CARDIOVASCULAR RISKS IN KAZAKH POPULATION IN XINJIANG PROVINCE OF CHINA Aim: Assess the cardiovascular risks i Kazakh populatio i Ili of Xijiag Provice. Methods: A total of 1126 participats (M/F: 443/683) aged $35 years, livig i Ili for more tha five years were selected via stratified radom samplig. Fastig plasma glucose (FPG), blood lipids, body mass idex (BMI), ad blood pressure (BP) were measured. The risk was evaluated by 10-year risk estimatio of ischemic cardiovascular disease (ICVD) i Chiese. Results: The mea values of systolic blood pressure (SBP), body mass idex (BMI), blood lipids were sigificatly higher i male tha female (P,.01). The mea value (%) of 10-year morbid risk was higher i males tha females aged,50 years (P,.05). A 10-year absolute risk of ICVD was,10% (P5.536) i 94.8% of males ad 95.6% of females. The ratio of highrisk populatio (20% 40%) was higher i males tha females (2.93% vs.73%, P5.004). There was sigificat differece i SBP, total cholesterol, ad BMI amog high, moderate, ad low risk groups (P,.05). Coclusio: Our study shows a high prevalece of cardiometabolic risks i the Kazakh populatio. Immediate short-term ad sustaiable log-term programs should be carried out to prevet the morbidity caused by kow prevetable risk factors. (Eth Dis. 2014;24[3]: 316 320) Key Words: Cardiovascular Disease, Kazakh From Departmet of Cardiology, First Affiliated Hospital of Xijiag Medical Uiversity, Urumqi, PR Chia (XM, XB, UKK, DH, YH, XX); ad Xijiag Key Research Laboratory of Cardiovascular Disease, Urumqi, PR Chia (XM, XX). Address correspodece to Yi-Tog Ma; Departmet of Cardiology; First Affiliated Hospital of Xijiag Medical Uiversity; Urumqi, 830011 PR Chia; 86.9914366169; 86.991.4366169 (fax); myt-xj@163.com Xiag Ma, PhD; Xue Bai, MD; Ujit Kumar Karmacharya, MD; Dig Huag, MD; Yig Huag, PhD; Xiag Xie, PhD; Xia Wei; Yi-Tog Ma, MD, PhD INTRODUCTION Sice the Framigham Heart Study cotributed to the idetificatio of risk factors for coroary heart disease (CHD), multivariable risk scorig methods icorporated i atioal guidelies to predict absolute CHD risk have served well i developed coutries. 1 4 Liu et al 5 foud that the origial Framigham Study overestimated the CHD risk i the Chiese populatio. Furthermore, as risk factor patters of cardiovascular disease are differet i Chia, 6 7 ad stroke is much more prevalet tha CHD, Chiese researchers validated the mai risk factors of cardiovascular diseases ad developed appropriate predictio models ad tools that could estimate the total cardiovascular risks (both CHD ad stroke). 8 Be that as it may, all these studies focused oly o mailad Chiese while little attetio was paid to the primary risk factors of ischemic cardiovascular disease (ICVD) i the Kazakh populatio. Our research aimed to study the primary risk factors of ICVD i the Kazakh populatio i Ili of Xijiag Provice. METHODS Participats Our study was approved by the Ethics Committee of Xijiag Medical Our research aimed to study the primary risk factors of ICVD i the Kazakh populatio i Ili of Xijiag Provice. Uiversity; it was coducted i accordace with the Helsiki Declaratio. All participats provided iformed writte coset. A radom populatio sample was idetified i a rural area of Ili i Xijiag Provice of Chia. A total of 1126 participats aged $35 years ad livig i Ili for.5 years were selected by stratified radom samplig ad ivestigated with epidemiological methods. Data Collectio All participats refraied from smokig ad drikig caffeiated beverages for $24 hours before beig examied. They were iterviewed by traied ad certified observers usig a structured questioaire. The participats completed a self-admiistered questioaire iquirig ito their past ad curret medical history, itake of medicatios, ad lifestyle. A traied urse, usig a stadard mercury sphygmomaometer, measured blood pressure two times, cosecutively, with the participat seated; the average of the two measuremets was used for our aalysis. Hypertesio was defied as blood pressure of $140 mm Hg systolic (SBP) ad/or $90 mm Hg diastolic (DBP) or beig o atihypertesive therapies. Body mass idex (BMI) was weight i kilograms divided by height i meters squared, ad obesity was defied as BMI $30. 9 Height, weight, ad waist circumferece were obtaied from each participat with stadard protocols. Veous blood samples collected after overight fastig were aalyzed by stadard automated methods for blood lipids ad fastig plasma glucose (FPG). We defied diabetes mellitus as either a history of treatmet or a fastig serum glucose level $126 mg/dl (7.0 mmol/l). 10 Dyslipidemia was defied as a ratio of total cholesterol to HDL-C of $4.5. 11 316 Ethicity & Disease, Volume 24, Summer 2014
Table 1. Characteristics of participats, mea ± SD Male Female t P 443 683 - - Age, years 45.54 6 6.93 44.75 6 6.67 1.914.056 BMI, kg/m 2 25.66 6 3.78 23.90 6 4.20 7.127,.001 SBP, mm Hg a 131.26 6 20.86 126.62 6 21.77 3.545,.001 Glucose, mmol/l 5.19 6 1.69 4.94 6 1.14 2.716.007 Triglycerides, mmol/l 1.56 6 1.20 1.21 6.78 5.348,.001 TC, mmol/l 4.89 6 1.07 4.60 6.93 4.727,.001 HDL-C, mmol/l 1.34 6.34 1.41 6.31 3.599,.001 LDL-C, mmol/l 3.29 6 1.01 2.98 6.88 5.406,.001 a 1mmHg5.133 kpa. BMI, body mass idex; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; HDL-C, high desity lipoproteis cholesterol; LDL-C, low desity lipoproteis cholesterol. Judgmet Stadards of Results Accordig to Chiese Predictio Model of Cardiovascular Diseases, the value of six idices (idividual age, curret smokig status, diabetes mellitus [DM], BMI, SBP, ad total cholesterol [TC]) were iserted ito a formula to get a absolute morbidity risk of 10- year ischemic cardiovascular disease (ICVD). 12 Ischemic cardiovascular disease is a combied ed poit of evets of coroary heart disease ad cerebral ischemic stroke. Coroary heart disease evets iclude acute myocardial ifarctio, coroary artery disease, or sudde cardiac death. Stroke evets iclude hemorrhagic stroke icludig subarachoid hemorrhage, ischemic cerebral stroke, ad stroke that caot be classified, except trasiet ischemic attack (TIA) ad other types of cerebral diseases. Accordig to risk value, the participats were divided ito extreme high risk ($40%), high risk (,40% ad $20%), moderate risk (,20% ad $10%), ad low risk (,10%). Risk abormality was defied as $10%. Statistical Aalysis The data were aalyzed with SPSS 13.0 statistical software. Data were preseted as mea 6 SD uless otherwise specified. The methods of aalysis icluded t tests for cotiuous variables ad x 2 tests for the dichotomous parameters. Stepwise multiple liear regressio was used to assess the idepedet relatios betwee arteriosclerosis ad risk factors. Comparisos for categorized variables were made usig Fisher s exact test. Statistical sigificace was stated whe the two-tailed P reached,.05. RESULTS Characteristics of Study Participats The characteristics of study participats are show i Table 1. The mea values of SBP, BMI, ad blood lipids i males were sigificatly higher tha those i females (P,.01), but there was o sigificat differece betwee the two groups i age (45.54 6 6.93 vs 44.75 6 6.67, P5.056). The rate of hypertesio, smokig, diabetes mellitus, dyslipidemia, ad obesity i males was sigificatly higher tha i females (24.8% vs 19.6%, P5.038; 10.43% vs 7.98%; P5.001; 95.49% vs 98.39%, P5.004; 20.32% vs 6.00%, P,.001; 13.54% vs 9.08%; P5.013, respectively) (data ot show). 10-Year Morbidity Risk of Cardiovascular Diseases i Kazakh Populatio Mea levels of 10-year morbidity risk of cardiovascular diseases of both sexes of the Kazakh populatio are show i Table 2. The mea value (%) of risk of each age group i me was higher tha that of correspodig age group i wome (P,.05). Detectio rates of abormal absolute risk i both sexes are show i Table 3. There was o sigificat differece i detectio rate betwee males ad females i absolute-risk (%) ad low-risk groups (94.8% vs 95.6%, P5.536). Proportio of moderate-risk populatio (10% 20%) was more or less similar betwee two groups (3.66% vs 2.25%, P5.185), but the costituet ratio of high-risk populatio (20% 40%) was higher i males (2.93% vs.73%, P5.004). There was o sigificat differece betwee males ad females i the above moderate risk groups (x 2 5.383, P5.536). The relatioship betwee cardiovascular risk factors ad mea levels of 10- year absolute risk are listed i Table 4. There was sigificat differece i levels of SBP, TC, ad BMI amog high, moderate, ad low risk groups (P,.05), with the exceptio of FPG (P5.354). Kazakh males teded to have higher levels of SBP, FPG, TC, ad BMI tha females i the low risk groups (P,.05), while there was o sigificat differece i above moderate risk groups betwee males ad females (P..05). The detectio rate of smokig was higher i highrisk groups i both sexes (P,.05), while Kazakh males ted to have a higher rate of smokig tha females i the low-risk groups (P,.001). Ethicity & Disease, Volume 24, Summer 2014 317
Table 2. Mea level of morbidity risk i differet sexes, mea ± SD Male Female Age groups, years Mea Level of Risk Mea Level of Risk t P 35 39 100 1.064 6.135 183.954 6.068 5.685,.001 40 44 117 1.824 6.863 194.724 6.272 4.838,.001 45 49 92 2.660 6.253 115 1.307 6.183 3.086.003 50 54 70 5.020 6.471 114 3.368 6.377 1.927.05 55 59 64 7.900 6.670 77 6.096 6.802 1.405.162 DISCUSSION Cardiovascular disease risks are a result of the itegratio of multiple risk factors. The curret cliical guidelies all adapted the strategy of applyig itervetios accordig to the magitude of itegrated risks. The Framigham Heart Study bega its exploratio i 1967 usig predictio models to estimate the global risk of CHD for idividuals. 1 However, the patters of distributio may vary from group to group, so it does ot fit Asias very well. I 2006, Wu et al 8 developed sex specific optimal 10-year risk predictio models for ICVD icludig ischemic stroke ad coroary evets from 17 years of follow-up data from the USA-PRC Collaborative Study of Cardiovascular Epidemiology cohort. The model showed ICVD positively related to age, SBP, serum TC, BMI, smokig, ad diabetes mellitus i both me ad wome. Several studies demostrated that the methods ad tools of 10-year risk estimatio of ICVD i Chiese adults work well. 13 16 However, we foud from the previous studies that most researchers focused oly o mailad Chiese ad o oe had applied the model to the Chiese Kazakh populatio, although they have more risk factors for ICVD. Therefore, usig this predictio model ad score tool ad testig it i Kazakh populatio would be oteworthy. What is otable about doig this study i the Kazakh populatio is that the Kazakhs also live i Easter Europe (Turkey) ad orther parts of Cetral Asia, mostly Kazakhsta, followed by Uzbekista, Russia, Mogolia, ad Chia itself, ad due to the cultural similarity of lifestyles ad religio, our study could help to make a predictive model for Kazakhs livig i those coutries. I Chia, the Kazakhs are a ethic miority group, with a populatio of aroud 1,250,458, maily livig i the Ili Kazakh Autoomous Prefecture, Mori Kazakh Autoomous Couty, ad Barkol Kazakh Autoomous Couty i the Xijiag Uyghur Autoomous Regio. Some are also located i Tibeta Kazakh Autoomous Prefecture i Qighai Provice ad Aksay Kazakh Autoomous Couty i Gasu Provice. Except for a few settled farmers, most of the Kazakhs live by aimal husbadry. Ya et al 17 evaluated ad compared the epidemiological ad cliical features of metabolic sydrome i the Uyghur ad Kazakh ethic populatios i 2005 ad foud that the prevalece of hypertesio ad cetral obesity i the Kazakh populatio was sigificatly higher tha that of Uyghur populatio. Jig Tao et al 18 also researched the prevalece of major cardiovascular risk factors amog Ha, Ughyur, ad Kazakh populatios i the Xijiag Ughyur Autoomous Regio ad foud that hypertesio, obesity, ad smokig rates were higher amog Kazakhs (54.6%, 24.5%, ad 35.8%, respectively), which agai demostrated the importace of applyig the predictio model ad score tool ad testig it i Kazakh populatio who ted to be at higher risks. I our study, we observed a sigificat icrease i ICVD with icreasig age i the Kazakh populatio. Amog mai risk factors of participats i the study, mea values of SBP, DBP, ad TC i males were sigificatly higher Table 3. Mea levels of absolute risk i differet sexes Groups Risk,10% Costituet Risk$10%,20% 20% 40% $40% Total Costituet Costituet Costituet Costituet Male 420 94.8 a 10 2.26 b 13 2.93 c 0 0 23 5.19 d Female 653 95.6 a 25 3.66 b 5.73 c 0 0 30 4.39 d a x 2 5.383, P5.536. b x 2 51.756, P5.185. c x 2 58.287, P5.004. d x 2 5.383, P5.536. 318 Ethicity & Disease, Volume 24, Summer 2014
Table 4. Cardiovascular risks factors accordig to absolute risk, mea ± SD Risk Factors SBP TC FPG BMI Smokig Male Female P Male Female P Male Female P Male Female P Male Female P Absolute risk,10% 128.06 6 15.43 124.27 6 18.47,.001 4.88 6 1.07 4.57 6.93,.001 5.15 6 1.69 4.91 6 1.15.01 25.13 6 3.79 23.23 6 4.09,.001 59.29% 27.87%,.001 $10% 189.61 6 21.39 177.83 6 25.38.079 5.25 6 1.23 5.26 6 1.01.969 5.29 6 1.08 5.12 6.85.51 26.48 6 3.46 27.70 6 5.05.325 73.91% 80%.6 P,.001,.001.354,.001,.001 SBP, systolic blood pressure; TC, total cholesterol; FPG, fastig plasma glucose; BMI, body mass idex. I our study, we observed a sigificat icrease i ICVD with icreasig age i the Kazakh populatio. tha i females. The mea value (%) of 10-year morbidity risk was higher i me tha wome aged,50 years (P,.05), but there was o differece i those aged.50 year(p$.05). This may suggest that several importat risk factors of cardiovascular diseases have superimposed the effects of each other o the oset of disease. I additio, we foud risk factors were greater i Kazakh males tha Chiese males aged.45 years, ad mea levels of 10-year morbid risk for cardiovascular diseases i both sexes of Kazakhs were more tha those of mailad Chiese. We foud sigificat differeces i the level of SBP, TC, ad BMI amog low, moderate, ad high-risk groups. The cardiovascular risk factors were more commo i moderate-ad highrisk populatios tha low-risk groups, which could make this method appropriate for detectig the high-risk idividuals i the Kazakh populatio. CONCLUSION A potetial weakess of our study is that the study populatio was aged 35 59 years, thus limitig applicability to those aged $60 years. Also, our method oly estimates the risk of developig ICVD withi a 10-year time period, so cautio should be take whe applyig these results to youg persos. Several stregths of our study iclude: the large cohort of idividuals from the commuity, ad our use of uiform protocols icludig questioaires, athropometric measuremets, assessmet of covetioal risk factors, ad the ABI measure. We believe our results will further uderstadig of the status of primary risk factors of cardiovascular diseases i the Kazakh populatio ad provide scietific evidece for formulatio of commual cotrol strategies for cardiovascular ad cerebrovascular diseases i Xijiag Provice. ACKNOWLEDGMENTS This work is supported by The Great Techology Special Item Foudatio of Xijiag Provice, P. R. Chia (200733146-3). REFERENCES 1. Truett J, Corfield J, Kael WB. A multivariate aalysis of the risk of coroary heart disease i Framigham. J Chroic Dis. 1967; 20(7):511 524. 2. Kael WB. Office assessmet of coroary cadidates ad risk factor isights from the Framigham study. JHypertes. 1991;9(suppl7): S13 S19. 3. Wilso PWF, D Agostio RB, Levy D, Belager AM,SilbershatzH,KaelWB.Predictioof coroary heart disease usig risk factor categories. Circulatio. 1998;97:1837 1847. 4. Coroy RM, Pyorala K, Fitzgerald AP, et al. o behalf of the SCORE Project. Estimatio of te-year risk of fatal cardiovascular disease i Europe: the SCORE project. Euro Heart J. 2003;24(11):987 1003. 5. LiuJ,HogY,D AgostioRBSr,etal.Predictive value for the Chiese populatio of the Framigham CHD risk assessmet tool compared with the Chiese Multi-Provicial Cohort Study. JAMA. 2004;291(21):2591 2599. 6. Zhou B, Zhag H, Wu Y, et al. Ecological aalysis of the associatio betwee icidece ad risk factors of coroary heart disease ad stroke i Chiese populatios. CVD Prev. 1998;1(3):207 216. 7. Grudy SM, D Agostio RB Sr, Mosca L, et al. Cardiovascular risk assessmet based o US Cohort studies: fidigs from a Natioal Heart, Lug, ad Blood Istitute workshop. Circulatio. 2001;104:491 496. 8. Yagfeg Wu, Xiaoqig Liu, Xia Li, et al. Estimatio of 10-Year Risk of Fatal ad Nofatal Ischemic Cardiovascular Diseases i Chiese Adults. Circulatio. 2006;114:2217 2225. 9. Wu Y, Zhou B, Tao S, et al. Prevalece of overweight ad obesity i Chiese middle-aged populatios: Curret status ad tred of developmet. Chi J Epidemiol. 2002;23(1):11 15. 10. The Expert Committee o the Diagosis ad Classificatio of Diabetes Mellitus. Report of the expert committee o the diagosis ad classificatio of diabetes mellitus. Diabetes Care. 2003;26(suppl 1):S2 S20. Ethicity & Disease, Volume 24, Summer 2014 319
11. Brow CD, Higgis M, Doato KA, et al. Body Mass Idex ad the Prevalece of Hypertesio ad Dyslipidemia. Obes Res. 2000;8(9):605 619. 12. The Collaborative Research Group of the Natioal 10th Five-Year Pla Project: A Study o Evaluatio ad Itervetio of the Coroary Heart Disease ad Stroke Itegrated Risk. A study o evaluatio of the risk of ischemic cardiovascular diseases i Chiese ad the developmet of simplified tools for the evaluatio. Chi J Cardiol. 2003;31(12):893 901. 13. Zhag XF, Attia J, D Este C, Yu XH, Wu XG. A risk score predicted coroary heart disease ad stroke i a Chiese cohort. J Cli Epidemiology. 2005;58(9):951 958. 14. Li HF, Wag P, Wag HY, Xu L, Yag DS, Jia SD. Perform aalyse o the predictive model of ischemic cardiovascular diseases i Qigdao. Chi J Cardiol. 2005;33(2):178 180. 15. Xi-zhuo S, Xue W, Xiao-fag P, et al. Ivestigatio of the prevalece ad distributig feature of cardiovascular disease risk factors i Zhagzi islad of Dalia. Chi J Cardiovasc Med. 2008;13(4):82 85. 16. Wei W, Dog Z, Jig L, et al. Prospective study o the predictive model of cardiovascular disease risk i a Chiese populatio aged 35 64. Chi J Cardiol. 2003;31(12):902 908. 17. Wei-li Y, Xiao-ya Y, Yu-jia Z, et al. The Metabolic Sydrome i Ughyur ad Kazak Populatios. Diabetes Care. 2005;28(10): 2554 2555. 18. Jig T, Yi-tog M, Yag X, et al. Prevalece of major cardiovascular risk factors ad adverse risk profiles amog three ethic groups i the Xijiag Ughyur Autoomous Regio, Chia. Lipids Health Dis. 2013;12:185. AUTHOR CONTRIBUTIONS Study desig ad cocept: X Ma, Karmacharya, D Huag, Y Ma Acquisitio of data: Bai Data aalysis ad iterpretatio: Bai, Y Huag, Xie, Wei, Y Ma Mauscript draft: X Ma, Bai, Karmacharya, Xie, Y Ma Statistical expertise: Wei, Y Ma Acquisitio of fudig: YMa Admiistrative: X Ma, Bai, Karmacharya, D Huag, Y Huag, Xie, Y Ma Supervisio: YMa 320 Ethicity & Disease, Volume 24, Summer 2014