A Wake Up Call for China

JACC in a Flash | 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 study published in JACC.

The study, based on 96,121 Chinese adults ages 20 and older in 2010, categorized participants’ health behaviors and conditions as ideal, intermediate, or poor for each of seven metrics for cardiovascular health: smoking status, body mass index (BMI), physical activity, healthy diet habits, untreated total cholesterol of < 200 mg/dL, untreated blood pressure < 120/< 80 mm Hg, and untreated fasting plasma glucose < 100 mg/dL) in the absence of cardiovascular disease history.

Results showed that only 0.2% of Chinese men and women have “ideal” cardiovascular health, defined by “the presence of all seven ideal metrics among subjects with no history of cardiovascular disease.” Chinese women surveyed were marginally more likely than men to have ideal cardiovascular health, at a rate of 0.4% vs. 0.1%, respectively. On a more micro scale, the percent of women found to have four of the seven metrics defined as “favorable healthy behaviors” by the American Heart Association (AHA) (ideal smoking status and BMI, physical activity at goal and healthy dietary behaviors) was also slightly higher: 1% vs. 0.4% than men. Likewise, 22.3% of women, but only 5 percent of men had all four of the “ideal health factors” as defined by the AHA (ideal smoking status, total cholesterol, untreated blood pressure, and untreated fasting plasma glucose in the absence of cardiovascular disease history).

In all, only 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. Of the seven metrics, adhering to a healthy diet was the least common among all cardiovascular health metrics for both men and women at approximately 1.6 percent.

According to Yufang Bi, MD, PhD, and Guang Ning, MD, PhD, of Shanghai Jiao-Tong University School of Medicine, China, and coauthors representing the 2010 China Noncommunicable Disease Surveillance Group, the study’s findings underscore the need for national and regional health policymakers to make cardiovascular health a major priority in China. They note that chronic diseases account for an estimated 80 percent of deaths and 70 percent of total disease burden in the country. In addition, the World Health Organization estimates the economic loss in China from heart disease, stroke and diabetes since 2005 alone, could reach $558 billion this year.

“These data suggest that cardiovascular disease will become epidemic in the near future in China without effective intervention,” the authors write. They urge the development and implementation of both population-wide strategies, as well as programs targeted at high-risk individuals, as means of reversing these trends.

Commenting on the study, Valentin Fuster, MD, PhD, editor-in-chief of the Journal of the American College of Cardiology, noted that “while China is tremendously advanced technologically, the country faces a terrible burden of cardiovascular disease, as demonstrated by this study and others. 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.”

In an accompanying editorial, K. Srinath Reddy MSc, MD, DM, president of the Public Health Foundation of India and the immediate past-president of the World Heart Federation, echoes these sentiments, writing 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 US, 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. “China has demonstrated that it can combine resolute political will with exceptional operational skill to move rapidly from intent to implementation. Can it do the same for cardiovascular health?”

Keywords: CardioSource WorldNews, ACC Publications

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