当今我国动脉血管硬化的危险因素英文课件

AtheroscleroticRiskFactorsinModernizingChina当今我国动脉血管硬化的危险因素 ProfWooKamSangandFungKwokPuiDepartmentofBiochemistryTheChineseUniversityofHongKong香港中文大学生物化学系胡锦生教授 冯国培教授 ChineseAtherosclerosisStudyintheAgedandYoung CATHAYStudy PanYu HongKong Macau Sydney SanFrancisco Shanxi ThreeGorges 2617asymptomaticsubjects Age 18 70yrs VascularEpidemiology AdpatedfromPepineCJAmJCardiol1998 82 10A 23S 27S No Normalintima mediathickness IMT ofCCA Atheroscleroticplaquesofcommoncarotidartery s CV 1 ComparisonofCCAIMTby2Investigators AutoCCA ManualRCCA ManualLCCA Carotidintima mediathickeningassurrogateatherosclerosismarker IsitrelevanttotheAsian WesternizationofChineseAdultsandIncreasedSubclinicalAtherosclerosisKamSWoo PingChook OlliTRaitakari BrendanMcQuillan JiangZhengFeng DavidSCelermajer WesternizationofChinesesubjectsisassociatedwithgreatersusceptibilitytothepro atherogeniceffectsoftraditionalvascularriskfactors suchaslipidsandsmoking andwithevidenceofincreasedIMTasamarkerofsubclinicalatheroscleosis EffectsofHDLCholesterolonCarotidIMT WC NC SubclinicalAtherosclerosisintheChinese CarotidIntima MediaThickening Agemeanage 42yr 44 male PanYu HongKong Sydney SanFrancisco DietaryPatternsinRuralandWesternizedChinese 0 50 100 150 200 250 p 0 001 p 0 02 p 0 001 p 0 001 MeanDailyIntakemlorg 1000Kcal p value PanYuvsothers 0 49 0 09 0 56 0 13 0 59 0 15 0 68 0 15 Karasek sJobDemand Control SupportmodelForworkenvironmentwherestressorsarechronic notinitiallylifethreatening Jobdemand 7items Decisionlatitude Jobcontrol 9items Jobsupport 19items ShiftworkChangebossPart timejobEducation Psychologicalfactors OddsRatioFromStepwiseLogisticRegressionAnalysisExplainingatherosclerosisbyDCSModel n 248 SubclinicalAtherosclerosisintheChinese Yes No Demand Control Yes Yes No No Atherosclerosis JobStress Diet Alcohol Support EffectsofSmoking PackYears onCarotidIMT WC NC HeavyTobaccoSmokePollutionisAssociatedwithHigherAtherosclerosisRiskYipTWC ChookP FengXH ChiuML PoonWH EvoraML KoonKV ChanYK LeongHC ChuCL WooKS Onmultipleregression carotidIMTwasassociatedwithageandpassivesmoking independentofbloodpressures bloodcholesterolandglucose R2 0 5 Fvalue3 6 p 0 05 BrachialFMDandCarotidIMT CasinoEmployeesvsCATHAYControls n 59 n 100 n 59 n 100 CAHTAYCohort Homocysteine CathayStudyResult Wehypothesisehyperhomocysteinaemiacontributestoatherogenesisprocessbeyondthelipideffect twounique lowbloodlipid andnovelclinicalmodelsofhyperhomocysteinaemia HongKongVoluntaryvegan vegetarian NorthernruralChineseObligatoryvegetarian Results Onmultipleregressionanalysis homocysteineandbloodpressurewereassociatedwithincreasedcarotidIMT partialR 0 59 F value 6 0 p 0 0001 independentofWHRandLDL C 6 31 1 79 6 34 1 44 6 88 1 90 7 37 1 71 P 0 05 P 0 01 P 0 001 n 41 ChangeinFMDduringtheB12SupplementationinVegetarians BaselinePlaceboB12B123mthDB6mthopenlabel 16 8 0 69 0 09 0 68 0 09 0 67 0 09 0 65 0 09 P 0 05 P 0 01 P 0 001 n 41 ChangeinIMTduringtheB12SupplementationinVegetarians BaselinePlaceboB12B123mthDB6mthopenlabel 5 7 YuCounty p 0 001 Log transferreddata Theclinicalcharacteristicsofstudysubjects RiskFactorsforCarotidAtherosclerosis FMDincreasedsignificantlyat6monthsafterthe3activetreatmentbutnotafterplacebo B12andFASupplementationinYuCounty MeanFMD Placebo n 53 B12 n 52 Folate n 51 B12 Folate n 51 Baseline DB6mths OL12mths P 0 0001 P 0 0001 P 0 0001 P 0 0001 P 0 0001 P 0 0001 P 0 0001 P 0 001 P 0 0001 P 0 0001 ThreeGorgesReservoirDam TheImpactofLifestyleChangesonAtherogenesisinMainlandChina ATaleofThreeGorgesinYangtzeRiver YJHu PChook ANWei MJWu XLWang LLi PGDong CelermajerDS KSWooChongqingUniversityofMedicalSciences ChongqingTheChineseUniversityofHongKong HongKongChongqingCenterforDiseaseControlandPrevention ChonqingWuShanCenterforDiseaseControlandPrevention ChongqingUniversityofSydney Sydney BMI bodymassindex WHR waist hipratio TC totalplasmacholesterol TG triglyceride MMS prevalenceofmultiplemetabolicsyndrome ClinicalFeaturesof2Cohorts 0 001 MeanIMT mm WuShan CarotidIMTwascorrelatedwithMMS R2 0 68 independentofbloodpressuresandHDL cholesterol DaiCheong CarotidIMTof2Cohorts P 0 001 Conclusion SedentarylifestylechangesinYangtzeriverThree Gorgesterritoriesareassociatedwithacceleratedatherogenicprocess withgreatimplicationsinatherosclerosispreventioninChina nowinfastmodernizationprocess EffectsofDietandExerciseonObesity RelatedVascularDysfunctioninChildren EffectsofDietandExerciseonObesity RelatedVascularDysfunctioninChildren P 0 001 Detrainingafter6weeks Continuedtraining P 0 001 CarotidIMTinDietary ExerciseIntervention 1yearResult Genes External Environment Internal Environment Endothelial Intima Media Dysfunction Thickening Atherosclerotic Disease DietaryHabits GreenTea Vegetables Carotene Folate AnimalProtein Fish Fator DairyProduct Life style Exercise Smoking AlcoholPsychologicalStress Bloodglucose Insulin LipidDisorders LDL CholOxidizability Antioxidants Folate Homocysteine Fibrinogen Thrombotic Factors Hypertension Obesity VCAM SUB CLINICAL CLINICAL ATHEROSCLEROSIS Gene EnvironmentInteractions Hypothesis1 HighprevalenceofatherosclerosisinwesternizedthannativeChineseHypothesis2 GenetichomogenityinmainsteamChineseethnicHypothesis3 Gene environmentalinteractionatherogenesisinmodernizingcommunities AdpatedfromPepineCJAmJCardiol1998 82 10A 23S 27S ChineseBreakfast BreakfastWesternStyle Leftupper SteamedGrassCarpwithTofuinBeanPasteLeftlower DaceFishBallswithChineseLettuceRight BraisedFishwithSweetBeanSheetsandWinterMelon Left FishCutletRight Pan friedFishSteak Leftupper SoyBeanMilkLeftlower ScrambledEggswithScallionsRightlower BraisedMixedSoyProductswithGluten Left PizzaRight MacaroniandCheesewithHam Right MincedBeefwithPotatoesLeft Stir friedBeefSliceswithChineseBroccoli Leftlower SirloinSteakDinnerRightupper SpahgettiinMeatBallSaucewithCheeseMiddle HamburgerandFrenchFries ChangingDietaryPatternsandSubclinicalAtherosclerosisinChineseAmericans TheImpactofProlongedandEarlyAcculturization KSWoo1SWChan2PChook1RKLIp1JLFWoo1DSCelermajer3 TheChineseUniversityofHongKong PRChina1TheChineseHospital SanFrancisco USA2TheUniversityofSydney NSW Australia3 ChangingDietaryPatterns SubclinicalAtherosclerosisinChineseAmericans TheImpactofProlongedAcculturization p 0 05 p 0 001 ChangingDietaryPatterns SubclinicalAtherosclerosisinChineseAmericans TheImpactofEarlyAcculturization p 0 05 p 0 01 p 0 001 Atherosclerosis EndothelialDysfunction ED AprecussorofatherosclerosisED Amarkerofearlyatherosclerosis SmokingCholesterolHypertensionDiabetesObesity EndothelialDysfunction Atherosclerosis LowerLDLcholesterolDietaryantioxidant soyprotein greentea plantphytoestrogen Genetic environmentalfactor Vesseltone Vesselgrowth Endothelialcells Smoothmusclecells tPAPAI 1 CAMs PGI2NO NOET 1VEGFMCP 1 CoagulationFibrinolysisMonocytePlateletinteractionadhesion FunctionofEndothelium weight 1 5kg DILATATION Endothelium ShearStress EDRF NO GTN SmoothMuscle BrachialArteryScans HighresolutionexternalvascularultrasoundBrachialarterydiametermeasuredfollowinghyperemiaandGTNsprayTestsendothelium dependentandindependentdilatation 10minsrest 4 5minscuffinflation 15minsrest 3mins ScanB2 ScanB3 ScanB4 ScanB1 GTN Cuffrelease Flow DependentDilatation SchachingerCirculation2000 101 1899 1906 FolicAcidandVitaminB 12SupplementationImproveAtherogenicProcessinRuralChinese ANovelandAffordableStrategyofAtherosclerosisPreventioninChina SKKwong1 PChook2 TWCYip3 YJHu4 XSHuang5 GGWang6 MJWu4 YMLiu7 WKLam2 DSCelermajer8 KSWoo2AliceHoMiuLingNethersoleHospital1 TheChineseUniversityofHongKong2 YanChaiHospital3 ChongqingUniversityofMedicalScience4 GuangdongProvincialCardiovascularInstitute5 FuWaiHospital6 SunYatSanUniversitySecondAffiliatedHospital7 TheUniversityofSydney8 PossibleContributoryFactors Reducedphysicalactivities jobandlifestyle DietarychangesSociopsychologicalstressMetabolicsyndrome Thesewillbefurtheranalysed andeffectofearlyhealth educationinterventionassessed Changesinlaser Dopplercutaneousbloodflowovertime MeanandindividualcirculatinglevelsofsCD40L PostTonsillectomy AtherogenesisinKawasakiDisease SLE SLE Kawasakidisease leftupper SteamedGrassCarpwithTofuinBeanPaste leftlower DaceFishBallswithChineseLettuce right BraisedFishwithSweetBeanSheetsandWinterMelon left FishCutlet right Pan friedFishSteak leftupper SoyaBeanMilk leftlower ScrambledEggswithScallions rightlower BraisedMixedSoyProductswithGluten left Pizza right MacaroniandCheesewithHam BlackTea ChineseTea Genes External Environment Internal Environment Endothelial Intima Media Dysfunction Thickening Atherosclerotic Disease DietaryHabits GreenTea Vegetables Carotene Folate AnimalProtein Fish Fator DairyProduct Life style Exercise Smoking AlcoholPsychologicalStress Bloodglucose Insulin LipidDisorders LDL CholOxidizability Antioxidants Folate Homocysteine Fibrinogen Thrombotic Factors Hypertension Obesity VCAM SUB CLINICAL CLINICAL ATHEROSCLEROSIS Gene EnvironmentInteractions Hypothesis1 HighprevalenceofatherosclerosisinwesternizedthannativeChineseHypothesis2 GenetichomogenityinmainsteamChineseethnicHypothesis3 Gene environmentalinteractionatherogenesisinmodernizingcommunities AdpatedfromPepineCJAmJCardiol1998 82 10A 23S 27S CentreforAtherosclerosisStudies ThefoundingmembersoftheCentreare HongKongDeptofMedicine TherapeuticsThmoasYKChan ProfessorKamSangWoo Professor DirectoroftheGregoryCheng AssociateProfessorCentre JohnESanderson Professor JulianAJHCritchley Professor PingChook ResearchFellowDeptofBiochemistryKwokPuiFung ProfessorDeptofChemicalPathologyChrisWKLam Professor ChairmanSchoolofPublicHealthJeanLFWoo Professor DirectorDeptofDiagnosticRadiology Organ ImagingConMetreweli ProfessorDeptofPaediatricsRitaYTSung AssociateProfessorCentreforClinicalTrials EpidemiologicalResearchJosephTFLau DirectorDrShirleyXuMainlandChinaTheChineseAcademyofMedicalSciences BeijingLiSheungLiu ProfessorTheChineseAcademyofMedicalSciences BeijingGuoGanWang ProfessorTheGuangdongProvinicialCardiovascularInstituteJianZhangFeng ProfessorYuCountyCardiovascularInstituteGuoD S TsinghuaUniversityMedicalSchoolMingZheChen ProfessorOverseasUniversityofSydney RoyalPrinceAlfredHospital DavidSCelermajer ProfessorClayStreetMedicalCentre SanFranciscoShuWingChan CardiologistUniversityofCalifornia VeteransAffairsMedicalCentre EdmundKeung Cardiologist Acknowledgement ResearchCollaborators CUHKKSWooPChookMQiaoJESandersonJeanLFWooCWKLamNThomasSLYXuAliceCheungLindyChanCMetreweliYKChanTWCYipSKKwong USASWChanEKeung MainlandChinaZJMaiWKLaiJZFengZSZhangLSLiuJXXieXHZhangDSGuoGGWangXSHuang TheRoyalPrinceAlfredHospitalDSCelermajerJTCRobinsonSMcMahomJAMcCrohonMRAdamsBBailey Results ComparingNon VEGwithVEG meanagewas45 8years ProgressTimeTable DifferenceintheEffectofCigaretteSmokingonEndothelialFunctioninChineseandWhiteAdultsKamSWoo JacquiTCRobinson PingChook MarkRAdams GabrielYip ZJMai ChrisWKLam KeldESorensen JohnEDeanfield DavidSCelermajer YoungChineseadultshavelessevidenceofarterialendothelialdysfunctionthanyoungwhiteadultswithsimilardirectorindirectexposuretocigarettesmoke ChineseAdultsAreLessSusceptibleThanWhitestoAge RelatedEndothelialDysfunctionKamSWoo JaneAMcCrohon PingChook MarkRAdams JacquiTCRobinson RobynJMcCredie ChristopherWKLam JianZFeng DavidSCelermajer Endothelium dependentdilation EDD issimilarinthearteriesofhealthyyoungChineseandwhiteadults Witholderage however Chinesesubjectsarelesssusceptibletoimpairedendothelialfunction P 0 001 WesternizationofChineseAdultsandIncreasedSubclinicalAtherosclerosisKamSWoo PingChook OlliTRaitakari BrendanMcQuillan JiangZhengFeng DavidSCelermajer WesternizationofChinesesubjectsisassociatedwithgreatersusceptibilitytothepro atherogeniceffectsoftraditionalvascularriskfactors suchaslipidsandsmoking andwithevidenceofincreasedIMTasamarkerofsubclinicalatheroscleosis TheImpactofHeavyPassiveSmokingonArterialEndothelialFunctioninModernizedChineseKamSWoo PingChook HokCLeong XinSHuang DavidSCelermajer InmodernizedChinese asinCaucasians exposuretoheavyenvironmentaltobaccosmokecausesarterialendothelialdysfunction akeyearlyeventinatherosclerosis ThismayhaveseriousimplicationsforcardiovascularhealthinChina currentlyinaprocessofrapidmodernization P 0 01 NS CATHAYCohort Age CathayStudyResult CATHAYCohort TotalCholesterol CathayStudyResult CATHAYCohort TotalTriglyceride CathayStudyResult CATHAYCohort HDL Cholesterol CathayStudyResult CATHAYCohort LDL Cholesterol CathayStudyResult CATHAYCohort Glucose CathayStudyResult CATHAYCohort Folate CathayStudyResult CATHAYCohort VitaminB12 CathayStudyResult CATHAYCohort FlowMediatedDilatation CathayStudyResult VitaminB12SupplementationImprovesAtherogenicProcessinVegetarians LuciaWYTam PingChook TimothyCYKwok MuQiao PeterYKPoon JeanLFWoo DSCelermajer KSWooDepartmentofMedicine Therapeutics TheChineseUniversityofHongKong Shatin HongKongSAR ChinaDepartmentofCardiology TheRoyalPrinceAlfredHospital UniversityofSydney Australia Methods Double BlindedRandomization 25vegetarians 25vegetarians VitaminB12 500 g day 1capsule Identicalplacebo 1capsule 12weekstreatment 12weekstreatment 10weekswashout VitaminB12 500 g day 1capsule Identicalplacebo 1capsule Background Micronutrientdeficiency folicacidandvitaminB12 isprevalentinnorthernruralChinaandmaybeassociatedwithatherosclerosis CATHAYStudy Preliminarystudysuggestedfolicacid FA andB12supplementationmayimprovearterialendothelialfunction surrogateatherosclerosismarker ObjectiveTofurthertestsuchsupplementationstrategyforatherosclerosisprevention Methods180asymptomaticsubjects 110males inruralShanxi YuCounty wererandomizedtoreceiveoralB12 500 g day FA 5mg day B12 FA orimage matchedplacebosindouble blind2x2factorialdesignfor6months followedbyopenlabelB12 FAfor6moremonths Flow mediateddilationofbrachialartery FMD andcarotidintima mediathickness IMT assurrogateatherosclerosismarkersweremeasuredbyhighresolutionB modeultrasoundatbaseline 6monthsand12months Methods Flow mediateddilationofbrachialartery FMD andcarotidintima mediathickness IMT assurrogateatherosclerosismarkersweremeasuredbyhighresolutionB modeultrasoundatbaseline 6monthsand12months O LearyNEJM1999 Results PreliminaryAnalysisof83Subjects Theirmeanagewas45 2 8 3years BloodB12andfolatewerelowatbaseline butsignificantlyincreasedat6monthsafterFA B12andFA B12 butnotafterplacebotreatment FA B12wasassociatedwithsignificantdecreaseinbloodhomocysteine HC andbloodpressures p 0 01 Results PreliminaryAnalysisof83Subjects Comparewithbaseline p 0 001 p 0 0001 Results Forthewhole83subjects furtherimprovementinFMD 7 0 1 6 to7 9 1 4 p 0 0001 andIMT 0 69mmto0 688mm p 0 05 at12monthswereseenafteradditionalB12 FAopenlabeltreatment Results Forthewholegroup n 89 furtherimprovementinFMDat12monthsafteradditionofB12 FAopenlabeltreatment Results Forthewholegroup n 89 furtherimprovementinIMTat12monthsafteradditionofB12 FAopenlabeltreatment ConclusionsandRemarks VitaminB12andfolicacidsupplementation eitheraloneorincombination improveatherogenicprocessinnorthernruralChinese proposinganovelandaffordableatherosclerosispreventionstrategyinChina DifferenceinB12vsFAbeneficialeffectisawaitedwithgreatenthusiasm andwillbeavailableoncompletionofanalysisof180subjectsdata Background AtherosclThrombVaasculBiol1999 19 2487 93 Near1millionfarmersoftheThree Gorgesareashavebeenresettleduplandsince1996intheThree Gorgesreservoirdamproject withobligatoryjobandlifestylechangesWesternizationofChineseadultsisassociatedwithsubclinicalatherosclreosis CATHAYStudy TheImpactofLifestyleChangesonAtherogenesisinMainlandChina ATaleofThreeGorgesinYangtzeRiver YJHu PChook ANWei MJWu XLWang LLi PGDong CelermajerDS KSWooChongqingUniversityofMedicalSciences ChongqingTheChineseUniversityofHongKong HongKongChongqingCenterforDiseaseControlandPrevention ChonqingWuShanCenterforDiseaseControlandPrevention ChongqingUniversityofSydney Sydney Methods 95residentsnon farmingresettledfor 3years28 4 maleage 49 7 9years 87farmersabouttoberesettled27 6 maleage 48 8 10years Toevaluatetheimpactoflifestylechangesonatherogenesis westudiedtwogroups Carotidintima mediathicknesswasmeasuredbyhighresolutionultrasound usingavalidatedautomaticedge detectingandmeasurementcomputerpackage WuShan WS巫山 DaChang DC大昌 O LearyNEJM1999 MultipleMetabolicSyndromes AdultTreatmentPanelIII CentralObesity Waist 91 5cm 36 inmale 82cm 32 infemaleLowHDL cholesterol1 7mmol l Hypertension BP 140 85mmHg Highbloodglucose 7 1mmol l 工作進程表 3 gorgesSurveillanceProject 2007 2009 Goodfarmland ModernTown Resident Preventive InterventionProgramme Genes External Environment Internal Environment Endothelial Intima Media Dysfunction Thickening Atherosclerotic Disease DietaryHabits GreenTea Vegetables Carotene Folate AnimalProtein Fish Fator DairyProduct Life style Exercise Smoking AlcoholPsychologicalStress Bloodglucose Insulin LipidDisorders LDL CholOxidizability Antioxidants Folate Homocysteine Fibrinogen Thrombotic Factors Hypertension Obesity VCAM SUB CLINICAL CLINICAL ATHEROSCLEROSIS Gene EnvironmentInteractions Hypothesis1 HighprevalenceofatherosclerosisinwesternizedthannativeChineseHypothesis2 GenetichomogenityinmainsteamChineseethnicHypothesis3 Gene environmentalinteractionatherogenesisinmodernizingcommunities PracticalStrategiestoCombantModernization RelatedAtherosclerosisinChina Healtheducation CounsellingBalancedChinesediet cookingmethodsandingradients Activelifestyle physicalactivitiesRiskfactorsandstressmanagement CommunityInterventionalHealthEducationProjectinHighRiskCommunityModel 3 Gorges PanYu 從調查三峽庫區移民生活環境改變對心臟血管健康狀況及常見疾病的影響去探討 香港中文大學 當今我國國民預防心腦血管粥樣硬化疾病之策略 第一次協作討論會議 日期 二零零四年十月地點 北京內容 初步討論項目的可行性 研究目的 了解庫區移民遷移前心血管疾病 危險因素及亞臨床動脈粥樣硬化性病變 心理壓力及情緒改變的發生率 評估遷移後生活環境及生活狀況改變對心血管健康的影響 比較遷移前後心血管疾病發生率和危險因素水平 原地後遷移民與外遷移民相比較 新移居地移民與當地居民相比較 計劃對社區移民進行干預試驗性研究 為移民提供衛生健康知識及普及教育 培訓基層衛生工作人員 建立基層衛生教育及疾病預防服務網絡 以此為試點 穫取一手資料 總結經驗 為我國其它經濟增長迅速地區居民提供心血管疾病一級預防的措施 研究方案 續 小樣本抽樣調查 移民與當地居民 心血管狀況基礎調查 移民後追蹤調查比較居民移民前後心血管病發生率 危險因素水平評估移民前後血管健康狀況的改變 研究方案 二 社區移民干預試驗 隨機抽樣 選兩組移民 同時進行基礎調查 一組接受衛生知識教育 提供諮詢及基本衛生醫療服務 另一組保持原狀比較兩組心血管疾病及危險因素的改變評估干預試驗的效果 計劃工作進程表 已調查人群分組 巫山 大昌 開縣 n 739 CATHAYSTUDYPUBLICATIONS WooKS McCrohonJA ChookP AdamsMR RobinsonJTC McCredieRJ FengJZ CelermajerDS