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China Facing Public Cardiovascular Disease Health Crisis By 2030

May 6, 2010

Smoking and Hypertension Cited as Causal Factors in Circulation Article Co-Authored by Columbia Physician-Scientists

Annual heart disease and stroke rates in China will rise by up to 73 percent by 2030, given an aging population and other increased risk factors, without policies and prevention efforts aimed at controlling blood pressure and smoking, according to research from Columbia University Medical Center published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

“China’s standard of living and life expectancy have improved for many, but aging, dietary changes and reduced physical activity are leading to more heart disease and stroke,” said lead author Andrew Moran, M.D., M.P.H., assistant professor of medicine at Columbia University Medical Center, and an attending physician in general internal medicine at NewYork-Presbysterian Hospital. “Our study used a computer model to forecast future cardiovascular disease (CVD) in Chinese adults, and is the first to project the individual and combined effects of major risk factor trends on a national scale.”

Dr. Moran and colleagues reviewed risk-factor surveys of Chinese adults, ages 35-84, since economic reforms in the 1980s, and used them to project future trends in blood pressure, cholesterol, smoking, diabetes and body weight. Although smoking prevalence has declined in men by more than 10 percent since the mid-1980s, 62 percent of Chinese men still smoke, and 49 percent of nonsmokers, mostly women, are exposed to passive smoke, researchers said.

Dr. Moran and his colleagues, including Lee Goldman, M.D., dean of the faculties of health sciences and medicine and professor of medicine and of epidemiology at Columbia University, and the senior author on the paper, projected that annual rates of cardiovascular disease in China will increase by more than 50 percent due to aging and growth of the population alone between 2010 and 2030. And projected trends of increased blood pressure, cholesterol and diabetes may result in an additional 23 percent increase in cardiac events. The risk factor trends alone may translate into 21.3 million more CVD events and 7.7 million related deaths between 2010 and 2030, researchers said.

Demographic changes, such as an aging population and fewer young people, will be the main driver of the CVD increase in China, a nation with approximately 1.3 billion. “We are seeing this as the start of a public health crisis that will only worsen in the next two decades,” Dr. Moran said. Certain dietary factors, which this paper did not address, such as the high salt diet in Northern China, also have a bearing on cardiovascular disease rates, Dr. Moran added.

Reducing smoking to 20 percent of the male population by 2020 and 10 percent by 2030, or lowering average systolic blood pressure by four points in men and women, would significantly counteract adverse trends in other risk factors and prevent between 2.9 and 5.7 million deaths by 2030, according to the study. Aggressive anti-tobacco policies and preventive efforts aimed at controlling elevated blood pressure are two promising areas that need to be studied in more detail, Dr. Moran said.

“China is our biggest trading partner, so these results are important not only for other middle-income nations in transition, but also for the United States,” Dr. Moran said.

Study co-author Dongfeng Gu, M.D., M.Sc., vice president of the Chinese Academy of Medical Sciences in Beijing, China, said that the demographic changes stand to increase the burden of CVD as well as that of cancer and other non-communicable diseases and disabilities.

“In China, as in many parts of the world, the government has mainly focused on infectious diseases; however, China now has a “Ëœdouble burden’ of disease,” Dr. Gu said. “If no massive preventive measures are taken, the burden of cardiovascular disease will inevitably continue to rise in China. The priority for prevention and control of cardiovascular diseases should be adequately addressed by the government and the Chinese public.”

Study co-authors are Dong Zhao, M.D., Ph.D.; Pamela Coxson, Ph.D.; Y. Claire Wang, M.D., M.Sc.; Chung-Shiuan Chen, M.S.; Jing Liu, M.D.; Jun Cheng, M.D.; Kirsten Bibbins-Domingo, M.D., Ph.D.; Yu-Ming Shen, Ph.D.; Jiang He, M.D., Ph.D.; and Lee Goldman, M.D., M.P.H.

The study was funded by an award from the National Heart, Lung, and Blood Institute and a grant from the William J. Matheson Foundation to Columbia University; and grants from the Flight Attendants Medical Research Institute and Swanson Family Fund to the University of California – San Francisco.

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