Analysis Of Atherosclerosis And Related Factors In Middle - Aged And Elderly People In Changfeng Community

Part I AbstractThe Frequency of Carotid Atherosclerosis and Associated Risk Factors in Chinese Middle-aged and Elderly Population:Shanghai Changfeng StudyBackground/Aims:Cardiovascular diseases(CVD) are the leading cause of both death and the burden of disease in China. This contribution of CVD to morbidity and mortality has directed attention to risk factors detection of atherosclerosis. The use of high resolution color-coded duplex sonography offers the opportunity to assess the carotid intima-media thickness (CIMT) and carotid plaque as reliable markers for CVD. The association between risk factors and carotid atherosclerosis in Chinese is less well-established. Moreever, there are considerable debates about whether CIMT is increased in pre-diabetic subjects. Therefore, the aim of the study was to determine the frequency of carotid atherosclerosis and to examine the association between risk factors and carotid atherosclerosis.Methods:From June2009to June2012, we conducted a community-based study among5375(2299men and3076women) residents at least45years old from Changfeng Study. A standard interview(included life style, diseases history through questionnaires), anthropometrics (height, weight, waist and hip circumference, blood pressure), laboratory parameters (including serum lipid, fasting blood glucose(FBG),2h postload plasma glucose (PPG) after oral glucose tolerance test were conducted for participants without diabetes mellitus). CIMT was measured using high-resolution B-mode ultrasonography. Common carotid artery, carotid bifurcation and internal carotid artery were scanned for the presence of plaque. All measurements were carried out by a single sonographer.Results:The mean age of the participants was62.6±9.9years. The median CIMT value of the cohort was0.768±0.160mm.31.2%participants had carotid plaque. The CIMT and the total prevalence of carotid plaque increased with age. The CIMT and the prevalence of carotid plaque was significantly higher in males than that in females. Linear regression analysis demonstrated that the CIMT was positively associated with aging, male sex, BMI, SBP, urine albumin creatinine ratio(UACR), smoking and LDL-C, while DBP was negatively associated with CIMT. Logistic regression analysis demonstrated that the prevalence of carotid plaque was positively associated with aging, male sex, SBP, UACR, smoking and LDL-C, while DBP was negatively associated with plaque. The increased CIMT was positively associated with ageing, male sex, BMI, SBP, LDL-C, UACR, hypertension and smoking, while negatively with DBP. In multiple linear and logistic regression analysis models, after adjustment for age and sex, the differences of CIMT and carotid plaque reached statistical significance only in new diagnosed diabetic and known diabetic group compared with NGT and IGR, but not in IGR compared with NGT. Hyperglycemic markers including FBG and PPG were not independently associated with CIMT and carotid plaque after adjusted for age, sex, and other conventional CVD risk factors.Conclusions:The mean CIMT value of the cohort was0.768±0.160mm.31.2%participants had carotid plaque. Carotid atherosclerosis was mainly related to multiple metabolic disorders. Increased carotid atherosclerosis was not observed among IGR group compared with NGT, although their CVD risk factors already had begun to deteriorate. Part Ⅱ Abstract Urinary Albumin Excretion Is Associated with Carotid Atherosclerosis in Chinese Middle-aged and Elderly Population:Shanghai Changfeng StudyBackground:Urinary albumin excretion(UAE) measured by the urine albumin creatinine ratio (UACR) is an easily measurable parameter which reflects systemic endothelial function. Microalbuminuria, defined as an UACR of30～300μg/mg, is an established risk factor for cardiovascular(CV) morbidity and mortality in general population or individuals with hypertension or diabetes mellitus. There is a lack of evidence on the association between UAE and carotid atherosclerosis in Chinese population. Low grade albuminuria(LGA) has been defined as UACR below the threshold of microalbuminuria. There are considerable debates about the relationship between LGA and atherosclerosis. UACR is associated with hyperglycemia and hypertension that may themselves be linked with CVD. Previous studies included different proportion of hypertensive or diabetic subjects. Even Framingham Heart Study and Strong Heart Study only excluded subjects with FBG≥7.0mmol/l or treated diabetes. Therefore, the results may be confounded by impaired glucose regulation and postprandial hyperglycemia. We address the question of the relationship between UACR and carotid atherosclerosis. Furthermore, we investigate whether LGA is independently associated with carotid atherosclerosis in a community-based normotensive and euglycemic population aged45years and above.Methods:The subjects were participants of the Changfeng Study from June2009to June2012. We excluded subjects with macroalbuminuria or leucocyturia or erythrocyturia.5033subjects(2210males and2823females) were included in the analyses. In subgroup analysis, we further excluded subjects with prevalent hypertension, prevalent diabetes mellitus or pre-diabetes, prevalent CVD. Finally,1341subjects (489males and852females) were included in the analysis. The urinary albumin excretion rate was measured from an early morning urine sample as the albumin-to-creatinine ratio (ACR).Results:The mean age of the participants was62.6±9.8years. The increased UACR and microalbuminuria were significantly associated with carotid atherosclerosis after adjusted for traditional CVD risk factors. In subgroup analysis, the median LGA was5.1u g/mg Cr in the normotensive and euglycemic population within normal UACR range. The subgroup cohort was stratified according to tertiles of LGA. The CIMT and prevalences of carotid plaque and carotid atherosclerosis increased across tertiles after adjustment for age, sex, smoking, BMI, WHR, SBP, DBP, FBG, PPG, TG, GFR, LDL-C and HDL-C. Compared with the subjects of the first and second tertile of UACR, those in the third tertile had significantly higher levels of CIMT and increased risk of carotid plaque and carotid atherosclerosis. The OR of carotid atherosclerosis in the third tertile was1.679folds compared with the lowest tertile after adjustment for age, sex and other conventional cardiovascular risk factors. Notably, logUACR was strongly associated with CIMT (standardized β=0.1, P<0.001) after adjustment for age, sex, smoking, BMI, WHR, SBP, DBP, FBG, PPG, TG, GFR, LDL-C and HDL-C. Similarly, by logistic regression analysis, logUACR independently predicted carotid plaque and carotid atherosclerosis(OR1.951,95%CI1.156-3.292; P=0.012, and OR2.126,95%CI1.363-3.316; P=0.001, respectively) after adjustment for all potential confounders. Conclusion:These results suggest that increased urinary albumin excretion is an independent risk factor for carotid atherosclerosis. And even in the normal UACR range we demonstrated that low-grade albuminuria remained a relatively strong positive relationship with CIMT and carotid atherosclerosis even after adjustment for conventional CVD risk in this middle-aged and elderly population with normal glucose and normal blood pressure. Part III AbstractSerum Levels of Osteocalcin are Associated with the Carotid Atherosclerosis and the Glucose Metabolism in Chinese Middle-aged and Elderly Population:Shanghai Changfeng StudyBackground and Aim:Serum levels of osteocalcin(OCN) are closely associated with the glucose metabolism. There is a lack of evidence on the association between OCN and glucose metabolism in Chinese general population. There are considerable debates about the relationship between OCN and atherosclerosis. As we known, there is an interaction between OCN and hyperglycemia. Previous studies included different proportion of diabetic subjects. Therefore, the association between OCN and atherosclerosis may be confounded by hyperglycemia. We address the question of the relationship between OCN and glucose metabolism. Furthermore, we investigate whether OCN is independently associated with carotid atherosclerosis in a euglycemic subgroup.Methods:The subjects were participants of the Changfeng Study from June2009to June2012. We excluded subjects with fracture within3months or therapy with bisphosphonate, calcitonin, vitamin D or corticosteroids.4852subjects(2154males and2371postmenopausal females and327premenopausal females) were included in the analyses. In subgroup analysis, we further excluded subjects with known hypertension, prevalent diabetes mellitus or pre-diabetes, therapy with lipid lowering drugs. Finally,1635subjects (638males and803postmenopausal females and194premenopausal females) were included in the analysis. Serum OCN was measured by electrochemiluminescence immunoassay.Results:The mean age of the participants was62.5±9.9years. The mean value of serum OCN was20.3±8.6ng/ml. The OCN was decreased with the worsening glucose status. Plasma glucose and the risk of diabetes decreased with the increasing OCN. Postmenopausal females had a higher level of serum OCN compared with males and premenopausal females. Linear regression analysis demonstrated that the OCN was positively associated with HOMA-B, SBP and smoking, while negatively associated with BMI, HOMA-IR and GFR in males. In premenopausal females the OCN was positively associated with HDL-C and negatively associated with HOMA-IR. In postmenopausal females the OCN was positively associated HOMA-B and SBP, while negatively associated with BMI, PPG and GFR. In subgroup analysis, the subgroup cohort was stratified according to quartiles of CIMT. After adjustment for age, sex, smoking, BMI, SBP, DBP, FBG, PPG, TG, LDL-C, HDL-C, GFR, HOMA-IR and HOMA-B, the subjects of the forth quartile had significantly higher levels of OCN compared with those in the first quartile in male NGT subjects. We found no differences on the levels of OCN among CIMT quartiles in premenopausal and postmenopausal females. Conclusions:The levels of OCN decreased with the worsening of glucose metabolism. OCN was positively associated with HOMA-B, while negatively with FBG, PPG and HOMA-IR. OCN was dependently and significantly associated with carotid atherosclerosis in middle aged and elderly male subjects with normal glucose tolerance. Exclusion for the effect of hyperglycemia on OCN, atherosclerosis may promote the expression of OCN.