Lin Duo

Background: School-based screening is a critical strategy for detecting congenital heart disease (CHD) in resource-limited regions, yet single-round programs may miss a substantial number of treatable cases. The value of repeat screening in identifying these missed cases remains underexplored. Methods: As part of the Yunnan Provincial Comprehensive Plan for CHD Prevention and Control, we conducted two rounds of community-based CHD screening using cardiac auscultation followed by portable echocardiography in 23 counties. The first round (2017–2020) screened 1,024,998 children aged 3–18 years, and the second round (2021–2025) screened 1,059,156 children after intervals of 4, 5, 6, or 7 years. Children with CHD requiring treatment were identified and categorized by screening history. Results: The first screening detected 938 cases (prevalence: 0.92/1000), while the second screening detected 557 cases (prevalence: 0.53/1000). Of note, a significant proportion of cases identified in the second round represented missed diagnoses from the first screening. When comparing these missed cases (“previously covered”) to the true new cases identified in the second round (“newly covered”), the “newly covered” cases were younger and had lower odds of moderate or great anatomical complexity [adjusted odds ratio (OR) for moderate complexity: 0.58, 95% confidence interval (CI) = 0.36–0.92; adjusted OR for great complexity: 0.29, 95% CI = 0.11–0.71]. Conclusions: Repeat school-based screening identifies a distinct group of previously missed and newly covered CHD cases, many of which are of higher anatomical complexity and would otherwise remain undiagnosed. These findings underscore the necessity for periodic rescreening to mitigate diagnostic gaps and improve CHD outcomes in resource-limited populations.

(1) Aim: The incidence of high-altitude pulmonary hypertension (HAPH) has risen in recent years and is expected to continue increasing; however, its diagnosis remains challenging. In this study, we employed proteomics and metabolomics to identify the proteins and metabolic biomarkers that contribute to the development of HAPH. (2) Methods: We applied integrated proteomics and metabolomics to match blood samples from 40 HAPH patients and 40 healthy controls in Yunnan’s high-altitude regions to characterize molecular profiles, identify biomarkers, and develop a predictive model. (3) Results: Proteomic analysis identified four proteins (A2IPH7, K1C14, PSME2, SERPINE2) commonly dysregulated in HAPH patients from two high-altitude regions. SERPINE2 was notably downregulated and showed a negative correlation with clinical severity, which was further validated in HAPH rat lung tissues and supported by UK Biobank data for idiopathic PAH. Concurrent metabolomics uncovered 11 shared metabolites, largely acyl fatty acids, enriched in pathways such as unsaturated fatty acid synthesis. Integration of these multi-omics data enabled the development of a robust predictive model. (4) Conclusion: Our study identified key protein and metabolic biomarkers involved in HAPH development, which were validated in animal models. Based on these findings, a predictive model was developed, highlighting SERPINE2 and 11 metabolites as promising targets for the prediction and prevention of HAPH.

Background: Congenital heart disease (CHD) represents a major contributor to the global burden of childhood disease. However, its burden across diverse socioeconomic and healthcare contexts in Asia remains poorly understood. This study compared CHD prevalence and its associations with socioeconomic conditions and health service capacity among school-age children in Nepal and two Chinese provinces (Yunnan and Xinjiang). Method: Cross-sectional studies were conducted in Nepal to two provinces in China (Yunnan Province and Xinjiang Uygur Autonomous Region) from June 2024 and May 2025. CHD screening consisted of cardiac auscultation followed by echocardiography for suspected or previously diagnosed cases. Children’s CHD prevalence, socio-economic levels and health service capacity in three regions were compared. Ridge regression was performed at the district/county level to examine the association between socioeconomic and health service capacity factors and the risk of CHD. Results: A total of 429,204 school-age children were screened, identifying 1,771 children with CHD. Marked interregional differences in CHD prevalence were observed: Nepal exhibited the highest prevalence (5.99 per 1,000 children), followed by Xinjiang (4.51 per 1,000 children) and Yunnan (3.42 per 1,000 children). Substantial disparities in socioeconomic and healthcare indicators were also evident across regions. GDP per capita (USD) ranged from 1,378 in Nepal to 8,751 in Yunnan and 10,071 in Xinjiang, while hospital bed density (per 1,000 population) was 0.39 in Nepal compared to 7.70 and 7.60 in Yunnan and Xinjiang, respectively. Ridge regression analysis revealed that hospital bed density was significantly negatively correlated with CHD prevalence. Conclusion: Substantial differences in CHD prevalence, socioeconomic conditions, and health service capacity were observed across the three regions. Children’s CHD prevalence was associated with health service capacity, suggesting that greater access to health service capacity may correspond with lower CHD prevalence at the population level.

Congenital heart disease (CHD) is a leading cause of birth defect-related morbidity and mortality globally. While neonatal screening programs exist, the un

Background The burden of valvular heart disease (VHD) is rising rapidly globally, accompanied by substantial geographical disparities. Although altitude may influence cardiovascular system, no community-based studies have yet explored altitudinal differences in VHD epidemiology. Objective This study aims to investigate the prevalence, spectrum and aetiology of VHD in different altitude areas. Methods We conducted two sequential community-based echocardiography screening programmes in Yunnan Province of China and included 5059 eligible participants aged 35 years and older. The multivariable Poisson regression models with robust variance were performed to assess the association of different altitude groups with VHD and its subtypes. Results The prevalence of overall VHD, clinically significant VHD and clinically significant regurgitant VHD was 36.7%, 2.5% and 2.4%, respectively. After stratification by altitude, the prevalence of any VHD among participants in the Conclusions Adults living at high altitudes have a higher prevalence risk of VHD; significant altitudinal differences exist in the characteristics and aetiology of VHD. The findings could provide insights into primary prevention and early screening for VHD in low- and middle-income countries where a majority of the population lives at high altitudes.

Background: The relationship between different grades of compliance to antihypertensive medication and blood pressure (BP) control rate remains unclear. This study highlighted the Chinese Basic Public Health Service (BPHS) program upgraded antihypertension medication compliance to improve the blood pressure control rate contributing to the UN sustainable development goal of lowering chronic illness fatalities by one‐third by 2030. Methods: In 2015, 1254 hypertensive patients aged ≥ 35 years were selected in the baseline survey in Yunnan Province by a multistage stratified random sampling method and followed up from 2018 to 2022. Then, they were divided into three groups by tertiles as antihypertensive medicine compliance “poor,” “intermittent,” and “sustained” groups. Then, the robust variance Poisson regression models were performed to estimate the association between three groups and the number of referrals. Kaplan–Meier curves calculated the cumulative risk of onset and survival probability of cardiovascular events from three medication compliance groups. Results: A total of 1254 hypertension patients were included in the study; 992, 1218, 1121, 1066, and 999 hypertension patients were followed up annually. From the baseline to last follow‐up, systolic BP declined with the largest decrease in the sustained group (2015: 152.88 ± 21.64 mmHg vs. 2022: 134.61 ± 10.49 mmHg, p < 0.05) and the least decrease in the poor group (2015: 157.07 ± 15.37 mmHg vs. 2022: 140.33 ± 12.04 mmHg, p < 0.05). Under the management of BPHS, the BP control rate of all three groups increased significantly. Compared with the baseline, the control rate in the sustained group reached 70% in 2022 ( p < 0.01). The number of referrals from the poor group was 11.5%, higher compared with the sustained group (IRR = 1.115 and 95% CI: 1.043–1.193). The poor group also had the highest probability of cardiovascular disease (CVD). The survival probability in the sustained group was the highest and kept at 0.950 at the end of 5 years. Conclusions: High‐grade compliance to antihypertensive drugs significantly improves BP control rate and reduces the risk of CVD events and mortality. The decline of medication compliance grades is closely related to decreasing BP control rate and increased risk of CVD and mortality.

Available evidence falls short in assessing the risk of long-term outcomes among individuals with hypertension residing at various altitudes. We aimed to investigate the association between residential altitude and the risk of all-cause and cardiovascular disease (CVD) mortality among hypertensive patients. This cohort study encompassed 67,275 hypertensive patients aged ≥35 years who participated in China’s Basic Public Health Service Program in 2018. Participants were categorized into four groups based on their residence altitude: 2,500 m. The associations between residential altitude and the risks of all-cause and CVD mortality were analyzed using Cox proportional hazards regression models. The dose-response relationship was performed by the restricted cubic spline with multivariable adjusted models. Among the 67,275 hypertensive patients included in the study (mean age of 63.9 years, with 45.3% male), 8,768 deaths were recorded, of which 5,666 were attributed to CVD. Following multivariate adjustment, when compared to the group residing at altitudes < 500 m, the groups living at altitudes of 500-1,499 m, 1500-2,500 m, and > 2,500 m exhibited significantly risks of all-cause mortality [HR = 1.45 (95% CI: 1.36–1.54), 1.35 (95% CI: 1.28–1.43), and 1.41 (95% CI: 1.28–1.54), respectively] and CVD mortality [HR = 1.47 (95% CI: 1.35–1.58), 1.42 (95% CI: 1.33–1.52), and 1.46 (95% CI: 1.31–1.62), respectively]. The restricted cubic spline curves revealed a nonlinear relationship between residential altitude and all-cause and CVD mortality. The risk of mortality was higher among participants with poorly controlled blood pressure, aged 65 years and above, and living in rural areas. This study demonstrated a significant association between long-term residential high-altitude exposure and increased risks of all-cause and CVD mortality among hypertension patients. The implications of the findings call for a prioritization of public health resource allocation and early intervention efforts, especially for those living at high altitudes and in low-income areas where hypertension is prevalent.

Background: Available evidence falls short in assessing the risk of all-cause mortality and cardiovascular disease (CVD) mortality among individuals with hypertension residing at various altitudes. This study’s objective was to investigate the correlation between residential altitude and the rates of all-cause mortality and CVD mortality among hypertensive patients. Methods: This prospective cohort study encompassed 67,275 hypertensive individuals aged 35 years and above in the year 2018. Participants were categorized into four distinct groups based on their residence altitude: those living below 500 meters, between 500 and 1499 meters, 1500 to 2500 meters, and above 2500 meters. The study spanned a mean follow-up duration of 4.78 years. The associations between residential altitude and the risks of all-cause and CVD mortality were analyzed using Cox proportional hazards regression models. Results: Among the 67,275 hypertensive patients included in the study (mean age of 63.9 years, with 45.3% being male), 8,768 deaths were recorded, of which 5,666 were attributed to CVD. Following multivariate adjustment, when compared to the group residing at altitudes below 500 meters, the groups living at altitudes of 500-1499 meters, 1500-2500 meters, and above 2500 meters exhibited significantly elevated risks of all-cause mortality [hazard ratio, HR = 1.45 (95% CI: 1.36-1.54), 1.35 (95% CI: 1.36), and 1.41 (95% CI: 1.28-1.54), respectively] and CVD mortality [HR = 1.47 (95% CI: 1.35-1.58), 1.42 (95% CI: 1.33-1.52), and 1.46 (95% CI: 1.31-1.62), respectively]. For each 500-meter increment in altitude, the risk of all-cause and CVD mortality increased by 10% and 11%, respectively. Subgroup analyses and sensitivity assessments consistently supported this association. Conclusions: This study’s findings indicate a substantial connection between long-term residential high-altitude exposure and increased risks of all-cause mortality and CVD mortality among individuals with hypertension. Key messages: • Increased altitude of residence increases the risk of subsequent all-cause and CVD mortality in hypertensive patients. • This study highlights that relevant guidelines and healthcare providers should consider altitude as an important factor in reducing the burden of hypertension and CVD.

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Background: The Basic Public Health Service (BPHS), a recently announced free healthcare program, aims to combat the most prevalent Noncommunicable Disease-“Hypertension” (HTN)-and its risk factors on a nationwide scale. In China, there is a rife that HTN less impacts women during their lifetime. We, therefore, aimed to evaluate the sex disparity in hypertension patients with comorbidities among south-west Chinese and the contribution of BPHS to address that concern. Methods: We have opted for a multistage stratified random sampling method to enroll hypertensive patients of 35 years and older, divided them into BPHS and non-BPHS groups. We assessed the sex disparity in HTN patients with four major comorbidities- Dyslipidemia, Diabetes Mellitus (DM), Cardiovascular Disease (CVD), and Chronic Kidney Disease (CKD), and descriptive data were compiled. Odds ratios from logistic regression models estimated the effectiveness of BPHS in the management of HTN with comorbidities. Results: Among 1521 hypertensive patients,1011(66.5%) were managed in the BPHS group. The proportion of patients who had at least one comorbidity was 70.7% (95% confidence interval [CI]: 66.3-76.8%), patients aged 65 years and older were more likely to have coexisting comorbidities. Participants who received the BPHS showed significant blood pressure (BP) control with two comorbidities (odds ratio [OR] = 2.414, 95% CI: 1.276–4.570), three or more (OR = 5.500, 95%CI: 1.174–25.756). Patients with dyslipidemia and DM also benefited from BPHS in controlling BP (OR = 2.169, 95% CI: 1.430–3.289) and (OR = 2.785, 95%CI: 1.242–6.246), respectively. In certain high-income urban survey centers, there was sex differences in the HTN management provided by BPHS, with men having better BP control rates than women. Conclusions: Perhaps this is the first study in China to succinctly show the effectiveness and sex disparity regarding “management of hypertensive comorbidities”. This supports that the BPHS program plays a pivotal role in controlling BP, therefore should recommend the national healthcare system to give women a foremost priority in BPHS, especially to those from low-socioeconomic and low-scientific literacy regions.