| Part 1Objective:This study is to evaluate whether the China-PAR equations may be used to predict 10-year risk of cardiovascular disease(CVD)in a prospective cohort of Mongolian population,northern China.Methods:Study participants aged 20 years and above were recruited from 32 villages in 2 adjacent townships located in Kezuohou Banner(county)and Naiman Banner in Inner Mongolia.A total of 2589 Mongolian residents were included between June 2002 and September 2003.Data on demographic characteristics,lifestyle risk factors,history of diseases and family history of CVD were collected at baseline.Blood pressure,body height,weight and waist circumference were measured.Blood samples were obtained to test fasting plasma glucose,total cholesterol,triglycerides,low-density lipoprotein cholesterol and high-density lipoprotein cholesterol etc.By the end of July 2012,all participants were followed up every two years on average to determine new CVD events including coronary heart disease and stroke.10-year predicted CVD risk was calculated for every participant based on the sex-specified China-PAR equations.Participants were categorized into 4 subgroups according to 10-year predicted CVD risks:0-4.9%,5.0-9.9%,10.0-19.9%,≥20.0%.Hazard ratios(HRs)and 95%confidence intervals(CIs)of CVD events were computed across each risk groups compared with the 0-4.9%category in a multivariate Cox proportional hazard model.In addition,Hosmer-Lemeshow x2 and C statistics were used to assess the calibration and discrimination of the China-PAR equations.Results:The participants have been followed up for an average of 9.2 years.A total of 195 CVD events were observed and the cumulative incidence was 7.69%.The multivariate adjusted HRs(95%CIs)of CVD for participants with predicted risk of 5.0-9.9%,10.0-19.9%,>20.0%were 4.94(3.15-7.74),7.78(4.88-12.39),15.37(9.13-25.87)respectively with the 0-4.9%as a reference(P for trend<0.001).The China-PAR equations discriminated well and the C statistics was 0.816(95%CI:0.769-0.849)for all participants,0.808(95%CI:0.766-0.856)for men and 0.810(95%CI:0.787-0.846)for women.However,the predicted risk of CVD was significantly lower than observed among Mongolian population.Hosmer-Lemeshow x2 test also showed a dissatisfactoty calibration for all participants(x2=64.80,P<0.001),men(x2=19.98,P<0.01)and women(x2=46.58,P<0.001).Conclusion:The China-PAR equations discriminated well but underestimated the 10-year CVD risk in Mongolian population,who may not share the same CVD risk characteristics as Chinese Han people.Relavant preventive measures should be taken to induce risk of CVD incidence.The performance of the China-PAR equations deserves further to be validated in other ethnic groups in China.Part 2Objective:The aim was to evaluate the prognostic effect of serum galectin-3 and fasting plasma glucose(FPG),high density lipoprotein-cholesterol(HDL-C)on composite outcome of death and vascular events,death,stroke reccurence and vascular events within 1 year after acute ischemic stroke.Methods:Based on the China Antihypertensive Trial in Acute Ischemic Stroke(CATIS),a prospective study was conducted from August 2009 to May 2013 among 3082 patients with acute ischemic stroke.Demographic characteristics,lifestyle risk factors,history of diseases and medications were obtained at the time of enrollment.Serum galectin-3 concentrations were tested using a commercially available ELISA kit.Fasting plasma glucose,total cholesterol,triglycerides,high-density lipoprotein cholesterol were tested.Hyperglycemia(high FPG)was defined as FPG≥6.lmmol/L.Low HDL-C was defined as HDL-C<1.04mmol/L.The primary outcome was a composite outcome of death and vascular events,and secondary outcomes were separately for death,stroke recurrence and vascular events within 1 year after stroke.According to FPG or HDL-C,study participants were classified into normoglycemia and hyperglycemia;or high HDL-C and low HDL-C subgroups.Multivariate Cox proportional hazards models were used to calculate hazards ratios(HRs)and 95%confidence intervals(95%CIs)of study outcomes for each category of galectin-3 stratified by FPG or HDL-C subgroups.Furthermore,restricted cubic splines were used to examine the shape of the association between galectin-3 and primary outcome.Participants were categorized into four groups according to the galectin-3 and FPG or HDL-C levels:low galectin-3/low FPG,low galectin-3/high FPG,high galectin-3/low FPG,high galectin-3/high FPG;or low galectin-3/high HDL-C,low galectin-3/low HDL-C,high galctin-3/high HDL-C,high galectin-3/low HDL-C.The multivariate HRs and 95%CIs were calculated across the four groups using multivariate Cox proportional hazard models.In addition,net reclassification index(NRI)and integrated discrimination improvement(IDI)were computed to assess the predictive value of combined galectin-3 and FPG or HDL-C.Results:Within 1 year after stroke,112(3.63%)participants were lost and a total of 263(8.86%)patients experienced primary outcome.Among them,131(4.41%)had a stroke recurrence,173(5.82%)had vascular events and 169(5.69%)died.Increased galectin-3 was significantly associated with the primary outcome,stroke recurrence and vascular events only in the patients with hyperglycemia but not in those with normoglycemia.The multivariate-adjusted HRs(95%CIs)were 1.72(1.05-2.84),2.64(1.14-6.12)and 2.68(1.33-5.38)for the primary outcome,stroke recurrence and vascular events,respectively.An interaction existed between galectin-3 and FPG on primary outcome,stroke recurrence and vascular events(P for interaction<0.05 for all).Furthermore,a dose-response association between galectin-3 and the primary outcome was observed in hyperglycemic patients(P for linearity=0.007).We didn’t find a significant combined effect between galectin-3 and FPG on stroke outcomes after adjusting multivariate risk factors.There was an interaction between galectin-3 and HDL-C on cardiovascular events(P for interaction=0.034).In patients with low HDL-C,after adjusting for multiple confounders,the risk of cardiovascular events was significantly increased in the highest galectin-3 group(HR 2.44,95%CI 1.08-5.52).Compared with the low galectin-3/high HDL-C group,the high galectin-3/low HDL-C group had a HR(95%CI)of 1.56(1.09-2.23)for primary outcome,1.99(1.21-3.25)for stroke recurrence and 1.89(1.27-3.08)for vascular events.The addition of galectin-3 and HDL-C in the model including traditional factors improved the predictive value of composite outcome of death and vascular events,stroke recurrence and vascular events by 15.7%,18.3%,and 20.5%,respectively(all P<0.05).Conclusion:Increased serum galectin-3 was only associated with the 1 year risk of compostite outcome of death and vascular events,stroke recurrence and vascular events in ischemic stroke patients with hyperglycemia.The risk of death and vascular events was increased with an increase of gelactin-3,suggesting that galectin-3 may be an important predictive factor for the progonosis of ischemic stroke patients with hyperglycemia.Combination of high galectin-3 and low HDL-C was associated with composite outcome of death and vascular events,stroke recurrence and vascular events within 1 year after ischemic stroke,suggesting that the combination of galectin-3 and HDL-C may be used to identify the individuals at risk of poor prognosis after ischemic stroke. |
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