REPORT ON CARDIOVASCULAR DISEASES IN CHINA (2013) 中国心血管病报告 2013 National Center for Cardiovascular Diseases,China 国家心血管病中心 Encyclopedia of China Publishing House 图书在版编目（CIP）数据 中国心血管病报告. 2013：英文/国家心血管中心著、译. -北京：中国大百科全书出版社， 2015.6 INBN 978-7-5000-9579-8 Ⅰ.①中… Ⅱ.①国… Ⅲ.①心脏血管疾病－研究报告－中国－2013－英文 Ⅳ .①R54 中国版本图书馆CIP数据核字（2015）第140131号 责任编辑：韩小群 出版发行 （北京阜成门北大街17号 邮政编码：100037 电话：010-88390718） http://www.ecph.com.cn 北京骏驰印刷有限公司印刷（北京市海淀区西北旺屯佃工业园区289号） 新华书店经销 开本：889×1194毫米 1/16印张：11.25 字数:300千字 2015年6月第一次印刷 印数：1－4000册 ISBN 978-7-5000-9579-8 定价:125.00元 本书如有印装质量问题，可与本出版社联系调换。 INBN 978-7-5000-9579-8 Copyright by Encyclopedia of China Publishing House,Beijing,China,2014.4 Published by Encyclopedia of China Publishing House 17 Fuchengmen Beidajie,Beijing,China 100037 http://www.ecph,com.cn Distributed by Xinhua Bookstore First Edition 2015.6 Printed in the People's Republic of China EDITORIAL COMMITTEE for Report on Cardiovascular Diseases in China (2013) Chief Editor: Hu Shengshou Deputy Chief Editors: Gao Runlin; Liu Lisheng; Zhu Manlu; Wang Wen; Wang Yongjun; Wu Zhaosu Secretaries: Chen Weiwei; Sui Hui; Yang Jingang Writing Group Chen Weiwei; Du Wanliang; He Jianguo; Jia Weiping; Li Guangwei; Li Xiaoying; Li Xiaomei; Li Ying; Liu Kejun; Liu Jing; Luo Xinjin; Mi Jie; Sui Hui; Wang Chunning; Wang Jinwen; Wang Wei; Wang Wen; Wang Yu; Wang Zengwu; Xu Zhangrong; Yang Jingang; Yang Xiaohui; Zeng Zhechun; Zhang Jian; Zhang Shu; Zhang Yuhui; Zhao Liancheng; Zhou Xin; Zhu Jun; Zuo Huijuan Editorial Committee Chen Chunming; Chen Weiwei; Chen Yude; Du Wanliang; Gao Runlin; Gu Dongfeng; Hu Dayi; Hu Shengshou; Li Guangwei; Li Wei; Li Xiaoying; Li Xiaomei; Li Ying; Liu Kejun; Liu Jing; Liu Lisheng; Luo Xinjin; Mi Jie; Rao Keqin; Tang Xinhua; Wang Bin; Wang Chunning; Wang Haiyan; Wang Mei; Wang Wei; Wang Wen; Wang Wenzhi; Wang Yilong; Wang Yongjun; Wang Yu; Wang Zengwu; Wu Di; Wu Liangyou; Wu Xigui; Wu Zhaosu; Xu Zhangrong; Yang Gonghuan; Yang Xiaohui; Yao Chonghua; Zeng Zhechun; Zeng Zhengpei; Zhang Jian; Zhang Shu; Zhao Dong; Zhao Liancheng; Zhu Jun; Zhu Manlu; Zuo Huijuan Academic Committee Chen Chunming; Chen Haozhu; Chen Jilin; Chen Junshi; Chen Lanying; Chen Wenxiang; Chen Xuli; Chen Yude; Chen Zaijia; Cheng Xiansheng; Dai Guizhu; Ding Jinfeng; Fang Qi; Feng Jianzhang; Gao Runlin; Gao Shan; Ge Junbo; Gong Lansheng; Gu Dongfeng; Guan Heng; Hong Shaoguang; Hu Dayi; Hu Jianping; Hu Shengshou; Hua Qi; Huang Dejia; Huang Jun; Huang Tigang; Hui Rutai; Huo Yong; Jia Guoliang; Jiang Weijian; Jin Shuigao; Kong Lingzhi; Li Guangwei; Li Jianjun; Li Nanfang; Li Xiaoying; Li Yishi; Li Ying; Li Yong; Li Yunqian; Liang Wannian; Liao Yuhua; Lin Shanyan; Lin Shuguang; Liu Guozhang; Liu Lisheng; Lu Guoping; Lu Zaiying; Lu Zongliang; Lv Chuanzhen; Ma Hong; Ma Shuping; Pan Changyu; Qi Wenhang; Rao Keqin; Shen Weifeng; Sun Ming; Sun Ningling; Tang Xinhua; Wang Daowen; Wang Fangzheng; Wang Haiyan; Wang Mei; Wang Wen; Wang Xiaowan; Wu Kegui; Wu Qinghua; Wu Xigui; Wu Yinsheng; Wu Zhaosu; Xiang Kunsan; Xu Zhangrong; Xu Zhimin; Xu Chengbin; Yan Shengkai; Yan Xiaowei; Yang Xiaoguang; Yang Xinchun; Yang Yuejin; Yao Chonghua; Ye Ping; You Kai; Yu Guoying; Zeng Dingyin; Zhang Qinyi; Zhang Tingjie; Zhang Tong; Zhang Weiwei; Zhang Weizhong; Zhang Zhuo; Zhao Dong; Zhao Jizong; Zhao Lianyou; Zhao Shuiping; Zhao Yuanli; Zhou Jingchun; Zhu Dingliang; Zhu Jun; Zhu Xiaodong; Zhu Junren; Zhu Zhiming Proofreader Ma Liyuan Preface With rapid economic growth and associated industrialization, urbanization, the accelerated process of ageing and lifestyle changes, the risk factors for cardiovascular diseases (CVD) are more prevalent in the Chinese population, and therefore increase the incidence of CVD. The prevalence of CVD will remain an upward trend in the next 10 years. CVD is the leading cause of death for Chinese in both urban and rural area. Nowadays, 38.7% of deaths in rural area and 41.1% of deaths in urban area are caused by CVD in China. The burden of CVD remains heavy and has become a major public health issue. Effective strategies should be enforced urgently for the prevention and treatment of CVD under the supervision of the government. In May 2012, fi fteen governmental ministries, including the Ministry of National Health and Family Planning, jointly issued the Work Plan for Chronic Disease Prevention and Control in China (2012-2015), a guideline for the prevention and control of chronic diseases, especially CVD in China. We should actively follow and implement its recommendations. Since 2005, the National Center for Cardiovascular Diseases has organized experts of cardiology, neurology, nephrology, diabetes, epidemiology, community health, health economics and biostatistics and other related fi elds to compile the annual report on Cardiovascular Diseases in China. The purpose is to provide technical guidance and authoritative evaluation for cardiovascular disease prevention and treatment, produce the theoretical foundation for government legislation and strategic planning and establish a platform for international communication and cooperation. Abbreviations CAD: Carotid Atherosclerotic Disease AAA: Abdominal Aortic Aneurysm CCEP: China Cholesterol Education Program AAI/R: Atrial sensing, Atrial pacing, Inhibited, CDS: China Diabetes Society Rate response single chamber pacing CHNS: China Health and Nutrition Survey ABI: Ankle Brachial Index CVD: Cardiovascular Diseases ACEI: Angiotensin Converting Enzyme Inhibitor CHD: Coronary Heart Disease ACS: Acute Coronary Syndrome CI: Confi dence Interval AMI: Acute Myocardial Infarction CKD: Chronic Kidney Disease BMI: Body Mass Index CNDMDS: China National Diabetes and Metabolic CABG: Coronary Artery Bypass Grafting Disorder Study 5 Report on Cardiovascular Diseases in China (2013) COPD: Chronic Obstructive Pulmonary Disease LVEF: Left Ventricular Ejection Fraction CRT: Cardiac Resynchronization Therapy OSAHS: Obstructive Sleep Apnea Hypopnea CTEPH: Chronic Thromboembolic Pulmonary Syndrome Hypertension Met: Metabolic Equivalent DALYs: Disability Adjusted Life Years MS: Metabolic Syndrome ECMO: Extracorporeal Membrane Oxygenation PAD: Peripheral Artery Disease ESRD: End Stage Renal Disease PAH: Pulmonary Arterial Hypertension EVAR: Endovascular Aneurysm Repair PARP: Population Attributable Risk Proportion GFR: Glomerular Filtration Rate PCI: Percutaneous Coronary Intervention HbA1c: Hemoglobin A1c PTCA: Percutaneous Transluminal Coronary HDL-C: High Density Lipoprotein-Cholesterol Angiography HF: Heart Failure PWV: Pulse Wave Velocity HR: Hazard Ratio RFCA: Radiofrequency Catheter Ablation ICD: Implantable Cardioverter-Defibrillator RR: Relative Risk IHD: Ischemic Heart Disease SHS: Second-Hand Smoking IMT: Intima-Media Thickness STEMI ST Elevation Myocardial Infarction INR: International Normalized Ratio TC: Total Cholesterol IPAH: Idiopathic Pulmonary Artery Hypertension TG: Triglyceride ISH: Isolated Systolic Hypertension WC: Waist Circumference LEAD: Lower Extremity Atherosclerotic Disease WHtR: Waist-Height Ratio LDL-C: Low Density Lipoprotein-Cholesterol YLD: Year Lived with Disability LVEDD: Left Ventricular End Diastolic Diameter Note: Cardiovascular diseases referred in this report include cardiovascular, cerebrovascular disease and their related diseases. 6 CONTENTS Outline of the Report on Cardiovascular Diseases in China, 2013 …………1 Chapter 1 Prevalence and Mortality of Cardiovascular Diseases …………10 1.1 Prevalence of Cardiovascular Diseases …………………………………………………10 1.2 Death of Cardiovascular Diseases ………………………………………………………10 1.2.1 Mortality of Cardiovascular Diseases ……………………………………………10 1.2.2 Deaths Attributable to Cardiovascular Diseases among All Causes of Death ……12 1.2.3 Trends of Cardiovascular Disease Mortality ………………………………………12 Chapter 2 Risk Factors of Cardiovascular Diseases ………………………15 2.1 Hypertension ……………………………………………………………………………15 2.1.1 Primary Hypertension ……………………………………………………………15 2.1.2 Secondary Hypertension …………………………………………………………35 2.1.3 Hypertension in Children and Adolescents ………………………………………36 2.2 Smoking …………………………………………………………………………………47 2.2.1 Prevalence of Smoking ……………………………………………………………47 2.2.2 Smoking Cessation …………………………………………………………………52 2.2.3 Hazards of Smoking and Passive Smoking ………………………………………52 2.2.4 Disease Burden and Economic Cost of Tobacco Use in China ……………………58 2.3 Dyslipidemia ……………………………………………………………………………59 2.3.1 Lipid Levels and Prevalence of Dyslipidemia in Adults …………………………59 2.3.2 Prevalence of Dyslipidemia among Children and Adolescents ……………………63 2.3.3 Effect of Dyslipidemia on Cardiovascular Diseases ………………………………64 2.3.4 Prevention and Control of Dyslipidemia …………………………………………66 2.4 Diabetes …………………………………………………………………………………69 1 2.5 Overweight and Obesity ………………………………………………………………76 2.5.1 The Current State of Obesity in China ……………………………………………76 2.5.2 Diseases Related to Overweight and Obesity ……………………………………79 2.6 Physical Inactivity ………………………………………………………………………81 2.6.1 Current Status, Trends, and Influence Factors of Physical Activity ………………81 2.6.2 Physical Inactivity and Cardiovascular Diseases …………………………………85 2.7 Diet and Nutrition ………………………………………………………………………88 2.7.1 Current State and Trends of Nutritional Health ……………………………………88 2.7.2 Effects of Diet on CVD and Associated Risk Factors ……………………………92 2.8 Metabolic Syndrome (MS) ……………………………………………………………95 2.8.1 Prevalence of MS …………………………………………………………………96 2.8.2 Risk Factors of MS ………………………………………………………………97 2.8.3 MS and CVD ………………………………………………………………………99 Chapter 3 Cardiovascular Diseases …………………………………………100 3.1 Stroke (Cerebrovascular