Woo K S, Chook P, Raitakari O T, McQuillan B, Feng J Z, Celermajer D S
Department of Medicine and Chemical Pathology, Chinese University of Hong Kong (People's Republic of China).
Arterioscler Thromb Vasc Biol. 1999 Oct;19(10):2487-93. doi: 10.1161/01.atv.19.10.2487.
Cardiovascular event rates are much lower in China compared with developed countries. "Westernization" of diet and lifestyle in the Chinese, however, may lead to an increased prevalence of atherosclerosis-related diseases. Because carotid intima-media thickness (IMT) is a marker of subclinical atherosclerosis, we examined IMT and vascular risk profile in community-based groups of rural Chinese, Westernized urban Chinese, and urban whites. Mean IMT of the common carotid artery was measured in 348 healthy adults, aged 42+/-13 years (range 21 to 71 years); 116 subjects from rural China, 116 urban Chinese subjects living in Hong Kong or in Australia, and 116 urban Caucasians living in Australia. These 3 groups were matched for age, sex, and cigarette smoke exposure. Urban Chinese subjects had slightly better risk factor profile (higher HDL-cholesterol and lower blood pressure) compared with rural Chinese subjects. Despite this, however, the mean IMT was lowest in rural Chinese (0.50+/-0.10 mm), intermediate in urban Chinese (0.56+/-0.12 mm), and highest in urban whites (0.64+/-0.13 mm) (P<0.001 for comparisons between all groups). These differences in IMT were not altered after adjustment for the major traditional cardiovascular risk factors (serum lipids, smoking, and blood pressure or for body mass index). The influence of vascular risk factors on atherosclerosis between urban versus rural Chinese subjects was studied by multivariate regression models and by comparing the steepness of regression slopes between risk factors and IMT in the subject groups. The effects of smoking, HDL-cholesterol, and triglycerides on IMT were significantly greater in the urban compared with the rural Chinese (P<0.01). These data suggest that 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 of increased IMT as a marker of subclinical atherosclerosis.
与发达国家相比，中国的心血管事件发生率要低得多。然而，中国人饮食和生活方式的“西方化”可能会导致动脉粥样硬化相关疾病的患病率上升。由于颈动脉内膜中层厚度（IMT）是亚临床动脉粥样硬化的一个标志物，我们对中国农村社区人群、西化的中国城市人群和城市白人的IMT及血管风险状况进行了研究。对348名年龄在42±13岁（范围为21至71岁）的健康成年人测量了颈总动脉的平均IMT；其中116名来自中国农村，116名居住在香港或澳大利亚的中国城市受试者，以及116名居住在澳大利亚的城市白种人。这三组在年龄、性别和吸烟暴露方面相匹配。与中国农村受试者相比，中国城市受试者的危险因素状况略好（高密度脂蛋白胆固醇较高，血压较低）。然而，尽管如此，中国农村人群的平均IMT最低（0.50±0.10毫米），中国城市人群居中（0.56±0.12毫米），城市白人最高（0.64±0.13毫米）（所有组之间比较，P<0.001）。在对主要的传统心血管危险因素（血脂、吸烟和血压）或体重指数进行调整后，这些IMT差异并未改变。通过多变量回归模型以及比较各受试者组中危险因素与IMT之间回归斜率的陡度，研究了血管危险因素对中国城市与农村受试者动脉粥样硬化的影响。与中国农村人群相比，吸烟、高密度脂蛋白胆固醇和甘油三酯对IMT的影响在城市人群中显著更大（P<0.01）。这些数据表明，中国受试者的西方化与对传统血管危险因素（如血脂和吸烟）的促动脉粥样硬化作用更易感性相关，并有IMT增加作为亚临床动脉粥样硬化标志物的证据。
