A Changing Face: The Epidemiology of Cardiovascular Diseases in Mainland China Trends in CHD Incidence and Mortality, in Comparison to Total Mortality: China MUCA Study All deathCHD deathCHD incidence Number One Killer Major Causes of Death in 2004 in Urban China RuralUrban Data source: Chinese Health Statistical Digest 2005, MOH, PRC * * * * ** Average Age-standardized Annual Incidence of CHD among 14 populations, China MUCA Study, y North South Adapted from Zhou BF, et al: CVD Prevention 1998;1: MenWomen Average Age-standardized Annual Incidence of Stroke among 14 populations, China MUCA Study, y North South Adapted from Zhou BF, et al: CVD Prevention 1998;1: MenWomen Summary I: The epidemiological characteristics of cardiovascular disease in China Stroke is predominant type of cardiovascular disease (CVD) in China CHD was used to be very low in comparison to the Western countries, but has been increasing dramatically in recent decades CVD has been the leading cause of death in China since 1990s and had over taken the US and many other Western countries according to the most recent data CVD varies largely among geographical locations and reasons are not fully understood. Major changeable risk factors of CVD and Their Trends in China The CHD Risk Factors Being Proved in Population Studies in China High Blood Pressure Smoking Dyslipidemia Diabetes Mellitus Overweight/Obesity In addition to Age and Gender Over 80% of ischemic cardiovascular diseases (CHD + ischemic stroke) risk in China is attributed to major risk factors, Population Attributable Risk (PARP) Hypertension 35% Smoking 32% Hypercholesterol 11% Diabetes 3% * Adjusted for age, sex the China MUCA Study Cohort Other Prevalence of CVD major risk factors in China data from the National Nutrition and Health Survey in 2002 Risk factor% # estimated nation- wide (million) Smoking Overweight/Obesity Hypertension Dyslipidemia Diabetes2.623 Data Source: National Nutrition and Health Survey 2002 Prevalence Rate of Dyslipidemia in China National Nutrition and Health Survey, 2002 What explain the increase of CVD? Age-adjusted prevalence of major CVD risk factors among Chinese, age years, MEN (China MUCA Study) *8 **3 Long-term secular changes *8 **3 Age-adjusted prevalence of major CVD risk factors among Chinese, age years, WOMEN (China MUCA Study) Long-term secular changes Prevalence of Smoking in China MenWomen Number of Participants % % , , , , a: Weng X, et al: Data from 1984 National Smoking Survey. b: Yang G. Smoking and Health in China: 1996 National Prevalence Survey of Smoking Pattern. Beijing, China Science and Technology Press, C: Wang L, ed. Series report #1, Chinese Nutrition and Health Status Report, p49, 2005 Number of Participants , , Changes in prevalence of overweight and obesity in China, data from National Nutrition Surveys in 1992 and 2002 Redraw from Ma GS, Li YP, Wu YF, et al. The prevalence of body overweight and obesity and its changes among Chinese people during Chinese Journal of Preventive Medicine 2005, Chin J Prev Med 2005;39(5): Prevalence of Hypertension in China Data from 4 national surveys Estimated rate for the whole nation. Criteria of diagnosis differed: Unknown for 1959 SBP141 and/or DBP91 not considering medication use in 2 wks for 1979; SBP140 and/or DBP90 or medication use in 2 wks for 1991and Participants aged 15 and above in all surveys. Age-standardized rate with the national census data in 1964 as reference. Same criteria as of 1979 survey was used. Increase in prevalence of DM in large cities in China Data for 1996 was from the National Survey of Diabetes; Data for 2002 was from the National Nutrition and Health Survey. What explain the changes of risk factors? Number of annual production of cars, PCs, TVs and Bicycles in China Redraw on data from the National Bureau of Statistics of China. Changes in hours working and watching TV in Chinese men and women, urban and rural, from 1990 to 2000 Redraw on data from the 1st and 2nd Survey of Social Status of Chinese Women. In book: Jingqui Ma (ed). Men and women in China. Age-adjusted intake and its increase for different foods among Chinese, age years *12 Changes in intake of foods Summary II: CVD risk factor in China Over 80% of CVD risk in China are attributed to few major risk factors, including hypertension, cigarettes smoking, hypercholesterol, diabetes, etc. All these major risk factors have been increasing during the past decades except for smoking, which started to decline after late 1990s but still very high in men. Modern lifestyle that increase sedentary but decrease physical activity, unhealthy dietary patterns, universal and country specific social economic factors, etc influence the future direction of the risk factor changes. Thus, future increase in both risk factors and CVDs are foreseen. We have done a lot but we need to do more. 2008 Framingham Step 1: Age YearsPoints Step 2: Total Cholesterol TC Points atPoints atPoints atPoints atPoints at (mg/dL) Age 20-39Age 40-49Age 50-59Age 60-69Age < HDL-C (mg/dL) Points