Advances in Systems Science and Applications (2012) Vol.12 No.2 194-206

Prevalence of Clustering for Current Smoking,
Current Drinking and Components of Metabolic
Syndrome among Adults of Lanxi, Heilongjiang,

China
Yuling Duan1, Jingbo Zhao2,Yujun Zhao3, Shiying Fu3, Fuman Wang2 and

Liting Yang2
1Harbin Center For Disease Control and Prevention, Harbin, Heilongjiang

Provence, 150056, China
2Department of Epidemiology, School of Public Health, Harbin Medical

University, Harbin 150081, China
3Department of Cardiology, First Clinical Medical College of Harbin Medical

University, Harbin 150086, China

Abstract

A total of 2967 participants were surveyed in a poor county of Heilongjiang by
a stratified randomized cluster sampling. Information on CVD risk factors was
collected with standardized questionnaires and Laboratory Measurements dur-
ing 2006 to 2007.Overall, 93.65%, 73.71%, 46.29%, 21.55% and 6.99% of rural
residents had ≥ 1,≥ 2,≥ 3,≥ 4 and ≥ 5 modifiable CVD risk factors (serum
triglycerides(TG), high density lipoprotein cholesterol(HDL-C), hypertension, di-
abetes, current smoking, current drinking and overweight. Both hypertension
prevalence and diabetes prevalence increased with age, but HDL-C prevalence
decreased with age among both men and women (each P for trend, < 0.001).
TG, current drinking and current smoking prevalence decreased with age (each
P for trend, < 0.05, except for overweight and MS, each P for trend, > 0.05)
Among men. While, TG, current drinking, current smoking and MS prevalence
increased with age (each P for trend, < 0.001) among women. In a multivariate
model including age and sex, the odds ratio (95% confidence interval [CI]) of
having ≥ 1,≥ 2,≥ 3,≥ 4, and ≥ 5 CVD risk factors versus none of the stud-
ied risk factors were 3.15(95%CI, 1.92-5.16), 3.73(95%CI, 2.27-6.13), 4.31(95%CI,
2.59-7.17), 5.24(95% CI, 3.04-9.03), and 9.29(95% CI, 4.78-18.06), respectively,
for Chinese adults 65 to 74 years old versus 35 to 44 years old; 1.77(95%CI, 1.28-
2.45), 1.98(95%CI, 1.42-2.74), 2.39(95%CI, 1.70-3.35), 2.40(95% CI, 1.66-3.74),
and 2.79(95% CI, 1.77-4.40), respectively, for men compared with women.
Keywords Smoking, Drinking, Metabolic Syndrome, Clustering, Prevalence

1 Introduction

The term “metabolic syndrome”(MS) refers to the clustering of visceral adiposity,
hyperglycemia, high blood pressure(BP) and dyslipidemia[1-2] ,associated with
increased risk of cardiovascular disease(CVD). Drinking and smoking are consid-



Advances in Systems Science and Applications (2012) Vol.12 No.2 195

ered as risk factors of CVD. CVD accounts for half of noncommunicable diseases
deaths worldwide, 16.7 million in 2002[3]. Nowadays, CVD are not exclusive in
developed countries. The majority of those deaths (≈ 9.1 million) occurred to
economically developing countries, and much of the burden of CVD in devel-
oping countries occurs to China[4-5]. Since the reform and opening-up in 1978,
infectious diseases has declined, but changes in lifestyle and diet have led to an in-
crease in life expectancy, a greatly increased frequency of CVD and other chronic
diseases[6-7] in China. Heilongjiang province located in the northeast of china.
Lanxi county is about 60 kilometers in the north of Harbin city, Heilongjiang.
Although at the beginning of opening-up and reform in China, Lanxis economy
was among poor counties of nation, and its economic is still lagging behind oth-
er developed regions, the income and lifestyle of residents have greatly changed
during recent decade. Although prevalence and risk factors of CVD in the devel-
oped country or developed population were paid much attention to, but little we
known about prevalence and risk factors of CVD in the poor population in the
rural. In order to provide important information and health education programs
to policy makers in economic poverty county of Heilongjiang province, it is im-
portant to quantify the proportion of the population at high risk for CVD. Such
data provide an understanding of the size of the population in need of targeted
interventions to lower the population burden of illness due to CVD. The goal of
this study was to quantify the proportion of adult residents in poor economic
county who had 1 or more of the following major modifiable CVD risk factors:
components of metabolic syndrome(which was defined by the International Di-
abetes Federation(IDF), including overweight, HDL-C, serum triglycerides(TC),
hypertension, diabetes),current smoking and current drinking, to determine the
percentage of adults with a clustering of 2 or more, 3 or more, 4 or more and 5
or more of these risk factors. This was completed with the use of data collected
from rural residents in Lanxi county of Heilongjiang province during 2006 to 2007.

2 Methods

2.1 Study Population

Multi-stage stratified sampling method was used to select a representative sam-
ple of the rural residents of Heilongjiang. In the first stage, Lanxi county was
selected as poor county, according to economic condition and residents income of
Lanxi during 1978 to 2006. secondly, each town was chosen from Lanxi county if
its economy was among middle, and then Pingshan was selected as its economy
was in the middle level of Lanxi county. Lastly, 11 villages were chosen by ran-
domized method from 35 villages of Pingshan. Total residents, who aged 35 year
and lived in the locate villages more than 5 years were considered as subject-
s, were 3480 persons. 3012 individuals completed the survey and examination,



196 Yuling Duan:Prevalence of Clustering for Current Smoking, Current Drinking and...

and others were excluded because of absence or denying to answer questions, as
well as exclusion criterion: type diabetes, fever, acute infection disease and other
factors which influenced measurement of blood pressure, blood glucose or blood
lipids. The response rate is 86.55%. At last, 2967 participants aged 35 to 74
(1324 males and 1643 females ) were used for analysis.

2.2 Data Collection

Data collection was conducted in examination centers at local health stations in
the participants residential area. In a few instances when participants were unable
to go to the examination center, the interview and examination were conducted
in their homes. During clinic or home visits, trained research staff administered a
standard questionnaire. Information on demographic characteristics include age,
gender, education, ethnicity, occupation, household income, cigarette smoking,
drinking, a self-reported history of stroke, myocardial infarction and congestive
heart failure, and the previous diagnosis and treatment of hypertension, high c-
holesterol, and diabetes. Smoking prevalence was calculated using data obtained
from the self report questionnaire. Current smoker is defined as a person who has
smoked cigarettes continuously or accumulatively for over 6 months during his or
her life and smoked at least once during the last month before the investigation[8].
current drinker was defined as a person who has drunk beer or wine or distilled
spirits at least once a week, apart from drinking in festivals and holidays[9].

2.3 Blood Pressure Measurement

For each participant, after 15 min of sitting, 3 blood pressure measurements were
obtained by a trained nurse using a standard sphygmomanometer, which proce-
dures recommended by the American Heart Association[10]. Before their blood
pressure measurement for at least 30 minutes, all subjects were advised to avoid
alcohol, cigarette smoking, coffee, tea, and excessive exercise. The mean value
of three blood pressure measurements was used for this study. Hypertension was
defined as an average systolic blood pressure (SBP) ≥ 140mm Hg and/or an
average diastolic blood pressure (DBP)≥ 90mm Hg and/or self-reported current
treatment for hypertension with antihypertensive medication[11-12].

2.4 Measurements of Weight, Height and Waist Circumstance

Body weight, height and waist circumstance were measured by trained and certi-
fied observers according to a standard protocol. Subjects wore light clothing and
no shoes. Weight was measured to the nearest 0.1kg by using calibrated balance
scales placed on a solid horizontal surface. Height was measured to the nearest
0.1cm with a Frankfort plane positioned at a 90◦ angle against a wall-mounted
metal tape by using calibrated stadiometer.



Advances in Systems Science and Applications (2012) Vol.12 No.2 197

BMI was calculated as weight divided by height squared (kg/m2). Waist cir-
cumference was taken at the midway point between the inferior margin of the
last rib and the crest of the ilium in a horizontal plane and measured to the
nearest 0.1 cm. Overweight was defined as having a waist circumference≥ 90 cm
(man),≥ 80cm (woman)[13].

2.5 Laboratory Measurements

Participants were asked to fast overnight before their study visit, and blood sam-
ples, to measure serum lipids and plasma glucose, were drawn by venipuncture.
Blood specimens were processed at the field center and then sent to a central clin-
ical laboratory of First Affiliated Hospital of Harbin Medical University in Harbin
by bus, where specimens were stored at -70◦C until laboratory assays were per-
formed. HDL-C and serum TC were analyzed enzymatically with commercially
available reagents[14]. Lipid measurements were standardized according to the
criteria of the Centers for Disease Control and Prevention-National Heart, Lung,
and Blood Institute Lipid Standardization Program[15]. Abnormal TC was de-
fined as TC ≥ 1.7 mmol/L. Abnormal HDL-C was defined as HDL-C < 0.91
mmol/L or self-reported current treatment with cholesterol-lowering medication.
For the glucose measurement, whole blood was collected in evacuated tubes con-
taining NaF. Plasma glucose was measured with a modified hexokinase enzymat-
ic method. Diabetes was defined as having a fasting plasma glucose level≥ 7.0
mmol/L and/or self-reported current treatment with antidiabetes medication (in-
sulin or oral hypoglycemic agents).

2.6 The IDF Consensus Worldwide Definition of The Metabolic Syndrome

According to the new IDF definition[13], for a person defined as having the
metabolic syndrome they must have Central obesity (defined as waist circum-
ference ≥ 90cm for Chinese men or ≥ 80cm for Chinese women) plus any two of
the following four factors: raised TG level: ≥ 1.7 mmol/L, or specific treatment
for this lipid abnormality, reduced HDL cholesterol: < 1.03 mmol/L in males and
< 1.29 mmol/L in females, or specific treatment for this lipid abnormality, raised
blood pressure: systolic BP ≥ 130 or diastolic BP ≥ 85 mm Hg, or treatment
of previously diagnosed hypertension, raised fasting plasma glucose (FPG) ≥ 5.6
mmol/L, or previously diagnosed type 2 diabetes, if above 5.6 mmol/L , OGTT
is strongly recommended but is not necessary to define presence of the syndrome.
In addition, Ethics committees of harbin medical university in china approved the
study. Written, informed consent was obtained from each participant before data
collection. Participants with untreated conditions, identified during the study,
were referred to their usual primary healthcare provider.



198 Yuling Duan:Prevalence of Clustering for Current Smoking, Current Drinking and...

2.7 Statistical Methods

Database was set up by EpiData 3.0, and all analyses were conducted with SAS
9.1.3. Analyses were conducted in these survey participants without a history
of myocardial infarction, stroke, or congestive heart failure. Crude rate were
standardized according to the age distribution for Chinese adults in the year
2000. Participants missing key variables measurements such as smoking, drink-
ing, height, weight, waist circumstances, HDL-C, TG, glucose, and blood pressure
were also excluded from the analyses, leaving a final study population of 2967.
The prevalence of each CVD risk factor (HDL-C, TC, hypertension, diabetes, cur-
rent smoking, current drinking and overweight, MS) was determined for men and
women separately, by age group (35 to 44, 45 to 54, 55 to 64, and 65 to 74 years),
all from rural residence. The prevalence of 0, 1, 2, 3, 4, and 5 CVD risk factors
was determined for the overall study population as well as for men and women
separately. Then, the percentage of the population with ≥ 1,≥ 2,≥ 3,≥ 4, and
≥ 5 CVD risk factors was determined by age group and sex separately. The sig-
nificance of the differences in the prevalence of ≥ 1,≥ 2,≥ 3,≥ 4, and ≥ 5 CVD
risk factors across subgroups was compared with the Wald-χ2 test. The adjusted
odds ratios(OR) and 95% confidence intervals (CI) of having ≥ 1,≥ 2,≥ 3,≥ 4,
and ≥ 5 major CVD risk factors versus no CVD risk factor were determined from
multivariable logistic-regression models that included age group and sex.

3 Results

3.1 Prevalence of CVD Risk Factors in Rural Residents in Heilongjiang

In the 11 villages of Lanxi county, population aged 35 to 74 years, the age s-
tandardized prevalence of HDL-C, TG, hypertension, diabetes, current drinking,
current smoking, overweight(WC≥ 90(man),≥ 80(woman)) and MS was 31.67%,
13.82 %, 39.26%, 6.49%, 24.65%, 41.81%, 32.86%, 19.84% respectively (Table 1).

Prevalence ± SE
∗HDL−C < 0.91mmol/L, serum TG ≥ 1.7 mmol/L, and/or current cholesterol-
lowering medication use.
†SBP ≥ 140mm Hg and/or DBP ≥ 90mm Hg and/or current antihypertensive
medication use. ‡Fasting plasma glucose ≥ 7.0mmol/L and/or current antidia-
betes medication use.
§overweight was defined as waist circumference (waist circumference ≥ 90(man),
≥ 80(woman)) SE indicates standard error.
Total SR indicates total standard rate, Standardized on the basis of the year 2000
age distribution of the Chinese population.

The age standardized prevalence of overweight, TG and MS was higher in
women than in men (each P < 0.001). While hypertension, diabetes, current



Advances in Systems Science and Applications (2012) Vol.12 No.2 199

Table 1 Age-Standardized Prevalence of CVD Risk Factors among Rural Study
Participants in Heilongjiang province

Population No TG∗ HDL∗ Hypertension† Diabetes‡ Current Current Overweight§ MS
Groups Drinking Smoking (90(man))

(80(woman))
Total SR 2967 31.67±0.85 13.82±0.63 39.26±0.90 6.49±0.45 24.65±0.79 41.81±0.91 32.86±0.86 19.84±0.73
Total 2967 32.69±0.86 13.38±0.63 41.32±0.90 6.81±0.46 25.45±0.80 42.67±0.91 33.50±0.87 20.63±0.74
Man
Overall 1324 31.80±1.28 14.34±0.96 43.96±1.36 6.90±0.70 53.22±1.37 53.59±1.37 21.06±1.12 14.17±0.96
SR 1324 31.34±1.27 13.52±0.94 48.04±1.37 7.48±0.72 53.32±1.37 53.10±1.37 20.77±1.11 14.12±0.96
Overall
Age, y
35- 321 31.78±2.60 17.45±2.11 25.86±2.44 4.67±1.18 52.02±2.79 53.89±2.78 21.81±2.30 14.02±1.94
45- 401 38.90±2.43 14.21±1.74 47.38±2.49 6.23±1.21 59.35±2.45 56.61±2.47 23.19±2.11 15.96±1.83
55- 331 29.31±2.50 10.88±1.71 56.19±2.73 9.37±1.60 56.50±2.72 54.08±2.74 21.15±2.24 14.20±1.92
65-74 271 22.14±2.52 11.07±1.91 65.31±2.89 10.33±1.85 42.07±3.00 45.76±3.03 15.50±2.20 11.44±1.93
Woman
Overall 1643 33.36±1.16 13.24±0.84 35.39±1.18 6.30±0.60 2.91±0.41 38.03±1.20 43.01±1.22 25.35±1.07
SR 1643 33.78±1.17 13.27±0.84 35.91±1.18 6.27±0.60 2.98±0.42 34.27±1.17 43.76±1.22 25.87±1.08
overall
Age, y
35- 524 20.80±1.77 17.18±1.65 19.47±1.73 2.86±0.73 1.15±0.47 24.05±1.87 34.16±2.07 15.27±1.57
45- 533 36.77±2.09 12.76±1.45 35.65±2.07 6.00±1.03 3.38±0.78 39.77±2.12 48.78±2.17 27.95±1.94
55- 376 40.96±2.54 12.23±1.69 46.81±2.57 7.71±1.38 3.46±0.94 36.44±2.48 48.67±2.58 33.51±2.41
65-74 210 45.71±3.44 6.67±1.72 58.10±3.40 12.86±2.31 5.71±1.60 41.90±3.40 46.19±3.44 35.24±3.30

drinking and current smoking prevalence were higher in men than in women (each
P < 0.001). There were no significant difference on HDL-C prevalence between
woman and man(P > 0.05). Hypertension and diabetes prevalence increased
with age among both men and women (each P for trend, < 0.001). Among men,
TG, HDL-C, current drinking and current smoking prevalence decreased with age
(each P for trend, < 0.05). Among women, HDL-C prevalence decreased with age
(P < 0.001). While, TG, current drinking, current smoking and MS prevalence
increases with age(each P for trend, < 0.001).

3.2 Prevalence of ≥ 1,≥ 2, and ≥ 3 CVD Risk Factors in Rural Residents in Hei-
longjiang

Overall, 4.32% of rural men and 7.98% of rural women, respectively, did not have
any of the risk factors investigated(TG, HDL-C, hypertension, diabetes, current
drinking, current smoking and, overweight; (Figure 1 and Table 2). CVD risk
factors: current smoking, current drinking and component of metabolic syndrome
(TG, HDL-C, hypertension, diabetes, overweight)

In contrast, 17.07%, 25.95%, 27.47%, 15.86%, and 9.33% of men and 22.11%,
28.75%, 22.53%, 13.52%, and 5.12% of women had 1, 2, 3, 4 and ≥ 5 of these
risk factors, respectively. Overall, 6.35%, 19.86%, 27.50%, 24.73%, 14.56%, and
6.99% of rural adults had 0, 1, 2, 3, 4 and 5 of these risk factors, respectively. In
total, 93.65% of the population had 1 or more CVD risk factors (Table 2). The
prevalence of ≥ 1,≥ 2,≥ 3,≥ 4, and ≥ 5 major modifiable CVD risk factors was
mainly higher at older ages (Table 3; each P < 0.001). Also, the age standardized
prevalence of ≥ 1,≥ 2,≥ 3,≥ 4, and ≥ 5 risk factors were higher among men
compared with women respectively (all P < 0.05)(Table 3 ).
Prevalence±SE; SE indicates standard error; Total SR indicates total standard



200 Yuling Duan:Prevalence of Clustering for Current Smoking, Current Drinking and...

Fig.1 Age-standardized prevalence of CVD risk factors among men and women
of poor county in Heilongjiang in China

Table 2 Standardized Prevalence of 0, 1 ,2 ,3 ,4 and ≥ 5 Risk Factors among
Total and Gender Rural Participants in Heilongjiang Province

0risk factors 1risk factors 2risk factors 3risk factors 4risk factors ≥ 5risk factors
N(%SE) N(%SE) N(%SE) N(%SE) N(%SE) N(%SE)

Age group
35- 102(12.07±1.12) 227(26.86±1.52) 225(26.63±1.52) 178(21.07±1.40) 85(10.06±1.03) 28(3.31±0.62)
45- 34(3.64±0.61) 172(18.44±1.27) 266(28.51±1.48) 234(25.08±1.42) 151(16.18±1.21) 76(8.15±0.90)
55- 32(4.55±0.78) 107(15.22±1.35) 192(27.31±1.68) 190(27.03±1.67) 130(18.49±1.46) 52(7.40±0.98)

65-74 20(4.18±0.91) 82(17.12±1.72) 131(27.35±2.04) 130(27.14±2.03) 65(13.57±1.56) 51(10.65±1.41)
Woman 137(7.98±0.67) 363(22.11±1.02) 472(28.75±1.11) 370(22.53±1.03) 222(13.52±0.84) 84(5.12±0.54)
Man 57(4.32±0.56) 225(17.07±1.03) 342(25.95±1.20) 362(27.47±1.23) 209(15.86±1.00) 123(9.33±0.80)
Total 188(6.35±0.45) 588(19.86±0.73) 814(27.50±0.82) 732(24.73±0.79) 431(14.56±0.65) 207(6.99±0.47)

Total SR 6.92±0.47 20.80±0.75 27.63±0.82 24.24±0.79 13.83±0.63 6.59±0.46

rate, Standardized on the basis of the year 2000 age distribution of the Chinese
population.
Prevalence±SE; N indicates number of participants with risk factors; % indicate
prevalence; SE indicates standard error

The adjusted odds ratio of having ≥ 1,≥ 2,≥ 3,≥ 4, and ≥ 5 major modifiable
CVD risk factors versus none decreased progressively with increasing age (Table
4). The adjusted odds ratios (95% CI) of ≥ 1,≥ 2,≥ 3,≥ 4, and ≥ 5 CVD risk
factors for persons 65 to 74 years of age compared with their counterparts 35 to
44 years of age were 2.43 (95% CI, 1.46 to 4.04), 2.96 (95% CI, 1.77 to 4.96), 3.78



Advances in Systems Science and Applications (2012) Vol.12 No.2 201

Table 3 Prevalence of 0,≥ 1,≥ 2,≥ 3,≥ 4, and ≥ 5 Risk Factors among Rural
Participants in Heilongjiang Province

0risk factors ≥ 1risk factors ≥ 2risk factors ≥ 3risk factors ≥ 4risk factors ≥ 5risk factors
N(%SE) N(%SE) N(%SE) N(%SE) N(%SE) N(%SE)

Age-group
35- 102(12.07±1.12) 743(87.93±1.12) 516(61.07±1.68) 291(34.44±1.63) 113(13.37±1.17) 28(3.31±0.62)
45- 34(3.64±0.61 899(94.36±0.61) 727(77.92±1.360) 461(49.41±1.64) 227(24.38±1.41) 76(8.15±0.90)
55- 32(4.55±0.78) 671(95.45±0.78) 564(80.23±1.50) 372(52.92±1.88) 182(25.89±1.65) 52(7.40±0.98)

65-74 20(4.18±0.91 ) 459(95.82±0.91) 377(78.71±1.87) 246(51.36±2.28) 116(24.22±1.96) 51(10.65±1.41)
Woman 131(7.98±0.67) 1511(92.02±0.67) 1148(69.91±1.13) 676(41.17±1.21) 306(18.64±0.96) 84(5.12±0.54)
Man 57(4.32±0.56) 1261(95.68±0.56) 1036(78.60±1.13) 694(52.66±1.37) 332(25.19±3.27) 123(9.33±0.80)
total 188(6.35±0.45) 2772(93.65±0.45) 2184(73.78±0.81) 1370(46.28±0.92) 638(21.55±0.75) 207(6.99±0.47)

(95% CI, 2.24 to 6.40), 4.62(95% CI, 2.62 to 8.15) and 7.39(95% CI,3.68 to 14.84),
respectively. In addition, after multivariable adjustment, men were more likely
to have ≥ 1,≥ 2, and ≥ 3 CVD risk factors compared with women, respectively
(all P < 0.001)(Table 4).

Table 4 Standardized Prevalence of 0, 1 ,2 ,3 ,4 and ≥ 5 Risk Factors among
Total and Gender Rural Participants in Heilongjiang Province

≥ 1risk factors ≥ 2risk factors ≥ 3risk factors ≥ 4risk factors ≥ 5risk factors
Age group

35- 1.00(ref) 1.00(ref) 1.00(ref) 1.00(ref) 1.00(ref)
45- 3.56(2.38-5.31) 4.19(2.80-6.29) 4.86(3.20-7.39) 5.85(3.71-79.23) 7.28(4.01-13.22)
55- 2.76(1.83-4.17) 3.41(2.25-5.17) 4.07(2.65-6.25) 5.07(3.17-8.10) 5.10(2.73-9.52)

65-74 2.43(1.46-4.04) 2.96(1.77-4.96) 3.78(2.24-6.40) 4.62(2.62-8.15) 7.39(3.68-14.84)
Male-gender 1.77(1.28-2.45) 1.98(1.42-2.74) 2.39(1.70-3.35) 2.40(1.66-3.47) 2.79(1.77-4.40)

∗All variables (age group, gender) were included in the same models. For exam-
ple, the odds ratios for age group were adjusted for gender, the odds ratios for
gender were adjusted for age group.
†Risk factors include components of metabolic syndromeoverweight, WC≥90
cm(man) or ≥80 cm(woman), HDL-C ≤0.91 mmol/L, TG≥1.7 mmol/L, or on
cholesterol-lowering medication, hypertension(SBP≥140 and/or DBP≥90 or on
high blood pressure medication), diabetes (fasting plasma glucose ≥7.0 mmol/L
or on antidiabetes medication), current smoking and current drinking.

4 Discussion

The metabolic syndrome is a common risk factor for cardiovascular diseases.
Individuals with this syndrome have an increased risk of developing cardiovascu-
lar disease(CVD)[16]. Sandra Costa Fuchs et al[17] revealed that hypertension,
diabetes mellitus, obesity, low fruit and vegetable intake, and lack of vigorous
or moderate physical activity were clustered into a combination of risk factors,
which were independently associated with self-reported cardiovascular disease.
A populationCbased, cross-sectional national health examination survey(1998)
of 8,816 subject aged 15-79 [18] showed that clustering of 3 or more CVD risk



202 Yuling Duan:Prevalence of Clustering for Current Smoking, Current Drinking and...

factors was 22.7% in man and 21.7% in women. Using < 21kg/m2 as a refer-
ent, subjects with BMI of 23kg/m2 and 27kg/m2 had an odds ratio of 3.5 and
10.2 in men, and 3.1 and 6.7 in women, respectively, for clustering of CVD risk
factors. Using <65 cm as a referent, subjects with WC of ≥90 cm in man and
≥80 cm in women had an odds ratio of 13.4 and 13.6, respectively, for clustering
of CVD risk factors. A study[19] explored how to influence effect of risk factors
on coronary artery disease(CAD) when the age gap between men and women
narrows, indicated that hypertension, diabetes, dyslipidemia and family history
were independent risk factors for women with stable CAD. Clustering of tradi-
tional risk factors may explain the precocity of CAD in women who are near in
age to men. A study from Souss, Tunisia[20] for clustering of cardiovascular risk
factors among obese urban school children showed that obese children were found
to have higher blood pressure, higher TG levels and lower HDL-C than children
of normal weight. This results indicated that clustering of cardiovascular risk
factors among obese is no longer limited to industrialized countries. Another s-
tudy from Japan[21] for multiple risk factors clustering and risk of hypertension,
which 5275 Japanese male office workers aged 23-59 years were involved, showed
that after controlling for potential risk factors of hypertension, the odds ratio of
hypertension compared with the absence of risk factors was 1.91, 2.65, 3.88, 6.54,
and 8.18 for the presence of 1, 2, 3, 4, and 5 risk factors, respectively ( each P
for trend < 0.001). The results indicated that the accumulation of risk factors is
highly associated with the increased risk of hypertension in Japanese men.

Multicentre collaborative study showed that high levels of CVD risk factors
are common in many economically developing countries[22]. In a study of 7 eco-
nomically developing countries, as many as 78%, 46%, 50%, and 20% of adults in
1 or more countries were current cigarette smokers, had a high cholesterol level,
were overweight, and had hypertension, respectively[22]. These risk factors have
emerged as important characteristics in predicting CVD morbidity and mortality
in economically developing countries, including China[23].

Result from international collaborative study of cardiovascular disease in Asi-
a[24] showed that 80.5%, 45.9%, and 17.2% of Chinese adults had ≥ 1,≥ 2, and
≥ 3 modifiable CVD risk factors (dyslipidemia, hypertension, diabetes, cigarette
smoking, and overweight), respectively. By comparison, 93.1%, 73.0%, and 35.9%
of US adults had ≥ 1,≥ 2, and ≥ 3 of these risk factors, respectively. In a mul-
tivariate model including age, sex, and area of residence, the odds ratio (95%
confidence interval [CI]) of having ≥ 1,≥ 2, and ≥ 3 CVD risk factors versus
none of the studied risk factors were 2.61 (2.09-3.27), 3.55 (2.77-4.54) and 4.97
(3.67-6.74), respectively, for Chinese adults 65 to 74 years old versus 35 to 44
years old; 3.65 (3.21-4.15), 4.67 (4.06-5.38), and 5.60 (4.70-6.67), respectively, for
men compared with women; 1.18 (1.07-1.30), 1.34 (1.21-1.50), and 1.84 (1.60-



Advances in Systems Science and Applications (2012) Vol.12 No.2 203

2.12), respectively, for urban compared with rural residents; and 1.98 (1.76-2.22),
2.75 (2.42-3.13), and 4.36 (3.68-5.18), for residents of northern compared with
southern China, respectively.

The present study indicates that 93.65% rural adults aged 35 to 74 years have
at least 1 of the following CVD risk factors: current smoking, current drinking
and component of syndrome (TG, HDL, hypertension, diabetes, and overweight).
In addition, clustering of 2 or more, 3 or more, 4 or more or 5 or more of these
risk factors was noted in 73.78%, 46.28%, 21.55% and 6.99 of rural adults, re-
spectively. The significantly higher prevalence of ≥ 1,≥ 2,≥ 3,≥ 4 and ≥ 5 risk
factors in men compared with women may be due to the fact that 43.96% of
rural men versus 35.39% of women were hypertension, 6.90% of rural men versus
6.30% of women were diabetes, 53.22% of rural men versus 2.91% of women were
current drinker and 53.59% of rural men versus 38.03% of women were current
smokers. Although the prevalence of current smoking and current drinking of
men was higher than those of women, the prevalence of current smoking and
current drinking decrease with age in man. In contrast, the prevalence of current
smoking and current drinking increase with age in woman. The prevalence of MS
in woman was higher than that in man.

In this study, we selected components of metabolic syndrome which is de-
fined by IDF, current smoking and current drinking to estimate prevalence of
cardiovascular disease. Indexes we selected were different from international col-
laborative study in Asia[24]. There were some reasons. Firstly, components of
MS are considered as risk factors of cardiovascular diseases, and prevalence of
MS increase with age. secondly, prevalence of CVD, which involved components
of metabolic syndrome, is limited. lastly, drinking should be considered as risk
factors of cardiovascular diseases in our clustering analysis.

This study contains the facts that its results are based on findings in 11vil-
lages, representative sample of the residents in the poor county, which allows
for calculation of rural representative estimates. Otherwise, standard protocols
and instruments were used, 86.55% response rate was achieved, and the trained
investigators were very careful to collect data.

This is a cross-sectional study, which assesses the prevalence of several CVD
risk factors. A limitation of the study was its reliance on estimates derived from
a cross-sectional study. Cross-sectional study has demonstrated the importance
of these risk factors to the development of CVD, but cross-sectional study do not
allow for quantification of the importance of risk factor clustering in the incidence
of CVD. Further design and statistics methods are needed[25-27].

In all, 93.65%, 73.78%, 46.28%, 21.55%, 6.99% have ≥ 1,≥ 2,≥ 3,≥ 4,≥ 5 of
the CVD risk factors investigated in the current study, respectively. It was noted
that hypertension and diabetes prevalence increased with age among both men



204 Yuling Duan:Prevalence of Clustering for Current Smoking, Current Drinking and...

and women (each P for trend, <0.001). At the same time, among women, cur-
rent drinking, current smoking and MS prevalence increases with age(each P for
trend, <0.001). Effective interventions for farmers such as improved diet, suit-
able drinking, smoking cessation and increased physical activity can safely and
effectively lower the risk of CVD[28-29]. Local government should take measure
to prevent, detect and treat metabolic syndrome, and improve lifestyle in order
to decrease the burden of CVD in the rural residents in the poor county.

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Corresponding author
Corresponding author:zhaojb168@sina.com,zyjddm@sohu.com