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To evaluate the prevalence of atrial fibrillation (AF) in physical laborers in rural China and identify contributing risk factors.A cross-sectional study of 11,956 permanent residents of Liaoning Province in rural China≥35y of age (primarily physical laborers) was conducted between January and August 2013 (response rate 85.3%). All participants completed a questionnaire and underwent a physical exam, echocardiography and electrocardiography. Blood samples were drawn for laboratory analyses, and AF was diagnosed on the basis of history and electrocardiograph findings. Risk factors for AF were evaluated with a stepwise logistic regression analysis.The prevalence of AF was 1.2% overall, but rose steeply with age (0.1% in those 35-44y of age, and 4.6% in those≥75y); there was no significant gender difference at any age. Independent risk factors for AF were age (odds ratio [OR] 1.89; P0.001), diabetes (OR 2.07; P=0.001), history of myocardial infarction (OR 5.91; P0.001), low left ventricular ejection fraction (OR 1.85; P=0.005), and low physical activity (OR 1.72; P=0.003), whereas obesity, hypertension, cholesterol and triglyceride levels, current smoking and drinking, left ventricular hypertrophy, and family history of AF were not significant contributors.Although the prevalence of AF in physical labors in rural China is low, age, diabetes, history of myocardial infarction, low left ventricular ejection fraction, and low physical activity are independent risk factors.

Although several studies have suggested that intensive statin pretreatment could reduce the incidence of procedure-related myocardial infarction in western population, the data on the effect in Asian patients have been still limited. The aim of the study was to investigate the efficacy and safety of intensive atorvastatin load in Chinese patients undergoing elective PCI. A total of 1202 patients with stable angina or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) scheduled to undergo PCI received either intensive statin treatment (80 mg atorvastatin daily × 2 days before PCI and 40 mg daily × 30 days after PCI) or usual care. The primary endpoint was incidence of major adverse cardiac events (cardiac death, myocardial infarction, or unexpected target vessel revascularization) within 30 days after PCI. Safety endpoints include the incidence of contrast induced nephropathy (CIN), ALT/AST >3 upper limit of normal (ULN), CK >5 ULN. The incidence of 30-day MACE did not significantly differ between the intensive group and control group (19.4 vs 18.3%, P = 0.63). Multivariate analysis revealed age (OR = 1.024, 95% CI 1.003–1.045, P = 0.023) and total stent length as an independent predictor of 30-day MACE (OR = 1.012, 95% CI 1.007–1.018, P < 0.0001). The incidence of CIN was comparable between intensive group and control group (4.09 vs 4.39%, P = 0.795). No significant differences were observed in other safety profile at all follow-ups between treatment groups. The ISCAP trial demonstrated that serial intensive atorvastatin therapy did not improve the clinical outcome with similar safety profile comparing with usual care among Chinese patients undergoing elective PCI.

Genetic factors have been shown to be associated with the risk of stroke. However, due to individual differences, the extent of the association between genetic factors and stroke varies widely. Hypertension is considered one of the most important risk factors for stroke, but it remains unknown whether the genetic association with stroke in a hypertensive population is the same as that in a non-hypertensive population. The aim of the present study was to explore the association between the phosphodiesterase 4D gene (PDE4D) and interleukin-6 receptor gene (IL6R) single nucleotide polymorphisms and ischemic stroke in a hypertensive population. The study included 307 ischemic stroke cases with hypertension and 227 controls (simple hypertension). The polymorphic loci rs12188950 and rs918592 in PDE4D, and rs4075015 and rs4537545 in IL6R were selected for analyzing the genotype and allele frequencies between cases and controls. rs12188950 was not found in the study population. In the univariate analysis, the rs918592 polymorphism in PDE4D was found to be significantly associated with ischemic stroke with the recessive model (P = 0.02), whereas no association with ischemic stroke was observed for rs4075015 and rs4537545 in IL6R. Following adjustment for binary logistic regression, the rs918592 polymorphism was not found to be associated with ischemic stroke. While prior studies have found an association between PDE4D and IL6R polymorphisms and ischemic stroke, our results suggest that this association may be different in a hypertensive population. Therefore, the association between PDE4D and IL6R polymorphisms and ischemic stroke among a hypertensive population requires further investigation.

Musculoskeletal embryonic nuclear protein 1 (MUSTN1) gene is involved in myogenic fusion and differentiation in rats. We previously showed the differential expression of MUSTN1 in week (W) 2 and W6 breast muscles of Pekin ducks. In this study, we further investigated its molecular characteristics and expression profiles in different tissues at W7 and in breast and leg muscles at W1, W3, W5, W7, and W9. The relationship between muscle development and muscle fiber areas was also investigated. A 358-bp cDNA sequence was obtained. The coding sequence of duck MUSTN1 cDNA encoded a 78-amino acid sequence, which showed high similarity with those of other species (96% similarity with zebra finch and 94% with chicken). In addition, a 6435-bp genomic DNA sequence of MUSTN1 was obtained. In total, 231 transcription factor-binding sites were found in the promoter region, and many of these transcription factors were involved in the regulation of muscle development. MUSTN1 expression in breast muscle increased from W1 to W5 and then decreased at W9. In leg muscle, the expression increased from W1 to W3 and then decreased. The relative growth rates of breast and leg muscle fibers reached their peaks at W3-W5 and W1-W3, respectively. Since the greatest relative growth rates appeared at the highest expression levels of the MUSTN1 gene, it was thought to play roles in duck muscle development. Our findings would be helpful in understanding the molecular characteristics and functions of the MUSTN1 gene in breast muscle development of ducks.

a Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China b Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China c Department of Prevention of Chronic Non-communicable Diseases, Center for Disease Prevention and Control of Liaoning Province, Shenyang, Liaoning, People's Republic of China d Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China

The purpose of this study is to track the trends of low visual acuity (VA) from 2005 to 2014, and to investigate its associations with systemic blood pressure (BP) components among adolescents in Northeast China. A total of 55320 students of Han nationality aged 13 to 18 years were included. There has been a significant increase in the prevalence of low VA, with 31.3% in 2005, 40.2% in 2010 and 43.4% in 2014. In multivariable-adjusted logistic regression models, each 1-mm Hg increment in systolic BP (SBP) was associated with 0.8% (95% confidence interval [CI]: 0.1–1.6%), 0.5% (95% CI: 0.1–0.9%) and 1.1% (95% CI: 0.6–1.6%) increased odds of low VA for males in 2005, 2010 and 2014; each 1-mm Hg increment in pulse pressure (PP) was associated with 1.6% (95% CI: 0.7–2.5%), 0.8% (95% CI: 0.4–1.2%) and 1.2% (95% CI: 0.7–1.7%) increased odds of low VA. Higher PP categories had greater odds for low VA compared with the reference group. Similar associations were not observed for females. We conclude that higher prevalence of low VA was significantly associated with higher SBP and PP in males. Furthermore, there was a dose-dependent association between the prevalence of low VA and the levels of PP.

Identification of inflammatory mediators that regulate the vascular response to vasopressor molecules may aid in the development of novel therapeutic agents to treat or prevent hypertensive vascular diseases. Leukocytes have recently been shown to be capable of modifying blood pressure responses to vasopressor molecules. The purpose of this study was to test the hypothesis that deficiency of the leukocyte ligand, Psgl-1, would reduce the pressor response to angiotensin II (Ang II). Mice deficient in Psgl-1 (Psgl-1−/−) along with wild-type (WT) controls were treated for 2 weeks with a continuous infusion of Ang II. No differences in blood pressure between the groups were noted at baseline, however after 5 days of Ang II infusion, systolic blood pressures were higher in WT compared to Psgl-1−/− mice. The pressor response to acute administration of high dose Ang II was also attenuated in Psgl-1−/− compared to WT mice. Chimeric mice with hematopoietic deficiency of Psgl-1 similarly showed a reduced pressor response to Ang II. This effect was associated with reduced plasma interleukin-17 (IL-17) levels in Psgl-1−/− mice and the reduced pressor response was restored by administration of recombinant IL-17. In conclusion, hematopoietic deficiency of Psgl-1 attenuates Ang II-induced hypertension, an effect that may be mediated by reduced IL-17.

Background Mounting evidence suggested that nontraditional lipid profiles have been recognized as a reliable indicator for unfavorable cardiovascular events. The purpose of this study was to explore the role of nontraditional lipid profiles as potential clinical indices for the assessment of prevalent diabetes in rural Chinese H-type hypertension population. Methods During 2012 to 2013, we conducted a large cross-sectional study of 2944 H-type hypertension participants (≥35 years of age) from rural areas in northeast China. Subjects underwent accurate assessment of lipid profiles, fasting plasma glucose (FPG), homocysteine (Hcy) according to standard protocols. Results The proportion of diabetes showed a graded and linear increase across the quartiles for all four nontraditional lipid parameters. Nontraditional lipid variables were independent determinants of FPG, and its correlation for TG/HDL-C was strongest, whether potential confounders were adjusted or not. Multivariable logistic regression analysis established that the highest triglycerides (TG)/ high-density lipoprotein cholesterol (HDL-C) quartile manifested the largest ORs of prevalent diabetes (OR: 3.275, 95%CI: 2.109–5.087) compared with the lowest quartile. The fully adjusted ORs (95%CI) were 2.753 (1.783–4.252), 2.178 (1.415–2.351), 1.648 (1.097–2.478) for the top quartile of total cholesterol (TC)/HDL-C, low-density lipoprotein cholesterol (LDL-C)/HDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C), respectively. On the basis of the area under receiver-operating characteristic curve (AUC), TG/HDL-C showed the optimal discriminating power for diabetes (AUC: 0.684, 95% CI: 0.650–0.718). Conclusions Nontraditional lipid profiles (TG/HDL-C, TC/HDL-C, LDL-C/HDL-C and non-HDL-C) were all consistently and independently correlated with prevalent diabetes among the H-type hypertension population in rural China. TG/HDL-C was prone to be more profitable in assessing the risk of prevalent diabetes and should be encouraged as an effective clinical tool for monitoring and targeted intervention of diabetes in H-type hypertension adults.

Background and aims Serum cystatin C (CysC) is associated with the risk of ischemic stroke and may predict cardiovascular events and death after ischemic stroke onset. However, the association between serum CysC and functional outcome in ischemic stroke patients remains unclear, and whether lipid component level influences the relationship between them has not been studied. Methods A total of 3348 ischemic patients from China Antihypertensive Trial in Acute Ischemic Stroke were included in the study. Serum CysC was used to calculate estimated glomerular filtration rate (eGFRCysC) at baseline. The primary outcome was poor functional outcome (modified Rankin Scale score ≥3) at one year after ischemic stroke. Secondary outcomes were death, stroke recurrence, vascular events and combination of the aforementioned outcomes. Results The association between eGFRCysC and primary outcome was appreciably modified by low-density lipoprotein cholesterol (LDL-C) (pinteraction = 0.048). Low eGFRCysC was associated with primary outcome only in ischemic stroke patients with LDL-C ≥4.14 mmol/l rather than all patients. The multivariable adjusted odds ratio (95% confidence interval) of poor functional outcome associated with low eGFRCysC was 3.94 (1.04–14.98) and a positive linear dose-response relationship between them was observed among patients with LDL-C ≥4.14 mmol/l (p for linearity = 0.021). Subgroup analyses further confirmed these associations. There was no association between eGFR based on serum creatinine and poor functional outcome of stroke. Conclusions Low eGFRCysC may be an independent predictor for 1-year poor functional outcome in ischemic stroke patients with LDL-C ≥4.14 mmol/l. Further studies are needed to replicate our findings and to clarify the potential mechanisms.

Corins are membrane-bound protease that regulates blood pressure by activating the natriuretic peptides. These pro-atrial natriuretic peptide convertases are essential for sodium homeostasis and normal blood pressure. CORIN variants have been identified in humans and other animals, but no studies of CORIN polymorphisms have been conducted in northeastern China. This study aims to investigate the association of 2 single nucleotide polymorphisms (SNPs) in CORIN (rs2271037 and rs3749585) with hypertension, as well as their potential interactions with some risk factors of hypertension in a Han population of northeastern China. A case-control study, including 402 patients with hypertension and 406 participants with normal blood pressure, was conducted in Liaoning province. SNP genotyping was carried out by high resolution melting (HRM) after polymerase chain reaction amplifications. Since rs3749585 is located in 3' untranslated region (UTR) of CORIN, in silico analysis was used to predict target micro RNAs on TargetScan, miRanda, and DIANA-microT. As a result, mutant T allele in rs2271037 (odds ratio [OR], 1.693; 95% confidence [CI], 1.528-1.877; p 0.001) and C allele in rs3749585 (OR, 1.114; 95% CI 1.011-1.227; p = 0.029) increased the risk of hypertension, comparing with wild G allele and T allele, respectively. Patients with genotype TT (OR, 10.209; 95% CI, 6.414-16.250; p 0.001) and GT (OR, 1.730; 95% CI, 1.226-2.443; p = 0.002) have higher risk of hypertension than those with genotype GG. SNP rs2271037 was significantly associated with susceptibility to hypertension in all genetic models (dominant model: OR, 2.879; 95% CI, 2.080-3.986; p 0.001; recessive model: OR, 7.159; 95% CI, 4.779-10.724; p 0.001; additive model: OR, 1.535; 95% CI, 1.163-2.027; p = 0.002). SNP rs3749585 was significantly correlated with hypertension susceptibility only in dominant model (OR, 1.533; 95% CI, 1.073-2.189; p = 0.019), but not in recessive model (OR, 1.220; 95% CI, 0.906-1.644; p = 0.191) or additive model (OR, 0.915; 95% CI, 0.694-1.205; p = 0.527). After adjusting for age, gender, body mass index (BMI), smoking, low-density lipoprotein cholesterol, and serum sodium level in logistic models, the same statistical results were obtained. Interaction study showed the association between CORIN polymorphisms and hypertension could be changed by overweight (BMI ≥ 25 kg/m

Arterial stiffness is an important risk factor for cardiovascular events. Radial augmentation index (AI r ) can be more conveniently measured compared with carotid-femoral pulse wave velocity (cfPWV). However, the performance of AI r in assessing arterial stiffness is limited. This study proposes a novel index AI rd , a combination of AI r and diastolic augmentation index (AI d ) with a weight α, to achieve better performance over AI r in assessing arterial stiffness. 120 subjects (43 ± 21 years old) were enrolled. The best-fit α is determined by the best correlation coefficient between AI rd and cfPWV. The performance of the method was tested using the 12-fold cross validation method. AI rd (r = 0.68, P cfPWV and a narrower prediction interval than AI r (r = 0.61, P AI d (r = −0.17, P = 0.06), the central augmentation index (AI c ) (r = 0.61, P AI c normalized for heart rate of 75 bpm (r = 0.65, P AI r (age, P P P P P = 0.001), AI rd has fewer confounding factors (age, P P AI rd derives performance improvement in assessing arterial stiffness, with a stronger correlation with cfPWV and fewer confounding factors.

Background/Aims: Abnormal proliferation of vascular smooth muscle cells (VSMCs) is a hallmark of vascular lesions, such as atherosclerosis and restenosis. PDGF-ββ, an isoform of PDGF (platelet-derived growth factor), has been demonstrated to induce proliferation and migration of VSMCs. Atorvastatin calcium, a selective inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, has favorable protective effects on VSMCs. This study examined the effects of atorvastatin calcium on the proliferation and migration of PDGF-ββ-treated VSMCs, as well as its underlying mechanisms. Methods: MTT assays, Edu imaging, cell cycle analysis, wound healing assays, transwell migration assays, and western blot analysis were performed. Results: Atorvastatin calcium significantly inhibited cell proliferation, DNA synthesis and cell migration of PDGF-ββ-treated VSMCs. We demonstrated that atorvastatin calcium induced cell cycle arrest in the G0/G1 phase in response to PDGF-ββ stimulation and decreased the expression of G0/G1-specific regulatory proteins, including proliferating cell nuclear antigen (PCNA), CDK2, cyclin D1, cyclin E and CDK4 in PDGF-ββ-treated VSMCs. Moreover, pretreatment with atorvastatin calcium inhibited the PDGF-ββ-treated phosphorylation of PDGFRβ and Akt, whereas atorvastatin calcium did not affect the phosphorylation of PLC-γ1 or (ERK) 1/2. Conclusion: Our data suggested that atorvastatin calcium inhibited abnormal proliferation and migration of VSMCs through G0/G1 cell cycle arrest and suppression of the PDGFRβ-Akt signaling cascade.

Previous studies found that hypertension and high homocysteine (HHcy) exhibited a synergistic effect on the risk of cardiovascular diseases. This study aimed to investigate the prevalence of hypertension accompanied by HHcy and its risk factors in the rural areas of northeast China. This study was conducted using a stratified cluster random sampling method, and included 6529 subjects with complete data. Demographic characteristics were obtained from a questionnaire. Blood pressure and anthropometric indices were measured, and serum indices were analyzed. Hypertension accompanied by HHcy was defined as hypertension plus HHcy [homocysteine (Hcy) > 10 µmol/L]. The mean concentration of Hcy was 17.29 μmol/L in the general population. The prevalence of hypertension accompanied by HHcy was so high that it reached 45.1% of our study population and accounted for 86.8% of the total participants with hypertension. Multiple logistic regression analysis indicated that the modifiable risk factors of hypertension accompanied by HHcy included obesity, diabetes, dyslipidemia, and inactive physical activities. We found that the mean level of Hcy, and the prevalences of HHcy and hypertension accompanied by HHcy were very high among the rural population of northeast China. Obesity, diabetes, dyslipidemia, and inactive physical activities were modifiable risk factors of hypertension accompanied by HHcy.

Background To examine the effect of abnormal glucose regulation on prognosis and whether hypoglycemic treatment during hospitalization improves prognosis in acute ischemic stroke patients. Methods A total of 3882 acute ischemic stroke patients with an elevated systolic blood pressure between 140 mm Hg and 220 mm Hg were included in the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The primary outcome was a combination of death and major disability (modified Rankin Scale score ≥ 3) at 3 months after stroke. Secondary outcomes included death, major disability, and vascular events. Results Compared with normal fasting plasma glucose, odds ratios (95% confidence interval) associated with impaired fasting glucose (IFG) and diabetes mellitus (DM) were 1.25 (0.92–1.68) and 1.38 (1.13–1.67) for composite outcome of death or major disability, respectively, and there was a significant trend for death or major disability ( P trend = 0.001). A linear association between fasting plasma glucose and the risk of combined outcome of death and major disability was observed among the patients without hypoglycemic treatment during hospitalization ( P for linearity = 0.005). We found protective effect of hypoglycemic treatment for risk of death (odds ratio, 0.47; 95% confidence interval, 0.24–0.92) among ischemic stroke patients with DM. Conclusions Abnormal glucose regulation, especially DM, increased risks of 3-month poor outcomes after an acute ischemic stroke and hypoglycemic treatment during hospitalization might improve prognosis in ischemic stroke patients with DM.

We aimed to investigate the effect of advanced glycation end products (AGEs) on the proliferation and migration ability of human umbilical vein endothelial cells (HUVECs). Cell proliferation was detected by methyl thiazolyl tetrazolium (MTT) assay, real-time cell analyzer and 5-Ethynyl-2′-deoxyuridine (EdU) staining. Cell migration was detected by wound-healing and transwell assay. AGEs significantly inhibited the proliferation and migration of HUVECs in a time-and dose-dependent way. Western blotting revealed that AGEs dramatically increased the expression of microtubule-associated protein 1 light chain 3 (LC3) II/I and p62. Immunofluorescence of p62 and acridine orange staining revealed that AGEs significantly increased the expression of p62 and the accumulation of autophagic vacuoles, respectively. Chloroquine (CQ) could further promote the expression of LC3 II/I and p62, increase the accumulation of autophagic vacuoles and promote cell injury induced by AGEs. In addition, AGEs reduced cathepsin D (CTSD) expression in a time-dependent way. Overexpression of wild-type CTSD significantly decreased the ratio of LC 3 II/I as well as p62 accumulation induced by AGEs, but overexpression of catalytically inactive mutant CTSD had no such effects. Only overexpression of wild-type CTSD could restore the proliferation of HUVECs inhibited by AGEs. However, overexpression of both wild-type CTSD and catalytically inactive mutant CTSD could promote the migration of HUVECs inhibited by AGEs. Collectively, our study found that AGEs inhibited the proliferation and migration in HUVECs and promoted autophagic flux, which in turn played a protective role against AGEs-induced cell injury. CTSD, in need of its catalytic activity, may promote proliferation in AGEs-treated HUVECs independent of the autophagy-lysosome pathway. Meanwhile, CTSD could improve the migration of AGEs-treated HUVECs regardless of its enzymatic activity.

Aortic pulse wave reflects cardiovascular status, but, unlike the peripheral pulse wave, is difficult to be measured reliably using noninvasive techniques. Thus, the estimation of aortic pulse wave from peripheral ones is of great significance. This study proposed an adaptive transfer function (ATF) method to estimate the aortic pulse wave from the brachial pulse wave. Aortic and brachial pulse waves were derived from 26 patients who underwent cardiac catheterization. Generalized transfer functions (GTF) were derived based on the autoregressive exogenous model. Then, the GTF was adapted by its peak resonance frequency. And the optional peak resonance frequency for an individual was determined by regression formulas using brachial systolic blood pressure. The method was validated using the leave-one-out cross validation method. Compared with previous studies, the ATF method showed better performance in estimating the aortic pulse wave and predicting the feature parameters. The prediction error of the aortic systolic blood pressure and pulse pressure were 0.2 ± 3.1 and -0.9 ± 3.1 mmHg, respectively. The percentage errors of augmentation index, percentage notch amplitude, and ejection duration were -2.1 ± 32.7%, 12.4 ± 9.2%, and -2.4 ± 3.3%, respectively.

Linear regression analyses for association between homocysteine and QTc interval. Linear regression analyses presented the result that homocysteine is associated with QTc interval. (DOCX 69 kb)

Supplementary flow chart. Baseline data from each participant with a final sample size of 7002 (3260 men and 3742 women). (DOC 41 kb)

Background Previous researches aiming to estimate the association between metabolic syndrome and depressive symptoms come out with inconsistent results. Besides, most of them are conducted in the developed areas. There is lack of the data from rural China. The aim of this study is to confirm whether gender difference exists among the relationship between MetS, metabolic components and depressive symptoms in the rural Chinese population. Methods A cross-sectional analysis enrolled 11430 subjects’ aged ≥35 from rural Northeast China. Metabolic and anthropometric indicators were measured according to standard methods. Depressive symptoms were defined using the Patient Health Questionnaire-9 (PHQ-9). Results The prevalence of depressive symptoms was 6% among rural Northeast general population and the prevalence of MetS and its components were 39.0% for MetS, 42.9% for abdominal obesity, 67.1% for elevated blood pressure, 47.1% for hyperglycemia, 32.1% for hypertriglyceridemia, 29.5% for low HDL-C. Depressive symptoms were associated with triglyceride component (OR = 1.24, 95%CI: 1.05–1.46, P = 0.01) but not MetS (OR = 1.11, 95%CI: 0.94–1.30, P = 0.23). Moreover, depressive symptoms were associated with triglyceride component (OR = 1.21, 95% CI = 1.00–1.47, P = 0.05) in women only. But once adjusted for menopause status, depressive symptoms were no longer statically associated with triglyceride component (OR = 1.20, 95% CI = 0.99–1.46, P = 0.07). Conclusions Depressive symptoms were associated with triglyceride component but not MetS in rural Chinese population. Routine lipid screening should be recommended among rural depressed residents especially among female.

Background It is necessary to develop a new thrombolytic agent which can be used by a single bolus at first aid sites to decrease the time to reperfusion in clinical practice. HTUPA, a genetically engineered new thrombolytic with a longer half-life, is well qualified. We aim to compare the thrombolytic efficacy and safety of human tissue urokinase type plasminogen activator (HTUPA) to recombinant tissue plasminogen activator (rt-PA) in Chinese patients with acute myocardial infarction (AMI). Methods AMI patients (n=221) were randomized to rt-PA (a standard protocol) or HTUPA (25mg bolus) treatment groups. All patients also received oral aspirin and intravenous heparin. Coronary angiography was performed 90min after therapy initiation to determine infarct-related coronary artery (IRA) patency. Clinical outcomes and changes of clotting variables, heart rate, blood pressure, left ventricular ejection fraction (LVEF), and electrocardiogram were evaluated. Results Patent IRA [thrombolysis in myocardial infarction (TIMI) grade 2 or 3] was observed in 77% of HTUPA-treated patients, compared to 76% of rt-PA-treated patients ( P =0.76). TIMI grade 3 patency rates were 52% and 44% in the HTUPA and rt-PA groups, respectively ( P =0.37). The total patency rate was 77% (86/111 patients) in the HTUPA group and 73% (80/110 patients) in the rt-PA group ( P =0.41). Adverse events were infrequent in both groups, and no significant differences were detected in mortality, re-occlusion rate, revascularization rate, adverse effects, clotting index, LVEF, or electrocardiogram between the two groups. Conclusions Intravenous HTUPA had a safe and efficacious profile as good as rt-PA in patients with AMI.

We aimed to compare the relative strength of the association between anthropometric obesity indices and chronic kidney disease (CKD). Another objective was to examine whether the visceral adiposity index (VAI) and lipid accumulation product index (LAPI) can identify CKD in the rural population of China. There were 5168 males and 6024 females involved in this cross-sectional study, and 237 participants (2.12%) suffered from CKD. Obesity indices included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), VAI and LAPI. VAI and LAPI were calculated with triglyceride (TG), high-density lipoprotein (HDL), BMI and WC. VAI = [WC/39.68 + (1.88 × BMI)] × (TG /1.03) × (1.31/ HDL) for males; VAI = [WC/36.58 + (1.89 × BMI)] × (TG/0.81) × (1.52/HDL) for females. LAPI = (WC-65) × TG for males, LAPI = (WC-58) × TG for females. CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m2. The prevalence of CKD increased across quartiles for WHtR, VAI and LAPI. A multivariate logistic regression analysis of the presence of CKD for the highest quartile vs. the lowest quartile of each anthropometric measure showed that the VAI was the best predictor of CKD in females (OR: 4.21, 95% CI: 2.09–8.47, p < 0.001). VAI showed the highest AUC for CKD (AUC: 0.68, 95% CI: 0.65–0.72) and LAPI came second (AUC: 0.66, 95% CI: 0.61–0.70) in females compared with BMI (both p-values < 0.001). However, compared with the traditional index of the BMI, the anthropometric measures VAI, LAPI, WC, and WHtR had no statistically significant capacity to predict CKD in males. Our results showed that both VAI and LAPI were significantly associated with CKD in the rural population of northeast China. Furthermore, VAI and LAPI were superior to BMI, WC and WHtR for predicting CKD only in females.

Reports on the performance and comparability of risk prediction algorithms for cardiovascular disease (CVD) risk stratification were mainly focused on Western samples. However, few data exist regarding the appropriate CVD risk equations for Asian men. Multiple health care registries, databases, and

The Fuster-BEWAT Score (FBS) has been recently developed for use in lifestyle-based cardiovascular disease (CVD) prevention, presenting similar accuracy in predicting subclinical atherosclerosis with ideal cardiovascular health score (ICHS), but it is unclear whether both scores exhibit comparable

The quantitative associations between prehypertension or its separate blood pressure (BP) ranges and the risk of main cardiovascular diseases (CVDs) have not been reliably documented. We performed a comprehensive search of PubMed (1966 to June 2012) and the Cochrane Library (1988 to June 2012) without language restrictions. Prospective studies were included if they reported multivariate-adjusted risk ratios (RRs) and corresponding 95 % confidence intervals (CIs) of desirable outcomes, including fatal or non-fatal incident stroke, coronary heart disease, myocardial infarction (MI) or total CVD events, with respect to prehypertension or its separate BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline with normal BP (

We determined the prevalence and risk profiles of being overweight or obese among children and adolescents in rural northeast China.We conducted a cross-sectional study consisting of 4,094 children and adolescents aged 5-18 y. Anthropometric measurements and information on health-related variables were collected by well-trained personnel. Odds ratios (ORs) are presented with 95% confidence intervals (CIs).The overall prevalence of subjects who were overweight or obese was 21.8% (15.4% overweight and 6.4% obese). Among boys, getting more sleep was found to be a protective factor against being overweight or obese, and a higher monthly family income (2,000-5,000 Chinese yuan (CNY); 1 CNY = 0.163 US dollar) was associated with an increased risk as compared with lower incomes. For girls, not having breakfast every day conferred higher odds of being overweight or obese (OR, 1.45 (95% confidence interval (CI), 1.11-1.91)). When both parents were overweight, this increased the risk of a child being overweight or obese in both boy (overweight father: OR, 1.54 (95% CI, 1.26-1.89); overweight mother: OR, 1.73 (95% CI, 1.35-2.22)) and girl participants (overweight father: OR, 2.01 (95% CI, 1.57-2.57); overweight mother: OR, 1.45 (95% CI, 1.07-1.96)).The prevalence of pediatric obesity in rural China was relatively high. Risk profiles should be fully considered when planning prevention and treatment programs for pediatric obesity.

The widest distribution and the highest uptake of methamphetamine (MA) in the human body occurred in the lungs, so that more and more attention should be paid to MA-induced pulmonary toxicity. MA induces the release of serotonin, which is an important mediator in pulmonary disease. The purpose of this study is to investigate the chronic response of the lung to MA and its potential mechanism in rats. Models of the chronic toxicity of MA were established with MA of 5 mg/kg and 10 mg/kg (intraperitoneally, twice per day) for 5 weeks. It was found that the high dose of MA induced rat pulmonary toxicity: crowded lung parenchyma, thickened septum, reduced number of alveolar sacs, inflammatory cell infiltration, and pulmonary arteriolar remodeling. In addition, MA resulted in a significant increase in the lung serotonin concentration and the marked upregulation of tryptophan hydroxylase 1, vesicular monoamine transporter 2, serotonin transporter, and downregulation of monoamine oxidase-A. These findings suggest that MA induced chronic pulmonary toxicity, which is concerned with the elevated serotonin concentration in rat lungs by increased synthesis, reduced metabolism, augmented accumulation, and promoted release of serotonin.

Hypertension/high blood pressure (HBP) is an emerging health issue of considerable importance in children and adolescents due to its rising prevalence in many areas and associated consequences. Although the worldwide prevalence in youths is not precisely known, high rates reported for various age groups, regions and races all indicate a global problem (1–6). There is increasing evidence that elevated BP in childhood is associated with target organ damage, notably left ventricular hypertrophy, which may result in premature cardiovascular morbidity and mortality in adults (7–9), and commonly leads to hypertension in young adulthood (10). Because HBP in childhood is often asymptomatic and, thus, is easily overlooked (even by health professionals), almost 75% of cases (90% with prehypertension) reportedly go undiagnosed (11). However, given the complexity of defining paediatric-onset HBP (via sex, age and height percentiles), the technical issues involved (such as appropriate cuff size) and the paucity of available diagnostic guidance, it is understandable why current detection rates are low. Although a simplified table developed by Kaelber et al (12) has enabled quick and easy identification of children and adolescents whose BP readings need further evaluation, it still requires consulting many normative values, which may not be readily available. Recently, Lu et al (13) developed novel criteria, using ratios of systolic BP to height (SBPHR) and diastolic BP to height (DBPHR) to identify HBP in Chinese Han adolescents. Diagnostic sensitivity and specificity were excellent with this method. Another study involving Caucasian adolescents (14) has subsequently substantiated the initial success, but the epidemiological merit of this technique has yet to be proven in children. Therefore, we chose to evaluate this approach with the following objectives in mind: to validate previous results via a sampling of adolescents from northern China; to determine applicability to children (five to 12 years of age); to determine optimal ratio cut-off points; and to investigate its utility in paediatric prehypertensive states.

Background The aim of this study was to describe the incidence, clinical sub-types, and associated risk factors of stroke among rural Chinese adults. Methods A population-based sample of 38 949 rural Chinese adults, aged ≥35 years and free from stroke at baseline, were followed from 2004–2006 to 2010. Stroke was defined by the World Health Organization diagnosis criteria. Results The age-standardized incidence rates per 100 000 person-years of overall, first ever stroke was 601·9 (95% confidence interval, 528·3 to 675·5), and mortality rate was 276·7 (95% confidence interval, 251·6 to 301·9). The age-standardized incidence rate was higher in men (775·9 per 100 000 person-years) than in women (435·6 per 100 000 person-years). Among 858 first ever stroke events, 56·3% were ischemic strokes, 40·6% were hemorrhagic strokes, and 3·1% were undetermined strokes. Hypertension and lipid disorder were common modifiable risk factors in the ischemic stroke and hemorrhagic stroke groups. Conclusions The annual incidence of stroke and resulting mortality has increased at an accelerated rate. Furthermore, the incidence of stroke in rural China was higher than that found in urban China and Western countries. Hypertension and lipid disorder were important modifiable risk factors. The primary sub-type of stroke observed in rural China was ischemic stroke. These findings underscored the need for more aggressive efforts to control the risk factors of stroke and other cardiovascular diseases in rural areas.

Background: There is a lack of study on the relation between undiagnosed diabetes and depression in the general population. Methods: A total of 11,531 adults were examined using a multistage cluster sampling method to select a representative sample of individuals who were at least 35 years old. Subjects were classified into three groups: no diabetes (ND), diagnosed diabetes (DD), and undiagnosed diabetes (UD). The participants were surveyed with the Patient Health Questionnaire-9 (PHQ-9). Results: Of all the 11,531 participants, the prevalence of depression was higher in the DD group than in the other two groups. Multi variable logistic regression analyses show that the DD group had significantly higher odds for depression compared with the ND group (p < 0.01), while the UD group showed no significant differences compared to the ND group. Subgroup analyses show that diagnosed diabetes in subjects with a lower educational level, compared with subjects with an educational level of high school or above, had higher odds for a PHQ-9 score ≥5 (p < 0.01). Conclusion: In this general population, diagnosed but not undiagnosed diabetes was significantly associated with depression. Much higher odds for depression were found among diagnosed diabetic individuals with a lower level of education.

Aims: β-blockers are underused in Chinese patients with coronary heart disease. The prescribed dose is often low. The aim of this study was to investigate the effect of metoprolol succinate doses of 95 mg and 190 mg on heart rate (HR) control, as well as drug tolerance, in Chinese patients with stable angina, low-dose β-blocker use and unsatisfactory HR control. Methods: This was a multicenter, randomized, open-label, parallel-group trial in 15 clinical sites. Patients with stable angina, taking low-dose β-blockers (equivalent to metoprolol succinate 23.75-47.5 mg/day), and having a resting HR of ≥ 65 bpm were enrolled and randomized to either the metoprolol 95-mg group or the 190-mg group. The change in 24-h average HR from baseline recorded by Holter monitoring and the percentages of patients with resting HR controlled to ≤ 60 bpm were compared between the two groups. Results: Two hundred thirty-one patients entered the intent-to-treat population for the main analysis. The change in 24-h average HR from baseline was -0.62 ± 0.66 bpm in the 95 mg group and -2.99 ± 0.62 bpm in the 190 mg group (p = 0.0077) after 8 weeks of treatment. The percentages of patients with resting HR controlled to ≤ 60 bpm were 24.1% (95% CI: 16.35%, 31.93%) and 40.0% (95% CI: 31.05%, 48.95%), respectively (p = 0.0019). Only 4 and 2 of the patients, respectively, discontinued the study drugs because of hypotension or bradycardia. Conclusions: The metoprolol succinate dose of 190 mg is superior to the 95 mg dose in terms of HR control, in Chinese patients with stable angina, low-dose β-blocker use and unsatisfactory HR control. Both doses were well tolerated.

Under normal physiological condition, the mature vascular smooth muscle cells (VSMCs) show differentiated phenotype. In response to various environmental stimuluses, VSMCs convert from the differentiated phenotype to dedifferentiated phenotype characterized by the increased ability of proliferation/migration and the reduction of contractile ability. The phenotypic transformation of VSMCs played an important role in atherosclerosis. Both Bcl-2-associated athanogene 3 (BAG3) and tumor necrosis factor-related apopt-osis inducing ligand (TRAIL) involved in apoptosis. The relationship between BAG3 and TRAIL and their effects the proliferation and migration in VSMCs are rarely reported. This study investigated the effects of BAG3 on the phenotypic modulation and the potential underlying mechanisms in primary rat VSMCs. Primary rat VSMCs were extracted and cultured in vitro. Cell proliferation was detected by cell counting, real-time cell analyzer (RTCA) and EdU incorporation. Cell migration was detected by wound healing, Transwell and RTCA. BAG3 and TRAIL were detected using real-time PCR and western blotting and the secreted proteins in the cultured media by dot blot. The expression of BAG3 increased with continued passages in cultured primary VSMCs. BAG3 promoted the proliferation and migration of primary rat VSMC in a time-dependent manner. BAG3 significantly increased the expression of TRAIL while had no effects on its receptors. TRAIL knockdown or blocking by neutralizing antibody inhibited the proliferation of VSMCs induced by BAG3. TRAIL knockdown exerted no obvious influence on the migration of VSMCs. Based on this study, we report for the first time that BAG3 was expressed in cultured primary rat VSMCs and the expression of BAG3 increased with continued passages. Furthermore, BAG3 promoted the proliferation of VSMCs via increasing the expression of TRAIL. In addition, we also demonstrated that BAG3 promoted the migration of VSMCs independent of TRAIL upregulation.

Although obesity and the metabolic syndrome (MS) often co-occur, many obese (OB) subjects have a favorable metabolic profile. It is unclear whether these factors independently influence cardiac electrophysiology including prolongation of the QT interval. We examined associations among obesity, MS, and prolonged corrected QT (QTc) interval in a large sample of Chinese research participants aged ≥35 years recruited from rural areas of Liaoning Province during 2012 to 2013. Of the 11,209 participants, 6,364 (56.8%) were nonobese and metabolically healthy (OB-/MS-), 2,853 (25.5%) were OB-/MS+, 493 (4.4%) were OB+/MS-, and 1,499 (13.4%) were OB+/MS+. Mean (±SD) QTc intervals were higher in OB-/MS+ (436.3 ± 24.3) and OB+/MS+ (436.6 ± 25.9) participants but not OB+/MS- participants (425.4 ± 24.0) than in OB-/MS- participants (426.8 ± 21.5, p0.001), and the prevalence of QTc prolongation was higher in OB-/MS+ and OB+/MS+ participants (adjusted odds ratios [aOR] 1.68, 95% confidence interval [CI] 1.52 to 1.85; aOR 1.92, 95% CI 1.69 to 2.17, respectively) compared with OB-/MS- group but not in OB+/MS- participants (aOR 0.92, 95% CI 0.73 to 1.15). Prevalence increased with each MS component (aOR 1.27, 95% CI 1.22 to 1.32) but not with body mass index (aOR 1.01, 95% CI 0.99 to 1.02). In conclusion, prolonged QTc interval is associated with the MS and not independently associated with obesity.

Arterial stiffness is an important risk factor for cardiovascular (CV) events and is increasingly used in clinical practice. Radial augmentation index (AI) is used in assessing arterial stiffness, but is not only dependent on pulse wave velocity (PWV), but also on several other factors like the reflect distance of pulse wave and height. This paper improved radial AI in assessing arterial stiffness by d-value, the subtraction between radial AI and diastolic AI (dAI). Nineteen subjects aged 18 to 80 years (mean±SD, 46±27 years) were enrolled in this study. Carotid-femoral PWV (cf-PWV), radial AI and dAI of each subject were measured. The d-value (r=0.69, P

Background Dual antiplatelet therapy is recommended as a standard antiplatelet strategy in acute coronary syndrome. For those with reduced pharmacologic response to clopidogrel, strengthening antiplatelet therapy (clopidogrel 150mg daily) may reduce adverse clinical events. Ticagrelor is a direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and offset than clopidogrel. Methods In this retrospective study, we compared ticagrelor (180mg loading dose 90mg twice daily thereafter), clopidogrel (300mg loading dose, 75mg or 150mg daily thereafter) for the prevention of cardiovascular events in 273 high-risk patients admitted to coronary care unit with acute coronary syndrome. Results The rate of IST in hospital was significantly reduced in patients of ticagrelor group comparing with those receiving clopidogrel 75mg (0.69% vs 8.2%, p=0.009). Moreover, the TVR rate was less in the ticagrelor group than clopidogrel 75mg group (2.7% vs 13.1%, p=0.007) 6months follow-up. The incidence of MACCE has no difference between the two clopidogrel groups. Kaplan–Meier analysis of MACCE-free indicated that there was no difference between the three groups. Ticagrelor significantly increased the rate of minor bleeding compared with clopidogrel 75mg daily during hospital (45.5% vs 26.2%,p=0.012) and 6-month follow-up (66.9% vs 45.9%,p=0.004).Bleeding-free prognosis was significantly better in the clopidogrel 75mg daily group. Conclusions In patients with acute coronary syndrome undergoing PCI, the rate of in-stent thrombosis and TVR were significantly reduced treated with ticagrelor compared with clopidogrel 75mg daily, without an increase of overall major bleeding, but with an increase of minor bleeding.

We studied the relationship of blood pressure (BP) trajectories during the first seven days after symptom onset with short- and long-term major clinical outcomes among patients with acute ischemic stroke. A total of 4,036 patients with acute ischemic stroke and elevated systolic BP from the CATIS trial were included in this analysis. Three BPs were measured every 2 hours for the first 24 hours, every 4 hours during the second and third days, and every 8 hours thereafter for the remainder of the seven days. Latent class models were used to identify subgroups that share a similar underlying trajectory in BP in the acute phase. Five systolic BP trajectories of high, high-to-moderate low, moderate high, moderate low, and low were identified. Compared to the high trajectory, multiple-adjusted odds ratios (95% CI) of death and major disability at 3 months for high-to-moderate low, moderate high, moderate low, and low trajectories were 0.61 (0.44 to 0.86), 0.63 (0.48 to 0.84), 0.49 (0.37 to 0.65), and 0.42 (0.30 to 0.59), respectively (overall p

Little is known about stroke with different obesity phenotype as determined using the Adult Treatment Panel-III criteria with metabolic health or not. This study aimed to investigate the effects of metabolically healthy and unhealthy obesity on ischemic stroke in a general population. A total of 11,150 adults were examined using a multi-stage cluster sampling method to select a representative sample of individuals 35 years or older. Ischemic stroke was defined as history of a cerebrovascular event, as documented by doctors via either cranial CT or MR scan within the past 2 years. All subjects were categorized as having metabolically healthy non-obesity (MHNO), metabolically unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO) or metabolically unhealthy obesity (MUO) using the Adult Treatment Panel-III criteria. Stratified analysis were done based on different body mass index group. For the total population, multiple regression analyses revealed that individuals with MUNO and MUO were more likely to experience ischemic stroke compared with those with MHNO (OR 2.136, 95 % CI 1.677–2.720; OR 2.712, 95 % CI 1.798–4.092; all p

The present study aimed to evaluate the relationship between the hypertriglyceridemic waist (HTGW) phenotype and hyperuricemia. We undertook a cross-sectional study with a sample of 11,576 adults from China. The HTGW phenotype was defined as elevated waist circumference (WC) and elevated triglyceride (TG) concentration. Logistic regression analysis was used to evaluate the association between the HTGW phenotype and hyperuricemia. The prevalence of hyperuricemia was significantly higher in individuals with the HTGW phenotype, as compared to those with the normal waist normal triglyceride (NWNT) group (25.9 vs. 6.1%, respectively, P

Background The cause-and-effect relationship between human cytomegalovirus (HCMV) and stroke has not been widely elucidated. We aimed to determine if HCMV infection has an increased risk of future stroke in hypertensive patients in rural areas of China. Methods and results This was a nested case-control study from a prospective cohort study. A total of 300 newly diagnosed stroke cases with a median follow-up period of 8.4 years and 300 matched controls were selected for the present analysis. Adjusted odds ratio (OR) for stroke associated with HCMV DNA seropositivity was calculated by conditional logistic regression. HCMV DNA was detected in 38 of 300 samples from stroke patients and in 17 of 300 control samples (12.7% vs. 5.7%; P=0.023). Seropositivity for HCMV DNA increased the risk of incident stroke (unadjusted OR, 1.437; 95% confidence interval (CI), 1.023-2.020, P=0.037) and adjustment for other potential cardiovascular confounders only slightly changed the OR (1.464; 95% CI, 1.003-2.137, P=0.048). After controlling for potential cardiovascular confounders, the OR for hemorrhagic stroke associated with HCMV DNA was 1.718 (95% CI, 1.042-2.832), whereas the OR for ischemic stroke was 0.450 (95% CI, 0.142-1.428). Conclusions Seropositivity for HCMV DNA was positively associated with total and hemorrhagic but not ischemic stroke, which persisted after controlling for other cardiovascular factors. (Circ J 2016; 80: 2235-2239).

This study aimed to comprehensively compare the general characteristics, lifestyles, serum parameters, ultrasonic cardiogram (UCG) parameters, depression, quality of life, and various comorbidities between empty nest and non-empty nest elderly among rural populations in northeast China. This analysis was based on our previous study which was conducted from January 2012 to August 2013, using a multistage, stratified, random cluster sampling scheme. The final analyzed sample consisted of 3208 participants aged no less than 60 years, which was further classified into three groups: non-empty nest group, empty nest group (living as a couple), and empty nest group (living alone). More than half of the participants were empty nest elderly (60.5%). There were no significant statistical differences for serum parameters, UCG parameters, lifestyles, dietary pattern, and scores of Patient Health Questionnaire-9 (PHQ-9) and World Health Organization Quality of Life questionnaire, abbreviated version (WHOQOL-BREF) among the three groups. Empty nest elderly showed no more risk for comorbidities such as general obesity, abdominal obesity, hyperuricemia, hyperhomocysteinemia, diabetes, dyslipidemia, left atrial enlargement (LAE), and stroke. Our study indicated that empty nest elderly showed no more risk for depression, low quality of life and comorbidities such as general obesity, abdominal obesity, hyperuricemia, hyperhomocysteinemia, diabetes, dyslipidemia, LAE, and stroke among rural populations in northeast China.

Background: Both the serum uric acid (SUA) level and elevated alanine aminotransferase (ALT) are related to metabolic syndrome. However, the association between SUA and elevated ALT has not been elucidated in the general population. The objective of this study was to investigate the association between SUA and elevated ALT in the general population of China; Methods: A total of 11,572 adults (≥35 years of age) participated in this survey. Elevated ALT was defined as >40 U/L. SUA ≥ 7.0 mg/dL in males or ≥6.0 mg/dL in females was defined as hyperuricemia. SUA within the reference range was divided into quartiles, and its associations with elevated ALT were evaluated by logistic regressions; Results: A total of 7.4% participants had elevated ALT. The prevalence of hyperuricemia was 14.9% in males and 7.3% in females. There was a significantly positive dose-response association between SUA levels and the prevalence of elevated ALT. After adjusting for potential confounders, a positive relationship for elevated ALT was observed in subjects with hyperuricemia (odds ratio [OR]: 2.032, 95% confidence interval [CI]: 1.443–2.861 for men; OR: 2.045, 95% CI: 1.221–3.425 for women, both p < 0.05). Within the reference range, the association between SUA and elevated ALT persisted in the fourth quartile (OR: 1.467, 95% CI: 1.063–2.025 for men; OR: 1.721, 95% CI: 1.146–2.585 for women, both p < 0.05); Conclusions: Our results indicated that an increased SUA level, even within the reference range, was independently associated with elevated ALT in Chinese adults.

Background: Heart failure with preserved ejection fraction (HFpEF) has attracted increasing attention worldwide. We aimed to estimate the prevalence of HFpEF and analyze its correlates in a sample of residents of northeast China; Methods: A population-based study of 2230 participants ≥35 years old was conducted in rural areas of Liaoning Province from January 2012 through August 2013. Information about lifestyle and other potential risk factors was obtained. HFpEF was diagnosed according to the recommendations of European Society of Cardiology; Results: The overall prevalence of HFpEF was 3.5% (1.8% in men and 4.9% in women). The prevalence of HFpEF increased with age in both genders and was greater in women than in men for every age group. Multivariable logistic regression analysis found that female gender (OR, 3.575; 95% CI, 1.761–7.256), hypertension (OR, 3.711; 95% CI, 2.064–6.674), and history of heart disease (2.086; 95% CI, 1.243–3.498) were associated factors for prevalent HFpEF; Conclusions: In a general population from rural northeast China, we found that female gender, hypertension, and history of heart disease were risk factors for prevalent HFpEF.

Objectives The brief version of the World Health Organization's Quality of Life Instrument (WHOQOL-BREF) is widely used for evaluating the personal subjective quality of life (QOL) of patients and particular populations. However, in the absence of sufficient studies among the general population, normative data for WHOQOL-BREF remain scarce. To fill this gap, the present study explored more sociodemographic and health-related factors affecting the QOL. Study design In total, 11,351 participants aged ≥35 years in rural areas of Liaoning Province were screened with a stratified cluster multistage sampling scheme in 2012–2013. Anthropometric measurements, laboratory examinations, and self-reported information on disease history were collected by trained personnel. Depression symptoms were assessed using the Patient Health Questionnaire-9. Methods Stepwise multiple linear regression was used to explore the association between multiple factors and QOL. Results Females and single/widowed subjects had lower QOL scores than males and married/cohabiting subjects, respectively. Total QOL scores and scores for each domain decreased as age increased, but a positive correlation was found between age and the environmental domain score. Participants with higher annual incomes, education levels, and activity levels had higher QOL scores. In the regression model, the coefficient for stroke was −2.17 (95% confidence interval [CI] −2.64, −1.71) for the total QOL score. For a one-level increase in depression level, the total QOL score decreased by 5.62 (95% CI −5.83 to −5.42), physical domain score decreased by 1.63 (95% CI −1.69 to −1.58), and psychological domain score decreased by 1.81 (95% CI −1.87 to −1.75). Conclusions Socio-economic status including marital status is highly related to QOL. Regarding chronic diseases, stroke is an important factor of QOL and depressive symptoms have a strong negative relationship with QOL.