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Li Y.,Harvard University | Wang D.D.,Harvard University | Ley S.H.,Harvard University | Howard A.G.,University of North Carolina at Chapel Hill | And 4 more authors.
Journal of the American College of Cardiology | Year: 2016

Background Cardiovascular disease (CVD) is a leading cause of death in China. Evaluation of risk factors and their impacts on disease burden is important for future public health initiatives and policy making. Objectives The study used data from a cohort of the China Health and Nutrition Survey to estimate time trends in cardiovascular risk factors from 1991 to 2011. Methods We applied the comparative risk assessment method to estimate the number of CVD events attributable to all nonoptimal levels (e.g., theoretical-minimum-risk exposure distribution [TMRED]) of each risk factor. Results In 2011, high blood pressure, high low-density lipoprotein cholesterol, and high blood glucose were associated with 3.1, 1.4, and 0.9 million CVD events in China, respectively. Increase in body mass index was associated with an increase in attributable CVD events, from 0.5 to 1.1 million between 1991 and 2011, whereas decreased physical activity was associated with a 0.7-million increase in attributable CVD events. In 2011, 53.4% of men used tobacco, estimated to be responsible for 30.1% of CVD burden in men. Dietary quality improved, but remained suboptimal; mean intakes were 5.4 (TMRED: 2.0) g/day for sodium, 67.7 (TMRED: 300.0) g/day for fruits, 6.2 (TMRED: 114.0) g/day for nuts, and 25.0 (TMRED: 250.0) mg/day for marine omega-3 fatty acids in 2011. Conclusions High blood pressure remains the most important individual risk factor related to CVD burden in China. Increased body mass index and decreased physical activity were also associated with the increase in CVD burden from 1991 to 2011. High rates of tobacco use in men and unhealthy dietary factors continue to contribute to the burden of CVD in China. © 2016 American College of Cardiology Foundation


BACKGROUND—: Cardiovascular disease (CVD) death rates are much higher in blacks than whites in the United States (US). It is unclear how CVD risk and events are distributed among blacks vs. whites and how interventions reduce racial disparities. METHODS—: We developed risk models for fatal and for fatal-and-nonfatal CVD using 8 cohorts in the US. We used 6,154 adults aged 50-69 years in the National Health and Nutrition Examination Survey 1999-2012 to estimate the distributions of risk and events in blacks and whites. We estimated the total as well as disparity impacts of a range of population-wide, targeted and risk-based interventions on 10-year CVD risks and event rates. RESULTS—: 25% (95% confidence interval 22-28) of black men and 12% (10-14) of black women were at ≥ 6.67% risk of fatal CVD (almost equivalent to 20% risk of fatal or nonfatal CVD), compared with 10% (8-12) of white men and 3% (2-4) of white women. These high-risk individuals accounted for 55% (49-59) of CVD deaths among black men and 42% (35-46) in black women, compared with 30% (24-35) in white men and 18% (13-22) in white women. We estimated that an intervention that treated multiple risk factors in high-risk individuals could reduce black-white difference in CVD death rate from 1,659 to 1,244 per 100,000 in men and from 1,320 to 897 in women. Rates of fatal-and-nonfatal CVD were generally similar between black and white men. In women, a larger proportion of women were at ≥ 7.5% risk of CVD (30% versus 19% in whites) and an intervention that targeted multiple risk factors among this group was estimated to reduce black-white differences in CVD rates from 1,688 to 1,197 per 100,000. CONCLUSIONS—: A substantially larger proportion of blacks have a high risk of fatal CVD and bear a large share of CVD deaths. A risk-based intervention that reduces multiple risk factors could substantially reduce overall CVD rates and racial disparities in CVD death rates. © 2016 by the American College of Cardiology Foundation and the American Heart Association, Inc.

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