Outline of the report on cardiovascular disease in China, 2010.

Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens.

[The current situation of blood pressure control and the influencing factors on hypertensive patients in residential communities of China].

OBJECTIVE: To understand the situation of blood pressure control and the major factors influencing the programs among those hypertensive patients living in the communities from different parts of China. METHODS: A protocol of community-based standardized blood pressure management was developed based on the current Chinese guideline for prevention, treatment of hypertension. Grass-roots caretakers from community health service centers across China were trained under the requirement of this protocol to manage the hypertensive patients. In this study, the hypertensive patients who had been registered in the project centers from Beijing, Hebei, Gansu, Jiangsu, Zhejiang, Guangdong provinces, were selected as the study subjects, and the baseline data for these patients was analyzed. RESULTS: By the end of 2010, a total of 242 182 patients were registered. The mean age was 61.0 ± 10.5, with 48.5% of them being males. The overall control rate of blood pressure was 27.4%. The control rate was significant lower among patients who were in lower age group, being male, with higher BMI, smoking, drinking or with more salt consumption. However, the control rate was significant higher among those patients who had family history of hypertension, always undertook physical exercise or receiving medical treatment. CONCLUSION: The blood pressure control rate for community hypertensive patients in China was still in a relatively low level. Standardization management measures should be strengthened so as to improve the rate of control on high blood pressure.

[Association between chronic kidney disease and cardiovascular events in middle-to-old-aged Chinese population].

OBJECTIVE: This study aimed to determine the relationships between estimated glomerular filtration rate (eGFR) and cardiovascular events. METHODS: 2500 residents aged more than 40 years old were selected from Shougang community, Shijingshan district, in Beijing. 2315 of them took part in the survey. First morning urinary sample was collected for all the participants. Albumin and creatinine were measured and eGFR was calculated using simplified MDAD formula. Cardiovascular risk factors were also investigated. The participants were followed up for 4 years, and all-cause mortality and cardiovascular events were collected. The subjects were divided into three groups according to eGFR [ml/(min·1.73 m(2))]: < 60, 60 - 90, > 90. Cox regression model was used to analyze the relationships between eGFR, all events, and cardiovascular events after adjusting for confounders. RESULTS: The prevalence of eGFR < 60 was 3.3%. The incidence rates of cardiovascular events were 43.9, 21.8 and 11.5/1000 person-years among three groups, and the incidence rates of all events (all-cause mortality and cardiovascular events) were 53.7, 28.8 and 14.6/1000 person-years, respectively. After adjusting for age, gender, smoking, body mass index, serum lipids, diabetes mellitus, cardiovascular disease, the hazard risk (HR) for cardiovascular events was 1.29 (95%CI: 0.85 - 1.96) in eGFR < 60 group and 2.14 (95%CI: 1.02 - 4.50) in 60 ≤ eGFR < 90 group, when compared with the eGFR > 90 group; the HR for all events were 1.25 (95%CI: 0.86 - 1.81) and 1.95 (95%CI: 1.00 - 3.80), respectively. CONCLUSION: In the population studied, eGFR < 60 seemed an independent predictor for cardiovascular events and all-cause events.

[Hypertension Control in Communities (HCC): evaluation result of blood pressure management among hypertensive].

OBJECTIVE: To determine the effects related to community-based standardized blood pressure management programs on the control of hypertension. METHODS: A protocol of community-based standardized blood pressure management was developed based on the current Chinese guideline for prevention, treatment of hypertension. Grass-roots caretakers from community health service centers across China were trained using this protocol and required to manage hypertensive patients according to the protocol. Patients were treated on therapeutic life style change or/and medication, and followed up based on the criteria of risk stratification. The control rate of hypertension was evaluated after 1 year. Effect of intervention (EI) was estimated as '1 year rate (mean)' minus the number showed at the baseline. RESULTS: By the end of 2008, a total of 29 411 hypertensive patients (47.2% for male, mean age 61.4 +/- 10.9 years) with full information had been under management for one year according to the protocol. Among all patients, 8.9% were classified as under low risk, 50.8% as moderate risk and 40.3% as high and very high risk showed in baseline data. After standardized management, the EI of smoking, drinking and systolic/diastolic blood pressure were -7.1% (P < 0.05), -7.3% (P < 0.05), and -14.8-8.3 mm Hg (P < 0.05), respectively. However, EI of overweight/obesity was 0.3% (P > 0.05). For all patients, the control rate rose to 74.7%, with EI as 53.1%, and all of the sub-groups, including age, risk stratification, had significant increases. The longer the management was under, the higher the control rate was seen. Results from the multivariate logistic regression showed that older age, male and having higher blood level were adverse factors for the undertaking the control and management programs of hypertension. CONCLUSION: Results from our study showed that standardized management could significantly improve the program on the control of hypertension at the community level, in China.

[Effects of underlying cerebrocardiovascular diseases on the incidence of critical conditions and multiple organs dysfunction syndrome in severe acute respiratory syndrome cases].

OBJECTIVE: To investigate the effects of underlying cerebrocardiovascular diseases on the incidence of critical conditions and multiple organs dysfunction syndrome (MODS) among the severe acute respiratory syndrome (SARS) cases. METHODS: A database of all SARS cases in Beijing in 2003 was established and the data of 1291 cases whose data were complete among them was analyzed. The effects of cerebrocardiovascular diseases, other comorbid diseases and absence of underlying diseases on the incidence of critical conditions and MODS in SARS cases were compared with chi-square test and logistic regression analysis. RESULTS: The incidence rates of critical conditions and MODS in SARS cases were 34.86% and 13.71% respectively. The incidence rates of critical conditions and MODS among the SARS cases without underlying diseases, with other comorbid diseases, and with cerebrocardiovascular diseases were 28.10%, 43.70%, and 58.18%, and 9.83%, 18.52%, and 27.27% respectively. The differences among the three groups were all statistically significant (all P < 0.0001). Logistic regression analysis showed that presence of cerebrocardiovascular diseases in SARS patients was independently associated with the risks of critical conditions and MODS in comparison with those without underlying diseases after adjusting for age and occupation. [odds ratio (OR) = 1.819, 95% CI = 1.276 approximately 2.592, and OR = 1.974, 95% CI = 1.273 approximately 3.060 respectively]. CONCLUSION: The SARS cases with cerebrocardiovascular diseases have the highest incidence rate of critical conditions and MODS. Presence of Cerebrocardiovascular diseases is an important risk factor for critical conditions and MODS in the SARS cases.