Academic literature on the topic 'Coronary heart disease China Hong Kong Statistics'

Elevated C-reactive protein (CRP) levels are associated with an increased risk of cardiovascular disease (CVD) in Caucasians; however, evidence is lacking for East Asians, who have low CRP levels. PubMed and Google Scholar searches were conducted (1966 through September 2014), and eight prospective studies in East Asian countries (China, Hong Kong, Japan, Korea, Macao, Mongolia, and Taiwan) that documented risk ratios of elevated CRP for CVD were included for meta-analysis with random-effects models. The overall association between CRP levels and stroke was significant in six studies (risk ratio = 1.40 [95% confidence interval {CI}, 1.10-1.77], P = 0.008). The association with ischemic stroke was more evident in subgroup analyses. For coronary heart disease (CHD) and CVD, the risk ratio was 1.75 (95% CI, 0.96-3.19, P = 0.07) and 1.76 (95% CI, 1.29-2.40, P < 0.001), respectively. Although East Asians have low CRP levels, this meta-analysis shows that elevated CRP levels were significantly associated with an increased risk of stroke, primarily ischemic stroke.

Background At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations, and there was no standardized and validated scale to measure the fear associated with the pandemic. Objective This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong. Methods A web-based questionnaire platform was developed for data collection; the study instruments were an adapted version of the 8-item Breast Cancer Fear Scale (“Fear Scale”) and the 4-item Patient Health Questionnaire. The internal construct validity, convergent validity, known group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarize the participants’ fear levels. Results A total of 2822 study participants aged 18 years or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach α coefficient of .93. The item-total correlations corrected for overlap were >0.4, confirming their internal construct validity. Regarding convergent validity, a small-to-moderate correlation between the Fear Scale and the 4-item Patient Health Questionnaire scores was found. Regarding known group validity, we found that the study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear compared with younger adults. Furthermore, having hypertension, liver disease, heart disease, cancer, anxiety, and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy, and depressed. Conclusions The psychometric properties of the adapted Fear Scale are acceptable to measure the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic.

Background Existing predictive outcomes models for type 2 diabetes developed and validated in historical European populations may not be applicable for East Asian populations due to differences in the epidemiology and complications. Despite the continuum of risk across the spectrum of risk factor values, existing models are typically limited to diabetes alone and ignore the progression from prediabetes to diabetes. The objective of this study is to develop and externally validate a patient-level simulation model for prediabetes and type 2 diabetes in the East Asian population for predicting lifetime health outcomes. Methods and findings We developed a health outcomes model from a population-based cohort of individuals with prediabetes or type 2 diabetes: Hong Kong Clinical Management System (CMS, 97,628 participants) from 2006 to 2017. The Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) simulation model comprises of 13 risk equations to predict mortality, micro- and macrovascular complications, and development of diabetes. Risk equations were derived using parametric proportional hazard models. External validation of the CHIME model was assessed in the China Health and Retirement Longitudinal Study (CHARLS, 4,567 participants) from 2011 to 2018 for mortality, ischemic heart disease, cerebrovascular disease, renal failure, cataract, and development of diabetes; and against 80 observed endpoints from 9 published trials using 100,000 simulated individuals per trial. The CHIME model was compared to United Kingdom Prospective Diabetes Study Outcomes Model 2 (UKPDS-OM2) and Risk Equations for Complications Of type 2 Diabetes (RECODe) by assessing model discrimination (C-statistics), calibration slope/intercept, root mean square percentage error (RMSPE), and R2. CHIME risk equations had C-statistics for discrimination from 0.636 to 0.813 internally and 0.702 to 0.770 externally for diabetes participants. Calibration slopes between deciles of expected and observed risk in CMS ranged from 0.680 to 1.333 for mortality, myocardial infarction, ischemic heart disease, retinopathy, neuropathy, ulcer of the skin, cataract, renal failure, and heart failure; 0.591 for peripheral vascular disease; 1.599 for cerebrovascular disease; and 2.247 for amputation; and in CHARLS outcomes from 0.709 to 1.035. CHIME had better discrimination and calibration than UKPDS-OM2 in CMS (C-statistics 0.548 to 0.772, slopes 0.130 to 3.846) and CHARLS (C-statistics 0.514 to 0.750, slopes −0.589 to 11.411); and small improvements in discrimination and better calibration than RECODe in CMS (C-statistics 0.615 to 0.793, slopes 0.138 to 1.514). Predictive error was smaller for CHIME in CMS (RSMPE 3.53% versus 10.82% for UKPDS-OM2 and 11.16% for RECODe) and CHARLS (RSMPE 4.49% versus 14.80% for UKPDS-OM2). Calibration performance of CHIME was generally better for trials with Asian participants (RMSPE 0.48% to 3.66%) than for non-Asian trials (RMPSE 0.81% to 8.50%). Main limitations include the limited number of outcomes recorded in the CHARLS cohort, and the generalizability of simulated cohorts derived from trial participants. Conclusions Our study shows that the CHIME model is a new validated tool for predicting progression of diabetes and its outcomes, particularly among Chinese and East Asian populations that has been lacking thus far. The CHIME model can be used by health service planners and policy makers to develop population-level strategies, for example, setting HbA1c and lipid targets, to optimize health outcomes.

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. 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Background: Identifying environmentally responsive genetic loci where DNA methylation is associated with coronary heart disease (CHD) may reveal novel pathways or therapeutic targets for CHD. We conducted the first prospective epigenome-wide analysis of DNA methylation in relation to incident CHD in the Asian population.Methods: We did a nested case-control study comprising incident CHD cases and 1:1 matched controls who were identified from the 10-year follow-up of the China Kadoorie Biobank. Methylation level of baseline blood leukocyte DNA was measured by Infinium Methylation EPIC BeadChip. We performed the single cytosine-phosphate-guanine (CpG) site association analysis and network approach to identify CHD-associated CpG sites and co-methylation gene module.Results: After quality control, 982 participants (mean age 50.1 years) were retained. Methylation level at 25 CpG sites across the genome was associated with incident CHD (genome-wide false discovery rate [FDR] < 0.05 or module-specific FDR <0.01). One SD increase in methylation level of identified CpGs was associated with differences in CHD risk, ranging from a 47% decrease to a 118% increase. Mediation analyses revealed 28.5% of the excessed CHD risk associated with smoking was mediated by methylation level at the promoter region of ANKS1A gene (P for mediation effect = 0.036). Methylation level at the promoter region of SNX30 was associated with blood pressure and subsequent risk of CHD, with the mediating proportion to be 7.7% (P = 0.003) via systolic blood pressure and 6.4% (P = 0.006) via diastolic blood pressure. Network analysis revealed a co-methylation module associated with CHD.Conclusions: We identified novel blood methylation alterations associated with incident CHD in the Asian population and provided evidence of the possible role of epigenetic regulations in the smoking- and BP-related pathways to CHD risk.Funding: This work was supported by National Natural Science Foundation of China (81390544 and 91846303). The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by grants from the UK Wellcome Trust (202922/Z/16/Z, 088158/Z/09/Z, 104085/Z/14/Z), grant (2016YFC0900500, 2016YFC0900501, 2016YFC0900504, 2016YFC1303904) from the National Key and Program of China, and Chinese Ministry of Science and Technology (2011BAI09B01).

Background Management of coronary heart disease remains a challenge even with modern advances. New anti-platelet agents which reduce thromboembolic events in patients with coronary heart disease were introduced. However, there are concerns about an increased in bleeding risk for patients taking these new anti-platelet agents. Platelet function test, such as VerifyNow, claimed to be able to predict bleeding risk. However, the evidence was limited, especially among the Asian population. This study aimed to evaluate the use of VerifyNow to assess bleeding risk. Subjects with low residual platelet reactivity, i.e. low PRU value, were hypothesized to have an increased bleeding risk. Methods This was a case control study performed in the Princess Margaret Hospital of Hong Kong. A total of 120 subjects who were taking a P2Y12 inhibitor and had a VerifyNow test were recruited. The cases were defined as subjects with a PRU value of less than or equal to 95, a threshold for increased bleeding risk as recommended by Western studies. The controls were age matched to the cases. The primary outcome was the increase in bleeding risk associated with a low PRU value at 30 days. The secondary outcome was the increase in bleeding risk associated with a low PRU value at 1 year. The use of the percentage of platelet inhibition was also evaluated as a secondary outcome. Multivariable logistic regression was used to obtain the odds ratio of the low PRU group. Results Bleeding events occurred more frequently in the low PRU group. At 30 days, 31.7% of subjects among the case had a bleeding event while 43.3% of the cases had a bleeding event at 1 year. The majority of these bleeding events were minor bleeding, such as easy bruising. After adjusting for confounders, there was no statistically significant increase in bleeding risk among those in the low PRU group at 30 days or 1 year. Subjects with a high percentage of platelet inhibition (>50%) was also not associated with a statistically significant increase in bleeding risk. Conclusion A low PRU value was not associated with an increased bleeding risk at 30 days. Thus the VerifyNow test was not shown to be useful in assessing the bleeding risk of patients in an Asian population, contrary to the findings from Western literature. A possible explanation was that the VerifyNow threshold for predicting bleeding might be higher among the Asian population. The definition for low residual platelet reactivity might be different in our locality. A larger sample size might also be needed. Further studies are needed to evaluate whether a different cut off is more optimal for the Asian population.
published_or_final_version
Public Health
Master
Master of Public Health

by Choi Ka Yan.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2000.
Includes bibliographical references (leaves 113-128).
Abstract and appendix in English and Chinese.
Acknowledgements --- p.i
Abstract --- p.ii
Abstract (Chinese version) --- p.iv
Table of Contents --- p.vi
List of Tables --- p.xi
List of Figures --- p.xiv
List of Abbreviations --- p.xv
Chapter CHAPTER ONE: --- BACKGROUND AND LITERATURE REVIEW
Chapter 1.1 --- Coronary Heart Disease: a global health problem --- p.1
Chapter 1.2 --- Risk Factors of Coronary Heart Disease --- p.3
Chapter 1.2.1 --- Age --- p.3
Chapter 1.2.2 --- Gender --- p.4
Chapter 1.2.3 --- Family History of Cardiovascular Disease --- p.5
Chapter 1.2.4 --- Hypercholesterolemia --- p.7
Chapter 1.2.5 --- Unhealthy Dietary Habits --- p.11
Chapter 1.2.6 --- Obesity --- p.14
Chapter 1.2.7 --- Physical Inactivity --- p.20
Chapter 1.3 --- Clustering of Risk Factors --- p.24
Chapter 1.4 --- Risk Factors in Children: Atherosclerosis Begins Early in Life --- p.26
Chapter CHAPTER TWO: --- RESEARCH IN HONG KONG AND PURPOSES OF THIS STUDY
Chapter 2.1 --- Nutrition Transition --- p.27
Chapter 2.2 --- CHD Mortality Trends in Hong Kong --- p.28
Chapter 2.3 --- Serum Total Cholesterol and Obesity in Hong Kong Adults --- p.29
Chapter 2.4 --- "Obesity, Serum Total Cholesterol, Dietary Habits and Physical Activity of Hong Kong Children and Adolescents" --- p.31
Chapter 2.5 --- Study Purpose and Objectives --- p.35
Chapter CHAPTER THREE: --- SURVEY DESIGN
Chapter 3.1 --- Sample Selection --- p.39
Chapter 3.2 --- "Blood Total Blood Cholesterol, Triglyceride and Anthropometric Measurements" --- p.40
Chapter 3.2.1 --- Total Blood Cholesterol and Triglyceride --- p.40
Chapter 3.2.2 --- Anthropometry Measures --- p.42
Chapter 3.3 --- Questionnaire --- p.45
Chapter 3.3.1 --- Questionnaire Design and Pre-testing --- p.45
Chapter 3.3.2 --- General Health and Socio-demographic Questionnaire --- p.47
Chapter 3.3.3 --- Physical Activity Questionnaire --- p.47
Chapter 3.3.4 --- Dietary Questionnaire --- p.48
Chapter 3.4 --- Data Management --- p.49
Chapter 3.5 --- Statistics --- p.49
Chapter 3.6 --- Data Analysis --- p.50
Chapter 3.6.1 --- Blood Total Cholesterol and Triglyceride --- p.50
Chapter 3.6.2 --- Obesity and Fat Distribution --- p.50
Chapter 3.6.3 --- Diet --- p.51
Chapter 3.6.4 --- Physical Activity Patterns --- p.51
Chapter 3.6.5 --- Body Mass Index of Parent and Family History of Diseases --- p.52
Chapter CHAPTER FOUR: --- RESULTS
Chapter 4.1 --- Sample Size and the Characteristics of the Students in the Two Schools --- p.54
Chapter 4.2 --- Gender and Age Distribution --- p.55
Chapter 4.3 --- Blood Total Cholesterol and Triglyceride --- p.56
Chapter 4.4 --- Anthropometry Measures --- p.58
Chapter 4.5 --- Dietary Habits --- p.60
Chapter 4.5.1 --- Dietary Composition of 3-day Dietary Record --- p.60
Chapter 4.5.2 --- Eating Behaviors --- p.65
Chapter 4.6 --- Physical Activity --- p.68
Chapter 4.7 --- Family History of Diseases --- p.70
Chapter 4.8 --- Parents' Anthropometry --- p.71
Chapter 4.9 --- Demographic Data --- p.71
Chapter 4.10 --- Inter-relationships --- p.75
Chapter 4.10.1 --- Blood Total Cholesterol and Triglyceride --- p.75
Chapter a. --- "Blood Total Cholesterol, Triglyceride and Body Fatness" --- p.75
Chapter b. --- "Blood Total Cholesterol, Triglyceride and Diet" --- p.75
Chapter c. --- "Blood Total Cholesterol, Triglyceride and Physical Activity Patterns" --- p.77
Chapter d. --- Blood Total Cholesterol，Triglyceride and Family History of Hypercholesterolemia --- p.78
Chapter e. --- Relative Importance of the Key Factors in Predicting Blood Total Cholesterol levels --- p.79
Chapter 4.10.2 --- Obesity and Body Fatness --- p.79
Chapter a. --- "Obesity, Body Fatness and Physical Activity Patterns" --- p.79
Chapter b. --- "Obesity, Body Fatness and Diets" --- p.82
Chapter c. --- Body Fatness and Genetics --- p.84
Chapter 4.10.3 --- Diet and Physical Activity --- p.86
Chapter 4.10.4 --- "Blood Total Cholesterol, Triglyceride, Obesity and Other Demographic or Economic Characteristics" --- p.87
Chapter 4.11 --- Clustering of Risk Factors among Obese children --- p.87
Chapter CHAPTER FIVE: --- DISCUSSION
Chapter 5.1 --- Implication of Research Findings --- p.89
Chapter 5.2 --- Limitations --- p.108
Chapter CHAPTER SIX: --- CONCLUSIONS AND RECOMMENDATIONS --- p.111
References --- p.113
Appendices
Chapter I --- Questionnaire (English version) --- p.129
Chapter II --- Questionnaire (Chinese version) --- p.139
Chapter III --- Introductory letter (English version) --- p.152
Chapter V --- Introductory letter (Chinese version) --- p.153
Chapter V --- Consent form (English version) --- p.154
Chapter VI --- Consent form (Chinese version) --- p.155
Chapter VII --- Photos of the standard household measures given to children for estimation of portion size (English version) --- p.156
Chapter VIII --- Photos of the standard household measures given to children for estimation of portion size (Chinese version) --- p.157
Chapter IX --- Responses from the children to the food frequency questionnaire --- p.158
Chapter X --- The frequency of the reported food items liked or disliked by the children --- p.160

Acute coronary syndrome (ACS), a term used to cover a group of clinical symptoms compatible with acute myocardial ischemia, represents a high-risk group of patients with coronary heart disease (CHD). To improve quality of care, international guidelines for the management of ACS have been established and are updated regularly. In the era of evidence based medicine, adherence to therapeutic guidelines is essential for optimal care of ACS patients. However, most data on ACS epidemiology, treatment and outcomes are derived from western population. There are limited data in Chinese population in terms of prevalence, presentation, response to treatment and clinical outcome.
Among 624 patients finished Short Form (SF)-36 questionnaires, health related quality of life (HRQoL) were compared between patients underwent PCI versus those treated conservatively across 3 age groups (<60, 60-79 and ≥80 years). PCI was performed in 73.6%,55.7% and 21.3% in patients aged <60,60-79 and older than 80 years, respectively (p<0.01). Elderly patients were more likely to be female (16.9 vs. 35.4 vs. 54.6%, p<0.01) and had more co-morbidities (p<0.01). Older patients were less likely to undergo angiography (84.8 vs. 65.2 vs. 24.8%, p<0.01). Baseline HRQoL decreased with advancing age (p<0.01). However, elderly patients who underwent PCI-experienced the most improvement in physical health than younger age groups. PCI was an independent predictor (OR, 1.79,95% CI: 1.10-2.92) of better physical health status at 6 months. In conclusion, elderly ACS patients who underwent PCI experienced the most improvement in physical health compared to younger patients. Our findings suggest that age per se should not deter against revascularization because of potential benefits in HRQOL.
In summary, this is the first registry which described patients' characteristics, treatment and management practices, and hospital outcomes over the whole spectrum of ACS in Hong Kong. The study identified gaps between guideline and clinical practice as well as the reasons of these gaps, and measured the impact of such gaps on the outcomes of patients with ACS. Compared with internationally reported data, Hong Kong patients are different in terms of age and risk factors distribution. Treatment gaps exist between international therapeutic guideline recommendations and clinical practice, especially among the high risk population, the elderly and female patients. Better understanding and narrowing these gaps between guideline and practice will lead to improvement in quality of care and clinical outcomes. Increase use ofrisk stratification models and health status assessments may improve decision making in the management of ACS.
Patients with ACS were divided into low- and high-predicted risk of mortality at 6 months using the GRACE risk score (≥142.5 was defined as high-risk). We evaluated the use of in-hospital angiography, revascularization, anti-platelet, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), beta-blockers and statins therapy between high and low-risk patients. There were 259 patients in the high- and 742 in the low-risk groups. Paradoxically, high-risk compared to low-risk patients were less likely to underwent coronary angiography and/or revascularization during the index hospitalization (33% vs. 64% and 25% vs. 50%, both p<0.01). Hospital initiated pharmacotherapies are also lower in high-risk patients (24% vs. 55% for c1opidogrel, 49% vs. 58% for ACEI/ARBs, 54% vs. 69% for beta-blockers and 56% vs. 77% for statins; all p<0.01). After adjustment, high-risk patients remained less likely to undergo revascularization (adjusted odds ratio [OR], 0.47; 95% CI, 0.33-0.73, p<0.001) than low-risk patients. Advanced age, increased creatinine level and higher GRACE score were independent predictors for failure to administer evidence-based therapies. Thus, patients with ACS at high risk of mortality were paradoxically less likely to undergo revascularization or receive medications according to guidelines. Better adherence to evidence-based therapies in high-risk patients may improve clinical outcome and quality of health care.
The Hong Kong ACS registry was designed to investigate epidemiology, treatment and outcome of ACS patients under current medical care system, it was conducted in a university affiliated teaching hospital from February 2006 to December 2009. Clinical characteristics and treatment data were collected at baseline, 30 days and 6 months after onset in a standard defined case report form. SF-36 questionnaire was completed after admission and at 6 months. Outcomes were evaluated mortality and morbidity in clinical aspect and quality of life in aspect of health status.
The Main findings were as followed: Totally 1001 patients admitted with ACS were recruited. Among all patients enrolled, 31.7% were diagnosed with ST-segment elevation myocardial infarction, 42.7% with non-S'T-segrnent myocardial infarction and 21.6% with unstable angina. The median age was 72 (interquartile range 61-79) years; 77.2% were >60 years old, and 31.5% were women.
Women presented more often with NSTE-ACS than men (77.3% of women vs. 63.2% of men, p<0.001). Despite having greater cornorbidities including hypertension, diabetes, hypercholesterolemia, renal impairment and history of heart failure etc., women were observed to have higher GRACE (global registry of acute coronaryevents) score than men (128+/-32 vs. 118+/-37, p score than men (128+/-32 vs. 118+/-37, p<0.01). Women were less likely to be assigned invasive procedures (43.3% vs. 62.9%, p<0.001) as well as pharmacotherapies such as clopidogrel (41.1% vs. 58.8%, p<0.001), glycoprotein (GP) IIb/IIIa antagonists (5.3% vs. 11.6%, p=0.001) and statins (64.1% vs. 77.2%, p<0.01) et al. than men. For in-hospital mortality, the adjusted odds ratio for men compared to women was similar (odds ratio [OR]: 1.32, 95% CI: 0.62-2.83, p=0.47). The higher 6 month mortality and major cardiac events rate in women were not significant after adjusting for differences in clinical characteristics and percutaneous coronary intervention (PCI) (OR=1.02; 95% CI 0.62 to 1.68; p=0.95). In summary, there were differences in baseline characteristics and in the management of women and men admitted for ACS. Advanced age and high comorbidities prevalence could explain most of the difference between genders suggesting that decision making bias in clinical practice is anti-age but not anti-female. Overall, in-hospital and 6 months mortality was similar for women and men after adjustments.
Li, Rujie.
"December 2010."
Adviser: Cheuk-Man Yu.
Source: Dissertation Abstracts International, Volume: 73-04, Section: B, page: .
Thesis (Ph.D.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 145-166).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.