Combined Effects Of Family History Of Cardiovascular Disease And Overweight,CRP And ApoB/A1 On Cardiovascular Disease

ObjectiveTo explore the independent and cumulative effect of family history of cardiovascular disease(CVD)and overweight on ischemic stroke events.To explore the independent and cumulative effect of both high CRP and high ApoB/A-1 ratio on ischemic stroke or coronary heart disease(CHD)incidence in an Mongolian populationSubjects and methodBaseline investigationThe study participants were recruited from 32 villages in Kezuohou Banner(county)and Naiman Banner in Inner Mongolia between june 2002 and july 2003.Among 3457Mongolian people who aged?20 years living in these villages,2589 of them wrote informed consent and received questionnaires,related physical examination,blood measurements and blood samples collection.None of the participants had chronic kidney disease,malignant tumor,thyroid disease or adrenalopathy,or acute infectious disease.The content of questionnaire included demographic characteristics,lifestyle risk factors,history of disease and family history of CVD.Standardized method was used to measure blood pressure,height,weight and waist circumference.Triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C)were measured in laboratory.Follow-up surveyFrom baseline investigation to July of 2012,once follow-up every two years were conducted to collect the information about the occurrence or death due to stroke or CHD during the time from baseline to the last follow up.Statistical analysisEpidata3.0 software was used to establish a database.All participants were categorized into four subgroups according to family history of CVD and overweight status.The Kaplan-Meier curves were used to estimate the cumulative incidence of ischemic stroke for the four subgroups.Multivariable Cox proportional hazards models were used to estimate the hazard ratios(HR)and 95%CI of ischemic stroke events among subgroups,compared with the subgroup with no family history of CVD and body mass index(BMI)<24 kg/m~2(the reference group).In addition,Net reclassification index(NRI)and integrated discrimination improvement(IDI)were calculated to evaluate the predictive value of adding family history of CVD and overweight to conventional risk factors.Similarly,All participants were categorized into four subgroups according to CRP and ApoB/A-1 level.The Kaplan-Meier curves were used to estimate the cumulative incidence of ischemic stroke and CHD for the four subgroups.Multivariable Cox proportional hazards models were used to estimate the hazard ratios(HR)and 95%CI of ischemic stroke and CHD events among subgroups,compared with the subgroup with low CRP with low ApoB/A-1(the reference group).In addition,NRI and IDI were calculated to evaluate the predictive value of adding CRP and ApoB/A-1 to conventional risk factors.All statistical analyses were conducted by using SAS 9.3 statistical software.All P-values were based on a two-sided test and a significance level of 0.05.ResultsThe study included 2589 participants who were followed for a mean 9.2 years,six participants were lost to follow up,and the follow-up rate was 99.8%.Among 2589 participants,8 were excluded because of lack of key data.Finally,2 581 participants were included in the analysis.After follow-up,76 ischemic stroke occurred.The cumulative incidence of events was 2.90%,and the incidence density was323/100,000 person-years.The cumulative incidence rates of ischemic stroke were2.48%,1.86%,6.67%and 9.00%in the no family history of CVD and BMI<24 kg/m~2,no family history of CVD and BMI?24 kg/m~2,family history of CVD and BMI<24kg/m~2 and family history of CVD and BMI?24 kg/m~2 subgroups,respectively.Compared with the reference group,the HR(95%CI)values in the no family history of CVD and BMI?24 kg/m~2,family history of CVD and BMI<24 kg/m~2 and family history of CVD and BMI?24 kg/m~2 subgroups were 1.18(0.5–2.39),1.27(0.67–2.42)and 2.61(1.16-5.87),respectively.Adding family history of CVD and overweight status to a model containing conventional risk factors improved predictive capability for ischemic stroke(NRI=0.280,P=0.018).Among 2589 participants,53 were excluded due to absence of key data,2536 were finally included in the analysis.After follow-up,151 IS or CHD events occurred.The cumulative incidence of IS and CHD events was 5.95%,and the incidence density was653/100,000 person-years.CRP was not significantly associated with IS and CHD,and only high ApoB/A-1 ratio kept marginally significant(HR,1.43(0.99-2.06))as a categorical variable.The cumulative incidence of IS and CHD was 4.30%for low CRP with low ApoB/A-1,6.56%for high CRP with low ApoB/A-1,8.00%for low CRP with high ApoB/A-1,and 11.97%for high CRP with high ApoB/A-1,respectively.Compared with the reference group,the HR(95%CI)values in the participants with low CRP and high ApoB/A-1,with high CRP and low ApoB/A-1 or with high CRP and high ApoB/A-1 were 1.33(0.84-2.12),1.17(0.69-1.88)and 1.91(1.17-3.11),respectively.Adding CRP and ApoB/A-1(as categorical variable)to a model containing conventional risk factors improved predictive capability for ischemic stroke and CHD(NRI=0.248,P=0.003).ConclusionIn the Mongolian population,a family history of CVD and coexistent overweight may increase the risk of ischemic stroke events,suggesting that in people with family history of cardiovascular disease,weight control is conducive to the prevention of ischemic stroke.In the Mongolian population,High ApoB/A-1 ratio might marginally increase the risk of IS and CHD.High CRP with high ApoB/A-1 ratio had the highest risk of IS and CHD,which suggest that combination of high CRP with high ApoB/A-1 ratio may improve the assessment of risk of IS and CHD.Adding family history of CVD and overweight status to conventional risk factors slightly improved risk prediction for ischemic stroke in the Mongolian population.Adding CRP and ApoB/A-1 ratio to conventional risk factors slightly improved risk prediction for ischemic stroke and CHD in the Mongolian population.