all P < 0.001)., Conclusion: Central adiposity and its indices, but not general adiposity and BMI, were independently associated with lower pulmonary function and higher risk of restrictive respiratory defect in older Chinese., (Copyright © 2017. Published by Elsevier Ltd.)

Background: Evidence describing the association between pulmonary function and carotid atherosclerosis has been inconclusive and the role of smoking in this association is unclear. We therefore examined this association in the Guangzhou Biobank Cohort Study-CVD Subcohort., Methods: Common carotid artery (CCA) intima-media thickness (IMT) and carotid plaques were measured by B-mode ultrasonography and lung function by spirometry using a turbine flowmeter. Chronic obstructive pulmonary disease (COPD) was defined as the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) of less than 0.70. Predicted FEV1 and FVC were derived using equations for Chinese., Results: Of 1625 participants aged 50 + years, 382 (23.5%) had evidence of carotid plaque. The mean CCA-IMT was higher in those with COPD than those without (0.82 ± 0.29 mm versus 0.76 ± 0.31 mm, P = 0.02). We found no evidence that the association of pulmonary function with CCA-IMT varied by smoking status (P values interaction: 0.23-0.83). After adjustment for a wide range of potential confounders, the increased risks of thickened CCA-IMT (CCA-IMT ≥1.0 mm) in those with COPD became marginally nonsignificant (adjusted odds ratio (OR) 1.45, 95% confidence interval (CI) 0.91-2.29; P = 0.12). Compared to those in the highest tertile, participants in the lowest tertile of FEV1 observed to predicted ratio had increased risk of thickened CCA-IMT (adjusted OR 2.18, 95% CI 1.42-3.34) and carotid plaque (adjusted OR 1.50, 95% CI 1.08-2.09), while participants in the lowest tertile of FVC observed to predicted ratio had increased risk of thickened CCA-IMT (adjusted OR 2.29, 95% CI 1.46-3.58), but the adjusted OR for carotid plaque was marginally nonsignificant (adjusted OR 1.29, 95% CI 0.93-1.80; P = 0.13)., Conclusion: Independent of smoking status, poor pulmonary function was dose-dependently associated with carotid atherosclerosis in older Chinese. (281 words)., (Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.)

Cognitive decline is a reduction in cognitive ability usually associated with aging, and those with more extreme cognitive decline either have or are at risk of progressing to mild cognitive impairment and dementia including Alzheimer's disease (AD). We hypothesized that genetic variants predisposing to AD should be predictive of cognitive decline in elderly individuals. We selected 1325 subjects with extreme cognitive decline and 1083 well-matched control subjects from the Guangzhou Biobank Cohort Study in which more than 30,000 southern Chinese older people have been recruited and followed up. Thirty single-nucleotide polymorphisms in 29 AD-associated genes were genotyped. No statistically significant allelic associations with cognitive decline were found by individual variant analysis. At the level of genotypic association, we confirmed that the APOE ε4 homozygote significantly accelerated cognitive decline and found that carriers of the ACE rs1800764&#95;C allele were more likely to show cognitive decline than noncarriers, particularly in those without college education. However, these effects do not survive after multiple testing corrections, and together they only explain 1.7% of the phenotypic variance in cognitive score change. This study suggests that AD risk variants and/or genes are not powerful predictors of cognitive decline in our Chinese sample., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: Peripheral arterial disease, as a result of atherosclerosis, is the commonest reason for lower limb revascularisation and amputation in England. We describe the prevalence rate of these procedures among the White, South Asian and Black populations living in England and describe the association of ethnicity to amputation, both with and without, revascularisation., Method: We extracted data from 90 million English hospital admissions between 2003 and 2009 and calculated prevalence rates among 50-84 year olds using census data. Logistic regression demonstrated whether ethnicity was related to amputation, both with and without revascularisation, independent of demographic (age, sex, social class) and disease risk factors (diabetes, hypertension, hypercholesterolaemia, coronary and cerebral vascular disease, smoking)., Results: There were 25,308 amputations and 136,215 revascularisations. The age adjusted prevalence rate for amputation was 26/100,000 and revascularisation 142/100,000. The prevalence ratio (95% confidence intervals) (White British=100) of amputation in the Asian and Black populations was; 60 (54-66) and 169 (155-183) respectively with revascularisation ratios; 89 (86-92) and 94 (89-98) respectively. South Asians had approximately half the risk of amputation both with and without a revascularisation than Whites despite much higher rates of known atherosclerotic risk factors. The odds of having an amputation without any revascularisation was 63% higher in Blacks but fully attenuated by demographic and disease risk factors., Conclusion: South Asians experience the lowest rate of both major lower limb amputation and revascularisation in England. The association cannot be explained by demographic or cardiovascular risk factors. This may have implications in the aetiopathology of atherosclerosis., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: To examine the association between serum uric acid (UA) levels and cardiovascular risk factors in subjects without diabetes or hyperuricemia., Methods: 6172 women and 2662 men aged 50+ years without diabetes from Phase 1 of the Guangzhou Biobank Cohort Study were included. Data on personal history, physical examination and biochemical parameters were collected. Subjects were categorized by serum UA concentration, and the association between UA levels and cardiovascular risk factors was examined using generalized linear models., Results: In both men and women with normouricemia (UA<420 μmol/l in men and <360 μmol/l in women), tertiles of UA levels were adversely associated with body mass index, waist circumference, waist-to-hip ratio, total- and HDL-cholesterol, apolipoprotein A1, systolic and diastolic blood pressures, pulse pressure, fasting plasma glucose and white blood cell count (P value for trend ranged from 0.04 to <0.001), and also consistently associated with metabolic disorders including obesity, hypertension, hypertension treatment, dyslipidemia, waist circumference increased since the age of 18 years and the metabolic syndrome (P value for trend ranged from 0.02 to <0.001)., Conclusion: Increasing UA levels, even in subjects with normouricemia and without diabetes, were associated with increasing prevalence of cardiovascular risk factors, suggesting that clinically dichotomous definition of hyperuricemia may be inadequate and high-normal value of UA may warn of metabolic disorders., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Conventional factors do not fully explain the distribution of cardiovascular outcomes. Biomarkers are known to participate in well-established pathways associated with cardiovascular disease, and may therefore provide further information over and above conventional risk factors. This study sought to determine whether individual and/or combined assessment of 9 biomarkers improved discrimination, calibration and reclassification of cardiovascular mortality., Methods: 3267 patients (2283 men), aged 18-95 years, at intermediate-to-high-risk of cardiovascular disease were followed in this prospective cohort study. Conventional risk factors and biomarkers were included based on forward and backward Cox proportional stepwise selection models., Results: During 10-years of follow-up, 546 fatal cardiovascular events occurred. Four biomarkers (interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D) were retained during stepwise selection procedures for subsequent analyses. Simultaneous inclusion of these biomarkers significantly improved discrimination as measured by the C-index (0.78, P = 0.0001), and integrated discrimination improvement (0.0219, P<0.0001). Collectively, these biomarkers improved net reclassification for cardiovascular death by 10.6% (P<0.0001) when added to the conventional risk model., Conclusions: In terms of adverse cardiovascular prognosis, a biomarker panel consisting of interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D offered significant incremental value beyond that conveyed by simple conventional risk factors., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: To examine the association between alcohol consumption and aortic arch calcification (AAC) in an older Chinese sample., Methods: In 27,844 older people aged 50-85, socioeconomic position and lifestyle factors were assessed by a questionnaire. The presence and severity of AAC were diagnosed from chest X-ray by two experienced radiologists., Results: In men, the risk for AAC increased significantly in frequent or excessive drinkers [adjusted odds ratio (OR)=1.36 (95% confidence interval (CI) 1.16-1.59) and 1.49 (1.21-1.83) for those who drank >5 times/week and those who drank excessively, respectively] (P for trend from 0.002 to 0.001). When AAC was analyzed as an outcome variable with 3 categories of severity, significant dose-response relations between the severity of AAC and alcohol consumption were observed, with those who drank frequently (>5/week) or excessively having more serious AAC (P for trend=0.03 and 0.02, respectively). No significant association was found in women as few drank excessively., Conclusion: The presence and severity of AAC were associated with quantity or frequency of alcohol consumption in a dose-response pattern, suggesting that alcohol drinking, even when moderate, has no benefit for AAC. Excessive drinking increased the risk of AAC by 50% compared to never drinkers., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

The impact of occupational dust and gas/fume exposure on chronic obstructive pulmonary disease (COPD) in developing countries has not been quantified. We examined the relationship between past dust and fume exposure and prevalence of COPD and respiratory symptoms in a cross-sectional analysis of a large Chinese population sample. Participants in the Guangzhou Biobank Cohort Study (n = 8216; 27.3% men, mean age 61.9 ± 6.8 years) had spirometry and a structured interview including exposures, symptoms, and lifestyle. Self-reported intensity and duration of dust and gas/fume exposure was used to derive cumulative exposure. COPD was diagnosed from spirometry using lower limit of normal based on prediction equations. COPD was associated with high exposure to dust or gas/fume (exposed: 87/1206 v non-exposed: 191/3853; adjusted odds ratio: 1.41; 95% confidence interval (CI) 1.06, 1.87) with no evidence of effect modification by smoking. Respiratory symptoms were associated with exposures to dust and gas/fume, with adjusted odds ratios for chronic cough/phlegm of 1.57 (1.13, 2.17) and 1.39 (1.20, 1.60) for dyspnoea. The overall population attributable fraction for COPD due to occupational exposure was 10.4% (95% CI -0.9%, 19.5%). Occupational dust and gas/fume exposure is associated with an increased prevalence of COPD in this Chinese sample, independent of smoking. The population attributable fraction in Chinese is similar to that in Western populations., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: White blood cells are known to predict cardiovascular mortality, but form a highly heterogeneous population. It is therefore possible that specific subtypes disproportionally contribute to the prediction of cardiovascular outcomes. Therefore, we compared leukocyte subsets alone and in conjunction with an established inflammatory marker, C-reactive protein, for predicting death due to cardiovascular disease in a high-risk population., Methods: Patients, 3316, (mean [SD] age, 62 [10] years) scheduled for coronary angiography were prospectively followed up. Neutrophil, monocyte and lymphocyte counts were determined. Neutrophil and monocyte subsets were further analysed on the basis of surface expression of CD11b, CD18, CD31, CD40 and CD58. Lymphocytes were further subdivided into CD3, CD4, CD8, and CD19 subsets. The association between each marker and subsequent cardiovascular mortality was assessed using multivariable Cox regression models., Results: During a median follow-up period of 7.8 years, 745 (22.5%) patients died, of which 484 were due to cardiovascular events. After entering conventional risk factors and removing patients with a current infection, neutrophil count (HR [95% CI]=1.90 [1.39, 2.60], P<0.001) and the neutrophil/lymphocyte ratio (HR [95% CI]=1.68 [1.24, 2.27], P=0.003) emerged as independent predictors of cardiovascular mortality. After mutual adjustment, neutrophil count (HR [95% CI]=1.87 [1.35, 2.50], P<0.001) out-performed C-reactive protein (HR [95% CI] 1.32 [0.99, 1.78], P=0.06) as a predictor of cardiovascular mortality., Conclusions: Due to its predictive potential and inexpensive determination, assessment of high neutrophil counts may represent an important marker, possibly improving cardiovascular mortality risk prediction., (Copyright © 2012. Published by Elsevier Ireland Ltd.)

Background: Persistent inflammation has been proposed to contribute to various stages in the pathogenesis of cardiovascular disease. Interleukin-6 receptor (IL6R) signalling propagates downstream inflammation cascades. To assess whether this pathway is causally relevant to coronary heart disease, we studied a functional genetic variant known to affect IL6R signalling., Methods: In a collaborative meta-analysis, we studied Asp358Ala (rs2228145) in IL6R in relation to a panel of conventional risk factors and inflammation biomarkers in 125,222 participants. We also compared the frequency of Asp358Ala in 51,441 patients with coronary heart disease and in 136,226 controls. To gain insight into possible mechanisms, we assessed Asp358Ala in relation to localised gene expression and to postlipopolysaccharide stimulation of interleukin 6., Findings: The minor allele frequency of Asp358Ala was 39%. Asp358Ala was not associated with lipid concentrations, blood pressure, adiposity, dysglycaemia, or smoking (p value for association per minor allele ≥0·04 for each). By contrast, for every copy of 358Ala inherited, mean concentration of IL6R increased by 34·3% (95% CI 30·4-38·2) and of interleukin 6 by 14·6% (10·7-18·4), and mean concentration of C-reactive protein was reduced by 7·5% (5·9-9·1) and of fibrinogen by 1·0% (0·7-1·3). For every copy of 358Ala inherited, risk of coronary heart disease was reduced by 3·4% (1·8-5·0). Asp358Ala was not related to IL6R mRNA levels or interleukin-6 production in monocytes., Interpretation: Large-scale human genetic and biomarker data are consistent with a causal association between IL6R-related pathways and coronary heart disease., Funding: British Heart Foundation; UK Medical Research Council; UK National Institute of Health Research, Cambridge Biomedical Research Centre; BUPA Foundation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Purpose: To examine, via cross-sectional analysis, the dose-response association between physical activity and cognitive function in Chinese subjects., Methods: A total of 27,651 participants aged 50 to 85 years were recruited from 2003 to 2008. Information on potential confounders, including demographic and anthropometric characteristics, socioeconomic position, lifestyle, and disease history, was collected by standardized interview and procedures. Cognitive function was assessed by the delayed 10-word recall test (DWRT)., Results: When the International Physical Activity Questionnaire was used, we found that most of the participants were classified as physically active (53.1%), with 42.4% moderately active and 4.5% physically inactive. Significant dose-response relations across quintiles of metabolic equivalent value (METs) with DWRT score in participants with or without good self-rated health were found (all p for trend <.001). In participants with poor self-rated heath, compared with the first quintile of METs, those in the fifth quintile (highest METs) had a significantly reduced risk for mild cognitive impairment by 28% (adjusted odds ratio, 0.72; 95% confidence interval, 0.58-0.89, p < .01; p for trend = .006). After additional adjustment for depression, we found that the association between physical activity and DWRT score remained significant., Conclusions: A significant dose-response relationship between physical activity and cognitive function was found, and the association was more pronounced in participants with poor self-rated health., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To study whether passive smoking is a risk factor for aortic arch calcification (AAC) among never smokers., Background: We have previously reported that active smoking increases the risk of AAC, but the effect of passive smoking has not been reported., Methods: We used baseline data of the Phase 1 Guangzhou Biobank Cohort Study (GBCS). 7702 older Chinese never smokers from the Phase 1 GBCS were included. Information on passive smoking and potential confounders were collected by standardized interviews and laboratory assays. AAC was diagnosed from chest X-ray by two experienced radiologists. Unconditional logistic regression was used to estimate odds ratios of AAC for passive smoking with adjustment for potential confounders., Results: In women, the risk for aortic arch calcification (AAC) increased significantly with increasing duration of adulthood passive smoking exposure at home, at work and total duration of adulthood home and work exposure [adjusted odds ratio 1.24 (95% confidence interval 1.09-1.41) for high level of total exposure] (P for trend from 0.012 to 0.001). For passive smoking at home, at work and total exposure, significant trends of increasing severity of AAC with increasing duration of exposure were observed in men and women combined (P for trend from 0.05 to 0.002)., Conclusion: Passive smoking is a risk factor for aortic arch calcification. Studies of passive smoking and AAC, especially in developing countries can generate important local evidence to raise awareness and to support public health measures to protect non-smokers from second-hand smoke., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To investigate the association between fish consumption and mortality in 36,003 Chinese., Methods: A case-control study collected 81% of all deaths of those aged 30+ from all four Hong Kong death registries in 1998. Relatives registering the deaths provided demographic, dietary and other lifestyle data for the deceased (case) and a similarly aged living person (control). Causes of death were provided by the Department of Health. Logistic regression was used to calculate the mortality odds ratios (ORs) for fish consumption adjusting for potential confounders in the 23,608 cases and 12,395 controls., Results: Compared with the lowest fish consumption of less than or equal to three times a month, higher consumption of one to three times a week was associated with lower mortality ORs (95% confidence interval [CI]) of 0.75 (0.62-0.89) for all-cause, 0.66 (0.48-0.92) for ischemic heart disease (IHD), 0.70 (0.50-0.98) for stroke, 0.66 (0.53-0.82) for cancer, but not for injury and poisoning. The highest level of fish consumption of greater than or equal to four times a week also reduced mortality with ORs (95% CI) of 0.80 (0.68-0.94) for all-cause and 0.63 (0.47-0.85) for IHD., Conclusions: Fish consumption significantly reduced mortality from several causes in this sample. Further longitudinal studies to confirm the association are needed., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: Polymorphisms of the transforming growth factor-β1 (TGFB1) gene have not been associated with asymptomatic atherosclerosis previously. We investigated the relationship between a single nucleotide polymorphism (SNP) rs4803455 in TGFB1 and atherosclerosis identified by the presence of carotid plaque and increased intima-media thickness (IMT) in an older Chinese population., Methods: 1996 subjects (992 (49.7%) men aged 50-85 years) from the Guangzhou Biobank Cohort Study-Cardiovascular Subcohort (GBCS-CVD) were genotyped. Carotid plaque and IMT were assessed by B-mode ultrasonography., Results: In male subjects, the C allele of TGFB1 rs4803455 was significantly associated with prevalence of carotid plaque (adjusted OR: 2.49, 95% CI: 1.16-5.36, P = 0.03). The C allele was related to increased number of common carotid artery (CCA) plaques (P=0.03) and larger carotid plaque area (P = 0.02) in men. The homozygous carriers of allele C in male subjects also had a higher risk of having carotid IMT ≥ 1 mm (adjusted OR: 1.75, 95% CI: 1.05-2.93, P = 0.03). These associations were independent of age, smoking, physical activity, body mass index, blood pressure, lipid profile, fasting glucose and high sensitivity C-reactive protein., Conclusion: This is the first study to show that the C allele in TGFB1 was associated with increased risk of atherosclerosis in older Chinese men. Further investigations on the linkage between the TGFB1 gene and progression of atherosclerosis in asymptomatic populations are warranted., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: abitual snoring and elevated high-sensitive C-reactive protein (HsCRP) have both been associated with increased risk of cardiovascular disease. However, snoring and HsCRP are elevated in obese states which may thus be the primary determinant of both. We therefore investigated whether snoring may mediate the increased vascular risk directly through increased inflammation as indicated by HsCRP levels or if other determinants predominated in a large older Chinese population., Methods: A total of 2508 males and 5709 females aged 50-85 years received a medical check-up including measurement of blood pressure, obesity indices, fasting total, LDL-, HDL-cholesterol, triglycerides, glucose and HsCRP. Information on self-reported snoring status was collected by standardized interview., Results: The age-adjusted geometric mean HsCRP concentrations increased significantly with higher snoring frequency in both genders (linear trend, p=0.02 for men and p<0.001 for women), but the association was no longer significant after controlling for waist and BMI. Furthermore, HsCRP levels were not significantly associated with snoring frequency groups stratified by BMI/waist quintiles in both genders, except for the 4th waist quintile in men. No interaction was observed between snoring and BMI/waist on HsCRP levels. The multivariate analysis showed that, in both genders, obesity, but not HsCRP, was associated with snoring., Conclusions: Our results showed that snoring frequency did not have an independent effect on inflammation after adjusting for adiposity, and may thus contribute to vascular disease through alternative mechanisms., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: The metabolic syndrome (MetS) increases the risk of cardiovascular disease morbidity and mortality. MetS is also associated with increases in the number of circulating white blood cells. Lymphocyte sub-population counts have also been implicated in cardiovascular disease; this analysis will examine whether or not they are associated with MetS., Methods: Participants were 4255 Vietnam-era US veterans. From military service files, telephone interviews, and a medical examination, occupational, socio-demographic, and health data were collected. MetS was ascertained from: body mass index; fasting blood glucose or a diabetes medication; blood pressure or a diagnosis of hypertension; HDL cholesterol; and triglyceride levels. Circulating T, T4, T8 and B lymphocytes cell numbers were determined by flow cytometry., Results: In fully adjusted logistic regression analyses, high lymphocyte sub-population counts were associated with an increased risk of MetS: T cells, OR=2.68, 95%CI 1.99-3.61, p<.001; T4 cells, OR=2.37, 95%CI 1.78-3.15, p<.001; T8 cells, OR=1.79, 95%CI 1.43-2.24, p<.001; B cells, OR=1.82, 95%CI 1.51-2.19, p<.001. High lymphocyte sub-population numbers were also associated with an increased likelihood of possessing each of the MetS components, as well as the number of components possessed., Conclusions: These results extend previous research which has largely been confined to total white blood cell or overall lymphocyte counts. If the present associations arise in prospective research, it is possible that simple lymphocyte cell counts could provide an additional prognostic indicator of risk for MetS., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: The metabolic syndrome increases mortality risk. However, as "non-affected" individuals may still have up to two risk factors, the utility of using three or more components to identify the syndrome, and its predictive advantage over individual components have yet to be determined., Methods: Participants, male Vietnam-era veterans (n=4265) from the USA, were followed-up from 1985/1986 for 14.7 years (61,498 person-years), and all-cause and cardiovascular disease deaths collated. Cox's proportional-hazards regression was used to assess the effect of the metabolic syndrome and its components on mortality adjusting for a wide range of potential confounders., Results: At baseline, 752 participants (17.9%) were identified as having metabolic syndrome. There were 231 (5.5%) deaths from all-causes, with 60 from cardiovascular disease. After adjustment for a range of covariates, the metabolic syndrome increased the risk of all-cause, HR 2.03, 95%CI 1.52, 2.71, and cardiovascular disease mortality, HR 1.92, 95%CI 1.10, 3.36. Risk increased dose-dependently with increasing numbers of components. The increased risk from possessing only one or two components was not statistically significant. The adjusted risk for four or more components was greater than for only three components for both all-cause, HR 2.30, 95%CI 1.45, 3.66 vs. HR 1.70, 95%CI 1.11, 2.61, and cardiovascular disease mortality, HR 3.34, 95%CI 1.19, 9.37 vs. HR 2.81, 95%CI 1.07, 7.35. The syndrome was more informative than the individual components for all-cause mortality, but could not be assessed for cardiovascular disease mortality due to multicollinearity. Hyperglycaemia was the individual strongest parameter associated with mortality., Conclusions: The metabolic syndrome is informative in predicting mortality, with risk increasing as the number of components increase above the threshold required for diagnosis., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

Background: Familial combined hyperlipidaemia (FCH) is the most common genetic dyslipidaemia associated with coronary artery disease. Single nucleotide polymorphisms (SNPs) and haplotypes in the APOA1/C3/A4/A5 gene cluster are associated with FCH in Caucasians and with elevated triglycerides (TG) in various ethnic groups. We examined these associations with FCH in Hong Kong Chinese., Methods: Fifty-six Chinese FCH patients and 176 unrelated controls were studied. Thirteen SNPs in the APOA1/C3/A4/A5 cluster were genotyped., Results: Four alleles in APOA5 were associated with FCH (P<0.001). The -1131T>C (rs662799) and -3A>G (rs651821) SNPs in APOA5 were in almost complete linkage disequilibrium (LD, r(2)=0.99), and their minor alleles were more frequent (P<0.001) in FCH than controls (0.60 vs. 0.24). The odds ratio (OR) for FCH was 6.2 (95% CI, 2.6-14.8) and 6.1 (2.6-14.6) per copy of -1131C and -3G, respectively, and 24.6 (8.4-72.0) and 24.4 (8.4-70.9) in -1131C and -3G homozygotes, respectively, as compared to wild-type homozygotes. The 1891T>C (rs2266788) SNP was in LD (r(2)=0.68) with -1131T>C and -3A>G, and the minor allele was more frequent in FCH than controls (0.42 vs. 0.19, P<0.001). The 553G>T (rs2075291) nonsynonymous variant was also associated with FCH (0.15 vs. 0.04, P=0.001) and, along with -3A>G (or -1131T>C) and 1891T>C, contributed to haplotypes predicting FCH. The two tightly linked SNPs, -1131T>C and -3A>G polymorphism were significantly associated with lipid traits in all subjects combined, with variant homozygous subjects having higher TG and LDL-C and lower HDL-C levels., Conclusions: Some common polymorphisms and haplotypes in APOA5 are closely associated with FCH in Hong Kong Chinese, and these differ from those found in Caucasians., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

Background: Few studies have explored the relationship between major mental health disorders and metabolic syndrome (MetS), although both have been linked to cardiovascular disease. The present study examined the cross-sectional associations of major depressive disorder (MDD) and generalized anxiety disorder (GAD) with MetS in a large study of male US veterans., Methods: The analyses were cross-sectional. Participants (n = 4256) were drawn from the Vietnam Experience Study. From military service files, telephone interviews, and a medical examination, occupational, socio-demographic, and health data were collected. One-year prevalence of MDD and GAD was determined with DSM-III criteria. Metabolic syndrome was ascertained from data on: body mass index, fasting blood glucose or a diagnosis of diabetes, blood pressure, high-density lipoprotein cholesterol, and triglyceride levels., Results: In models that adjusted for age (p = .01) and additionally for place of service, ethnicity, marital status, smoking, alcohol consumption, IQ at enlistment, household income in midlife, and education grade achieved (p = .02), GAD was positively associated with MetS. Major depressive disorder was not related to MetS., Conclusions: Depression has very much been the focal condition for studies on mental health and physical health outcomes. The current data suggest that future research should perhaps pay equal attention to GAD.

Aims: Smoking increases the risk of cardiovascular disease and inflammation plays a key role in the process of atherosclerosis. We therefore study the role of smoking and smoking cessation on the levels of inflammatory markers, C-reactive protein (CRP) and white blood cell (WBC) count, in older Chinese men., Methods: This cross-sectional analysis included 2999 men aged 50-85 years who received a medical check-up including measurement of fasting plasma vascular risk factors. Information on smoking status, socioeconomic and lifestyle factors was collected by standardized interview., Results: After adjustment for potential confounders, both CRP and WBC increased linearly across never, former and current smokers (both p<0.01). The odds ratios of elevated CRP and WBC (upper tertiles) were also increased across never, former and current smokers (both p<0.01). Dose-response relationships were observed among current smokers. Compared to current smokers, the odds ratios of elevated CRP and WBC and means of CRP and WBC declined with longer duration of smoking cessation (all p<0.01)., Conclusions: Smoking is associated with increased CRP and WBC levels, and smoking cessation is associated with the reduction of the increase, confirming the benefits of quitting. Inflammation may be a potential mechanism by which smoking promotes atherosclerotic disease.

Objective: To study the association between smoking, smoking cessation and aortic arc calcification (AAC) in an older Chinese population., Methods: A total of 3022 men and 7279 women aged 50-85 years were recruited and received a medical check-up including measurement of fasting plasma vascular risk factors. Two radiologists reviewed the posterior-anterior plain chest X-ray radiographs and assessed AAC together. Information on smoking status, socioeconomic and lifestyle factors was collected., Results: The crude prevalence of AAC in men (38.58%) was lower than that in women (41.37%). The adjusted odds ratios of AAC increased significantly across never, ex- and current smokers in both genders. Dose-response relationships were observed among current smokers for smoking amount (cigarettes/day), smoking duration (years) and cigarette pack-years in both genders (all p<0.01). The odds ratios decreased significantly (p=0.018) with longer duration of quitting in light ex-smoking men (<23.5 pack-years) but showed no beneficial effect (p=0.72) for heavy ex-smokers (>or=23.5 pack-years)., Conclusion: Smoking increased the risk of AAC in Chinese, while smoking cessation decreased the risk only in male light ex-smokers. Chest X-ray is a cheap and simple method to detect AAC, which should be an important warning signal for immediate smoking cessation.

Background: Both active and passive smoking are prevalent in China but cardiovascular diseases were less prevalent in the past. We studied the current relationship between surrogate atherosclerosis markers and smoking in Chinese., Methods: Endothelium-dependent flow-mediated dilation (FMD) of brachial artery and carotid intima-media thickness (IMT) were measured non-invasively by ultrasound in 616 apparently healthy Chinese (23% smokers), recruited from greater China and the USA., Results: The Chinese smokers had significantly impaired FMD (7.0+/-2.3 vs. 8.2+/-2.5%, p<0.001) and endothelium-independent vasodilation (GTN, 17.4+/-3.9 vs. 18.7+/-4.1%, p=0.001) and thicker IMT (0.61+/-0.13 vs. 0.58+/-0.12 mm, p=0.025). 91% of the smokers were male. Both endothelium-dependent (6.9+/-2.2 vs. 8.0+/-2.5%, p<0.001) and independent (17.3+/-3.5 vs. 18.2+/-3.7%, p=0.047) vasodilation were significantly lower in the male smokers than non-smokers, although their age and cholesterol levels were lower. FMD-to-GTN ratio in the smokers were lower (0.41+/-0.12 vs. 0.45+/-0.13, p=0.005). Multivariate analyses confirmed an independent adverse impact of smoking on vascular functions. There were no consistent interactions between subject location and impact of smoking on FMD and IMT., Conclusion: In these apparently healthy native and overseas Chinese subjects, smoking is adversely associated with endothelial dysfunction and arterial wall thickening, with serious implication in atherosclerosis prevention.

Background: The relationships between weight and waist on vascular risk are well described, but the long-term impact of these parameters is less clearly defined, particularly in Chinese populations., Methods: Ten thousand four hundred and ten older subjects (50-85 years) were recruited and blood pressure, anthropometric, and fasting vascular risk factors measured. Socioeconomic and demographic data, including self-reported weight and waist gain since 18 years. The association of weight and waist gain with these vascular risk factors was analysed., Results: Weight, and particularly waist gain were associated with a more adverse vascular risk factor profile, with the most adverse profile associated with gains in both weight and waist. Anthropometric gains were associated with increased risk even in non-obese subjects (p<0.05). Even after adjustment for a range of demographic and socioeconomic factors, waist gain was associated with additional risk of having the metabolic syndrome and its components and self-reported vascular disease in those centrally obese subjects (p<0.05 for all)., Conclusion: Increased weight and waist increased the level of vascular risk factors and self-reported disease in both non-obese and obese subjects. The high prevalence of vascular risk factors in this population forewarns of a major developing health burden in the rapidly modernising 1.2 billion Chinese population.

Objective: To examine the association between serum c-reactive protein (CRP) concentration and the metabolic syndrome (MS) using the International Diabetes Federation Metabolic Syndrome Guidelines (April, 2005) definition in an older Chinese population., Methods: Three thousand and fourteen men and 7275 women aged 50-85 years were recruited and received a full medical check-up including measurement of blood pressure, obesity indices, fasting total, LDL-, HDL-cholesterol, triglycerides, glucose and c-reactive protein. Data describing socioeconomic and lifestyle factors was also collected., Results: Vascular risk factors including waist circumference, weight gain and waist gain since the age of 18, body mass index, waist-hip-ratio, triglyceride, HDL-cholesterol, and systolic and diastolic blood pressures were positively associated with CRP in both men and women (p from <0.001 to 0.016). Compared to those without MS components, adjusted odds ratios for having elevated CRP increased in those with the MS or its components compared those without MS or components (all p<0.001), except for the low HDL-cholesterol in both genders and raised fasting glucose in men. Similarly, the risk of elevated CRP increased with escalating MS components even after adjustment of a range of potential confounders., Conclusions: There is a strong relationship between CRP and the constellation of MS components and associated vascular risk in this older Chinese population.

Purpose: Epidemiologic data from various regions have shown familial correlations of cardiovascular risk factors and the metabolic syndrome (MES), but not spousal concordance that reflects shared environmental factors, which we describe in a Korean general population., Methods: We selected 3141 couples; both partners of all couples had completed a national health examination. MES was determined according to National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III) definitions, except for waist circumference, where Asian cutoffs were used. For each MES component, unadjusted and age-adjusted spousal correlations and spousal concordance, were calculated, using logistic regression analysis after adjustment for spousal ages., Results: There were strong positive spousal correlations for each component of the MES, even after adjustment for age. Significant spousal concordance of MES was also observed. Men whose wives had MES had 1.29 (95%CI, 1.07-1.57) times higher risk of having MES, compared to those whose wives did not. Women whose husbands had MES were also at 1.32 (95% CI, 1.09-1.61) times higher risk of having the MES., Conclusions: There was significant spousal concordance of the MES in Koreans, which implies shared environmental factors contribute to the development of the MES. Targeting screening or disease prevention measures of partners of people with the MES may be beneficial.

Introduction: Two MspI polymorphisms in the ApoA-I gene (G-75A and C83T) have been shown to be associated with plasma HDL-cholesterol levels., Methods: We used a PCR-based RFLP method to determine the association of these polymorphisms with lipid parameters in 271 non-diabetic, normotriglyceridaemic Chinese subjects, of whom 104 were patients with hypertension, with 10.2% having hypercholesterolaemia and the remainder were controls., Results: As expected, the hypertensive group had higher blood pressure and indices of obesity, and a more adverse lipid profile. No differences in the ApoA-I G-75A genotype or allele frequency distributions between the controls and patients were identified. However, there was a significantly lower frequency of the CT genotype (p=0.012) and T allele (p=0.011) in the affected subjects with hypercholesterolaemia or hypertension. Similarly, blood pressure and triglyceride levels were significantly lower and HDL-cholesterol levels significantly higher in the subjects with the CT genotype compared to those with the CC genotype (p<0.05). However, the G-75A genotypes did not appear to influence the lipid or blood pressure levels. The -75A allele frequency was higher in our healthy controls than an equivalent Caucasian population (31.1% vs. 18.3%, p<0.001), whereas the 83T allele frequency was similar between the healthy Chinese and Caucasian groups., Conclusion: The 83T allele may be associated with a better lipid profile and blood pressure levels in this group of Chinese subjects.

Background: Dopamine modulates a variety of physiological functions including natriuresis and satiety. We have previously reported that the TaqI polymorphism of the dopamine D2 receptor (DD2R) gene is associated with both blood pressure and obesity indices in a normoglycaemic Hong Kong Chinese population. In this study, we present evidence confirming the linkage between this gene polymorphism, obesity and hypertension., Methods: Two hundred and seventy-four siblings from 96 normoglycaemic hypertensive families were recruited, including 133 who were hypertensive. Central obesity was defined as a waist-to-hip ratio of > or = 0.9 and > or = 0.85 in males and females, respectively, and was identified in 99 of the siblings. The DD2R gene TaqI polymorphism was identified with a polymerase chain reaction based restriction fragment length polymorphism protocol. The affected pedigree member (APM) linkage analysis (sib-pair program, version 0.99.9, by D.L. Duffy) was used to assess for linkage between this gene polymorphism, obesity and hypertension in 73 families with siblings discordant for hypertension., Results: The A1 allele frequencies were similar in the 133 hypertensive, and 141 normotensive siblings, including the 99 centrally obese siblings at 0.431, 0.421 and 0.418, respectively. APM linkage analysis suggested that the DD2R gene TaqI polymorphism had evidence of linkage with blood pressure (T = -1.86, P = 0.013), as well as with obesity (T = -1.58, P = 0.007)., Conclusion: Our data in normoglycaemic Hong Kong Chinese supports that the DD2R gene TaqI polymorphism is a marker associated with the pathogenesis of obesity and hypertension.

The tannins are natural polyphenols, able to precipitate water-soluble alkaloids and possess an inhibitory action on the angiotensin converting enzyme (ACE). We identified 18 polyphenolic compounds (tannins) from Chinese herbs and examined the in vitro effects of these tannins on ACE activity, including determination of the 50% inhibitory concentrations (IC50), specificity and mode of inhibition. We also assessed the in vivo inhibitory effect of the tannins on angiotensin I-induced blood pressure elevation in spontaneously hypertensive rats (SHR). Nine tannins with an IC50 <200 microM for ACE inhibitors were identified belonging to three tannin classes: caffeoylquinates, flavan-3-ols and gallotannins. In vitro, we found caffeoylquinates chelate the ACE zinc cofactor. Two of the flavan-3-ols: epigallocatechin-3-O-gallate and epigallocatechin-3-O-methylgallate, and one of gallotannin: 1, 2, 3, 4, 6-penta-O-galloyl-beta-D-glucose were non-specific inhibitors because also reduced the activity of trypsin and chymotrypsin. The ACE inhibition of 1, 2, 3, 4, 6-penta-O-galloyl-beta-D-glucose was also reduced after addition of bovine serum albumin, suggesting a non-specific mode of action. In vivo, 1,2,3,6-tetra-O-galloyl-beta-D-glucose and epigallocatechin-3-O-methylgallate had a strong dose-dependent hypotensive effect reducing the blood pressure significantly in the SHR with infusion of the angiotensin I. These findings indicate that some of the tannins isolated from herbs inhibit ACE activity non-specifically. The ACE inhibitory effect of these tannins may explain the hypotensive effects of some traditional Chinese herbs.