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Table 1 shows the risk factors included in the 10-year ASCVD or ICVD risk estimation and those that were not included but considered as important risk factors for ASCVD. Men had lower TC, HDL-C, and LDL-C concentrations and higher DBP than women. Moreover, men were more likely to smoke, drink, have diabetes mellitus, and be physically inactive and less likely to take hypertensive medications than women.
Characteristics Men (N = 27, 837; weighted N = 263, 166, 099)b Women (N = 33, 704; weighted N= 256, 992, 553)b P Value Risk factors used to estimate ASCVD or ICVD risk Age, y 53.7 (53.3, 54.1) 53.9 (53.4, 54.3) 0.325 SBP (mmHg) 138.0 (137.0, 139.0) 137.8 (136.5, 139.0) 0.451 TC (mg/dL) 163.6 (160.9, 166.3) 166.7 (163.8, 169.6) < 0.001 HDL-C (mg/dL) 42.5 (41.6, 43.3) 44.2 (43.4, 45.0) < 0.001 < 40 mg/dL HDL-C, % 47.5 (44.7, 50.3) 38.4 (35.6, 41.3) < 0.001 BMI (kg/m2) 24.1 (23.9, 24.2) 24.5 (24.3, 24.6) < 0.001 Current smokers, % 56.0 (54.2, 57.8) 3.2 (2.5, 4.0) < 0.001 Diabetes mellitus, % 14.5 (13.5, 15.5) 12.9 (12.2, 13.6) < 0.001 Hypertension treatment, % 13.9 (13.0, 14.8) 17.4 (16.4, 18.4) < 0.001 Risk factors not used to estimate CVD risk DBP (mmHg) 83.9 (83.3, 84.5) 82.8 (82.3, 83.3) < 0.001 LDL-C (mg/dL) 92.7 (91, 94.4) 94.1 (92.1, 96.1) 0.002 Waist circumference (cm) 83.4 (82.8, 84.0) 80.8 (80.2, 81.3) < 0.001 Triglycerides (mg/dL) 60.0 (58.2, 61.8) 54.7 (53.3, 56.1) < 0.001 Regular drinkers, % 23.4 (10.7, 13.0) 2.2 (1.7, 2.7) < 0.001 Physically inactive, % 18.2 (16.5, 19.9) 13.5 (11.5, 15.6) < 0.001 Note. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; ICVD, ischemic cardiovascular disease; SBP, systolic blood pressure; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; BMI, body mass index. aSelf-reported ASCVD, including stroke and myocardial infraction. bContinuous variables and categorical values are presented as mean [95% confidence intervals (CIs)] and percentage [95% confidence intervals (CIs)], respectively. All analyses were weighted, and the complex sampling design was taken into account upon CI estimation. Table 1. Descriptive Information on the Risk Factors for Cardiovascular Disease among Chinese Adults Aged 40-79 Years without Self-reported ASCVDa
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The average 10-year ASCVD risk among adults aged 40-79 years and without self-reported stroke or MI was 12.6%. The average ASCVD risk increased with age but decreased with the educational level and physical activity. Furthermore, the average ASCVD risk was higher in men, smokers, and drinkers than in their counterparts. The risks were similar between residents living in urban and rural areas and those residing in different economic development zones (Table 2).
Characteristics Sample Number 10-year ASCVD Risk Mean, 95% CIsb P Value Total 61, 541 12.6 (12.1, 13) Age, y < 0.001 40-49 24, 038 4.2 (4.0, 4.3) 50-59 19, 970 9.8 (9.5, 10.0) 60-69 12, 044 20.6 (20.2, 21.1) 70-79 5, 489 41.4 (40.7, 42.1) Sex < 0.001 Male 27, 837 15.1 (14.7, 15.6) Female 33, 704 10.0 (9.4, 10.5) Residence 0.665 Urban 24, 493 12.7 (12.1, 13.3) Rural 37, 048 12.5 (11.9, 13.1) Educational level < 0.001 Below primary school 18, 748 17.2 (16.5, 17.9) Primary school graduate 13, 251 12.7 (12.1, 13.2) Junior school graduate 17, 463 9.8 (9.4, 10.2) Senior school graduate and above 12, 079 9.7 (9.3, 10.2) Site's economic development zone 0.09 Undeveloped 17, 811 12.0 (11.0, 12.9) Intermediately developed 21, 481 12.5 (11.8, 13.1) Developed 22, 249 13.3 (12.5, 14.0) Smoking status < 0.001 Nonsmoker 44, 872 11.0 (10.5, 11.5) Smoker 16, 669 16.3 (15.8, 16.8) Alcohol drinking habit < 0.001 Nondrinker/occasional drinkers 54, 303 12.1 (11.7, 12.6) Regular drinkers 7, 238 15.5 (14.9, 16.1) Physical activity level < 0.001 Active 32, 585 10.7 (10.3, 11.2) Moderately active 16, 176 13.7 (13.1, 14.4) Inactive 12, 780 15.7 (14.9, 16.5) Note. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; CIs, confidence intervals. aSelf-reported ASCVD, including stroke and myocardial infraction. bAll analyses were weighted, and the complex sampling design was taken into account upon CI estimation. Table 2. Weighted Estimates of 10-year ASCVD Risk Based on Selected Sociodemographic Characteristics among Chinese Adults Aged 40-79 Years without Self-Reported ASCVDa
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A total of 47.4% adults had ≥ 7.5% 10-year ASCVD risk, which was higher in men than in women (data not shown in table). Among these adults, 8.3%, 18.6%, and 20.6% had 10-year ASCVD risks of 7.5%-9.9%, 10%-20%, and > 20%, respectively. The proportion of men in every risk stratum subgroup was higher than that of women. The proportion of adults with > 20% risk significantly increased after 60 years of age but decreased with advancing educational and physical activity levels.
By applying the age-specific proportions of participants in each risk stratum to the 2010 Chinese population aged 40-79 years, we estimated that a total of 247 million, 43 million, 97 million, and 107 million people had ≥ 7.5%, 7.5%-9.9%, 10%-20%, and > 20% 10-year ASCVD risks, respectively (Table 3).
Table 3. Distribution of 10-year ASCVD Risk Based on Selected Sociodemographic Characteristics among Chinese Adults Aged 40-79 Years without Self-reported ASCVD a
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Table 4 presents the cross-tabulation of the risk strata using the 10-year ICVD and ASCVD risks. Overall, 66.5% of men and women were included in the same risk strata by the two assessment tools (60.5%, 0.9%, and 4.1% of the < 10%, 10%-20%, and > 20% risks, respectively), and 29.0% of the participants were overclassified with the PCEs. The percentage of women included in the same risk strata by both methods was higher than that of women. A total of 40.9% and 1.1% of men categorized using the Chinese model were overclassified and underclassified with the PCEs, respectively.
10-year ICVD Risk (Chinese model) 10-year ASCVD Risk (PCEs) < 10% (95% CIs) 10%-20% (95% CIs) > 20% (95% CIs) Men < 10% 49.4 (47.9, 50.8) 22.2 (21.7, 22.8) 12.9 (12.2, 13.6) 10%-20% 0.4 (0.3, 0.5) 1.3 (1.1, 1.5) 5.8 (5.3, 6.2) > 20% 0.1 (0.0, 0.1) 0.6 (0.4, 0.7) 7.4 (6.8, 7.9) Women < 10% 71.9 (70.3, 73.4) 12.5 (11.8, 13.1) 10.2 (9.5, 10.9) 10%-20% 0.0 (0.0, 0.0) 0.5 (0.4, 0.6) 4.3 (3.7, 4.8) > 20% - - 0.7 (0.5, 0.8) Men and women < 10% 60.5 (59.1, 61.9) 17.4 (16.9, 17.9) 11.6 (11.0, 12.2) 10%-20% 0.2 (0.1, 0.3) 0.9 (0.8, 1.0) 5.0 (4.6, 5.5) > 20% 0.0 (0.0, 0.1) 0.3 (0.2, 0.4) 4.1 (3.7, 4.4) Note. Abbreviations: CIs, confidence intervals. All analyses were weighted, and the complex sampling design was taken into account upon CI estimation. Table 4. Comparison of 10-year Risk Calculated Using PCEs and Chinese Model
The difference between the two assessment tools was more apparent in men than in women. The risk stratum distribution derived from the two assessment tools was similar only in women aged 40-49 years. Based on the PCEs, more than 90% of men and women aged 70-79 years and more than 50% and 20% of men and women aged 60-69 years, respectively, had a > 20% 10-year ASCVD risk. However, among the same age groups, less than 40% and 10% of men and women aged 70-79 years, respectively, had a > 20% 10-year ICVD risk and less than 20% and 5% of men and women aged 60-69 years, respectively, had a 10%-20% 10-year ICVD risk (Figures 2 and 3). Furthermore, 27.0% of women categorized using the Chinese model were overclassified with the PCEs, but almost none were underclassified.