1. BASIC analysis of --- Stress/overwork and cardiovascular disease data Sino-Japanese cooperation project ---------by Mile Xiu

2. Background about this project Supported by Japanese ministry of health fund Project implementation: Medicine school of Tongji university, Shanghai China Setting: Shanghai East Hospital and Shanghai Tenth People’s Hospital Physical examination center.

3. Experimental design We focus on the relationship between work stress and cardiovascular disease. Work stress is assessed by Job demand control scale. Cardiovascular risk factors and the ankle-brachial index(ABI) and Brachial–ankle pulse wave velocity (baPWV) is also collected Participants: 3,000 Chinese people and 100 Japanese people work in Shanghai rolled in our research Inclusion criteria: Cooperate with the investigation;≥18 years old; blood and urine sample left. Exclusion criteria: Do not finish our questionnaire ;<18 years old; blood or urine sample missed

4. Protocol Blood and urine will be left for experimental test Anthropometric will be finished Baseline, questionnaire and ABI, baPWV will be finished Copy test result of blood and urine

5. Ｗ WORK HOURS DECISION LATITUDE SOCIAL SUPPORT JOB DEMAND JOB STRENGTH ＳＰＹＳＰＹ waist ＳＹＳＹ SBP PP HR LDL HDL U UA HbA1c Ｐ PWV Albumin Us smoking Working condition Cardiovascular risk Organ damage e1e1 e15e15 e16e16 e2e2 e3e3 e4e4 e5e5 e6e6 e7e7 e8e8 e9e9 e 10 e 11 e 12 e 13 e 14

6. Baseline Basic information: Name, gender, birthday, occupational type,educational level, marital status, address, phone number. Anthropometric: height; body weight, abdominal circumference, blood pressure, heart rate. Family history: focus on cardiovascular-related family history Personal history: smoke(no/post/yes), alcohol intake(yes/no), Fatty liver(mild/moderate or heavier/no), exercise situation Drug therapy: Antihypertensive drug, Antidiabetic drugs Antilipemic drugs, Aspirin.

7. Blood and urine laboratory Total cholesterol(TC); Triglyceride(TG); High-density lipoprotein cholesterol (HDL-C); Low-density lipoprotein cholesterol (LDL-C) Fasting blood; Glycosylated Hemoglobin A_(1C)(HbA1c%). Alanine aminotransferase (ALT);Aspartate aminotransferase (AST);r-GTP Uric acid, Urea nitrogen, Total protein, Albumin, Urinary protein Vascular screening: ABI and baPWV

8. Work stress scale Work time per week( 55);sleep time and clock in weekday; walk time everyday (none; in 1 hour;1- 2 hours; >hours); diet type(Never eating too much from youth; can't eat too full due to the health concerns; Eating too much or eating too little; Eating full) Desicion latitude: The higher the score the greater the power Social support: The higher the score the lower the support Job demand: The higher the score the lower the required degree. Job strength: The higher the score the lower the work strength.

9. Traditional CVD risk factors Blood pressure ≥ 140/90 mm Hg and/or hypertension history Diabetes mellitus fasting glucose ≥ 7.0 mmol/L and/or diabetes mellitus history (HbA1c ≥6.5%??) Hyperlipidemia total cholesterol ≥ 5.72 mmol/L, and/or total triglyceride ≥1.7 mmol/L, and/or low-density lipoprotein ≥ 3.64 mmol/L, and/or Hyperlipidemia history. Body mass index (BMI) normal(≤24), overweight (>24 and <28), and obesity (≥28) Smoke Alchol intake

10. Data analysis Soft ware : SPSS version17.0 chi-square test or t test Logistic regression

12. Description by gender CharacteristicAll 2504 Mean SD Male 1582 Mean SD Female 922 Mean SD P value Gender25041579(63.2)922(36.8)<0.001 Age46.147.5(11.4)43.7(16.2)0.005 Education Lower than senior high school;259(10.5)151108 0.124 Senior high school;599(24.2)366233 Bachelor1455(58.9)945510 Master OR higher158(6.4)10157 Marital status Unmarried16974(4.7%)95(10.5%) <0.001 Married22681475(94.7%)793(87.7%) Divorced84(0.3%)4(0.4%) Widowed175(0.3%)12(1.3%) Height167.4(7.98)171.4(6.4)160(5.3)<0.001 Body weight67.7(16.5)72.7(10.6)59.1(20.7)<0.001 BMI24.08(5.96)24.77(4.25)22.89(7.97)<0.001 Abdominal circumference85.02(11.16)88.8(8.96)77.38(11.28)<0.001 SBP126.1(17.6)129.2(16.3)120.9(18.6)<0.001 DBP78.0(11.7)80.0(11.0)73.3(11.2)<0.001 PP48.2(11.2)48.4(10.6)47.7(12.0)0.127 Heart rate73.7(10.9)73.3(10.7)74.2(11.2)0.063 Smoke history Non-smoker1638(65.7%)740(47%)898(97.9%) <0.001 Post-smoker126(5.1%)123(7.8%)3(0.3%) Smoker729(29.2%)713(45.2)16(1.7) History of alcohol intake Non-drinker1682(67.5%)805(51.1%)877(95.8%) <0.001 Post-drinker58(2.3%)57(3.6%)1(0.1%) Drinker751(30.1%)714(45.3%)37(4.0%) Adiposis hepatica situation none1612(64.8%)863(53.5%)749(81.4%) <0.001 mild665(26.7%)541(34.5%)124(13.5%) Moderate or heavier212(8.5%)165(10.5%)47(5.1%) Active physical activity no1552(62.6%)878(56.1%)674(73.7%) <0.001 yes928(37.4%)687(43.9%)241(26.3%) baPWV1357(255.7)1399.5(235.4)1284.1(272.1) <0.001 ABI1.06(0.085)1.07(0.85)1.04(0.83) <0.001

13. Description by stress score CharacteristicLow score ≤104 Frequency/Percentage High score >105 Frequency/Percentage P value Gender Male688799 <0.001 Female425361 Education Lower than high school;10188 0.002 (wilcoxon) Senior high school;270243 Bachelor661727 Master OR higher6393 Marital status Unmarried10263 0.002 Married9851074 Divorced34 Widowed15 Smoker history Non-smoker768(69.4%)706(60.9%) <0.001 Post-smoker123(3.5%)56(4.8%) Smoker713(27.1%)397(34.3%) History of alcohol intake Non-drinker809(73.1%)700(60.5%) <0.001 Post-drinker23(2.1%)25(2.2%) Drinker275(24.8%)432(37.3%) Adiposis hepatica situation None736(66.5%)727(63.1%) 0.002 Mild303(27.4%)307(26.6%) Moderate or heavier68(6.1%)118(10.2%) Exercise situation No685(62%)716(62.2%) 0.959 Yes419(38%)436(37.8%) Antihypertensive drug situation No926(83.5%)993(85.7%) 0.151 Yes183(16.5%)166(14.3%) Antidiabetic Drugs situation No1080(97.8%)1130(97.7%) 0.798 Yes24(2.2%)27(2.3%) Antilipemic situation No1096(99.2%)1146(99%) 0.729 Yes9(0.8)11(1%) Aspirin situation No1083(98.1%)1134(97.9%) 0.772 Yes21(1.9%)24(2.1%)

14. CharacteristicLow score ≤104 Mean SD High score >105 Mean SD P value BMI23.74(3.34)24.19(4.91)0.011 Age44.7(11.4)44.6(10.56)0.789 Abdominal circumference84.2(10.55)85.76(12.15)0.005 SBP124.8(17.1)125.6(16.4)0.516 PP47.6(10.4)46.9(9.99)0.131 Heart rate73.9(11.2)73.4(10.8)0.301 TC4.75(0.85)4.89(1.00)<0.001 TG1.53(1.28)1.61(1.43)0.181 HDL-C1.27(0.34)1.3(0.46)0.018 LDL-C2.78(0.7)2.89(0.76)<0.001 BG4.86(1.03)4.85(1.14)0.848 HbA1c(%)5.31(0.842)5.35(0.89)0.847 ALT24.29(17.7)27.25(23.29)<0.001 AST23.58(10.45)23.87(15.8)0.679 r-GTP30.8(34.74)33.7(37.3)<0.001 UA321.8(95.4)334.3(96.9)0.002 UN5.23(3.51)5.48(4.42)0.147 Total protein73.1(5.67)72.4(6.47)0.002 Albumin46.5(3.2)46.2(3.65)0.066 Urine protein16.04(33.5) (14.45-18.0) 16.59(47.1) (13.85-19.33) 0.778 ABI1.058(0.09)1.059(0.081)0.860 baPWV1340.6(261.8)1338.8(219.7)0.245 Work hour/week <2566(6%)36(3.2%) <0.001 25-3443(3.9%)43(3.8%) 35-44762(69.8%)615(54.1%) 45-54169(15.5%)296(26.1%) ≥5552(4.8%)146(12.9%) Sleep duration7.14(0.975)7.16(0.968)0.666 Diet type Never eating too much from youth501(45.3%)439(38.2) <0.001 can't eat too full due to the health concerns180(16.3%)225(19.6%) Eating too much or eating too little186(16.8%)161(14%) Eating full239(21.6%)325(28.3%)

15. Thanks !!!