© 1999 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Westernization of Chinese Adults and Increased Subclinical Atherosclerosis
From the Department of Medicine and Chemical Pathology, Chinese University of Hong Kong (People's Republic of China) (K.S.W., P.C.); the Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (O.T.R., D.S.C.); the Department of Clinical Physiology, University of Turku (Finland) (O.T.R.); the Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia (B.M.); Guangdong Provincial Cardiovascular Institute, Guangzhou, People's Republic of China (J.Z.F.); and the Department of Medicine, University of Sydney (Australia) (D.S.C.).
Correspondence to Dr David S. Celermajer, Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Sydney, Australia. E-mail davidc{at}card.rpa.cs.nsw.gov.au
Abstract—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.
Key Words: atherosclerosis • diet • Chinese • intima-media thickness
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