Interventions needed to curb heart disease epidemic
Nearly three out of four Chinese adults have poor cardiovascular health, with poor diet and growing rates of obesity compounding the risks associated with continuing high rates of smoking, according to a new survey published in the Journal of the American College of Cardiology.
The 2010 China Noncommunicable Disease Surveillance Group collected cardiovascular health data from a nationally representative sample of more than 96,000 men and women in the general Chinese population. According to estimates derived from the survey results, just 0.2 percent of Chinese men and women enjoy "ideal" cardiovascular health as defined by the American Heart Association's seven health behaviors/health factors.
"Without effective intervention, cardiovascular disease will become epidemic in the near future in China," concluded the study authors, including lead author Yufang Bi M.D., Ph.D. and senior author Guang Ning M.D., Ph.D. of Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
Previous studies representative of the Chinese general population have focused on cardiovascular risk factors but did not include comprehensive data on health behaviors such as diet and exercise, Bi said.
"The information provided by our study is of crucial importance because currently, cardiovascular disease is the leading cause of death in China," Bi said.
The researchers categorized participants' health behaviors and conditions as ideal, intermediate, or poor for each of seven metrics for cardiovascular health: smoking status, body mass index, physical activity, diet, untreated total cholesterol, untreated blood pressure, and untreated fasting plasma glucose levels in the absence of cardiovascular disease history.
Researchers found Chinese women surveyed were marginally more likely than men to have ideal cardiovascular health, at a rate of 0.4 percent versus 0.1 percent, respectively. The percent of women found to have all four ideal health behaviors was also slightly higher: 1 percent versus 0.4 percent. Likewise, 22.3 percent of women, but only 5 percent of men had all four ideal health factors. For this study, body mass index was considered a behavior, and smoking status was considered both a behavior and a health factor.
In all, 43.4 percent of men reported that they had never smoked or had quit smoking for more than 12 months, compared to 97.3 percent of women. Women were also more likely to have ideal blood pressure and glucose levels compared with men. Of the seven metrics, adhering to a healthy diet was the least common among all cardiovascular health metrics at 1.6 percent and similar between men and women.
The prevalence of diabetes in China has more than doubled over the past decade and smoking rates, primarily among men, remain high, the authors note.
"China is the most populous country in the world, and changes in disease prevalence in the Chinese population will significantly affect the global burden of disease," the authors wrote. "It is crucial for China to obtain national data on cardiovascular health, as well as to monitor its trends over time with nationwide surveillance."
In an accompanying editorial, K. Srinath Reddy M.Sc., M.D., D.M., president of the Public Health Foundation of India and the immediate past-president of the World Heart Federation, noted that strategies tackling cardiovascular risk factors at the individual, community, and national level have paid off in a number of high-income countries like the United States, Canada, and the United Kingdom where cardiovascular disease mortality rates have fallen in recent years. These same strategies, however, have not yet been adopted by large, developing countries like China, which already has high stroke mortality rates. Until recently, "coronary mortality rates were lower in China than in the developed countries or even some other large developing countries," Reddy said. With a rise in risk factors such as diabetes and blood cholesterol, along with the already high rates of smoking, "coronary heart disease rates are also likely to rise sharply," he said.
"While China is tremendously advanced technologically, the country faces a terrible burden of cardiovascular disease, as demonstrated by this study and others," said Valentin Fuster, M.D., Ph.D., Editor-in-Chief of the Journal of the American College of Cardiology. "The nation would benefit from a strategic country-wide approach aimed at lessening each of the risk factors, along with regional and individual educational efforts."
Unless these trends are reversed through effective prevention strategies at both the population and individual level, the impact will be felt both nationally and globally, Reddy said.
"This survey throws light on the nature of these risks that threaten cardiovascular health of the Chinese people and sounds a clarion call for urgent action to protect and promote their health through effective application of evidence based strategies," Reddy commented.
"We cannot remain passive observers of health transition, content with carefully cataloguing the catastrophe of cardiovascular disease as it advances menacingly across the low and middle income countries," Reddy said. "The price of inaction will be unbearably high, in health and economic costs. The prize of timely action will be huge, in terms of health gains, enhanced productivity, and averted health care costs."