Potential Impact of Time Trend of Life-Style Factors on Cardiovascular Disease Burden in China

Abstract

Background: Cardiovascular disease (CVD) is a leading cause of death in China. Evaluation of risk factors and their impacts on disease burden is important for future public health initiatives and policy making.

Objectives: The study used data from a cohort of the China Health and Nutrition Survey to estimate time trends in cardiovascular risk factors from 1991 to 2011.

Methods: We applied the comparative risk assessment method to estimate the number of CVD events attributable to all nonoptimal levels (e.g., theoretical-minimum-risk exposure distribution [TMRED]) of each risk factor.

Results: In 2011, high blood pressure, high low-density lipoprotein cholesterol, and high blood glucose were associated with 3.1, 1.4, and 0.9 million CVD events in China, respectively. Increase in body mass index was associated with an increase in attributable CVD events, from 0.5 to 1.1 million between 1991 and 2011, whereas decreased physical activity was associated with a 0.7-million increase in attributable CVD events. In 2011, 53.4% of men used tobacco, estimated to be responsible for 30.1% of CVD burden in men. Dietary quality improved, but remained suboptimal; mean intakes were 5.4 (TMRED: 2.0) g/day for sodium, 67.7 (TMRED: 300.0) g/day for fruits, 6.2 (TMRED: 114.0) g/day for nuts, and 25.0 (TMRED: 250.0) mg/day for marine omega-3 fatty acids in 2011.

Conclusions: High blood pressure remains the most important individual risk factor related to CVD burden in China. Increased body mass index and decreased physical activity were also associated with the increase in CVD burden from 1991 to 2011. High rates of tobacco use in men and unhealthy dietary factors continue to contribute to the burden of CVD in China.

Keywords: China; cardiovascular disease; disease burden; preventable; risk factor.

Figure 1. CVD attributable to 17 individual risk factors (thousands) in 2011

Cardiovascular Diseases (CVD) events, represented as solid bars, refer to the combined burden from coronary heart diseases, ischemic stroke and hemorrhagic stroke. SSB = Sugar-Sweetened Beverages; PUFA = Poly-Unsaturated Fatty Acid; BMI = Body Mass Index; LDL = Low Density Lipoprotein. Data of glucose and LDL cholesterol were collected in 2009 and carried forward for estimation of CVD burden in 2011.

Figure 2. Time trend and estimated CVD events attributable to a high intake of moderation dietary components

Time trend and estimated Cardiovascular Diseases (CVD) events attributable to a high intake of sodium (1), sugar-sweetened beverages (SSBs, 2), red meat (3), and processed meat (4). CVD events, represented as solid bars, refer to the combined burden from coronary heart diseases, ischemic stroke and hemorrhagic stroke; Circles represent Means and I bars represent Standard Errors (SE) of each risk factor distribution at each time point, which were standardized by age, sex, and urban/rural distribution using the 2010 Chinese Population Census data as the standard.

Figure 3. Time trend and estimated CVD events attributable to a low intake of adequacy dietary components

Time trend and estimated Cardiovascular Diseases (CVD) events attributable to a low intake of dietary fiber (1), fruits (2), vegetables (3), nuts (4), whole grains (5), poly-unsaturated fatty acids (PUFA, 6), and marine omega-3 fatty acids (7). CVD events, represented as solid bars, refer to the combined burden from coronary heart diseases, ischemic stroke and hemorrhagic stroke; Circles represent Means and I bars represent Standard Errors (SE) of each risk factor distribution at each time point, which were standardized by age, sex, and urban/rural distribution using the 2010 Chinese Population Census data as the standard

Central Illustration. Preventable CVD Burden in China: Time trend and Estimated Cardiovascular Disease (CVD) Events

Attributable to high systolic blood pressure (1), high body mass index (2), smoking (3) and lower physical activity (4). Cardiovascular diseases (CVD) events, represented as solid bars, refer to the combined burden from coronary heart diseases, ischemic stroke and hemorrhagic stroke; Circles represent Means and I bars represent Standard Errors (SE) of each risk factor distribution at each time point, which were standardized by age, sex, and urban/rural distribution using the 2010 Chinese Population Census data as the standard; Reference line represents the level of CVD events associated with each risk factor at 1991 for a visual comparison of CVD burden changes with time from the baseline.