Cardiovascular Diseases ; epidemiology ; Humans ; Risk Factors

OBJECTIVEHigh-density lipoprotein cholesterol (HDL-C) has cardio-protective effects. However, results from clinical trials showed that improving HDL-C levels alone did not reduce the cardiovascular disease (CVD) events and different HDL particles (HDL-P) subfractions may relate to different CVD risk. In this meta-analysis, we reviewed prospective studies reported relationships of HDL-P subfractions with CVD risk.

METHODS

DATA SOURCESMEDLINE, Cochrane Library and China National Knowledge Infrastructure (CNKI) were searched up to July 1st, 2013.

STUDY SELECTIONProspective studies that reported an association of HDL-P subfractions with the incidence of CVD were included and studies did not assess the hazard ratio, relative risk, or odds ratio of HDL-P and studies did not adjust for any other risk factors were excluded.

DATA EXTRACTION AND SYNTHESISAll studies were extracted by 1 researcher and verified by another researcher. Full data were extracted from the studies meanwhile the quality was evaluated. Heterogeneity was analyzed. Pooled relative risk (RR) and 95% confidence interval were calculated.

RESULTSSix studies were enrolled in this meta-analysis. HDL-P can be grouped into three subfractions: large HDL-P, medium HDL-P and small HDL-P. Only higher large HDL-P concentration was associated with decreased risk for CVD and pooled RR was 0.65 (95%CI:0.55-0.76). Medium HDL-P and small HDL-P were not associated with the incidence of CVD events.

CONCLUSIONHigher large HDL-P concentration is associated with lower CVD risk. Assessment of HDL-P subfractions may thus be of great clinical importance for evaluating the CVD risk.

Cardiovascular Diseases ; blood ; epidemiology ; China ; Cholesterol, HDL ; blood ; Humans ; Risk Factors

OBJECTIVETo evaluate the association between very low density lipoprotein cholesterol (VLDL-C) and cholesterol absorption and synthesis markers in patients with moderate and high risk of coronary heart disease.

METHODSA total 363 statin-naïve patients with moderate and high risk of coronary heart disease were consecutively recruited from two hospitals in Shanxi and Henan provinces between October 2008 and June 2009. A standard questionnaire and physical examination were performed at baseline. Atorvastatin (20 mg/day) was administered to patients for 4 weeks. Venous blood samples after an overnight fast were collected before and after treatment for measuring VLDL-C and cholesterol absorption and synthesis markers. In qualitative analyses, the baseline level of cholesterol absorption and synthesis markers and their reduction after atorvastatin treatment were categorized into 3 tertile groups.

RESULTS(1) Of 363 patients, 283 patients with mean age of (55.43±9.01)years old with complete data were finally analyzed. The median level of baseline VLDL-C was 1.06 (0.65, 1.86) mmol/L. The median level of baseline cholesterol absorption marker (Campesterol) and cholesterol synthesis marker (Lathosterol) was 6.01 (3.78, 9.45) mg/L and 13.46 (8.30, 21.07) mg/L, respectively. (2) Partial correlation analysis and multiple regression showed the baseline level of VLDL-C was positively correlated with Campesterol (r=0.153, P<0.05) but not with Lathosterol(r=0.182, P=0.173). Furthermore, baseline VLDL-C level significantly increased with tertile of the baseline level of Campesterol in the qualitative analyses(P for trend=0.035). (3) Mean reduction in VLDL-C levels was 38.0% after 4 weeks atorvastatin treatment. VLDL-C reduction was positively correlated with Campesterol reduction (r=0.331, P<0.001). VLDL-C reduction significantly increased with the tertile of Campesterol reduction (P for trend=0.032). But this trend was not observed between VLDL-C level and Lathosterol (P for trend=0.798).

CONCLUSIONThe level of VLDL-C was closely related to cholesterol absorption marker, and further studies are needed to validate if inhibitor of cholesterol absorption (for example by Ezetimibe) could bring about more effective VLDL-C lowering effect in this patient cohort.

Atorvastatin Calcium ; Biomarkers ; Cholesterol ; analogs & derivatives ; Cholesterol, LDL ; Cholesterol, VLDL ; Coronary Artery Disease ; Ezetimibe ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Phytosterols ; Risk Factors

OBJECTIVETo investigate the status of the clustering of cardiovascular risk factors and hypertension control among hypertensive patients in the outpatient setting in China.

METHODSThis multi-center cross-sectional study was carried out from June to December 2009. Study patients were consecutively recruited from 46 hypertension outpatient clinics in 22 provinces, autonomous regions, and municipalities of China according to identical inclusion criteria. More than 100 consecutive patients should be recruited in each outpatient clinic, and 5206 hypertensive outpatients were included. The patients were examined by questionnaires, physical examinations, and biochemical analyses. Risk factors were defined according to the 2010 Chinese guidelines for the management of hypertension.

RESULTSIn this patient cohort, dyslipidemia was found in 61.5% (3203/5206), obesity in 56.0% (2917/5206), and impaired glucose regulation in 27.8% (1449/5206) patients. The prevalence of smoking was 34.9% (910/2605) in male hypertensive patients, 88.9% (4630/5206) hypertensive patients had at least one of the above-mentioned four risk factors and 17.4% (906/5206) had three or more risk factors. Only 4.1% (211/5206) hypertensive outpatients were classified as low cardiovascular risk patients, 72.5% (3774/5206) hypertensive outpatients were classified as high or very high cardiovascular risk patients. The general blood pressure control rate was 44.3% (2304/5206), which was higher in the age group of ≥ 65 years than in those of 35-44 years [51.3% (818/1596) vs. 29.6% (160/541), P < 0.01], higher in low-risk patients than in high-risk patients [65.4% (138/211)vs. 41.9% (1581/3774), P < 0.01] and higher in patients under regular therapy ( ≥ 9 months per year) than in those of irregular therapy (< 6 months per year) [50.7% (1744/3442)vs. 30.0% (391/1305), P < 0.01].

CONCLUSIONClustering of cardiovascular risk factors, especially dyslipidemia and obesity, is common, and cardiovascular risk is high while blood pressure control rate is low among hypertensive outpatients in China.

Adult ; Blood Pressure ; Cross-Sectional Studies ; Female ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Obesity ; complications ; Outpatients ; Risk Factors ; Smoking ; adverse effects

OBJECTIVETo observe the association between the leukocyte count and blood pressure value and hypertension risk in a Chinese community-based population.

METHODSA total of 4 188 participants who took part in the baseline examination in 1992 and the follow-up survey in 2007 from the Chinese Multi-Provincial Cohort Study were included in this study. The relationship of leukocyte and blood pressure value and hypertension risk were evaluated by cross-sectional analyses.The prospective association between baseline leukocyte count and blood pressure changes and risk of hypertension were analyzed in 2 954 normotensive individuals at baseline examination.The associations between leukocyte count and blood pressure was evaluated with Spearman's rank correlation analyses and linear regression models,and the associations between leukocyte count and risk of hypertension was evaluated with logistic regression models.

RESULTS(1) The cross-sectional study results showed that the correlation coefficient of leukocyte count and systolic blood pressure and diastolic blood pressure was 0.208 and 0.154 (both P < 0.001), respectively.Multiple linear regression analyses showed that every 1×10(9)/L increment in leukocyte count was associated with 1.41 mmHg (1 mmHg = 0.133 kPa) systolic blood pressure increase (95% CI: 1.20-1.63 mmHg, P < 0.001) and 0.63 mmHg diastolic blood pressure increase (95% CI: 0.51-0.76 mmHg, P < 0.001). Multivariable logistic regression analyses showed that every 1×10(9)/L increment in leukocyte count was associated with a 15% increased risk of hypertension (OR: 1.15, 95% CI: 1.12-1.19, P < 0.001). (2) During 15 years of follow-up, 47.2% (1 394/2 954) normotensive individuals progressed to hypertension. Spearman's rank correlation analyses showed that, the correlation coefficient of leukocyte count and systolic blood pressure change and diastolic blood pressure change was 0.062 (P = 0.003) and 0.102 (P < 0.001), respectively.Multiple linear regression analyses showed that every 1×10(9)/L increment in baseline leukocyte count was associated with 1.03 mmHg systolic blood pressure increase (95% CI: 0.74-1.32 mmHg, P < 0.001) and 0.64 mmHg diastolic blood pressure increase (95% CI: 0.48-0.80 mmHg, P < 0.001). Multivariable logistic regression analyses showed that every 1×10(9)/L increment in leukocyte count was associated with a 9% increased risk of incident hypertension (OR: 1.09, 95% CI: 1.06-1.13, P < 0.001).

CONCLUSIONElevated leukocyte count is associated with increased blood pressure value and hypertension among Chinese community-based population, suggesting that inflammation may participate in the pathogenesis of hypertension.

Blood Pressure ; Cohort Studies ; Cross-Sectional Studies ; Diastole ; Humans ; Hypertension ; epidemiology ; Leukocyte Count ; Logistic Models ; Prospective Studies ; Regression Analysis ; Systole