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To implement and realize a shift from hospitals to the community as the main locus of cardiovascular disease (CVD) prevention and control efforts, the National Center for Cardiovascular Diseases compiles the “Report on Cardiovascular Health and Diseases in China” by experts in related fields nationwide, every year since 2005. The materials selected for inclusion are representative, published, and high-quality research results such as large-sample cross-sectional and cohort population epidemiological investigations, randomized controlled clinical studies, large-sample registry studies, and typical cases of community prevention and control. After the collective discussion of the expert team of the compilation group, to ensure that the content is comprehensive, accurate, complete, and fully reflects representativeness and authority, this year’s report also incorporates the project materials undertaken by the National Center for Cardiovascular Diseases. These first-hand data have greatly enriched the report and reflect the status of CVD prevention and treatment in China in a timely and comprehensive manner.
Since 1990, hospital-based clinical technology service capabilities have been persistently enhanced, and the accessibility and quality index of medical care have made remarkable progress in China, ranking first among middle-income countries. The number of inpatients with CVD has increased rapidly in China. Numerous cardiovascular technologies are at or near the leading levels globally, hospital deaths from many diseases have declined, and substantial progress has been achieved in China in solving the problem of “treatment difficulty” of CVD. However, owing to accelerated population aging and the prevalence of CVD risk factors, CVD remains the leading cause of death among both urban and rural residents in China. In 2021, CVD accounted for 48.98% and 47.35% of the causes of death in rural and urban areas, respectively, with two out of every five deaths attributed to CVD.
Prevention remains the most economical and effective health strategy. China has entered a new transition phase from high-speed to high-quality development. Accordingly, CVD prevention and control should also shift from a previous emphasis on scale-oriented growth to focusing on strategic and key technological development to curb the growing incidence and mortality rates of CVD. The National Health Commission, in conjunction with multiple departments, has formulated the “Healthy China Action—Implementation Plan for the Prevention and Control of Cardiovascular and Cerebrovascular Diseases (2023–2030)”, proposing to adhere to the focus on the grassroots level, prioritize prevention, attach equal importance to both traditional Chinese and Western medicine, innovate institutional mechanisms and working models, promote the transformation from “centering on treating diseases” to “centering on people’s health”, and enhance the health literacy level of the people. Moreover, this plan aims to integrate health into all policies, mobilize the whole society to take action, strengthen policy guidance and resource coordination, and strive to establish a comprehensive prevention, control, early diagnosis, and early treatment system for cardiovascular and cerebrovascular diseases covering the whole country by 2030. The prevention and treatment capabilities and quality of cardiovascular and cerebrovascular diseases in medical and health institutions at all levels will be further improved; the health literacy related to cardiovascular and cerebrovascular diseases of the individuals will be markedly enhanced; and major breakthroughs will be achieved in the prevention and treatment technologies of cardiovascular and cerebrovascular diseases. The upward trend of the incidence rate and risk factor level of cardiovascular and cerebrovascular diseases will be effectively controlled, while the mortality rate of cardiovascular and cerebrovascular diseases will reduced to less than 190.7/100,000.
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From 1958 to 2022, sampling surveys on the prevalence of hypertension across China indicated that the prevalence of hypertension showed an overall upward trend (Table 1). The 2018 CCDRFS survey showed that the weighted rate of the prevalence of hypertension among residents aged ≥ 18 years was 27.5%, with a higher rate detected among males than among females (30.8% vs. 24.2%)[47]. From 2020 to 2022, the preliminary investigation results of the “Chinese Residents CVD and Its Risk Factors Surveillance” project, which was conducted at 262 monitoring points in 31 provinces, autonomous regions, and municipalities directly under the Central Government involving 298,438 individuals, showed that the prevalence of hypertension among residents aged ≥ 18 years was 31.6%. The rate was higher among males (36.8%) than among females (26.3%) and higher in rural areas (33.7%) than in urban areas (29.1%).
Table 1. Survey results on the prevalence of hypertension in China from 1958 to 2022
Study name Year Age (years old) Sampling method Sample size (number of individuals) Prevalence (%) Key project of Chinese Academy of Medical Sciences: Hypertension Research 1958–1959 ≥ 15 Non-random sampling 739,204 5.1 National Hypertension Sampling Survey 1979–1980 ≥ 15 Random sampling 4,012,128 7.7 National Hypertension Sampling Survey 1991 ≥ 15 Stratified random sampling 950,356 13.6 China Health and Nutrition Survey 2002 ≥ 18 Multi-stage stratified cluster random sampling 272,023 18.8 Chinese Residents Nutrition and Chronic Diseases Survey 2012 ≥ 18 Multi-stage stratified random sampling − 25.2 China Hypertension Survey 2012–2015 ≥ 18 Multi-stage stratified random sampling 451,755 27.9 (weighted rate 23.2) China Health and Nutrition Survey 2015 ≥ 20–79 Multi-stage stratified cluster random sampling 8,907 34.1 (standardized rate 25.6) China Chronic Disease and Risk Factor Surveillance 2018 ≥ 18 Multi-stage stratified cluster random sampling 179,873 27.5 (weighted rate) Chinese Residents CVD and Its Risk Factors Surveillance 2020–2022 ≥ 18 Multi-stage stratified cluster random sampling 298,438 31.6 (weighted rate) Note. −: No specific data. According to the 2019 National Student Physical Fitness and Health Survey (190,000 individuals, aged 7–17, Han ethnicity), the prevalence of hypertension among children and adolescents was 13.0%, with a higher rate noted among young females than among males (13.2% vs. 12.7%), higher rate in rural areas than in urban areas (14.1% vs. 11.9%), and a gradually increasing trend with age[48]. The prospective cohort survey of 12,952 Chinese residents aged ≥ 18 years in the CHNS study showed[49] that the age-standardized incidence rate of hypertension increased from 40.8/1,000 person-years from 1993 to 1997 to 48.6/1,000 person-years from 2011 to 2015. Several survey studies showed that there was an upward trend in the awareness rate, treatment rate, and control rate of hypertension across China (Table 2).
Table 2. Awareness, treatment, and control rates of hypertension in various studies in China
Study name Year Age (years) Sampling method Sample size (number of individuals) Awareness rate (%) Prevalence (%) Control rate (%) National Hypertension Sampling Survey 1991 ≥ 15 Multi-level random sampling 950,356 27.0 12.0 3.0 China Health and Nutrition Survey 2002 ≥ 18 Multi-stage stratified cluster random sampling 272,023 30.2 24.7 6.1 Chinese Residents Nutrition and Chronic Diseases Survey 2012 ≥ 18 Multi-stage stratified random sampling − 46.5 41.1 13.8 China Nutrition and Health Surveillance 2010–2012 ≥ 18 Multi-stage stratified cluster random sampling 120,428 46.5 41.1 14.6 Investigation of the prevalence, awareness, treatment, and control rates of hypertension in the Chinese working population 2012–2013 18–60 Multi-stage cluster sampling 37,856 57.6
(standardized rate 47.8)30.5
(standardized rate 20.6)11.2
(standardized rate 8.5)China Hypertension Survey 2012–2015 ≥ 18 Multi-stage stratified random sampling 451,755 51.6
(weighted rate 46.9)45.8
(weighted rate 40.7)16.8
(weighted rate 15.3)Early screening and comprehensive intervention program for high-risk groups of cardiovascular disease in China 2014 35–75 Convenience sampling 640,539 46.5 (standardized rate) 38.1 (standardized rate) 11.1 (standardized rate) China Health and Nutrition Survey 2015 20–79 Multi-stage stratified cluster random sampling 8,907 43.8 (standardized rate 27.2) 39.2 (standardized rate 23.6) 13.8 (standardized rate 8.4) China Chronic Disease and Risk Factor Surveillance 2018 ≥ 18 Multi-stage stratified cluster random sampling 179,873 41.0 (weighted rate) 34.9 (weighted rate) 11.0 (weighted rate) Chinese Residents CVD and Its Risk Factors Surveillance 2020–2022 ≥ 18 Multi-stage stratified cluster random sampling 298,438 43.3 (weighted rate) 38.7 (weighted rate) 12.9 (weighted rate) Note. −: No specific data. According to the data from six national surveys of CCDRFS from 2004 to 2018, the awareness rate, treatment rate, and control rate of hypertension among adults aged 18–69 years all showed an upward trend in China (Figure 12)[50]. From 2020 to 2022, the preliminary survey results of the “Chinese Residents CVD and Its Risk Factors Surveillance” project, conducted at 262 surveillance sites in 31 provinces, autonomous regions, and municipalities directly under the Central Government among 298,438 residents, showed that the awareness rate, treatment rate, and control rate of hypertension among those aged ≥ 18 years were 43.3%, 38.7%, and 12.9%, respectively.
Figure 12. Changes in the awareness rate, treatment rate, and control rate of hypertension in adults aged 18–69 years in China from 2004 to 2018.
The results of the CHNS showed that the age-standardized detection rate of high-normal blood pressure among adults aged ≥ 18 years in China increased from 30.1% in 1991 to 43.1% in 2015[51]. The China Hypertension Survey (CHS) found that the crude detection rate of high-normal blood pressure among adults aged ≥ 18 years in China from 2012 to 2015 was 39.1%, with a weighted rate of 41.3%. It is estimated that there are 435 million individuals with high-normal blood pressure in China[52]. The results of CHS showed that the weighted value of systolic blood pressure in the population was 126.1 mmHg (1 mmHg = 0.133 kPa), and the weighted value of diastolic blood pressure was 76.0 mmHg. Systolic blood pressure was found to increase with age, while diastolic blood pressure increased initially and then decreased with age[50].
The DECIDE-Salt study assessing older Chinese adults showed that the use of potassium-rich low-sodium salt (substitute salt) can effectively reduce the blood pressure in these individuals and substantially reduce the risk of cardiovascular events. Although the substitute salt can increase the incidence of hyperkalemia, it does not increase adverse clinical outcomes[53].
According to the study on mortality, morbidity, and risk factors in China and its provinces from 1990 to 2017, high systolic blood pressure is one of the four major risk factors for death and DALY. In 2017, high systolic blood pressure caused 2.54 million deaths, of which 95.7% were due to CVD[54]. The study on the burden of CVD attributed to high systolic blood pressure in China and its provinces from 2005 to 2018 found that the number of CVD deaths caused by high systolic blood pressure has continued to rise, from 1.98 million in 2005 to 2.67 million in 2018. The years of life lost related to CVD have also continued to rise, from 40.14 million person-years in 2005 to 48.16 million person-years in 2018[55].
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The findings of the CHNS study in 2002[56], the investigation of the Chinese Chronic Kidney Disease Working Group (CNSCKD) in 2010[57], the CHNS study in 2011[58], and the Chinese Residents Nutrition and Chronic Diseases Survey in 2012[59] all indicated that the prevalence of dyslipidemia among adults aged ≥ 18 years in China had increased considerably, with the survey of the prevalence of dyslipidemia among adults aged ≥ 35 years in the CHS study from 2012 to 2015[60] and the million-population project of early screening and comprehensive intervention for high-risk groups of CVD in China (China-PEACE MPP) from 2014 to 2019[61] reporting similar results (Figure 13). The definition of dyslipidemia used in the above studies was the presence of any type of abnormal blood lipid level, including total cholesterol (TC) ≥ 6.22 mmol/L, low-density lipoprotein cholesterol (LDL-C) ≥ 4.14 mmol/L, high-density lipoprotein cholesterol (HDL-C) < 1.04 mmol/L, triglyceride (TG) ≥ 2.26 mmol/L, or currently taking lipid-regulating drugs.
From 2020 to 2022, the preliminary survey results of the “Chinese Residents CVD and Its Risk Factors Surveillance” project, conducted in 262 surveillance sites in 31 provinces, autonomous regions, and municipalities directly under the Central Government among 275,961 individuals, showed that the prevalence of dyslipidemia among residents aged ≥ 18 years was 38.1%. The prevalence was higher among males (46.1%) than among females (29.6%) and higher in urban areas (38.9%) than in rural areas (37.4%).
According to the data from the fourth CCDRFS[62] 2013–2014 and the Chinese Adults Nutrition and Chronic Diseases Surveillance (CANCDS) 2015[63], the survey results of the 2014 China Stroke Screening and Prevention Project (CNSSPP)[64] and the 2014–2019 China-PEACE MPP Project (currently, known as the China-HEART project) revealed that low HDL-C and high TG are the main types of dyslipidemia in China (Figure 14)[61].
The Non-Communicable Disease Risk Factor Collaborative Group pooled data from 1,127 population studies worldwide, testing the blood lipid levels of 102.6 million individuals aged ≥ 18 years, and evaluated and analyzed the trends of average TC, non-HDL-C and HDL-C levels in 200 countries from 1980 to 2018. The highest increase in the average non-HDL-C levels was recorded in East Asian countries (such as China) and Southeast Asian countries. The age-standardized average non-HDL-C levels increased by 0.23 mmol/L every 10 years. Under this trend, although China was one of the countries with the lowest average non-HDL-C levels globally in 1980, by 2018, it had reached or even exceeded many high-income Western countries[65].
High LDL-C can substantially impact the attributable mortality and disability burden among the Chinese population. In 2017, the attributable mortality rate of high LDL-C in the Chinese population was 61.08/100,000, and the DALY caused by high LDL-C was 18.1621 million person-years[66]. The attributable risk percentages of high LDL-C to the disease burden of CHD and stroke were 41.9% and 9.6%, respectively[67,68]. Upon assessing 179,728 residents aged ≥ 18 years, the survey results of the CANCDS project showed that the levels of TC, LDL-C, non-HDL-C, and TG of Chinese residents were all higher in 2015 than those in 2002 (Figure 15)[63].
Figure 15. Comparison of blood lipid levels in Chinese adults aged ≥ 18 years in 2002 and 2015. TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TG, triglyceride.
From 2020 to 2022, the preliminary analysis results of the “Chinese Residents CVD and Its Risk Factors Surveillance” project, conducted across 262 surveillance sites in 31 provinces, autonomous regions, and municipalities directly under the Central Government, revealed that the awareness rate, treatment rate, and control rate of dyslipidemia among residents aged ≥ 18 years old (n = 275,961 individuals) in China were 11.7%, 10.1%, and 4.8% respectively; these values were higher than those recorded in the Chinese Chronic Disease Surveillance Project in 2010 (awareness rate 10.93%, treatment rate 6.84%, control rate 3.53%)[69].
From 2007 to 2008, the China Diabetes and Metabolic Disorders Study (CNDMDS) (n = 46,239, ≥ 20 years) conducted a survey on the population with hypercholesterolemia type of dyslipidemia, including adults with elevated (TC ≥ 6.22 mmol/L or LDL-C ≥ 4.14 mmol/L) or borderline elevated (TC: 5.18–6.21 mmol/L or LDL-C: 3.37–4.14 mmol/L) cholesterol or self-reported individuals taking cholesterol-lowering drugs. The results showed that the awareness rate, treatment rate, and control rate of hypercholesterolemia were all low, and these values were markedly lower in rural areas than in urban areas (Figure 16)[70].
Figure 16. Awareness rate, treatment rate, and control rate of hypercholesterolemia in urban and rural residents in China from 2007 to 2008.
Based on the risk stratification defined by the 10-year atherosclerotic CVD (ASCVD) risk assessment process in the 2016 Chinese Guideline for the Management of Dyslipidemia in Adults (Revised version in 2016), the China-HEART survey identified 236,579 individuals (10.2% of the total population) at high risk for ASCVD over 10 years. The attainment rate for LDL-C < 2.6 mmol/L was 42.9%, whereas the treatment rate for those not meeting the target was only 4.5%. Among them, 71,785 individuals (3.2% of the total population) were at an extremely high risk of ASCVD, with an compliance rate of 26.6% for LDL-C < 1.8 mmol/L and a treatment compliance rate of 14.1%. The treatment compliance rate of LDL-C was 44.8%[62]. Patients with familial hypercholesterolemia (FH) are at high risk of ASCVD for life. The China-PEACE MPP project screened 1,383 patients with FH from among 1,059,936 subjects using the Chinese consensus standard. The treatment rate of LDL-C was only 18.1%, and no patient had LDL-C < 1.8 mmol/L[71].
The China Cardiovascular Care Improvement (CCC) project evaluated 80,282 patients registered in 192 hospitals across the country who were hospitalized for acute coronary syndrome (ACS). In patients with recurrent ACS, the lipid-lowering treatment rate at admission was 50.8%, and the compliance rate of LDL-C (< 1.8 mmol/L) was 36.1%; among them, the treatment rate of statins at admission was even lower among those aged ≥ 75 years (only 33.9%) and the compliance rate of LDL-C (< 1.8 mmol/L) was also lower (only 24.7%)[72,73].
The DYSIS II-China study included 1,103 inpatients with ACS from 28 tertiary hospitals in the cardiology department from September 2017 to May 2019. At the 6-month follow-up, the blood lipid levels of 752 patients who received lipid-lowering therapy were re-examined. The results showed that the compliance rate of LDL-C treatment (< 1.8 mmol/L) was 41.2%[74].
In the China-HEART cohort, simulating intensifying lipid-lowering therapy among individuals who had failed to reach the corresponding LDL-C targets showed that the use of atorvastatin 20 mg could enable more than 99% of the low- or moderate-risk population to reach the LDL-C target; 11.3% of the high-risk and 24.5% of the extremely high-risk warranted additional non-statin drugs for treatment. Following the additional use of ezetimibe, 4.8% of the high-risk and 11.3% of the extremely high-risk still needed evolocumab; 99% of the patients in these two groups could reach the LDL-C target after using evolocumab[75].
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The prevalence of diabetes in the Chinese population has shown a markedly growing trend (Figure 17). From 2015 to 2017, a cross-sectional survey of 75,880 adults aged > 18 years in 31 provinces, autonomous regions, and municipalities indicated that, according to the World Health Organization (WHO) standard, the prevalence of diabetes was 11.2% (95% CI: 10.5%–11.9%), the detection rate of diabetes in early stages was 35.2% (95% CI: 33.5%–37.0%)[76]. Based on the American Diabetes Association diagnostic criteria, the prevalence of diabetes was 12.8% (95% CI: 12.0%–13.6%), of which the prevalence of previously diagnosed diabetes was 6.0% (95% CI: 5.4%–6.7%), and newly diagnosed diabetes was 6.8% (95% CI: 6.1%–7.4%). An estimated 129.8 million adults have diabetes in China (70.4 million males and 59.4 million females). The 2017 survey revealed that the awareness rate of diabetes in China was 43.3%, the treatment rate was 49.0%, and the control rate was 49.4%.
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In 2011, among patients admitted to tertiary hospitals in China, diabetes-induced chronic kidney disease surpassed chronic glomerulonephritis for the first time and ranked first[77]. From August 2018 to June 2019, among 176,874 adults aged ≥ 18 years included in “The 6th National Surveillance on Chronic Diseases and Risk Factors” in 31 provinces, autonomous regions, and municipalities directly under the Central Government across the country, the prevalence rates of albuminuria and impaired renal function were 6.7% and 2.2%, respectively, and the total prevalence rate of chronic kidney disease was 8.2%[78], which was lower than 10.8% reported in 2009–2010[79].
According to the annual report of the China Kidney Network (CK-NET), among patients admitted to tertiary hospitals in China, the proportions of diabetic nephropathy, hypertensive nephropathy, and obstructive nephropathy in 2016 were 26.7%, 21.4%, and 16.0%, respectively, which were all higher than that of chronic glomerulonephritis (14.4%)[80].
From 2015 to 2019, the “Early Screening and Comprehensive Intervention Project for High-risk Groups of Cardiovascular Diseases” surveyed 269,026 adults aged ≥ 35 years across 31 provinces, autonomous regions, and municipalities directly under the Central Government. The prevalence rate of morning urine albumin-creatinine ratio (UACR) ≥ 30 mg/g was 8.75%, among which those with 30–300 mg/g accounted for 7.38% and those with UACR ≥ 300 mg/g accounted for 1.37%. Within the entire range of UACR, the risks of all-cause death, cardiovascular death, and CVD-specific death increased with increasing UACR levels. The risks of these deaths were substantially increased even at UACR levels within the traditionally considered normal range (< 30 mg/g) when compared with the risk at UACR < 5 mg/g.
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In 2019, a survey of 107,650 residents over the age of 15 in 31 provinces, autonomous regions, and municipalities directly under the Central Government in China found that the age-standardized prevalence rate of sleep difficulties was 21.25%. Among them, 90.27% had difficulty falling asleep, and 75.70% had sleep interruption or early awakening[81]. In 2020, a meta-analysis of 13,920 patients with hypertension showed that the prevalence rate of sleep difficulties was 52.5% (95% CI: 46.1%–58.9%), which was substantially higher than the prevalence rate of sleep difficulties in healthy controls [32.5% (95% CI: 19.0%–49.7%), OR = 2.66 (95% CI: 1.80–3.93)][82].
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A 2012 national epidemiological survey of mental disorders surveyed 32,552 individuals and found that the lifetime prevalence of depressive disorders was 6.8%, while the 12-month prevalence was 3.6%; the lifetime prevalence of anxiety disorders was 7.6%, while the 12-month prevalence was 5.0%[83]. A national study published in 2021 included a total of 47,841 individuals (≥ 45 years) covering 7 regions in China[84]. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptoms, and the Self-Rating Anxiety Scale (SAS) was used to assess anxiety symptoms. The prevalence rates of depressive and anxiety symptoms in patients with HF were 12.0% and 9.1% respectively, and 10.9% and 7.9% respectively in patients with stroke. The prevalence rates of depressive and anxiety symptoms in females with ≥ 3 kinds of CVDs were 9.7% and 7.3% respectively, and 6.3% and 3.5% respectively in males.
In a 2022 study of the CKB cohort, methods such as face-to-face screening and review with the WHO Composite International Diagnostic Interview Short Form (CIDI-SF) were used to determine symptoms of persistent anxiety and panic attacks[85]. Panic attacks increased the risk of new-onset CVD (HR = 1.08, 95% CI: 1.04–1.13), IHD (HR = 1.10, 95% CI: 1.02–1.19), hemorrhagic stroke (HR = 1.20, 95% CI: 1.05–1.38), and ischemic stroke (HR = 1.20, 95% CI: 1.11–1.30). Persistent anxiety was positively correlated with new-onset CVD (HR = 1.12, 95% CI: 1.04–1.20) and IHD (HR = 1.21, 95% CI: 1.07–1.37).
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According to GBD data, the top two environmental factors affecting the health of the Chinese population are air pollution and inappropriate temperatures. In 2013 and 2019, inappropriate temperatures ranked eighth among the risk factors for disease death burden in China. In 2019, inappropriate temperatures resulted in 400,000 excess deaths due to CVD. In China, air pollution ranked third among the risk factors for disease-related deaths in 2013 and dropped to fourth in 2019. However, the number of excess deaths (1.842 million) remained high, and the number of excess deaths from CVD related to PM2.5 exposure was 1.140 million.
From 2000 to 2016, the number of deaths attributed to PM2.5 pollution in China reached 30.8 million. Since 2013, the total number of annual deaths due to PM2.5 exposure in China has shown a gradual downward trend.
From 2006 to 2017, a time-series study on the impact of high temperatures in summer on mortality conducted in 353 locations in China found that high-temperature events were associated with a 12.95% increase (95% CI: 12.82%–13.09%) in excess deaths from CVD[86]. An association study on the relationship between high-temperature heat waves and the risk of CVD death conducted in 272 cities in different regions of China from 2013 to 2015 found that the risk of total CVD and CHD deaths related to heat waves increased by 14% (RR = 1.14, 95% CI: 1.09–1.18) and 13% (RR = 1.13, 95% CI: 1.07–1.19), respectively[87].
From 2013 to 2015, a study assessing the relationship between low-temperature exposure and CVD death conducted in 272 cities in China found that, compared with the threshold temperature (the temperature with the lowest population mortality rate of 22.8 °C), the risk of CVD death increased during low-temperature cold wave exposure (RR = 1.92, 95% CI: 1.75–2.10)[88]. A case-control study conducted across 15 cities in China found that 15.8% (95% CI: 13.1–17.9%) of CVD deaths (305,902 deaths) could be attributed to low-temperature exposure[89].
The Report on the State of the Ecology and Environment in China showed that among 339 prefecture-level and above cities across the country, the outdoor air quality of 218 cities met the standards in 2021, with a compliance rate of 64.3%, an increase of 3.5% when compared with that recorded in 2020. The levels of six major air pollutants (PM2.5, PM10, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone) were reduced when compared with those recorded in 2020 (Figure 18)[90].
Figure 18. Trends of six major air pollutants from 2013 to 2022. SO2, sulfur dioxide; O3, ozone; NO2, nitrogen dioxide; CO, carbon monoxide.
According to a prospective cohort study assessing 226,000 urban residents in China, cooking with solid fuels markedly increased the risks of cardiopulmonary diseases and all-cause mortality among residents. Compared with residents who have persistently cooked with clean fuels, residents cooking with solid fuels had increased risks of all-cause death, CVD death, and respiratory disease death by 19% (95% CI: 10%–28%), 24% (95% CI: 10%–39%), and 43% (95% CI: 10%–85%), respectively[91-92]. Moreover, studies have shown that the use of clean energy and stove upgrades can reduce the risk of premature death caused by cardiopulmonary diseases among residents[93].
According to the CHS sub-cohort data, residents using solid fuels for heating have a 44% (HR = 1.44, 95% CI: 1.00–2.08) and 55% (HR = 1.55, 95% CI: 1.10–2.17) increased risk of stroke and all-cause death, respectively, compared with residents using clean fuels for heating[94].
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In Chinese mainland, high-level cardiovascular basic research gained momentum after 2005, with high-impact papers published in journals such as Circulation, Cir Res, Signal Transduct and Target Ther, Cell Discovery, and Nature Commun. Data from journals such as Nature, Circulation, Eur Heart J, Cir Res, Nature Commun, and Cardiovasc Res clearly underscore the rapid development of high-level cardiovascular basic research in China in recent years (Figure 40).
Figure 40. The number of basic research papers on cardiovascular diseases published by the first unit and the corresponding author’s unit in China from 2013 to 2023.
From 2022 to 2023, a total of 97 basic research papers with corresponding authors and main authors from Chinese mainland were published. These reports explored the anatomy, development, function/pathogenesis of the heart and blood vessels. These papers examined aspects such as myocardial infarction, HF, ischemia-reperfusion injury, cardiomyopathy, cardiac remodeling, arterial dissection, atherosclerosis, and vascular remodeling. Among them, hot research topics include cardiac protection and regeneration, as well as gene therapy (Table 3).
Table 3. Summary of cardiovascular research progress in 2022–2023
August 2021 to August 2022 (74 articles) August 2022 to October 2023 (97 articles) 1 CHD, heart injury/remodeling/regeneration 1 CHD, heart injury/remodeling/regeneration Non-coding RNA, MSC transplantation, TRIM16, macrophages, brown fat exosomes, CaMKII-δ, tyrosine-protein kinase, obesity, histone-binding protein 2, immunoglobulin E, epigenetics, LARP7, PTPMT1, GSDMD, LSD1, liver-heart axis, sodium channel inhibitor, phosphodiesterase 4B, RalGAPα1-RalA signaling axis, pioglitazone, and cardiolipin. CircRNA (Samd4), lysine crotonylation, LPA, FNDC5, PUFA, USP25 (deubiquitination), Fap, PIASy, ketone body, MG53, 3D printing, PDCD5, small molecule inhibitor s89, METTL14, DUSP6, TREM2, MMPP, TRPC, single cell, MRPS5, HIPK1, ACADL, FOXP1, cardiac patch, exosome, cell transplantation therapy, optogenetics, Tisp40, M2 macrophage, APOE, RNF27, ABRO1, gut microbiota, BACH1, TMEM, α-myosin heavy chain lactylation, and glutathione reductase 2 Arrhythmia 2 Sinoatrial node/arrhythmia/atrial fibrillation Calbindin 1 Hippo, LCR, Herg/PATL1, KCNQ1 gating characteristics, and neutrophil extracellular trap 3 Cardiomyopathy (hypertrophic cardiomyopathy and dilated cardiomyopathy) 3 Cardiomyopathy (hypertrophic cardiomyopathy, dilated cardiomyopathy, diabetic cardiomyopathy) Gene therapy, histone-binding protein 1, ubiquitin ligase, and glycosylation Cannabinoid receptor 2, Jmjd4, Dectin-1 macrophage, single-cell sequencing, Kaposi's sarcoma-associated herpesvirus infection, Schisandra chinensis, mitochondrial function, gene therapy, metformin, and Ago2 4 Arterial dissection/aneurysm 4 Arterial dissection/aneurysm Erythropoietin, MALAT1, regulatory T cells, naringenin, Lgmn gene, succinic acid, and NR1D1 gene Best3, and endothelial tight junction 5 Atherosclerosis 5 Atherosclerosis S-adenosyl-L-cysteine, deubiquitinating enzyme USP9X, transcription factor BACH1, CTH/H2S, coagulation factor prekallikrein, YAP-TGF-β, PCSK9, PGC-1α, liver-derived angiotensinogen, shear stress, non-coding RNA, nuclear factor of activated T-cells c3, gut microbiota, autophagy, and nitric oxide synthase Cholesterol, gut microbiota, APOE, eosinophil, CCL17, GMD, brown fat, ultrasound-targeted nanomedicine, plastic particles, periodontitis-atherosclerosis association, and ANGPTL8 6 Vascular injury/remodeling/regeneration/calcification 6 Vascular injury/remodeling/regeneration/calcification Mitochondrial fusion protein 2, protein tyrosine phosphatase, tetrahydrobiopterin, matrix protein Nidogen-2, FcγRIIB, shear force, endothelial-mesenchymal transition (brain), heart valve, transcriptional mediator Med23, fibronectin FNDC5, and phospholipid small molecule LPA2 Nidogen-2, LncRNA (PSR), PHCDH, bile acid-FXR axis, endothelin, fish oil, Sema34, ferroptosis, and Sirtuin 2 7 Pulmonary hypertension miRNA-182, statins 7 Hypertension OVGP1 methylation and lymphangiogenesis-blood pressure 8 Others
Lineage tracing, cardiovascular events8 Others
Lineage tracing, platelets, heart transplantation, cardio-oncology, cardiorenal interaction, CIB2, cardiac imaging, stem cell related, PTBP1, heart development, mitochondrial disease model, anti-postoperative adhesion (Jaus gel), and myocarditisNote. RNA, ribonucleic acid; MSC, mesenchymal stem cell; TRIM, tripartite motif protein; CircRNA, circular RNA; CaMKII, calcium/calmodulin-dependent protein kinase II; LARP, La-related protein; FNDC5, fibronectin type III domain-containing protein 5; PUFA, polyunsaturated fatty acid; LSD1, Lysine-specific demethylase 1; PDCD5, programmed cell death molecule 5; DUSP6, dual specificity phosphatase 6; TREM2, microglial receptor-adaptor complex; MMPP, magnetic resonance imaging melanin nanoparticles; TRPC, canonical transient receptor potential; MRPS5, mitochondrial ribosomal protein S5; HIPK1, homeodomain-interacting protein kinase 1; ACADL, long-chain acyl-CoA dehydrogenase; MALAT1, metastasis-associated lung adenocarcinoma transcript 1; USP9X, ubiquitin-specific protease 9X; CTH, cystathionine-γ-lyase; H2S, hydrogen sulfide; YAP, Yes-associated protein; TGF-β, transforming growth factor-β; PCSK9, proprotein convertase subtilisin/kexin type 9; PGC-1α, peroxisome proliferator-activated receptor γ coactivator-1α; LCR, Local calcium release; FcγRIIB, Receptor IIB for the Fc portion of immunoglobulin G; LPA, lysophosphatidic acid; miRNA: microRNA; GMD, Nyingchi derivative; CCL17, CC motif chemokine ligand 17; ANGPTL8, angiopoietin-like protein 8; FXR, farnesoid X receptor; PHCDH, Phosphoglycerate dehydrogenase; Sirtuin 2, Sirtuin 2; LncRNA, Long non-coding RNA; OVGP1, oviductal glycoprotein 1; PTBP1, polypyrimidine tract-binding protein 1; CIB2, calcium and integrin-binding protein 2. CHD, coronary heart disease. -
In recent years, research in the field of cardiovascular diseases in China has advanced considerably, with continuous improvement in both quantity and quality. Currently, the number of papers in the field of cardiovascular diseases in China ranks second globally, second only to the United States. Since 2018, the growth rate of paper numbers has exceeded that of the United States. The most active subspecialties include CHD, hypertension, arrhythmia, and HF. Among them, the number of papers on CHD and hypertension has exceeded that of the United States.
In 2022, 14 clinical research articles were published in the six comprehensive medical journals with the highest impact and four cardiovascular journals. The most common type of study was randomized controlled clinical trials, followed by large prospective cohort studies. This reflects that the focus of clinical researchers in China has shifted from understanding the laws of disease development to scientifically evaluating the effects of interventional measures. The intervention measures evaluated in these studies were treatment plans proposed based on clinical practice or disease prevention measures proposed based on China’s national conditions.
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From August 5, 2022 to July 31, 2023, the National Medical Products Administration approved a total of 68 medical devices to enter the review channel for innovative medical devices. Among them, 42 were cardiovascular products, indicating that innovation in the cardiovascular field played a dominant role in China’s medical device innovation field, accounting for 61.5%. There were 67 domestic original products, accounting for 98.5% of the new medical devices.
During the same period, the National Medical Products Administration approved a total of 196 registration certificates for Class III medical devices in the cardiovascular field. Among them, 156 are domestic products, and 4 products have entered the review channel for national innovative medical devices. Among these 156 domestic products, 125 were interventional products, 4 were imaging products, 6 were blood flow measurement systems, 4 were open surgery products, 3 were active surgery products, 6 were artificial intelligence software products, and 8 were diagnostic products.
doi: 10.3967/bes2024.162
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Abstract: Since 1990, China has made considerable progress in resolving the problem of “treatment difficulty” of cardiovascular diseases (CVD). The prevalent unhealthy lifestyle among Chinese residents has exposed a massive proportion of the population to CVD risk factors, and this situation is further worsened due to the accelerated aging population in China. CVD remains one of the greatest threats to the health of Chinese residents. In terms of the proportions of disease mortality among urban and rural residents in China, CVD has persistently ranked first. In 2021, CVD accounted for 48.98% and 47.35% of deaths in rural and urban areas, respectively. Two out of every five deaths can be attributed to CVD. To implement a national policy “focusing on the primary health institute and emphasizing prevention” and truly achieve a shift of CVD prevention and treatment from hospitals to communities, the National Center for Cardiovascular Diseases has organized experts from relevant fields across China to compile the “Report on Cardiovascular Health and Diseases in China” annually since 2005. The 2024 report is established based on representative, published, and high-quality big-data research results from cross-sectional and cohort population epidemiological surveys, randomized controlled clinical trials, large sample registry studies, and typical community prevention and treatment cases, along with data from some projects undertaken by the National Center for Cardiovascular Diseases. These firsthand data not only enrich the content of the current report but also provide a more timely and comprehensive reflection of the status of CVD prevention and treatment in China.
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Key words:
- Cardiovascular disease /
- Risk factor /
- Prevalence /
- Mortality /
- Rehabilitation /
- Basic research /
- Medical device development /
- Health economics
注释:1) Conflicts of interest: -
Figure 10. Detection rates and predicted detection rates of overweight/obesity and obesity among children and adolescents aged 7–18 years in China from 1985 to 2019 and predicted detection rates. The “BMI Classification Standard for Screening Overweight and Obesity among School-aged Children and Adolescents in China”, established by the Working Group on Obesity in China, is utilized for determining overweight and obesity. BMI, body mass index.
Figure 11. The rates of overweight (A), obesity (B), and central obesity (C) among residents of different sexes and ages in China from 2020 to 2022. Overweight and obesity are determined based on Chinese criteria (Overweight: 24 kg/m2 ≤ BMI < 28 kg/m2; Obesity: BMI ≥ 28 kg/m2. Central obesity: Male waist circumference > 90 cm and female waist circumference > 85 cm). BMI: body mass index.
Figure 14. Prevalence of different types of dyslipidemia among Chinese adults.
CCDRFS, China Chronic Disease and Risk Factors Surveillance; CANCDS, Chinese Adults Nutrition and Chronic Diseases Surveillance; China-PEACE MPP, China-PEACE Million Persons Project; CNSSPP, China Stroke Screening and Prevention Project. TC, Total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, High-density lipoprotein cholesterol; TG, triglyceride.
Figure 32. Comorbidities in patients with HF (A) and proportion of surgeries and procedures performed during hospitalization (B). HF, heart failure; COPD, chronic obstructive pulmonary disease; IABP, intra-aortic balloon pump; CRT, cardiac resynchronization therapy; ICD, implantable cardioverter-defibrillator; ECMO, extracorporeal membrane oxygenation.
Figure 33. Comparison of the standardized treatment of HF between the China-HF study and the American GWTG-HF study. China-HF study, China Heart Failure Registry Study; GWTG-HF study, Get with the Guidelines-Heart Failure Registry Study; RAS, renin-angiotensin system; ICD, Implantable cardioverter-defibrillator; CRT, cardiac resynchronization therapy; LVEF, left ventricular ejection fraction. *In the GWTG-HF study, patients with missing LVEF data were excluded during enrollment. Therefore, the rate of ultrasound assessment of cardiac function in the GWTG-HF study is 100%. #In the China-HF study, this value refers to the implantation rate of ICD/CRT, while in the GWTG-HF study, it refers to the implantation or recommended implantation rate of ICD/CRT.
Figure 41. Trend of discharge person-times of patients with cardiovascular and cerebrovascular diseases in China from 1980 to 2021. Cardiovascular and cerebrovascular diseases include IHD (angina pectoris, AMI, and other IHDs), chronic rheumatic heart disease, acute rheumatic fever, pulmonary embolism, arrhythmia, HF, hypertension (including hypertensive heart disease and kidney disease), and cerebrovascular disease (including cerebral hemorrhage and cerebral infarction). Chronic rheumatic heart disease is not included in 2021. AMI, acute myocardial infarction. IHD, ischemic heart disease
Table 1. Survey results on the prevalence of hypertension in China from 1958 to 2022
Study name Year Age (years old) Sampling method Sample size (number of individuals) Prevalence (%) Key project of Chinese Academy of Medical Sciences: Hypertension Research 1958–1959 ≥ 15 Non-random sampling 739,204 5.1 National Hypertension Sampling Survey 1979–1980 ≥ 15 Random sampling 4,012,128 7.7 National Hypertension Sampling Survey 1991 ≥ 15 Stratified random sampling 950,356 13.6 China Health and Nutrition Survey 2002 ≥ 18 Multi-stage stratified cluster random sampling 272,023 18.8 Chinese Residents Nutrition and Chronic Diseases Survey 2012 ≥ 18 Multi-stage stratified random sampling − 25.2 China Hypertension Survey 2012–2015 ≥ 18 Multi-stage stratified random sampling 451,755 27.9 (weighted rate 23.2) China Health and Nutrition Survey 2015 ≥ 20–79 Multi-stage stratified cluster random sampling 8,907 34.1 (standardized rate 25.6) China Chronic Disease and Risk Factor Surveillance 2018 ≥ 18 Multi-stage stratified cluster random sampling 179,873 27.5 (weighted rate) Chinese Residents CVD and Its Risk Factors Surveillance 2020–2022 ≥ 18 Multi-stage stratified cluster random sampling 298,438 31.6 (weighted rate) Note. −: No specific data. Table 2. Awareness, treatment, and control rates of hypertension in various studies in China
Study name Year Age (years) Sampling method Sample size (number of individuals) Awareness rate (%) Prevalence (%) Control rate (%) National Hypertension Sampling Survey 1991 ≥ 15 Multi-level random sampling 950,356 27.0 12.0 3.0 China Health and Nutrition Survey 2002 ≥ 18 Multi-stage stratified cluster random sampling 272,023 30.2 24.7 6.1 Chinese Residents Nutrition and Chronic Diseases Survey 2012 ≥ 18 Multi-stage stratified random sampling − 46.5 41.1 13.8 China Nutrition and Health Surveillance 2010–2012 ≥ 18 Multi-stage stratified cluster random sampling 120,428 46.5 41.1 14.6 Investigation of the prevalence, awareness, treatment, and control rates of hypertension in the Chinese working population 2012–2013 18–60 Multi-stage cluster sampling 37,856 57.6
(standardized rate 47.8)30.5
(standardized rate 20.6)11.2
(standardized rate 8.5)China Hypertension Survey 2012–2015 ≥ 18 Multi-stage stratified random sampling 451,755 51.6
(weighted rate 46.9)45.8
(weighted rate 40.7)16.8
(weighted rate 15.3)Early screening and comprehensive intervention program for high-risk groups of cardiovascular disease in China 2014 35–75 Convenience sampling 640,539 46.5 (standardized rate) 38.1 (standardized rate) 11.1 (standardized rate) China Health and Nutrition Survey 2015 20–79 Multi-stage stratified cluster random sampling 8,907 43.8 (standardized rate 27.2) 39.2 (standardized rate 23.6) 13.8 (standardized rate 8.4) China Chronic Disease and Risk Factor Surveillance 2018 ≥ 18 Multi-stage stratified cluster random sampling 179,873 41.0 (weighted rate) 34.9 (weighted rate) 11.0 (weighted rate) Chinese Residents CVD and Its Risk Factors Surveillance 2020–2022 ≥ 18 Multi-stage stratified cluster random sampling 298,438 43.3 (weighted rate) 38.7 (weighted rate) 12.9 (weighted rate) Note. −: No specific data. Table 3. Summary of cardiovascular research progress in 2022–2023
August 2021 to August 2022 (74 articles) August 2022 to October 2023 (97 articles) 1 CHD, heart injury/remodeling/regeneration 1 CHD, heart injury/remodeling/regeneration Non-coding RNA, MSC transplantation, TRIM16, macrophages, brown fat exosomes, CaMKII-δ, tyrosine-protein kinase, obesity, histone-binding protein 2, immunoglobulin E, epigenetics, LARP7, PTPMT1, GSDMD, LSD1, liver-heart axis, sodium channel inhibitor, phosphodiesterase 4B, RalGAPα1-RalA signaling axis, pioglitazone, and cardiolipin. CircRNA (Samd4), lysine crotonylation, LPA, FNDC5, PUFA, USP25 (deubiquitination), Fap, PIASy, ketone body, MG53, 3D printing, PDCD5, small molecule inhibitor s89, METTL14, DUSP6, TREM2, MMPP, TRPC, single cell, MRPS5, HIPK1, ACADL, FOXP1, cardiac patch, exosome, cell transplantation therapy, optogenetics, Tisp40, M2 macrophage, APOE, RNF27, ABRO1, gut microbiota, BACH1, TMEM, α-myosin heavy chain lactylation, and glutathione reductase 2 Arrhythmia 2 Sinoatrial node/arrhythmia/atrial fibrillation Calbindin 1 Hippo, LCR, Herg/PATL1, KCNQ1 gating characteristics, and neutrophil extracellular trap 3 Cardiomyopathy (hypertrophic cardiomyopathy and dilated cardiomyopathy) 3 Cardiomyopathy (hypertrophic cardiomyopathy, dilated cardiomyopathy, diabetic cardiomyopathy) Gene therapy, histone-binding protein 1, ubiquitin ligase, and glycosylation Cannabinoid receptor 2, Jmjd4, Dectin-1 macrophage, single-cell sequencing, Kaposi's sarcoma-associated herpesvirus infection, Schisandra chinensis, mitochondrial function, gene therapy, metformin, and Ago2 4 Arterial dissection/aneurysm 4 Arterial dissection/aneurysm Erythropoietin, MALAT1, regulatory T cells, naringenin, Lgmn gene, succinic acid, and NR1D1 gene Best3, and endothelial tight junction 5 Atherosclerosis 5 Atherosclerosis S-adenosyl-L-cysteine, deubiquitinating enzyme USP9X, transcription factor BACH1, CTH/H2S, coagulation factor prekallikrein, YAP-TGF-β, PCSK9, PGC-1α, liver-derived angiotensinogen, shear stress, non-coding RNA, nuclear factor of activated T-cells c3, gut microbiota, autophagy, and nitric oxide synthase Cholesterol, gut microbiota, APOE, eosinophil, CCL17, GMD, brown fat, ultrasound-targeted nanomedicine, plastic particles, periodontitis-atherosclerosis association, and ANGPTL8 6 Vascular injury/remodeling/regeneration/calcification 6 Vascular injury/remodeling/regeneration/calcification Mitochondrial fusion protein 2, protein tyrosine phosphatase, tetrahydrobiopterin, matrix protein Nidogen-2, FcγRIIB, shear force, endothelial-mesenchymal transition (brain), heart valve, transcriptional mediator Med23, fibronectin FNDC5, and phospholipid small molecule LPA2 Nidogen-2, LncRNA (PSR), PHCDH, bile acid-FXR axis, endothelin, fish oil, Sema34, ferroptosis, and Sirtuin 2 7 Pulmonary hypertension miRNA-182, statins 7 Hypertension OVGP1 methylation and lymphangiogenesis-blood pressure 8 Others
Lineage tracing, cardiovascular events8 Others
Lineage tracing, platelets, heart transplantation, cardio-oncology, cardiorenal interaction, CIB2, cardiac imaging, stem cell related, PTBP1, heart development, mitochondrial disease model, anti-postoperative adhesion (Jaus gel), and myocarditisNote. RNA, ribonucleic acid; MSC, mesenchymal stem cell; TRIM, tripartite motif protein; CircRNA, circular RNA; CaMKII, calcium/calmodulin-dependent protein kinase II; LARP, La-related protein; FNDC5, fibronectin type III domain-containing protein 5; PUFA, polyunsaturated fatty acid; LSD1, Lysine-specific demethylase 1; PDCD5, programmed cell death molecule 5; DUSP6, dual specificity phosphatase 6; TREM2, microglial receptor-adaptor complex; MMPP, magnetic resonance imaging melanin nanoparticles; TRPC, canonical transient receptor potential; MRPS5, mitochondrial ribosomal protein S5; HIPK1, homeodomain-interacting protein kinase 1; ACADL, long-chain acyl-CoA dehydrogenase; MALAT1, metastasis-associated lung adenocarcinoma transcript 1; USP9X, ubiquitin-specific protease 9X; CTH, cystathionine-γ-lyase; H2S, hydrogen sulfide; YAP, Yes-associated protein; TGF-β, transforming growth factor-β; PCSK9, proprotein convertase subtilisin/kexin type 9; PGC-1α, peroxisome proliferator-activated receptor γ coactivator-1α; LCR, Local calcium release; FcγRIIB, Receptor IIB for the Fc portion of immunoglobulin G; LPA, lysophosphatidic acid; miRNA: microRNA; GMD, Nyingchi derivative; CCL17, CC motif chemokine ligand 17; ANGPTL8, angiopoietin-like protein 8; FXR, farnesoid X receptor; PHCDH, Phosphoglycerate dehydrogenase; Sirtuin 2, Sirtuin 2; LncRNA, Long non-coding RNA; OVGP1, oviductal glycoprotein 1; PTBP1, polypyrimidine tract-binding protein 1; CIB2, calcium and integrin-binding protein 2. CHD, coronary heart disease. -
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