A person's occupation may help identify cardiovascular risk patterns, care gaps and prevention opportunities among China's working adults, according to a nationwide cross-sectional study published Oct. 16 in JACC and simultaneously presented at the Great Wall International Congress of Cardiology.

Zixu Zhao, MD, et al., analyzed almost 1.5 million employees aged 20 to 65 in China who underwent health examinations at 167 centers across 24 provinces. Participants had a mean age of 34 years and a little over half were male. Data were collected between 2021 and 2023.

Eighteen occupations were defined and classified into primary, secondary and tertiary sectors; the tertiary sector was then subclassified into modern, public and life services. Researchers estimated age- and sex-standardized prevalence of coronary heart disease (CHD) and cardiometabolic risk factors, as well as age- and sex-standardized rates of treatment and control for hypertension and diabetes, and treatment for hypercholesterolemia and LDL-C control.

Ten-year ASCVD risk was also assessed using the Prediction for ASCVD Risk in China model, and changes in the proportion of individuals classified as having moderate-to-high 10-year ASCVD risk were assessed using simulated scenarios accounting for hypertension, total cholesterol levels and smoking status.

Results showed that CHD prevalence was 1% and demonstrated a pronounced north-south gradient (p<0.001), highest in the North and lowest in the South. Geographic distribution was similar for cardiometabolic risk factors. For CHD and cardiometabolic risk factors, employees in modern service sectors had the lowest prevalence, particularly employees in "information transmission, software and information technology." The highest burden was seen in the secondary sector, particularly among employees in "production and supply of electricity, heat power, gas and water."

The age- and sex-standardized rates of treatment and control were 30% and 21% for hypertension and 37% and 22% for diabetes. The hypercholesterolemia treatment rate was 17% and the LDL-C control rate was 10%. Employees in the modern services tertiary sector experienced the lowest treatment rates for all three cardiometabolic conditions, as well as the lowest control rates for hypertension and LDL-C.

Regarding ASCVD, 23% of individuals aged ≥35 years without prior ASCVD were classified as having moderate-to-high 10-year ASCVD risk. This proportion was highest in the "agriculture, forestry, animal husbandry, and fishery" occupation (30%) and lowest in the "service to advanced manufacturing" occupation (15%). Simulated control of hypertension, hypercholesterolemia and smoking status showed that potential reductions in ASCVD risk varied markedly by occupation.

The authors believe their findings "have important public health implications for cardiovascular disease surveillance and prevention resource allocation," noting that they may "inform cardiovascular prevention strategies in countries undergoing similar socioeconomic transitions and facing challenges related to healthcare access and resource constraints."

"The broader lesson extends beyond China," writes Yuan Lu, DSc, FACC, in an accompanying editorial. "The next step is to turn surveillance into implementation – using what we learn about where risk and management gaps concentrate to build systems that detect risk early, connect people to effective care and achieve sustained risk-factor control."