Yuhong Chen

Background: Metabolic diseases remain a fast‐growing global health burden. Besides other known factors, socioeconomic status (SES) has been recognized as a key determinant of metabolic health. This study aimed to investigate the association between SES and the prevalence of metabolic diseases in the Chinese population. Methods: We analyzed data from a nationwide community‐based cross‐sectional study in China. SES was derived to a composite score (range 0–3) using three indicators (educational attainment, living conditions, and marital status), with higher scores indicating better SES. Chronic diseases were diagnosed through biochemical testing and clinical assessments. Logistic regression models were applied to estimate associations between SES scores and metabolic diseases. Results: Among 201 532 participants, the lowest SES group had 87.1% higher odds of metabolic diseases than the highest SES group (odds ratio [OR] = 1.871, 95% confidence interval [CI]: 1.739, 2.016). One‐point decrease in SES score was associated with increased prevalence of hypertension (OR = 1.096, 95% CI: 1.080, 1.113) and obesity (OR = 1.112, 95% CI: 1.091, 1.134). In contrast, lower SES scores were linked to a reduced prevalence of dyslipidemia (OR = 0.931, 95% CI: 0.918, 0.945) and diabetes (OR = 0.974, 95% CI: 0.958, 0.990) after adjusting for covariates. We also observed that lower SES scores showed stronger associations with increased prevalence of obesity and hypertension in women but decreased risks of diabetes, dyslipidemia, and obesity in men. Conclusions: Lower SES was associated with a higher prevalence of hypertension and obesity but a lower prevalence of dyslipidemia and diabetes, with significant gender differences.

Aims: To investigate the associations of general and central obesity with premature mortality in a Chinese population. Materials and Methods: A total of 162 776 participants from the China Cardiometabolic Disease and Cancer Cohort Study were included in the current analysis. General and central obesity were assessed using body mass index ( BMI ) and waist‐to‐hip ratio ( WHR ), respectively. Premature mortality was defined as all‐cause mortality occurring before the age of 75 years, including cardiovascular disease ( CVD )‐related and non‐ CVD ‐related premature mortality. Cox proportional hazards models were used to estimate the hazard ratios ( HRs ) and 95% confidence intervals ( CIs ). Results: During a median follow‐up of 10.1 years, 5477 (3.36%) premature deaths were documented. Compared with normal weight (18.5 to 2 ), those with general obesity ( BMI ≥28 kg/m ² ) were associated with elevated risk of CVD ‐related premature mortality ( HR : 1.53; 95% CI : 1.30–1.82). Central obesity ( WHR ≥0.95 for men or ≥0.90 for women) was associated with increased risks of all‐cause ( HR : 1.20; 95% CI : 1.11–1.31), CVD ‐related ( HR : 1.51; 95% CI : 1.29–1.77) and non‐ CVD ‐related premature mortality ( HR : 1.11; 95% CI : 1.01–1.22). These associations persisted after mutual adjustment for BMI and WHR . A significant interaction between BMI and WHR on the risk of premature mortality was observed ( p for interaction = 0.028). Individuals with normal weight but central obesity exhibited the highest risk of all‐cause premature death ( HR : 1.21; 95% CI : 1.06–1.37), whereas the highest risk of CVD ‐related mortality was observed in those with both general and central obesity ( HR : 1.89; 95% CI : 1.50–2.39). Conclusions: The combination of normal weight and central obesity significantly increases premature mortality risk, emphasizing the importance of integrating WHR into obesity assessments to improve risk stratification and prevention strategies among Chinese adults.

Background: The effects of intensive blood pressure (BP) control on adverse kidney outcomes remain undetermined. Methods: This post hoc analysis included the Systolic Blood Pressure Intervention Trial (SPRINT) participants and the Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD‐BP) participants receiving standard glucose‐lowering treatment and satisfying SPRINT eligibility criteria. The risks of kidney events between intensive (systolic BP < 120 mmHg) and standard (systolic BP < 140 mmHg) controls in participants with or without baseline chronic kidney disease (CKD) were compared using Cox proportional hazards models. Results: A total of 10,946 participants (2724 with CKD and 8222 without CKD) were included. During the intervention and post‐intervention periods, the risk of renal failure was either reduced by intensive BP control in participants with CKD (HR = 0.46; 95% CI = 0.22–0.97) or was not significantly different between intensive and standard BP control in participants without CKD (HR = 0.88, 95% CI = 0.52–1.49; p _interaction = 0.128). The risk of ≥ 30% reduction in estimated glomerular filtration rate (eGFR) was increased and the risk of albuminuria was decreased by intensive BP control in participants with or without CKD. Intensive BP control increased the risk of CKD progression to moderate‐ or high‐risk category, but not to very‐high risk category according to the Kidney Disease Improving Global Outcomes (KDIGO) risk categories. Conclusions: The intensive BP control might increase the risk of mild CKD progression but not of more advanced CKD progression or renal failure compared with the standard BP control.

Background: The cardioprotective effects of glucagon‐like peptide‐1 receptor agonist (GLP‐1RA)‐based therapies in nondiabetic individuals with overweight or obesity remain underexplored. This meta‐analysis evaluates their impact on cardiovascular events and metabolic parameters in this population.Methods: A meta‐analysis was conducted using PubMed, Embase, Cochrane, and Web of Science databases from inception to June 18, 2024. Eligible studies were randomized controlled trials (RCTs) enrolling nondiabetic adults with overweight or obesity. These studies compared GLP‐1RA‐based therapies with placebo and reported cardiovascular events and metabolic parameters.Results: A total of 29 RCTs involving 9 GLP‐1RA‐based drugs and 37 348 eligible participants were included. Compared to placebo, GLP‐1RA‐based therapies significantly reduced the risk of total cardiovascular events (relative risk: 0.81, 95% confidence interval [CI]: [0.76, 0.87]), major adverse cardiovascular events (0.80, [0.72, 0.89]), myocardial infarction (0.72, [0.61, 0.85]), and all‐cause mortality (0.81, [0.71, 0.93]). No significant differences were observed in cardiovascular death or stroke. Additionally, GLP‐1RA‐based therapies were associated with significant reductions in some cardiometabolic parameters. Among GLP‐1RA‐based therapies, orfroglipron demonstrated strong benefits in reducing systolic blood pressure (mean difference: −7.10 mmHg, 95% CI: [−11.00, −2.70]). Tirzepatide induced the greatest reduction in body mass index (−6.50 kg/m², [−7.90, −5.10]) and hemoglobin A1c concentrations (−0.39%, [−0.52, −0.26]). Retatrutide and semaglutide were most effective in improving lipid profiles and reducing C‐reactive protein levels (−1.20 mg/dL, [−1.80, −0.63]), respectively.Conclusions: In nondiabetic individuals with overweight or obesity, GLP‐1RA‐based therapies significantly reduce cardiovascular events and improve cardiometabolic parameters. These findings underscore the potential for individualized GLP‐1RA‐based therapies targeting cardiovascular risk factors.

The cover image is based on the article Association of body roundness index with cardiovascular disease and all‐cause mortality among Chinese adults by Hong Lin et al., https://doi.org/10.1111/dom.16272 . image

Aims: To determine the impact of body roundness index (BRI) on the 10‐year risk of cardiovascular disease (CVD) and all‐cause mortality in Chinese adults. Materials and Methods: We utilized data from a nationwide prospective cohort of 165 785 Chinese adults (aged ≥40 years, free of CVD and cancer at baseline), which was extracted from the China Cardiometabolic Disease and Cancer Cohort (4C). Cox regression and restricted cubic splines quantified BRI‐outcome associations and identified optimal BRI cutoffs. Results: During a median follow‐up of 10.1 years, we documented 10 538 CVD events and 8679 deaths. A monotonic increasing dose–response association was observed between BRI and CVD risk, while BRI and all‐cause mortality exhibited a U‐shaped relationship ( p for non‐linear p p = 0.0097). Conclusions: Our findings indicate a positive association between BRI and CVD and a U‐shaped association between BRI and mortality. These findings underscore the importance of the BRI in assessing the risk of CVD and all‐cause mortality, particularly when considering different genders and age groups.

Aim: To explore the holistic impact of socioeconomic and mental health inequalities on the global burden of type 2 diabetes. Materials and Methods: This cross‐sectional study used data on the incidence, disability‐adjusted life years (DALYs), and mortality of type 2 diabetes as well as DALYs attributable to risk factors during 1990–2021 from the Global Burden of Disease Study 2021. Average annual percent change (AAPC) was applied to assess the temporal trends from 1990 to 2021. Countries were categorised according to levels of sociodemographic index (SDI) and prevalence of depressive disorders or anxiety disorders. Results: In 2021, the highest age‐standardised incidence rate (per 100 000 population) for type 2 diabetes was in countries with a higher prevalence of depressive or anxiety disorders (ranging from 466.35 to 517.08), wherein those with higher SDI experienced the fastest increase from 1990 to 2021 (AAPC ranging from 2.51% to 2.61%). The highest age‐standardised rates of DALY and mortality (per 100 000 population) for type 2 diabetes in 2021 were in countries with lower SDI, of which countries with a higher prevalence of depressive or anxiety disorders exhibited the greatest burden (ranging from 1714.38 to 2012.12 for DALY; from 48.66 to 51.91 for mortality). The attributable risk factors for DALYs of type 2 diabetes varied across countries with different SDI levels and prevalence of mental disorders. Conclusions: The results suggest that the imbalance of faster socioeconomic development but worse mental health underpins diabetes incidence, while slower socioeconomic development and worse mental health jointly contribute to the disability and mortality burdens of diabetes. It is imperative to promote mental health alongside economic and social development to address the public health challenge of type 2 diabetes.

Background: Sex differences in blood pressure (BP) levels and hypertension are important and the role of socioeconomic status (SES) in sex differences in hypertension remains unclear. Objective: This study aimed to evaluate the impact of SES on sex differences of hypertension in a nationally representative survey study. Methods: A total of 98,658 participants aged ≥18 years who have lived in their current residence for ≥6 months were recruited from 162 study sites across mainland China. Sex was self-reported. Individual-level SES included the highest level of education and annual household income. Area-level SES included economic development status, urban/rural residency, and north/south location. Outcomes included levels of systolic and diastolic BP, and hypertension. Linear and Cox regression models were used to examine the associations between sex (women vs men) and BP characteristics stratified by individual or combined SES indicators. Results: Systolic and diastolic BP levels and the prevalence of hypertension were higher in men than in women. This sex difference was found across categories of SES with widened sex disparities in participants having more favorable SES. Significant multiplicative interaction effects of SES on the association of sex with BP characteristics were found. Women with improving SES were associated with lower BP and hypertension prevalence compared to men. For combined SES, a 9% (prevalence ratio 0.91, 95% CI 0.83-0.98) and a 30% lower probability (prevalence ratio 0.70, 95% CI 0.63-0.78) of having hypertension were found in women with an overall intermediate SES and high SES, respectively, compared to those with low SES, while no significant reduction was found in men. Conclusions: There are significant sex differences in BP characteristics and SES has a potent impact on the disparities. Sex-specific public health policies to alleviate socioeconomic inequalities, especially in women are important for the prevention of hypertension.

Background: An updated definition was developed to better evaluate cardiovascular health (CVH). We aimed to investigate whether optimal or improvement of six CVH metrics defined by new Life's Essential 8 (LE8) may counteract the risk of subclinical atherosclerosis among patients with hyperglycemia.Methods: We conducted a prospective analysis of 5225 participants without prior cardiovascular diseases, of whom 4768 had complete data on CVH change. Subjects with CVH scores of 0–49, 50–79, and 80–100 points were categorized as having low, moderate, or high CVH, respectively. Subclinical atherosclerosis was evaluated by brachial‐ankle pulse wave velocity, pulse pressure and albuminuria, both separately and in combination.Results: Of the 5225 participants, 1937 (37.1%) had normal glucose regulation, while 3288 (62.9%) had hyperglycemia. The multivariable‐adjusted odds ratio (OR) for composite subclinical atherosclerosis was 2.34 (95% confidence interval [CI], 1.88–2.91), 1.43 (95% CI, 1.21–1.70), and 0.74 (95% CI, 0.46–1.18), for participants with hyperglycemia who had low, moderate, or high overall CVH scores, respectively, compared with participants with normal glucose regulation. In addition, compared with those with stable CVH and normal glucose regulation, participants who exhibited greater improvements in overall CVH from 2010 to 2014 had a reduced risk of composite subclinical atherosclerosis with an OR of 0.72 (95% CI, 0.53–0.98) for those with normal glucose regulation, and 1.13 (95% CI, 0.87–1.48) for those with hyperglycemia.Conclusions: The novel defined CVH using six metrics was inversely associated with subsequent risk of subclinical atherosclerosis. Both the status of CVH and its changes modified the relationship between hyperglycemia and subclinical atherosclerosis. image