我国心血管疾病流行和负担

我国心血管疾病：我国心血管疾病：流行和负担流行和负担顾东风顾东风中国医学科学院阜外心血管病医院中国医学科学院阜外心血管病医院卫生部心血管病防治研究中心卫生部心血管病防治研究中心背 景 我国目前面临低出生率、低死亡率和较高期望寿命（73岁）, 和人口老龄化，在2007年底，8.0% 的人口年龄 65 岁, 达1亿。 重要心脑肺血管疾病患病率和危险因素水平在发达国家已经降低，如高血压和吸烟患病率但我国还在继续上升。 我国目前正处于人口、社会和经济高速发展变化的阶段，这将进一步加重心血管病负担。9.413.617.75.17.712.47.5024681012141618201959197919912002prevalence(%)中国高血压患病率全国性调查中国高血压患病率全国性调查1959-2002 National BP Survey Cooperative Group Chinese J Hypertension Gu D Hypertension 2002 1995, 3(suppl):9-13 40:920-927 30246Age 15-74 Age 35-74MenWomen在过去20年，年龄调整的高胆固醇血症患病率变化趋势* =200 mg/dl.BJ: Beijing worker BJF: Beijing farmer SYF: Shanxi farmer SZF: Shaanxi farmer JJF: Jiangsu farmer GWF: Guangxi farmer GZW: Guangzhou workerGZF: Guangzhou farmer ZZFs:Zhejiang fishermen Wu YF. Chinese Journal of Cardiology 2001, 29(2):74-79. 男男 性性 女女 性性中国35-74 岁成年人中血清胆固醇发布百分比, 2000-2001 240He J, Gu D. Circulation 2004;110 :405-11 Hazard ratioMean usual total cholesterol (mmol/l)血清胆固醇和心血管病关系4.55.05.56.06.5+1 mmol/L: 1.32 (1.20-1.46)0.71.01.42.0TC和CHD4.55.05.56.06.5+1 mmol/L: 0.81 (0.72-0.92)0.250.501.002.004.00TC和出血性中风 +1 mmol/L: 1.23 (1.12-1.35)4.55.05.56.06.50.501.002.004.00TC和缺血性中风TC TC 上升上升 +1 mmol/L+1 mmol/L 冠心病危险 32上升缺血性中风危险上升 23 出血性中风下降 19 中国中国18成年人的成年人的年龄调整的超重肥胖患病率年龄调整的超重肥胖患病率 全国营养和健康调查全国营养和健康调查, 200216.121.6254.87.210.6010203040Rural S.cityL.cityPopulationRate(%) 中国成年人吸烟率中国成年人吸烟率 男男女女Number ofParticipants % %1984258,42261.0261,178 4.21996 65,00063.0 57,000 3.8a: 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, 2005Number ofParticipants200273,19353.9 87,360 3.1中美人群CVD危险因素年龄标化患病率*p=200 mg/dl.BJ: Beijing worker BJF: Beijing farmer SYF: Shanxi farmer SZF: Shaanxi farmer JJF: Jiangsu farmer GWF: Guangxi farmer GZW: Guangzhou workerGZF: Guangzhou farmer ZZFs:Zhejiang fishermen Wu YF. Chinese Journal of Cardiology 2001, 29(2):74-79.Percentage Distribution of Serum Total Cholesterol in Adult Population Aged 35-74 Years in China, 2000-2001 240He J, Gu D. Circulation 2004;110 :405-11 TC and fatal CHD, fatal and non fatal ischemic and haemorrhagic stroke in AsiaHazard ratioMean usual total cholesterol (mmol/l)4.55.05.56.06.5+1 mmol/L: 1.32 (1.20-1.46)0.71.01.42.0TC and CHD4.55.05.56.06.5+1 mmol/L: 0.81 (0.72-0.92)0.250.501.002.004.00TC and haemorrhagic stroke +1 mmol/L: 1.23 (1.12-1.35)4.55.05.56.06.50.501.002.004.00TC and ischemic strokeTC incresing +1 mmol/L CHD risk 32ischemic stroke risk 23 haemorrhagic stroke 19 Circulation. 2004;110:2678-86Ann Epidemiol 2005;15:504-13 Age-standardized Prevalence of Overweight/ Obesity among Adults Aged18, China National Nutrition and Health Survey, 200216.121.6254.87.210.6010203040Rural S.cityL.cityPopulationRate(%)Prevalence of Smoking in ChinaMenWomenNumber ofParticipants % %1984258,42261.0261,178 4.21996 65,00063.0 57,000 3.8a: 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, 2005Number ofParticipants200273,19353.9 87,360 3.1Age-Standardized Prevalence of Major CVD Risk Factors in China and the United States*p0.001 Standardized on the basis of the year 2000 age distribution of the Chinese population.CVD Incidence and Mortality and Their Trends in ChinaProportionate Mortality for the Ten Leading Causes of Death in China, 1957-2000He J & Gu D, et al, N Engl J Med 2005;353;11:1124-113419572000Heart diseasestrokeAge-standardized Mortality for the Five Leading Causes of Death in AdultsHe J & Gu D, et al, N Engl J Med 2005;353;11:1124-1134WomenMenCPHD-chronic pulmonary heart disease; CHD-coronary heart disease; HF-heart failure; RHD-rheumatic heart diseaseAge-standardized Mortality for the Five Leading Causes of Vascular DeathNumber of Patients with cardiovascular diseases in Adult Population Aged 35-74 Years in China, 2000-2001*30% causes of death by CVD World-wideCVD mortality rate /100,000 ： China 12th，400/100,000; USA 15th，360/100,000;Number of Patients with Diabetics and Hypertension Discharged from Hospitals, 1980-2006Diabetics HypertensionChina Health Statistics Yearbook (1980-2007). Ministry of Health, P.R.ChinaNumber of Patients with Five Major Heart Diseases Discharged from Hospitals, 1980-2006Number of Patients with CVD and CBVD Discharged from Hospitals, 1980-2006HemorrhagicIschemicHemorrhagicIschemic1991-1999 Trends in CHD Incidence and Mortality, in Comparison to Total Mortality: China MUCA Study 010203040506070809010019911993199519971999MaleFemaleAll deathCHD death0100200300400500600700800900100019911993199519971999MaleFemale010203040506019911993199519971999MaleFemaleCHD incidence Burden and Challenges:Major Public Health Issues in Adults, China 26 m.DM200 m.Dyslipidemia200 m.Hypertension260 m.Overweight/OB300 m.Smoking2002 National Nutrition and Health Survey 2002InterAsia Study 2000-2001 77 m.MS 3 m.MI (0.6 %) 7 m.Stroke (1.4 %) 4 m.Heart Failure 3.2 m. die of CVD per yearProjected Global Burden of Hypertension in 2025The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion). Most of this rise can be attributed to an expected increase in economically developing countries (1.15 billion or 80%)Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Lancet 2005;365:217-223Annual CHD deaths in Chinese men 35-64 and 65-84 years old forecasted from 2000-2029Moran A, Zhao D, Gu D, et al. BMC Public Health. 2008;8(1):394ConclusionsSecular Trends of CVD in ChinaConclusionsdyslipidemia Prevention, detection, and treatment of hypertension, dyslipidemia, diabetes, smoking, and overweight may greatly reduce the future burden of CVD in China.Thank you