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Multicenter Study
. 2018 Jan 26;7(3):e007462.
doi: 10.1161/JAHA.117.007462.

Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

Yuan Lu  1   2 , Pei Wang  3 , Tianna Zhou  1 , Jiapeng Lu  4 , Erica S Spatz  1   2 , Khurram Nasir  5 , Lixin Jiang  4 , Harlan M Krumholz  6   2   7
Affiliations
Multicenter Study

Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States

Yuan Lu et al. J Am Heart Assoc. .

Abstract

Background: The reasons for China's high stroke prevalence are not well understood. The cardiovascular risk factor profiles of China and the United States have not been directly compared in nationally representative population samples.

Methods and results: Using data from the CHARLS (China Health and Retirement Longitudinal Study) and the NHANES (US National Health and Nutrition Examination Survey), we compared cardiovascular risk factors from 2011 to 2012 among people aged 45 to 75 years between the 2 countries (China, 12 654 people; United States, 2607 people): blood pressure, cholesterol, body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, and high-sensitivity C-reactive protein. Compared with the United States, China had a lower prevalence of hypertension but a higher mean blood pressure and a higher proportion of patients with severe hypertension (≥160/100 mm Hg) (10.5% versus 4.5%). China had substantially lower rates of hypertension treatment (46.8% versus 77.9%) and control (20.3% versus 54.7%). Dyslipidemia was less common in China, but lipid levels were not significantly different because dyslipidemia awareness and control rates in China were 3- and 7-fold lower than US rates, respectively. High-sensitivity C-reactive protein, body mass index, and waist circumference were significantly lower in China than in the United States. Clustering of hypertension with other cardiovascular risk factors was more common in China.

Conclusions: Hypertension is more common in the United States, but blood pressure levels are higher in China, which may be responsible for China's high stroke prevalence. The low rates of awareness, treatment, and control of hypertension provide an exceptional opportunity for China to reduce risk in its population.

Keywords: cardiovascular diseases prevention; cardiovascular diseases risk factors; global disparities; international comparison.

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Figures

Figure 1
Figure 1
Distribution of blood pressure (A), lipids (B), and fasting plasma glucose (C), by treatment status, in China and the United States (US), from 2011 to 2012. HDL indicates high‐density lipoprotein; and LDL, low‐density lipoprotein.
Figure 2
Figure 2
Prevalence of dyslipidemia (we defined dyslipidemia as total cholesterol [TC] ≥240 mg/dL, low‐density lipoprotein [LDL‐C] cholesterol ≥160 mg/dL, high‐density lipoprotein [HDL‐C] cholesterol <40 mg/dL, triglycerides [TG] ≥200 mg/dL, or taking lipid‐modifying medications, according to the 2007 Chinese guidelines on the prevention and treatment of dyslipidemia) and prevalence of each component, in China and the United States (US), from 2011 to 2012.
Figure 3
Figure 3
Mean fasting plasma glucose and prevalence of diabetes mellitus, in China and the United States (US), from 2011 to 2012.
Figure 4
Figure 4
Mean body mass index (BMI) and prevalence of BMI categories, in China and the United States (US), from 2011 to 2012.
Figure 5
Figure 5
Distribution of high‐sensitivity C‐reactive protein (high‐sensitivity C‐reactive protein data are from NHANES [US National Health and Nutrition Examination Survey] 2009–2010, because they were unavailable in NHANES 2011–2012), in China and the United States (US), from 2011 to 2012.
Figure 6
Figure 6
Clustering of cardiometabolic risk factors (hypertension, dyslipidemia, diabetes mellitus, overweight, and obesity) in China and the United States (US), from 2011 to 2012.
See this image and copyright information in PMC

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