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Cardiovascular Disease in China: Why Should We Care?

Cardiovascular Disease in China: Why Should We Care?

Editorial Board

Cardiovascular disease (CVD) is the leading cause of death in China.1 From 2005 to 2015, productivity losses are estimated to be RMB $3.6 trillion (US $550 billion) from hypertension, heart disease, diabetes and stroke, according the World Health Organization and World Economic Forum.2,3,4 In May of 2010, the American Heart Association published that deaths from CVD will increase by 73% by the year 2030.1,3,4 Such an increase in cardiovascular morbidity has been associated with China’s rapid economic development and urbanization, change to a sedentary lifestyle, smoking and dietary habits. Thus, it is predicted that an additional 21.3 million cardiovascular events, and an additional 7.7 million deaths will accrue between 2010 and 2030 placing the Chinese population at risk for heart disease.1 As a response to the projected rise in mortality from heart disease the Chinese government has increased funding for healthcare to RMB $1trillion, for the years 2009 to 2011.5

Three million deaths annually are due to cardiovascular disease in China, accounting for 40% of all deaths.6More importantly, 230 million are thought to have cardiovascular disease, of which 200 million have hypertension. These statistics suggest that 1 in 5 people in China have cardiovascular disease. According to the American Heart Association, Asia has higher stroke mortality than developed Western countries.6

With an aging populationand increased life expectancy, numbers of CVD events are anticipated to escalate across Asia over the next 20 years. The rate of CVD deaths have increased in China by 16.5% between 2004 and 2008,7while theGDP per capitahas grown by 30% over the same time period, suggesting the connection between economic growth and health. In 2005, China lost RMB$ 116.7 billion (US $18 billion) in national income from heart disease, stroke, and diabetes.8

Key risk factors that contribute to this surge in CVD incidence across Asia include: high smoking rate, hypertension, increased body mass index (BMI) with glucose intolerance (leading to higher prevalence of diabetes mellitus), and heightened serum total cholesterol due to increase in dietary fat intake.3 Many individuals do not know the cardiovascular risk factors and do not how to prevent a CVD incident, consequently further amplifying the frequency of CVD death rates.1


Smoking is a primary issue contributing to CVD occurrence in Asia due to elevated smoking rates. As many as 62% of males in China actively smoke; while female smokers are significantly less common, at least 49% of nonsmoking women are exposed to second hand smoke on a consistent basis.1,10 China has a large cigarette market with over 300 million smokers consuming an estimated 3 million cigarettes per minute,2 whereas the US has 43 million smokers.11 China is also the source of one quarter of the world’s tobacco, making it the largest tobacco producer in the world.2

To offset the millions of projected CVD incidence and deaths, China has instituted a “tobacco control policy” to reduce smoking rates to 10% by 2030, by creating a law outlawing smoking in public indoor spaces on May 1, 2011. Such areas are hotels, restaurants, theatres, public transportation waiting rooms.12 Culturally, smoking is currently perceived as a positive social activity among the young urbanites as a connotation of friendship, collegiality. In fact, a British-Hong Kong-Chinese study found that two thirds of the Chinese people surveyed think smoking is harmless, 60% do not think smoking causes lung cancer and 96% surveyed do not know that smoking contributes to heart disease.13

The overwhelming prevalence of smoking in Asian culture affects physicians. A survey of Chinese physicians found that 31.9% of male physicians smoke while another survey of Chinese cardiologists determined that 29.8% of the males are smokers.14, 15 Moreover, physicians do not advise their patients to stop smoking as only 48% of Chinese patients have received physician advice to do so, despite research suggesting that physician advice is most effective in modifying the habit of smoking.16 Currently, the Chinese health care providers have not educated the public about the health risks of smoking.16

Thus, in the future, online medical journals, such as ours, would disseminate medical information to physicians in Asia. There could be increased awareness of cardiovascular disease risks and premature deaths. All physicians could work in conjunction with public health education efforts to decrease the numbers of cardiovascular disease related deaths in Asia.1


  1. Moran A, Gu D, Zhao D, Coxson P et al. Future Cardiovascular Disease in China: Markov model and Risk Factor Scenario Projections from the Coronary Heart Disease Policy Model-China. Circ Cardiovasc Qual Outcomes. 2010. 3(3): 243-252.
  2. Fact Sheets Smoking Statistics.http://www.wpro.who.int/media_centre/fact_sheets/fs_20020528.htm. Accessed 29 May 2011.
  3. Attaining MDGs in Health: Isn’t Economic Growth Enough?www.adb.org/Documents/EDRC/Policy_Briefs/PB035.pdf. Accessed 29 May 2011.
  4. Zheng Y, Stein R, Kwan T. Evolving Cardiovascular Disease Prevalence, Mortality, Risk Factors, and the Metabolic Syndrome in China. Clinical Cardiology. 2009. 32(9): 491-497.
  5. Eight mln More Chinese to be Covered by Health Insurance in 2011.http://news.xinhuanet.com/english2010/china/2011-03/09/c_13768939.htm. Accessed 28 May 2011.
  6. Heart Disease Rising in China, Now Leading Cause of Death. www.managing-stress.org/heart-disease-rising-in-china-now-leading-cause-of-death/. Accessed 28 May 2011.
  7. Moran A, Zhao D, Gu D et al. The Future Impact of Population Growth and Aging on Coronary Heart Disease in China: Projections From the Coronary Heart Disease Policy Model-China. BMC Public Health. 2008. 8:394.
  8. Facing the Facts #4: Rethinking “Diseases of Affluence”: The Economic Impact of Chronic Diseases 2005. http://www.who.int/chp/chronic_disease_report/media/Factsheet4.pdf. Accessed 28 May 2011.
  9. Yong-Guan Z, Ioannidis J P A, Li H, et al. Understanding and Harnessing the Health Effects of Rapid Urbanization in China. Environmental Science and Technology. 2011.
  10. http://pubs.acs.org/doi/pdf/10.1021/es2004254. Accessed 29 May 2011.
  11. Indonesia: A Paradise for Tobacco Companies. 2009. http://www.seatca.org/index.php?option=com_content&view=article&id=65:indonesia-a-paradise-for-tobacco-companies&catid=1:latest-news&Itemid=57. Accessed 29 May 2011.
  12. How Many People in America Smoke Cigarettes? www.stopsmokingbible.com/how-many-people-in-america-smoke-cigarettes. Accessed May 29, 2011.
  13. Hogg C. 2011. China Ban on Smoking in Public Places Comes into Force. An Hour Ago New Zealand.http://www.anhourago.co.nz/show.aspx?l=8371272&d=507. Accessed 29.May 2011.
  14. Liu BQ, Peto R, Chen ZM et al. Emerging Tobacco Hazards in China:1. Retrospective Proportional Mortality Study of One Million Deaths. Brit Med J. 1998. 317:1411-1422.
  15. Yu JM, Hu DY, Jiang QW et al. Smoking Status in Chinese Cardiovascular Physicians in 2008. Zhonghua Yi Xue Za Zhi. 2009. 89(34): 2400-3.
  16. Smith DR, Wei N, Zhang YJ et al. Tobacco Smoking Habits Among a Cross-Section of Rural Physicians in China. Aust J Rural Health. 2006. 14(2):66-71.
  17. Jiang Y, Elton-Marshall T, Fong GT, Li Q. Quitting Smoking in China: Findings from the ITC China Survey. Tobacco Control. 2010. 19(2): i12-i17.

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