Cardiovascular diseases

The situation in China

  • According to official data, in China, about 230 million people have cardiovascular disease.1
  • One in 5 adults in the China has a cardiovascular disease.
  • In 2010, 154.8 per 100,000 deaths per year are estimated to be associated with cardiovascular diseases in urban areas and 163.1 per 100,000 in rural areas.
  • This number accounts for 20.9% /17.9% (urban/rural) of China's total number of deaths per year.2

Cardiovascular disease predicted to increase in China

Projected annual cardiovascular events are predicted to increase by 50% between 2010 and 2030 based on population aging and growth alone in China. Projected trends in blood pressure, total cholesterol, diabetes (increases), and active smoking (decline) would increase annual cardiovascular disease events by an additional 23%, an increase of approximately 21.3 million cardiovascular events and 7.7 million cardiovascular deaths.

Modifiable risk factors include cholesterol, blood pressure, weight, and smoking

Risk factors for cardiovascular disease include the following, which can be modified (changed) with behavior:

  • Hypertension (high blood pressure)
  • Tobacco use
  • Raised blood glucose (diabetes)
  • Physical inactivity
  • Unhealthy diet
  • Cholesterol/lipids
  • Overweight and obesity

Non-modifiable Risk factors for cardiovascular disease

Important, non-modifiable risk factors for cardiovascular disease include the following:

  • Age
  • Gender
  • Family history of cardiovascular disease

Expense of cardiovascular disease in China

A study published by authors from the National Center For Cardiovascular Diseases and the Ministry of Health of the People’ Republic of China showed that in 2008, the cost of a hospitalization associated with a heart attack (myocardial infarction) was 12,566 RMB, representing a 9.7% annual increase since 2004.

Urbanization and cardiovascular disease

In 2012, the World Heart Federation (WHF) published a report on urbanization and cardiovascular disease. CVD continues to be the leading cause of death worldwide, and places a massive socioeconomic burden on individuals and societies, particularly in low and middle-income countries, where urbanization is continuing to occur rapidly. City living can impose certain limitations on the way in which people live, and restricts their opportunities to be healthy. Informed action by governments and other stakeholders has been shown to dramatically reduce the level of CVD risk.

Based on the report conclusions, the WHF is calling for improved prevention of CVD via what the report’s authors have termed the ‘S.P.A.C.E’ approach: Stakeholder Collaboration; Planning Cities, Access to Healthcare; Child-focused dialogue; and, Evaluation.

Shanghai is one of seven cities described as a case-report in the publication demonstrating the tremendous growth and the negative effect it has had on cardiovascular health. However, the examples of increasing the number of playgrounds in the city and a bike-sharing program are some positive examples of reversing the trend for increasing CVDs.

To combat cardiovascular disease

A WHO partner, the World Heart Federation put out a report entitled State of the Heart to emphasize global cardiovascular disease. Highlights of the report are in the areas of policy, medicine, and science.

Policy objectives include the recognition of non-communicable diseases (NCDs) of which CVD is the number one killer, the widespread adoption of the WHO Framework Convention on Tobacco Control, which catalyzed global action towards a smoke-free world, the launch of awareness campaigns to highlight the importance of diet and physical activity on heart health, and expanded efforts by organizations to mobilize companies to invest in workplace-wellness initiatives to promote health amongst employee.

Medicine objectives were to improve recognition of the symptoms and treatment for heart attacks, introduce quality improvement programmes within hospitals, and improve public awareness of, and access to, CVD healthcare in developing countries.

Science objectives included administering statin therapy which ‘revolutionized’ the treatment of elevated cholesterol, reducing the risk of heart disease and heart attacks in people with very high cholesterol levels, the development of monitors to assist in the correct diagnosis of atrial fibrillation, and advances in diagnosing and treating congenital heart defects.

What is being done by the Chinese government about cardiovascular disease in China?

In May 2012, the Chinese Ministry of Health in conjunction with the 15 departments of the Development and Reform Commission signed the "China National Plan for NCD Prevention and Treatment (2012-2015)" which will be carried out between 2012 and 2015. In this plan, cardiovascular disease objectives are listed.

China is at the forefront in terms of plans for primary prevention. To decrease the risk factors for cardiovascular disease, there must be a focus on living a healthy lifestyle; as such, encouraging exercise and eating a healthy diet are key, which will result in a lower cholesterol level in adulthood. Cholesterol is one of the key risk factors in CVD.

One unique aspect about China's approach to NCD control is the multi-sectoral approach. Multiple departments are involved with the planning process. As far as increasing exercise, in the plan it is stated, the sports department shall implement the "Regulation on National Fitness,” and actively implement the "National Fitness Program (2011-2015)”, [to] guide and carry out mass sports activities.

For dietary change, in the plan it is stated to "provide scientific guidance for healthy diets, and actively develop and promote healthy foods with low-salt, low fat, low sugar and low calories." The agriculture department will guide the production of safe and nutritious food. The industry and information technology department will guide and support the implementation of the "General Principles for Nutrition Labeling of Prepackaged Foods." The commerce department will promote and encourage food sales businesses to establish healthy food special counters which will guide consumers to choose healthy foods.

The Ministry of Health is in the process of writing a specific action plan for cardiovascular disease, along with COPD, Cancer, Diabetes, and Behavioral risk factors. China has a registry in place for acute myocardial infarction (heart attack), which is important to track for surveillance purposes. With improved surveillance of cardiovascular and other diseases, interventions can be appropriately targeted.

WHO's response

Very cost effective interventions that are feasible to be implemented even in low resource settings have been identified by WHO for prevention and control of cardiovascular diseases.

Heart disease and stroke can be prevented through healthy diet, regular physical activity and avoiding tobacco smoke. Individuals can reduce their risk of CVDs by engaging in regular physical activity, avoiding tobacco use and second-hand tobacco smoke, choosing a diet rich in fruit and vegetables and avoiding foods that are high in fat, sugar and salt, and maintaining a healthy body weight and avoiding the harmful use of alcohol.

Comprehensive and integrated action are the means to prevent and control CVDs.

  • Comprehensive action requires combining approaches that seek to reduce the risks throughout the entire population with strategies that target individuals at high risk or with established disease.
  • Examples of population-wide interventions that can be implemented to reduce CVDs include: comprehensive tobacco control policies, taxation to reduce the intake of foods that are high in fat, sugar and salt, building walking and bicycle paths to increase physical activity, and providing healthy school meals to children.
  • Integrated approaches focus on the main common risk factors for a range of chronic diseases such as CVD, diabetes and cancer: unhealthy diet, physically inactivity and tobacco use.

There are several interventions available. Some of these interventions can be implemented even by non-physician health workers. They are very cost effective and high impact interventions and have been prioritized by WHO. For example:

  • People at high risk can be identified early in primary care, using simple tools such as specific risk prediction charts. If people are identified early, inexpensive treatment is available to prevent many heart attacks and strokes.
  • Survivors of a heart attack or stroke are at high risk of recurrences and at high risk of dying from them. The risk of a recurrence or death can be substantially lowered with a combination of drugs – statins to lower cholesterol, drugs to lower blood pressure, and aspirin.
  • In addition surgical operations are sometimes required to treat CVDs. They include coronary artery bypass, balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), valve repair and replacement, heart transplantation, and artificial heart operations.
  • Medical devices are required to treat some CVDs. Such devices include pacemakers, prosthetic valves, and patches for closing holes in the heart.

There is a need for increased government investment in prevention and early detection through national programmes aimed at prevention and control of noncommunicable diseases including CVDs.