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Objective To validate the World Health Organization (WHO) non-laboratory-based cardiovascular disease risk prediction model in regions of China. Methods We performed an external validation of the WHO model for East Asia using the data set of China Kadoorie Biobank, an ongoing cohort study with 512 725 participants recruited from 10 regions of China from 2004-2008. We also recalculated the recalibration parameters for the WHO model in each region and evaluated the predictive performance of the model before and after recalibration. We assessed discrimination performance by Harrell's C index. Findings We included 412 225 participants aged 40-79 years. During a median follow-up of11 years, 58 035 and 41 262 incident cardiovascular disease cases were recorded in women and men, respectively. Harrell's C of the WHO model was 0.682 in women and 0.700 in men but varied among regions. The WHO model underestimated the 10-year cardiovascular disease risk in most regions. After recalibration in each region, discrimination and calibration were both improved in the overall population. Harrell's C increased from 0.674 to 0.749 in women and from 0.698 to 0.753 in men. The ratios of predicted to observed cases before and after recalibration were 0.189 and 1.027 in women and 0.543 and 1.089 in men. Conclusion The WHO model for East Asia yielded moderate discrimination for cardiovascular disease in the Chinese population and had limited prediction for cardiovascular disease risk in different regions in China. Recalibration for diverse regions greatly improved discrimination and calibration in the overall population. Objectif Valider le modele de prevision hors laboratoire des risques de maladies cardiovasculaires de l'Organisation mondiale de la Sante (OMS) dans plusieurs regions de Chine. Methodes Nous avons effectue une validation externe du modele de l'OMS pour l'Asie orientale en nous fondant sur l'ensemble de donnees de la China Kadoorie Biobank, une etude de cohorte en cours qui compte 512 725 participants recrutes dans dix regions de Chine entre 2004 et 2008. Nous avons egalement recalcule les parametres de recalibrage du modele de l'OMS dans chaque region, et mesure les performances previsionnelles de ce dernier avant et apres recalibrage. Enfin, nous avons evalue ses capacites de discrimination selon l'index C de Harrell. Resultats Nous avons inclus 412 225 participants ages de 40 a 79 ans. Sur un suivi median de 11 ans, 58 035 cas de maladies cardiovasculaires ont ete enregistres chez les femmes et 41 262 chez les hommes. Le modele de l'OMS affichait un index C de Harrell de 0,682 pour les femmes et de 0,700 pour les hommes, mais variait d'une region a l'autre. En outre, il sous-estimait les risques de maladies cardiovasculaires sur dix ans dans la plupart des regions. Un recalibrage pour chacune d'elles a permis d'optimiser la discrimination et le calibrage pour la population dans son ensemble. Lindex C de Harrell est passe de 0,674 a 0,749 pour les femmes et de 0,698 a 0,753 pour les hommes. Le ratio entre cas prevus et cas observes avant et apres recalibrage s'elevait a 0,189 et 1,027 chez les femmes, contre 0,543 et 1,089 chez les hommes. Conclusion Le modele de l'OMS pour l'Asie orientale a revele des taux de discrimination moderes en termes de maladies cardiovasculaires au sein de la population chinoise, et ses performances previsionnelles en la matiere sont limitees dans diverses regions du pays. Un recalibrage en fonction des regions a permis d'ameliorer considerablement la discrimination et le calibrage pour la population generale. Objetivo Validar el modelo de prediccion del riesgo de enfermedades cardiovasculares sin pruebas de laboratorio de la Organizacion Mundial de la Salud (OMS) en regiones de China. Metodos Se realizo una validacion externa del modelo de la OMS para Asia Oriental a partir del conjunto de datos del China Kadoorie Biobank, un estudio de cohortes en curso con 512 725 participantes seleccionados en 10 regiones de China entre 2004 y 2008. Tambien se volvieron a calcular los parametros de recalibracion para el modelo de la OMS en cada region y se evaluo el rendimiento predictivo del modelo antes y despues de la recalibracion. Asimismo, se evaluo el rendimiento discriminatorio mediante el indice C de Harrell. Resultados Se incluyeron 412 225 participantes de entre 40 y 79 anos. Durante una mediana de seguimiento de 11 anos, se registraron 58 035 y 41 262 casos nuevos de enfermedades cardiovasculares en mujeres y hombres, respectivamente. El indice C de Harrell del modelo de la OMS fue de 0,682 en mujeres y 0,700 en hombres, pero vario entre regiones. El modelo de la OMS subestimo el riesgo de enfermedad cardiovascular a 10 anos en la mayoria de las regiones. Tras la recalibracion en cada region, tanto la discriminacion como la calibracion mejoraron en toda la poblacion. El indice C de Harrell aumento de 0,674 a 0,749 en las mujeres y de 0,698 a 0,753 en los hombres. Los cocientes entre los casos predichos y los observados antes y despues del recalibrado fueron de 0,189 y 1,027 en las mujeres y de 0,543 y 1,089 en los hombres. Conclusion El modelo de la OMS para Asia Oriental arrojo una discriminacion moderada para las enfermedades cardiovasculares en la poblacion china y tuvo una prediccion limitada para el riesgo de enfermedades cardiovasculares en diferentes regiones de China. La recalibracion para diversas regiones mejoro considerablemente la discriminacion y la calibracion en la poblacion general., Introduction Cardiovascular diseases, including coronary artery disease and stroke, are the leading causes of death and disability worldwide. (1) Risk prediction models are important tools for identifying high-risk individuals who [...]

A nationwide survey in China found that skin diseases are common among college students, with a prevalence rate of 60.1%. Acne was the most common skin disease, followed by eczema, androgenetic alopecia, chronic urticaria, and rosacea. The study estimated that the overall burden of skin disease was 667.0 years lived with disabilities (YLDs) per 100,000, with noncommunicable skin diseases accounting for the majority of the burden. The study emphasized the need for accurate data to inform policymakers and recommended prioritizing the prevention, screening, and management of noncommunicable skin diseases. [Extracted from the article]

Background and Purpose: Previous studies, mostly focusing on the European population, have reported polygenic risk scores (PRSs) might achieve risk stratification of stroke. We aimed to examine the association strengths of PRSs with risks of stroke and its subtypes in the Chinese population., Methods: Participants with genome-wide genotypic data in China Kadoorie Biobank were split into a potential training set (n=22 191) and a population-based testing set (n=72 150). Four previously developed PRSs were included, and new PRSs for stroke and its subtypes were developed. The PRSs showing the strongest association with risks of stroke or its subtypes in the training set were further evaluated in the testing set. Cox proportional hazards regression models were used to estimate the association strengths of different PRSs with risks of stroke and its subtypes (ischaemic stroke (IS), intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH))., Results: In the testing set, during 872 919 person-years of follow-up, 8514 incident stroke events were documented. The PRSs of any stroke (AS) and IS were both positively associated with risks of AS, IS and ICH (p<0.05). The HR for per SD increment (HR SD ) of PRS AS was 1.10 (95% CI 1.07 to 1.12), 1.10 (95% CI 1.07 to 1.12) and 1.13 (95% CI 1.07 to 1.20) for AS, IS and ICH, respectively. The corresponding HR SD of PRS IS was 1.08 (95% CI 1.06 to 1.11), 1.08 (95% CI 1.06 to 1.11) and 1.09 (95% CI 1.03 to 1.15). PRS ICH was positively associated with the risk of ICH (HR SD =1.07, 95% CI 1.01 to 1.14). PRS SAH was not associated with risks of stroke and its subtypes. The addition of current PRSs offered little to no improvement in stroke risk prediction and risk stratification., Conclusions: In this Chinese population, the association strengths of current PRSs with risks of stroke and its subtypes were moderate, suggesting a limited value for improving risk prediction over traditional risk factors in the context of current genome-wide association study under-representing the East Asian population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Previous studies on the associations between socioeconomic status (SES) and cutaneous malignant melanoma (CMM) failed to distinguish the effects of different SES factors under an individual-data-based prospective study design., Methods: Based on UK Biobank (UKB) and China Kadoorie Biobank (CKB), we estimated the effects of four SES factors on transitions from baseline to CMM in situ, subsequently to invasive CMM and further CMM mortality by applying multistate models. We further explored to which extent the associations between SES and CMM incidence could be explained by potential mediators including sun exposure, lifestyle and ageing in UKB., Results: In multistate analyses, good household income was independently associated with an increased risk of CMM in situ (HR=1.38, 95% CI: 1.21 to 1.58) and invasive CMM (HR=1.34, 95% CI: 1.22 to 1.48) in UKB. These findings were partly validated in CKB. Especially in UKB, we observed an increased risk of CMM in situ and invasive CMM among participants with good type of house; only good education was independently associated with lower risk of evolving to invasive CMM among patients with CMM in situ (HR=0.69, 95% CI: 0.52 to 0.92); only good household income was independently associated with lower risk of CMM mortality among patients with CMM (HR=0.65, 95% CI: 0.45 to 0.95). In mediation analysis, the proportions attributable to the mediating effect were <6% for all selected variables, including self-reported sun exposure-related factors., Conclusion: SES factors have different effects on the incidence and progression of CMM. The association between SES and incident CMM is neither causal nor well explained by selected mediators., Competing Interests: Competing interests: The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. This research has been conducted using the China Kadoorie Biobank (CKB) resource (www.ckbiobank.org, Request No. DAR-2023-00149). Publication of results does not require or imply approval by the membership of the CKB Collaborative Group., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Identifying environmentally responsive genetic loci where DNA methylation is associated with coronary heart disease (CHD) may reveal novel pathways or therapeutic targets for CHD. We conducted the first prospective epigenome-wide analysis of DNA methylation in relation to incident CHD in the Asian population., Methods: We did a nested case-control study comprising incident CHD cases and 1:1 matched controls who were identified from the 10 year follow-up of the China Kadoorie Biobank. Methylation level of baseline blood leukocyte DNA was measured by Infinium Methylation EPIC BeadChip. We performed the single cytosine-phosphate-guanine (CpG) site association analysis and network approach to identify CHD-associated CpG sites and co-methylation gene module., Results: After quality control, 982 participants (mean age 50.1 years) were retained. Methylation level at 25 CpG sites across the genome was associated with incident CHD (genome-wide false discovery rate [FDR] < 0.05 or module-specific FDR < 0.01). One SD increase in methylation level of identified CpGs was associated with differences in CHD risk, ranging from a 47 % decrease to a 118 % increase. Mediation analyses revealed 28.5 % of the excessed CHD risk associated with smoking was mediated by methylation level at the promoter region of ANKS1A gene (P for mediation effect = 0.036). Methylation level at the promoter region of SNX30 was associated with blood pressure and subsequent risk of CHD, with the mediating proportion to be 7.7 % ( P = 0.003) via systolic blood pressure and 6.4 % ( P = 0.006) via diastolic blood pressure. Network analysis revealed a co-methylation module associated with CHD., Conclusions: We identified novel blood methylation alterations associated with incident CHD in the Asian population and provided evidence of the possible role of epigenetic regulations in the smoking- and blood pressure-related pathways to CHD risk., Funding: This work was supported by National Natural Science Foundation of China (81390544 and 91846303). The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by grants from the UK Wellcome Trust (202922/Z/16/Z, 088158/Z/09/Z, 104085/Z/14/Z), grant (2016YFC0900500, 2016YFC0900501, 2016YFC0900504, 2016YFC1303904) from the National Key R&D Program of China, and Chinese Ministry of Science and Technology (2011BAI09B01)., Competing Interests: JS, SY, DS, CY, YG, YL, IM, RW, LY, YC, HD, YH, JL, JC, ZC, WC, JL, LL, LL No competing interests declared, The members of the steering committee and collaborative group are listed in the Supplementary file 1., (© 2021, Si et al.)

Background Active commuting is related to a higher level of physical activity but more exposure to ambient air pollutants. With the rather serious air pollution in urban China, we aimed to examine the association between active commuting and risk of incident cardiovascular disease in the Chinese population. Methods and Results A total of 104 170 urban commuters without major chronic diseases at baseline were included from China Kadoorie Biobank. Self-reported commuting mode was defined as nonactive commuting, work at home or near home, walking, and cycling. Multivariable Cox regression was used to examine associations between commuting mode and cardiovascular disease. Overall, 47.2% of the participants reported nonactive commuting, 13.4% reported work at home or work near home, 20.1% reported walking, and 19.4% reported cycling. During a median follow-up of 10 years, we identified 5374 incidents of ischemic heart disease, 664 events of hemorrhagic stroke, and 4834 events of ischemic stroke. After adjusting for sex, socioeconomic status, lifestyle factors, sedentary time, body mass index, comorbidities, household air pollution, passive smoking, and other domain physical activity, walking (hazard ratio, 0.90; 95% CI, 0.84-0.96) and cycling (hazard ratio, 0.81; 95% CI, 0.74-0.88) were associated with a lower risk of ischemic heart disease than nonactive commuting. Cycling was associated with a lower risk of ischemic stroke (hazard ratio, 0.92; 95% CI, 0.84-1.00). No significant association was found of walking or cycling with hemorrhagic stroke. The associations of commuting mode with major cardiovascular disease were consistent among men and women and across different levels of other domain physical activity. Conclusions In urban China, cycling was associated with a lower risk of ischemic heart disease and ischemic stroke. Walking was associated with a lower risk of ischemic heart disease.

Background and Purpose: Both genetic factors and smoking are associated with ischemic stroke (IS) risk. However, little is known about the potential interaction of these factors. We aimed to assess whether smoking and a positive family history interact to increase the risk of IS., Methods: The nationwide prospective study recruited 210,000 men and 300,000 women in 2004 to 2008 at ages 30 to 79 years. During 9.7 years of follow-up, we documented 16,923 and 20,656 incident IS cases in men and women without major chronic diseases at baseline, respectively. Multivariable Cox regression models were used to examine associations between family history and IS. Likelihood ratio tests were used to test the smoking-family history interactions on IS., Results: About 67.8% (n=135,168) of men ever smoked regularly compared with 2.7% (n=7,775) of women. Among men, a significant interaction between family history and smoking on IS was observed (P for interaction=0.03), with more pronounced association between family history and IS among ever-regular smokers (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.16 to 1.27) than among never-smokers (HR, 1.11; 95% CI, 1.01 to 1.23). The association between family history and IS among ex-smokers after more than 10 years of cessation (HR, 1.01; 95% CI, 0.85 to 1.20) appeared similar to that among never-smokers. Among women, a similar but not significant interaction between family history and smoking on IS was observed. Ever-regular smokers who had a family history of stroke had the highest risk of IS., Conclusions: Among Chinese men, the association of family history with IS was accentuated by smoking, and such accentuation tended to be lowered by cessation.