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

• Published in: Journal of the American College of Cardiology Vol. 68; no. 8; pp. 818 - 833
• Main Authors: Li, Yanping, PhD, Wang, Dong D., MD, DSc, Ley, Sylvia H., PhD, Howard, Annie Green, PhD, He, Yuna, PhD, Lu, Yuan, DSc, Danaei, Goodarz, DSc, Hu, Frank B., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 23.08.2016; Elsevier Limited
• Subjects: Adult; Age; Age Factors; Aged; Blood pressure; Body mass index; Cardiology; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - psychology; Cause of Death - trends; China; China - epidemiology; disease burden; Female; Follow-Up Studies; Food; Humans; Internal Medicine; Life Style; Male; Middle Aged; Morbidity - trends; Motor Activity; Nutrition Surveys; Population; preventable; Prospective Studies; Risk Assessment - methods; risk factor; Risk Factors; Sex Factors; Smoking; Stroke; Trends; Young Adult; China; RR; systolic blood pressure; theoretical-minimum-risk exposure distribution; preventable; LDL; China; sugar-sweetened beverages; TMRED; BMI; SBP; cardiovascular disease; population-attributable fraction; SSB; PUFA; body mass index; metabolic equivalent of task; disease burden; risk factor; relative risk; low-density lipoprotein; CVD; polyunsaturated fatty acid; PAF; CHNS; coronary heart disease; China Health and Nutrition Survey; MET; CHD
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2016.06.011

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.