BACKGROUND:Previous studies have reported that insulin resistance (IR), blood pressure, body mass index (BMI), and dyslipidemia are associated with arterial stiffness. However, limited evidence exists regarding these relationships in prediabetes patients. The purpose of this study was to investigate the longitudinal associations between cardiometabolic risk markers and progression of arterial stiffness. METHODS:This study included 5771 adults with prediabetes at baseline from the Shougang cohort study. Cardiometabolic risk markers included the triglyceride glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, mean arterial pressure (MAP), BMI, and dyslipidemia. Arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV), and its progression was defined as the annual change in baPWV between baseline and the last visit. Multivariate linear and logistic regression models were used to investigate the associations. RESULTS:Multivariate linear regression analyses showed TyG index, TG/HDL-C ratio, MAP, and dyslipidemia were significantly associated with baseline baPWV. Over a mean follow-up of 3.24 years, each one-unit increase in the MAP was significantly associated with a faster progression of baPWV (difference, 0.72 cm/s per year; 95% CI, 0.40 to 1.04 cm/s per year). After adjusting for all covariates, the risk for arterial stiffness increased 3% with each one-unit increase of MAP. CONCLUSION:Among individuals with prediabetes, MAP showed consistent longitudinal associations with arterial stiffness, highlighting the importance of early blood pressure management for vascular protection prior to the onset of diabetes.

To explore whether healthy lifestyle factors (HLFs) predict a lower risk of major macrovascular and microvascular events and death in people with type 2 diabetes (T2D) with a high risk of vascular complications. Post hoc analyses of 11,133 participants with T2D in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial who were assigned a score ranging from 0 to 4 based on the number of baseline HLFs: never smoked, moderate-to-vigorous physical activity, ideal waist/hip ratio, and low-to-moderate alcohol consumption. Multivariable Cox models were used to determine associations of 0, 1, 2, and ≥ 3 HLFs with vascular events and all-cause mortality. Compared to participants with no HLFs, hazard ratios for participants with 3 or 4 HLFs were 0.68 (95

Ambulatory blood pressure monitoring (ABPM) is increasingly recommended in clinical practice, but few large-scale studies were conducted on the characteristics of ABPM in obese hypertensive patients. The purpose of the present study was to assess the roles of age and body weight in modulating blood pressure (BP). In this cohort, 35,367 hypertensive patients were recruited and the International Obesity Task Force criteria were used to classify weight groups. Hypertension was defined according to the guidelines. According to ABPM records, 70.5% of participants had 24-h hypertension and 26.1% had dipper rhythm. Of these, 2.6% were underweight, 51.0% were normal, 38.2% were overweight, and 8.2% were in the obese category. In overweight and obese participants, 48%, and 45.1% of patients were non-dippers. Obese patients had higher 24h BP, especially morning BP surge. The prevalence of reverse-dipper rhythm hypertension and morning hypertension increased with age and obesity degree. A positive correlation between BP and variability was observed. Obese hypertensives had elevated 24h, diurnal and nocturnal heart rates. In hypertensives, ABPM characteristics were significantly modulated by body weight in the present cohort, implying that body weight control may constitute an approach for normalizing the ABPM pattern.

Objective: To examine the effects of long-term consumption of potassium-enriched salt (KCl: NaCl=1:1 by weight) on various health outcomes, including blood pressure, urinary sodium-potassium ratio, stroke, cardiovascular disease (CVD), and all-cause mortality, among individuals living in nursing homes. Design and method: In northern China, a total of 29 nursing homes were selected using cluster random sampling, with each county representing a cluster. These nursing homes were then divided into two groups: the intervention group, which consumed potassium-enriched, low-sodium salt, and the control group, which consumed regular salt. Baseline and seven follow-up surveys were conducted using standard cardiovascular disease epidemiological survey methods from 2011 to 2018. For the purpose of survival analysis, the population considered consisted of individuals aged 40 years or older who had stayed in the nursing home for at least six months. Results: In the baseline assessment, there were no significant differences in the average blood pressure between the two groups. However, during the follow-up surveys, it was observed that the intervention group had significantly lower systolic blood pressure (SBP) and a lower sodium-potassium ratio. The survival analysis was conducted on a total of 3543 participants, with 1065 death events recorded. After adjusting for age and sex using Cox proportional hazards models, the intervention group had an HR of 0.883 (95% CI 0.782-0.997) compared to the control group for all-cause mortality. Subgroup analysis was also performed for individuals aged 40-70 years, which revealed that the intervention group had lower HRs for all-cause mortality, CVD (including stroke), and stroke death, with HRs of 0.780 (95% CI 0.633-0.964), 0.664 (95% CI 0.489-0.903), and 0.681 (95% CI 0.473-0.981), respectively. For individuals aged over 70 years, the results were not statistically significant. Conclusions: Long-term consumption of potassium-enriched salt in northern China is safe and feasible. It significantly reduces blood pressure, and urinary sodium-potassium ratio, and lowers the risk of mortality in individuals aged 40-70. These results support the potential benefits of using potassium-enriched, low-sodium salt as a public health intervention to improve cardiovascular health outcomes in this population.

BACKGROUND:Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China). METHODS:The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes. RESULTS:Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants. CONCLUSION:Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.

Objective: to explore the promoting effect of long-term consumption of potassium-enriched salt (KCL/NACL=1:1) on dietary salt restriction in the nursing home population. Design and method: In northern China, a total of 29 nursing homes were selected using cluster random sampling. The nursing homes were divided into intervention group (using potassium-enriched salt in the dining room) and control group (using regular salt in the dining room). The usage of salt and high-sodium condiments in the dining room was recorded, including the amount of salt used and the number of diners. The average per capita daily sodium intake from condiments (TNA/PD) in the nursing home was calculated, as well as the average per capita daily sodium intake from dietary salt (SNA/PD). The two values were added together to calculate the total per capita daily sodium intake (ANA/PD). Results: Over 6 years, a total of 18,046 meals were consumed in the dining room. The intervention group demonstrated a significant reduction in per capita daily sodium intake (ANA/PD) compared to the control group (3.0 vs 5.0g). There was no statistically significant difference in per capita daily sodium intake from condiments (TNA/PD) between the two groups, but the intervention group exhibited a significantly lower per capita daily sodium intake from dietary salt (SNA/PD) compared to the control group (2.2 vs 4.1g). Furthermore, the intervention group consistently maintained a lower urine sodium-to-potassium ratio than the control group. By incorporating potassium-enriched salt, the intervention group achieved an average increase of 1.2±0.31g in daily potassium intake. Subgroup analysis of 24-hour urine results indicated that the intervention group had significantly lower urinary sodium excretion and higher potassium excretion. Following one year of using potassium-enriched salt, the estimated dietary salt intake in the intervention group decreased from approximately 15g to around 9g based on urinary sodium excretion. Conclusions: These findings suggest that the utilization of potassium-enriched salt can effectively reduce sodium intake without necessitating alterations in dietary habits.

Background:Smoking is a major risk factor for the global burden of stroke. We have previously reported a global population attributable risk (PAR) of stroke of 12.4% associated with current smoking. In this study we aimed to explore the association of current tobacco use with different types of tobacco exposure and environmental tobacco smoke (ETS) exposure on the risk of stroke and stroke subtypes, and by regions and country income levels. Methods:The INTERSTROKE study is a case-control study of acute first stroke and was undertaken with 13,462 stroke cases and 13,488 controls recruited between January 11, 2007 and August 8, 2015 in 32 countries worldwide. Association of risk of tobacco use and ETS exposure were analysed with overall stroke, ischemic and intracerebral hemorrhage (ICH), and with TOAST etiological stroke subtypes (large vessel, small vessel, cardioembolism, and undetermined). Findings:Current smoking was associated with an increased risk of all stroke (odds ratio [OR] 1.64, 95% CI 1.46-1.84), and had a stronger association with ischemic stroke (OR 1.85, 95% CI 1.61-2.11) than ICH (OR 1.19 95% CI 1.00-1.41). The OR and PAR of stroke among current smokers varied significantly between regions and income levels with high income countries (HIC) having the highest odds (OR 3.02 95% CI 2.24-4.10) and PAR (18.6%, 15.1-22.8%). Among etiological subtypes of ischemic stroke, the strongest association of current smoking was seen for large vessel stroke (OR 2.16, 95% CI 1.63-2.87) and undetermined cause (OR 1.97, 95% CI 1.55-2.50). Both filtered (OR 1.73, 95% CI 1.50-1.99) and non-filtered (OR 2.59, 95% CI 1.79-3.77) cigarettes were associated with stroke risk. ETS exposure increased the risk of stroke in a dose-dependent manner, exposure for more than 10 h per week increased risk for all stroke (OR 1.95, 95% CI 1.69-2.27), ischemic stroke (OR 1.89, 95% CI 1.59-2.24) and ICH (OR 2.00, 95% CI 1.60-2.50). Interpretation:There are significant variations in the magnitude of risk and PAR of stroke according to the types of tobacco used, active and ETS exposure, and countries with different income levels. Specific strategies to discourage tobacco use by any form and to build a smoke free environment should be implemented to ease the global burden of stroke. Funding:The Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, and through unrestricted grants from several pharmaceutical companies with major contributions from Astra Zeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MERCK, Sharp and Dohme, Swedish Heart and Lung Foundation, UK Chest, and UK Heart and Stroke.

Background and Aim: Little is known about whether early menopause in Chinese ethnicity is associated with acute myocardial infarction (AMI). We aimed to determine whether self-reported early menopause (either surgical or natural menopause at an age <50 year) was associated with first AMI in Chinese women. Methods: The study population was from the INTERHEART China Study, part of the INTERHEART global study. INTERHEART global study was a standardized case-control study that was designed to evaluate the risk factors for first AMI among 52 countries. Data for demographic factors, education, income, and cardiovascular risk factors were obtained by structured questionnaires. A standard set of questions that inquired about menstrual history was included in the interview. Results: Of the 1,771 Chinese women, 1,563 (88.3%) reported either natural or surgical menopause. In univariate logistic regression model, women with early menopause had higher risk of AMI (odds ratio [OR]: 1.51; 95% confidence interval [CI]: 1.23-1.87). After controlling for age, birth control measures, type of menopause, and other traditional risk factors (including waist/hip ratio, lifestyle factors, history of hypertension and diabetes, psychosocial factors, and apolipoprotein B [ApoB]/A1 [ApoA1]), the risk for AMI remained (OR: 1.36; 95% CI: 1.03-1.79). The population attributable risk for AMI in women with early menopause at <50 years was 10.1% (95% CI: 4.0-20.0) compared with women who had menopause at ≥50 years. Conclusion: Early menopause is associated with increased risk of AMI in Chinese women, independent of other traditional coronary heart disease risk factors.

Preeclampsia (PE) is a complication of pregnancy characterized by the new onset of hypertension after 20 weeks of gestation. The incidence of PE is steadily rising, posing a significant threat to the lives of both the pregnant woman and the fetus. Most studies on PE pathogenesis currently focus on the placenta, but maternal decidualization forms the foundation for placental growth and development. Recent studies have shown that impaired decidualization is also a cause of PE. Decidualization is a process where endometrial stromal cells gradually transform into secretory decidual cells during early pregnancy. While NSUN5 encodes a member of a conserved family of proteins, its role in pregnancy remains unknown. In this study, we conducted experiments and observed a significant downregulation of NSUN5 expression in severe PE decidual tissues compared to those of normal pregnant women. When inducing decidualization in vitro, we found an increase in NSUN5 expression. However, when we used siRNA to knockdown NSUN5 expression, the process of decidualization was prevented. Moreover, we observed a decrease in ATP content during both cell decidualization and after knockdown of NSUN5. Finally, through immunoprecipitation combined with mass spectrometry, we discovered that the protein ATP5B interacts with NSUN5. Furthermore, after knocking down ATP5B using siRNA, we observed impaired decidualization. Moreover, transfection with siRNA to suppress NSUN5 resulted in a decrease in ATP5B expression. These significant findings provide strong evidence that NSUN5 plays a crucial role in decidualization and is closely associated with the development of PE through its interaction with ATP5B.

Background: To date, many studies have proved the association between siesta and cardiovascular events. As the baPWV can assess the degree of atherosclerosis and the arterial stiffness, little is known about the association between siesta and baPWV levels. Thus we used a cross-sectional study to examine the association between siesta and baPWV levels. Methods: The baseline examination of 6,566 participants aged > 35 years included interviews, physical examinations, laboratory tests, and electron beam computed tomography. We compared the baseline data in 3 categories of siesta habits: irregular or no siestas; daily short siestas (1 hour or less); and daily long siestas (> 1 hour). Logistic regression models and multiple linear regression were applied to find the association between siesta and baPWV. Results: Among all participants, the different siesta groups have a significant difference of the prevalence of several AS degrees (P < 0.001). We also found a similar result in male or female (male P < 0.001, female P < 0.001). Daily long siestas had positive associations with prevalence of several cardiovascular risk factors and measures of subclinical atherosclerosis. Results from model3 (fully adjusted model) showed that long siesta (> 60 min, OR = 1.18, 95%CI: 1.06–1.31, P = 0.002) was associated with more severe level of the baPWV. For age or gender stratification, we found significant differences between non-siesta and > 60 min siesta groups from model3. Multiple linear regression analysis showed a positive relationship be¬tween siesta duration and baPWV (b; = 0.197, P = 0.038). Conclusions: Long siesta was associated with increased risk of atherosclerosis. These findings warrant further examination with prospective studies and laboratory investigations.

Objective: Our study aimed to investigate the association between obesity status change and hypertension onset based on a longitudinal community-based cohort study in north China. Design and method: A total of 2618 individuals free of hypertension at baseline were collected from the longitudinal cohort study from 2011 to 2019. The correlation between the obesity status change and the hypertension onset was analyzed by inter groups differences analysis, an adjusted Cox regression model, and Kaplan-Meier survival analysis. Furthermore, the forest plot was used to visualize the subgroups analysis results including age, gender, and the differences of BMI and blood pressure between the baseline and the follow-up. Results: Over nearly 7 years follow-up, a total of 811 (31%) were found to develop future hypertension. The new-onset hypertension was mostly observed in participants who were keeping obese all the time (P for trend < 0.01). In the fully adjusted Cox regression model, keeping obese all the time would result in a 30.10% elevated risk of hypertension. The Kaplan-Meier survival analysis revealed the change in obesity status as an important feature to predict the occurrence of hypertension. What's more, we found the female gender and age over 60 years old were the important risks for people with different degree of BMI to have future hypertension. Conclusions: This study suggested maintaining obesity status was significantly associated with the risk of hypertension onset among Chinese adults based on a community-based longitudinal cohort. Even if people delivered weight loss after obesity, their hypertension level could not return to normal in a short time.

Objective: The aim of our study was to investigate the association between BMI and Chinese hypertensive patients’ ambulatory blood pressure characteristics. Design and method: According to the inclusion criteria and exclusion criteria, recruiting participants for analysis. Overweight was defined as BMI = > 18.5 kg/m 2 , and obesity as BMI = > 25 kg/m 2 . ABPM characteristics were defined according to European guidelines. Hypertension was defined as elevated mean ambulatory BP (>135/85 mmHg in day-time, >120/70 mmHg in the night-time, >130/80 mmHg over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers, and extreme dippers. The effects of BMI on ambulatory blood pressure characteristics were analyzed using between-group analysis of variance and logistic regression analysis. Results: In our cohort, 35367 hypertensive patients who were eligible for this study were analyzed finally, including 19380 men (54.8%) and 15987 women (45.2%) aged from 19 to 99 (mean age 58.86 years). The mean 24hBP of the study subjects was 126.41±16.00/78.79±11.62 mmHg. The different BMI groups showed that ambulatory BP increased with BMI, and the obese group had the highest increase in BP, HR, and systolic BP (P < 0.05). Blood pressure variability and systolic load tended to increase with BMI, while the nocturnal blood pressure drop rate tended to decrease. When analyzing the type of hypertension among the participants, the prevalence of MBPS and morning hypertension increased significantly with the elevated BMI (P < 0.05), and the highest prevalence of MBPS was found in the obese group. Logistic regression analysis revealed that the increased risks of MBPS and morning hypertension were the highest in the obese group, corresponding to a 2.1-fold (P < 0.05) and 1.6-fold (P < 0.05) increase in risk, respectively, with no change in trend after adjustment. Conclusions: BMI may affect the characteristics of hypertensive patients’ ambulatory blood pressure. The blood pressure variability and 24h SBP tended to increase with BMI, and the incidence of MBPS was highest in the obese group.

ObjectiveThe purpose of our study was to investigate the association of obesity status change with hypertension onset based on a community-based longitudinal cohort study in North China.MethodsThis longitudinal study included 3,581 individuals free of hypertension at baseline in the first survey (2011–2012). All participants were followed up (2018–2019). According to the criteria, a total of 2,618 individuals were collected for analysis. We used adjusted Cox regression models and Kaplan–Meier survival analysis to estimate the association between obesity status change and hypertension onset. Additionally, we applied the forest plot to visualize the subgroup analysis including age, gender, and the differences in some variables between baseline and follow-up. Finally, we conducted a sensitivity analysis to examine the stability of our results.ResultsOver nearly 7 years of follow-up, a total of 811 (31%) developed hypertension. The new hypertension incidence was mostly observed in those who were obese all the time (P for trend < 0.01). In the fully adjusted Cox regression model, being obese all the time increased the risk of hypertension by 30.10% [HR 4.01 (95% CI 2.20–7.32)]. The Kaplan–Meier survival analysis revealed the change in obesity status as an important feature to predict the occurrence of hypertension. Sensitivity analysis shows a consistent trend between the change in obesity status and hypertension onset in all populations. Subgroup analysis showed that age above 60 years was an important risk factor for hypertension onset, that men were more likely than women to develop hypertension, and that weight control was beneficial in avoiding future hypertension in women. There were statistically significant differences in ΔBMI, ΔSBP, ΔDBP, and ΔbaPWV between the four groups, and all variables, except baPWV changes, increased the risk of future hypertension.ConclusionOur study shows that obese status was notably associated with a significant risk of hypertension onset among the Chinese community-based cohort.

Hypertension is the leading cause of death and disability worldwide, due to its high prevalence and severe complications (stroke, heart attack, etc). Control of hypertension could prevent most unnecessary outcomes. However, detecting hundreds of millions of hypertensive patients globally and controlling BP to target for the rest of their lives could be a huge burden to all health care systems. The HEARTS technical package developed by WHO provides tools for governments and professional organizations to support primary care services (PCS) to apply evidence-based strategies to control and prevent cardiovascular diseases. The HEARTS China hypertension control project was initiated in 2017. It is owned by governments, technically supported by a hypertension specialist committee and managed by the secretariat. The standard protocol with screening for all adult visitors, and stepwise treatment with calcium channel blockers + ARB + thiazide-like diuretic was selected by the advisory committee. The supply of selected medications was supported by governments. The HEARTS monitoring system, with ID card-driven automatic BP measurement and data transfer to the doctors web page (no data entry), records screening, registration and prescriptions during daily practice. The information helps physicians with decision making in diagnosis and treatment and provides regular quality and progress reports to PSCs and health authorities. Up to December 2021, a cumulative total of 894 PSCs participated in the project. They screened more than 620,000 adults, registered over 268,000 and treated 190,000 hypertensive patients. A total of 86,523 patients achieved the goal of BP control at their last visit. The awareness, treatment and control rates improved continuously in the project-involved areas. Consequently, the episodes of hospitalization for cardiovascular disease among all-cause hospitalizations reduced by 13%. It reduced more in the service areas that screened and treated more hypertensive patients, than in those that screened and treated fewer patients (-15% vs -6%). However, the data recorded in the monitoring system indicated serious clinical inertia in the implementation of the HEARTS protocol: screening does not yet involve all visitors; nearly 30% of diagnosed patients were untreated, 70% of treated patients were not regularly followed-up; only 19% of patients with BP> = 160/100 initiated treatment with combined medications; 64% of revisited patients with uncontrolled BP failed to intensify treatment. More training courses and incentive mechanisms may help PSCs to improve the quality of care. Implementing HEARTS has improved quality and coverage for hypertension control. Overcoming clinical inertia should be able to accelerate this progress.

The past two to three decades have seen a steady increase in the prevalence of hypertension in China, largely owing to increased life expectancy and lifestyle changes (particularly among individuals aged 35–44 years). Data from the China hypertension survey conducted in 2012–2015 revealed a high prevalence of grade 3 hypertension (systolic blood pressure ≥180 mmHg and diastolic blood pressure ≥110 mmHg) in the general population, which increased with age to up to 5% among individuals aged ≥65 years. The risk profile of patients with hypertension in China has also been a subject of intense study in the past 30 years. Dietary sodium and potassium intake have remained largely the same in China in the past three decades, and salt substitution strategies seem to be effective in reducing blood pressure levels and the risk of cardiovascular events and death. However, the number of individuals with risk factors for hypertension and cardiovascular disease in general, such as physical inactivity and obesity, has increased dramatically in the same period. Moreover, even in patients diagnosed with hypertension, their disease is often poorly managed owing to a lack of patient education and poor treatment compliance. In this Review, we summarize the latest epidemiological data on hypertension in China, discuss the risk factors for hypertension that are specific to this population, and describe several ongoing nationwide hypertension control initiatives that target these risk factors, especially in the low-resource rural setting.

Introduction: To this date, many studies have proposed an association between napping and multiple cardiovascular events. The brachial-ankle pulse wave velocity (baPWV) level can be used as an indicator of vascular stiffness and is becoming a non-invasive indicator of diseases such as atherosclerosis and coronary artery disease (CAD). However, few associations between napping and baPWV levels combined with cardiovascular disease are known. Therefore, we investigated the association of napping with baPWV and CAD in a prospective cohort study. Hypothesis: To study the association of napping with baPWV and CAD in a prospective cohort study, and to guide the lifestyle of the population. Methods: Interviews, physical examinations, laboratory tests, and bapwv testing were part of baseline assessments of 3636 participants who were continuously followed from 2012 to 2018. The population was divided into three groups based on nap frequency that non-siesta group, intermittent siesta group and continuous siesta group. The association of napping with baPWV and CAD were determined using survival curve, COX regression models and multivariate linear regression. Results: Among all participants, the different groups have a significant difference of baPWV and the highest was in the continuous siesta group (2012: 1668.59cm/s, 2019: 1723.69cm/s). After χ2 test, the incidence of abnormal baPWV showed an ascending trend as the frequency of napping increased, siesta was positively correlated with baPWV (P<0.001). Of the participants, 45, 97 and 47 (6.4% vs 5.5% vs 4.0%) persons in three groups newly found CHD after baseline (P<0.001). According to Cox regression analysis, in the fully controlled model, participants in the continuous siesta group [ HR 1.519 (95%CI 1.004-2.296); P<0.05] exhibited a 1.519-fold risk of CAD occurrence when setting the non-siesta group as reference. After adjusting for multiple variables in multiple linear regression analysis, we found the positive relationship between nap frequency and baPWV values (P=0.008) Conclusions: An elevated baPWV and danger of CAD were shown to influenced by increased frequency of siestas. These results need to be verified by additional lab work.

Background and Objectives Symptoms of sleep disturbance are common and may represent important modifiable risk factors of stroke. We evaluated the association between a spectrum of sleep disturbance symptoms and the risk of acute stroke in an international setting. Methods The INTERSTROKE study is an international case-control study of patients presenting with first acute stroke and controls matched by age (±5 years) and sex. Sleep symptoms in the previous month were assessed through a questionnaire. Conditional logistic regression estimated the association between sleep disturbance symptoms and acute stroke, expressed as odds ratios (ORs) and 95% CIs. The primary model adjusted for age, occupation, marital status, and modified Rankin scale at baseline, with subsequent models adjusting for potential mediators (behavioral/disease risk factors). Results Overall, 4,496 matched participants were included, with 1,799 of them having experienced an ischemic stroke and 439 an intracerebral hemorrhage. Short sleep (<5 hours: OR 3.15, 95% CI 2.09–4.76), long sleep (>9 hours: OR 2.67, 95% CI 1.89–3.78), impaired quality (OR 1.52, 95% CI 1.32–1.75), difficulty getting to sleep (OR 1.32, 95% CI 1.13–1.55) or maintaining sleep (OR 1.33, 95% CI 1.15–1.53), unplanned napping (OR 1.48, 95% CI 1.20–1.84), prolonged napping (>1 hour: OR 1.88, 95% CI 1.49–2.38), snoring (OR 1.91, 95% CI 1.62–2.24), snorting (OR 2.64, 95% CI 2.17–3.20), and breathing cessation (OR 2.87, 95% CI 2.28–3.60) were all significantly associated with an increased odds of acute stroke in the primary model. A derived obstructive sleep apnea score of 2–3 (2.67, 2.25–3.15) and cumulative sleep symptoms (>5: 5.38, 4.03–7.18) were also associated with a significantly increased odds of acute stroke, with the latter showing a graded association. After an extensive adjustment, significance was maintained for most of the symptoms (not difficulty getting to/maintaining sleep and unplanned napping), with similar findings for stroke subtypes. Discussion We found that sleep disturbance symptoms were common and associated with a graded increased risk of stroke. These symptoms may be a marker of increased individual risk or represent independent risk factors. Future clinical trials are warranted to determine the efficacy of sleep interventions in stroke prevention.

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recommended for clinical practice, but more knowledge about the characteristics of Chinese obese hypertensive patients ABPM remains to further explore. This study aimed to assess the features in Chinese obese and hypertensive patients from multi-regions ambulatory blood pressure database in China. Methods: In this cohort, 35,367 hypertensive patients who were eligible for this study including 19,380 men (54.8%) and 15,987 women (45.2%) aged from 19 to 99 were recruited. ABPM characteristics were defined according to European guidelines. Overweight was defined as BMI 18.5 kg/m 2 or greater, and obesity BMI 25 kg/m 2 or greater. Hypertension was defined as elevated mean ambulatory BP (135/85 mmHg greater in day-time, 120/70 mmHg greater in night-time, 130/80 mmHg greater over 24-h). There are four kinds of blood pressure circadian rhythm, dippers, non-dippers, reverse dippers and extreme dippers. Results: Based on the ABPM recordings, 70.5% of participants had 24-h hypertension, 26.1% had dippers rhythm. 2.6% of participants had normal weight, 51.0% were overweight, 38.2% were obesity, and 8.2% were in severe obesity state. Considering blood pressure circadian rhythm, 48% non-dippers rhythm, 23.6% reverse dippers rhythm and 2.3% extreme dippers rhythm. Among participants who were obesity and severe obesity, 48% and 45.1% of patients were non-dippers. Severe obesity patients had higher 24-h blood pressures, especially in independent nocturnal hypertension. The prevalence of reverse dippers rhythm hypertension increased with age and the obesity degree. A positive association between blood pressure level and variability was observed, and within-person and between-person SD and CV were of similar magnitude. Conclusions: In Chinese obese hypertensive population, circadian rhythm blood pressure variation is an underappreciated problem on the population level. Therefore, the ambulatory blood pressure monitoring in obese hypertensive population needs to be expanded.

Background and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. Methods Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). Results Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). Conclusions The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.