Six-month adherence to Statin use and subsequent risk of major adverse cardiovascular events (MACE) in patients discharged with acute coronary syndromes

Acknowledgements: The authors thank all participants who contributed to the study. Funding: CPACS-1 was funded by unrestricted educational grants from Guidant and Sanofi-Aventis, and grants from The Royal Australasian College of Physicians. AP is supported by an Australian National Heart Foundation Career Development Award. CPACS-2 was funded by an unrestricted grant from Sanofi-Aventis China. The George Institute for Global Health at Peking University Health Science Center sponsored the study and owns the data. Data analyses and reports were supported by Beijing Science and Technology Key Research Plan (D151100002215001). However, the authors are solely responsible for the design, analyses, the drafting and editing of the manuscript, and its final contents.Peer reviewedPublisher PD

A Survey on Clinical Research Training Status and Needs in Public Hospitals from Shenzhen

Objective: To obtain information on the current clinical research training status and evaluate the training needs comprehensively for medical staff in hospitals.Methods: This survey was initiated and conducted by the Health and Family Planning Commission of Shenzhen in conjunction with the Peking University Clinical Research Institute (Shenzhen) from Sep 2016 through Nov 2016. It was planned that no less than 10% of the total staff from each participating hospital were invited to complete the survey. All participants filled out the questionnaire anonymously and voluntarily.Results: A total of 644 subjects from 12 hospitals completed the survey with the response rate of 28.7%. The majority of respondents (80%) have attended training related to clinical research knowledge and skills, however, medical research ethical aspects and statistics knowledge have been provided only for 40% and 27% of respondents, respectively. With regard to preference on training subjects and contents, Protocol design and development (74%) is ranked first, followed by the data analysis and summary (59%) among those researchers from medical professions. Project management and quality control course are mostly demanded for technicians and nurses (53%). Unpredictably, no more than 40% of the respondents consider that it is necessary to receive “Regulation and Research ethics” course even for those Principal investigators.Conclusions: Our survey results indicated that training subjects on protocol design and research ethics are urgently needed and relatively inadequate in China. An appropriate clinical research competency training model should be developed and provided for hospital staffs in China

Factors explaining the gender disparity in lipid-lowering treatment goal attainment rate in Chinese patients with statin therapy

Background: The lipid-lowering treatment goal attainment rate is lower for women than for men among Chinese patients, but the reasons for this disparity have not been fully explored yet. Objectives: To elucidate the potential factors and the significance of their contributions towards the observed discrepancy in lipid-lowering treatment goal attainment rates between Chinese women and men. Methods: We used data from 1808 patients from 21 tertiary and 6 secondary hospitals in China who received and maintained statin therapy treatment for at least 2 months. Lipid-lowering treatment goal attainment was defined as low-density lipoprotein cholesterol (LDL-C) reaching the treatment targets recommended by the Chinese Guidelines on Prevention and Control of Dyslipidemia in Adults. Logistic Regression was used to explore possible factors associated with gender disparity in goal attainment rates, and to what extent each factor contributes. Results: A total of 674 women and 1134 men were enrolled in the study. Women had a significantly lower LDL-C goal attainment rate than that of men (46.0% vs 53.8%, P = 0.002), particularly in high and very high CVD risk groups. Among high and very high risk patients, approximately 35%, 7%, 5%, and 5% of gender disparity in LDL-C goal attainment rate was attributable to the gender difference in baseline LDL-C level, cardiovascular co-morbidities and associated risk factors, socioeconomic status, and the dosage of statin treatment, respectively. Approximately 50% of the gender disparity remained unexplained by these factors. Conclusions: Although nearly half of the gender disparity in lipid-lowering treatment goal attainment rate can be explained by the gender differences in baseline lipid level, socioeconomic status, cardiovascular co-morbidities and associated risk factors, and the dosage of statin in high and very high CVD risk patients, the other half of the gender disparity remains unexplained and requires further study to fully understand what other factors are at play.Biochemistry & Molecular BiologyNutrition & DieteticsSCI(E)PubMed6ARTICLE591

Using low-cost sensor technologies and advanced computational methods to improve dose estimations in health panel studies: results of the AIRLESS project.

BACKGROUND: Air pollution epidemiology has primarily relied on fixed outdoor air quality monitoring networks and static populations. METHODS: Taking advantage of recent advancements in sensor technologies and computational techniques, this paper presents a novel methodological approach that improves dose estimations of multiple air pollutants in large-scale health studies. We show the results of an intensive field campaign that measured personal exposures to gaseous pollutants and particulate matter of a health panel of 251 participants residing in urban and peri-urban Beijing with 60 personal air quality monitors (PAMs). Outdoor air pollution measurements were collected in monitoring stations close to the participants' residential addresses. Based on parameters collected with the PAMs, we developed an advanced computational model that automatically classified time-activity-location patterns of each individual during daily life at high spatial and temporal resolution. RESULTS: Applying this methodological approach in two established cohorts, we found substantial differences between doses estimated from outdoor and personal air quality measurements. The PAM measurements also significantly reduced the correlation between pollutant species often observed in static outdoor measurements, reducing confounding effects. CONCLUSIONS: Future work will utilise these improved dose estimations to investigate the underlying mechanisms of air pollution on cardio-pulmonary health outcomes using detailed medical biomarkers in a way that has not been possible before.This project is funded under the Newton Fund Programme awarded by Natural Environmental Research Council (NERC Grant NE/N007018/1) with support from Medical Research Council (MRC) and by the National Natural Science Foundation of China (NSFC Grant 81571130100). The NSFC funding is mainly used to support the field work in China, and NERC funding is mainly used for coordination and the further analysis

Association between plant-based diets and blood pressure in the INTERMAP study.

BACKGROUND: Plant-based diets are associated with a lower risk of cardiovascular diseases; however, little is known how the healthiness of the diet may be associated with blood pressure (BP). We aimed to modify three plant -based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) according to country-specific dietary guidelines to enable use across populations with diverse dietary patterns - and assessed their associations with BP. DESIGN: We used cross-sectional data including 4,680 men and women ages 40-59y in Japan, China, the United Kingdom, and the United States from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). During four visits, eight BP measurements, and four 24-h dietary recalls were collected. Multivariable regression coefficients were estimated, pooled, weighted, and adjusted extensively for lifestyle/dietary confounders. RESULTS: Modified PDI was not associated with BP. Consumption of hPDI higher by 1SD was inversely associated with systolic (-0.82 mm Hg;95% CI:-1.32,-0.49) and diastolic BP (-0.49 mm Hg; 95% CI:-0.91, -0.28). In contrast, consumption of an uPDI was directly associated with systolic (0.77 mm Hg;95% CI:0.30,1.20). Significant associations between hPDI with BP were attenuated with separate adjustment for vegetables and whole grains; associations between uPDI and BP were attenuated after adjustment for refined grains, sugar-sweetened beverages, and meat. CONCLUSION: An hPDI is associated with lower BP while a uPDI is adversely related to BP. Plant-based diets rich in vegetables and whole grains and limited in refined grains, sugar-sweetened beverages, and total meat may contribute to these associations. In addition to current guidelines, the nutritional quality of consumed plant foods is as important as limiting animal-based components. TRIAL REGISTRATION NUMBER: The observational INTERMAP study was registered at www.clinicaltrials.gov as NCT00005271

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition.

Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and$24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action

Prevalence of overweight and obesity among Chinese Yi nationality: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Overweight and obesity are considered a serious health problem. There are little data on the prevalence of overweight and obesity among the Yi ethnic group in China. This study aimed to investigate the epidemiologic features of overweight/obesity among Chinese Yi nationality.</p> <p>Methods</p> <p>A cross-sectional study, including 1255 subjects aged 20-75 years, was carried out in Liangshan Yi Autonomous Prefecture of Sichuan province from 2007 to 2008. Overweight/overall obesity was defined by World Health Organization (WHO) or the Working Group on Obesity in China.</p> <p>Results</p> <p>Overall, the prevalence of overweight and obesity was 19.0% and 2.9%, respectively, based on the WHO definition, while it was 21.0% and 7.4%, respectively, according to the Working Group on Obesity in China, which is similar to data reported in the 2002 Chinese National Nutrition and Health Survey. Urban residents had a significantly higher prevalence of obesity (WHO criteria: 4.3% vs 1.7% <it>p </it>= 0.008; China criteria: 11.4% vs 3.7%, <it>p </it>< 0.001) and overweight (WHO criteria: 28.9% vs 8.9% <it>p </it>< 0.001; China criteria: 31.2% vs 10.4%, <it>p </it>< 0.001) than that in rural residents. Older age, a family history of obesity, higher income, drinking and urban residence were significantly associated with an increased risk of overweight/obesity.</p> <p>Conclusions</p> <p>The prevalence of overweight/obesity in the Yi nationality is similar to that in Chinese adults 5 years ago. However, urban residents have a much higher prevalence of overweight/obesity than their rural counterparts. Lifestyle and diet patterns associated with socioeconomic status may explain the difference between urban and rural residents. The prevention of overweight/obesity among urban inhabitants deserves more attention in national health education programs.</p

Association of Monosodium Glutamate Intake With Overweight in Chinese Adults: The INTERMAP Study

Animal studies indicate that monosodium glutamate (MSG) can induce hypothalamic lesions and leptin resistance, possibly influencing energy balance, leading to overweight. This study examines the association between MSG intake and overweight in the human species. We conducted a cross-sectional study of 752 healthy Chinese (48.7% women), ages 40 to 59 years, randomly sampled from three rural villages in north and south China. The great majority of participants prepared their foods at home, without use of commercially processed foods. Diet was assessed with four in-depth multi-pass 24-hour recalls. Participants were asked to demonstrate MSG amounts added in food preparation. Amounts shaken out were weighed by trained interviewers. Overweight was defined as body mass index ≥25.0 kg/m2 or ≥23.0 (based on World Health Organization recommendations for Asian populations). Eighty-two percent of participants used MSG. Average intake was 0.33 gram/day (standard deviation=0.40). With adjustment for potential confounders including physical activity and total energy intake, MSG intake was positively related to body mass index. Prevalence of overweight was significantly higher in MSG users than non-users. For users in the highest tertile of MSG intake compared to non-users, the multivariable-adjusted odds ratios of overweight (body mass index ≥23.0 and ≥25.0) were 2.10 (95% CI, 1.13–3.90, P for trend across four MSG categories=0.03) and 2.75 (95% CI, 1.28–5.95, P=0.04). This research provides human data that MSG intake may be associated with increased risk of overweight independent of physical activity and total energy intake