Prevalence Of Coronary Heart Disease And Characteristics Of Gut Microbiota Among Rural Residents In Xinxiang County,Henan Province

BackgroundThe burden of coronary heart disease（CHD）in rural areas is increasing and the mortality has exceeded that in urban areas,which has become a considerable public health problem.Recently,numerous studies have reported the intimate association between gut microbiota and CHD,and targeted intervention of gut microbiota is considered a new opportunity for CHD prevention and treatment.However,as a complex ecosystem with dynamic evolution,the gut microbiota has strong regional heterogeneity.It is important to decipher the features of gut microbiota in rural areas.ObjectiveInvestigate the prevalence of CHD and reveal its characteristics of gut microbiota among rural residents in Xinxiang county,Henan province.MethodsBase on the Prospective Cohort Study on the Common Chronic Non-Communicable Diseases in Rural areas of Henan Province,we conducted a cross-sectional study in Xinxiang county utilizing a multistage,stratified,random cluster sampling method.10691 rural residents,aged 18 to 79 years,participated in this study and underwent questionnaires,physical examinations,and laboratory tests from April to June 2017.According to the medical history,19 patients with CHD alone and 19 healthy controls（HC）with similar baseline were selected from the Xinxiang cohort.Then,fecal samples were collected and genomic DNA was extracted to perform the metagenomic sequencing.Results1.Prevalence and distribution of CHD among rural residents in Xinxiang county:In total,10376 participants were included in the final analysis.There were 886 residents suffering from CHD and the prevalence was 8.54%in Xinxiang county.The prevalence of males and females was 8.35%and 8.67%,which existed no significant difference（P>0.05）.Stratified analysis indicated that CHD prevalence of farmers elevated along with age and the number of comorbidities,and declined with personal monthly income(P _trend<0.05).2.Diversity of microbial communities and taxonomic composition in CHD and HC:The diversity of gut microbiota between CHD and HC demonstrated no disparities（P>0.05）.Top 5 phyla in both groups were Firmicutes,Bacteroidetes,Actinobacteria,Proteobacteria,and Verrucomicrobia.At the genus level,Top 5 genera were Bacteroides,Lachnospiraceae＿Unclassified,Escherichia,Faecalibacterium,and Blautia in CHD patients,whereas Top 5 genera in HC were Bacteroides,Prevotella,Faecalibacterium,Lachnospiraceae＿Unclassified,and Bifidobacterium.At the species level,Top 5 species in CHD patients ranked by Eubacterium rectale,Escherichia coli,Faecalibacterium prausnitzii,Blautia sp.SC05B48,and Bacteroides fragilis,while Top 5 species sorted by F.prausnitzii,Bacteroides vulgatus,Bacteroides ovatus,B.fragilis,and Bacteroides sp.A1C1in HC.Relative abundance of Bacteroidetes,Lachnospiraceae＿Unclassified and E.rectale displayed significant differences between groups（P<0.05）.3.Functional characteristics of gut microbiota in CHD and HC:KEGG orthology（KO）and carbohydrate-active enzymes（CAZymes）of gut microbiota between CHD and HC showed no significant differences（Adonis test P>0.05）.Genetic information processing,cellular community（prokaryotes）,membrane transport,translation,drug resistance（antimicrobial）,carbohydrate metabolism,unclassified metabolism,and immune system were the most abundant functions at Level 2 of each KO hierarchy,respectively.Glycoside hydrolases（GHs）and glycosyl transferases（GTs）were the enriched CAZymes and the relative abundances were more than 90%.4.Differential profiles,clinical association and diagnostic value of gut microbiota between CHD and HC:LEfSe identified 39 differential taxa and random forest model further identified the Top20 differential species,KO,and CAZymes.Top20 differential KOs demonstrated that sulfur metabolism,bacterial invasion of epithelial cells,secretion system,and two-component system were enhanced in HC,whereas ABC transporters,butanoate metabolism,enzymes with EC numbers,and transcription factors were elevated in CHD.Bacterial invasion of epithelial cells（K13735）was enriched in the KO-species network.Top20 differential CAZymes indicated protein glycotransferase,arabinanβ-1,2-arabinofuranosyltransferase,and modules of chitin-binding function were elevated in CHD,whereas other functions were enhanced in HC.Rhamnogalacturonan endolyase（PL4）,β-glucuronidase（GH79）,andβ-1,2-arabinofuranosyltransferase（GT89）were enriched in the KO-CAZymes network.Top20 differential species mainly enriched in Clostridial clusters,which harbored positive correlations with systolic blood pressure（SBP）,total cholesterol（TC）,low-density lipoprotein cholesterol（LDL-C）,waist circumference（WC）and body mass index（BMI）（FDR adjust P<0.05）.The specificity,sensitivity,Youden’s index,and the area under the receiver operating characteristic curve（AUC）of Top20 differential species were 0.789,0.89,0.578 and 0.842,respectively.Conclusions1.The prevalence of CHD among rural residents in Xinxiang county,Henan province is relatively high.2.Relative abundance of species in the Clostridia cluster,among rural CHD patients in Xinxiang county,is increased and butanoate metabolism is enhanced.