Fangchao Liu

Hypertension burden and control in mainland China: Analysis of nationwide data 2003–2012

BACKGROUND No nationwide survey on hypertension was conducted in China since 2002. We assessed the prevalence, awareness, treatment, and control of hypertension in mainland China and in various regions using nationwide data from 2003 to 2012. METHODS AND RESULTS We identified studies that reported age- and gender-specific prevalence and/or age-specific awareness, treatment and control of hypertension in representative population samples from 31 provinces, using China National Knowledge Infrastructure, Wanfang and PubMed, supplemented by a manual search of references of retrieved articles. All data were extracted independently by two investigators using a standardized data-collection form. Overall, 265 million adults (145 million men and 120 million women) had hypertension for a prevalence of 26.7% (28.9% among men and 24.5% among women) in 2010. Among hypertensive patients, only 44.6% were aware of their condition, 35.2% were taking antihypertensive medication, and 11.2% achieved adequate blood pressure control. There were substantial geographic variations in the prevalence and control of hypertension. Hypertension prevalence was the highest in east region (32.6%) followed by northeast region (31.8%). Worse still, the control rate among hypertensive people was very poor in southwest (4.8%) and northeast (5.9%) regions. CONCLUSIONS Hypertension is highly prevalent in mainland China, with inadequate awareness, treatment, and control of hypertension. Effective strategies are urgently needed in China, especially in the regions with high prevalence and low control.

Rate of caesarean section is alarming in China

www.thelancet.com Vol 383 April 26, 2014 1463 Third, Chinese mothers like to choose a delivery date on the basis of luck and belief, and it is easier to deliver on a scheduled day by caesarean section than to deliever an unplanned vaginal birth. Fourth, some doctors do recommend caesarean section to women in view of the present uneasy doctor–patient relationship and possible lawsuits. Furthermore, caesarean section is fi nancially profi table for the hospital. For example, in large Chinese cities such as Beijing, the price is about 6000 RMB (US

Mobile Phone Intervention and Weight Loss Among Overweight and Obese Adults: A Meta-Analysis of Randomized Controlled Trials

1000) for vaginal birth, whereas it is at least 12 000 RMB (

Control of hypertension in China: challenging.

2000) for caesarean section in some top-level hospitals. Fifth, increasing numbers of macrosomia in China attributable to the increasing prevalence of diabetes and obesity in women, and increasing pregnancies in older women will further increase the rate of caesarean section. To effectively control the rate of caesarean section in China, the Chinese Government should develop specific policies and measures, such as use of rate of caesarean section without medical necessities as one of the hospital’s overall rating components, and popularising of natural childbirth. Hospitals and communities should promote health education in women of reproductive age to provide a more accurate idea of delivery. Additionally, prevention of obesity and diabetes in women of reproductive age, which will reduce the risk of macrosomia, is also important to decrease rates of caesarean section. Women of reproductive age should also be encouraged to give birth before age 35 years.

Predicting the Ten-Year Risks of Atherosclerotic Cardiovascular Disease in Chinese Population: The China-PAR Project

We conducted a meta-analysis of randomized controlled trials to examine the association of mobile phone intervention with net change in weight-related measures among overweight and obese adults. We searched electronic databases and conducted a bibliography review to identify articles published between the inception date of each database and March 27, 2014. Fourteen trials (including 1,337 participants in total) that met the eligibility criteria were included. Two investigators independently abstracted information on study characteristics and study outcomes. Net change estimates comparing the intervention group with the control group were pooled across trials using random-effects models. Compared with the control group, mobile phone intervention was associated with significant changes in body weight and body mass index (weight (kg)/height (m)(2)) of -1.44 kg (95% confidence interval (CI): -2.12, -0.76) and -0.24 units (95% CI: -0.40, -0.08), respectively. Subgroup analyses revealed that the associations were consistent across study-duration and intervention-type subgroups. For example, net body weight changes were -0.92 kg (95% CI: -1.58, -0.25) and -1.85 kg (95% CI: -2.99, -0.71) in trials of shorter (<6 months) and longer (≥6 months) duration, respectively. These findings provide evidence that mobile phone intervention may be a useful tool for promoting weight loss among overweight and obese adults.

Risk stratification of atherosclerotic cardiovascular disease in Chinese adults

The most recent data shows that during the period of 2005–2009, about 42% of Chinese adults aged 35–70 years were hypertensive and only 8.2% of hypertensive patients were well controlled [1]. Compared with the data in 2000–2001, prevalence of hypertension has drastically increased while hypertension control rate maintained at low level as well as awareness and treatment rates in midlife Chinese adults (Fig. 1) [1,2]. It is estimated that in China, the number of premature death due to hypertension is more than 2 million, and the corresponding direct medical costs are more than 3.66 billion [3]. In addition, 70% of stroke and 50% of myocardial infarction are attributable to hypertension in China [3]. High salt intake and obesity are main risk factors for hypertension. Data from the China Health and Nutrition Survey showed that an average of 12 g salt per day are consumed by Chinese adults [4], twice more than the recommended salt intake (less than 5 g/d) by World Health Organization (WHO). In addition, approximately 11% of Chinese adults were generally obese and 37% of them were abdominally obese in 2009 and the prevalence of general and abdominal obesity increased greatly from 1993 to 2009 [5]. Besides, lack of physical activity and sedentary behavior (e.g., TV viewing and computer use) are common in Chinese adults, which are other important risk factors for hypertension, as well as smoking and alcohol consumption [3]. Based on the current situation, it is time for China to establish intervention programs to control hypertension and its related risk factors. Indeed, several national intervention programs, such as “National Action of Healthy Lifestyle” and “National Fitness Program (2012–2015)”, have been conducted to reduce hypertension related risk factors. Although there was still a gap on coverage of hypertensive patients in China, community-based standardized management of hypertension (launched by the China Ministry of Health in 2006) and “2010 Guidelines for Prevention and Control of Hypertension in China” played an important role in hypertension management and control. In addition, “China Hypertension Education and Management Action” was launched in August, 2013 in Beijing. The aim of this action was to improve discipline level and service ability of grassroots units of China by standardizing the procedure of diagnosis and treatment and implementing comprehensive management and control strategy. Given the high prevalence, and low awareness, treatment and control of hypertension, national strategies aimed at this disease is urgently needed. As for hypertension prevention, control and management, Chinese government should be the leader and should cooperate with other components, including experts, media, and grassroots units. We believe prevention and control of hypertension will make periodical success through the joint effort of the whole society. Funding: This work was supported by the National “Twelfth FiveYear” Plan for Science & Technology Support Program (2012BAI03B03), the Research Fund for the Doctoral Program of Higher Education of China (20120131120004) and the Foundation for Outstanding Young Scientist in Shandong Province (BS2011YY026).

Predicting the 10-Year Risks of Atherosclerotic Cardiovascular Disease in Chinese PopulationClinical Perspective: The China-PAR Project (Prediction for ASCVD Risk in China)

Background: The accurate assessment of individual risk can be of great value to guiding and facilitating the prevention of atherosclerotic cardiovascular disease (ASCVD). However, prediction models in common use were formulated primarily in white populations. The China-PAR project (Prediction for ASCVD Risk in China) is aimed at developing and validating 10-year risk prediction equations for ASCVD from 4 contemporary Chinese cohorts. Methods: Two prospective studies followed up together with a unified protocol were used as the derivation cohort to develop 10-year ASCVD risk equations in 21 320 Chinese participants. The external validation was evaluated in 2 independent Chinese cohorts with 14 123 and 70 838 participants. Furthermore, model performance was compared with the Pooled Cohort Equations reported in the American College of Cardiology/American Heart Association guideline. Results: Over 12 years of follow-up in the derivation cohort with 21 320 Chinese participants, 1048 subjects developed a first ASCVD event. Sex-specific equations had C statistics of 0.794 (95% confidence interval, 0.775–0.814) for men and 0.811 (95% confidence interval, 0.787–0.835) for women. The predicted rates were similar to the observed rates, as indicated by a calibration &khgr;2 of 13.1 for men (P=0.16) and 12.8 for women (P=0.17). Good internal and external validations of our equations were achieved in subsequent analyses. Compared with the Chinese equations, the Pooled Cohort Equations had lower C statistics and much higher calibration &khgr;2 values in men. Conclusions: Our project developed effective tools with good performance for 10-year ASCVD risk prediction among a Chinese population that will help to improve the primary prevention and management of cardiovascular disease.

Prevalence of active and passive tobacco smoking among Beijing residents in 2011

Objective This study aims to determine the distribution of observed atherosclerotic cardiovascular disease (ASCVD) incidence in contemporary cohorts in China, and to identify cut-off points for ASCVD risk classification based on traditional criteria and new equations developed by Prediction for ASCVD Risk in China (China-PAR). Methods The study populations included cohorts in the China-PAR project, with 34,757 participants eligible for the current analysis. Traditional risk stratification was assessed by using Chinese guidelines on prevention of CVD and hypertension, and 5 risk groups were classified based on these guidelines after slight modification for available risk factors. Kaplan–Meier analysis was conducted to obtain the cumulative incidence of observed ASCVD events for all subjects and sub-groups. The predicted 10-year ASCVD risk was obtained using the China-PAR equations. Results A total of 1922 ASCVD events were identified during an average follow-up of 14.1 years. According to the group classification based on traditional risk stratification, the observed 10-year risks for ASCVD were 4.61% (95% confidence interval [CI]: 4.11–5.10%) in the moderate-risk group and 8.74% (95% CI: 7.82–9.66%) in the high-risk group. Based on the China-PAR equations for risk assessment of ASCVD, those with predicted risks of <5%, 5–10%, and ≥10% could be classified into categories of low-, moderate-, and high-risk for ASCVD, respectively. Conclusion The findings enable development of a simple method for classification of individuals into low-, moderate-, and high-risk groups, based on the China-PAR equations. The method will be useful for self-management and prevention of ASCVD in Chinese adults.

Diabetes awareness, treatment, control rates and associated risk factors among Beijing residents in 2011: A cross-sectional survey

Background: The accurate assessment of individual risk can be of great value to guiding and facilitating the prevention of atherosclerotic cardiovascular disease (ASCVD). However, prediction models in common use were formulated primarily in white populations. The China-PAR project (Prediction for ASCVD Risk in China) is aimed at developing and validating 10-year risk prediction equations for ASCVD from 4 contemporary Chinese cohorts. Methods: Two prospective studies followed up together with a unified protocol were used as the derivation cohort to develop 10-year ASCVD risk equations in 21 320 Chinese participants. The external validation was evaluated in 2 independent Chinese cohorts with 14 123 and 70 838 participants. Furthermore, model performance was compared with the Pooled Cohort Equations reported in the American College of Cardiology/American Heart Association guideline. Results: Over 12 years of follow-up in the derivation cohort with 21 320 Chinese participants, 1048 subjects developed a first ASCVD event. Sex-specific equations had C statistics of 0.794 (95% confidence interval, 0.775–0.814) for men and 0.811 (95% confidence interval, 0.787–0.835) for women. The predicted rates were similar to the observed rates, as indicated by a calibration &khgr;2 of 13.1 for men (P=0.16) and 12.8 for women (P=0.17). Good internal and external validations of our equations were achieved in subsequent analyses. Compared with the Chinese equations, the Pooled Cohort Equations had lower C statistics and much higher calibration &khgr;2 values in men. Conclusions: Our project developed effective tools with good performance for 10-year ASCVD risk prediction among a Chinese population that will help to improve the primary prevention and management of cardiovascular disease.

Ideal cardiovascular health and incidence of atherosclerotic cardiovascular disease among Chinese adults: the China-PAR project

Objectives This study was aimed to investigate the prevalence of active and passive tobacco smoking among Beijing residents in 2011. Methods A cross-sectional survey was conducted, using a stratified multistage cluster random sampling method to select a representative sample of 20,242, among Beijing residents aged 18–79 years. Active and passive tobacco smoking information was collected by a standardized and validated questionnaire in a face-to-face interview. All estimates of prevalence and numbers were weighted by the 2010 Beijing Population Census data and the sampling scheme. Results Among Beijing residents aged 18–79 years, the overall prevalence of ever smokers and current smokers were 33.13% and 30.18%, respectively. The prevalence in males was much higher than that in females (60.75% vs. 3.75% for ever smokers, and 55.53% vs. 3.21% for current smokers, respectively). For overall current smokers, 14.12 cigarettes were consumed per day. However, only 8.91% of ever smokers quitted smoking at the time of the survey, and 2.44% of ever smokers quitted smoking in recent two years. Furthermore, 44.74% of overall nonsmokers and former smokers, with 47.03% of males and 43.63% of females, reported exposure to secondhand smoke for at least 15 minutes per day and at least one day per week. Conclusions Tobacco smoking prevalence is still extremely high in Beijing. Nonsmokers do still suffer from secondhand smoke critically. Further urgent efforts for tobacco control are warranted in Beijing.