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Cigarettes will most likely kill half of China's 300 million smokers, according to a 20-year study of factory workers in Xi'an. A survey of 1,124 men and 572 women found that smokers had a significantly higher death rate from cancer, cardiovascular disease and lung disease. Among smokers, the death rate was 2.42 times higher in men and 2.32 times higher in women compared to those who never smoked. Strong measures are required to control this growing threat to public health., Context.--The few published prospective studies of smoking and mortality in China have reported low relative risks, but the durations of follow-up were short. Objective.--To assess the mortality of ever- and never-smokers in a cohort after 20 years of follow-up. Design, Setting, and Subjects.--A cohort analytic study in a machinery factory in Xi'an, China, involving 1696 people aged 35 years or older (1124 men and 572 women) examined in May 1976. Main Outcome Measures.--All-cause and tobacco-associated mortality. Results.--A total of 56% of the men and 12% of the women were ever-smokers at baseline. Through August 31,1996, 218 persons (173 men and 45 women) had died. The relative risks (95% confidence intervals [Cls]) for ever smoking (after adjusting for age, marital status, occupation, education, diastolic blood pressure, and triglyceride and cholesterol levels) for deaths resulting from all causes, all cancer, and coronary heart disease were, respectively, 2.42 (95% Cl, 1.72-3.42), 2.50 (95% Cl,1.41-4.43), and 3.61 (95% Cl, 1.35-9.67) in men and 2.32 (95% Cl,1.18-4.56), 1.98 (95% Cl, 0.50-7.92), and 4.67 (95% Cl, 0.78-27.8) in women. Conclusions.--Previous prospective studies of smoking-related mortality in China tended to underestimate the risks, probably because of short durations of follow-up. We have demonstrated that smoking is a major cause of death in China, and the risks are similar to those seen in the United States and the United Kingdom. Thus, about half of the 300 million smokers in China will eventually die of smoking-related diseases if urgent tobacco-control measures are not instituted to prevent this growing epidemic.

Objective: The predictive value of the metabolic syndrome (MetS) for mortality from all-cause and cardiovascular disease (CVD) in the Chinese population is unclear. The aim of this present study was to compare MetS with its individual components as predictors of mortality in Chinese elderly adults., Methods: A cohort of 1,535 subjects (994 men and 541 women) aged 50 years or older was selected from employees of a machinery factory in 1994 and followed until 2009. Cox models were used to estimate the hazard ratios (HRs) predicted by MetS according to the harmonized definition and by its individual components., Results: The baseline prevalence of MetS was 28.0% in men and 48.4% in women. During a median follow-up of 15 years, 414 deaths occurred, of these, 153 participants died from CVD. Adjusted for age and gender, the HRs of mortality from all-cause and CVD in participants with MetS were 1.47 (95% confidence interval (CI): 1.20-1.80) and 1.96 (95%CI: 1.42-2.72), respectively, compared with those without MetS. Non-significant higher risk of CVD mortality was seen in those with one or two individual components (HR = 1.22, 95%CI: 0.59-2.50; HR = 1.82, 95%CI: 0.91-3.64, respectively), while a substantially higher risk of CVD mortality only appeared in those with 3, 4, or 5 components (HR = 2.81-3.72), compared with those with no components. On evaluating the MetS components individually, we found that, independent of MetS, only hypertension and impaired glucose predicted higher mortality., Conclusions: The number of positive MetS components seems no more informative than classifying (dichotomous) MetS for CVD risks assessment in this Chinese cohort.

Objective: To determine whether blood lipids profile, fibrinogen and viscosity were associated with passive smoking (i. e. environmental tobacco smoke, ETS) in Chinese women who never smoke., Methods: In Xi'an, China, a case-control study was carried out on 115 cases of coronary heart disease (CHD) defined by coronary arteriography (CAG) and 208 non-CHD controls confirmed by CAG and/or exercise electrocardiography. Data on exposure to ETS, defined as exposure from cigarettes smoking husband or co-workers or both for at least 5 years, was obtained through standardized interviews. Standard laboratory methods were used and the lipid measurements were under US CDC quality control programs., Results: In the subjects defined by CAG, the levels of high density lipoprotein cholesterol (HDL-C), HDL2C, apolipoprotein (apo) A1 among passive smokers appeared lower than those in non-passive smokers,but the low density lipoprotein cholesterol (LDL-C), apoB, apoB/A1, fibrinogen, plasma and whole blood viscosity were higher than that in non-passive smokers. There were positive associations of the numbers of coronary arteriosclerosis with the levels of blood lipids,fibrinogen and viscosity. In the non-CHD controls, 81 subjects were not exposed and 127 were exposed to ETS. The P values of t-test for the adjusted (for age, body mass index, present diseases history) means between two groups were listed below: 0.06 (total cholesterol), 0.30 (triglyceride), 0.004 (HDL-C), <0.001 (HDL2-C), < 0.001 (apoA1), 0.009 (apoB), <0.001 (apoB/apoA1), <0.001 (fibrinogen), <0.001 (plasma viscosity), <0.001 and 0.004 [two measures (5.75/s and 230/s) of whole blood viscosity]. The correlation coefficients between cumulative exposure of passive smoking and HDL-C,HDL2-C,apoA1, apoB, apoB/apoA1, fibrinogen, plasma viscosity, and two measures of whole blood viscosity were -0.25, -0.27, -0.30, 0.24, 0.31, 0.32, 0.43, 0.51 and 0.36 (all P<0.01), respectively., Conclusion: Passive smoking could affect blood lipid metabolism, fibrinogen and viscosity in the never smoking women which might contribute to the causation of coronary heart disease.