Summary of the 2022 Report on Cardiovascular Health and Diseases in China
Cardiovascular diseases (CVD) remain a significant public health challenge in China, with increasing morbidity and mortality rates despite advancements in medical technology and accessibility. The 2022 Report on Cardiovascular Health and Diseases in China provides a comprehensive overview of the current state of CVD in the country, highlighting key risk factors, epidemiological trends, and the economic burden of these diseases. This report also emphasizes the importance of community prevention, basic research, and the development of medical devices to address the growing CVD crisis.
Factors Affecting Cardiovascular Health
Several factors influence cardiovascular health in China, including tobacco use, diet and nutrition, physical activity, overweight and obesity, and psychological factors.
Tobacco Use
China is the world’s largest consumer of tobacco, with over 300 million smokers. The prevalence of smoking among people aged 15 years and older is 26.6%, and the number of deaths caused by smoking increased from 1.5 million in 1990 to 2.4 million in 2019. Second-hand smoke exposure affects 68.1% of non-smokers, and the smoking cessation rate remains low at 20.1%.
Diet and Nutrition
The dietary habits of the Chinese population have improved, but challenges remain. The average daily caloric intake is 2007.4 kcal, with a decreasing trend in carbohydrate consumption and an increasing trend in fat consumption, which now exceeds the recommended upper limit of 30%. The intake of grains and vegetables has decreased, while the consumption of animal-based foods has increased. However, the intake of fruits, eggs, aquatic products, milk, and soybeans remains low.
Physical Activity
Physical inactivity is a growing concern in China. Only 5.12% of primary and secondary school students meet the recommended physical activity guidelines. The rate of regular physical activity among adults aged 18 years and older is 12.5%, and sedentary behavior averages 3.2 hours per day.
Overweight and Obesity
Overweight and obesity rates are rising across all age groups. In 2017, 6.8% of children under 6 years were overweight, and 3.6% were obese. Among adults aged 18 years and older, 33.3% are overweight, and 14.1% are obese. These conditions significantly increase the risk of CVD-related mortality.
Psychological Factors
Psychiatric and psychological disorders are on the rise, with 5.81 million people registered with severe psychiatric disorders as of 2017. Depressive symptoms are significantly associated with an elevated risk of CVD and mortality.
Risk Factors for Cardiovascular Disease
The report identifies several key risk factors for CVD, including hypertension, dyslipidemia, diabetes, chronic kidney disease, metabolic syndrome, and air pollution.
Hypertension
The prevalence of hypertension among Chinese adults aged 18 years and older is 27.9%, with an estimated 245 million adults affected. The awareness, treatment, and control rates of hypertension are 51.6%, 45.8%, and 16.8%, respectively. Approximately 4% of children in China have persistently elevated blood pressure levels.
Dyslipidemia
The prevalence of dyslipidemia has increased dramatically, from 18.6% in 2002 to 40.4% in 2012. Low high-density lipoprotein cholesterol and high triglycerides are the principal types of dyslipidemia in China.
Diabetes
The prevalence of diabetes in China has risen significantly, with 129.8 million adults estimated to have diabetes. The detection rate of pre-diabetes is 35.2%.
Chronic Kidney Disease
The overall prevalence of chronic kidney disease (CKD) in China is 10.8%, accounting for an estimated 120 million patients. Abnormal renal function and albuminuria are common among CKD patients.
Metabolic Syndrome
The prevalence of metabolic syndrome (MS) has increased from 6.6% in 2002 to 15.4% in 2012. Among children and adolescents aged 10–17 years, the prevalence of MS is 2.4%.
Air Pollution
Air pollution remains a significant risk factor for CVD. In 2021, 64.3% of cities in China met outdoor air quality standards. The number of deaths attributed to PM2.5 pollution has gradually decreased since 2013.
Community Prevention of Cardiovascular Disease
The “Healthy China 2030” initiative emphasizes the importance of community-based prevention and management of chronic diseases. The construction of demonstration areas has led to significant improvements in CVD risk factors, including reductions in smoking, alcohol consumption, and the prevalence of hypertension and diabetes.
Epidemiological Trends of Cardiovascular Disease
The prevalence of CVD in China is continuously increasing, with an estimated 330 million patients currently affected. The leading causes of CVD-related death are ischemic heart disease (IHD), hemorrhagic stroke, and ischemic stroke. Rural areas have consistently higher CVD mortality rates than urban areas.
Coronary Heart Disease
Coronary heart disease mortality has been increasing, particularly in rural areas. Acute myocardial infarction (AMI) mortality rates have also risen. Late percutaneous coronary intervention (PCI) has been shown to significantly reduce the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and improve survival.
Cerebrovascular Disease
Cerebrovascular disease mortality has been increasing, with higher rates among men than women. The age-standardized incidence of stroke has decreased by 9.0% since 1990, but the prevalence of stroke has increased by 13.2%.
Arrhythmias
The prevalence of atrial fibrillation (AF) among Chinese adults aged 18 years and older is 1.6%. The number of pacemaker placements and radiofrequency catheter ablation (RFCA) procedures has been increasing rapidly.
Valvular Heart Disease
The prevalence of valvular heart disease in China is 3.8%, with rheumatic valvular disease remaining the leading cause. The prevalence of degenerative valve disease has increased significantly in recent years.
Congenital Heart Disease
The mortality rate of congenital heart disease in rural areas is higher than in urban areas. The number of surgeries for congenital heart diseases has been increasing, particularly among adults.
Cardiomyopathy
The prevalence of hypertrophic cardiomyopathy (HCM) in China is 0.16%, with an estimated 1 million cases. The prevalence of dilated cardiomyopathy (DCM) is 19 per 100,000.
Heart Failure
The prevalence of heart failure among Chinese adults aged 35 years and older is 1.3%. The number of heart transplants has been increasing, with a 91.0% in-hospital survival rate.
Pulmonary Vascular Disease and Venous Thromboembolism
Congenital heart disease is the predominant cause of pulmonary arterial hypertension (PAH) in China. The incidence of venous thromboembolism (VTE) has been increasing, with active cancer being the principal etiology.
Aortic and Peripheral Arterial Diseases
The incidence of acute aortic dissection in China is 2.78 per 100,000 person-years. The prevalence of lower extremity arterial disease (LEAD) among adults aged 35 years and older is 6.6%.
Basic Research in Cardiovascular Diseases and Medical Device Development
Basic research in cardiovascular diseases has focused on investigating the cardiac anatomy, development, function, and pathogenesis of the cardiovascular system. The development of cardiovascular medical devices has been a priority, with 44.1% of approved innovative medical devices being cardiovascular products.
Economic Burden of Cardiovascular Diseases
The economic burden of CVD in China is substantial. In 2020, 24.29 million patients with cardiovascular and cerebrovascular diseases were discharged from hospitals, accounting for 14.68% of all discharges. The total hospitalization cost for cardiovascular diseases was RMB 270.901 billion Yuan.
Conclusion
China has entered a new stage of transforming from high-speed development focusing on scale growth to high-quality development emphasizing strategic and key technological development to curb the trend of increasing incidence and mortality of CVD. The 2022 Report on Cardiovascular Health and Diseases in China underscores the need for continued efforts in prevention, treatment, and research to address the growing burden of CVD in the country.
doi.org/10.1097/CM9.0000000000002927
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