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Epidemiology of Cardiovascular Disease in China

Epidemiology of Cardiovascular Disease in China. Prof. Lu Guoping, Ruijin Hospital Affiliated to Shanghai Jiaotong University. Introduction. Chief physician, professor, doctoral supervisor, director of cardiology department

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Epidemiology of Cardiovascular Disease in China

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  1. Epidemiology of Cardiovascular Disease in China Prof. Lu Guoping, Ruijin Hospital Affiliated to Shanghai Jiaotong University

  2. Introduction Chief physician, professor, doctoral supervisor, director of cardiology department Concurrent academic posts: member of the Chinese Medical Association Atherosclerosis and Coronary Artery Disease Group, Standing Committee Member of the Collateral Disease Branch of China Association of Chinese Medicine, evaluation expert of the National Continuation Education Project, deputy director of the Shanghai Medical Association Cardiology Committee, head of the Atherosclerosis Group. Prof. Lu Guoping

  3. Contents 1. Prevalence, mortality and recurrence rate of CVD in China 2. Burden of CVD in China 3. Risk factors of CVD in China 4. Treatment of CVD in China 5. Prevention of CVD in China

  4. Prevalence of CVD in China We are facing the great challenge of CVD! Heart failure 4.5million Pulmonary heart disease5 million Rheumatic heart disease2.5 million HTN0.27 billion Stroke7million MI2.5 million Congenital heart disease 2 million CVD patient No. 0.29 billion 1 in5adultsis suffering from CVD, and the prevalence rate is increasing! Reports on Cardiovascular Diseases in China (2013)

  5. Prevalence of CVD in China Growth trend of stroke patients Stroke Prevalence rate is rising; 1.5-2 million new cases each year; More serious in urban areas; Ischemic stroke 66.4%, cerebral hemorrhage 23.4%. Coronary Heart Disease Prevalence rate 1.5%, 20 million patients. Heart Failure Prevalence rate 0.9%; Lower in male than in female (0.7% VS 1.0%); Lower in rural areas than in urban areas (0.8% VS 1.1%). Cardiac Death Prevalence rate 4.18 per million, 544 thousand cases each year; Higher in male than in female (4.46 VS 3.90 per million); Reports on Cardiovascular Diseases in China (2013)

  6. PCI cases in China from 2009 to 2013 Clinic: BIG DATA ERA OF PCI IN CHINA

  7. Mortality of CVD in China CVD is the current leading cause of death both in urban and rural areas of China, 1 death per second on average. Since 2009, the increase of death from CVD has slowed down, with a tendency of plateauing. The mortality of CVD in 2012 is 25.5 per million! Reports on Cardiovascular Diseases in China (2013)

  8. CVD in China – mortality of coronary heart disease The mortalities of coronary heart disease and of MI are both increasing in China; the mortality of coronary heart disease is higher in urban areas 1. • The mortality of coronary heart disease in the US reached the inflection point in 1970s; the UK also realized its target of reducing the mortality of CVD patients under the age of 75 by 40% 5 years ahead of schedual2. Target : reducing the mortality of CVD by 40%：(baseline:1995-97) inflection point ! 5 years ahead of schedule mortality/100 thousand mortality/100 thousand year NHLBI Chartbook 2007 baseline Progress target 1:Reports on Cardiovascular Diseases in China (2013) 2.OECD Health Data 2011 (June 2011).

  9. CVD in China – mortality of stroke (n/100 thousand) • The National Survey on Death Causes showed that CVD had become the leading cause of death. • Deaths caused by stroke increase year by year, from 1.34 million in 1990 to 1.73 million in 2010 2 • From 2003 -2011, the mortality rate of cerebrovascular in rural areas is higher than that in cities (12.54/million VS 13.67/million) 3 • The disability rate, mortality and recurrence rate all increase with age. The Third National Survey on Death Causes 1 1.Natinal survey on death causes, 2008，People's Medical Publishing House 2.Global burden on diseases study 2010 (China) 3.China’s Health Statistics Yearbook 2012

  10. Recurrence rate of stroke With HTN group Without HTN group With HTN group Without HTN group Of 11,560 ischemic stroke patients, the recurrence rates within 1 year of 8409 (72.7%) with hypertension and of 2050 (17.7%) without hypertension are 18.0% and 17.0%, respectively ( P=0.21). Stroke. 2013;44:1232-1237

  11. Contents 1. Prevalence, mortality and recurrence rate of CVD in China 2. Burden of CVD in China 3. Risk factors of CVD in China 4. Treatment of CVD in China 5. Prevention of CVD in China

  12. Economic Burden of CVD in China YLLS led by 21 causes grouped by age in China (A) 1990. (B) 2010 1 YLLS(million) YLL (million) • From 1990-2010, CVD is the main cause of YLLS in China. • Compared to 1990, the YLLS caused by CVD in the elderly group increased in 2010, reaching the peak in the 55-59 age group. Lancet 2013;381:1987-2015

  13. Economic Burden of CVD in China Chronic disease brought huge economic losses From 2010 to the next 30 years, if the mortality of CVD reduces by 1% each year, the overall economic benefit is equal to 68% of the real Chinese GDP in 2010, or 10.7 trillion dollars! Three scenarios of CVD mortality in labor age population1 The simulated growth trend of GDP per capita 2 心血管病死亡率/每10万人口，（16-45岁 人均GDP 1,2: World Bank Report on China, 2011

  14. Contents 1. Prevalence, mortality and recurrence rate of CVD in China 2. Burden of CVD in China 3. Risk factors of CVD in China 4. Treatment of CVD in China 5. Prevention of CVD in China

  15. Hyperlipidaemia Diabetes Hypertension Controllable risk factors Overweight and obesity Smoke Main Risk factors of CVD in China

  16. Risk factors of CVD in China A large-scale epidemiological study of global trends in systolic blood pressure and serum total cholesterol involving adults aged 25 and above in 199 countries and regions from 1980 to 2008

  17. Trend in blood pressure: The decline trend in blood pressure in the East Asia is consistent with that in the Globe Male Female East Asia East Asia Every 10 years ↓ 0.3mmHg Every 10 years↓ 0.5mmHg Globe Globe Lancet 2011; 377: 568–77

  18. Trend in BMI:The increase trend in BMI in the East Asia is consistent with that in the Globe Male Female East Asia East Asia Globe Globe Every 10 years ↑ 0.4kg/m2 Every 10 years ↑ 0.5kg/m2 BMI: Body Mass Index Lancet 2011; 377: 557–567

  19. Trend in serum total cholesterol: The trend in serum total cholesterol in the East Asia is contrary to that in the Globe Male Female Every 10 years ↑ 0.09mmol/L Every 10 years ↑ 0.08mmol/L East Asia/South East Asia/Pacific regions East Asia/South East Asia/Pacific regions Globe Globe Lancet 2011; 377: 578–86

  20. Proportion and clinical diagnosis of PCI cases with clinical risk factors in China in 2013 Clinic: BIG DATA ERA OF PCI IN CHINA

  21. 2012: lipid situation of Chinese adults is more serious (Age-standardized level, 2007-2008) 31.5% 308 196 20.4% * Including people taking lipid-lowering drugs Yang WY, et al., Circulation 2012;125:2212-2221

  22. In China, nearly 80% dyslipidemia patients LDL-C＜130mg/dl 2007-2008National Survey on Diabetes and Metabolic Disorders Circulation. 2012;125(18):2212-21. -22-

  23. Change of risk factors of MI in Beijing from 1991 to 2010 Change of risk factors of MI in Beijing from 1991 to 20101 From 1991 to 2010, risk factors of MI such as diabetes, hypertension, hypercholesterolemia, and smoke havechanged: Prevalence of hypertension increased from 40.8% to 55.6% in male, from 58.0% to 69% in female; Prevalence of diabetes increasedfrom 12.9% to 30.8% in male, from 23.0% to 42.3% in female; Prevalence of hypercholesterolemia decreasedfrom 53.1% to 30.7% in male, from 57.0% to 44.0% in female; Prevalence of smoke decreased from 29.0% to 11.1% in female, and did not change in male. 1Chin Med J 2013;126 (22)

  24. Awareness, treatment and control rates of dyslipidemia Awareness, treatment and control rates of total cholesterol and high LDL hyperlipidemia among Chinese people aged 20 and above Circulation. 2012; 125: 2212-2221

  25. The huge difference in the prevention and treatment of dyslipidemia and hypertension between China and the US China1, 2 USA3 Dyslipidemia （LDL-C） Morbidity Treatment rate Acknowledgement rate Treatment and control rate Hypertension Morbidity Treatment rate Acknowledgement rate Treatment and control rate 1. Yang WY, et al., Circulation 2012;125:2212-2221 2. A description on the Chinese national nutrition and health survey in 2002 3. Circulation. 2012;125:e2-e220

  26. With the increase of risk categories, the LDL-C control rate of Chinese outpatients significantly reduced • REALITY-CHINA included 12,244 outpatients at 84 centers in 19 provinces to evaluate the LDL-C coincidence rate (according to ATPIII), indicating the existing situation of hyperlipidemia in China. REALITY-China investigation of existing situation of hyperlipidaemia in China （n=12,244） # The high risk patient here is defined according to the ATPIII, which should be the very high risk patient according to the 2011 ESC/EAS. Zhou YJ, et al. Presented at 2012 ACC.

  27. Method（1） DYSIS-China • Primary objective: • To investigate the achievement rate of serum lipid and lipid-modifying drug treatment status in the patients aged 45 and above who have taken lipid-lowering drugs for at least 3 months • Data collection: • Demographic data • serum lipid parameters: TC, TG, LDL-C, HDL-C • Risk factors: hypertension, diabetes, smoke, alcohol consumption, obesity, and sedentary lifestyle • Use of lipid-lowering drugs • Study scale: • 25,000 patients • 6districts • 122hospitals • Involving departments of cardiology, endocrinology, neurology, geriatric, Internal medicine, etc. Data on file Prospective、cross-section study

  28. Northeast：4559 • Tier 1 954 • Tier 2 1049 • Tier 32577 Method（2） DYSIS-China Northwest: 3931 • Tier 1 1134 • Tier 2 1130 • Tier 3 1680 North：4451 • Tier 1 971 • Tier 2 1028 • Tier 3 2474 Distribution of enrolled subjects East：4245 • Tier 1 969 • Tier 2 989 • Tier 32297 South：4086 • Tier 1 1078 • Tier 2 1003 • Tier 3 2012 Conducted in 200 clinical departments at 122 hospitals in 27 provinces, which include different titer hospitals Planned 25000 patients, 25317 patients included in reality Northwest：4045 • Tier 1 1005 • Tier 2 1197 • Tier 3 1874 Data on file

  29. Method（3） DYSIS-China Inclusion criteria Outpatients aged 45 or older; Patients taking at least one kind of lipid-lowering drugs; Patients who had documented fasting lipid profile during the previous 6 months performed after drug therapy for at least 3 months Patients who are willing to sign informed consent *patients who begin to take lipid-lowering drugs when visited should not be included. Exclusion criteria Patients currently participating in other clinical trials. Data on file

  30. Control of lipid in China over the recent decade: the overall LDL-C achievement rate has been increased, but it is still poor in the very high risk population. Resutls comparison between the DYSIS-China (subgroup of Tier 3 hospitals) and the second national survey on dyslipidemia. Very high risk patients High risk patients Moderate risk patients Low risk patients Overall patients The Second national survey on DYS DYSIS study for Tier 3 hosp.

  31. DYSIS-China: with hospitals level lowering, the achievement rate decreased • According to the 2007 China guideline on lipid management, the control rate of patients in different level hospitals are significantly different. Patients in the Tier 3 hospitals have the highest control rate, while patients in Tier 1 hospitals have the lowest control rates. P<0.0001 P<0.0001 Control Rate Tier 1 Tier 2 Tier 3 Data on file

  32. DYSIS-China: patients in endocrinology department have the lowest control rate Geriatric 68.1% Endocrinology 50.4% Internal medicine 54.5% • When analyzed the control rate of patients from different department, patients in endocrinology have the lowest control rate (50.4% according to the 2007 China guidelines) Control rate of patients in different departments Others 69.0% Neurology 60.6% Cardiology 69.6% Data on file

  33. Contents 1. Prevalence, mortality and recurrence rate of CVD in China 2. Burden of CVD in China 3. Risk factors of CVD in China 4. Treatment of CVD in China 5. Prevention of CVD in China

  34. Treatment of CVD in China Proportion of patients taking drugs in countries with different levels of income 1 Use of three drug against CHD in different countries and regions 2 China 80.2% 69.3% Patient proportion % 45.1% 11.2% Up to 69.3% of patients with CHD in China have not taken any effective drugs; The use rate of statin is only 2.0% in China, lower than that of other drugs, and much lower than that in other countries and regions. 1&2：Lancet 2011; 378: 1231–43

  35. Treatment of CVD in China Proportions of patients taking statin in different risk stratifications of heart affairs in the US between 1999 and 2008 according to the risks of heart 1 Proportions of CHD and stroke patients taking statin in different countries and regions2 1.October 2012 31 : 10 Health Affairs 2.Lancet. 2011 online; ESC 2011, Paris

  36. Treatment of CVD in China Statin Anti-platelet drugs The proportion of CVD patients taking drugs declines as the years after diagnosis increases; The proportion of patients taking statin declines the most. Proportion ACEI or ARB Β receptor blocker Proportion Year after diagnosis Year after diagnosis Lancet 2011; 378: 1231–43

  37. Proportions of lipid-lowering drugs taken by patients in different risk Data on file

  38. Contents 1. Prevalence, mortality and recurrence rate of CVD in China 2. Burden of CVD in China 3. Risk factors of CVD in China 4. Treatment of CVD in China 5. Prevention of CVD in China

  39. Duties and missions of cardiologists Management of multiple risk factors and control of the morbidity and mortalityof CVD Secondary prevention Primary prevention For CVD patients with or without atherosclerosis, strengthening treatment to control multiple risk factors, prevent the recurrence of CVD events and lower the mortality Taking preventive measures to control risk factors and prevent CVD events

  40. Cardiologists should act as leader in chronic disease prevention and control

  41. 5.18 Vascular Health Day and Chinese Heart Day One World, One Home, One HeartHealthy heart starting from family Alert to vascular plaque

  42. Cardiologists should act as leader in chronic disease prevention and control

  43. Lipid risk stratification practical action Lipid risk stratification practical action

  44. Promote the hierarchial concept and guideline practice Moderate risk LDL-C＜3.37mmol/L(130mg/dL) High risk LDL-C LDL-C＜2.59mmol/L(100mg/dL) Extremely high risk LDL-C＜2.07mmol/L(80mg/dL) Note: high risk: CHD, Stroke/TIA, DM, HTN+≧ 3 RFTs, CKD (1-4 degree) Extremely high risk:ACS, CHD/Stroke+DM

  45. Smoking control and glucose management Putting prevention first in the practical work Early detection of CHD patients with hypertension

  46. Cardiologists should act as leader in chronic disease prevention and control

  47. Single-disease Quality Control Improving the diagnosis and treatment of specific diseases (such as AMI), and promote better clinical results (control rate, cure rate, patient satisfaction, etc.) ACS Quality Control Hyperlipidemia quality control Quality control of blood pressure Progress of the pilot project of the quality evaluation of ACS treatment and diagnosis: 2012.10-11 2012.8-10 2012.12 2012.7-8 2012.10-11 2012.11-12 • discussion of indictors • draft of CRF • Data acquisition system for single diseases • Software system of quality control work station Design of data interface • design of new medical records for pilot hospitals • appliance of new medical records Design of overall evaluation and evaluating algorithm Go-live test

  48. To improve the diagnosis rate and treatment rate of CVD——we are always on the move! Hope that we can soon bend the Curve of the mortality of CVD in China! Thank you!

  49. Change of risk factors of MI in Beijing from 1991 to 2010 Risk factors of MI in Beijing from 1991 to 20102 The proportion of patients with more than three risk factors increased from 19.0% to 27.1%; Although the prevalence of hypercholesterolaemia and smoke decreased, the overall prevalence of risk factors in China is still high, needing immediate intervention. The self-awareness of risk factors is deficient. A study showed that the self-awareness rates of CAD patients with hypertension, diabetes, and dyslipidemia were respectively 64.4%, 66.3%, and 28.5% 3 2Chin Med J 2013;126 (22) 3The Scientific World J 2013: 416192

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