The "China Cardiovascular Health and Disease Report 2022 Summary" was released, and the disease inflection point has not yet appeared

In order to implement the national policy of "focusing on the grassroots and focusing on prevention" and promote the gradual transfer of the main battlefield of cardiovascular disease (CVD) prevention and treatment from hospitals to communities, the National Center for Cardiovascular Disease organizes experts in relevant fields across the country to compile the "China Cardiovascular Health and Disease Report" every year, providing support for health administrators and professionals with detailed and scientific data.

One. Epidemiological features of cardiovascular disease

Due to the prevalence of unhealthy lifestyles among mainland residents, the huge population with CVD risk factors, the acceleration of population aging, the incidence and case fatality rate of CVD in mainland China are still increasing, and the inflection point of disease burden reduction has not yet appeared.

CVD ranked first in the proportion of disease deaths among urban and rural residents in mainland China, accounting for 48.00% and 45.86% of the causes of death in rural and urban areas in 2020, respectively. CVD accounts for 2 out of every 5 deaths. It is estimated that there are 330 million cases of CVD in mainland China, including 13 million cases of stroke, 11.39 million cases of coronary heart disease, 8.9 million cases of heart failure, 5 million cases of pulmonary heart disease, 4.87 million cases of atrial fibrillation, 2.5 million cases of rheumatic heart disease, 2 million cases of congenital heart disease, 45.3 million cases of peripheral arterial disease and 245 million cases of hypertension.

Since 2009, the rural CVD case fatality rate has exceeded and continues to be higher than the urban level. In 2020, the case fatality rate of CVD in rural areas was 336.13/100,000, of which the case fatality rate of heart disease was 171.36/100,000, and the mortality rate of cerebrovascular disease was 164.77/100,000. The case fatality rate of urban CVD was 291.04/100,000, of which the case fatality rate of heart disease was 155.86/100,000, and the mortality rate of cerebrovascular disease was 135.18/100,000.

The number of CVD deaths in China increased from 3.09 million in 2005 to 4.58 million in 2020, and ischemic heart disease, hemorrhagic stroke and ischemic stroke were the three leading causes of CVD death in China in 2020.

Two. Cardiovascular health influencing factors

1. Tobacco use

China is the world's largest consumer of tobacco and the largest tobacco victim. According to the Global Burden of Disease 2019 study, the number of smoking-related deaths in China increased by 57.9% from 1.5 million to 2.4 million between 1990 and 2019. Smoking and secondhand smoke exposure are one of the main preventable risk factors for adult mortality in China, with a relative risk of death of 1.23 in Chinese groups and a population-attributable risk of death of 7.9%.

According to the China Adult Tobacco Survey, the smoking rate of ≥15-year-olds in mainland China was 26.6% in 2018, down from 2010 and 2015, with 50.5% of men and 2.1% of women.

2. Dietary nutrition

The dietary nutrition status of Chinese residents has generally improved. According to the monitoring data of nutrition and health status of Chinese residents from 2015 to 2017, the average daily energy intake of Chinese residents per standard person is 2007.4 kcal, which is sufficient and the three major nutrients of carbohydrate, protein and fat are sufficient.

The total energy intake of Chinese residents showed a downward trend, of which protein intake did not change much, while the carbohydrate energy supply ratio showed a significant downward trend, and the fat energy supply ratio showed an upward trend, exceeding the upper limit of 20%~30% recommended by the dietary guidelines since 2012, and the rural fat energy supply ratio exceeded the recommended upper limit of 30% for the first time from 2015 to 2017, reaching 33.2%.

From 1982 to 2015, the intake of major foods in China changed, the intake of cereals and vegetables decreased, the intake of animal foods increased, and the intake of fruits, eggs, aquatic products, milk and soybeans remained very low. Cooking oil intake increased and home cooking salt intake decreased, but both cooking oil and cooking salt intake were much higher than the recommended amount.

3. Physical activity

A cross-sectional survey of 298 counties (districts) in 31 provinces, autonomous regions and municipalities directly under the Central Government in China showed that in 2015, the proportion of adults aged 18 in China ≥ regularly participating in physical activity (moderate to high intensity physical activity at least 3 times a week for at least 30 minutes) was 12.5%, an increase from 11.9% in 2010, but still at a low level. Except for ≥ 65-year-olds, 25~34-year-olds have the lowest proportion of regular physical activity.

The data also showed that the average amateur static behavior time of 18-year-old adults ≥in 2018 was 3.2 h/d, which was close to 2013 (3.3 h/d) and significantly higher than in 2010 (2.7 h/d).

4. Overweight and obesity

Three nationally representative data analyses from 2002~2017 show that the overweight rate and obesity rate of mainland residents are generally on the rise. According to the 2015-2017 monitoring report on nutrition and health status of Chinese residents, in 2017, the overweight and obesity rates of children under 6 years old in China were 6.8% and 3.6%, 11.1% and 7.9% among children and adolescents aged 6~17, and 33.3% and 14.1% among adults aged 1≥8 years old, respectively.

It is estimated that by 2030, the overweight and obesity rates of adults, children and adolescents aged 7~17 and children aged ≤6 in China may reach 65.3%, 31.8% and 15.6%, respectively, and the number of overweight and obese children may reach 789.95 million, 58.92 million and 18.19 million respectively.

Residents are less concerned about obesity, and in 2018, the weight measurement rate of ≥18-year-old residents in China was 59.2% in the past 1 month. According to the study estimate, in 2019, 549,500 CVD deaths attributed to high body mass index (BMI) in China, 38.64 per 100,000 CVD deaths attributed to high BMI, and 11.98% of CVD deaths were attributed to high BMI.

5. Psychological factors

A meta-analysis of 23 studies showed that the prevalence of depression in hospitalized patients with coronary heart disease in China was 51%, of which 0.50%~25.44% were severe depression. A meta-analysis of 41 clinical studies showed that the overall prevalence of depression in hypertensive patients was 26.8%, compared with 28.5% in China, higher than in other countries (22.1%). THE INTERHEART STUDY SHOWED THAT THE PREVALENCE OF DEPRESSION IN CHINESE PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WAS 21.66%, WHICH WAS SIGNIFICANTLY HIGHER THAN THAT OF PEOPLE WITHOUT A HISTORY OF CVD (10.36%).

Bibliography:

Chinese Cardiovascular Health and Disease Report Writing Group. Overview of China Cardiovascular Health and Disease Report 2022. Chinese Journal of Circulation,2023,38(6):583-612.