Sleep is a highly conserved phenomenon in endotherms, and has a universal physiological function across all species. In mammals, sleep can be divided into two stages: rapid eye movement (REM) sleep and non-REM (NREM) sleep, which alternate in a cyclic manner. Humans spend about one-third of their lives asleep. Sufficient sleep is necessary for humans to sustain everyday functioning. Sleep plays an important role in regulating energy metabolism, immune defense, endocrine function, and the consolidation of memory process. With the development of social economy and the change of life style, sleep duration of the residents has gradually decreased and the incidence of sleep disturbances has increased. Sleep disturbances can lead to severe mental disorders, such as depression, anxiety disorders, dementia, and other mental diseases, and may increase the risk of physical diseases, such as chronic inflammation, heart disease, diabetes, hypertension, atherosclerosis and others. Maintaining good sleep is of great significance for developing social productive forces, promoting sustainable development of economic society, and is a necessary condition for carrying out the "Healthy China Strategy". The sleep research in China started in 1950s. After decades of development, researchers have made great progress in the molecular mechanisms of sleep and wakefulness, the pathogenesis of sleep disorders and the development of new therapies. With the advancement of science and technology and the public's attention to sleep, the level of clinical diagnosis and therapy of sleep disorders in China is gradually brought in line with international standards. The publication of diagnosis and treatment guidelines in the field of sleep medicine will promote the standardization of the construction. In the future, it is still necessary to promote the development of sleep medicine in the following aspects: Strengthening the professional training and discipline construction, improving the cooperation of sleep research, promoting the intelligent diagnosis and treatment of sleep disorders, and developing the new intervention strategies. Therefore, this review will comprehensively summarize the origin, current situation, and future expectations of sleep medicine in China, including discipline construction of sleep medicine, the number of sleep project grants, research findings, the status and progress of diagnosis and treatment of sleep disorders, and the development direction of sleep medicine.
Animals ; Humans ; Sleep ; Sleep Wake Disorders/therapy* ; Atherosclerosis ; China/epidemiology* ; Health Status ; Mammals

BACKGROUND: Atherosclerosis-related diseases represent significant health issues among adults globally. Despite their widespread impact, comprehensive data concerning the global and national burden and trends of these diseases remain sparse. Our objective is to examine the trends in the burden of atherosclerosis among adults from 1990 to 2019 at both global and national levels. METHODS: We reported the average annual percentage changes (AAPCs) in prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of atherosclerosis-related diseases (ischemic heart disease [IHD], ischemic stroke, and peripheral arterial disease [PAD]) at the global and national levels among individuals based on a trend analysis of the Global Burden of Diseases Study (GBD) 2019. We further analyzed these global trends as a function of age, gender, and the social development index. We also used joinpoint regression analysis to identify the year with the most substantial changes in global trends. RESULTS: Globally, the AAPC of IHD incidence rose from 1990 to 2019 (0.20; 95% confidence interval [CI], 0.12-0.28), with substantial surges in 1995, 2001, 2005, 2010, and 2017. Conversely, AAPC of IHD mortality rates exhibited a different trend until a rise in 2014. The AAPC of incidence rates of ischemic stroke and PAD also escalated during the same period, with respective 0.43 (95% CI, 0.39-0.48) and 0.13 (95% CI, 0.06-0.21). For ischemic stroke, both incidence and mortality soared in 2014, while PAD incidence declined in 1994 and 1998, then sharply climbed in 2016. Nationally, the Northern Mariana Islands experienced the steepest increase in IHD and PAD incidence and mortality between 1990 and 2019. China saw a significant rise in ischemic stroke incidence, whereas the highest mortality rate increase occurred in Timor-Leste. By sociodemographic index (SDI) quintile, low-middle-, middle-, and high-middle-SDI countries all showed upward trends in IHD, ischemic stroke, and PAD incidence. Simultaneously, IHD and ischemic stroke mortality rates, as well as DALYs, dropped in the low-, high-middle-, and high-SDI nations. However, PAD mortality rates and DALYs saw an uptick across all SDI quintiles. Regarding age demographics, a global decrease in the AAPC IHD incidence as noted in individuals above 55 years old, in contrast to an increase in the 20-55 age group during this period. AAPC of mortality rates for IHD, ischemic stroke, and PAD decreased across all ages. The AAPC showed an increase in IHD incidence in both genders. Conversely, IHD's DALYs saw a reduction in both males and females. Ischemic stroke patterns mirrored these trends, whereas all measures for PAD exhibited growth for both sexes. CONCLUSIONS From 1990 to 2019, there was an overall increasing trend in the global incidence of all three clinical manifestations of atherosclerosis. Between 1990 and 2019, both the mortality rate and DALYs for IHD and ischemic stroke declined across all age groups. Overall, the burden of atherosclerosis-related diseases has not significantly decreased and even shows signs of trending upward. These findings strongly suggest that despite some progress made, efforts to control atherosclerosis diseases globally need to be intensified.
Adult ; Humans ; Male ; Female ; Middle Aged ; Global Burden of Disease ; Quality-Adjusted Life Years ; Atherosclerosis/epidemiology* ; Myocardial Ischemia/epidemiology* ; Incidence ; Ischemic Stroke

BACKGROUND: Aging is a process that increases oxidative stress. Increased oxidative stress leads to the development of atherosclerosis and mitochondrial dysfunction. Mitochondria contribute to energy production that might have a beneficial influence on maintaining muscle strength. Therefore, the height-related single nucleotide polymorphism (SNP) rs17081935, which is also reported to be associated with mitochondrial metabolism, might be associated with reduced muscle strength and this association might be affected by atherosclerosis status. To clarify those associations, a cross-sectional study of 1374 elderly Japanese individuals aged 60-89 years was conducted. METHODS: Logistic regression was used to clarify the association between rs17081935 and reduced handgrip strength. Since atherosclerosis might affect handgrip strength, participants were stratified by atherosclerosis status. Reduced handgrip strength was defined as being in the lowest quintile of handgrip strength (< 25.6 kg for men and < 16.1 kg for women). RESULTS: No significant associations were found between a minor allele of rs17081935 and reduced handgrip strength among elderly participants without atherosclerosis. A significant inverse association was observed among elderly participants with atherosclerosis. After adjusting for known cardiovascular risk factors and height, the adjusted odd ratio (OR) and 95% confidence interval (CI) for reduced handgrip strength and a minor allele of rs17081935 were 1.13 (0.86, 1.43) for elderly participants without atherosclerosis and 0.55 (0.36, 0.86) for those with atherosclerosis, respectively. CONCLUSION A minor allele of the height-related SNP rs17081935 was significantly inversely associated with reduced handgrip strength among older individuals with atherosclerosis, but not among those without atherosclerosis.
Aged ; Aged, 80 and over ; Atherosclerosis/epidemiology* ; Body Height ; Cross-Sectional Studies ; Female ; Hand Strength ; Humans ; Japan/epidemiology* ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; Prevalence

Recent studies have revealed an inverse association between height and cardiovascular disease. However, the background mechanism of this association has not yet been clarified. Height has also been reported to be positively associated with cancer. Therefore, well-known cardiovascular risk factors, such as increased oxidative stress and chronic inflammation, are not the best explanations for this inverse association because these risk factors are also related to cancer. However, impaired blood flow is the main pathological problem in cardiovascular disease, while glowing feeding vessels (angiogenesis) are the main characteristic of cancer pathologies. Therefore, endothelial maintenance activity, especially for the productivity of hematopoietic stem cells such as CD34-positive cells, could be associated with the height of an individual because this cell contributes not only to the progression of atherosclerosis but also to the development of angiogenesis. In addition, recent studies have also revealed a close connection between bone marrow activity and endothelial maintenance; bone marrow-derived hematopoietic stem cells contribute towards endothelial maintenance. Since the absolute volume of bone marrow is positively associated with height, height could influence endothelial maintenance activity. Based on these hypotheses, we performed several studies. The aim of this review is not only to discuss the association between height and bone marrow activity, but also to describe the potential mechanism underlying endothelial maintenance. In addition, this review also aims to explain some of the reasons that implicate hypertension as a major risk factor for stroke among the Japanese population. The review also aims to clarify the anthropological reasons behind the high risk of atherosclerosis progression in Japanese individuals with acquired genetic characteristics.
Aged ; Atherosclerosis/physiopathology* ; Body Height/physiology* ; Bone Marrow/physiology* ; Disease Progression ; Endothelium/physiology* ; Humans ; Hypertension/physiopathology* ; Japan/epidemiology* ; Male ; Middle Aged ; Risk Factors ; Stroke/physiopathology*

The incidence and mortality of cardiovascular diseases in the world are increasing, and the age of onset is gradually getting younger. Extensive atherosclerotic lesions are rare in patients under 35 years old with acute myocardial infarction, and the atherosclerotic burden is low. The risk factors are unique. In addition to traditional risk factors such as smoking and dyslipidemia, new risk factors such as genetic polymorphisms related to blood coagulation, fibrinogen, homocysteine and uric acid, may play an important role in the pathogenesis of patients with early-onset acute myocardial infarction. Enhanced prevention can reduce the incidence of premature coronary heart disease, early detection and early treatment can improve the prognosis. .
Adult ; Atherosclerosis ; Coronary Artery Disease ; Dyslipidemias ; Humans ; Myocardial Infarction ; epidemiology ; Risk Factors

OBJECTIVE: Ideal cardiovascular health (CVH) could predict a lower risk of developing cardiovascular diseases. This study was conducted to investigate the association between ideal CVH and subclinical atherosclerosis in a population cohort of Chinese adults aged ⪖ 40 years. METHODS: This study was designed as a cross-sectional analysis of 8,395 participants who had complete data at baseline and a prospective analysis of 4,879 participants who had complete data at 4.3 years of follow-up. Ideal CVH metrics were defined according to the American Heart Association. Subclinical atherosclerosis was evaluated by plaques in carotid arteries, carotid intima-media thickness (CIMT), brachial-ankle pulse wave velocity (baPWV), and urinary albumin-to-creatinine ratio (UACR). RESULTS: Both the prevalence and incidence of atherosclerosis measures were found to be decreased with increasing numbers of ideal CVH metrics at baseline (all P values for trend < 0.01). The levels of CIMT and UACR at follow-up showed an inverse and significant association with the numbers of ideal CVH metrics at baseline (both P values for trend < 0.05) but a borderline significant association with baPWV (P for trend = 0.0505). Taking participants with 0-1 ideal metric as reference, we found that participants with 5-6 ideal metrics had significantly lower risks of developing carotid plaques (odds ratio, OR = 0.46; 95% confidence interval, CI 0.27-0.79), increased CIMT (OR = 0.60; 95% CI 0.42-0.84), and increased baPWV (OR = 0.57; 95% CI 0.34-0.97) after full adjustments. A significant interactive effect of age and CVH was detected on CIMT and baPWV progression (both P values for interaction < 0.05). CONCLUSION The numbers of ideal CVH metrics showed a significant and inverse association with the risk of developing subclinical atherosclerosis in middle-aged and elderly Chinese adults, whereas its dose-response effect was attenuated in individuals aged ≥ 60 years and partially weakened in male participants.
Aged ; Atherosclerosis ; epidemiology ; China ; epidemiology ; Cross-Sectional Studies ; Female ; Health Status ; Humans ; Male ; Middle Aged ; Prospective Studies

OBJECTIVE: To assess the 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score among adults in eastern China using the China-PAR equation which formulated primarily for the Chinese population. METHODS: Data from 72,129 individuals from 35-74 years old who received routine physical examinations in eastern China were analyzed in this study. The 10-year risk scores were calculated using the China-PAR equation. The chi-square test and logistic regression were then performed to evaluate the association between the selected risk factors and overall CVD risk. RESULTS: The mean 10-year ASCVD risk scores were 3.82% ± 3.76% in men and 1.30% ± 1.65% in women based on the China-PAR equation. Overall, 20% of men and 3.5% of women were intermediate-risk, and 7.3% of men and 0.3% of women were high-risk. Waist to hip ratio (WHR) [OR = 1.16 (CI 95% = 1.06-1.26)], waist to height ratio (WHtR) [OR = 1.16 (CI 95% = 1.05-1.28)], non-high-density lipoprotein cholesterol (non-HDL-C) [OR = 1.23 (CI 95% = 1.09-1.39)], and total cholesterol (TC)/HDL-C [OR = 1.68 (CI 95% = 1.46-1.94)] were more strongly associated with CVD risk than body-mass index (BMI), waist circumference (WC), and TC alone. CONCLUSION Male-specific prevention and treatment strategies for ASCVD are needed in eastern China. In addition, WHR, WHtR, non-HDL-C, and TC/HDL-C which not included in the the China-PAR equation were also independently associated with 10-year ASCVD risk score categories.
Adult ; Aged ; Algorithms ; Atherosclerosis ; epidemiology ; China ; Female ; Humans ; Male ; Middle Aged ; Physical Examination ; Risk Factors

BACKGROUND: Cigarette smoking increases the risk of atherosclerosis, which often develops as vascular calcification on radiologic examinations. This study evaluated the relationship between smoking-related factors and incidental abdominal aorta calcification (AAC) detected by computed tomography (CT) among middle-aged and elderly men. METHODS: We assessed the abdominal CT findings of 218 men aged 40 to 81 years who underwent health checkups. The associations between smoking factors and AAC were analyzed using logistic regression analysis to adjust for confounding variables such as age, lifestyle factors, and chronic diseases. RESULTS: Adjusting for confounding variables, the risk of AAC was significantly increased in association with smoking for at least 20 years (adjusted odds ratio [AOR], 5.22; 95% confidence interval [CI], 1.82–14.93), smoking 10+ pack-years (10–20 pack-years: AOR, 4.54; 95% CI, 1.07–5.68; >20 pack-years: AOR, 5.28; 95% CI, 2.10–13.31), and a history of smoking (former smoker: AOR, 2.10; 95% CI, 1.07–5.68; current smoker: AOR, 5.05; 95% CI, 2.08–12.26). In terms of the daily smoking amount, even a low smoking level increased the risk of AAC. CONCLUSION: These findings suggest that smoking for 20+ years, smoking 10+ pack-years, and even a low level of smoking daily increases the likelihood of developing AAC. Clinicians should recommend that patients quit smoking and stress the importance of smoking duration when promoting health in middle-aged and elderly patients.
Aged ; Aorta, Abdominal ; Atherosclerosis ; Chronic Disease ; Confounding Factors (Epidemiology) ; Humans ; Life Style ; Logistic Models ; Male ; Odds Ratio ; Smoke ; Smoking ; Tomography, X-Ray Computed ; Vascular Calcification

BACKGROUND: Carotid artery intima medial thickness (IMT), brachial-ankle pulse wave velocity (baPWV), and ankle-brachial index (ABI) are commonly used surrogate markers of subclinical atherosclerosis in patients with type 2 diabetes mellitus (T2DM). The cardio-ankle vascular index (CAVI) is a complement to the baPWV, which is affected by blood pressure. However, it is unclear which marker is the most sensitive predictor of atherosclerotic cardiovascular disease (ASCVD). METHODS: This was a retrospective non-interventional study that enrolled 219 patients with T2DM. The correlations among IMT, ABI, and CAVI as well as the relationship of these tests to the 10-year ASCVD risk were also analyzed. RESULTS: Among the 219 patients, 39 (17.8%) had ASCVD. In the non-ASCVD group, CAVI correlated significantly with IMT after adjusting for confounding variables, but ABI was not associated with CAVI or IMT. The analyses after dividing the non-ASCVD group into three subgroups according to the CAVI score ( < 8, ≥8 and < 9, and ≥9) demonstrated the significant increase in the mean IMT, 10-year ASCVD risk and number of metabolic syndrome risk factors, and decrease in the mean ABI in the high-CAVI group. A high CAVI was an independent risk factor in the non-ASCVD group for both a high 10-year ASCVD risk (≥7.5%; odds ratio [OR], 2.42; P < 0.001) and atherosclerosis (mean IMT ≥1 mm; OR, 1.53; P=0.007). CONCLUSION: In Korean patients with T2DM without ASCVD, CAVI was the most sensitive of several surrogate markers for the detection of subclinical atherosclerosis.
Ankle Brachial Index ; Atherosclerosis ; Biomarkers* ; Blood Pressure ; Cardiovascular Diseases* ; Carotid Arteries ; Complement System Proteins ; Confounding Factors (Epidemiology) ; Diabetes Mellitus, Type 2* ; Humans ; Korea ; Odds Ratio ; Pulse Wave Analysis ; Retrospective Studies ; Risk Factors

BACKGROUND: The effect of the redox state of human serum albumin (HSA) on the antioxidant properties of the entire body has been a focus of recent research. The usefulness of HSA redox state as a biomarker for reducing oxidative stress has been investigated in clinical settings; however, evidence for its significance as a health index in non-clinical settings is yet to be established. This study aimed to examine the associations between HSA redox state and the atherosclerotic indices of carotid intima-media thickness (IMT) and plaque formation in a rural Japanese population. METHODS: We conducted a cross-sectional study as part of a health check-up program in the rural area of Hokkaido, Japan, at the end of August 2013. A total of 281 residents (124 men and 157 women) were included in the final analysis. Lifestyle-related data were obtained through a self-reported questionnaire, and ultrasound examinations were performed to measure IMT and determine plaque formation. The high-performance liquid chromatography postcolumn bromocresol green method was used to separate HSA into human nonmercaptalbumin and human mercaptalbumin (HMA). RESULTS: We found a significant negative relationship between the fraction of HMA [f(HMA)] and IMT (standardized β = - 0.132, p = 0.03). Moreover, f(HMA) was significantly associated with plaque formation (p < 0.01) with an odds ratio of 0.89 (95% confidence interval, 0.81-0.97) for every 10% increment in f(HMA). CONCLUSIONS We found that the HSA redox state, as determined by f(HMA), was associated with atherosclerotic indices in Japanese subjects. These results suggest that the HSA redox state indicates the risk of developing atherosclerosis.
Adult ; Aged ; Aged, 80 and over ; Atherosclerosis ; epidemiology ; etiology ; Biomarkers ; Carotid Intima-Media Thickness ; statistics & numerical data ; Cross-Sectional Studies ; Female ; Humans ; Japan ; epidemiology ; Male ; Middle Aged ; Oxidation-Reduction ; Risk Factors ; Serum Albumin ; metabolism ; Serum Albumin, Human ; metabolism