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Comparative Study
. 2021 Sep 1;4(9):e2127573.
doi: 10.1001/jamanetworkopen.2021.27573.

Prevalence of Dyslipidemia and Availability of Lipid-Lowering Medications Among Primary Health Care Settings in China

Yuan Lu  1 , Haibo Zhang  2 , Jiapeng Lu  2 , Qinglan Ding  1 , Xinyue Li  3 , Xiaochen Wang  3 , Daqi Sun  3 , Lingyi Tan  3 , Lin Mu  1 , Jiamin Liu  2 , Fang Feng  2 , Hao Yang  2 , Hongyu Zhao  3 , Wade L Schulz  1 , Harlan M Krumholz  1 , Xiangbin Pan  2 , Jing Li  2   4 ; China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project Collaborative Group
Collaborators, Affiliations
Comparative Study

Prevalence of Dyslipidemia and Availability of Lipid-Lowering Medications Among Primary Health Care Settings in China

Yuan Lu et al. JAMA Netw Open. .

Abstract

Importance: Dyslipidemia, the prevalence of which historically has been low in China, is emerging as the second leading yet often unaddressed factor associated with the risk of cardiovascular diseases. However, recent national data on the prevalence, treatment, and control of dyslipidemia are lacking.

Objective: To assess the prevalence, treatment, and control of dyslipidemia in community residents and the availability of lipid-lowering medications in primary care institutions in China.

Design, setting, and participants: This cross-sectional study used data from the China-PEACE (Patient-Centered Evaluative Assessment of Cardiac Events) Million Persons Project, which enrolled 2 660 666 community residents aged 35 to 75 years from all 31 provinces in China between December 2014 and May 2019, and the China-PEACE primary health care survey of 3041 primary care institutions. Data analysis was performed from June 2019 to March 2021.

Exposures: Study period.

Main outcomes and measures: The main outcome was the prevalence of dyslipidemia, which was defined as total cholesterol greater than or equal to 240 mg/dL, low-density lipoprotein cholesterol (LDL-C) greater than or equal to 160 mg/dL, high-density lipoprotein cholesterol (HDL-C) less than 40 mg/dL, triglycerides greater than or equal to 200 mg/dL, or self-reported use of lipid-lowering medications, in accordance with the 2016 Chinese Adult Dyslipidemia Prevention Guideline.

Results: This study included 2 314 538 participants with lipid measurements (1 389 322 women [60.0%]; mean [SD] age, 55.8 [9.8] years). Among them, 781 865 participants (33.8%) had dyslipidemia. Of 71 785 participants (3.2%) who had established atherosclerotic cardiovascular disease (ASCVD) and were recommended by guidelines for lipid-lowering medications regardless of LDL-C levels, 10 120 (14.1%) were treated. The overall control rate of LDL-C (≤70 mg/dL) among adults with established ASCVD was 26.6% (19 087 participants), with the control rate being 44.8% (4535 participants) among those who were treated and 23.6% (14 552 participants) among those not treated. Of 236 579 participants (10.2%) with high risk of ASCVD, 101 474 (42.9%) achieved LDL-C less than or equal to 100 mg/dL. Among participants with established ASCVD, advanced age (age 65-75 years, odds ratio [OR], 0.63; 95% CI, 0.56-0.70), female sex (OR, 0.56; 95% CI, 0.53-0.58), lower income (reference category), smoking (OR, 0.89; 95% CI, 0.85-0.94), alcohol consumption (OR, 0.87; 95% CI, 0.83-0.92), and not having diabetes (reference category) were associated with lower control of LDL-C. Among participants with high risk of ASCVD, younger age (reference category) and female sex (OR, 0.58; 95% CI, 0.56-0.59) were associated with lower control of LDL-C. Of 3041 primary care institutions surveyed, 1512 (49.7%) stocked statin and 584 (19.2%) stocked nonstatin lipid-lowering drugs. Village clinics in rural areas had the lowest statin availability.

Conclusions and relevance: These findings suggest that dyslipidemia has become a major public health problem in China and is often inadequately treated and uncontrolled. Statins were available in less than one-half of the primary care institutions. Strategies aimed at detection, prevention, and treatment are needed.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Y. Lu reported receiving grants from the National Heart, Lung, and Blood Institute outside the submitted work. Dr Ding reported receiving grants from Marion General Hospital (HRSA-19-018) outside the submitted work. Dr Mu reported receiving personal fees from HealthCare Royalty Partners outside the submitted work. Dr Schulz reported receiving personal fees from the National Center for Cardiovascular Disease, HugoHealth, and Refactor Health outside the submitted work. Dr Krumholz reported receiving personal fees from UnitedHealth, IBM Watson Health, Element Science, Aetna, Facebook, Siegfried & Jensen Law Firm, Arnold & Porter Law Firm, Martin/Baughman Law Firm, F-Prime, and National Center for Cardiovascular Diseases, Beijing; being a cofounder of HugoHealth and Refactor Health; receiving contracts from Centers for Medicare & Medicaid Services through Yale New Haven Hospital to develop and maintain measures of hospital performance; and receiving grants from Medtronic, the Food and Drug Administration, Johnson & Johnson, and Shenzhen Center for Health Information outside the submitted work. Dr J. Li reported receiving grants from Ministry of Science and Technology of the People’s Republic of China during the conduct of the study and receiving nonfinancial support from Amgen, Sanofi, University of Oxford, AstraZeneca, and Lilly outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Prevalence of Abnormal Lipid Profiles Among China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project Participants, by Age and Sex
HDL-C indicates high-density lipoprotein cholesterol (to convert to millimoles per liter, multiply by 0.0259); LDL-C, low-density lipoprotein cholesterol (to convert to millimoles per liter, multiply by 0.0259); TC, total cholesterol (to convert to millimoles per liter, multiply by 0.0259); TG, triglycerides (to convert to millimoles per liter, multiply by 0.0113).
Figure 2.
Figure 2.. Prevalence, Treatment, and Low-Density Lipoprotein Cholesterol (LDL-C) Control of Participants With High or Extremely High Risk of Atherosclerotic Cardiovascular Disease (ASCVD)
Panel A shows prevalence of low, medium, high and extremely high risk of ASCVD among all study participants. Panel B shows treatment and control of LDL-C among participants with extremely high risk of ASCVD. Panel C shows treatment and control of LDL-C among participants with high risk of ASCVD. Participants with extremely high risk of ASCVD were those with established ASCVD.
See this image and copyright information in PMC

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