| Objective:1. To explore the association between inflammation and endothelial dysfunction and cardiovascular risk factors ( hypertension,obesity,hyperglycemia and dyslipidemia) among Mongolian population in agricultural and pastoral areas,Inner Mongolia. 2.To investigate relationship between inflammation and endothelial dysfunction and risk of cardio-cerebrovascular events. 3.To investigate the association between extraneous pathogen(Chlamydia pneumonia, Mycoplasma pneumonia, Helicobacter pylon, Coxackie Virus) infection and risk of cardio-cerebrovascular events.Subjects and methods:1. Baseline investigation: We conducted a cross-sectional study between 2002 and 2003 in Inner Mongolia, study participants aged 20 years and older were recruited from 32 villages in two adjacent townships located in Kezuohou Banner (county) and Naiman Banner.Data on demographic information, lifestyle risk factors including smoking and alcohol drinking, family history of hypertension and personal medical history were obtained using a standard questionnaire administered by trained staff,and the related physical examination and blood samples collection were also conducted during field investigation. Body hight, weight, waist circumference,hip circumference and three times of blood pressures were measured for all participants.Fasting plasma glucose(FPG), insulin, triglyceride(TG), total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1(ApoA1), apolipoprotein B(ApoB), C-reactive protein(CRP), E-selectin, intercellular adhesion molecules-1(ICAM-1), angiotensinⅡ( AngⅡ) , and IgG antibodies for Chlamydia pneumonia, Mycoplasma pneumonia, Helicobacter pylori and Coxsackie virus were detected for all participants.2. nest case-control study: Follow-up investigations had been conducted for the subjects involved in baseline study since year 2004. The cardio-cerebrovascular events (including stroke and coronary heart disease incidence) were the study outcome.We used household interview by designed questionnaires, monitoring data and hospital medical records to investigate cardio-cerebrovascular events. Based on follow-up investigations, a nested case-control study were conducted, and stroke and coronary heart disease patients occurred during follow-up period were served as the cases, and controls were selected from the participants without cardio-cerebrovascular events, matched by sex,age (±3 years) and residence address with cases.3. Statistical analysis: The Epidata3.0 Software was used to build database. All data were checked after data entry for two times. SAS9.1 Software was used for statistical analysis, using P=0.05 as test level.Results1.A total of 2589 subjects aged 20-84 years old, 1064 males and 1525 females with average age of 46.51 years old, were included in the study.2. AngⅡ, CRP, ICAM-1 and E-selectin in hypertension group were higher than that in normotensive group. Logistic regression analysis showed that AngⅡand CRP were positively and significantly associated with risk of hypertension, after adjustment for multivariate, compared with those with lowest AngⅡand CRP levels, the ORs (95% CIs) of hypertension were 1.87 (1.43-2.46) and 1.40 (1.06-1.85) for the participants with highest levels, respectively.3. Multivariate logistic regression analysis showed that high WC was positively and significantly associated with risk of increased CRP (OR = 1.46, 95% CI = 1.21-1.76), high BMI was positively and significantly associated with risk of increased E-selectin (OR = 1.30, 95% CI = 1.08-1.55). impaired FPG or diabetes was positively and significantly associated with risks of increased CRP and ICAM-1, and compared with those without impaired FPG or diabetes, the ORs (95% CIs) of increased CRP and ICAM-1 were 2.93 (2.39-3.59) and 3.48 (2.85-4.24 ) for participants with impaired FPG or diabetes, respectively. High TG, high TC, high LDL-C and low HDL-C were positively and significantly associated with risk of increased CRP, and ORs (95% CIs) were 3.36(2.65-4.27), 1.87(1.40-2.48), 1.69(1.32-2.19) and 1.79(1.47-2.19) of increased CRP for participants with High TG, high TC, high LDL-C and low HDL-C respectively, compared with those with normal TG, TC, LDL-C and HDL-C. 4. Participants with CRP≥11. 39mg/L was almost 3 times the risk of stroke compared to participants with CRP<3.95mg/L , and OR (95%CI) was 3.40(1.13-10.24) , after multivariable adjustment, no matter whether unadjustment or multivariable adjustment, elevated AngⅡ, ICAM-1 and E-selectin levels were not significantly associated with increased risk for stroke incidence. The association of inflammation and endothelial dysfunction biomarkers with coronary heart disease incidence were not found in the present nest case-control study.5. There was significant relationship between the clustering of elevated AngⅡ, CRP, ICAM-1 and E-selectin levels at baseline and stroke events, the proportion(51.06%) of≥2 elevated biomarkers was higher in the stroke cases than that in controls(30.85%), P<0.05. After multivariate adjustment, OR (95%CI) of stroke was 10.76 (2.54-45.63) for participants≥2 elevated biomarkers at baseline compared to those without elevated biomarker.6. Participants infected with Chlamydia pneumoniae had 3.09 (1.20-7.94) times the risk of stroke compare to participants without Chlamydia pneumoniae infection under unadjustment for other variables, after multivariable adjustment, infection of Chlamydia pneumoniae was associated with increased risk for stroke, with OR (95%CI) of 2.59(1.07-6.29). After multivariable adjustment, OR (95%CI) of coronary heart disease was 5.56(1.15-26.90) for participants infected with coxsackie virus compare to those without coxsackie virus infection.Conclusions:1 Participants with elevated CRP level and AngⅡhad increased risk of hypertension, which indicate that inflammation and endothelial dysfunction may play a role in the development of hypertension.2 High WC and BMI were associated with risk of elevated inflammation and endothelia biomarkers; abnormal levels of blood lipids were associated with elevated CRP; elevated inflammation and endothelial biomarkers was associated with impaired FPG or diabetes.3 Elevated CRP might increase the risk of stroke incidence, 2 or more elevated inflammation and endothelial biomarkers might increase the risk for stroke incidence.4 Participants infected with Chlamydia pneumonia had increased risk for stroke compared with those without Chlamydia pneumonia infection. Infection of Chlamydia pneumonia maybe a risk factor for stroke.Participants infected with coxsackie virus had increased risk for coronary heart disease compared with those without coxsackie virus infection. Infection of coxsackie virus maybe a risk factor for coronary heart disease.5 The present study suggest that inflammation and endothelial dysfunction are also risk factors of cardio-cerebrovascular diseases as other cardiovascular risk factors, maybe inflammation and endothelial dysfunction and other cardiovascular risk factors promote them mutually or a mechanism in development cardio-cerebrovascular diseases. |
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