The Relationship For Blood Lipid Levels And Stroke Incidence In Chinese Rural Population Aged 45～75 With Primary Hypertension

CSPPT was a multicenter randomized controlled trial with the selections aged among 45～75. The trial was designed to confirm that enalapril maleate combined folic acid tablets was more effective in preventing stroke among patients with hypertension when compared with enalapril maleate tablets alone. We used the data from CSPPT to explore the relationship for blood lipid levels and stroke incidence in Chinese rural population aged 45～75 with hypertension.Part Ⅰ The distribution and impact factors for dyslipidemia in Chinese rural population aged 45～75 with primary hypertensionBackground:As an important risk factor for cardiovascular disease, dyslipidemia was highly concerned. The lifelong low serum total cholesterol level in Asian people and the relative low incidence for coronary heart disease (CHD) was considered as the powerful evidence for high level for cholesterol increased the CHD incidence. According to the report provided by Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group, total serum cholesterol levels fell in Australia, North America and the western, central and eastern part of Europe, but the serum total cholesterol level increased in east and southeast Asia and Pacific region. But in China, we had few data to describe this status, and there were even less data for Chinese rural population.Objects:Describe the dyslipidemia incidence in Anqing and Lian yungang rural population which participated the CSPPT program. The cutoff point for dyslipidemia was followed by Chinese guidelines on prevention and treatment of dyslipidemia in adults.Methods:All the subjects for this study came from the CSPPT program in Anqing and Lian yungang,20702 Chinese rural people were included. Baseline data (laboratory tests, behavioral questionnaire and physical examination data.) was obtained as the standard operational procedure (SOP) declared.Results:There were 20702 subjects with primary hypertension participated CSPPT programme, which 8500 male subjects were recruited and 12201 female subjects were recruited. The plasma glucose levels and blood lipids levels were higher in female population. The prevalence of current smoking subjects were higher in male population. The prevalence of dyslipidemia was higher in Lianyungang district. There were no significant difference between the age >=65 subgroup and the age <65 subgroup in dyslipidemia prevalence. There were no significant difference among the different baseline systolic blood pressure subgroups in dyslipidemia prevalence. The dyslipidemia prevalence increased as the BMI categories raised up.Part II Relationship for baseline blood lipid level and stroke incidence in Chinese rural population aged 45～75 with primary hypertensionBackground:Serum total cholesterol level elevation increased the coronary heart disease incidence has been highly proven. While the relationship for serum total cholesterol and stroke incidence was still a complex issue. The relationship varied among different ethics, races, sexes and regions. On the other hand, HDL-c level was considered a protective factor, but there were still some arguments for it. However, there were even less evidence for the Chinese population, especially for Chinese rural population.Objects:Explore the relationship for blood lipid level and over-all stroke incidence and its subtypes in Chinese rural population aged 45～75.Methods:Cox proportional hazard model was used to investigate the association between the four baseline blood lipid level and the overall stroke incidence and its subtypes. All the subjects were from the CSPPT program.Results:There were 20702 subjects included in this program, the average following time was 4.6years, and there were 565 subjects with stroke onset. The multivariable HRs(95%CI) of all-type stroke for serum total cholesterol levels(the whole population were divided into four subgroups according to the total cholesterol categories, the lowest category was considered as the reference, three subgroups were as follows): 1.00,1.08(0.88,1.32); 1.20(0.98,1.47) when come to the LDL-c levels:1.00, 1.23(1.00,1.52),1.38(1.12,1.69), the HDL-c levels:1.00,1.18(0.98,1.43), 1.03(0.84,1.26), and the total triglyceride levels:1.00,0.97(0.79,1.18),0.98(0.80,1.20). After multivariable HRs(95%CI) adjustment, the hazard ratios for ischemic stroke was as follows:total cholesterol levels:1.00,1.10(0.87,1.39),1.29(1.02,1.62),LDL-c levels: 1.00,1.24(0.97,1.58),1.54(1.21,1.94), HDL-c levels:1.00,1.09(0.88,1.34), 0.95(0.76,1.18), and total glyceride levels:1.00,1.05(0.84,1.31),1.11(0.88,1.39). When we referred to the hemorrhagic stroke, the multivariable HRs was as followed. The multivariable hazard ratios for total cholesterol:1.00,1.15(0.74,1.78), 1.02(0.62,1.66), LDL-c levels:1.00,1.39(0.90,2.16),0.96(0.57,1.61), HDL-c levels:1.00, 1.66(1.01,2.70),1.61(0.98,2.67)and the total glyceride levels:1.00,0.76(0.49,1.17), 0.57(0.34,0.94).Part Ⅲ explore the relationship between blood lipid levels and stroke incidence among different risk factors’ stratificationBackground:Different risk factors leaded to the stroke attack. And their mechanisms varied due to different risk factors. Age, blood pressure and body mass index (BMI) were among the most important ones. The interactions for blood lipid levels and other stroke risk factors hadn’t been deeply investigate.Objects:To investigate the relationship between blood lipid levels and stroke incidence among different risk factors’ stratificationMethods:We divided the whole population into 9 categories according to the teretile of the blood lipids levels and the risk factors levels. And then, we describe the stroke incidence in each categories.Results:In the highest age categories, the blood lipids seemed to be more related to the stroke incidence. And in the highest mean systolic blood pressure before stroke attack, the serum totol cholesterol levels seemed more related to the over-all stroke and ischemic stroke incidence. While in the lowest categories in BMI stratification, as the total cholesterol levels raised up, the incidence for hemoragic stroke incidence decreased.