Future cardiovascular disease in china: markov model and risk factor scenario projections from the coronary heart disease policy model-china

Abstract

Background: The relative effects of individual and combined risk factor trends on future cardiovascular disease in China have not been quantified in detail.

Methods and results: Future risk factor trends in China were projected based on prior trends. Cardiovascular disease (coronary heart disease and stroke) in adults ages 35 to 84 years was projected from 2010 to 2030 using the Coronary Heart Disease Policy Model-China, a Markov computer simulation model. With risk factor levels held constant, projected annual cardiovascular events increased by >50% between 2010 and 2030 based on population aging and growth alone. Projected trends in blood pressure, total cholesterol, diabetes (increases), and active smoking (decline) would increase annual cardiovascular disease events by an additional 23%, an increase of approximately 21.3 million cardiovascular events and 7.7 million cardiovascular deaths over 2010 to 2030. Aggressively reducing active smoking in Chinese men to 20% prevalence in 2020 and 10% prevalence in 2030 or reducing mean systolic blood pressure by 3.8 mm Hg in men and women would counteract adverse trends in other risk factors by preventing cardiovascular events and 2.9 to 5.7 million total deaths over 2 decades.

Conclusions: Aging and population growth will increase cardiovascular disease by more than a half over the coming 20 years, and projected unfavorable trends in blood pressure, total cholesterol, diabetes, and body mass index may accelerate the epidemic. National policy aimed at controlling blood pressure, smoking, and other risk factors would counteract the expected future cardiovascular disease epidemic in China.

Figure 1

Proportions of CHD, stroke, and cardiovascular disease events attributable to selected major risk factors in China, base case scenario 2010–2030.

Figure 2

Figures 2a and 2b. Number of ischemic strokes, hemorrhagic strokes, and CHD events in Chinese men and women aged 35–84 years projected from the CHD Policy Model-China for the years 2010, 2015, 2020, 2025, and 2030. Dark blue areas represents events projected due to aging and population growth alone; red areas additional events attributable to projected SBP, TC, diabetes, and smoking trends.

Figure 2

Figures 2a and 2b. Number of ischemic strokes, hemorrhagic strokes, and CHD events in Chinese men and women aged 35–84 years projected from the CHD Policy Model-China for the years 2010, 2015, 2020, 2025, and 2030. Dark blue areas represents events projected due to aging and population growth alone; red areas additional events attributable to projected SBP, TC, diabetes, and smoking trends.

Figure 3

Crude event rates (per 100,000) of ischemic stroke, hemorrhagic stroke, and CHD in Chinese men and women aged 35–84 years projected for 2010, 2015, 2020, 2025, and 2030. Base case: risk factors held at year 2000 levels. Risk factor trend case: main SBP, TC, diabetes, and smoking trends.

Figure 4

Figures 4a and 4b. Sensitivity Analyses with CHD and total stroke risk coefficieints estimated from Framingham Heart Study (FHS) data substituted for China Multi-provincial Cohort Study (CMCS) coefficients, and main trend simulations repeated. Bars represent incremental percent change compared with the base case.

Figure 4

Figures 4a and 4b. Sensitivity Analyses with CHD and total stroke risk coefficieints estimated from Framingham Heart Study (FHS) data substituted for China Multi-provincial Cohort Study (CMCS) coefficients, and main trend simulations repeated. Bars represent incremental percent change compared with the base case.