Qingdao Port Cardiovascular Health Study: a prospective cohort study

Erica S Spatz, Xianyan Jiang, Jiapeng Lu, Frederick A Masoudi, John A Spertus, Yongfei Wang, Xi Li, Nicholas S Downing, Khurram Nasir, Xue Du, Jing Li, Harlan M Krumholz, Xiancheng Liu, Lixin Jiang, Erica S Spatz, Xianyan Jiang, Jiapeng Lu, Frederick A Masoudi, John A Spertus, Yongfei Wang, Xi Li, Nicholas S Downing, Khurram Nasir, Xue Du, Jing Li, Harlan M Krumholz, Xiancheng Liu, Lixin Jiang

Abstract

Purpose: In China, efforts are underway to respond to rapidly increasing rates of heart disease and stroke. Yet the epidemiology of cardiovascular disease in China may be different from that of other populations. Thus, there is a critical need for population-based studies that provide insight into the risk factors, incidence and outcomes of cardiovascular disease in China. The Qingdao Port Cardiovascular Health Study is designed to investigate the burden of cardiovascular disease and the sociodemographic, biological, environmental and clinical risk factors associated with disease onset and outcomes.

Participants: For this study, from 2000 through 2013, 32,404 employees aged 18 years or older were recruited from the Qingdao Port Group in China, contributing 221,923 annual health assessments. The mean age at recruitment was 43.4 (SD=12.9); 79% were male. In this ongoing study, annual health assessments, governed by extensive quality control mechanisms, include a questionnaire (capturing demographic and employment information, medical history, medication use, health behaviours and health outcomes), physical examination, ECG, and blood and urine analysis. Additional non-annual assessments include an X-ray, echocardiogram and carotid ultrasound; bio-samples will be collected for future genetic and proteomic analyses. Cardiovascular outcomes are accessed via self-report and are actively being verified with medical insurance claims; efforts are underway to adjudicate outcomes with hospital medical records.

Findings to date: Early findings reveal a significant increase in cardiovascular risk factors from 2000 to 2010 (hypertension: 26.4-39.4%; diabetes: 3.3-8.9%; hyperlipidaemia: 5.0-33.6%; body mass index >28 m/kg(2): 14.1-18.6%).

Future plans: We aim to generate novel insights about the epidemiology and outcomes of cardiovascular disease in China, with specific emphasis on the potentially unique risk factor profiles of this Chinese population. Knowledge generated will be disseminated in the peer-reviewed literature, and will inform population-based strategies to improve cardiovascular health in China.

Trial registration number: NCT02329886.

Keywords: cardiovascular diseases; cohort studies; longitudinal studies; outcomes research; population surveillance.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Examination sites for the Qingdao Port Cardiovascular Health Study.
Figure 2
Figure 2
Organisational structure of the Qingdao Port Cardiovascular Health Study.
Figure 3
Figure 3
Distribution of frequency of study participant follow-up.
Figure 4
Figure 4
Distribution of new and returning study participants per year.

References

    1. Mahmood SS, Levy D, Vasan RS et al. . The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet 2014;383:999–1008. 10.1016/S0140-6736(13)61752-3
    1. No authors listed]. The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. Am J Epidemiol 1989;129:687–702.
    1. Bild DE, Bluemke DA, Burke GL et al. . Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol 2002;156:871–81. 10.1093/aje/kwf113
    1. Keku E, Rosamond W, Taylor HA Jr et al. . Cardiovascular disease event classification in the Jackson Heart Study: methods and procedures. Ethn Dis 2005;15(4 Suppl 6):S6–62–70.
    1. Liu J, Hong Y, D'Agostino RB Sr et al. . Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study. JAMA 2004;291:2591–9. 10.1001/jama.291.21.2591
    1. Ueshima H, Sekikawa A, Miura K et al. . Cardiovascular disease and risk factors in Asia: a selected review. Circulation 2008;118:2702–9. 10.1161/CIRCULATIONAHA.108.790048
    1. Kuulasmaa K, Tunstall-Pedoe H, Dobson A et al. . Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet 2000;355:675–87. 10.1016/S0140-6736(99)11180-2
    1. Tunstall-Pedoe H. Autres pays, autres moeurs. BMJ 1988;297:1559–60. 10.1136/bmj.297.6663.1559
    1. Evans AE, Ruidavets JB, McCrum EE et al. . Autres pays, autres coeurs? Dietary patterns, risk factors and ischaemic heart disease in Belfast and Toulouse. QJM 1995;88:469–77.
    1. Gupta M, Singh N, Verma S. South Asians and cardiovascular risk: what clinicians should know. Circulation 2006;113:e924–9. 10.1161/CIRCULATIONAHA.105.583815
    1. Sheth T, Nair C, Nargundkar M et al. . Cardiovascular and cancer mortality among Canadians of European, south Asian and Chinese origin from 1979 to 1993: an analysis of 1.2 million deaths. CMAJ 1999;161:132–8.
    1. Mariotti S, Capocaccia R, Farchi G et al. . Differences in the incidence rate of coronary heart disease between north and south European cohorts of the Seven Countries Study as partially explained by risk factors. Eur Heart J 1982;3:481–7.
    1. Liu M, Wang J, Jiang B et al. . Increasing prevalence of metabolic syndrome in a Chinese elderly population: 2001–2010. PLoS ONE 2013;8:e66233 10.1371/journal.pone.0066233
    1. Chen Z, Peto R, Collins R et al. . Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations. BMJ 1991;303:276–82. 10.1136/bmj.303.6797.276
    1. Lawes CM, Rodgers A, Bennett DA et al. . Blood pressure and cardiovascular disease in the Asia Pacific region. J Hypertens 2003;21:707–16. 10.1097/01.hjh.0000052492.18130.07
    1. Zhang LF, Yang J, Hong Z et al. . Proportion of different subtypes of stroke in China. Stroke 2003;34:2091–6. 10.1161/01.STR.0000087149.42294.8C
    1. Hu SS, Kong LZ, Gao RL et al. . Outline of the report on cardiovascular disease in China, 2010. Biomed Environ Sci 2012;25:251–6. 10.3967/0895-3988.2012.03.001
    1. Yang ZJ, Liu J, Ge JP et al. . Prevalence of cardiovascular disease risk factor in the Chinese population: the 2007–2008 China National Diabetes and Metabolic Disorders Study. Eur Heart J 2012;33:213–20. 10.1093/eurheartj/ehr205
    1. Modesti PA, Agostoni P, Agyemang C et al. . ESH Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings. J Hypertens 2014;32:951–60. 10.1097/HJH.0000000000000125
    1. Yang G, Wang Y, Zeng Y et al. . Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2013;381:1987–2015. 10.1016/S0140-6736(13)61097-1
    1. Zheng Y, Stein R, Kwan T et al. . Evolving cardiovascular disease prevalence, mortality, risk factors, and the metabolic syndrome in China. Clin Cardiol 2009;32:491–7. 10.1002/clc.20605
    1. World Health Organization Western Pacific Region: Cardiovascular Disease in China. Secondary World Health Organization Western Pacific Region: Cardiovascular Disease in China, 2014.
    1. Xu Y, Wang L, He J et al. . Prevalence and control of diabetes in Chinese adults. JAMA 2013;310:948–59. 10.1001/jama.2013.168118
    1. Yusuf S, Reddy S, Ounpuu S et al. . Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001;104:2746–53. 10.1161/hc4601.099487
    1. Smith S, Ralston J, Taubert K. Urbanization and cardiovascular disease: raising heart-healthy children in today's cities. Geneva: The World Heart Federation, 2012.
    1. Sun Q, Hong X, Wold LE. Cardiovascular effects of ambient particulate air pollution exposure. Circulation 2010;121:2755–65. 10.1161/CIRCULATIONAHA.109.893461
    1. Xie W, Li G, Zhao D et al. . Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality. Heart 2015;101:257–63. 10.1136/heartjnl-2014-306165
    1. Brook RD, Rajagopalan S, Pope CA III et al. . Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation 2010;121:2331–78. 10.1161/CIR.0b013e3181dbece1
    1. Pan A, Malik VS, Hu FB. Exporting diabetes mellitus to Asia: the impact of Western-style fast food. Circulation 2012;126:163–5. 10.1161/CIRCULATIONAHA.112.115923
    1. Popkin BM. Synthesis and implications: China's nutrition transition in the context of changes across other low-income and middle-income countries. Obes Rev 2014;15(Suppl 1):60–7. 10.1111/obr.12120
    1. He J, Gu D, Chen J et al. . Premature deaths attributable to blood pressure in China: a prospective cohort study. Lancet 2009;374:1765–72. 10.1016/S0140-6736(09)61199-5
    1. Odegaard AO, Koh WP, Yuan JM et al. . Western-style fast food intake and cardiometabolic risk in an eastern country. Circulation 2012;126:182–8. 10.1161/CIRCULATIONAHA.111.084004
    1. He J, Gu D, Wu X et al. . Major causes of death among men and women in China. N Engl J Med 2005;353:1124–34. 10.1056/NEJMsa050467
    1. Zhou T, Li X, Tang Z et al. . Risk factors of CVD mortality among the elderly in Beijing, 1992–2009: an 18-year cohort study. Int J Environ Res Public Health 2014;11:2193–208. 10.3390/ijerph110202193
    1. Qian Z, He Q, Lin HM et al. , HEI Health Review Committee. Part 2. Association of daily mortality with ambient air pollution, and effect modification by extremely high temperature in Wuhan, China. Res Rep Health Eff Inst 2010;154:91–217.
    1. Wu Z, Yao C, Zhao D et al. . Sino-MONICA project: a collaborative study on trends and determinants in cardiovascular diseases in China, part i: morbidity and mortality monitoring. Circulation 2001;103:462–8. 10.1161/01.CIR.103.3.462
    1. No authors listed]. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol 1988;41:105–14. 10.1016/0895-4356(88)90084-4
    1. Zhang W, Sun K, Yang Y et al. . Plasma uric acid and hypertension in a Chinese community: prospective study and metaanalysis. Clin Chem 2009;55:2026–34. 10.1373/clinchem.2009.124891
    1. Shang X, Li J, Tao Q et al. . Educational level, obesity and incidence of diabetes among Chinese adult men and women aged 18–59 years old: an 11-year follow-up study. PLoS ONE 2013;8:e66479 10.1371/journal.pone.0066479
    1. Chen Z, Chen J, Collins R et al. . China Kadoorie Biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up. Int J Epidemiol 2011;40:1652–66. 10.1093/ije/dyr120
    1. Li Q, Babor TF, Hao W et al. . The Chinese translations of Alcohol Use Disorders Identification Test (AUDIT) in China: a systematic review. Alcohol Alcohol 2011;46:416–23. 10.1093/alcalc/agr012
    1. Macfarlane DJ, Lee CC, Ho EY et al. . Reliability and validity of the Chinese version of IPAQ (short, last 7 days). J Sci Med Sport 2007;10:45–51. 10.1016/j.jsams.2006.05.003
    1. Duale N, Lipkin WI, Briese T et al. . Long-term storage of blood RNA collected in RNA stabilizing Tempus tubes in a large biobank—evaluation of RNA quality and stability. BMC Res Notes 2014;7:633 10.1186/1756-0500-7-633
    1. Li J, Li X, Wang Q et al. . China PEACE Collaborative Group. ST-segment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data. Lancet 2015;385:441–51. 10.1016/S0140-6736(14)60921-1
    1. Sun S, Chen J, Johannesson M et al. . Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008. Qual Life Res 2011;20:309–20. 10.1007/s11136-010-9762-x
    1. Gu D, Gupta A, Muntner P et al. . Prevalence of cardiovascular disease risk factor clustering among the adult population of China: results from the International Collaborative Study of Cardiovascular Disease in Asia (InterAsia). Circulation 2005;112:658–65. 10.1161/CIRCULATIONAHA.104.515072
    1. Huang Y, Gao L, Xie X et al. . Epidemiology of dyslipidemia in Chinese adults: meta-analysis of prevalence, awareness, treatment, and control. Popul Health Metr 2014;12:28 10.1186/s12963-014-0028-7
    1. Hu S, Tang S, Liu Y et al. . Reform of how health care is paid for in China: challenges and opportunities. Lancet 2008;372:1846–53. 10.1016/S0140-6736(08)61368-9
    1. Hankin JH, Stram DO, Arakawa K et al. . Singapore Chinese Health Study: development, validation, and calibration of the quantitative food frequency questionnaire. Nutr Cancer 2001;39:187–95. 10.1207/S15327914nc392_5
    1. Strauss J, Lei X, Park A et al. . Health outcomes and socio-economic status among the elderly in Gansu and Zhejiang Provinces, China: evidence from the CHARLS Pilot. J Popul Ageing 2010;3:111–42. 10.1007/s12062-011-9033-9
    1. Li J, Dharmarajan K, Li X et al. . Protocol for the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) retrospective study of coronary catheterisation and percutaneous coronary intervention. BMJ Open 2014;4:e004595 10.1136/bmjopen-2013-004595
    1. Chen ZM, Pan HC, Chen YP et al. . Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366:1622–32. 10.1016/S0140-6736(05)67661-1
    1. Chen ZM, Jiang LX, Chen YP et al. . Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005;366:1607–21. 10.1016/S0140-6736(05)67660-X
    1. Ogunmoroti O, Younus A, Rouseff M et al. . Assessment of American Heart Association's Ideal Cardiovascular Health Metrics Among Employees of a Large Healthcare Organization: the Baptist Health South Florida Employee Study. Clin Cardiol 2015;38:422–9. 10.1002/clc.22417

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe