Biomedical and Environmental Sciences

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Report on Cardiovascular Health and Diseases in China 2023: An Updated Summary (30 day view times: 53)

National Center for Cardiovascular Diseases The Writing Committee of the Report on Cardiovascular Health and Diseases in China

2024, 37(9): 949-992. doi: 10.3967/bes2024.162

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Since 1990, China has made considerable progress in resolving the problem of “treatment difficulty” of cardiovascular diseases (CVD). The prevalent unhealthy lifestyle among Chinese residents has exposed a massive proportion of the population to CVD risk factors, and this situation is further worsened due to the accelerated aging population in China. CVD remains one of the greatest threats to the health of Chinese residents. In terms of the proportions of disease mortality among urban and rural residents in China, CVD has persistently ranked first. In 2021, CVD accounted for 48.98% and 47.35% of deaths in rural and urban areas, respectively. Two out of every five deaths can be attributed to CVD. To implement a national policy “focusing on the primary health institute and emphasizing prevention” and truly achieve a shift of CVD prevention and treatment from hospitals to communities, the National Center for Cardiovascular Diseases has organized experts from relevant fields across China to compile the “Report on Cardiovascular Health and Diseases in China” annually since 2005. The 2024 report is established based on representative, published, and high-quality big-data research results from cross-sectional and cohort population epidemiological surveys, randomized controlled clinical trials, large sample registry studies, and typical community prevention and treatment cases, along with data from some projects undertaken by the National Center for Cardiovascular Diseases. These firsthand data not only enrich the content of the current report but also provide a more timely and comprehensive reflection of the status of CVD prevention and treatment in China.

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Identification of Critical Intervention Windows for Central Obesity from Childhood to Early Adulthood: A 30-year Longitudinal Study in China (30 day view times: 45)

Weiwei Zhou, Hanyi Li, Feifei Huang, Jiguo Zhang, Chang Su, Xiaofang Jia, Xianglin Qin, Wenwen Du, Huijun Wang, Aidong Liu

2026, 39(4): 396-407. doi: 10.3967/bes2026.027

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Objective To characterize long-term transition probabilities in waist circumference (WC) status from childhood into early adulthood and identify critical age windows for the development, persistence, and reversal of central obesity. Methods Using the China Health and Nutrition Survey data (1993–2022), 7,007 WC measurements from 2,440 participants aged 6–17 years at baseline were analyzed. Participants were grouped by baseline age: 6–11, 12–14, and 15–17 years. Generalized linear mixed-effects models were used to estimate WC transition probabilities, adjusting for sociodemographic factors. Results Central obesity prevalence increased from age 6, declined in early adulthood (approximately 22 years), and subsequently increased again. The 6–14-year age window exhibited dynamic, bidirectional transitions; specifically, the 10-year reversal probabilities from central obesity to normal WC were 44.19% (ages 6–11) and 41.39% (ages 12–14), decreasing to 26.93% for ages 15–17. Among those aged 15–17 years with central obesity, boys had a > 80% probability of maintaining increased WC for 20 years. Conclusion Ages 6–14 years represent a critical “reversal period” for central obesity. Interventions should prioritize this window using age- and sex-specific strategies to maximize normalization and curb long-term obesity risk.

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Interpretation of Annual Report on Cardiovascular Health and Diseases in China 2024 (30 day view times: 37)

Mingbo Liu, Xinye He, Xiaohong Yang, Zengwu Wang

2025, 38(8): 893-917. doi: 10.3967/bes2025.099

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Cardiovascular diseases (CVD) and their risk factors are exerting an increasingly significant impact on public health, and the incidence rate of CVD continues to rise. This article provides an interpretation of essentials from the newly published Annual Report on Cardiovascular Health and Diseases in China (2024), aiming to offer scientific evidence for CVD prevention, treatment, and the formulation of relevant policies.

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Association between Dietary Diversity during Pregnancy and Gestational Diabetes Mellitus: A Prospective Cohort Study (30 day view times: 37)

Weiming Wang, Qian Liang, Jin Liu, Chenfan Zhang, Yuhui Luo, Xuefeng Yang, Liping Hao, Nianhong Yang

2026, 39(4): 418-426. doi: 10.3967/bes2025.160

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Objective The study aims to prospectively examine the association between the minimum dietary diversity for women (MDD-W) score and risk of gestational diabetes mellitus (GDM). Methods All participants were pregnant women enrolled in the Tongji Maternal and Child Health Cohort. Dietary intake was assessed using a food frequency questionnaire (FFQ) or 24-h dietary recall. The MDD-W score was constructed by categorizing all food items into 10 food groups, following the Food and Agriculture Organization guidelines. Oral glucose tolerance tests (OGTT) were conducted during 24−28 weeks of gestation to screen for GDM. Poisson regression models were used to assess the association between MDD-W scores and GDM risk. Results In total, 357 (11.8%) of the 3,026 women were diagnosed with GDM. Compared with participants whose MDD-W score was ≥ 8, those with a score of 5−7 had an increased risk of GDM (relative risk (RR): 1.32; 95% confidence interval (CI): 1.03, 1.69), and those with a score ≤ 4 had a significantly higher GDM risk (RR: 1.58; 95% CI: 1.12, 2.26). Furthermore, these findings indicate that pregnant women with MDD-W scores < 8, in conjunction with being overweight or obese before pregnancy and excessive gestational weight gain, have the highest risk of developing GDM. Conclusions These data suggest that a higher MDD-W score during pregnancy is independently associated with a lower GDM risk. Therefore, promoting dietary diversity and weight management is recommended to protect pregnant women from developing gestational diabetes.

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Cardiovascular Health and Disease Report in China: Two Decades of Progress (30 day view times: 33)

Shuyao Su, Fangchao Liu

2025, 38(8): 891-892. doi: 10.3967/bes2025.098

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Heat Wave and Mortality Burden of Chronic Kidney Disease: Current Assessment and Future Projection in China (30 day view times: 24)

Mengen Guo, Jiangmei Liu, Guanhao He, Jinlei Qi, Jianxiong Hu, Peng Yin, Sujuan Chen, Yulin Zhuo, Yi Lin, Xuelong Gu, Tao Liu, Ziqiang Lin, Fengrui Jing, Jinling You, Wenjun Ma, Fanna Liu, Maigeng Zhou

2026, 39(4): 464-475. doi: 10.3967/bes2026.013

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Objective Although many studies have examined temperature-related non-accidental mortality, the impact of heat waves on the mortality burden of chronic kidney disease (CKD) remains poorly understood. This study aimed to assess the CKD mortality burden associated with heat waves in China under global warming. Methods Mortality data on CKD from 2,790 counties/districts in China from 2004 to 2022 were collected from the Chinese Center for Disease Control and Prevention; meteorological data for the same period were obtained from the fifth-generation European Reanalysis Land dataset. A time-stratified case-crossover design combined with a distributed lag nonlinear model was used to examine the association between heat waves and CKD mortality. Future CKD mortality burdens attributable to heat waves under climate change and future population scenarios were projected. Results In total, 236,260 CKD deaths were included in this study. Compared to that during non–heat wave days, CKD mortality increased by 3.48% (95% confidence interval [CI]: 1.67% to 5.33%) during heat waves, and the mortality risk escalated by 2.48% (95% confidence interval [CI]: 0.12% to 4.91%) for each 1 °C increment during heat wave days. Stratified analyses revealed that CKD mortality risks were greater for women (Excess Risk [ER] = 5.52%, 95% CI: 2.71% to 8.40%), individuals aged 65 years and older (ER = 4.60%, 95% CI: 2.30% to 6.96%), and people in mesic/cold regions (ER = 6.20%, 95% CI: 1.13% to 11.53%). The projections showed that the attributable fraction(AF) of CKD mortality due to heat waves would rise from 0.64% (95% CI: 0.52% to 0.78%) in the 2020s to 2.44% (95% CI: 1.97% to 2.95%) in the 2090s under the SSP5-8.5 scenario, with the highest burden in southeastern China, including Hainan (3.31%, 95% CI: 1.66% to 5.02%), Yunnan (3.05%, 95% CI: 1.46% to 4.75%), and Guangdong Province (2.84%, 95% CI: 1.24% to 4.41%). Conclusion This nationwide study demonstrated that exposure to heat waves significantly increased the mortality risk of CKD, and that women, older individuals, and people in mesic/cold regions are more susceptible to heat waves. Global warming will significantly increase the future CKD mortality burden attributed to heat waves, particularly in southeastern China. Our findings emphasize the need to address CKD in the context of ongoing climate change.

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Association between Sensitivity to Thyroid Hormones and Metabolic Dysfunction-Associated Fatty Liver Disease: A Cohort Study (30 day view times: 21)

Xuan Wang, Jianmin Tang, Linrun Kong, Yumei Han, Shuo Chen, Bo Gao, Xinghua Yang

2026, 39(4): 427-436. doi: 10.3967/bes2026.005

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Objective To investigate the association between thyroid hormone sensitivity indices and metabolic dysfunction-associated fatty liver disease (MAFLD) in euthyroid Chinese adults. Methods This cohort study included 5,356 euthyroid patients. The peripheral and central thyroid hormone sensitivity indices were calculated. Cox regression models were used to evaluate associations with MAFLD risk, and restricted cubic splines were used to assess potential nonlinearity. Mediation analyses based on an accelerated failure-time model were used to examine the role of the triglyceride-glucose (TyG) index. Results MAFLD incidence in euthyroid participants was 18.26%. After adjustment, higher free thyroxine (FT4) levels were inversely associated with MAFLD (HR = 0.973, 95% CI: 0.948 to 0.999, P = 0.043), whereas higher free triiodothyronine (FT3) levels increased MAFLD risk (HR = 1.118, 95% CI: 1.000 to 1.250, P = 0.050). Enhanced thyroid hormone sensitivity, as reflected by elevated FT3/FT4 levels and lower total thyroxine resistance index (TT4RI), thyroid stimulating hormone index (TSHI), and thyroid feedback quantile-based index (TFQI_FT4), was also associated with a higher incidence (all P < 0.05). Mediation analyses indicated that TyG partially mediated the FT3/FT4-MAFLD and TFQI_FT4-MAFLD associations, with indirect effects of –96.27 (95% CI: –124.67 to –70.42) and –4.95 (95% CI: –8.29 to –2.10), respectively. Conclusion Increased FT3/FT4 and decreased TFQI_FT4 levels were significantly associated with a higher MAFLD risk in euthyroid adults, with TyG acting as a partial mediator.

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Association of Planetary Health Diet with Decreased Risk of All-cause Mortality and Environmental Benefits: Insights from a Multi-national Prospective Cohort Study (30 day view times: 21)

Xi Li, Liyuan Tao, Jue Liu

2026, 39(4): 476-481. doi: 10.3967/bes2026.026

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Whether adherence to the Planetary Health Diet (PHD) benefits human and environmental health is less known. We included 131,130 adults from the National Health and Nutrition Examination Survey and UK Biobank. Adherence to the PHD was measured using the Planetary Health Diet Index (PHDI) and mortality was ascertained by linking to national registries. Cox proportional hazards and linear/ordinal logistic regression models were used to analyze the association between PHD and the risk of mortality and environmental impacts, respectively. During a median follow-up of 10.6 years, participants in higher adherence groups (Quartile 2: hazard ratio = 0.88, 95% confidence interval = 0.82–0.95; Quartile 3: 0.87, 0.82–0.93; Quartile 4: 0.70, 0.54–0.92) had a lower risk of mortality, compared to Quartile 1. The relationship between the PHDI and mortality showed linearity in the two cohorts (P = 0.1877 and 0.5456, respectively), and body mass index mediated 11.88% of the relationship. A higher PHDI was associated with lower greenhouse gas emissions but higher freshwater use. Our findings suggest that greater compliance with the PHD reduces mortality risk; however, its benefits for environmental sustainability are less certain.

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Correlation between Anxiety, Depression, and Sleep Quality in College Students (30 day view times: 16)

ZHANG Yu Tong, HUANG Tao, ZHOU Fang, HUANG Ao Di, JI Xiao Qi, HE Lu, GENG Qiang, WANG Jia, MEI Can, XU Yu Jia, YANG Ze Long, ZHAN Jian Bo, CHENG Jing

2022, 35(7): 648-651. doi: 10.3967/bes2022.084

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Report on Cardiovascular Health and Diseases in China 2022: an Updated Summary (30 day view times: 16)

The Writing Committee of the Report on Cardiovascular Health and Diseases in China

2023, 36(8): 669-701. doi: 10.3967/bes2023.106

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In the past 30 years, the accessibility and quality index of medical care have made remarkable progress in China, ranking the first among middle-income countries. Many cardiovascular technologies are at or near the world's leading level, and significant progress has been achieved in China solving the problem of “treatment difficulty” of cardiovascular diseases (CVD). However, due to the prevalence of unhealthy lifestyles among Chinese residents, a huge population with CVD risk factors, accelerated population aging, and other reasons, the incidence and mortality rate of CVD are still increasing, and the turning point of the decline in disease burden has not appeared yet in China. In terms of proportions of disease mortality among urban and rural residents, CVD still ranks the first. In 2020, CVD accounted for 48.00% and 45.86% of the causes of death in rural and urban areas, respectively; two out of every five deaths were due to CVD. It is estimated that the number of current CVD patients in China is around 330 million, including 13 million stroke, 11.39 million coronary heart disease, 8.9 million heart failure, 5 million pulmonary heart disease, 4.87 million atrial fibrillation, 2.5 million rheumatic heart disease, 2 million congenital heart disease, 45.3 million peripheral artery disease, and 245 million hypertension cases. China has entered a new stage of transformation from high-speed development to high-quality development, and the prevention and control of CVD in China should also shift from previous emphasis on scale growth to strategies focusing more on strategic and key technological development in order to curb the trend of increasing incidence and mortality rates of CVD.

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Total Energy Expenditure in Healthy Middle-aged Chinese Adults with Light-intensity Physical Activity: A Doubly Labeled Water Study (30 day view times: 16)

Minghang Guo, Jie Feng, Guangbo Tong, Weidong Li, Xinghua Tong, Zhibin Ren, Deqian Mao, Lichen Yang

2026, 39(4): 482-485. doi: 10.3967/bes2026.028

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Hemoglobin Thresholds for Defining Anemia among Healthy Infants Aged 0–5 Months in China: A Population-based Study (30 day view times: 16)

Shuxia Wang, Shan Jiang, Xuehong Pang, Qian Zhang, Bowen Chen, Tao Xu, Yuying Wang, Wenhua Zhao, Zhenyu Yang

2026, 39(4): 408-417. doi: 10.3967/bes2025.144

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Objective To develop hemoglobin (Hb) percentiles and thresholds for defining anemia among infants aged 0–5 months in China. Methods The National Nutrition and Health Systematic Survey for children aged 0–17 years in China, a nationwide cross-sectional study, was conducted between 2019 and 2021. Hb levels were measured in infants using the HemoCue 201+ analyzer. Age- and sex-specific Hb distributions were constructed for “healthy infants”, defined as those with adequate iron reserves at birth, exclusive breastfeeding, normal weight-for-age Z-score and weight growth velocity, normal neuropsychological development, and absence of acute or chronic diseases. A generalized additive model for location, scale, and shape was applied to fit the Hb percentiles. The 5th percentile of the Hb distribution was defined as the threshold for anemia. Results A total of 10,174 infants aged 0–5 months participated in the study, among whom 2,155 healthy infants were included in the analysis. Hb levels peaked at birth, gradually decreased to a nadir around 60 days after birth, and then rose to a plateau. The Hb thresholds defining anemia were 102.7 g/L, 96.3 g/L, 92.8 g/L, 95.4 g/L, 97.1 g/L, and 95.8 g/L for the 0-, 1-, 2-, 3-, 4-, and 5-month age groups, respectively. Conclusion This study establishes hemoglobin thresholds for defining anemia in infants aged 0–5 months based on a nationwide, population-based dataset in China.

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Cardiac Organoids: Emerging Tools for Investigating Environmental Roles in Cardiomyopathy Pathogenesis and Therapeutic Development (30 day view times: 15)

Yaoyao Xu, Zhimin Wang

2026, 39(1): 82-104. doi: 10.3967/bes2025.104

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Human cardiac organoids have revolutionized the study of cardiac development, disease modeling, drug discovery, and regenerative therapies. This review systematically discusses strategies and progress in the construction of cardiac organoids, categorizing them into three main types: cardiac spheroids, self-organizing/assembloid organoids, and organoid-on-a-chip systems. This review uniquely integrates the advances in vascularization, organ-on-chip design, and environmental cardiotoxicity modeling within cardiac organoid platforms, offering a critical synthesis that is absent in the literature. In the context of escalating environmental threats to cardiovascular health, there is an urgent need for physiologically relevant models to accurately identify cardiac toxicants and elucidate their underlying mechanisms of action. This review highlights advances in cardiac organoid applications for disease modeling—including congenital heart defects and acquired cardiovascular diseases—drug development, toxicity screening, and the study of environmentally induced cardiovascular pathogenesis. In addition, it critically examines ongoing challenges and underscores opportunities brought by bioengineering approaches. Finally, we propose future directions for developing standardized cardiac organoid platforms with clinical predictability, aiming to expand the utility of this technology across broader research applications.

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Compound Temperature–humidity Extremes Increase Acute Mental Health Outcomes: A 12-year Case-crossover Metropolitan Study (30 day view times: 15)

Xin Liu, Xin Huang, Jingya Zhang, Haoran Li, Ning Zhang, Yingying Su, Yang Wang, Tongyan Liu, Rengyu Wu, Jincai Wei, Bin Zhu

2026, 39(4): 493-498. doi: 10.3967/bes2025.150

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A Nationwide Analysis of Key Environmental Determinants Shaping the Spatial Distribution of Kashin-Beck Disease in China (30 day view times: 15)

Fang Qi, Ying Liu, Bing Zhang, Qian Yu, Songyao Zhang, Haoyu Du, Jiaxin Li, Yue Zhao, Chenxi Wang, Jiayuan Li, Silu Cui, Jun Yu

2026, 39(5): 609-615. doi: 10.3967/bes2026.030

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Modifying Effect of Wind Speed on the Temperature-humidity Interaction Impacting Hand, Foot, and Mouth Disease as Assessed by Years Lived with Disability in Western China (30 day view times: 14)

Jie Sun, Junyan Xi, Zhishen Wu, Wangjian Zhang, Jianjun Bai, Yining Xiang, Yucan Zhang, Jiajia Wang, Shihao Wang, Jing Gu, Yuantao Hao, Xiao Lin

2026, 39(5): 529-540. doi: 10.3967/bes2026.008

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Objective Hand, foot, and mouth disease (HFMD) transmission is sensitive to temperature-humidity interactions; however, the role of wind speed in modifying these effects remains unknown. This study investigated how wind speed modifies the combined effects of temperature and humidity on HFMD burden and identified subgroups of individuals with increased vulnerability to these climate exposures. Methods We analyzed data from 524,100 HFMD cases and daily meteorological measurements across Guizhou, China, between 2012 and 2019. Disease burden was quantified as the number of years lived with disability. Exposure-response relationships and lag effects were modeled via distributed lag non-linear models. Additive interactions were assessed based on the proportions attributable to the interaction. The effects of sex, ethnicity, and urbanization were examined using stratified analyses. Results Meteorological factors showed synergistic effects on HFMD burden. The peak burden occurred at moderate mean temperatures (8.7–22.8 °C) combined with high relative humidity (> 73.7%), showing a 2.4-fold increase versus the reference. High wind speed (> 2.5 m/s) further increased this effect, with a 3.1-fold increase in burden. This joint effect was attributable to the additive interaction involving wind speed and remained robust in stratified analyses that identified heightened vulnerability among boys, minority areas, and urban agglomerations. Conclusion The HFMD burden was highest under specific combinations of temperature and humidity, and further increased with concurrent exposure to high wind speeds. Public health strategies for HFMD prevention should incorporate wind speed monitoring into early warning systems and address vulnerable subgroups, including boys and populations in minority areas and urban agglomerations.

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Association of Ambient PM_2.5 Components with Lung Function in Adults Aged 40–89 Years: A Cross-sectional Study in China (30 day view times: 14)

Yunhan Zou, Ning Li, Yu Wang, Jiaonan Wang, Chen Chen, Jianlong Fang, Xiaoming Shi

2026, 39(5): 584-590. doi: 10.3967/bes2026.039

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This study evaluated the impact of Particulate Matter 2.5 (PM_2.5) and its components on lung function. In total, 2,045 participants aged 40–89 years were recruited for this multi-center cross-sectional study. Lung function measurements were performed. Real-time PM_2.5 and its component data were obtained from atmospheric monitoring sites. Linear mixed-effects (LME) models were used to assess the relationships between PM_2.5, its components, and lung function. Weighted quantile sum regression, quantile g-computation, and Bayesian kernel machine regression were applied to assess the joint effects of PM_2.5 components on lung function. The mean PM_2.5 concentration during the study period was 71.92 μg/m³. Among PM_2.5 components, nitrate had the highest mean concentration (16.82 μg/m³), followed by organic carbon and sulfate. In the LME models, PM_2.5 exposure at a 1-day lag, scaled to its interquartile range, was significantly related to decreased lung function. Specifically, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), one-second rate (FEV₁/FVC), peak expiratory flow (PEF), and forced expiratory flow at 25% FVC (FEF_25%) decreased by 3.75%, 6.56%, 2.89%, 10.48%, and 8.71%, respectively. An age-stratified analysis showed stronger negative associations among participants aged ≥ 60 years compared with middle-aged adults. In mixed-exposure models, the PM_2.5 mixture was significantly linked to a decline in lung function. Zinc (Zn) and magnesium ion (Mg²⁺) were significantly linked to reduced FVC and ammonium ion (NH₄⁺) was identified as a key contributor to reduced FEV₁, PEF, and FEF_75%. Lung function declined with increasing PM_2.5 and its components. Zn, Mg²⁺, and NH₄⁺ were identified as key components.

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Low Cardiac Output Augmentation during Exercise Stress Echocardiography at Low Altitude Predicts High Risk of Acute Mountain Sickness (30 day view times: 14)

Yang Shen, Boji Wu, Zhen Liu, Yuanqi Yang, Chun Li, Siming Gong, Shizhu Bian, Xi Liu, Chen Zhang, Jihang Zhang, Chuan Liu, Zhexue Qin

2026, 39(5): 541-552. doi: 10.3967/bes2026.014

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Objective Stress-induced changes in echocardiographic parameters reflect cardiac reserve function. This study aimed to identify predictors of acute mountain sickness (AMS) using exercise stress echocardiography (ESE) before ascent. Methods In this prospective cohort study, 104 healthy adults were enrolled and treated using ESE using a mechanically braked bicycle ergometer at a low altitude (LA) (500 m). Physiological data and echocardiographic parameters were collected before and during exercise. An ascent from 500 m to 4,100 m was completed by the bus within two days. AMS was identified using the Lake Louise Questionnaire. Results Among the 104 participants, 49 developed AMS at 4,100 m. Compared with individuals without AMS, those with AMS had a higher low-altitude (500 m) heart rate (HR) but lower stroke volume (SV) at rest, lower cardiac output (CO) and SV during exercise, and lower rates of change in CO, SV, and HR. Multivariate regression analysis revealed that female sex (odds ratio [OR] = 3.17, P = 0.039) and the rate of change in CO during exercise (OR = 0.98, P = 0.001) were independent risk factors for AMS. Participants with the lowest CO change rate after ESE presented the highest AMS risk. Conclusion ESE could serve as an effective screening tool for AMS susceptibility, and blunted CO augmentation during exercise is an independent predictive marker for AMS risk.

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Short-term Ozone Exposure and Its Impact on Mortality Risk from Circulatory System Diseases: A Comparative Analysis Based on Multi-source Data (30 day view times: 14)

Chaodong Long, Shunshun Zhang, Wenjing Su, Mike Z. He, Qinghua Sun, Cheng Liu, Tiantian Li

2026, 39(5): 501-511. doi: 10.3967/bes2026.036

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Objective Ozone pollution significantly impacts public health; however, inconsistent exposure assessment data introduce uncertainty to health risk evaluations. The accurate assessment of health risks and disease burden is essential to protecting public health and formulating effective control strategies. Methods This study used a generalized linear model to compare health risks and disease burdens assessed using three ozone datasets (CNEMC, TAP, and USTC) based on circulatory system disease mortality data from 199 Chinese counties (2014–2018). Results The impact of ozone exposure on the risk of death from circulatory system diseases was most significant at lag03. In the CNEMC dataset, a 10 μg/m³ increase in O₃-MAD8 was associated with a 0.14% (95% CI: 0.01%—0.26%) increase in the risk of death. In contrast, the risk estimates for TAP and USTC were 0.26% (95% CI: 0.10%—0.42%) and 0.23% (95% CI: 0.09%—0.37%), respectively, indicating a difference of up to 46%. The estimated annual attributable deaths by TAP and USTC were 1.96 and 1.85 times higher than those in the CNEMC dataset, respectively. Conclusion Ozone exposure was associated with increased circulatory system disease mortality. Both risk estimates and attributable mortality burdens varied substantially across different datasets, thus highlighting that exposure data selection can materially influence health risk evaluation.

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The Global, Regional, and National Burden of Cardiovascular Diseases Attributable to Household Air Pollution from 1990 to 2021: Findings from the Global Burden of Disease Study 2021 (30 day view times: 14)

Zehao Zhao, Yong Zeng

2026, 39(4): 447-463. doi: 10.3967/bes2025.141

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Objective This study investigates the global, regional, and national cardiovascular disease (CVD) burden caused by household air pollution (HAP) from 1990 to 2021 across regions, time periods, sexes, and age groups. Methods The global CVD mortality and disability-adjusted life years (DALYs) attributable to HAP are analyzed to assess their current status and historical trends. Quantitative methods are used to assess health inequalities. Projections up to the year 2040 are made using the Nordpred method. Results In 2021, 0.758 million deaths and 18.175 million DALYs were attributed to HAP-related CVD, with age-standardized rates (ASR) for mortality and DALYs of 8.950 and 210.354 per 100,000 individuals, respectively. The disease burden increased with age and was higher in men. While mortality and DALYs rates have decreased over the past three decades, with more significant reductions in low- and middle-income regions, health inequalities persist despite improvements. Projections indicate a slow increase in the CVD burden attributable to HAP by 2040, even as the per capita rates decline. Conclusion Although significant reductions in CVD attributable to HAP have occurred globally, particularly in low- and middle-income countries, disparities persist. Health inequalities have improved but remain significant. As the global population grows and ages, total cases will increase, highlighting the need for continued, targeted interventions.

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