Urgent Need for Comprehensive Management to Address Increasing Cardiovascular Disease Risks in China
A recent study, featured in BMC Public Health, has quantified the profound impact of individual and combined cardiometabolic risk factors on the incidence of cardiovascular disease (CVD) and overall mortality. This research underscores the critical need for comprehensive management strategies to address the alarming rise in CVD cases and mortality rates.
Background:
In 2020, China witnessed approximately 4.58 million deaths attributed to cardiovascular disease, reflecting a concerning trend in a nation experiencing rapid development and an aging population. Conditions closely linked to CVD, such as hypertension, diabetes, and dyslipidemia, have surged in prevalence, further exacerbating the problem.
Remarkably, around 66% of individuals with diabetes also grapple with concurrent dyslipidemia and hypertension. Previous studies have individually explored the connections between these conditions and CVD. However, there remains a notable gap in comprehensive investigations that consider their combined effects, particularly within the context of the Chinese population.
Understanding the individual and cumulative impacts of these cardiometabolic risk factors on CVD risks and overall life expectancy is crucial for shaping effective public health policies.
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The Study in Focus:
The study relied on data from the China Hypertension Survey (CHS), conducted between 2012 and 2015, which enrolled approximately half a million participants across 31 provinces. The present research specifically focused on selected cities and counties, tracking the health data of over 30,000 individuals during 2018-2019.
After excluding individuals with pre-existing CVD and incomplete records, the study’s primary analysis centered on 22,596 participants.
Cardiovascular risk factors were classified based on specific criteria, including blood pressure thresholds for hypertension, guidelines from the 2017 Chinese Diabetes Society for diabetes, and high levels of low-density lipoprotein cholesterol (LDL-C) above 4.12 mmol/L.
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Baseline data encompassed various aspects such as demographics, lifestyle factors, medical histories, physical measurements, and blood test results.
Outcomes were defined by fatal and nonfatal cardiovascular disease incidents, meticulously documented and verified using medical records. The study employed advanced statistical methods to group participants based on their cardiometabolic risk profiles.
Results:
The study began with 22,596 participants, averaging 56.2 years of age. Notably, 37.33% reported a single cardiometabolic risk factor, including hypertension, diabetes, or high LDL-C, while 8.28% had two of these factors, and 6.06% exhibited all three.
Participants with multiple risk factors tended to be older, often resided in urban eastern regions, and had a family history of cardiovascular disease. Disturbingly, as cardiometabolic health deteriorated, body mass index (BMI), fasting plasma glucose (FPG), and lipid levels increased, with individuals possessing all three risk factors showing an alarming average systolic blood pressure (SBP) of 152.7 mmHg.
Over the study period, 991 participants experienced fatal or nonfatal CVD events. Both cardiovascular disease and all-cause mortality had incidence rates of 9.48 and 10.83 per 1,000 person-years, respectively. Clearly, having one to three risk factors significantly increases the risk of CVD.
However, the study could not establish a direct correlation between isolated diabetes or high LDL-C and increased cardiovascular disease risk. Interestingly, individuals with diabetes alone faced an elevated risk of all-cause mortality, which escalated when combined with hypertension or when high LDL-C coexisted with hypertension.
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When considering non-cardiovascular deaths as competing risks, the results remained consistent. Strikingly, when applying the American Heart Association/American College of Cardiology (AHA/ACC) criteria for hypertension, individuals with one or two cardiometabolic conditions exhibited a heightened risk of stroke.
In comparison, the reference group displayed adjusted mortality and cardiovascular disease incidence rates of 9.74 and 7.31 per 1,000 person-years. Conversely, those with all three risk factors experienced rates of 22.93 and 31.48 per 1,000 person-years, respectively.
Regarding overall impact, diabetes and hypertension contributed to 2.65% and 19.35% of total CVD cases, respectively. Surprisingly, high LDL-C did not exhibit a significant association with CVD risk.
Collectively, diabetes and hypertension accounted for 5.08% and 10.85% of all-cause mortality. Furthermore, the combined influence of hypertension and diabetes was responsible for 21.48% of CVD cases and 15.38% of all-cause deaths.
In age-based predictions, individuals aged 40 to 60 with all three cardiometabolic risk factors anticipated developing CVD approximately 3.1 years earlier than their healthier counterparts. The disparity in CVD-free years diminished for those over 60 with these conditions.
Alarming findings emerged for individuals aged over 75, where these factors had minimal impact on cardiovascular disease-free years. Moreover, by the age of 40, individuals with all three disorders experienced a notable reduction in life expectancy, with a loss of approximately 4.3 years.
Conclusions:
This study highlights that individuals with cardiometabolic disorders like diabetes, hypertension, or high LDL-C face significantly heightened risks of cardiovascular disease and all-cause mortality. The combined impact of diabetes and hypertension alone accounted for 21.48% of CVD cases.
For those aged 40 to 60, these risk factors substantially reduce -free years and overall life expectancy. Despite the well-documented risks, many individuals in China continue to struggle with managing these conditions simultaneously.
The study underscores the urgent need for integrated health management in China and emphasizes the importance of primary prevention, promoting healthier lifestyles to mitigate CVD risks, particularly for those under 65.
