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There were 72, 129 individuals (male/female = 63.1%/36.9%) who met all conditions required for the China-PAR equation. Basic characteristics of the individuals who satisfied the calculation conditions are presented in Supplementary Table S1 (available in www.besjournal.com). The average age of the individuals was 49.8 ± 9.6 years, all lived and worked south of the Yangtze River for at least three years, and the vast majority lived in cities (96.7%).
There were more male than female smokers (35.5% vs. 0.14%). The medical history was entirely self-reported, and 9% (male/female = 11.6%/4.7%) reported having diabetes, 1.6% (male/female = 1.4%/1.9%) reported taking statins, 12.2% (male/female = 14.6%/8.2%) reported receiving antihypertensive treatment, and 5.7% (male/female = 7.5%/2.7%) reported having a family history of ASCVD.
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The mean China-PAR 10-year CVD risks are presented in Supplementary Table S2 (available in www.besjournal.com). The mean 10-year CVD risk score of the total population was 2.89% ± 3.38%, and the risk scores of males and females were 3.82% ± 3.76% and 1.30% ± 1.65%, respectively. The mean risk scores for the three age subgroups were 0.94% ± 1.59%, 3.48% ± 3.13%, and 8.43% ± 4.39%, respectively.
The proportion of participants in each risk category based on sex is presented in Figure 1. Of the total 72, 129 individuals evaluated, 13.9% had moderate 10-year CVD risk, and 4.7% were high-risk. The proportions of intermediate-risk and high-risk individuals in the male subgroup were 20% and 7.3%, respectively, and 3.5% and 0.3% in the female subgroup.
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The risk factor profile of the study population in each risk categorization is shown in Table 1. Among the risk factors used in the China-PAR, the average or proportion of individuals with a given risk factor tended to be higher in each subsequent risk classification, but the percentages of current smokers and those with a family history of ASCVD were not significantly different between the intermediate- and high-risk groups. Similar to the risk factors used in the China-PAR, the average value of additional risk factors evaluated outside of the equation also increased as the CVD risk level increased except for BMI and AST.
Characteristics < 5% (n = 58, 696) 5%-10% (n = 10, 037) ≥ 10% (n = 3, 395) Risk factors used in equation Age, y 47.3 ± 8.2 59.5 ± 7.2 63.3 ± 8.2 Male, n (%) 33, 089 (56.4) 9, 100 (90.7) 3, 306 (97.4) SBP (mmHg) 120.6 ± 14.8 139.1 ± 14.2 154.4 ± 16.2 TC (mmol/L) 4.81 ± 0.87 4.96 ± 0.94 5.12 ± 1.08 HDL-C (mmol/L) 1.51 ± 0.34 1.38 ± 0.31 1.32 ± 0.29 WC (cm) 79.7 ± 10.4 86.9 ± 8.3 88.7 ± 24.7 Current smoking, n (%) 10, 847 (18.5) 3, 969 (39.5)* 1, 365 (40.2)* Diabetes mellitus, n (%) 2, 266 (3.9) 2, 458 (24.5) 1, 799 (53.0) Hypertension treatment, n (%) 2, 959 (5.0) 3, 765 (37.5) 2, 096 (61.7) Urban, n (%) 57, 193 (97.4) 9, 514 (94.7) 3, 027 (89.2) Southern China, n (%) 58, 696 (100) 10, 037 (100) 3, 395 (100) Family history of ASCVD, n (%) 2, 483 (4.2) 1, 214 (12.1)* 437 (12.9)* Risk factors not used in equation BMI (kg/m2) 23.7 ± 3.0 25.6 ± 3.1* 25.9 ± 3.1* WHR 0.84 ± 0.08 0.91 ± 0.05 0.93 ± 0.25 WHtR 0.48 ± 0.05 0.51 ± 0.04 0.53 ± 0.15 DBP (mmHg) 75.2 ± 10.7 85.3 ± 10.8 89.7 ± 12.5 UA (μmol/L) 336.1 ± 87.1 381.8 ± 82.4 384.4 ± 85.3 FPG (mmol/L) 5.64 ± 0.94 6.51 ± 1.74 7.49 ± 2.35 TG (mmol/L) 1.51 ± 1.14 2.01 ± 1.63 2.41 ± 2.37 LDL-C (mmol/L) 2.71 ± 0.74 2.78 ± 0.81 2.83 ± 0.88 Non-HDL-C (mmol/L) 3.31 ± 0.87 3.58 ± 0.93 3.8 ± 1.09 TC/HDL-C 3.33 ± 0.88 3.72 ± 0.99 4.05 ± 1.42 ALT (U/L) 26.9 ± 20.1 29.9 ± 19.8 30.6 ± 19.5 AST (U/L) 21.8 ± 10.5 23.7 ± 10.8* 24.3 ± 10.2* ALP (U/L) 64.7 ± 18.4 70.1 ± 19.0 72.0 ± 20.4 Note.*Asterisk represents no statistical difference between the two groups. ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; WC, waist circumference; WHR, waist to hip ratio; WHtR, waist height ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; UA, plasma uric acid; FPG, fasting plasma glucose; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Non-HDL-C, calculated as TC- HDL-C; TC/HDL-C, calculated as TC divided by the HDL-C; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase. Table 1. The Value of Risk Factors in the Three 10-year ASCVD Risk Categorization
The characteristics of CVD risk factors are shown in Table 2. The proportion of overweight/ obesity and metabolic abnormalities in both 10-year CVD risk categorizations were compared using a chi-square test. The results show that the intermediate/high-risk group has a higher proportion of individuals with general and abdominal overweight/obesity classifications, hypertension, hyperuricemia, and glycolipid abnormalities.
aParameters < 5% (n = 58, 696) ≥ 5% (n = 13, 432) Overweight/obesity, n(%) BMI ≥ 24 kg/m2 45.0% 71.3% WC ≥ 85/80 cm 17.2% 40.2% WHR ≥ 0.9/0.85 30.3% 61.3% WHtR ≥ 0.5 34.6% 66.7% Hypertension, n(%) SBP ≥ 140 mmHg 9.9% 55.4% DBP ≥ 90 mmHg 9.4% 38.0% Abnormal glucose metabolism, n(%) FPG ≥ 6.1 mmol/L 15.6% 51.8% Dyslipidemia, n(%) TC ≥ 5.2 mmol/L 30.0% 38.7% TG ≥ 1.7 mmol/L 28.1% 46.9% HDL-C < 1.0 mmol/L 1.7% 4.5% LDL-C ≥ 3.4 mmol/L 16.5% 21.9% Non-HDL-C ≥ 4.1 mmol/L 17.0% 27.6% TC/HDL-C ≥ 5.0 3.7% 9.4% Hyperuricemia, n(%) UA ≥ 420/350 μmol/L 18.4% 30.0% Note. BMI, body mass index; WC, waist circumference; HC, hip circumference; WHR, waist to hip ratio; WHtR, waist height ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; UA, plasma uric acid; FPG, fasting plasma glucose; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Non-HDL-C, calculated as TC-HDL-C; TC/HDL-C, calculated as TC divided by the HDL-C; WC ≥ 85 cm in men and ≥ 80 cm in women; WHR ≥ 0.9 in men and ≥ 0.85 in women; UA ≥ 420 μmol/L in men and postmenopausal women, and ≥ 350 μmol/L in premenopausal women. Table 2. The Proportion of Overweight/obesity and Metabolic Abnormalities in the Two 10-year CVD Risk Categorization
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Univariate regression analysis showed that all risk factors, whether or not components of the China-PAR equation, were significantly associated with 10-year CVD risk. However, the adjusted OR of WC decreased to 0.91 (CI 95% = 0.83-1.00) when analyzed together with other variables (P = 0.049). Similarly, BMI was no longer associated with intermediate or high CVD risk (P = 0.057) after further adjustment for other CVD risk factors. The adjusted OR of both WHR and WHtR was 1.16 with statistically significant differences in P-values when multiple regression analysis was performed (Table 3).
Variables Simple Logistic Regression Analysis Multiple Logistic Regression Analysis β Unadjusted OR (95% CI) P Values β Adjusted OR (95% CI) P Values Risk factors used in equation Age 2.457 11.67 (11.08-12.28) < 0.001 3.670 39.26 (35.73-43.14) < 0.001 Female -2.236 0.10 (0.10-0.11) < 0.001 -4.204 0.01 (0.01-0.01) < 0.001 SBP 2.420 11.24 (10.76-11.74) < 0.001 2.574 13.12 (12.06-14.27) < 0.001 TC 0.389 1.47 (1.42-1.53) < 0.001 0.119 1.12 (1.01-1.24) 0.021 HDL-C 1.012 2.75 (2.48-3.05) < 0.001 0.512 1.66 (1.38-2.01) < 0.001 WC 1.171 3.22 (3.09-3.35) < 0.001 -0.093 0.91 (0.83-1.00) 0.049 Current smoking 1.067 2.90 (2.79-3.02) < 0.001 0.650 1.91 (1.78-2.05) < 0.001 Diabetes 2.447 11.55 (10.93-12.21) < 0.001 2.108 8.23 (7.41-9.13) < 0.001 Hypertension treatment 2.680 14.58 (13.86-15.33) < 0.001 2.358 10.57 (9.74-11.46) < 0.001 Family history of ASCVD 1.155 3.17 (2.97-3.38) < 0.001 0.606 1.83 (1.62-2.06) < 0.001 Risk factors not used in equation BMI 1.109 3.03 (2.90-3.15) < 0.001 -0.084 0.91 (0.84-1.00) 0.057 WHR 1.294 3.64 (3.50-3.79) < 0.001 0.149 1.16 (1.06-1.26) < 0.001 WHtR 1.328 3.77 (3.62-3.92) < 0.001 0.151 1.16 (1.05-1.28) 0.002 DBP 1.772 5.88 (5.62-6.15) < 0.001 0.542 1.72 (1.58-1.86) < 0.001 UA 0.645 1.90 (1.82-1.98) < 0.001 -0.030 0.97 (0.90-1.04) 0.427 FPG 1.760 5.81 (5.58-6.05) < 0.001 0.375 1.45 (1.34-1.57) < 0.001 TG 0.815 2.25 (2.17-2.34) < 0.001 0.066 1.06 (0.99-1.14) 0.069 LDLc 0.353 1.42 (1.35-1.49) < 0.001 0.226 1.25 (1.13-1.38) < 0.001 Non-HDL-C 0.618 1.85 (1.77-1.93) < 0.001 0.211 1.23 (1.09-1.39) 0.001 TC/HDL-C 0.994 2.70 (2.51-2.90) < 0.001 0.523 1.68 (1.46-1.94) < 0.001 Note. OR, Odds ratio; CI, confidence interval; ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; WC, waist circumference; WHR, waist to hip ratio; WHtR, waist height ratio; SBP, systolic blood pressure; DBP, diastolic blood pressure; UA, plasma uric acid; FPG, fasting plasma glucose; TC, total cholesterol; triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Non-HDL-C, calculated as TC-HDL-C; TC/HDL-C, calculated as TC divided by the HDL-C. Table 3. Simple and Multiple Regression Analysis of Risk Factors for 10-year ASCVD Risk
The adjusted ORs of TC and HDL-C were 1.12 (CI 95% = 1.01-1.24) and 1.66 (CI 95% = 1.38-2.01), and the adjusted ORs of LDL-C, non-HDL-C, and TC/HDL-C were 1.25 (CI 95% = 1.13-1.38), 1.23 (CI 95% = 1.09-1.39), and 1.68 (CI 95% = 1.46-1.94), respectively, which are all higher than that of TC. FPG and DBP were significantly associated with CVD risk with adjusted ORs of 1.45 (CI 95% = 1.34-1.57) and 1.72 (CI 95% = 1.58-1.86), respectively. The risk factors of UA and TG were excluded from the binary logistic regression model when analyzed together with other variables (P-values were 0.427 and 0.069, respectively) (Table 3).