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1、Atherosclerotic Risk Factors in Modernizing China 当今我国动脉血管硬化的危险因素,Prof Woo Kam Sang and Fung Kwok Pui Department of Biochemistry The Chinese University of Hong Kong 香港中文大学生物化学系 胡锦生教授，冯国培教授,Chinese Atherosclerosis Study in the Aged and Young,CATHAY Study,Pan Yu, Hong Kong, Macau, Sydney, San Francisc
2、o, Shanxi, Three Gorges,2617 asymptomatic subjects,Age: 18-70 yrs,Vascular Epidemiology,Adpated from Pepine CJ Am J Cardiol 1998;82(10A):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,Auto CCA,M
3、anual RCCA,Manual LCCA,Carotid intima-media thickening as surrogate atherosclerosis marker: Is it relevant to the Asian?,Westernization of Chinese Adults and Increased Subclinical Atherosclerosis Kam S Woo, Ping Chook, Olli T Raitakari, Brendan McQuillan, Jiang Zheng Feng, David S Celermajer,Western
4、ization 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 atheroscleosis.,Effects of HDL Cholesterol on Carotid IMT,WC,NC,Subclin
5、ical Atherosclerosis in the Chinese (Carotid Intima-Media Thickening),(* Age mean 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,(p0.001),(p0.02),(p0.001),(p0.001),Mean Daily Intake ml or g/1000 Kcal,*p-value: Pan Yu
6、 vs others,(0.490.09)*,(0.560.13)*,(0.590.15)*,(0.680.15)*,Karaseks Job Demand-Control-Support model For work environment where stressors are chronic, not initially life threatening. Job demand (7 items) Decision latitude (Job control) (9 items) Job support (19 items) Shift work Change boss Part-tim
7、e job Education,Psychological factors,Odds Ratio From Stepwise Logistic Regression Analysis 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 Years) o
8、n Carotid IMT,WC,NC,Heavy Tobacco Smoke Pollution is Associated with Higher Atherosclerosis Risk Yip TWC, Chook P, Feng XH, Chiu ML, Poon WH, Evora ML, Koon KV, Chan YK, Leong HC, Chu CL, Woo KS ,On multiple regression, carotid IMT was associated with age and passive smoking, independent of blood pr
9、essures, blood cholesterol and glucose (R2=0.5; F value 3.6; p0.05).,Brachial FMD and Carotid IMT (Casino Employees vs CATHAY Controls),(n=59),(n=100),(n=59),(n=100),CAHTAY Cohort:Homocysteine,Cathay Study Result,*,*,We hypothesise hyperhomocysteinaemia contributes to atherogenesis process beyond th
10、e lipid effect - two unique (low blood lipid) and novel clinical models of hyperhomocysteinaemia :,Hong Kong Voluntary vegan-vegetarian,Northern rural Chinese Obligatory vegetarian,Results,On multiple regression analysis, homocysteine and blood pressure were associated with increased carotid IMT (pa
11、rtial R=0.59; F-value=6.0; p0.0001), independent of WHR and LDL-C.,6.311.79,6.341.44,6.881.90,7.371.71,*,*,* P0.05 * P0.01 * P0.001 (n=41),Change in FMD during the B12 Supplementation in Vegetarians,Baseline Placebo B12 B12 3 mth DB 6mth open label,(16.8%),0.690.09,0.680.09,0.670.09,0.650.09,*,*,* P
12、0.05, * P0.01, *P0.001 (n=41),Change in IMT during the B12 Supplementation in Vegetarians,Baseline Placebo B12 B12 3 mth DB 6mth open label,*,*,*,(5.7%),Yu County,* p0.001, Log-transferred data,The clinical characteristics of study subjects,Risk Factors for Carotid Atherosclerosis,FMD increased sign
13、ificantly at 6 months after the 3 active treatment but not after placebo.,B12 and FA Supplementation in Yu County,Mean FMD (%),Placebo (n=53),B12 (n=52),Folate (n=51),B12+Folate (n=51),Baseline,DB 6mths,OL 12mths,P0.0001,P0.0001,P0.0001,P0.0001,P0.0001,P0.0001,P0.0001,P=0.001,P0.0001,P0.0001,Three G
14、orges 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 Chongqing University of Medical Sciences, Chongqing The Chinese University of Hong Kong, Hong K
15、ong Chongqing Center for Disease Control and Prevention, Chonqing Wu Shan Center for Disease Control 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,Clini
16、cal Features 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,P0.001,Conclusion:,Sedentary lifestyle changes in Yangtze river Three-Gorges territories are associated with acc
17、elerated atherogenic process, with great implications in atherosclerosis prevention in China, now in fast modernization process.,Effects of Diet and Exercise on Obesity-Related Vascular Dysfunction in Children,Effects of Diet and Exercise on Obesity-Related Vascular Dysfunction in Children,P0.001,De
18、training after 6 weeks,Continued training,P0.001,Carotid IMT in Dietary / Exercise Intervention-1 year Result,Genes,External,Environment,Internal,Environment,Endothelial,Intima-Media,Dysfunction,Thickening,Atherosclerotic,Disease,Dietary Habits:,Green Tea,Vegetables,Carotene,Folate,Animal Protein,Fi
19、sh, Fat or,Dairy Product,Life-style:,Exercise,Smoking,Alcohol Psychological Stress,Blood glucose/Insulin,Lipid Disorders,LDL-Chol Oxidizability,Antioxidants,Folate,Homocysteine,Fibrinogen/Thrombotic,Factors,Hypertension,Obesity,VCAM,SUB-CLINICAL,CLINICAL, ATHEROSCLEROSIS ,*,Gene-Environment Interact
20、ions,Hypothesis 1: High prevalence of atherosclerosis in westernized than native Chinese Hypothesis 2: Genetic homogenity in main steam Chinese ethnic Hypothesis 3: Gene-environmental interaction atherogenesis in modernizing communities,#,#,*,Adpated from Pepine CJ Am J Cardiol 1998;82(10A):23S-27S.
21、,Chinese Breakfast,Breakfast Western Style,Left upper: Steamed Grass Carp with Tofu in 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: Soy Bean Milk Left lower: Scrambled
22、 Eggs with Scallions Right lower: Braised Mixed Soy Products with Gluten,Left: Pizza Right: Macaroni and Cheese with Ham,Right: Minced Beef with Potatoes Left: Stir-fried Beef Slices with Chinese Broccoli,Left lower: Sirloin Steak Dinner Right upper: Spahgetti in Meat Ball Sauce with Cheese Middle:
23、Hamburger and French Fries,Changing Dietary Patterns and Subclinical Atherosclerosis in Chinese Americans: The Impact of Prolonged and Early Acculturization,KS Woo1 SW Chan2 P Chook1 RKL Ip1 JLF Woo1 DS Celermajer3,The Chinese University of Hong Kong, PR China1 The Chinese Hospital, San Francisco, U
24、SA2 The University of Sydney, NSW, Australia3,Changing Dietary Patterns & Subclinical Atherosclerosis in Chinese Americans: The Impact of Prolonged Acculturization,*p0.05; *p0.001,Changing Dietary Patterns & Subclinical Atherosclerosis in Chinese Americans: The Impact of Early Acculturization,*p0.05
25、; *p0.01; *p0.001,Atherosclerosis & Endothelial Dysfunction,ED: A precussor of atherosclerosis ED: A marker of early atherosclerosis,Smoking Cholesterol Hypertension Diabetes Obesity,Endothelial Dysfunction,Atherosclerosis,Lower LDL cholesterol Dietary antioxidant (soy protein, green tea, plant phyt
26、oestrogen) Genetic / environmental factor,Vessel tone,Vessel growth,Endothelial cells,Smooth muscle cells,tPA PAI-1,CAMs,PGI2 NO,NO ET-1 VEGF MCP-1,Coagulation Fibrinolysis Monocyte Platelet interaction adhesion,Function of Endothelium (weight =1.5kg),DILATATION,Endothelium,Shear Stress,EDRF (NO),GT
27、N,Smooth Muscle,Brachial Artery Scans,High resolution external vascular ultrasound Brachial artery diameter measured following hyperemia and GTN spray Tests endothelium-dependent and independent dilatation,10 mins rest,4.5 mins cuff inflation,15 mins rest,3 mins,Scan B2,Scan B3,Scan B4,Scan B1,GTN,C
28、uff release,Flow - 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 Prevention in China,SK Kwong1, P Chook2, TWC Yip3, YJ Hu4, XS Huang5, GG W
29、ang6, MJ Wu4, YM Liu7, WK Lam2, DS Celermajer8, KS Woo2 Alice Ho Miu Ling Nethersole Hospital1, The Chinese University of Hong Kong2, Yan Chai Hospital3, Chongqing University of Medical Science4, Guangdong Provincial Cardiovascular Institute5, Fu Wai Hospital6, Sun Yat San University Second Affiliat
30、ed Hospital7, The University of Sydney8,Possible Contributory Factors,Reduced physical activities (job and lifestyle) Dietary changes Sociopsychological stress Metabolic syndrome,These will be further analysed, and effect of early health-education intervention assessed,Changes in laser-Doppler cutan
31、eous 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 Bean Paste,(left lower),Dace Fish Balls with Chinese Lettuce,(right),Braised Fish with Sweet Be
32、an Sheets and Winter Melon,(left),Fish Cutlet,(right),Pan-fried Fish Steak,(left upper),Soya Bean Milk,(left lower),Scrambled 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,In
33、ternal,Environment,Endothelial,Intima-Media,Dysfunction,Thickening,Atherosclerotic,Disease,Dietary Habits:,Green Tea,Vegetables,Carotene,Folate,Animal Protein,Fish, Fat or,Dairy Product,Life-style:,Exercise,Smoking,Alcohol Psychological Stress,Blood glucose/Insulin,Lipid Disorders,LDL-Chol Oxidizabi
34、lity,Antioxidants,Folate,Homocysteine,Fibrinogen/Thrombotic,Factors,Hypertension,Obesity,VCAM,SUB-CLINICAL,CLINICAL, ATHEROSCLEROSIS ,*,Gene-Environment Interactions,Hypothesis 1: High prevalence of atherosclerosis in westernized than native Chinese Hypothesis 2: Genetic homogenity in main steam Chi
35、nese ethnic Hypothesis 3: Gene-environmental interaction atherogenesis in modernizing communities,#,#,*,Adpated from Pepine CJ Am J Cardiol 1998;82(10A):23S-27S.,Centre for Atherosclerosis Studies,The founding members of the Centre are: Hong Kong Dept of Medicine & Therapeutics Thmoas YK Chan, Profe
36、ssor Kam Sang Woo, Professor (Director of the Gregory Cheng, Associate Professor Centre) John E Sanderson, Professor (Julian AJH Critchley, Professor) Ping Chook, Research Fellow Dept of Biochemistry Kwok Pui Fung, Professor Dept of Chemical Pathology Chris WK Lam, Professor & Chairman School of Pub
37、lic Health Jean LF Woo, Professor & Director Dept of Diagnostic Radiology & Organ-Imaging Con Metreweli, Professor Dept of Paediatrics Rita YT Sung, Associate Professor Centre for Clinical Trials & Epidemiological Research Joseph TF Lau, Director Dr Shirley Xu Mainland China The Chinese Academy of M
38、edical Sciences, Beijing Li Sheung Liu, Professor The Chinese Academy of Medical Sciences, Beijing Guo Gan Wang, Professor The Guangdong Provinicial Cardiovascular Institute Jian Zhang Feng, Professor Yu County Cardiovascular Institute Guo D.S. Tsinghua University Medical School Ming Zhe Chen, Profe
39、ssor Overseas University of Sydney (Royal Prince Alfred Hospital) David S Celermajer, Professor Clay Street Medical Centre, San Francisco Shu Wing Chan, Cardiologist University of California, (Veterans Affairs Medical Centre) Edmund Keung, Cardiologist,Acknowledgement,Research Collaborators,CUHK KS
40、Woo P Chook M Qiao JE Sanderson Jean LF Woo CWK Lam N Thomas SLY Xu Alice Cheung Lindy Chan C Metreweli YK Chan TWC Yip SK Kwong,U S A SW Chan E Keung,Mainland China ZJ Mai WK Lai JZ Feng ZS Zhang LS Liu JX Xie XH Zhang DS Guo GG Wang XS Huang,The Royal Prince Alfred Hospital DS Celermajer JTC Robin
41、son S McMahom JA McCrohon MR Adams B Bailey,Results,Comparing Non-VEG with VEG (mean age was 458 years),Progress Time Table,Difference in the Effect of Cigarette Smoking on Endothelial Function in Chinese and White Adults Kam S Woo, Jacqui TC Robinson, Ping Chook, Mark R Adams, Gabriel Yip, ZJ Mai,
42、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 to cigarette smoke.,Chinese Adults Are Less Susceptible Than Whites to Age-Related Endothel
43、ial Dysfunction Kam S Woo, Jane A McCrohon, Ping Chook, Mark R Adams, Jacqui TC Robinson, Robyn J McCredie, Christopher WK Lam, 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
44、subjects are less susceptible to impaired endothelial function.,P0.001,Westernization of Chinese Adults and Increased Subclinical Atherosclerosis Kam S Woo, Ping Chook, Olli T Raitakari, Brendan McQuillan, Jiang Zheng Feng, David S Celermajer,Westernization of Chinese subjects is associated with gre
45、ater 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 atheroscleosis.,The Impact of Heavy Passive Smoking on Arterial Endothelial Function in Modernized Chinese Kam S Woo, Pin
46、g Chook, Hok C Leong, Xin S Huang, David S Celermajer,In modernized Chinese, as in Caucasians, exposure 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
47、 in a process of rapid modernization.,P0.01,NS,CATHAY Cohort:Age,Cathay Study Result,CATHAY Cohort:Total Cholesterol,Cathay Study Result,*,*,CATHAY Cohort:Total Triglyceride,Cathay Study Result,*,*,CATHAY Cohort:HDL-Cholesterol,Cathay Study Result,*,CATHAY Cohort:LDL-Cholesterol,Cathay Study Result,
48、*,*,CATHAY Cohort:Glucose,Cathay Study Result,CATHAY Cohort:Folate,Cathay Study Result,*,*,CATHAY Cohort:Vitamin B12,Cathay Study Result,*,*,CATHAY Cohort:Flow Mediated Dilatation,Cathay Study Result,*,*,Vitamin B12 Supplementation Improves Atherogenic Process in Vegetarians,Lucia WY Tam, Ping Chook, Timothy CY Kwok, Mu Qiao, Peter YK Poon, Jean LF Woo, DS Celermajer, KS Woo Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China Department of Cardiology, T