Nested Case-control Study On Risk Factors Of Coronary Heart Disease In Rural Minority Population Of Xinjiang

Objective:1.The study used a two-way cohort study to understand the incidence and epidemiological characteristics of CHD in the rural minority population in Xinjiang;2.To construct a nested case-control study,comprehensively explore the main factors of CHD,and the interaction between the factors on the risk of CHD in the rural minority population in Xinjiang;3.To explore the dose-response relationship between influencing factors and the risk of CHD,and to provide scientific basis for the intervention and prevention of CHD in Xinjiang.Methods:1.The epidemiological investigation was carried out in jiangbazi township,kashgar county,xinjiang province,and in narati town and halabra town,xinyuan county,yili county.The survey from 2010 to 2012 was used as the baseline,and three follow-up visits were conducted in 2013,2016 and 2017.Local medical insurance information and hospital medical records from 2010 to 2017 were collected in 2018 for verification.Finally,a total of 7,282 subjects were included in the study,the mean follow-up time was 6.50 person-years.In this cohort,304 patients with the first occurrence of CHD were selected as the case group,and case-control matching was conducted in 1:2 to establish a nested case-control study.2.Using t test,?² test compared baseline characteristics of study subjects and Cox regression was used to analyze the relationship between factors and CHD.3.Constructing subgroups in the Cox regression model was used to evaluate the multiplicative interactions among the factors.The additive interaction index was used to evaluate the additive interaction between the factors on the risk of CHD.4.The dose-response relationships were described by STATA software.The nolinear dose-response fitted by the restrictive cubic spline model of Cox regression model,and the generalized least square method was used to describe the linear dose-response relationship between each continuous factor and CHD risk ratio,and to reveal the dose-response relationship between different factors and CHD riskResults:1.Incidence of CHD: the cumulative incidence of CHD was 4.17%?304/7282?in rural areas of Xinjiang,4.90%?194/3961?in Kazakh,4.18%?70/1675?in Kazakh males and 5.42%?124/2286?in Kazakh females.The cumulative incidence of CHD was 3.31%?110/3321?in Uygur,2.43%?41/1685?for Uygur males and 4.22%?69/1636?for Uygur females.2.Influencing factors analysis: univariate Cox analysis found high-fat diet?HR 1.46,95% CI 1.16-1.84?,abnormal glucose metabolism?HR 1.83,95% CI 1.39-2.41?,and dyslipidemia?HR 1.50,95% CI1.19-1.90?,hypertension?HR 1.79,95% CI 1.42-2.26?increased the risk of CHD,further adjusted the family history of CHD,smoking and drinking to find that high-fat diet?HR 1.36,95% CI 1.07-1.73?,abnormal glucose metabolism?HR 1.76,95% CI 1.33-2.33?,dyslipidemia?HR 1.33,95% CI 1.05-1.69?,and hypertension?HR 1.67,95% CI 1.31-2.11?still increased the risk of CHD.High-fat diet,abnormal glucose metabolism,dyslipidemia,and hypertension are independent risk factors for the minority population in rural areas of Xinjiang.Analysis by minority group found that high-fat diet?HR 1.67,95% CI 1.23-2.27?,abnormal glucose metabolism?HR 1.47,95% CI 1.01-2.16?,and hypertension?HR1.57,95% CI 1.16-2.13?were independent factors of CHD in Kazakh.In Uighur,abnormal glucose metabolism?HR 2.54,95% CI 1.61-4.00?,and hypertension?HR 1.83,95% CI 1.23-2.71?were independent CHD factors.3.Interaction analysis: after adjusting the family history of CHD,smoking and drinking,the multiplicative interaction between high-fat diet,abnormal glucose metabolism,dyslipidemia,and hypertension increased the risk of CHD in nested case-control populations,but there were no additive interactions.In the Kazakh population,the multiplicative interactions between high-fat diet,abnormal glucose metabolism,and high blood pressure increased the risk of CHD,and there were no additive interactions among the factors;in the Uyghur population,abnormal glucose metabolism,high blood pressure.The multiplicative interactions increased the risk of CHD,and there were no additive interactions among the factors of CHD.4.The dose-response relationship: After adjusting for age,gender,family history of CHD,smoking and drinking.With increasing each 1kg/m² in BMI level can increase the risk of new-onset CHD by 3.16%?RR 1.03,95%CI 1.02-1.05?,and an increase of 1 mmol/L in LDL-C level can increase the risk of new-onset coronary heart disease by 24.06%?RR 1.24,95%CI 1.05-1.46?,each 5 mm Hg increase in SBP can increase the risk of new CHD by 5.31%?RR 1.05,95%CI 1.03-1.08?.When the waist circumference> 87 cm,the waist circumference of the cohort had a positive non-linear dose-response relationship with the risk of CHD,and had a statistical difference(P_model <0.001,P_nonlinearity = 0.039).When 5 mmol / L < FBG <6.8 mmol / L,a positive nonlinear dose-response relationship(P_model = 0.003,P_nonlinearity = 0.003),and had a statistical difference.Conclusions:1.The incidence of CHD in rural minority population of Xinjiang was 4.17%,and the incidence of CHD in Kazak and Uygur populations?4.9% vs 3.3%?were higher than the national level.2.High-fat diet,abnormal glucose metabolism,dyslipidemia,and hypertension were independent risk factors for CHD in rural minority population of Xinjiang.High-fat diet,abnormal glucose metabolism and hypertension are independent risk factors of CHD in Kazakh,abnormal glucose metabolism and hypertension are independent risk factors of CHD in Uygur.3.There are multiplicative interactions between the risk factors of CHD will increase the risk of CHD in rural minority population of Xinjiang,but there is no additive interaction.4.Among minority populations in rural areas of Xinjiang,BMI level,LDL-C level,SBP level have linear dose-response relationship with the risk of CHD,and waist circumference and fasting blood glucose levels have nonlinear dose-response relationship with CHD risk.