Importance Body mass index (BMI) is positively associated with blood pressure (BP); this association has critical implications for countries like China, where hypertension is highly prevalent and obesity is increasing. A greater understanding of the association between BMI and BP is required to determine its effect and develop strategies to mitigate it. Objective To assess the heterogeneity in the association between BMI and BP across a wide variety of subgroups of the Chinese population. Design, Setting, and Participants In this cross-sectional study, data were collected at 1 time point from 1.7 million adults (aged 35-80 years) from 141 primary health care sites (53 urban districts and 88 rural counties) from all 31 provinces in mainland China who were enrolled in the China PEACE (Patient-Centered Evaluative Assessment of Cardiac Events) Million Persons Project, conducted between September 15, 2014, and June 20, 2017. A comprehensive subgroup analysis was performed by defining more than 22 000 subgroups of individuals based on covariates, and within each subgroup, linearly regressing BMI to BP. Main Outcomes and Measures Systolic BP was measured twice with the participant in a seated position, using an electronic BP monitor. Results The study included 1 727 411 participants (1 027 711 women and 699 700 men; mean [SD] age, 55.7 [9.8] years). Among the study sample, the mean (SD) BMI was 24.7 (3.5), the mean (SD) systolic BP was 136.5 (20.4) mm Hg, and the mean (SD) diastolic BP was 81.1 (11.2) mm Hg. The increase of BP per unit BMI ranged from 0.8 to 1.7 mm Hg/(kg/m 2 ) for 95% of the subgroups not taking antihypertensive medication. The association between BMI and BP was substantially weaker in subgroups of patients taking antihypertensive medication compared with those who were untreated. In untreated subgroups, 95% of the coefficients varied by less than 1 mm Hg/(kg/m 2 ). Conclusions and Relevance The association between BMI and BP is positive across tens of thousands of individuals in population subgroups, and, if causal, given its magnitude, would have significant implications for public health.
The diagnostic criteria for cirrhotic cardiomyopathy (CCM) were recently revised to reflect the contemporary advancements in echocardiographic technology. This study evaluates the prevalence of CCM, according to the new criteria, and its impact on posttransplant cardiovascular disease (CVD). This is a single‐center retrospective matched cohort study of liver transplantation (LT) recipients who underwent LT between January 1, 2008 and November 30, 2017. A total of 3 cohorts with decompensated cirrhosis (nonalcoholic steatohepatitis, alcohol‐related liver disease, or other etiologies) were matched based on age, sex, and year of transplant after excluding patients listed without evidence of hepatic decompensation. CCM was defined, according to 2020 criteria, as having diastolic dysfunction, left ventricular ejection fraction ≤50%, and/or a global longitudinal strain (GLS) absolute value <18%. The study echocardiographers were blinded to the clinical data. Posttransplant CVD included new coronary artery disease, congestive heart failure, atrial and ventricular arrhythmia, and stroke. The study included 141 patients of whom 59 were women. The mean age at LT was 57.8 (±7.6) years. A total of 49 patients (34.8%) had CCM. Patients with CCM were at an increased risk for post‐LT CVD (hazard ratio, 2.57; 95% confidence interval, 1.2‐5.5; P = 0.016). Changes in CCM individual parameters pretransplant, such as GLS, early diastolic transmitral flow to early diastolic mitral annular velocity, and left atrial volume index were associated with an increased risk for posttransplant CVD. CCM, defined by the new diagnostic criteria, affects approximately one‐third of decompensated LT candidates. CCM predicts an increased risk for new CVD following LT. Studies into addressing and follow‐up to mitigate these risks are needed.
A set of maps which display the patterns of cancer mortality in China has been prepared and published by the China Map Press. The 200 page atlas was edited by the National Cancer Control Office of the Ministry of Health and the Nanjing Institute of Geography of the Chinese Academy of Sciences on the basis of a nation-wide cancer mortality survey. The Cancer Institute of the Chinese Academy of Medical Sciences with related Colleges, Universities and Institutes provided the data and took part in the preparation of the atlas, which is published both in Chinese and English. 58 maps and several dozen charts depict, in seven colours, the mortality distribution in this 2392 countries and county-level administrative units of 9 types of cancer common in China--stomach, oesophagus, liver, cervix, lung, colon and rectum, breast, nasopharynx, and leukaemia as well as 5 less common cancers--brain tumours, malignant lymphoma, cancer of the bladder, of the penis, and choriocarcinoma. The Atlas of Cancer Mortality will be an important new aid for cancer control and research in the People's Republic of China.
Background Patients with interstitial lung disease (ILD) are occasionally positive for anti-neutrophil cytoplasmic antibodies (ANCAs). Differences between ILDs secondary to microscopic polyangiitis (MPA) and isolated ANCA-positive idiopathic interstitial pneumonia (IIP) remain unclear. The aim of this study was to explore the differences in clinical features and outcomes between MPA-associated ILDs and isolated ANCA-positive IIPs. Methods We reviewed 1338 ILDs patients with available ANCA results and retrospectively analysed 80 patients who were ANCA-positive. MPA-associated ILDs (MPA-ILDs group) and isolated ANCA-positive IIPs (ANCA-IIPs group) were compared. Results Among 80 patients with ANCA-positive ILDs, 31 (38.75%) had MPA-ILDs, and 49 (61.25%) had isolated ANCA-positive IIPs. Compared with ANCA-IIPs group, patients in MPA-ILDs group had a higher proportion of fever (p = 0.006) and higher neutrophil count (p = 0.011), erythrocyte sedimentation rate (ESR) (p < 0.001) and C-reactive protein (CRP) (p = 0.005). Multivariable analysis showed that ESR level was an independent risk factor for mortality in all 80 ANCA-positive ILDs patients (HR 1.028, p = 0.001). Survival in MPA-ILDs group was lower than that in ANCA-IIPs group, and further stratified analysis revealed that ANCA-IIPs patients with elevated ESR or CRP had a worse prognosis than those with normal inflammation markers, with 5-year cumulative survival rates of 60.00%, 86.90% and 100.00% in MPA-ILDs and ANCA-IIPs with and without elevated inflammation markers, respectively. Conclusions Among patients with ANCA-positive ILDs, the prognoses of ANCA-IIPs with normal inflammation markers, ANCA-IIPs with elevated inflammation markers and MPA-ILDs were sequentially poorer. Therefore, stratified treatment should be considered in the management of ILDs patients positive for ANCAs.
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