當(dāng)今我國(guó)動(dòng)脈血管硬化的危險(xiǎn)因素英文

1、Atherosclerotic Risk Factors in Modernizing China當(dāng)今我國(guó)動(dòng)脈血管硬化的危險(xiǎn)因素,Prof Woo Kam Sang and Fung Kwok PuiDepartment of BiochemistryThe Chinese University of Hong Kong香港中文大學(xué)生物化學(xué)系胡錦生教授，馮國(guó)培教授,Chinese Atherosclerosis Study

2、 in the Aged and Young,CATHAY Study,Pan Yu, Hong Kong, Macau, Sydney, San Francisco, Shanxi, Three Gorges,2617 asymptomatic subjects,Age: 18-70 yrs,Vascular Epidemiology,Adpated from Pepine CJ Am J Cardiol 1998;82(10A)

3、:23S-27S.,No,Normal intima-media thickness (IMT) of CCA,Atherosclerotic plaques of common carotid artery,,,,s,,,CV=1%,Comparison of CCA IMT by 2 Investigators,,AutoCCA,,ManualRCCA,,ManualLCCA,,Carotid intima-media thi

4、ckening as surrogate atherosclerosis marker: Is it relevant to the Asian?,,Westernization of Chinese Adults and Increased Subclinical AtherosclerosisKam S Woo, Ping Chook, Olli T Raitakari, Brendan McQuillan, Jiang Zhe

5、ng Feng, David S Celermajer,Westernization of Chinese subjects is associated with greater susceptibility to the pro-atherogenic effects of traditional vascular risk factors, such as lipids and smoking, and with evidence

6、of increased IMT as a marker of subclinical atheroscleosis.,,Effects of HDL Cholesterol on Carotid IMT,WC,NC,,Subclinical Atherosclerosis in the Chinese (Carotid Intima-Media Thickening),(* Age & gender matched; mea

7、n age: 42 yr, 44% male),,Pan Yu,Hong Kong,Sydney,San Francisco,Dietary Patterns in Rural and Westernized Chinese,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0,50,100,150,200,250,(p<0.001),(p<0.02),(p<0.001),(p<0.001),Mean D

8、aily Intake ml or g/1000 Kcal,*p-value: Pan Yu vs others,,(0.49?0.09)*,(0.56?0.13)*,(0.59?0.15)*,(0.68?0.15)*,,Karasek’s Job Demand-Control-Support model For work environment where stressors are chronic, not initially

9、life threatening.Job demand (7 items)Decision latitude (Job control) (9 items)Job support (19 items)Shift workChange bossPart-time jobEducation,Psychological factors,,Odds Ratio From Stepwise Logistic Regression A

10、nalysis Explaining atherosclerosis by DCS Model (n=248),Subclinical Atherosclerosis in the Chinese,,,,,,,,,,Yes,No,Demand,Control,Yes,Yes,No,No,,,Atherosclerosis,Job Stress,Diet,Alcohol,Support,,Effects of Smoking (Pack

11、Years) on Carotid IMT,WC,NC,,,Heavy Tobacco Smoke Pollution is Associated with Higher Atherosclerosis RiskYip TWC, Chook P, Feng XH, Chiu ML, Poon WH, Evora ML, Koon KV, Chan YK, Leong HC, Chu CL, Woo KS ,On multiple r

12、egression, carotid IMT was associated with age and passive smoking, independent of blood pressures, blood cholesterol and glucose (R2=0.5; F value 3.6; p<0.05).,Brachial FMD and Carotid IMT (Casino Employees vs CATHAY

13、 Controls),(n=59),(n=100),(n=59),(n=100),CAHTAY Cohort:Homocysteine,Cathay Study Result,*,*,We hypothesise hyperhomocysteinaemia contributes to atherogenesis process beyond the lipid effect - two unique (low blood lipid)

14、 and novel clinical models of hyperhomocysteinaemia :,,,Hong Kong Voluntary vegan-vegetarian,,,Northern rural ChineseObligatory vegetarian,,Results,On multiple regression analysis, homocysteine and blood pressure were

15、associated with increased carotid IMT (partial R=0.59; F-value=6.0; p<0.0001), independent of WHR and LDL-C.,,,6.31±1.79,6.34±1.44,6.88±1.90,7.37±1.71,***,***,* P<0.05** P<0.01*** P&l

16、t;0.001 (n=41),Change in FMD during the B12 Supplementation in Vegetarians,Baseline Placebo B12 B12 3 mth DB 6mth open label,(1

17、6.8%),,0.69±0.09,0.68±0.09,0.67±0.09,0.65±0.09,***,***,* P<0.05, ** P<0.01, ***P<0.001 (n=41),Change in IMT during the B12 Supplementation in Vegetarians,Baseline

18、Placebo B12 B12 3 mth DB 6mth open label,*,**,***,(5.7%),,Yu County,,* p<0.001, ? Log-transferred data,The clinical characteristics

19、of study subjects,,Risk Factors for Carotid Atherosclerosis,FMD increased significantly at 6 months after the 3 active treatment but not after placebo.,B12 and FA Supplementation in Yu County,Mean FMD (%),Placebo(n=53),

20、B12(n=52),Folate(n=51),B12+Folate(n=51),Baseline,DB 6mths,OL 12mths,,,,P<0.0001,,,,P<0.0001,,,,P<0.0001,,,,P<0.0001,,,,P<0.0001,,,,P<0.0001,,,,P<0.0001,,,,P=0.001,,,,P<0.0001,,,,P<0.0001,,Th

21、ree Gorges Reservoir Dam,The Impact of Lifestyle Changes on Atherogenesis in Mainland China: A Tale of Three Gorges in Yangtze River,YJ Hu, P Chook, AN Wei, MJ Wu, XL Wang, L Li, PG Dong, Celermajer DS, KS Woo Chong

22、qing University of Medical Sciences, Chongqing The Chinese University of Hong Kong, Hong Kong Chongqing Center for Disease Control and Prevention, Chonqing Wu Shan Center for Disease Control

23、 and Prevention, Chongqing University of Sydney, Sydney,BMI: body mass index, WHR: waist-hip ratio, TC: total plasma cholesterol, TG: triglyceride, MMS: prevalence of multiple metabolic syndrome,Clinical F

24、eatures of 2 Cohorts,<0.001,,,,,,,Mean IMT (mm),Wu Shan,Carotid IMT was correlated with MMS (R2=0.68) independent of blood pressures and HDL-cholesterol.,,Dai Cheong,Carotid IMT of 2 Cohorts,P<0.001,,,,,Conclu

25、sion:,Sedentary lifestyle changes in Yangtze river Three-Gorges territories are associated with accelerated atherogenic process, with great implications in atherosclerosis prevention in China, now in fast modernization p

26、rocess.,,,,,,,,,Effects of Diet and Exercise on Obesity-Related Vascular Dysfunction in Children,,,,,Effects of Diet and Exercise on Obesity-Related Vascular Dysfunction in Children,,,P<0.001,Detraining after 6 weeks,

27、,,,Continued training,,,,P<0.001,,Carotid IMT in Dietary / Exercise Intervention-1 year Result,,,Genes,,External,Environment,,Internal,Environment,,Endothelial,Intima-Media,Dysfunction,Thickening,,Atherosclerotic,Dise

28、ase,,,Dietary Habits:,Green Tea,Vegetables,Carotene,Folate,Animal Protein,Fish, Fat or,Dairy Product,Life-style:,Exercise,Smoking,AlcoholPsychological Stress,Blood glucose/Insulin,Lipid Disorders,LDL-Chol Oxidizability,

29、Antioxidants,Folate,Homocysteine,Fibrinogen/Thrombotic,Factors,Hypertension,Obesity,VCAM,SUB-CLINICAL,CLINICAL,~~~~~~~~ ATHEROSCLEROSIS ~~~~~~~~,*,@,@,@,Gene-Environment Interactions,,,,,,,Hypothesis 1: High prevalen

30、ce of atherosclerosis in westernized than native ChineseHypothesis 2: Genetic homogenity in main steam Chinese ethnicHypothesis 3: Gene-environmental interaction

31、 atherogenesis in modernizing communities,#,,#,*,@,Adpated from Pepine CJ Am J Cardiol 1998;82(10A):23S-27S.,,Chinese Breakfast,Breakfast Western Style,Left upper: Stea

32、med Grass Carp with Tofu in Bean PasteLeft lower: Dace Fish Balls with Chinese LettuceRight: Braised Fish with Sweet Bean Sheets and Winter Melon,Left: Fish CutletRight: Pan-fried Fish Steak,Left upper: Soy Bean Milk

33、Left lower: Scrambled Eggs with ScallionsRight lower: Braised Mixed Soy Products with Gluten,Left: PizzaRight: Macaroni and Cheese with Ham,Right: Minced Beef with PotatoesLeft: Stir-fried Beef Slices with Chinese Br

34、occoli,Left lower: Sirloin Steak Dinner Right upper: Spahgetti in Meat Ball Sauce with CheeseMiddle: Hamburger and French Fries,Changing Dietary Patterns and Subclinical Atherosclerosis in Chinese Americans: The Impac

35、t of Prolonged and Early Acculturization,,KS Woo1 SW Chan2 P Chook1 RKL Ip1 JLF Woo1 DS Celermajer3,The Chinese University of Hong Kong, PR China1The Chinese Hospital, San Francisco, USA2The University of Sydney,

36、NSW, Australia3,Changing Dietary Patterns & Subclinical Atherosclerosis in Chinese Americans: The Impact of Prolonged Acculturization,*p<0.05; ***p<0.001,,Changing Dietary Patterns & Subclinical Atheroscl

37、erosis in Chinese Americans: The Impact of Early Acculturization,*p<0.05; **p<0.01; ***p<0.001,,Atherosclerosis & Endothelial Dysfunction,ED:A precussor of atherosclerosisED:A marker of early at

38、herosclerosis,SmokingCholesterolHypertensionDiabetesObesity,,Endothelial Dysfunction,,,Atherosclerosis,Lower LDL cholesterolDietary antioxidant (soy protein, green tea, plant phytoestrogen)Genetic / environmental f

39、actor,,,,,,,,,,,,,,,,Vessel tone,Vessel growth,Endothelialcells,Smoothmuscle cells,,tPA PAI-1,CAMs,PGI2 NO,NO ET-1 VEGF MCP-1,CoagulationFibrinolysis MonocytePlatelet interaction

40、 adhesion,Function of Endothelium (weight =1.5kg),,DILATATION,,,,,,,,Endothelium,Shear Stress,EDRF (NO),GTN,Smooth Muscle,Brachial Artery Scans,High resolution external vascular ultrasoundBrachial artery diam

41、eter measured following hyperemia and GTN sprayTests endothelium-dependent and independent dilatation,10 mins rest,4.5 mins cuff inflation,15 minsrest,3 mins,,Scan B2,,Scan B3,,Scan B4,,Scan B1,,GTN,Cuff release,,Fl

42、ow - Dependent Dilatation,(Schachinger Circulation 2000;101:1899-1906),Folic Acid and Vitamin B-12 Supplementation Improve Atherogenic Process in Rural Chinese: A Novel and Affordable Strategy of Atherosclerosis Preve

43、ntion in China,SK Kwong1, P Chook2, TWC Yip3, YJ Hu4, XS Huang5, GG Wang6, MJ Wu4, YM Liu7, WK Lam2, DS Celermajer8, KS Woo2Alice Ho Miu Ling Nethersole Hospital1, The Chinese University of Hong Kong2, Yan Chai Hospita

44、l3, Chongqing University of Medical Science4, Guangdong Provincial Cardiovascular Institute5, Fu Wai Hospital6, Sun Yat San University Second Affiliated Hospital7, The University of Sydney8,Possible Contributory Factors,

45、Reduced physical activities (job and lifestyle)Dietary changesSociopsychological stressMetabolic syndrome,These will be further analysed, and effect of early health-education intervention assessed,,,Changes in laser-D

46、oppler cutaneous blood flow over time,,Mean and individual circulating levels of sCD40L(Post Tonsillectomy),,,Atherogenesis in Kawasaki Disease / SLE,SLE* / Kawasaki disease,,(left upper),Steamed Grass Carp with Tofu in

47、 Bean Paste,(left lower),Dace Fish Balls with Chinese Lettuce,(right),Braised Fish with Sweet Bean Sheets and Winter Melon,(left),Fish Cutlet,(right),Pan-fried Fish Steak,,(left upper),Soya Bean Milk,(left lower),Scrambl

48、ed Eggs with Scallions,(right lower),Braised Mixed Soy Products with Gluten,(left),Pizza,(right),Macaroni and Cheese with Ham,Black Tea,Chinese Tea,,Genes,,External,Environment,,Internal,Environment,,Endothelial,Intima-M

49、edia,Dysfunction,Thickening,,Atherosclerotic,Disease,,,Dietary Habits:,Green Tea,Vegetables,Carotene,Folate,Animal Protein,Fish, Fat or,Dairy Product,Life-style:,Exercise,Smoking,AlcoholPsychological Stress,Blood glucos

50、e/Insulin,Lipid Disorders,LDL-Chol Oxidizability,Antioxidants,Folate,Homocysteine,Fibrinogen/Thrombotic,Factors,Hypertension,Obesity,VCAM,SUB-CLINICAL,CLINICAL,~~~~~~~~ ATHEROSCLEROSIS ~~~~~~~~,*,@,@,@,Gene-Environme

51、nt Interactions,,,,,,,Hypothesis 1: High prevalence of atherosclerosis in westernized than native ChineseHypothesis 2: Genetic homogenity in main steam Chinese ethni

52、cHypothesis 3: Gene-environmental interaction atherogenesis in modernizing communities,#,,#,*,@,Adpated from Pepine CJ Am J Cardiol 1998;82(10A):23S-27S.,Centre for

53、 Atherosclerosis Studies,The founding members of the Centre are:Hong KongDept of Medicine & TherapeuticsThmoas YK Chan, Professor Kam Sang Woo, Professor (Director of the Gregory Cheng, Associate Professor C

54、entre)John E Sanderson, Professor (Julian AJH Critchley, Professor) Ping Chook, Research FellowDept of BiochemistryKwok Pui Fung, ProfessorDept of Chemical PathologyChris WK Lam, Professor & Chairm

55、anSchool of Public HealthJean LF Woo, Professor & DirectorDept of Diagnostic Radiology & Organ-ImagingCon Metreweli, Professor Dept of PaediatricsRita YT Sung, Associate ProfessorCentre for Clinical

56、Trials & Epidemiological ResearchJoseph TF Lau, DirectorDr Shirley XuMainland ChinaThe Chinese Academy of Medical Sciences, BeijingLi Sheung Liu, ProfessorThe Chinese Academy of Medical Sciences, Beijing G

57、uo Gan Wang, ProfessorThe Guangdong Provinicial Cardiovascular InstituteJian Zhang Feng, ProfessorYu County Cardiovascular InstituteGuo D.S.Tsinghua University Medical SchoolMing Zhe Chen, ProfessorOverseasUniv

58、ersity of Sydney (Royal Prince Alfred Hospital)David S Celermajer, ProfessorClay Street Medical Centre, San FranciscoShu Wing Chan, CardiologistUniversity of California, (Veterans Affairs Medical Centre)Edmund Keu

59、ng, Cardiologist,Acknowledgement,Research Collaborators,CUHKKS WooP ChookM QiaoJE SandersonJean LF WooCWK LamN ThomasSLY XuAlice CheungLindy ChanC MetreweliYK ChanTWC YipSK Kwong,U S ASW ChanE Keung,Mainl

60、andChinaZJ MaiWK LaiJZ FengZS ZhangLS LiuJX XieXH ZhangDS GuoGG WangXS Huang,The Royal Prince Alfred HospitalDS CelermajerJTC RobinsonS McMahomJA McCrohonMR AdamsB Bailey,Results,,Comparing Non-VEG with

61、VEG(mean age was 45?8 years),,Progress Time Table,,Difference in the Effect of Cigarette Smoking on Endothelial Function in Chinese and White AdultsKam S Woo, Jacqui TC Robinson, Ping Chook, Mark R Adams, Gabriel Yip,

62、 ZJ Mai, Chris WK Lam, Keld E Sorensen, John E Deanfield, David S Celermajer,,Young Chinese adults have less evidence of arterial endothelial dysfunction than young white adults with similar direct or indirect exposure t

63、o cigarette smoke.,,Chinese Adults Are Less Susceptible Than Whites to Age-Related Endothelial DysfunctionKam S Woo, Jane A McCrohon, Ping Chook, Mark R Adams, Jacqui TC Robinson, Robyn J McCredie, Christopher WK Lam,

64、Jian Z Feng, David S Celermajer,,Endothelium-dependent dilation (EDD) is similar in the arteries of healthy young Chinese and white adults. With older age, however, Chinese subjects are less susceptible to impaired endo

65、thelial function.,,P<0.001,,Westernization of Chinese Adults and Increased Subclinical AtherosclerosisKam S Woo, Ping Chook, Olli T Raitakari, Brendan McQuillan, Jiang Zheng Feng, David S Celermajer,Westernization o

66、f Chinese subjects is associated with greater susceptibility to the pro-atherogenic effects of traditional vascular risk factors, such as lipids and smoking, and with evidence of increased IMT as a marker of subclinical

67、atheroscleosis.,,The Impact of Heavy Passive Smoking on Arterial Endothelial Function in Modernized ChineseKam S Woo, Ping Chook, Hok C Leong, Xin S Huang, David S Celermajer,,In modernized Chinese, as in Caucasians, e

68、xposure to heavy environmental tobacco smoke causes arterial endothelial dysfunction, a key early event in atherosclerosis. This may have serious implications for cardiovascular health in China, currently in a process o