Increasing prevalence of hypertension in Hong Kong Cardiovascular Risk Factor Prevalence Study: role of general and central obesity

Introduction: General obesity and central obesity are well-known risk factors of hypertension. We investigated the change in the prevalence of hypertension in the population-based prospective Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS) and the relationship of change in blood pressure with change in body mass index (BMI) and waist circumference over a follow-up period of 11.9 years. Methods: A total of 2888, 1942 and 1798 subjects in CRISPS-1 (1995-1996), CRISPS-2 (2000-2004) and CRISPS-3 (2005-2008) were included in this analysis respectively. Hypertension was defined as blood pressure ≥140/90 mm Hg or taking anti-hypertensive medication. General obesity was defined as BMI ≥27.5 kg/m2 and central obesity was defined as waist circumference ≥90 cm in men or ≥80 cm in women. Results: The prevalence of hypertension increased from 18.1% to 39.4% (P<0.001 after adjusting for age and sex). The prevalence of central obesity increased from 25.4% to 41.4%, but that of general obesity decreased from 16.8% to 14.8% (both P<0.001 after adjusting for age and sex). Among 1347 subjects who did not take any anti-hypertensive medication at both CRISPS-1 and CRISPS-3, the change in waist circumference, but not that in BMI, was associated with the changes in both systolic and diastolic blood pressures (beta=0.087, P=0.015 and beta=0.122, P<0.001 respectively). Conclusions: The increase in prevalence of hypertension might be explained by the increase in central obesity. Our findings further confirm the importance of waist circumference in this population; calculating the BMI alone may give a false sense of security. Acknowledgement: This study was funded by Hong Kong Research Grant Council grants (HKU7229/01M and HKU7626/07M) and the Sun Chieh Yeh Heart Foundation.published_or_final_versio

Using glycosylated haemoglobin to define the metabolic syndrome in adults in the United States

Introduction: Recently, the American Diabetes Association has proposed the use of glycosylated haemoglobin (GHb) in the definition of diabetes and the category of increased diabetes risk. We therefore investigated whether GHb can be used instead of fasting plasma glucose in identifying individuals with the metabolic syndrome, which is associated with increased risk of cardiovascular diseases. Methods: Participants of the US National Health and Nutrition Examination Survey (NHANES) 1999-2006 who had fasting blood glucose were included (n=3551 in 1999-2002 and n=3412 in 2003-2006). The metabolic syndrome was defined using International Diabetes Federation criteria in 2009. Raised blood glucose was defined either as fasting glucose ≥100 mg/dL (5.6 mmol/L), or as GHb ≥5.7%. Results: In 2003-2006, there was 91.3% agreement between GHb and fasting glucose when either is used to define the metabolic syndrome, although the use of GHb slightly lowered the syndrome’s prevalence (34.8% vs 38.8%, P=0.012). The agreement was good (≥87%) irrespective of age, sex, race/ethnicity and body mass index. Only 2.3% of the sample population had the metabolic syndrome defined using GHb but not using fasting glucose. The syndrome, defined using GHb alone, was associated with cardiovascular diseases (ischaemic heart disease, heart failure or stroke) [OR=1.95, P=0.002]. Similar results were found in 1999-2002. Conclusions: Using GHb instead of fasting glucose to define the metabolic syndrome is feasible. The syndrome defined in this way also identifies individuals with increased cardiovascular risk.published_or_final_versio

A woman with raised alkaline phosphatase and forearm deformity

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High-sensitivity C-reactive protein and other inflammatory markers in predicting cardiovascular risk in Hong Kong Chinese

Poster PresentationINTRODUCTION: Inflammation is increasingly recognised as a key player in atherosclerosis, and C-reactive protein measured using high-sensitivity assay (hsCRP) is the most promising inflammatory marker in predicting the risk of cardiovascular diseases (CVD). In this prospective cohort study, we examined the predictive value of hsCRP for CVD in Hong Kong Chinese and determined if other biomarkers would enhance the predictive value of hsCRP. METHODS: Subjects were recruited from the Hong Kong Cardiovascular Risk Factors Prevalence Study …published_or_final_versionThe 16th Medical Research Conference, The University of Hong Kong, Hong Kong, 22 January 2011. In Hong Kong Medical Journal, 2011, v. 17 suppl. 1, p. 66, abstract no. 11

Blogs, Amazônia e a Floresta Sintá(c)tica: um corpus de um novo gênero?

Hypertension is an important risk factor for cardiovascular disease, which is the leading cause of death in women. We, therefore, analyzed gender-specific trends in the control of blood pressure and prevalence of 5 other cardiovascular risk factors (central obesity, elevated total cholesterol, low high-density lipoprotein cholesterol, hyperglycemia, and smoking) among adults with diagnosed hypertension in the United States. We included 3475 participants aged ≥18 years with diagnosed hypertension in the National Health and Nutrition Examination Survey 1999-2004. The age-adjusted prevalence of uncontrolled blood pressure was 50.8±2.1% in men and 55.9±1.5% in women, which were not significantly different and had not changed significantly with time. Central obesity, elevated total cholesterol level, and low high-density lipoprotein cholesterol were significantly more prevalent in women than in men (79.0±1.0%, 61.3±1.6%, and 39.7±1.6% versus 63.9±1.6%, 48.1±1.8%, and 35.6±1.7%, respectively; P<0.05). The age-adjusted proportion with ≥3 of the 6 risk factors studied was higher in women than in men (52.5±1.4% versus 40.9±1.8%; P<0.001), and this proportion decreased significantly by 7.7% in women from 1999-2000 to 2003-2004 (P<0.05) but not in men. Our study shows that blood pressure control in women with diagnosed hypertension was not significantly inferior compared with men and had not changed significantly in 1999-2004. However, women had higher prevalence of other concomitant cardiovascular risk factors. Although there is room for improvement in blood pressure control, our study has highlighted the importance of addressing concomitant cardiovascular risk factors in women with hypertension. © 2008 American Heart Association, Inc.link_to_subscribed_fulltex

Non-traditional biomarkers in the prediction of cardiovascular events among Chinese

Poster PresentationINTRODUCTION: Biomarkers of subclinical systemic chronic inflammation are increasingly recognised as a key player in atherosclerosis. C-reactive protein, measured using high-sensitivity assay (hsCRP), is the most promising inflammatory marker in predicting the risk of cardiovascular diseases (CVD). As obesity is associated with disregulated expression of various adipokines, either pro-inflammatory or anti-inflammatory, such adipokines may also serve as non-traditional biomarkers for the accelerated atherosclerosis associated with obesity. In this prospective cohort study, we examined the predictive value of a variety of non-traditional biomarkers for CVD among Hong Kong Chinese, and determined if they would …published_or_final_versionThe 17th Medical Research Conference, The University of Hong Kong, Hong Kong, 14 January 2012. In Hong Kong Medical Journal, 2012, v. 18 suppl. 1, p. 20, abstract no. 2

Gamma-glutamyl transferase level predicts the development of hypertension in Hong Kong Chinese

Introduction: Liver enzymes are elevated in cardiometabolic diseases, particularly when there is non-alcoholic fatty liver disease. We therefore investigated if hypertension is associated with elevated levels of alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase and γ-glutamyl transferase (GGT). Methods: We included 235 hypertensive and 708 normotensive subjects from the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS-2) in 2000-2004 who had fewer than one alcoholic drink a week. In the follow-up study in 2005-2008 (CRISPS-3), 126 out of the 708 subjects had developed hypertension. Results: In CRISPS-2, plasma ALT (OR=1.31 per SD of log-transformed level, P=0.005) and GGT (OR=1.52 per SD of log-transformed level, P<0.001) were significantly associated with prevalent hypertension after adjusting for age, sex and body mass index (BMI). Among subjects not on anti-hypertensive medication, plasma ALP and GGT were significantly associated with both systolic blood pressure (beta=0.141, P<0.001 for ALP and beta=0.096, P=0.004 for GGT) and diastolic blood pressure (beta=0.131, P<0.001 for ALP and beta=0.102, P=0.004 for GGT). In forward stepwise logistic regression analysis of subjects normotensive at CRISPS-2, the highest tertile of plasma GGT level was an independent predictor of the development of hypertension in CRISPS-3 (OR=2.40, P=0.010), together with age, BMI, systolic blood pressure and plasma CRP at baseline, and change in BMI. The other liver enzymes were not significantly predictors of new-onset hypertension. Conclusions: Among the four liver enzymes, elevated GGT level is the strongest risk factor for hypertension in Hong Kong Chinese. Acknowledgement: This study was funded by Hong Kong Research Grant Council grants (HKU7229/01M and HKU7626/07M) and the Sun Chieh Yeh Heart Foundation.published_or_final_versio

Role of genetic variants in gene encoding lipocalin-2 in the development of elevated blood pressure

Introduction: Lipocalin-2 is recently recognised as a biomarker of obesity and inflammation, which are both risk factors for hypertension. We therefore investigated the association of common single nucleotide polymorphisms (SNPs) in the gene encoding lipocalin-2 (LCN2) with elevated blood pressure in Hong Kong Chinese. Methods: Five tagging SNPs were genotyped in 1936 subjects from the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS-2) with a median follow-up period of 6.4 years. Elevated blood pressure was defined as ≥130/85 mm Hg or taking anti-hypertensive medication. Results: There were only two haplotypes with frequency of >5%, namely AGATC (45.5%) and GGTCC (41.2%). Haplotype GGTCC was associated with elevated blood pressure at follow-up (OR=1.17 compared to haplotype AGATC, P=0.031 after adjusting for age and sex). Among 1381 subjects without elevated blood pressure at baseline, 321 subjects developed elevated blood pressure at follow-up. Haplotype GGTCC was associated with the development of elevated blood pressure at follow-up (OR=1.30 compared to haplotype AGATC, P=0.011 after adjusting for age, sex, systolic blood pressure, and follow-up duration; OR=1.44, P=0.0015 after further adjusting for other covariates). Among subjects not taking anti-hypertensive medication, carriers of the haplotype GGTCC had higher systolic blood pressure than non-carriers (119.7±16.4 mm Hg vs 117.9±17.3 mm Hg, P=0.043). Conclusion: Our findings suggest, for the first time, that genetic variants in LCN2 may affect blood pressure. Further studies on the role of lipocalin-2 in blood pressure regulation are warranted. Acknowledgement: This study was funded by Hong Kong Research Grant Council grants (HKU7229/01M and HKU7626/07M) and the Sun Chieh Yeh Heart Foundation.published_or_final_versio

Gamma-glutamyl transferase level predicts the development of hypertension in Hong Kong Chinese

Background: Plasma activities of alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase, and γ-glutamyl transferase (GGT) are often increased in cardiometabolic diseases. We investigated if hypertension is associated with increased activities of these plasma markers. Methods: We included 235 hypertensive and 708 normotensive subjects (mean age 47.3 ± 9.6 and 58.0 ± 10.2. years respectively) from the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS-2) in 2000-2004 who had drank < 1/week. In the follow-up study in 2005-2008 (CRISPS-3), 126 out of the 708 subjects had developed hypertension. Results: Raised plasma ALT (OR = 1.22 per SD of log-transformed level, P=0.045) and GGT (OR = 1.38 per SD of log-transformed level, P=0.001) levels were associated with hypertension at baseline in CRISPS-2 after adjusting for covariates. Among subjects not on anti-hypertensive medications, plasma ALP, ALT and GGT were related to blood pressure (P< 0.01). In subjects normotensive at CRISPS-2, plasma GGT, but not ALP, ALT and AST, was an independent predictor of new-onset hypertension at CRISPS-3 (OR = 1.38 per SD of log-transformed level, P=0.020 and OR = 2.68 for 3rd tertile vs. 1st tertile, P=0.004) after adjusting for covariates. Conclusions: Among the 4 plasma markers, increased GGT activity is the strongest predictor for existing and new-onset hypertension in Hong Kong Chinese. © 2011 Elsevier B.V.postprin

Implication of the obesity-associated genetic variants identified from recent genome-wide association studies in Hong Kong Chinese

published_or_final_versionThe 15th Annual Research Conference of the Department of Medicine, The University of Hong Kong, Hong Kong, 16 January 2010. In Hong Kong Medical Journal, 2010, v. 16, suppl. 1, p. 15, abstract no. 1