1. A Changing Face: The Epidemiology of Cardiovascular Diseases in Mainland China 首都医科大学附属北京安贞医院 马长生

2. 1991-1999 Trends in CHD Incidence and Mortality, in Comparison to Total Mortality: China MUCA Study All deathCHD deathCHD incidence

3. Number One Killer Major Causes of Death in 2004 in Urban China RuralUrban Data source: Chinese Health Statistical Digest 2005, MOH, PRC

4. * * * *

5. **

6. Average Age-standardized Annual Incidence of CHD among 14 populations, China MUCA Study, 25-74 y 1991-1995 North South Adapted from Zhou BF, et al: CVD Prevention 1998;1:207-216. MenWomen

7. Average Age-standardized Annual Incidence of Stroke among 14 populations, China MUCA Study, 25-74 y 1991-1995 North South Adapted from Zhou BF, et al: CVD Prevention 1998;1:207-216. MenWomen

8. Summary I: The epidemiological characteristics of cardiovascular disease in China Stroke is predominant type of cardiovascular disease (CVD) in China CHD was used to be very low in comparison to the Western countries, but has been increasing dramatically in recent decades CVD has been the leading cause of death in China since 1990’s and had over taken the US and many other Western countries according to the most recent data CVD varies largely among geographical locations and reasons are not fully understood.

9. Major changeable risk factors of CVD and Their Trends in China

10. The CHD Risk Factors Being Proved in Population Studies in China High Blood Pressure Smoking Dyslipidemia Diabetes Mellitus Overweight/Obesity In addition to Age and Gender

11. Over 80% of ischemic cardiovascular diseases (CHD + ischemic stroke) risk in China is attributed to major risk factors, Population Attributable Risk (PARP) Hypertension 35% Smoking 32% Hypercholesterol 11% Diabetes 3% * Adjusted for age, sex the China MUCA Study —— Cohort Ⅱ Other

12. Prevalence of CVD major risk factors in China ， data from the National Nutrition and Health Survey in 2002 Risk factor% # estimated nation- wide (million) Smoking25.8310 Overweight/Obesity23.2270 Hypertension18.8160 Dyslipidemia18.6160 Diabetes2.623

13. Data Source: National Nutrition and Health Survey 2002 Prevalence Rate of Dyslipidemia in China National Nutrition and Health Survey, 2002

14. What explain the increase of CVD?

15. Age-adjusted prevalence of major CVD risk factors among Chinese, age 35-59 years, MEN (China MUCA Study) *8 组可比人群资料； **3 组可比人群资料。 Long-term secular changes

16. *8 组可比人群资料； **3 组可比人群资料。 Age-adjusted prevalence of major CVD risk factors among Chinese, age 35-59 years, WOMEN (China MUCA Study) Long-term secular changes

17. Prevalence of Smoking in China MenWomen Number of Participants % % 1984258,42261.0261,178 4.2 1996 65,00063.0 57,000 3.8 a: Weng X, et al: Data from 1984 National Smoking Survey. b: Yang G. Smoking and Health in China: 1996 National Prevalence Survey of Smoking Pattern. Beijing, China Science and Technology Press, 1997. C: Wang L, ed. Series report #1, Chinese Nutrition and Health Status Report, p49, 2005 Number of Participants 200273,19353.9 87,360 3.1

18. Changes in prevalence of overweight and obesity in China, data from National Nutrition Surveys in 1992 and 2002 Redraw from Ma GS, Li YP, Wu YF, et al. The prevalence of body overweight and obesity and its changes among Chinese people during 1992-2002. Chinese Journal of Preventive Medicine 2005, Chin J Prev Med 2005;39(5):311-315.

19. Prevalence of Hypertension in China Data from 4 national surveys Estimated rate for the whole nation. Criteria of diagnosis differed: Unknown for 1959 ； SBP≥141 and/or DBP≥91 ， not considering medication use in 2 wks for 1979; SBP≥140 and/or DBP≥90 or medication use in 2 wks for 1991and 2002. Participants aged 15 and above in all surveys. Age-standardized rate with the national census data in 1964 as reference. Same criteria as of 1979 survey was used.

20. Increase in prevalence of DM in large cities in China Data for 1996 was from the National Survey of Diabetes; Data for 2002 was from the National Nutrition and Health Survey.

21. What explain the changes of risk factors?

22. Number of annual production of cars, PCs, TVs and Bicycles in China Redraw on data from the National Bureau of Statistics of China.

23. Changes in hours working and watching TV in Chinese men and women, urban and rural, from 1990 to 2000 Redraw on data from the 1st and 2nd Survey of Social Status of Chinese Women. In book: Jingqui Ma (ed). Men and women in China. http://www.stats.gov.cn/tjsj/qtsj/men&women/men&women.pdf

24. Age-adjusted intake and its increase for different foods among Chinese, age 35-59 years *12 组可比人群资料 Changes in intake of foods

25. Summary II: CVD risk factor in China Over 80% of CVD risk in China are attributed to few major risk factors, including hypertension, cigarettes smoking, hypercholesterol, diabetes, etc. All these major risk factors have been increasing during the past decades except for smoking, which started to decline after late 1990’s but still very high in men. Modern lifestyle that increase sedentary but decrease physical activity, unhealthy dietary patterns, universal and country specific social economic factors, etc influence the future direction of the risk factor changes. Thus, future increase in both risk factors and CVDs are foreseen.

26. We have done a lot but we need to do more.

27. 世界心脏日 2008

28. 男性 Framingham 风险积分计算 Step 1: Age YearsPoints 20-34-9 35-39-4 40-440 45-493 50-546 55-598 60-6410 65-6911 70-7412 75-7913 Step 2: Total Cholesterol TC Points atPoints atPoints atPoints atPoints at (mg/dL) Age 20-39Age 40-49Age 50-59Age 60-69Age 70-79 <16000000 160-19943210 200-23975310 240-27996421  280118531 HDL-C (mg/dL) Points  60-1 50-590 40-491 <402 Step 3: HDL-Cholesterol Systolic BPPointsPoints (mm Hg)if Untreatedif Treated <12000 120-12901 130-13912 140-15912  16023 Step 4: Systolic Blood Pressure Step 5: Smoking Status Points atPoints atPoints atPoints atPoints at Age 20-39Age 40-49Age 50-59Age 60-69Age 70-79 Nonsmoker00000 Smoker85311 Age Total cholesterol HDL-cholesterol Systolic blood pressure Smoking status Point total Step 6: Adding Up the Points Point Total10-Year RiskPoint Total10-Year Risk <0<1%118% 01%1210% 11%1312% 21%1416% 31%1520% 41%1625% 52%  17  30% 62% 73% 84% 95% 106% Step 7: CHD Risk Framingham heart study.

29. Framingham 积分预测 10 年 CHD 风险（男 ） Point Total10-Year RiskPoint Total10-Year Risk <0<1%118% 01%1210% 11%1312% 21%1416% 31%1520% 41%1625% 52%  17  30% 62% 73% 84% 95% 106% Framingham heart study.

30. 中国高血压指南的总体危险评估 （ 2005 ） 注： RF ，危险因素； DM ，糖尿病； OD ，亚临床靶器官损害

31. 中国成人血脂异常防治指南 （ 2007 ）

32.  Framingham 研究样本量小  Framingham 研究的人群社会和经济地位与其他地区 相差巨大  Framingham 积分高估国人冠心病发病率 Framingham 风险积分适合中国人吗？

33. 10 年 CHD 发 病危险 （ % ） JAMA. 2004; 291: 2591 Framingham 积分对国人 CHD 风险预测价值 （ CMCS ） Framingham 积分

34. 中美合作研究 USA-PRC Study Circulation. 2006;114:2217

35. 2 1 0 1 0 0 0

36. 中国 MUCA 队列研究中进行了验证 1993 ～ 1994 年 11 个人群中入选 17329 例参加者，随访 11 年

39. 1. 选择表格（男女） 2. 选择年龄段 3. 是否有糖尿病 4. 是否吸烟 选出对应方块 1 g 2 糖尿病 无糖尿病 3 4

40. 1. 男性 2.48 岁 3. 无糖尿病 4. 吸烟 选中方块 1 2 糖尿病 无糖尿病 3 4

41. 1. 收缩压 150mmHg 2. 总胆固醇 260mg/dl 3. 对应小方块为橙色 ——10 年内患严重心脑血 管疾病的危险为同龄男性的 5.0 ～ 9.9 倍 危险性低于平均值 是平均值的 1.0 ～ 4.9 倍 是平均值的 5.0 ～ 9.9 倍是平均值的 10.0 ～ 14.9 倍 是平均值的 15 倍以上

42. 1970 ～ 2002 年美国 6 个主要死因 年龄标化的死亡率变化趋势 JAMA. 2005,294:1255 心脏病 肿瘤 COPD 意外 卒中 糖尿病

43. 中国心脑血管病出院人数变化趋势 1980~2006 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2003 2005 2006 胡盛寿主编. 《中国心血管病报告 2006 》,69

44. Ford ES. N Eng J Med. 2007; 356:2388

45. 控制危险因素降低 CHD 死亡风险 44% （ 1980 ～ 2000 ） Ford ES. N Eng J Med. 2007; 356:2388

46. 北京 CHD 死亡率升高的相关危险因素 （ 1984 ～ 1999 ） Circulation. 2004;110:1236. Critchley J. Circulation. 2004;110:1236.

47. 管住嘴迈开腿不吸烟好心态 Know your risk !