1066vip威尼斯 - Apple App Store

Latest Edition of China’s Cardiovascular Disease Report has been released: The report shows that while China’s efforts in cardiovascular disease prevention and control have achieved initial results, it faces new and serious challenges.

Currently, the prevalence and mortality of cardiovascular disease continues to be on the rise. 290 million patients nationally are affected by cardiovascular disease, with rural cardiovascular related deaths higher than those in the city. The total cost of hospitalization for those affected by cardiovascular/cerebrovascular diseases is also increasing rapidly, far more than the growth rate of GDP (since 2004). 

1、Cardiovascular related mortality remains as the highest cause of death. Two out of every five deaths in China are due to cardiovascular diseases.

The prevalence of cardiovascular disease in China is on the rise. The estimated number of cardiovascular diseases is 290 million, including 13 million strokes, 11 million coronary heart disease, 5 million pulmonary heart disease, 4.5 million heart failure, 2.5 million rheumatic heart disease, 2 million congenital heart diseases, and 245 million with hypertension

The mortality rate of cardiovascular disease in rural areas has exceeded and continues to be higher than the urban level since 2009. The mortality rate of cardiovascular disease in rural areas is 309.33/100,000, and the mortality rate of urban cardiovascular disease is 265.11/100,000. The proportion of cardiovascular deaths in rural and urban areas are 45.5% and 43.16%, respectively.

2、Cardiovascular Risk Factors

Prevalence of hypertension is on the rise, with an estimate of 23% of people in China diagnosed with some form of hypertension. Five national surveys were conducted in 1958-1959, 1979-1980, 1991, 2002, and 2012-2015, showing that the prevalence of hypertension in China is on the rise. The 2012-2015 China Hypertension Survey (CHS) showed that the weighted rate of Chinese adult hypertension was 23.2% (roughness 27.9%). 

Treatment and Control rate has significantly improved

The results of China's hypertension survey (CHS) conducted in 2012~2015 showed that the prevalence of hypertension in Chinese adults was 27.9% (weighted rate was 23.2%), males were higher than females; the normal high blood pressure detection rate was 39.1% ( The weighting rate is 41.3%).

The awareness rate, treatment rate and control rate of hypertension were 51.6%, 45.8% and 16.8%, respectively, and the treatment control rate was 37.5%, which was significantly improved compared with previous investigations. The awareness rate, treatment rate and control rate of female hypertension are higher than that of males, with urban residents higher than rural residents. 

The prevalence of hypertension among children is 14.5%

In 2010, the prevalence of hypertension in Chinese children was 14.5%, with boys being higher than girls (16.1% vs 12.9%). The prevalence of hypertension in children increases with age. Children with hypertension in the hospital are mainly secondary hypertension (52.0%~81.5%). Kidney-derived diseases are the first cause of secondary hypertension in Chinese children. 

Increased smoking rate and exposure to second hand smoke

According to a Tobacco Survey conducted in 2015, the standardization rate of people who smoke in China over 15 years old is 27.7%. Compared with 2010, the number of smokers has increased by 15 million. In 2015, smokers now smoke 15.2 cigarettes per day, an increase from 2010.

The 2014 China Youth Tobacco Survey showed that 6.9% of Chinese teenagers who use tobacco

According to a 2010 Global Adult Tobacco Survey (GATS)-China project survey, an estimated 738 million non-smoker Chinese suffer from secondhand smoke. However, compared with 2010, the proportion of people who smoked in indoor workplaces, public places, public transport and homes declined in 2015, indicating that the exposure of second-hand smoke has decreased.

The smoking cessation rate of the Chinese people aged 15 or over rose from 9.42% in 1996 to 16.90% in 2010.

The 2013-2014 China Chronic Diseases and Risk Factors Monitoring Survey (CCDRFS) survey showed that the average serum levels of total cholesterol, low-density lipoprotein cholesterol, triglyceride and high-density lipoprotein cholesterol in Chinese ≥ 18 years old were 4.70, 2.88, 1.14, respectively. At 1.35 mmol/L, the total cholesterol level was significantly higher than before. 

From 2002-2012, the prevalence of dyslipidemia in the Chinese population aged 18 years and older rose from 18.6% to 40.4%. With males at a higher prevalence than females as well as the urban population being higher than the rural one.

The 2010 National Chronic Kidney Disease Survey (CNSCKD) project showed that the awareness rate, treatment rate, and control rate of dyslipidemia were ≥18 years old, 31.0%, 19.5%, and 8.9%, respectively, with prevalence in men significantly lower than women. 

10% of Chinese have diabetes and insufficient measures to prevent cardiovascular disease 

In 2013, the national large-scale diabetes epidemiological survey showed that the standardization rate of adult diabetes in China was 10.9%, with prevalence among men higher than that of women (11.7% vs 10.2%). The pre-diabetes detection rate was 35.7%. The diabetes awareness rate was 36.5%, the treatment rate was 32.2%, and the treatment control rate was 49.2%. 

Prospective studies of chronic diseases in China have shown that all-cause mortality in diabetic patients is significantly higher than in those without diabetes. In addition to low rates of diabetes treatment and control as well as low rates of cardiovascular protective drugs (aspirin, statins, and antihypertensives), the use of cardiovascular protective drugs are also low across patients.

Overweight and obesity: The prevalence continues to increase, especially among children.

According to the "Report on Nutrition and Chronic Diseases of Chinese Residents (2015)", the overweight and obesity rates of residents aged 18 years and older in 2012 were 30.1% and 11.9%, respectively, which were 7.3% and 4.8% higher than those in 2002.

Although the overweight and obesity rate of rural residents in 2012 was lower than that of urban residents, the rate of increase was greater than that of urban residents. The prevalence of central obesity in adults also showed an increasing trend. The average waist circumference level increased significantly, with the increase in rural population being greater than that in urban populations, lowering the urban-rural stat differences.

In 2012, the overweight and obesity rates of urban and rural children aged ≤6 years and 7-17 years in China were significantly higher than those in 2002. According to a sample survey of Chinese students' physical fitness and health from 1985 to 2014, the overweight and obesity rates of Chinese youth aged 7-18 in 2014 were 11 times and 73 times higher than those in 1985, respectively. The 2013 study showed that the overweight rate of Chinese children and adolescents was 12.2%. The obesity rate was 7.1%. 

Only 1/3 of citiz4ns in china regularly participate in physical activities

CHNS results showed that the physical activity of residents aged 18-60 years old showed a significant downward trend from 1991 to 2011, among which the decline in occupational activity was the most obvious, and physical exercise was also very low. The 2014 National Physical Fitness Monitoring showed that the fitness rate of leisure time in China's 20-59 year olds (150 minutes of moderate-intensity exercise or 75 minutes of high-intensity exercise) increased slightly compared with previous surveys, but multiple body rates such as static heart rate and other physical indicators showed a downward trend. 

In 2014, 33.9% of the people who regularly participated in physical activities in China (including children and adolescents), also increased by 5.7% compared with 2007. The exercise rate of young adults aged 20 to 49 is still low. 

According to the results of the Sixth National Physical and Health Survey of China in 2014, 73.3% of boys had physical activity to that of less than one hour a day, with prevalence among girls were higher (79.1%). 

Salt intake among the populace is more controlled, but still double the recommended levels. 

From 1992-2012, the dietary fat supply ratio of Chiense residents showed a significant upward trend. In 2012, the national average was 32.9%, which exceeded the recommended online level of dietary guidelines (recommended range of dietary guidelines: 20%~30%); The energy supply ratio showed a significant downward trend, with a national average of 55% in 2012, which has fallen to the lower limit recommended by the dietary guidelines (recommended range of dietary guidelines: 55% to 65%). The imbalance of energy sources of urban residents is more serious than that of rural residents. 

In addition, vitamin C, calcium and potassium intake also showed a downward trend, dietary sodium intake decreased significantly.Furthermore in 2012 dietary sodium intake (5702 mg / standard person day) is still high, synthetic The amount of salt is 14.5 g, which is more than double the recommended intake (China: <6 g/d; World Health Organization: <5 g/d). 

1;3 of adults suffer from metabolic syndrome

The 2002 CHNS survey showed that the prevalence of metabolic syndrome in Chinese adults aged 18 years and older was 6.6% and 13.8%, respectively. The 2010 China Chronic Disease Surveillance Report showed that the prevalence of metabolic syndrome in adults aged 18 years or older was 33.9%, which was significantly higher than that in 2002.

The China Chronic Disease Prospective Study Project showed that during the median follow-up of 7.2 years, people aged 30-79 years old could not smoke or quit early, drink <30 g daily, participate in physical activity, have sufficient intake of fruits and vegetables, and consume less red meat. At least 4 of the healthy weight, the risk of severe coronary heart disease, coronary heart disease, and cerebral infarction can be reduced by 58%, 43%, and 39%, respectively; the burden of cardiovascular disease decreases with the increase of healthy lifestyle factors. 

Indoor air pollution and related cause of death 

The 2010 China Disease Burden Study showed that environmental air pollution and indoor air pollution are the fourth and fifth risk factors affecting China's Disability Adjusted Life Year (DALY). For every 10 μg/m3 increase in PM2.5 concentration, the risk of ischemic heart disease increased by 0.27% on the day. The long-term effects of air pollution have a greater impact on cardiovascular disease.

In 2013, the total death caused by indoor air pollution in China was 807,000 cases, including 169,000 cases of hemorrhagic stroke, 152,000 cases of ischemic heart disease, and 88,000 cases of ischemic stroke. Compared with 1990, the total number of deaths caused by indoor air pollution decreased by 24.5%, and the loss of DALY decreased by 42.4%. 

3、Cardiovascular/Cerebrovascular diseases

Cerebrovascular disease: urban mortality is slightly lower than in rural areas.

The mortality rate of cerebrovascular disease in China showed an upward trend from 2003 to 2016; the mortality rate of cerebrovascular disease in rural areas was higher than that in urban areas. Compared with 2015, the number of Chinese cerebrovascular disease deaths in China decreased slightly in 2016.

The Stroke Screening Project found that the prevalence of stroke in adults over 40 years old in China was 2.06% in 2014. From 2002 to 2013, the incidence of first stroke in adults aged 40-74 years increased by 8.3% per year, and the mortality rate of stroke was stable, about 124/100,000. 

Coronary heart disease: Rural heart attack related deaths rapidly rise.

In 2016, the mortality rate of coronary heart disease in urban and rural residents in China continues to rise since 2012. The mortality rate of coronary heart disease in rural areas increased significantly, and the mortality rate of coronary heart disease in men was higher than that of women. Since 2005, acute myocardial infarction mortality has shown a rapid upward trend, especially in rural areas in 2013 and 2016, which significantly exceeded the urban average. 

Coronary treatment and intervention has increased by 13%

In 2017, the total number of interventional treatments for coronary heart disease in the mainland increased by 13% compared with 2016. The average interventional stent placement was 1.47, and more than 90% of the interventional procedures were performed through the radial artery. The mortality rate of patients after coronary intervention was stable at a low level (0.23%). The proportion of direct PCI in patients with ST-segment elevation myocardial infarction was 42.2%, which was further improved compared with 2016 (38.91%).

Arrhythmia: RF ablation, pacemakers, defibrillators, cardiac synchronization therapy have grown

A 2004 survey showed that the prevalence of age-corrected atrial fibrillation in China was 0.77% (0.78% for men and 0.76% for women). In addition, a survey of 31,000 community residents in 31 provinces in mainland China showed that the prevalence of atrial fibrillation in Chinese residents aged 35 years or older was 0.71%. 

From 2010 to 2017, the annual growth rate of radiofrequency ablation was 13.2%~17.5%, and the proportion of atrial fibrillation radiofrequency ablation surgery increases year by year.

In 2017, the number of implanted pacemakers increased by 4.98% compared with 2016, and the proportion of dual-chamber pacemakers was nearly 73%. The implanted cardioverter defibrillator (ICD) implants continued to grow, with an annual growth rate of more than 10%, 55.5% for secondary prevention and 44.5% for primary prevention.

In 2017, cardiac resynchronization treatment increased by 29.3% and 16.2% compared with 2016 and 2015, respectively. The proportion of cardiac synchronized defibrillator (CRT-D) implanted increased year by year. 

Heart failure: reduced mortality in hospitalized patients

According to a survey of 20 cities in 10 provinces and 15518 citizens of rural areas in China, the prevalence of chronic heart failure in Chinese people aged 35-74 years was 0.9% in 2000 (0.7% for men and 1.0% for women).

The China Heart Registry for Heart Failure (China-HF) shows that the average age of patients with heart failure in China is on the rise from 2012 to 2014. Hypertension and coronary heart disease have become the main causes of heart failure in China. The most common cause of exhaustion. The hospital mortality rate of patients with heart failure was 4.1%, which was significantly lower than before. 

Pulmonary vascular disease: the mortality rate of chronic obstructive pulmonary disease has decreased

According to the "Report on Nutrition and Chronic Diseases of Chinese Residents (2015)", the prevalence of chronic obstructive pulmonary disease (KD) in China aged 40 years or older in 2012 was 9.9%. According to the 2013 Global Burden of Disease Study, the prevalence of COPD in Chinese people aged 40 years or older in 2013 was 7.3%, and the prevalence rate increased with age. Compared with 1990, the mortality rate of chronic obstructive pulmonary disease decreased in 2013, but it still corresponds to the global level set in 1990.

The Chinese Pulmonary Embolism Prevention and Control Project showed that the annual incidence of pulmonary embolism in hospitalized patients in more than 60 top three hospitals in China from 1997 to 2008 was 0.1%. 

Cardiovascular Surgery: The number of heart transplants has increased year by year, and the success rate of intervention for congenital heart disease has reached 98.6%.

In 2017, the number of cardiac surgery operations in mainland China was 228,938, of which 162,597 were cardiopulmonary bypass operations, accounting for 71%; 77,305 cases of congenital heart disease surgery and 65,749 heart valve surgery in China and Hong Kong, coronary artery There were 45,455 cases of bypass grafting, 19,585 cases of aortic surgery, and 2002 cases of extracorporeal membrane oxygenation (ECMO).

The number of heart transplants in China has increased year by year, and 559 heart transplants were performed in 2017. In 2017, 32126 cases of interventional treatment for congenital heart disease were carried out in mainland China, and the total success rate of interventional therapy was 98.6%. 

Chronic kidney disease: 120 million people, 30% of which has cardiovascular disease

The 2009-2010 national chronic kidney disease prevalence survey showed that the total prevalence of chronic kidney disease in Chinese adults >18 years old was 10.8%, and it is estimated that there are about 120 million chronic kidney disease patients in China.

According to the CKD-NET annual report, 27.8% of hospitalized patients with chronic kidney disease have cardiovascular disease, of which coronary heart disease is the most common (17.7%), followed by heart failure (13.0%) and stroke (9.2%).

Peripheral arterial disease: more than one third of the elderly have carotid atherosclerosis

30% of patients with cerebrovascular disease and 25% of patients with ischemic heart disease have atherosclerotic disease of the lower extremity.

The National Stroke Prevention Program in China showed that the overall prevalence of carotid atherosclerosis was 36.2% in the >40-year-old population, of which 26.5% had carotid intima-media thickening and 13.9% had carotid plaque. 

Renal artery stenosis caused by renal atherosclerosis gradually increased from 50% in 1999-2000 to 85% in 2015-2016; the proportion of multiple arteritis in the overall cause decreased gradually, from 31% to 10%; The proportion of fibromuscular dysplasia did not change much, and the fluctuation ranged from 2.9% to 6.5%.

Quality of Medical care is rapidly improving, but there are deficiencies.

China Acute Coronary Syndrome Clinical Pathway Study (CPACS), China Cardiovascular Disease Medical Quality Improvement Program (CCC), Early Screening and Comprehensive Intervention Program for Cardiovascular Diseases at High Risk (ChinaPEACE), China Acute Myocardial Infarction Registry Study (CAMI) And China's coronary heart disease secondary prevention bridging project (BRIG) and other studies show that in recent years, China's cardiovascular field medical quality has improved rapidly, but there are also shortcomings.

According to the ChinaPEACE study, compared with 2001, the proportion of patients with acute myocardial infarction recommended by the guideline in 2011 increased, and the rate of coronary intervention increased, but the proportion of thrombolysis decreased. Due to the significant delay in patient visit time, the total reperfusion therapy rate was low, and the in-hospital mortality rate of patients with ST-segment elevation myocardial infarction did not decrease significantly. 

4、Cardiovascular disease community prevention and treatment:

For more than 40 years, the prevention and treatment of cardiovascular disease communities in China has been gradually promoted and implemented by points and areas. Comprehensive interventions have been carried out for people who have taken the prevention and treatment of hypertension as a breakthrough. They have been continuously exploring and achieving remarkable results.

On March 30, 2017, the National Cardiovascular Center established the National Basic Public Health Service Project's Basic Hypertension Management Office. The office is responsible for organizing the development of grassroots hypertension management guidelines, monitoring and evaluation of primary hypertension management and carrying out health education and other related work for the masses and gradually achieving homogenization of hypertension management levels in primary medical institutions.

5、Cardiovascular disease and Cerebrovascular disease medical and cost: Cardiovascular and cerebrovascular disease discharge rate of an average annual growth rate of nearly 10%

Since 1980, the number of discharged patients with cardiovascular and cerebrovascular diseases and diabetes in Chinese hospitals has increased. Accordingly, the total cost of hospitalization for cardiovascular and cerebrovascular diseases is also rapidly increasing.

In 2016, the total number of discharged patients with cardiovascular and cerebrovascular diseases in Chinese hospitals was 2002.19 million, accounting for 12.57% of the total number of discharged patients in the same period, including 6.30% of cardiovascular diseases and 6.27% of cerebrovascular diseases. Among the number of discharged patients with cardiovascular and cerebrovascular diseases, ischemic heart disease and cerebral infarction, accounting for 36.87% and 31.98% respectively.

From 1980 to 2016, the average annual growth rate of hospitalized patients with cardiovascular and cerebrovascular disease in China was 9.85%, which was faster than the average annual growth rate of the total number of discharged patients (6.33%). The average annual growth rate of the number of discharged patients in cardiovascular and cerebrovascular diseases was cerebral infarction (12.16%), ischemic heart disease (11.42%), acute myocardial infarction (10.73%), intracranial hemorrhage (9.48%). High blood pressure (7.45%), hypertensive heart disease and kidney disease (5.77%), rheumatic heart disease (1.20%). The average annual growth rate of diabetes dischargers was 13.59%.

Since 2004, the average annual growth rate of total hospitalization costs for acute myocardial infarction, intracranial hemorrhage and cerebral infarction in China has been 29.15%, 16.88% and 22.24%, respectively.

In 2016, the average hospitalization cost of acute myocardial infarction was about 26,000 yuan, intracranial hemorrhage was about 18,000 yuan, and cerebral infarction about 9387 yuan.

Source: Hu Shengshou, Gao Runlin, Liu Lisheng, et al. Outline of China Cardiovascular Disease Report 2018. China Journal of Circulation, 2019, 34: 209-220.