Prevention and Control of Cardiovascular Disease in the Rapidly Changing Economy of China

Abstract

With one-fifth of the world's total population, China's prevention and control of cardiovascular disease (CVD) may affect the success of worldwide efforts to achieve sustainable CVD reduction. Understanding China's current cardiovascular epidemic requires awareness of the economic development in the past decades. The rapid economic transformations (industrialization, marketization, urbanization, globalization, and informationalization) contributed to the aging demography, unhealthy lifestyles, and environmental changes. The latter have predisposed to increasing cardiovascular risk factors and the CVD pandemic. Rising CVD rates have had a major economic impact, which has challenged the healthcare system and the whole society. With recognition of the importance of health, initial political steps and national actions have been taken to address the CVD epidemic. Looking to the future, we recommend that 4 priorities should be taken: pursue multisectorial government and nongovernment strategies targeting the underlying causes of CVD (the whole-of-government and whole-of-society policy); give priority to prevention; reform the healthcare system to fit the nature of noncommunicable diseases; and conduct research for evidence-based, low-cost, simple, sustainable, and scalable interventions. By pursuing the 4 priorities, the pandemic of CVD and other major noncommunicable diseases in China will be reversed and the global sustainable development goal achieved.

Keywords: China; cardiovascular diseases; prevention & control; risk factors; socioeconomic factors.

Figure 1

Number of annual production of cars, computers, televisions and bicycles in China from 1990 to 2010. Data source: National Bureau of Statistics of China.

Figure 2

The increasing trend in prevalence of hypertension in China in the past decades, crude and age-standardized rate based on data from national hypertension surveys. Criteria of diagnosis: Not documented for the survey in 1959; SBP≥141mmHg and/or DBP≥91mmHg for the survey in 1979; SBP≥140 and/or DBP≥90 or medication use in 2 wks for the surveys in 1991 and 2002. Age of participants: Participants aged 15 years and above except for the survey in 2012, which was among adults age 20 and above. Age-standardized rate with the national census data in 1964 as reference. Same criteria as of 1979 survey was used.

Figure 3

Map showing provincial differences in age-adjusted prevalence of hypertension in China in 1991

Figure 4

The increasing trend in high cholesterol (total cholesterol ≥ 200 mg/dL) in China in the past decades, age-standardized rate on pooling data from 9 populations at 35 to 59 years and with urban-rural and geographic diversity. Data source: Chinese Journal of Cardiology. 2001;29:74–79.

Figure 5

The increasing trend of overweight and obesity in China in the past decades, age-standardized rate (BMI>=25Kg/m²). Data source: Lancet 2014; 384(9945): 766–781.

Figure 6

Age-standardized Mortality Rates from Major NCDs in China and Selected Upper and Upper Middle Income Countries. Data source: World Health Organization, Disease and injury country estimates

Figure 7

Changes in infant, maternal and total mortality and life expectancy in China from 1930 to 2012. Data source: National Bureau of Statistics and National Health and Family Planning Commission