Jiapeng Lu, MD, PhD *; Yuan Lu, ScD *; Hao Yang, BSc; Wuhan Bilige, MB; Yetong Li, BSc; Wade Schulz, MD, PhD; Frederick A. Masoudi, MD, PhD; Harlan M. Krumholz, MD, PhD
Acknowledgment: The authors thank Prof. Lixin Jiang, who takes responsibility for study design and implementation of the China PEACE Million Persons Project, conceived of this article with Dr. Lu, and contributed to critical revisions of the first submitted version of the manuscript. The authors also thank all study participants. They appreciate the contributions made by project teams at the National Center for Cardiovascular Diseases and the Yale–New Haven Hospital Center for Outcomes Research and Evaluation in the realm of project design and operations, particularly data collection by Yang Yang, Jingwei Yang, Jianlan Cui, Wei Xu, Bo Gu, Xi Li, Chaoqun Wu, Hao Dai, Hui Zhong, and Minghui Zhang. The authors thank the Ministry of Finance of China and National Health Commission of China for funding support. They also thank all provincial and regional officers and research staff in all 31 provinces for data and biosample collection.
Grant Support: By grants 2017-I2M-2-002, 2017-I2M-B&R-02, 2016-12M-1-006, and 2016-12M-2-004 from the Ministry of Finance of China and National Health Commission of China; the CAMS Innovation Fund for Medical Science; grants 2017YFC1310801 and 2017YFC1310803 from the National Key Research and Development Program of the Ministry of Science and Technology of China; grant B16005 from the 111 Project from the Ministry of Education of China; and grant 2017330003 from the PUMC Youth Fund and the Fundamental Research Funds for the Central Universities.
Disclosures: Dr. Schulz reports personal fees from Hugo Health outside the submitted work. Dr. Masoudi reports travel expenses paid by China Oxford Centre and serves as chief medical officer for the American College of Cardiology National Cardiovascular Data Registry, outside the submitted work. Dr. Krumholz reports personal fees from UnitedHealth Group, IBM Watson Health, Element Science, and Aetna; reports grants from Medtronic, the U.S. Food and Drug Administration, and Johnson and Johnson; is the founder of Hugo Health; and has a contract with the Centers for Medicare & Medicaid Services to develop and maintain measures of hospital performance, outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1932.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Available at http://dx.doi.org/10.1136/bmjopen-2015-010200. Statistical code: Available from Dr. J. Lu (e-mail, email@example.com). Data set: Not available.
Corresponding Author: Jiapeng Lu, MD, PhD, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. J. Lu and Bilige, Mr. Yang, and Mr. Li: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China.
Drs. Y. Lu, Schulz, and Krumholz: Center for Outcomes Research and Evaluation, Yale University/Yale–New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut 06510.
Dr. Masoudi: Division of Cardiology, University of Colorado Anschutz Medical Campus, 12401 East 17th Avenue, Aurora, Colorado 80045.
Author Contributions: Conception and design: J. Lu, H.M. Krumholz.
Analysis and interpretation of the data: J. Lu, Y. Lu, F.A. Masoudi, H.M. Krumholz.
Drafting of the article: J. Lu, Y. Lu, W. Schulz, F.A. Masoudi.
Critical revision for important intellectual content: Y. Lu, W. Bilige, Y. Li, W. Schulz, F.A. Masoudi, H.M. Krumholz.
Final approval of the article: J. Lu, Y. Lu, H. Yang, W. Bilige, Y. Li, W. Schulz, F.A. Masoudi, H.M. Krumholz.
Collection and assembly of data: J. Lu, H. Yang, W. Bilige.
As cardiovascular risk increases in China, interest in strategies to mitigate it is growing. However, national information about the prevalence and treatment of high cardiovascular disease (CVD) risk is limited.
To assess the prevalence and treatment of high CVD risk as well as variations in risk across population subgroups.
National project of CVD screening and management.
141 county-level regions in all 31 provinces of China.
Local residents aged 35 to 75 years.
Rates of high CVD risk were assessed both in the overall study population and by age, sex, body mass index, geographic region, and socioeconomic status. Multivariable mixed models were fitted to assess the associations between individual characteristics and high CVD risk. Statin and aspirin use was evaluated among persons at high risk for CVD.
Among 1 680 126 participants, 9.5% (95% CI, 9.5% to 9.6%) had high risk for CVD. Mixed models identified persons who were of Han ethnicity, had medical insurance, were currently using alcohol, or were obese as more likely to be at high risk for CVD. Of those with high CVD risk, only 0.6% (CI, 0.5% to 0.6%) and 2.4% (CI, 2.3% to 2.5%) reported using statins and aspirin, respectively. Among persons with high CVD risk and hypertension, 31.8% were receiving antihypertensive medications.
Samples were not nationally representative.
Of the 1.7 million participants, 1 in 10 had a high risk for CVD; among those at high risk, fewer than 3% were receiving statins or aspirin. An immense opportunity exists for risk mitigation in this substantial population.
Ministry of Finance and National Health Commission, China.
Lu J, Lu Y, Yang H, et al. Characteristics of High Cardiovascular Risk in 1.7 Million Chinese Adults. Ann Intern Med. 2019;170:298–308. [Epub ahead of print 19 February 2019]. doi: https://doi.org/10.7326/M18-1932
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Published: Ann Intern Med. 2019;170(5):298-308.
Published at www.annals.org on 19 February 2019
Cardiology, Coronary Risk Factors, Prevention/Screening.
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