Challenges to tackling the burden of cardiovascular disease in China must be urgently addressed

Recently, by invitation of Professor Fuster, Chief Editor of 'Journal of the American College of Cardiology' (JACC), the research team of Professors Changsheng Ma and Du Xin of Beijing Anzhen Hospital, and Professors Craig Anderson and Anushka Patel of the George Institute for Global Health, jointly undertook a review of the cardiovascular disease in China and proposed that strengthening the prevention of cardiovascular diseases and capacity building of community health service centers, as the only ways to solve the challenges of the rapidly increasing burden of cardiovascular disease in China.

The tremendous economic growth in China has led to the emergence of many new challenges to its health and community services that has seen a change from predominantly infectious to chronic disease management. Cardiovascular disease, in particular, is now well established as the leading cause of premature death and disability in China. The economic consequences of cardiovascular disease are enormous in China – a combination of high direct healthcare costs and indirect productivity loss  -  cause deaths and disability, exacerbated by population ageing.

According to studies, in an inverted pyramid healthcare system where primary healthcare is weak and the bulk of the burden is placed on tertiary care, it is not sustainable to continue to increase pressure on this system. The authors propose that combining population-level strategies towards the control of cardiovascular disease risk factors and reforms to strengthen primary health system are urgently needed for the large and rapidly aging population.

Elevated blood pressure was cited as being responsible for approximately two-thirds of all strokes, and nearly half of coronary heart disease, and 7.6 million deaths (13.5% of all deaths) annually, worldwide. China, along with India, has the greatest burden of hypertension-related diseases, accounting for some 60% of cardiovascular disease-related deaths in adults aged 55 to 64 years in 2005, and 750,000 cardiovascular disease-related deaths in 2010. Moreover, data suggest there is an increasing temporal trend in the prevalence of hypertension, and is an even greater issue for the 576 million people living in rural regions of China. In a cited study, only 42% were aware of their hypertension, and 34% and 8.2% received treatment and with effective control, respectively, among 45,108 participants aged between 35 and 70 years in China. This demonstrates that most such individuals do not have their hypertension effectively treated or controlled.

Professor Xin Du, Director of the Heart Health Research Center and cardiovascular specialist at the Beijing Anzhen Hospital, said,

“In order to reduce the extremely severe burden of cardiovascular and cerebrovascular diseases, and to effectively address serious gaps in the management of coronary heart disease, heart failure and atrial fibrillation, remedying the existing deficiencies within the Chinese health care system should be the preferred response measure.”

Key facts:

• The combination of population growth and ageing are expected to contribute at least another 3.4 million deaths from cardiovascular disease over the next two decades, and related costs are projected to increase by USD 7.8 trillion from 2012 to 2030;
• It is estimated that some 235 million adults have uncontrolled hypertension which goes untreated in China;
• Clinicians and patients tend to pursue expensive invasive treatments, often ignoring basic medical and lifestyle principles governing cardiovascular disease;
• The current primary care workforce is insufficient to deliver effective care to the approximately 200 million people falling under the high risk segment of the Chinese population, and for much of the existing healthcare workforce, skills of managing those with hypertension has to be improved. In rural areas, access to appropriate antihypertensive medications needs to be improved as well.

Efforts are being made to reduce hypertension incidence in China, especially with regards to its primary care management. The Chinese government has adopted policies to promote healthy lifestyle behaviours, invested resources to strengthen the primary healthcare workforce such as capacity building in order to improve the effectiveness of the healthcare system in combatting chronic diseases. According to the Healthy China 2030 plan, the number of general physicians is expected to double by 2030 (from 2-3 to 5 per 10,000 residents).

“Given the vast size as well as the geographically and culturally diverse population of China, there is still a long journey ahead towards adopting the learnings and insights from within and outside to conquer cardiovascular disease.” said Professor Du.