China Facing Rising Epidemic of Heart Disease, Stroke: Why America Cares

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A 20-year rise in cardiovascular disease (CVD) in China appears to have been spurred largely by increases in high blood pressure, according to a new study from Harvard T.H. Chan School of Public Health (Boston).

Increasing body mass index (BMI), decreasing physical activity, a high prevalence of smoking, and unhealthy diet have also contributed to the growing burden of CVD–now the leading cause of death in China.

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This is the first large study to analyze a wide range of dietary, lifestyle, and metabolic risk factors that may be impacting CVD burden in China, according to the report published at the Harvard Chan School website.

The authors suggested that major changes in Chinese society–including a dramatic shift from a traditional to a more “Western” diet and lifestyle and rapid urbanization and industrialization–may have contributed to the jump in cardiovascular diseases, such as heart attack and stroke.

These changes have been accompanied by marked increases in high cholesterol, obesity, and type 2 diabetes among the Chinese population. The full study was published August 15, 2016 in the Journal of the American College of Cardiology.

“We described trends from 1991 to 2011 in dietary and other lifestyle risk factors for CVD in China and projected how these trends might play out from 2011 to 2031,” said Yanping Li, research scientist in the Department of Nutrition at Harvard Chan School and lead author of the study. “Our estimates suggest that the continued rise in high blood pressure, an increasingly sedentary lifestyle, increasing obesity, and worsening dietary trends will add millions of new cases of heart attacks and stroke over the next two decades.

The researchers analyzed data collected over a 20-year period, from 1991-2011, from 26,000 people living in nine Chinese provinces, as part of the China Health and Nutrition Survey.

They looked at 17 dietary and lifestyle risk factors that have been previously linked with heart attack and stroke–including high systolic blood pressure, high cholesterol, high blood glucose, high BMI, low physical activity, smoking, and 11 dietary factors–and analyzed that data along with information on CVD-related disease and death incidence extracted from the China Health Statistical Yearbook and the National Population Census.

The study found that high blood pressure, high cholesterol, and high blood glucose accounted for most of the CVD disease burden in China in 2011. That year, those three risk factors were associated, respectively, with 3.1, 1.4, and 0.9 million new cases of heart attack or stroke.

Of 6.8 million Chinese over age 35 who died in 2011, about 3 million of the deaths–44%–were CVD-related. The researchers estimated that high blood pressure alone was responsible for roughly 40% of heart attacks or stroke.

High blood pressure has jumped dramatically in China over the past three decades, the authors noted: In 1979, its prevalence in the population was 7.7%; by 2010 it was 33.5%–comparable to that among U.S. adults.

The study also found that decreased physical activity during the study period was associated with a 0.7 million increase in CVD cases and BMI increases were associated with a 0.6 million increase.

Although tobacco use is declining in China, a large percentage of the population still smokes (53.4% of men); the study found that, in 2011, tobacco use was associated with 1.3 million CVD-related cases–roughly a third of the CVD burden in men.

The authors also noted that while the Chinese diet has improved in certain ways–with increased consumption of fiber, fruit, nuts, and omega-3 fatty acids–dietary quality is still far short of optimal goals.

Consumption of red meat and sugary beverages is increasing. High sodium intake–which averaged 5.4g/day in 2011–was estimated to be responsible for one fifth of CVD cases in China. Both increases in high blood pressure and increases in BMI over time were more pronounced among younger people and rural residents, the authors said.

“China is facing a rising epidemic of cardiovascular disease and it shows no sign of abating,” said senior author Frank Hu, professor of nutrition and epidemiology at Harvard Chan School. “It’s imperative to continue to monitor the problem, which has serious social and economic consequences. Prevention of chronic diseases through promoting healthy diet and lifestyle should be elevated to a national public policy priority.”

Other Harvard Chan School researchers involved in the study included Dong Wang, Sylvia Ley, Yuan Lu, and Goodarz Danaei.

Steve’s Take: Are we really China’s adversary, or ally? Or both? This question deserves pages and pages of thoughtful writing, which my daily editorial tasks and deadlines don’t permit. Well, not today at least.

The question occurred to me after reading the reports of how dire that nation’s heart-disease epidemic has become, so quickly. Given the JAMA study as our context, here’s a quick take on how/why the U.S. may fairly be viewed simultaneously as foe and friend.

First: Adversaries. The legendary competitiveness of American industry and China’s race to eclipse us, or our efforts to avoid being eclipsed, is a key theme in this year’s presidential race.

Of course, candidates like Donald Trump tend to use more colorful language when describing their belief that the United States has lost its economic edge. Trump and candidates like Bernie Sanders hate recent trade deals, which they feel have proven that the U.S. can’t compete with countries like China and Vietnam, which have far cheaper labor and less onerous environmental regulations.

The Conference Board estimates that by 2018, China’s contribution to global GDP will surpass that of the U.S. In other words, China’s economy will become more significant than America’s.

How is this possible? Is the golden era of “Made in America” in our rearview mirror? Is China entering a modern-day economic dynasty? Worrisome questions for some observers.

But if you ask actual manufacturing executives, they’re far more bullish on America’s future than many of its political leaders. Recently, professional services firm Deloitte teamed up with the Council on Competitiveness to release its 2016 Global Manufacturing Competitiveness Index, showing that the United States is the second most competitive manufacturing economy after China.

What’s more, global manufacturing executives predict that by 2020, the United States will be the most competitive manufacturing economy in the world. Either way, it seems like the story of two economic titans, duking it out for King (Queen?) of the GDP stats.

Second: Ally. The two countries have a long, shared history of phenomenal economic achievement but now, China faces an epidemic of heart disease brought on by a shift toward the Western lifestyle. And the Harvard researchers say the trend shows no sign of slowing down.

Here in the U.S., we raced to the No. 1 ranking, then spent decades watching our national health collapse as a result. Same culprits: high blood pressure, high cholesterol, and high blood glucose.

Then there’s decreased physical activity, tobacco, alcohol and other drug abuse. Oh, and let’s not forget a gradual (and still rising) BMI. We’ve made enormous strides reversing our sad health history. It didn’t happen overnight.

Some facts about China’s health outlook: Without a change, deaths from heart disease and stroke are expected to reach approximately 23 million per year by 2030. The threat is of special concern in China, where cardiovascular disease and its risk factors have steadily increased over the last two decades, currently accounting for 45% of total deaths in that nation, according to the Global Health Council. This has happened even as living standards have improved dramatically.

Now for the encouraging stuff. To lower these rates, the American Heart Association (AHA), the world’s leading voluntary health organization dedicated to fighting cardiovascular disease, collaborates globally to share emerging science, best practices and training.

Most recently, the AHA and the Chinese Society of Cardiology, a branch of the Chinese Medical Association, formally announced joint steps to improve heart attack outcomes in China.

Steve's Take: Need more joint Chinese-American actions to improve health outcomes in China Click To Tweet

The two organizations will develop and implement an emergency medical systems and hospital-based program to improve care for patients experiencing heart attacks in China, marking a significant step forward in advancing the World Health Assembly’s goal of a 25% reduction in premature deaths from noncommunicable diseases worldwide by 2025.

“Adherence to evidence-based guidelines for cardiovascular care that implement effective therapies for patients remains incomplete and highly variable,” said Sidney C. Smith, Jr., MDFAHA, FACC, FESC, University of North Carolina Professor of Medicine, Cardiology and Past President of the American Heart Association. “The backing of China’s National Health and Family Planning Commission to advance these topics accelerates cooperation to reduce the global burden of heart disease and stroke.”

Hospital networks and emergency medical systems in Tianjin, Suzhou, Beijing and Shanghai will be part of the initial collaborative that will collect, share and report back on data regarding intervention designs, new and revised protocols, and implementation strategies.

Additionally, a public awareness campaign will educate consumers about the signs and symptoms of heart attacks and the importance of immediately calling local emergency response for ambulance transport to the hospital.

Historically, the AHA’s work in China dates back a decade through its alliance with Laerdal Medical and spans the Greater China Region. Last year, the AHA and the Ministry of Science and Technology (MOST) reached a breakthrough agreement that outlined three key areas of cooperation between the U.S.-based non-profit and the Chinese government: science sharing, physician exchange and CPR training.

These efforts have largely targeted healthcare providers through strategic relationships with hospital systems, government health offices and national medical associations.

In cooperation with the China Heart Federation and Laerdal China, the AHA recently entered the second year of a cardiovascular care training education program for healthcare providers affiliated with the China County Hospital Confederation, a consortium of 400 regional hospitals.

Based on AHA’s successful Get with the Guidelines program in the United States, the Chinese Society of Cardiology and Beijing Institute of Heart, Lung and Blood Vessel Diseases rolled out a patient care quality improvement program in 2014.

Approximately 150 hospitals in China participate in the Improving Care for Cardiovascular Disease in China (CCC) program, funded by a $3 million grant secured by AHA.

Expansion to bystander education is imminent. Earlier this year, MOST, AHA and the China Social Assistance Foundation announced the implementation of the first CPR training and awareness initiative in China to deliver quality AHA first aid and CPR training to the general public.

To support this effort, the AHA will launch its first China-based Training Center focused on training the general public during the Great Wall International Congress of Cardiology, the largest cardiology meeting in the Asia Pacific region, in October. The AHA currently boasts more than 160 Training Centers and Sites in the region which focus mainly on delivering its training programs to healthcare providers.

I’ll leave with this time-tested idiom, tweaked a bit to personalize it: “China…be careful what you wish for.” You’ve guaranteed yourself the top spot in the world’s overall economy, finally eclipsing the United States–something you’ve desired for a long time and finally achieved. But sometimes, when you get things that you desire, you get more than you ever imagined; there may be unforeseen and unpleasant consequences.

It’s no secret I favor globalization and the collective prosperity and well being of all peoples and nations, rather than the “Let’s build a wall” mentality of Donald Trump. The American Heart Association has for nearly a decade been lending China a helping hand to fight cardiovascular disease. The courageous efforts of Doctors Without Borders have also had an immensely positive impact on global health, hearts and minds.

Let’s make certain our state and federal representatives know we want more of that type of collaboration. It’s in our best interest in the long run; I believe China will be our most important trading partner for a long, long time. Perhaps our cultures will also draw closer as a result. Now that would be a very pleasant, even if unintended, consequence of achieving the economic goal.