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Since 2010, China has made vast financial investments and policy changes to the primary care system. We aimed to assess how hypertension awareness, treatment, and control might be used to assess quality of primary care systems, which reflect the outcomes of public health services and medical care.We used The China Patient-centred Evaluative Assessment of Cardiac Events Million Persons Project, a government-funded public health project that focuses on cardiovascular disease risk in China. We linked primary care institution characteristics that were captured in the survey between 2016 and 2017 to the participant-level data gathered in baseline visits between 2014 and 2021. Participants were included if they had hypertension and lived in the towns or streets that took part in the primary care survey. Participants were excluded if they had missing data for blood pressure measurement, history of hypertension, sex, or age. Primary care institutions were excluded if the catchment area had fewer than 100 participants with hypertension. Hypertension awareness was defined as the proportion of participants with hypertension who self-reported a hypertension diagnosis. Hypertension treatment was defined as the proportion of participants who currently use antihypertensive medications among those who were aware. Hypertension control was defined as the proportion of participants with an average systolic blood pressure less than 140 mm Hg and an average diastolic blood pressure less than 90 mm Hg over two readings among those who were treated during the study. All patients were included in the analysis. This trial was registered at ClinicalTrials.gov, NCT02536456.Between Sept 15, 2014, and March 16, 2021, we assessed 503 township-level primary care institutions for eligibility. 70 institutions were excluded as they could not be linked with individual data or because their catchment area had fewer than 100 participants with hypertension. We analysed 433 township-level primary care institutions across all 31 provinces of mainland China, including 660 565 individuals with hypertension in their catchment areas. Across townships, age-sex standardised hypertension awareness varied from 8·2% to 81·0%, treatment varied from 2·6% to 96·5%, and control proportions varied from 0% to 62·4%. Hypertension awareness, treatment, and control were significantly associated with the following institutional characteristics: government funding through balance allocation (ie, institutions have their human resources funded by local government, but need to be self-supporting in other aspects; awareness odds ratio 0·88, 95% CI 0·78-0·99; p=0·027), having financial problems that interrupted routine service delivery (awareness 0·81, 0·72-0·92; p=0·0007, control 0·84; 0·75-0·94, p=0·0034), setting performance-based bonus (treatment 1·39, 1·07-1·80; p=0·013), basic salary defined by number of patient visits (control 0·85, 0·76-0·95; p=0·0053), using electronic referrals (treatment 1·41, 1·14-1·73; p=0·0012, control 1·17; 1·03-1·33, p=0·014), implementing family physician contract services (awareness 1·13, 1·00-1·28; p=0·045, control 1·30; 1·15-1·46, p0·0001), and proportion of physicians who are formally licensed (awareness per 10% increase 1·04, 1·01-1·08; p=0·019, treatment 1·08; 1·02-1·14, p=0·0077; control per 10% increase 1·07, 1·03-1·10; p=0·0006).The role of primary care role in hypertension management might benefit from new strategies that promote best practices in institutional financing, performance appraisal, service delivery, and information technology.Chinese Academy of Medical Sciences Innovation Fund for Medical Science, and the National High Level Hospital Clinical Research Funding.For the Chinese translation of the abstract see Supplementary Materials section.

China has been undergoing a rapid urbanisation. There are substantial disparities between old and new urban citizens in access to health care. We aimed to compare cardiovascular disease prevention and death risks among four distinct urban groups.Urban residents aged 35-75 years living in 96 prefecture-level cities from 31 provinces in mainland China were enrolled in the national population-based cohort China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project. They were categorised into four groups by their former and current places of residence as follows: old-urban in situ residents (local residents in established urban areas since birth), new-urban in situ residents (local residents in newly urbanised areas established during urbanisation), urban-to-urban migrants (migrants from other urban areas), and rural-to-urban migrants (migrants from rural areas). We excluded participants with missing data for former and current places of residence, medical history, socioeconomic status, or lifestyle information. After adjusting for demographic and socioeconomic characteristics, relative risks (RRs) of cardiovascular disease prevention indicators and hazard ratios (HRs) of cardiovascular mortality and all-cause mortality of the other three population groups were estimated by modified log-Poisson models with robust standard error and Cox proportional hazard models, with old-urban in situ residents as the reference group.From Sept 1, 2015, to Aug 17, 2020, 1 339 329 residents were enrolled, 270 606 were excluded for missing data in key variables, and 1 068 723 were subsequnetly included in the study. Compared with old-urban in situ residents, new-urban in situ residents were less likely to adhere to a healthy diet (RR 0·72 [95% CI 0·62-0·83]), while no significant results were observed in rural-to-urban migrants; new-urban in situ residents were less likely to use statins as primary prevention (RR 0·60 [0·46-0·79]), angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs; RR 0·78 [0·65-0·93]) and β-blockers (RR 0·68 [0·53-0·88]) as secondary prevention; and rural-to-urban migrants were less likely to use aspirin as a primary (RR 0·67 [0·46-0·96]) and secondary (RR 0·71 [0·54-0·94]) prevention and statins (RR 0·70 [0·51-0·97]) and ACEIs or ARBs (RR 0·68 [0·50-0·93]) as secondary prevention. Furthermore, in people diagnosed with hypertension, new-urban in situ residents were less likely to have their blood pressure controlled (RR 0·79 [95% CI 0·72-0·87]), while no significant results were observed in rural-to-urban migrants. New-urban in situ residents had higher risk of cardiovascular mortality (HR 1·16 [95% CI 1·05-1·29]; p=0·005) than did old-urban in situ residents, after a median follow-up of 2·7 years (IQR 2·0-4·2).New-urban in situ residents and rural-to-urban migrants both showed poorer utilisation of primary and secondary prevention medications than did old-urban in situ residents, while new-urban in situ residents also had lower adherence to healthy lifestyles and higher death risks. Comprehensive measures should be taken to strengthen the primary health-care system in newly urbanised areas, and promote interprovincial medical insurance reimbursement.Chinese Academy of Medical Sciences Innovation Fund for Medical Science and the National High Level Hospital Clinical Research Funding.For the Chinese translation of the abstract see Supplementary Materials section.

Long-term weight loss (LTWL) has been shown to be associated with lower metabolic risk in young adults with overweight/obesity. However, the dose-response association is uncertain.In a large-scale nationwide screening project in China, the participants aged 35 to 64 years who recalled overweight/obesity at age 25 years and experienced LTWL or maintained stable weight were included. The dose-response association between LTWL from age 25 to screening (35 to 64 years) and the odds of metabolic syndrome at screening were assessed using multivariable adjusted regression models with restricted cubic splines.A total of 40,150 participants (66.4% women) were included. The increment of LTWL was associated with continuously decreased odds of metabolic syndrome. The odds of metabolic syndrome were 0.64 (0.60 to 0.67), 0.42 (0.40 to 0.45), 0.27 (0.25 to 0.29), and 0.15 (0.13 to 0.17) for those with LTWL of 5% to 9.9%, 10% to 14.9%, 15% to 19.9%, and 20% or greater compared with5% LTWL, respectively. Moreover, the incremental pattern was observed across all population subgroups.An incremental association between LTWL from young adulthood and odds of later-life metabolic syndrome was observed. Our findings highlight the effective ways to achieve LTWL to improve lifetime metabolic health for young adults with overweight/obesity.

The fluorescent molecule N,N-bis(3',5'–bis(trifluoromethyl)-[1,1'–biphenyl]-4–yl)perylen-3-amine (TFPA) was designed and synthesized by introducing the strong electron-withdrawing trifluoromethyl group and the strong electron-donating diphenylamino group, with perylene as the core. The structure of the target product was identified by nuclear magnetic resonance, and its UV–vis absorption properties, fluorescence emission properties, quantum yield and lifetime were studied systematically. The results showed that the HOMO of TFPA was mainly localized in the perylene part with a small part localized in the triphenylamine structure. The LUMO was almost localized in the perylene part. Therefore, the ground-state absorption of TFPA is mainly attributed to the π–π* transition accompanied by with little the slight intramolecular charge transfer effect. The maximum emission peak (534 nm) of TFPA in the solid state was 18 nm redshifted compared to that of TFPA in solution (516 nm). TG results show that TFPA still does not decompose at 300 ℃, indicating good thermal stability. In addition, a yellow-light-emitting diode device based on the fluorescent molecule TFPA was constructed (CIE coordinates: 0.45, 0.54). The LED device showed good color purity (color purity: 97.8%). The results showed that TFPA was a luminescent material with excellent thermal stability and high color purity and had potential for use in fabricating yellow LEDs.

Transition metal complexes (TMCs) with strong and long-lived excited state absorption (ESA) usually exhibit high-performance optical power limiting (OPL) response. Several techniques, such as transmission vs. incident fluence curves and Z-scan have been widely used to assess the OPL performance of typical TMCs. The OPL performance of TMCs is highly molecular structure-dependent. Special emphasis is placed on the structure-OPL response relationships of Pt(II), Ir(III), Ru(II), and other metal complexes. This review concludes with perspectives on the current status of OPL field, as well as opportunities that lie just beyond its frontier.

Subtle ligand modifications on RuII -polypyridyl complexes may result in different excited-state characteristics, which provides the opportunity to tune their photo-physicochemical properties and subsequently change their biological functions. Here, a DNA-targeting RuII -polypyridyl complex (named Ru1) with highly photosensitizing 3 IL (intraligand) excited state was designed based on a classical DNA-intercalator [Ru(bpy)2 (dppz)]⋅2 PF6 by incorporation of the dppz (dipyrido[3,2-a:2',3'-c]phenazine) ligand tethered with a pyrenyl group, which has four orders of magnitude higher potency than the model complex [Ru(bpy)2 (dppz)]⋅2 PF6 upon light irradiation. This study provides a facile strategy for the design of organelle-targeting RuII -polypyridyl complexes with dramatically improved photobiological activity.

ObjectiveWe aimed to estimate the current use of secondary prevention drugs and identify its associated individual characteristics among those with established cardiovascular diseases (CVDs) in the communities of China.MethodsWe studied 2 613 035 participants aged 35–75 years from 8577 communities in 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, a government-funded public health programme conducted from 2014 to 2018. Participants self-reported their history of ischaemic heart disease (IHD) or ischaemic stroke (IS) and medication use in an interview. Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of individual characteristics with the reported use of secondary prevention therapies.ResultsAmong 2 613 035 participants, 2.9% (74 830) reported a history of IHD and/or IS, among whom the reported use rate either antiplatelet drugs or statins was 34.2% (31.5% antiplatelet drugs, 11.0% statins and 8.3% both). Among the 1 530 408 population subgroups, which were defined by all possible permutations of 16 individual characteristics, reported use of secondary prevention drugs varied substantially (8.4%–60.6%). In the multivariable analysis, younger people, women, current smokers, current drinkers, people without hypertension or diabetes and those with established CVD for more than 2 years were less likely to report taking antiplatelet drugs or statins.ConclusionsThe current use of secondary prevention drugs in China is suboptimal and varies substantially across population subgroups. Our study identifies target populations for scalable, tailored interventions to improve secondary prevention of CVD.

ObjectivesWe aimed to assess the dose–response association between weight gain from young to middle adulthood and odds of metabolic syndrome, across body mass index (BMI) categories at young adulthood.MethodsBased on a national population-based screening project, middle-aged (35–64 years) participants who recalled weight at age 25 years and received standardized measurements were included. Multivariable adjusted restricted cubic splines and logistic regression models were applied.ResultsIn total, 437,849 participants were included (62.1% women, 52.0 ± 7.6 years). Larger weight gains from young to middle adulthood were associated with higher odds of metabolic syndrome at middle adulthood, with odds of 2.01 (1.98–2.05), 1.93 (1.92–1.94), and 1.67 (1.64–1.7) per 5-kg weight gain across participants who were underweight, normal-weight, and overweight/obese at young adulthood, respectively. After further adjusting for current BMI, larger weight gains still correlated with higher odds of metabolic syndrome among underweight and normal-weight participants, while an inverted U-shaped association was observed in overweight/obese participants.ConclusionsWeight maintenance from young to middle adulthood could be effective to mitigate metabolic syndrome burden, especially among underweight and normal-weight people. Historical weight gain confers varied information about metabolic syndrome risk independent of attained BMI across BMI categories at young adulthood.

A family of novel bis-tridentate Ir(III) complexes (Ir1-Ir5) incorporating both functional N∧C∧N-type ligands (L1-L5) and N∧N∧C-type ligand (L0) were synthesized attentively and characterized scientifically. The crystalline structures of Ir1, Ir3 and Ir4 were resoundingly confirmed by XRD. With the aid of experimental and theoretical methods, their photophysical properties at transient and steady states were scientifically investigated. The broadband charge-transfer absorption for these aforementioned Ir(III) complexes is up to 600 nm as shown in the UV-visible absorption spectrum. The emission lifetimes of their excited states are good. Between the visible and near-infrared regions, Ir1-Ir5 possessed powerful excited-state absorption. Hence, a remarkably robust reverse saturable absorption (RSA) process can occur once the complexes are irradiated by a 532 nm laser. The RSA effect follows the descending order: Ir3 > Ir5 > Ir4 ≈ Ir1 > Ir2. To sum up, modifying electron-donating units (-OCH3) and large π-conjugated units to the pyridyl N∧C∧N-type ligands is a systematic way to markedly raise the RSA effect. Therefore, these octahedral bis-tridentate Ir(III) complexes are potentially state-of-the-art optical limiting (OPL) materials.

With the development of E-bank, the use of credit cards gets an unprecedented improvement as well as the problem of credit card fraud. To overcome this problem, we need automatic systems to finish the fraud detection. The number of monitored account data is so large that our human resources are unable to detect the whole dataset. Also, since the number of fraudulent transactions is (fortunately) much smaller than the legitimate ones, the data distribution is unbalanced, skewed towards non-fraudulent observations. To solve the problem of unbalanced dataset, there exist many learning algorithms which are used to underperform this kind of problem; to improve the accuracy or predicting, there exist many methods like over or under sampling.

Supplemental Digital Content is available in the text., Background: China has seen a burgeoning epidemic of obesity in recent decades, but few studies reported nationally on obesity across socio-demographic subgroups. We sought to assess the prevalence and socio-demographic associations of obesity nationwide. Methods: We assessed the prevalence of overall obesity (body mass index ≥28 kg/m2) and abdominal obesity (waist circumference ≥85/90 cm for women/men) among 2.7 million community-dwelling adults aged 35 to 75 years in the China PEACE Million Persons Project from 2014 to 2018 and quantified the socio-demographic associations of obesity using multivariable mixed models. Results: Age-standardized rates of overall and abdominal obesity were 14.4% (95% CI, 14.3%–14.4%) and 32.7% (32.6%–32.8%) in women and 16.0% (15.9%–16.1%) and 36.6% (36.5%–36.8%) in men. Obesity varied considerably across socio-demographic subgroups. Older women were at higher risk for obesity (eg, adjusted relative risk [95% CI] of women aged 65–75 versus 35–44 years: 1.29 [1.27–1.31] for overall obesity, 1.76 [1.74–1.77] for abdominal obesity) while older men were not. Higher education was associated with lower risk in women (eg, adjusted relative risk [95% CI] of those with college or university education versus below primary school: 0.47 [0.46–0.48] for overall obesity, 0.61 [0.60–0.62] for abdominal obesity) but higher risk in men (1.07 [1.05–1.10], 1.17 [1.16–1.19]). Conclusions: In China, over 1 in 7 individuals meet criteria for overall obesity, and 1 in 3 for abdominal obesity. Wide variation exists across socio-demographic subgroups. The associations of age and education with obesity are significant and differ by sex. Understanding obesity in contemporary China has broad domestic policy implications and provides a valuable international reference.

Objective To examine the association of kidney stones with new-onset hypertension, diabetes and obesity. Participants and methods This prospective cohort study included participants in the Qingdao Port Cardiovascular Health Study who were aged ≥18 years and had abdominal ultrasonography results in 2013 that were negative for kidney stones. Multivariable Cox regression models with time-dependent covariates were used to estimate the effects of new-onset hypertension, diabetes and obesity on the incidence of kidney stones. Results There were 9667 participants without kidney stones in 2013 (mean age 46.2 years; 75.6% men). During a mean (range) follow-up of 33.5 (6-42) months, 676 (7.0%) incident cases of kidney stones were identified. Kidney stones were more frequent among those who had new-onset of a metabolic factor vs those who did not (hypertension: 7.7 vs 6.0%; diabetes: 8.4 vs 6.6%; obesity: 7.4 vs 6.8%). Adjusted Cox models identified that increased risk of kidney stones was associated with new-onset hypertension (adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.25-2.27), new-onset diabetes (HR 1.78, 95% CI 1.07-2.96), and new-onset obesity (HR 1.78, 95% CI 1.15-2.74). Conclusions New-onset of hypertension, diabetes and obesity were all strongly associated with an increased risk of kidney stones in this prospective cohort study. Results suggest that a substantial proportion of kidney stones are potentially preventable by appropriate control of these metabolic risk factors.

Four D-π-A or D-π-D phenothiazine compounds bearing different substituents on central π-bridge (R = -H (PTZ-1), -Br (PTZ-2), -CN (PTZ-3) and -OC12H25 (PTZ-4)) were synthesized and characterized. The influence of the substituents on the photophysics of these compounds is systematically investigated by spectroscopic methods and simulated by density functional theory (DFT) calculations. All compounds exhibit intense absorption bands in UV and visible region, which are influenced by the different substituents on the central π-bridge. Both electron-withdrawing and electron-donating substituents cause bathochromic shifts of the low energy 1π-π*/1ICT (intramolecular charge transfer) absorption bands. Meanwhile, all compounds are emissive in solution at room temperature (λem = 400–800 nm, Φem = 0.01–0.74). Their fluorescent quantum yields decrease when the electron-withdrawing substituents attached on the central π-bridge, but increase when electron-donating substituents were introduced. In addition, PTZ-1–PTZ-4 all exhibit strong triplet transient absorption (TA) in visible region. When the electron-donating substituents attached, the triplet excited-state molar extinction coefficient (190200 L mol−1 cm−1) and triplet excited-state lifetime (53.2 μs) of PTZ-4 were significantly enhanced. Their luminescent and excited state absorption properties could provide us a basis for elucidating the structure-property correlations of phenothiazine compounds and developing novel optical functional materials.

Familial hypercholesterolemia (FH) is a genetic disorder with a high burden of arteriosclerotic cardiovascular disease. The prevalence of heterozygous FH is currently 0.2%-0.5% in Europe, while no such data has yet been published about the general population in China. We aimed to investigate the prevalence and characteristics of FH in a Chinese population aged 35-75 years.We used a nationwide general population from 31 provinces in mainland China (n = 1,059,936, age 35-75) based on the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project). The diagnosis of FH was based on 2 (untreated LDL-C ≥4.7 mmol/L and first-degree relatives with premature ASCVD history) of the 3 diagnostic criteria from the Chinese expert consensus on diagnosis of FH (CEFH criteria). FH prevalence was estimated and clinical phenotypic characteristics were further analyzed.The overall FH prevalence was 0.13% (95% confidence interval [CI], 0.12-0.14) by the CEFH criteria, and age and sex standardized FH prevalence was slightly lower (0.11%; 95%CI, 0.10-0.12). FH prevalence in female was twice as high as in male (0.16% vs. 0.08%, p 0.001). Across different age groups, the prevalence also varied and peaked among 55-to 64-year-olds. Regarding geographical areas, the prevalence ranged from 0.19% in Eastern, to 0.11% in Central, and 0.08% in Western China (p 0.001). Participants living in rural areas had a lower prevalence than urban participants (0.10% vs. 0.18%, p 0.001). The rate of coronary artery disease in FH patients was 5 folds higher than in the general population (10.5% vs. 2.1%, p 0.001). The rate of FH patients receiving lipid-lowering medications was 18.1%. None of the treated patients achieved guideline recommended LDL-C targets.The prevalence of FH in the Chinese population aged 35-75 years was 0.13% (about 1 in 769) defined by 2 of the CEFH criteria, and the patients were seriously undertreated and under-controlled. The screened FH prevalence varied by age, sex, geographical distributions, and urban/rural areas.

Background: China is undergoing the largest urbanization in history. The new urban population in rapid expanding cities were usually at a disadvantaged position in avoiding disease risk and accessing health care. Methods: During 2015-2020, urban population aged 35-75 years living in 96 cities in 31 provinces in mainland China were enrolled in a national population-based epidemiological project China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project). They were divided into four groups by their former and current place of residence as follows: old-urban in-situ residents, new-urban in-situ residents, urban-to-urban migrants, and rural-to-urban migrants. We assessed twelve indicators related to their vulnerability to cardiovascular disease (CVD) on adherence to healthy lifestyles, use of primary and secondary prevention of CVD, and outcomes of blood pressure risk management. Findings: Among 1 068 723 included participants, 48·3% were old-urban in-situ residents, 34·4% were new-urban in-situ residents, 11·9% were urban-to-urban migrants, and 5·4% were rural-to-urban migrants. In the four groups of urban population, after standardized by age and sex, new-urban in-situ residents had the lowest adherence to non-smoking (73·1% [95% CI 72·8-73·3]), none or moderate alcohol use (94·5% [94·4-94·6]), sufficient leisure-time activity (18·9% [18·7-19·1]), and healthy diet (10·2% [10·0-10·4]). New-urban in-situ residents and rural-to-urban migrants had the lowest use of statin in primary prevention of CVD (0·9% [0·8-1·0] and 1·2% [0·9-1·6], respectively). Rural-to-urban migrants had the lowest use of aspirin in secondary prevention of CVD (12·2% [10·3-14·3]). New-urban in-situ residents had the lowest rate of awareness of high blood pressure (44·8% [44·6-45·1]) and lowest rate of control of blood pressure among people diagnosed as hypertension (21·9% [21·6-22·3]). Odds ratios of the population type after adjusting potential confounding factors in the multivariable logistic model showed similar results. Interpretation: New-urban in-situ residents and rural-to-urban migrants were the most vulnerable groups of urban population to CVD. Focused intervention is urgently in need. Funding Statement: This project was supported by the National Key Research and Development Program (2017YFC1310801, 2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-2-002); the Ministry of Finance of China and National Health Commission of China; the 111 Project from the Ministry of Education of China (B16005). Declaration of Interests: The authors declared no relevant conflict of interest. Ethics Approval Statement: The project protocol was approved by the central ethics committee at the National Center for Cardiovascular Disease (NCCD), Beijing, China. Written informed consent was obtained from all enrolled participants.

LiDAR sensing is a newly developed 3D acquisition technology which is widely applied in auto-driving area. Different from the human perception point cloud, the generated 3D data is machine perception point clouds which are designed for specific vision tasks in realistic life, such as point cloud detection, segmentation and recognition. Therefore, instead of traditional subjective quality estimation, the quality assessment of machine perception point cloud is a new challenge. In this paper, we propose a machine perception point cloud quality assessment via various vision tasks, evaluating the point cloud quality based on the performance in vision tasks of different level of distorted point cloud. Firstly, we utilize the state-of-the-art point cloud compression algorithm to obtain the distorted point cloud. Then, we explore the potentials of distorted point clouds in detection and segmentation precision, comparing the results in different testing conditions. Finally, we propose the machine perception ROI based point cloud compression framework achieves notable performance on vision tasks result while do insignificant influence on PSNR.The experimental results illustrate the correspondence between point cloud quality and the performance in vision tasks, verifying the effectiveness of the proposed method.

Key Points Question What are the characteristics of young and middle-aged adults with isolated systolic hypertension in China, and what is the prevalence and awareness of isolated systolic hypertension among this population? Findings In this cross-sectional study of young and middle-aged adults in China, isolated systolic hypertension was identified in 27% of participants with hypertension, 87% of whom had not received treatment; less than 7% of individuals with untreated isolated systolic hypertension were aware of having hypertension. Among individuals with isolated systolic hypertension, 16% had systolic blood pressure of 160 mm Hg or higher, but awareness rates remained low even in this group. Meaning In this study, a substantial proportion of young and middle-aged adults with hypertension had isolated systolic hypertension; there is an opportunity to improve awareness of isolated systolic hypertension among this population., Importance Isolated systolic hypertension (ISH) is increasing in prevalence among young and middle-aged adults. However, most studies of ISH are limited to older individuals, and a substantial knowledge gap exists regarding younger adults with ISH. Objective To assess the prevalence, awareness, and characteristics of ISH among younger and middle-aged adults in China. Design, Setting, and Participants This cross-sectional study was performed as part of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, which enrolled 3.1 million community residents aged 35 to 75 years from all of the 31 provinces in China between December 15, 2014, and May 15, 2019. The present analysis included only participants younger than 50 years. Data were analyzed from May to November 2019. Main Outcomes and Measures Prevalence and awareness of ISH (defined as systolic blood pressure of 140 mm Hg or higher and diastolic blood pressure of less than 90 mm Hg) and individual characteristics of participants with ISH. Results Among 898 929 participants aged 35 to 49 years, the mean (SD) age was 43.8 (3.9) years; 548 657 participants (61.0%) were women, and 235 138 participants (26.2%) had hypertension. Of those with hypertension, 62 819 participants (26.7%; 95% CI, 26.5%-26.9%) had ISH (mean [SD] age, 45.0 [3.5] years; 41 417 women [65.9%]), and 54 463 of those with ISH (86.7%; 95% CI, 86.4%-87.0%) had not received treatment. The prevalence of ISH was higher among individuals who were older, were female, were farmers, resided in the eastern region of China, and had an educational level of primary school or lower. Women and older individuals were more likely to have ISH than to be normotensive or to have other hypertension subtypes. Participants who were obese, currently used alcohol, had diabetes, and experienced previous cardiovascular events were more likely to have other types of hypertension and less likely to have normotension than to have ISH. Among the 54 463 participants with ISH who had not received treatment, only 3682 individuals (6.8%; 95% CI, 6.6%-7.0%) were aware of having hypertension, and awareness rates remained low even among those with systolic blood pressure of 160 mm Hg or higher (7135 individuals [13.1%; 95% CI, 12.4%-13.9%]). Conclusions and Relevance In this study, ISH was identified in 1 of 4 young and middle-aged adults with hypertension in China, most of whom remained unaware of having hypertension. These results highlight the increasing need for better guidance regarding the management of ISH in this population., This cross-sectional study includes younger and middle-aged adult participants from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project to assess the prevalence, awareness, and individual characteristics of isolated systolic hypertension (ISH) among this population.

Introduction: Healthy lifestyles are effective means to reduce premature deaths. However, comprehensive knowledge about adherence to multiple healthy lifestyles in Chinese adults is still lacking. Methods: We interviewed 938,545 adults aged 35-75 years from 248 counties/districts of China in a national population-based epidemiological project, the China PEACE-MPP. We defined four healthy lifestyles as non-smoking, none or moderate alcohol use, sufficient leisure-time physical activity (LTPA), and healthy diet. We established multi-level logistic regression models to explore the factors associated with the adherence. Multivariable Cox proportional hazard models were fitted to assess the impact of adherence to healthy lifestyles on all-cause and cardiovascular mortality. Results: Among the participants, 78.6% were non-smokers, 98.0% had none or moderate alcohol use, 25.7% had sufficient LTPA, 19.7% had healthy diet, and only 5.8% adhered to all four heathy lifestyles. The overall adherence varied substantially across seven regions (P Conclusions: The adherence to healthy lifestyles in Chinese adults was far from ideal. Targeted health promotion strategies were urgently in need.

Background With demographic and epidemiologic transitions, China has become home to the greatest number of obese individuals in the world. Effective policy intervention requires a contemporary assessment of obesity across broad socio-demographic subgroups. Purpose We aim to assess the prevalence of overall and abdominal obesity by socio-demographic characteristics and the associations of these characteristics with obesity in China. Methods Using the data of 2.7-million community-dwelling participants aged 35–75 years in the China PEACE Million Persons Project, a nationwide cross-sectional screening project from 2014 to 2018, we calculated the prevalence of overall and abdominal obesity based on national guideline definitions (body mass index ≥28 kg/m2, waist circumference ≥85/90 cm for women/men). We examined 12 available socio-demographic variables that are potentially associated with obesity, in addition to self-reported co-morbidities, and quantified the associations of these socio-demographic characteristics with obesity using multivariable mixed models. Results The prevalence of overall and abdominal obesity were 15.8% and 37.6% in women and 15.0% and 36.3% in men (Figure). Compared to individuals with normal weight, those with overall obesity had a higher prevalence of hypertension, dyslipidemia, and diabetes (in women: by 30.4, 16.1, and 6.0 percent points; in men, by 29.9, 31.2, and 5.8 percent points). A similar pattern was observed with abdominal obesity. In women, those aged 55–64 years constituted the largest age group with overall and abdominal obesity (33.7% and 35.0%), while in men, those aged 45–54 and 55–64 years constituted the largest age group with overall obesity (30.4%) and abdominal obesity (30.5%), respectively. Older women were at substantially higher risk for obesity (e.g., adjusted relative risk [95% CI] of women aged 65–75 vs. 35–44 years: 1.29 [1.27–1.31] for overall obesity and 1.76 [1.74–1.77] for abdominal obesity) while older men were not. Higher education was associated with lower risk in women (e.g., those with college or university education vs. less than primary school: 0.47 [0.46–0.48] for overall obesity and 0.61 [0.60–0.62] for abdominal obesity) but higher risk in men (1.07 [1.05–1.10] and 1.17 [1.16–1.19]). In both women and men, current smoking was associated with lower risk for obesity, and current drinking was associated with higher risk, but the magnitude of associations was smaller in women than men. Conclusions In China, over one in seven individuals meet criteria for overall obesity, and one in three for abdominal obesity. Wide variation exists across socio-demographic subgroups. The associations of age and education with obesity are significant and differ by sex. Understanding obesity in contemporary China has broad domestic policy implications and provides a valuable international reference. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China, the CAMS Innovation Fund for Medical Science

International audience; Full text linksfull-text provider logoActionsFavoritesSharePage navigation Title & authors Abstract Similar articles Publication types MeSH terms Substances Related information LinkOut - more resourcesComparative StudyAm Heart J. 2020 Sep;227:19-30.doi: 10.1016/j.ahj.2020.06.005. Epub 2020 Jun 20.Rationale and design of the RIGHT trial: A multicenter, randomized, double-blind, placebo-controlled trial of anticoagulation prolongation versus no anticoagulation after primary percutaneous coronary intervention for ST-segment elevation myocardial infarctionYan Yan 1 , Xiao Wang 2 , Jincheng Guo 3 , Yongjun Li 4 , Hui Ai 5 , Wei Gong 6 , Bin Que 7 , Lei Zhen 8 , Jiapeng Lu 9 , Changsheng Ma 10 , Gilles Montalescot 11 , Shaoping Nie 12Affiliations PMID: 32663660 DOI: 10.1016/j.ahj.2020.06.005 AbstractBackground: Current guidelines recommend anticoagulation therapy during primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). However, whether anticoagulation should be continued after pPCI has not been well investigated.Methods/design: The RIGHT trial is a prospective, multicenter, randomized, double-blind, placebo-controlled trial in STEMI patients treated with pPCI evaluating the prolongation of anticoagulation after the procedure. Patients are randomized in a 1:1 fashion to receive either prolonged anticoagulant or matching placebo (no anticoagulation) for at least 48 hours after the procedure. When randomized to anticoagulation prolongation, the patient is assigned to intravenous unfractionated heparin (UFH) or subcutaneous enoxaparin or intravenous bivalirudin (same drug and same regimen at each center). The primary efficacy endpoint is the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, stent thrombosis (definite) or urgent revascularization (any vessel) at 30 days. The primary safety endpoint is major bleeding (BARC 3-5) at 30 days. Based on a superiority design and assuming a 35% relative risk reduction (from 7% to 4.5%), 2856 patients will be enrolled, accounting for a 5% drop-out rate (α = 0.05 and power = 80%).Conclusion: The RIGHT trial tests the hypothesis that post-procedural anticoagulation is superior to no anticoagulation in reducing ischemic events in STEMI patients undergoing pPCI.