Abstract BACKGROUND To investigate the association between cumulative cardiac metabolic index (cumCMI) exposure and cardiovascular disease (CVD) risk. METHODS The study was based on 87 967 participants of the Kailuan study who underwent at least two health examinations between 2006 and 2010. Time-weighted average cumCMI was calculated, and participants were categorized into four groups based on cumCMI quartiles: Q1 (cumCMI<0.327), Q2 (cumCMI 0.327–<0.483), Q3 (cumCMI 0.483–<0.755), and Q4 (cumCMI ≥ 0.755). Cox proportional hazard models were used to assess the relationship between cumCMI and the risk of CVD and its subtypes, with stratification by age and gender. Based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) model, the values of cumCMI and other related indicators in predicting the risk of CVD were evaluated using C-statistic, integrated discrimination improvement, and net reclassification index. In the sensitivity analysis, the Cox proportional hazards analyses were repeated after excluding individuals who experienced endpoint events within 2 years of follow-up, and those who took antihypertensive, antidiabetic, and lipid-lowering medications at baseline, as well as replacing low-density lipoprotein cholesterol (LDL-C) with cumulative LDL-C (cumLDL-C) as a covariate. Fine-Gray competing risk models were used, with non-CVD mortality considered a competing event, to assess the potential risk of disease mortality from competing events. RESULTS During a mean follow-up of (10.41 ± 2.51) years, 6337 individuals experienced CVD events. With the increase of cumCMI quartile, the cumulative incidence of CVD increased (the cumulative incidence in the Q1 to Q4 group was 5.20%, 6.54%, 7.89%, and 9.18%, respectively, χ2 = 289.789, P<0.001). Multivariate Cox regression analysis showed that after adjusting for other confounding factors, compared with Q1 group, Q2, Q3, and Q4 groups exhibited 21% (HR = 1.21, 95% CI 1.12–1.30), 38% (HR = 1.38, 95% CI: 1.28–1.49), and 58% (HR = 1.58, 95% CI: 1.47–1.70) higher risks, respectively. Stratified analyses indicated a stronger association between elevated cumCMI and CVD risk in populations aged <60 years and females, with the Q4 group showing 91% (HR = 1.91, 95% CI: 1.69–2.16) and 64% (HR = 1.64, 95% CI: 1.33–2.03) higher risk relative to Q1 group, respectively. Sensitivity analysis yielded consistent results. Prediction analysis based on the China-PAR model indicated that cumCMI outperforms other single indicators in predicting CVD risk. CONCLUSIONS High cumCMI levels are significantly associated with the risk of cardiovascular disease and can effectively predict the risk of CVD.

BACKGROUND AND OBJECTIVES:As the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) rises, identifying reliable biomarkers for risk prediction is essential. This study assessed baseline triglyceride glucose (TyG) index and TyG-derived parameters as predictors of future MASLD risk in older adults. METHODS AND STUDY DESIGN:We analyzed data from 2,757 Chinese adults (60-91 years) undergoing annual health checks (2017-2023). Incident MASLD was detected using ultrasound after excluding baseline cases. Cox proportional hazards models (with parameters in quartiles) and time-dependent ROC curves quan-tified associations and time-varying predictive performance among TyG-related parameters. The predictive performance of TyG-BMI was also compared with the hepatic steatosis index (HSI) in ROC analysis. RESULTS:Over a median six-year follow-up, 584 incident MASLD cases occurred. TyG-derived parameters showed stronger associations than TyG index. Specifically, triglyceride glucose-body mass index (TyG-BMI) demon-strated the highest risk, with an adjusted hazard ratio of 6.42 (95% CI: 5.33-7.73) for the highest versus lowest quartile. This association remained robust in sensitivity analysis. TyG-BMI demonstrated numerically higher AUC values than the HSI (Men: TyG-BMI 0.758 vs. HSI 0.747; Women: TyG-BMI 0.759 vs. HSI 0.756), with overlapping confidence intervals. Time-dependent ROC analysis confirmed TyG-BMI's superior predictive accuracy over time. The optimal TyG-BMI cut-offs were 187.97 for men and 191.33 for women. CONCLUSIONS:TyG-BMI demonstrated superior predictive performance compared to TyG index itself, other TyG-derived parameters, and the HSI, supporting its utility as a practical screening tool in primary care.

BACKGROUND AND AIM:The Metabolic Score for Insulin Resistance (METS-IR) is recognized as an indicator associated with the risk of Heart Failure (HF). However, evidence regarding its long-term impact is limited. This study aimed to evaluate the association between cumulative METS-IR (cumMETS-IR) and the risk of incident HF. METHODS AND RESULTS:We performed a prospective cohort analysis involving 51,155 participants from the Kailuan Study who underwent three health examinations (2006-2010) and were followed for incident HF until December 31, 2022. CumMETS-IR was calculated and analyzed using Cox proportional hazards models. Over a median follow-up of 12 years, higher cumMETS-IR was strongly and progressively associated with an increased risk of HF. Participants in the highest quartile had a 59% higher risk than those in the lowest. The incidence density of HF per 1000 person-years increased progressively across quartiles: Q1: 0.90 (0.76-1.07), Q2: 1.61 (1.41-1.83), Q3: 2.38 (2.14-2.64), and Q4: 3.60 (3.30-3.93). Maintaining high exposure for 2, 4, and 6 years increased risk by 23%, 49%, and 57%, respectively. Notably, these associations were significantly stronger in males and in adults aged ≥60 years. Adding cumMETS-IR to a conventional risk model also improved the prediction of HF. CONCLUSION:Higher levels of cumMETS-IR are associated with an increased risk of HF, particularly pronounced in males and older adults. Long-term monitoring of METS-IR may facilitate the early identification of high-risk individuals.

The purpose was to conduct a cohort study to investigate the association between body mass index (BMI) trajectory and future changes in blood pressure and fasting blood glucose (FBG) in Chinese aged people. This cohort included 2576 participants (1544 men and 1032 women; aged 67.7 ± 6.9 years) who were recruited in Shanghai, China. The trajectory of BMI was calculated based on BMI measurement in 2014, 2015 and 2016, and 3 BMI trajectories were determined: low-BMI (n = 418, 17.1%), medium-BMI (n = 1806, 68.5%) and high-BMI (n = 352, 14.4%). All participants were then followed up to 2022. The median follow-up time was 5 years. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and FBG were annually measured. We used MIXED model to evaluate the relationship between BMI trajectory and changes in SBP, DBP and FBG during the follow up. The mean BMI for participants of low-, medium-, and high-BMI trajectories was 20.63 kg/m2, 24.52 kg/m2, and 28.80 kg/m2, respectively. BMI trajectory was significantly associated with future increase in blood pressure and FBG (P < .001). After adjustment of potential covariates, compared with low-BMI trajectory the mean increase in SBP was 4.9 mm Hg (95% CI: 2.5, 7.2 mm Hg) for those with medium-BMI trajectory and it was 3.8 mm Hg (95% CI: 0.7, 6.9 mm Hg) for those with high-BMI trajectory. It was 1.0 mm Hg (95% CI: -0.4, 2.4 mm Hg) and 2.2 mm Hg (95% CI : 0.4, 4.0 mm Hg) for DBP while it was 0.2 mmol/L (95% CI: 0, 0.4 mmol/L) and 0.3 mmol/L (95% CI: 0.1, 0.6 mmol/L) for FBG for those with medium-BMI and high-BMI trajectories compared with those low-BMI trajectory. Sex and age interacted with the association between BMI trajectory and changes in blood pressure and FBG. BMI trajectory was significantly associated with future increase in blood pressure and FBG in aged population, indicating maintenance of optimal BMI was important for the prevention of metabolic diseases.

AIMS:Dietary inflammatory potential and genetic factors are reported as being linked to coronary heart disease (CHD). We aimed to investigate their joint association with CHD incidence. METHODS AND RESULTS:We included 51 889 British participants from the UK Biobank who completed the 24-h dietary assessment at baseline. We used reduced rank regression and stepwise linear regression analyses to generate an empirical dietary inflammatory pattern (EDIP) score to assess dietary inflammatory potential. A polygenic risk score (PRS) for CHD was constructed based on 1.7 million genetic variants. During a median follow-up of 11 years, 1346 incident cases of CHD were observed. High EDIP scores significantly increased the risk of CHD with the hazard ratio (HR) [95% confidence interval (CI)] of 1.26 (1.10-1.45) for high EDIP scores (T3) compared with low EDIP scores (T1). Interestingly, we observed a gradient in the risk of CHD across PRS categories, with the HRs of 1.12 (95% CI: 0.73-1.71), 1.20 (95% CI: 1.01-1.43), and 1.42 (95% CI: 1.10-1.83) in low (Q1), intermediate (Q2-4), and high (Q5) PRS categories, respectively. When the joint effect was examined, individuals with high PRS (Q5) and high EDIP scores (T3) would have the highest risk of CHD with a HR of 3.87 (95% CI: 2.74-5.46) compared with individuals with both low PRS (Q1) and low EDIP scores. CONCLUSION:High dietary inflammatory potential was associated with a higher CHD risk, especially in those with high PRS, suggesting that a comprehensive assessment of inflammatory diet and genetic factors may be beneficial in the prevention of CHD.

BACKGROUND:The study utilized the remnant cholesterol (RC) to high-density lipoprotein cholesterol (HDL-C) ratio as a lipidemia indicator. Assessing its long-term impact on cardiovascular disease (ASCVD) is crucial for primary prevention. METHODS:84,380 participants were enrolled in the prospective cohort. Participants were classified into low, medium, and high levels based on baseline RC/HDL-C levels at the 50th percentile and 90th percentile. Participants were followed until December 31, 2023. Calculate the incidence density of ASCVD for each group. The time-dependent Cox proportional hazards model was utilized to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for ASCVD risk among different groups. RESULTS:The study included 42,181, 33,739, and 8460 participants in the low, medium, and high levels respectively. A median follow-up of 16.92 years, 8397 ASCVD cases were identified. The 1000 person-years incidence density and 95% CIs for ASCVD were 5.86 (5.67, 6.05) in the low level, 6.92 (6.70, 7.15) in the medium level, and 8.85 (8.35, 9.39) in the high level. Compared to the low level, the Cox model showed that the HRs and 95% CIs for ASCVD were 1.09 (1.04, 1.14) and 1.23 (1.15, 1.32), respectively in medium and high levels. CONCLUSION:Higher RC/HDL-C level was significantly associated with an increased risk of ASCVD. Including the RC/HDL-C in lipid evaluation can reduce the onset of ASCVD. CLINICAL TRIAL REGISTRATION NUMBER:ChiCTR2000029767.

AIMS:This study aimed to investigate the association between Chinese visceral adiposity index (CVAI) and heart failure (HF) risk in diabetic individuals and to evaluate the predictive capability of CVAI compared to other obesity metrics. MATERIALS AND METHODS:A prospective cohort study (Kailuan Study) spanning 2006 to 2022 involved 12 243 diabetic patients. Participants were stratified into CVAI quartiles (Q1: <96.13, n = 3060; Q2: 96.13 to <121.25, n = 3061; Q3: 121.25 to <146.85, n = 3061; Q4: ≥146.85, n = 3061). The relationship between CVAI and HF occurrence was assessed using the Kaplan-Meier analysis and Cox regression models, supplemented by sensitivity analyses. Restricted cubic splines were used to evaluate potential nonlinear associations. Subgroup analyses examined the influence of sociodemographic factors and health behaviours. Receiver operating characteristic (ROC) analysis compared CVAI with other obesity indices. Statistical significance was set at p < 0.05. RESULTS:Over a median follow-up of 15 years, 861 new HF cases were recorded. HF incidence rose with increasing CVAI quartiles (Q1-Q4: 3.05-7.20/1000 person-years; p < 0.05). Adjusted HRs (95% CI) for HF in Q2-Q4 compared to Q1 were 1.32 (1.06-1.65), 1.41 (1.13-1.75) and 1.91 (1.55-2.35) (Ptrend < 0.01). Age significantly modified the CVAI-HF relationship (≥60 years: HR = 2.06, 1.60-2.64; Pinteraction <0.01). CVAI exhibited a linear correlation with HF (Pnonlinear = 0.75) and demonstrated superior ROC-predictive accuracy compared to other indices (p < 0.01). CONCLUSION:CVAI is independently associated with HF risk, especially in elderly patients, supporting its utility for visceral fat-related risk stratification.

Background:Metabolic syndrome (MetS) and elevated high-sensitivity C-reactive protein (hs-CRP) have been identified as risk factors for heart failure (HF) in some studies. However, little was known about the co-exposure of MetS and inflammation to HF. We aimed to investigate the combined effect of MetS and high hs-CRP levels on the risk of incident HF. Methods:The study included 94,841 participants without HF selected from the Kailuan cohort in 2006 (the baseline) and then followed up until 31 December 2020. Participants were divided into four groups based on the presence of MetS and high hs-CRP levels (>3mg/L) at baseline: MetS-CRP- (n=53,937), MetS-CRP+ (n=10,338), MetS+CRP- (n=23,521), MetS+CRP+ (n=7,045). Cox regression models were used to analyze the association of MetS and inflammation with the risk of HF. Statistical significance was defined as a two-tailed P value < 0.05. Results:The mean age of the participants was 51.5 ± 12.5 years, and 75,976 (80.0%) were male. During 13.1 years of follow-up, 3,058 participants were diagnosed with HF. The HF incidence rate of four groups were 1.69/1000pys, 2.95/1000pys, 3.27/1000pys, 5.33/1000pys. The HR for MetS-CRP+, MetS+CRP-, and MetS+CRP+ were 1.29 (95% CI, 1.15-1.45), 1.40 (95% CI, 1.29-1.53), and 1.85 (95% CI, 1.65-2.06), respectively, compared with MetS-CRP-. After stratification by age (p for interaction < 0.01), compared with the MetS-CRP- group, the HR of the MetS+CRP+ group was 2.17 (95% CI, 1.83-2.57) in participants with < 60 years and 1.53 (95% CI, 1.32-1.78) in participants with ≥ 60 years. There was an interaction between groups and ues of antihypertension medication (p for interaction <0.01). Compared with MetS-CRP-, the risk of HF in the MetS+CRP+ group was increased 1.38-fold (95% CI, 1.12-1.70) in participants with antihypertension medication use and 2.00-fold (95% CI, 1.75-2.27) in participants without antihypertension medication use. Conclusions:The combination of MetS and elevated hs-CRP was associated with increased risk of HF in the Chinese population. Clinical trial registration:https://www.chictr.org.cn, identifier ChiCTR-TNRC-11001489.

BACKGROUND:Previous post hoc analyses of clinical trials have suggested that a higher percentage of systolic blood pressure time in target range (SBP-TTR) was associated with a decreased risk of cardiovascular disease (CVD). However, there is limited evidence from large prospective cohort studies on the relationship between long-term SBP-TTR and the risk of CVD. OBJECTIVES:The purpose of this study was to assess the association between long-term SBP-TTR and the risk of CVD in adults with hypertension. METHODS:This study included 26,929 hypertensive patients (mean age 52.8 ± 10.7 years; 83.1% males), free of CVD at baseline from the Kailuan Study. Blood pressure was measured biennially from 2006 to 2012, and the SBP target range was defined as 120 to 140 mm Hg. SBP-TTR was calculated by the Rosendaal linear interpolation method. Incident CVD events were ascertained via the linkage of electronic health record data. RESULTS:During a median follow-up of 8.6 years, 2,565 CVD, including 472 myocardial infarction and 2,151 stroke cases were documented. Comparing the high SBP-TTR (75%-100%) with the low SBP-TTR (0%-25%) group, the multivariable HRs were 0.67 (95% CI: 0.59-0.76) for CVD, 0.76 (95% CI: 0.56-1.02) for myocardial infarction, and 0.64 (95% CI: 0.56-0.74) for stroke. In addition, the association between SBP-TTR and CVD risk was stronger among individuals aged <65 years than their older counterparts (P for interaction <0.001). CONCLUSIONS:A greater percentage of SBP-TTR was associated with a lower risk of CVD among patients with hypertension. These findings underscore the importance of maintaining SBP within the target range for the prevention of CVD among hypertensive individuals.

BACKGROUND:Diabetes is a major global public health issue. This study investigated the trends in the age-and gender-specific burden of diabetes in China and worldwide from 1990 to 2021, and predicted the prevalence of diabetes in 2050. METHODS:Using publicly available data from the Global Burden of Disease (GBD) database from 1990 to 2021, we comprehensively applied Joinpoint regression and age-period-cohort (APC) analysis to reveal the epidemiological characteristics, conducted decomposition analysis to identify the driving factors of burden changes, and used the autoregressive integrated moving average (ARIMA) model to project the disease burden of diabetes from 2022 to 2050. RESULTS:From 1990 to 2021, both in China and globally, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized disability-adjusted life year rate (ASDR) of diabetes showed an upward trend. In contrast, China's age-standardized mortality rate (ASMR) of diabetes decreased, while the global ASMR increased. The average annual percentage changes (AAPC) of China's ASIR, ASPR, ASMR, and ASDR were 1.29, 1.76,- 0.30, and 0.76% respectively, compared with 1.74, 2.10, 0.25, and 1.05% for the global diabetes burden. CONCLUSIONS:In China, the incidence, prevalence, and Disability-Adjusted Life Years (DALYs) of diabetes increased, while the mortality rate decreased. It is projected that by 2050, the number of diabetes patients in China will reach 84.01 million, and globally, it will reach 1038.2 million. Given China's large population and the trend of population aging, it is essential to formulate targeted prevention and control strategies to address the challenge of diabetes.

ObjectivesThis study aimed to fill the data gap of the course of renal function decline in old age and explore changes in renal function across different health states with increasing age.MethodsThis observational, retrospective, single-center cohort study included 5,112 Chinese older adults (3,321 men and 1,791 women, range 60–104 years). The individual rate of estimated glomerular filtration rate (eGFR) decline was analyzed using linear mixed-effects model to account for repeated measures over the years.ResultsThe median age was 66 years, median BMI was 24.56 kg/m2, and median eGFR was 89.86 mL/min.1.73 m2. For every 1-year increase in age, women’s eGFR decreased by 1.06 mL/min/1.73 m2 and men’s by 0.91 mL/min/1.73 m2. We observed greater age-related eGFR decline in men and women with high systolic blood pressure (SBP). Men with high triglyceride (TG), high low-density lipoprotein cholesterol (LDL-C), and low high-density lipoprotein cholesterol (HDL-C), had greater age-related eGFR decline. In women, different BMI groups showed significant differences in age-related eGFR decline, with the highest decline in those with obesity. Additionally, participants with normal baseline eGFR had a faster age-related decline than those with low baseline eGFR.ConclusionThe eGFR declined linearly with age in Chinese older adults, with women exhibiting a slightly faster decline than men. Both men and women should be cautious of SBP. Older adults with normal baseline renal function experienced a faster eGFR decline. Men with high TG, LDL-C, and low HDL-C levels, as well as obese women, should be vigilant in monitoring renal function.

Objectives Studies have found that a high Life's Essential 8 (LE8) score is associated with a reduced risk of cardiovascular disease(CVD) in cancer populations and young adults. However, the association between LE8 and the risk of CVD in hyperuricemia (HUA) is not fully understood. Methods The main analysis included 6814 HUA participants. In a secondary analysis, 5,418 participants were selected from the main analysis to model the trajectory of uric acid (UA) levels from 2006 to 2010. Cox regression model was used to investigate the relationship between LE8 total score and cardiovascular disease risk in different populations. Results Follow-up of 15.79 years in the main analysis, 986 CVD events occurred. With tertile 1 as the control group, the HR and 95% CI of CVD in tertile 2 and tertile 3 were 0.75(0.65,0.87) and 0.56(0.47,0.66). In the secondary analysis, the HR and 95%CI of individuals with low and medium levels of UA reduced CVD were 0.49(0.26,0.89) and 0.56(0.41,0.76), respectively, but this association was not found in individuals with sustained high UA levels. The risk of CVD was different between the sexes. There are differences in cardiovascular disease risk among different age groups. Conclusions The risk of CVD in HUA population decreased with the increase of LE8 score, especially in young and middle-aged people and women. However, it is important to note that LE8 may not reduce the risk of CVD in individuals with sustained high UA levels.

Background Cardiovascular disease (CVD) is a chronic disease with a serious prognosis, and obesity is a risk factor for CVD. Lipid accumulation product index (LAP) is a new indicator of obesity, waist circumference, and triglycerides were included in the formula, but its association with CVD is inconsistent. Therefore, this study researched the effect of LAP levels on CVD. Methods This prospective cohort study was based on the Kailuan cohort. A total of 95,981 participants who completed the first physical examination in 2006 and had no history of CVD or LAP absence were included. The participants were divided into four groups according to the LAP quartile (Q1 - Q4). Up until December 31, 2022, incidence density was calculated for each group. The hazard ratio (HR) and 95% confidence interval (CI) of CVD in each group were calculated by the Cox proportional hazards model. Results During a median follow-up period of 15.95 years, 9925 incident CVD events occurred (2123 myocardial infarction and 8096 stroke). There were differences in potential confounders among the four groups (P < 0.001). The incidence density and 95% CI of CVD in Q1-Q4 groups were 4.76(4.54, 5.00), 6 0.50(6.24, 6.77), 8.13(7.84, 8.44) and 9.34(9.02, 9.67), respectively. There were significant differences in the survival curves among the four groups by log-rank test (P < 0.001). After adjusting for potential confounders, Cox proportional hazards model results showed that compared with the Q1 group, the HR and 95% CI of CVD in the Q2, Q3, and Q4 groups were1.15(1.08, 1.23), 1.29(1.21, 1.38) and 1.39(1.30, 1.49), respectively. The HR and 95%CI of myocardial infarction were 1.28(1.10, 1.49), 1.71(1.47, 1.98) and 1.92(1.64, 2.23), respectively. The HR and 95%CI of stroke were 1.11 (1.03, 1.19), 1.20 (1.12, 1.29) and 1.28 (1.19, 1.38), respectively. After subgroup analysis by gender, there was no significant interaction (P = 0.169), and the relationship between LAP and CVD in different genders was consistent with the main results. After subgroup analysis by age, there was a significant interaction (P = 0.007), and the association between LAP and CVD in different age groups was consistent with the main results. After subgroup analysis by BMI, there was no significant interaction (P = 0.506), and the association between LAP and CVD in different BMI groups was consistent with the main results. The results remained robust after sensitivity analyses. For each unit increase in ln(LAP), the HR and 95%CI of CVD were 4.07 (3.92, 4.23). Conclusion This study demonstrated that the risk of CVD increased with the increase of LAP level. The risk of CVD in group Q2 - Q4 was 1.15, 1.29, and 1.39 times higher than that in group Q1, respectively. Clinical trial registration number ChiCTR2000029767

Background Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), has been associated with several cancer risks in observational studies, but the observed associations have been inconsistent and may face the bias of confounding and reverse causality. The potential causal relationships between IBD and the risk of cancers remain largely unclear. Methods We performed genome-wide linkage disequilibrium score regression (LDSC), standard two-sample Mendelian randomization (MR), and colocalization analyses using summary genome-wide association study (GWAS) data across East Asian and European populations to evaluate the causal relationships between IBD and cancers. Sensitivity analyses for the MR approach were additionally performed to explore the stability of the results. Results There were no significant genetic correlations between IBD, CD, or UC and cancers (all P values > 0.05) in East Asian or European populations. According to the main MR analysis, no significant causal relationship was observed between IBD and cancers in the East Asian population. There were significant associations between CD and ovarian cancer (odds ratio [OR] = 0.898, 95% CI = 0.844–0.955) and between UC and nonmelanoma skin cancer (OR = 1.002, 95% CI = 1.000–1.004, P = 0.019) in the European population. The multivariable MR analysis did not find any of the above significant associations. There was no shared causal variant to prove the associations of IBD, CD, or UC with cancers in East Asian or European populations using colocalization analysis. Conclusions We did not provide robust genetic evidence of causal associations between IBD and cancer risk. Exposure to IBD might not independently contribute to the risk of cancers, and the increased risk of cancers observed in observational studies might be attributed to factors accompanying the diagnosis of IBD.

To investigate whether early-life exposure to the Great Famine of 1959-1961 in China was associated with the risk of digestive system cancer. The prospective cohort study involved 17 997 participants from the Kailuan Study (Tangshan, China) that began in 2006. All participants were divided into three groups based on their date of birth. The unexposed group (born from 1 October 1962 to 30 September 1964), fetal-exposed group (born from 1 October 1959 to 30 December 1961), and early-childhoodexposed group (born from 1 October 1956 to 30 December 1958). The Cox proportional hazards model was used to analyze the association between early famine exposure and digestive system cancer. During the mean follow-up period of (10.4 +/- 2.2) years, a total of 223 digestive system cancer events occurred. Including 54 cases in the unexposed group (62.14/100 000 personyears), 57 cases in the fetal-exposed group (114.8/100 000 person-years), and 112 cases in the early-childhood-exposure group (122.2/100 000 person-years). After adjusting covariates, compared with the unexposed group, the HR and 95% CI were 1.85 (1.28, 2.69) for participants in the fetal-exposed group and 1.92 (1.38, 2.66) for participants in the early-childhood-exposed group. No interactions were observed in our study. After classifying digestive system cancers, the HR and 95% CI were 2.02 (1.03, 3.97) for colorectal cancer for participants in the fetal-exposed group and 2.55 (1.43, 4.55) for participants in the earlychildhood-exposed group. The HR and 95% CI were (1.13, 3.83) of liver cancer for participants in the fetal-exposed group and 1.15 (0.63, 2.10) for participants in the early-childhood-exposed group. Early-life famine exposure was associated with a higher risk of digestive system cancer in adulthood. Fetal-exposed individuals might increase the risk of colorectal cancer and liver cancer, and early childhood-exposed might increase the risk of colorectal cancer.

Background Recently, metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed to replace non-alcoholic fatty liver disease (NAFLD) to emphasize the pathogenic association between fatty liver disease and metabolic dysfunction. Studies have found that MAFLD independently increases the risk of myocardial infarction and stroke. But the relationship between MAFLD and heart failure (HF) is not fully understood. Objectives This study aimed to explore the association between MAFLD and the risk of HF. Methods The study included 98,685 participants without HF selected from the Kailuan cohort in 2006. All participants were divided into non-MAFLD group and MAFLD group according to MAFLD diagnostic criteria. After follow-up until December 31, 2020, the Cox regression analysis model was used to calculate the effect of MAFLD on the risk of HF. Results During the median follow-up of 14.01 years,3260 cases of HF were defined, the HF incidence density of non-MAFLD group and MAFLD group was 2.19/1000pys and 3.29/1000pys, respectively. Compared with the non-MAFLD group, participants with MAFLD had an increased risk of HF (HR: 1.40, 95% CI: 1.30–1.50); in addition, an exacerbation of fatty liver disease was associated with an increased risk of HF in people with MAFLD. We also observed a higher risk of HF among the different metabolic dysfunction of MAFLD in people with both fatty liver disease and type 2 diabetes (HR, 1.95; 95% CI, 1.73–2.20). Conclusions Our findings suggest that the risk of HF was significantly increased in participants with MAFLD, and an exacerbation of fatty liver disease was associated with an increased risk of HF in people with MAFLD. In addition, we should pay more attention to people with MAFLD with type 2 diabetes.

BackgroundThe association between mean arterial pressure (MAP) trajectory in young adults and risk of cardiovascular diseases (CVD) and all-cause mortality is not well-characterized. The objective of this study was to investigate the effects of different MAP trajectory on the risk of CVD and all-cause mortality among the young.MethodsIn the Kailuan cohort study, 19,171 participants aged 18-40 years were enrolled without CVD (including myocardial infarction, stroke, atrial fibrillation and heart failure). The potential hybrid model was used to fit different trajectory patterns according to longitudinal changes of MAP. Hazard ratios and 95% confidence intervals for risk of CVD and all-cause mortality were analyzed using Cox proportional hazard regression models for participants with different trajectories.ResultsFive distinct MAP trajectories were identified during 2006-2013. Each of the trajectories was labelled as low-stable, middle-stable, decreasing, increasing, or high-stable. With the low-stable trajectory group as the reference, the multivariate adjusted HR (95%CI) of CVD for the middle-stable, decreasing, increasing and high-stable groups were 2.49 (1.41-4.40), 5.18 (2.66-10.06), 5.91 (2.96-11.80) and 12.68 (6.30-25.51), respectively. The HR (95%CI) for all-cause deaths were 1.27 (0.84-1.94), 2.01 (1.14-3.55), 1.96 (1.04-4.3.72), and 3.28 (1.69-6.37), respectively.ConclusionIn young adults, MAP trajectories were associated with the risk of CVD or all-cause mortality and increasing MAP trajectories within the currently designated "normal" range may still increase the risk for CVD.

ObjectivesThis study aimed to assess the association between longitudinal change in non-high-density lipoprotein cholesterol (non-HDL-C) and subsequent cardiovascular disease (CVD) risk.DesignA retrospective study.SettingData were obtained from the Kailuan Study, a dynamic cohort study initiated in 2006 in Tangshan, China.ParticipantsThe current study included 41 085 participants (mean age 53.9±11.6 years) free of CVD events in or before 2012. The non-HDL-C trajectory was developed according to the repeated measurement during 2006–2012 surveys to predict the CVD risk from 2012 to 2020.Primary outcome measuresCVD events included myocardial infarction and stroke.Results3 discrete non-HDL-C trajectories were identified: low-increasing (n=20 038), moderate-increasing (n=17 987) and high-increasing (n=3060). During 8 years of follow-up, 1797 CVD events were documented. Relative to the low-increasing pattern, adjusted HRs were 1.25 (95% CI: 1.13 to 1.38) for the moderate-increasing pattern and 1.46 (95% CI: 1.24 to 1.71) for the high-increasing pattern after adjustment for potential confounders such as age, sex, education background, smoking status, drinking status, physical activity, body mass index, low-density lipoprotein cholesterol, hypertension, diabetes and lipid-lowering medications.ConclusionsChanges in non-HDL-C were significantly associated with subsequent risk of CVD events, and participants with a high-increasing pattern had a higher CVD risk. Long-term monitoring of non-HDL-C could be useful to improve the prediction of CVD risk.Trial registration numberChiCTR-TNC-1100148.

BACKGROUND:The association of atherosclerotic cardiovascular disease (ASCVD) with cancer occurrence is not well examined, and the impact of common risk factors on the risk of cancer in ASCVD patients is not known. This study aimed to explore the effect and possible causes of ASCVD on cancer risk through a cohort study. METHODS:A total of 14,665 age- and sex-matched pairs of participants were recruited from the Kailuan cohort (ASCVD vs non-ASCVD). A competing risk model was used to calculate the risk of cancer after ASCVD. RESULTS:A total of 1124 cancers occurred after 5.80 (3.05-9.44) years of follow-up. The ASCVD group had a reduced risk of cancer (hazard ratio 0.74; 95% confidence interval, 0.65-0.85). Also, the risk of cancer in the digestive system, respiratory system, urinary system, and reproductive system was reduced by 17%, 16%, 14%, and 52%, respectively. According to the status of systolic and diastolic blood pressure, fasting blood glucose, high-sensitivity C-reactive protein and body mass index after ASCVD, the risk of overall cancer and digestive system cancer decreased with the increase in the number of ideal indicators (P for trend < .01). With the increase of follow-up time, the risk of cancer and the 5 site-specific cancers gradually decreased. CONCLUSIONS:Cancer risk can be reduced by controlling for common risk factors after ASCVD event. This risk reduction is site-specific-, time-, and the number of ideal indicator-dependent.