The current state of cardiology in China

Abstract

Cardiology in China has shown significant changes in the last decade or so. Interventional cardiology, in particular, has shown remarkable advances, especially in the management of coronary artery disease, which, unfortunately, has shown a disconcerting increase in incidence in a country traditionally known for very low incidence of coronary artery disease. Important contributing factors include increasing affluence, westernization of dietary habit and lifestyle, and rampant cigarette smoking. At present, the Chinese population has an annual coronary mortality of one sixth of that reported in the West, an incidence of acute myocardial infarction of one tenth to one eighth, and a mortality of acute myocardial infarction of one eighth. The prevalence of coronary artery disease among the general Chinese population (3-7%) is roughly one quarter of that among the Caucasians in the West, but this will get worse for sure. China still has a lot of catching up to do to reach full modernization. There is a price that every developing country must pay for modernization. However, let the price the Chinese pay not exceed the benefits derived from modernization. Can we achieve a utopian stage in the 21st century in which the modern Chinese retain their ancestral low rates of coronary artery disease while adapting the positive aspects of a modern western lifestyle?

Fig. 1

Chinese stamp commemorating the conquest of SARS in China: “All Hearts United Against SARS” (courtesy of G.W. Yang and Dr. T.Y. Chen, both from China).

Fig. 2

The first McDonald's restaurant in China, located in Beijing.

Fig. 3

The first KFC restaurant in China, located in Beijing, opposite the mausoleum where Mao Zedong was buried (visible in the left background).

Fig. 4

Obesity is prevalent in China among not only adults (A) but also children (B). Obese people in China are often compared to Buddha (C) and represent prosperity (courtesy of Beijing Review).

Fig. 5

Worldwide cigarette consumption.

Fig. 6

National survey in 1996 of the prevalence of smoking in China according to age, with the steepest rise in males between the ages of 15 and 20 years (courtesy of the Chinese Ministry of Health).

Fig. 7

Woman smoker in Inner Mongolia, China.

Fig. 8

Large billboards advertising Marlboro cigarettes in China.

Fig. 9

Mao Zedong smoking cigarette on an airplane.

Fig. 10

Deng Xiaoping, also an avid cigarette smoker.

Fig. 11

Rapid growth of PCIs in China from 1984 to 2001 (modified from Ref. [55]).

Fig. 12

Dr. I. Snapper, a highly regarded diagnostician from Holland, who served as chairman of the Department of Medicine of the Peking Union Medical College in the 1940s.

Fig. 13

(A) The first edition of The Textbook of Modern Cardiology was published as a single volume in 1994. (B) The second edition of The Textbook of Modern Cardiology was published as a two-volume set in 2002, being compared in size to Braunwald's Heart Disease, 6th edition.

Fig. 14

(A) A monograph on Congestive Heart Failure, first published in 1990. (B) Congestive Heart Failure as a textbook published in 2003, being compared in size to Braunwald's Heart Disease.