The world has watched the dramatic economic growth and industrialization of China unfold in awe. But, according to a new Harvard study, these changes are also fueling the rise of China’s deadliest killer: cardiovascular disease.
The study, published Monday, asserts that major shifts in Chinese lifestyle – like the adoption of a more Western diet, increased television time and decreases in bicycle ownership – facilitated a 20-year rise in cardiovascular disease (CVD) due mostly to high blood pressure and obesity. Unhealthy diets, decreased physical activity and rampant smoking have also added to this growing burden that appears will worsen over the next 20 years.
“China is facing a rising epidemic of cardiovascular disease, and it shows no sign of abating,” said Frank Hu, senior author of the study and professor of nutrition and epidemiology at Harvard, in a statement.
In fact, the World Health Organization reported a projected 50 percent increase in annual cardiovascular disease events between 2010 and 2030 based solely on population aging and growth in China. Just in 2011, cardiovascular disease was responsible for 44 percent of the deaths of people older than 35, the Harvard study found.
The WHO also reports that about 230 million people – or one in five adults – in China have cardiovascular disease. That number is “equivalent to the total populations of the United Kingdom, Australia, Canada and Mexico combined,” the editorial comment in the journal pointed out. By sheer numbers, the cardiovascular disease problem in China is a global health epidemic.
Fortunately, “CVD is a preventable disease and all the risk factors have effective strategies of prevention,” Yanping Li, research scientist in the Department of Nutrition at the Harvard T.H. Chan School of Public Health and lead author of the study, told Humanosphere.
For example, Li is quick to note that with the government’s encouragement, tobacco use is on the decline. However, they still have a long way to go, she said, since more than half of all men in China still smoke, and tobacco use was associated with a third of cardiovascular disease burden in men in 2011.
Likewise, China’s diet has changed positively in some ways: more fiber, nuts, fruit and omega-3 fatty acids in fish. But consumption of red meat, sugary sodas and sodium have also increased, contributing to diabetes, high cholesterol, obesity and high blood pressure – the leading risk factor in China, responsible for around 40 percent of heart attacks and strokes, the study estimated.
To highlight how quickly this problem has evolved: In 1979, when China began to implement its economic reforms, high blood pressure affected less than 8 percent of the population. By 2010, it had jumped to 33.5 percent – similar to adults in the U.S.
And while it might be reasonable to assume urban areas have been most affected, the study found that increases in high blood pressure (or hypertension) and obesity over time were actually more pronounced among rural residents and younger people. High blood pressure, Li says, is everywhere in China. In richer urban areas it may be largely caused by fast food and obesity, but in poorer rural areas, hypertension is a result of eating popular salty vegetables.
As many developing countries look to China for a positive example of booming economic growth, should they all expect this accompanying health crisis? Perhaps – but Li says the key is prevention not treatment, even for China.
“The government should [recognize]the first priority is not treatment but prevention, and we really need a very intensive effort to nationalize prevention for every single risk factor,” she told Humanosphere.
Li also emphasized that effective prevention requires close cooperation between policy and medicine, including early detection. “A lot of people with hypertension and diabetes have no idea they have the disease, so they have no treatment and no control,” she says.
Other suggested strategies include infrastructure that encourages physical activity, controlling air pollution, health education and promoting a healthy diet.
If countries need a working model to emulate, Li says there are several examples to follow.
“CVD prevalence is not increasing everywhere,” she says. “In a lot of countries it’s starting to decrease. I’m thinking Australia and northern European countries, the CVD rate is starting to decrease. They put a lot of effort into prevention and health care.”
This study, published in the Journal of the American College of Cardiology, is the first of its scope, based on data from 1991 to 2011 of 26,000 people in nine provinces and examining 17 dietary and lifestyle risk factors.
“It’s imperative to continue to monitor the problem, which has serious social and economic consequences,” said senior author Frank Hu in a statement. “Prevention of chronic diseases through promoting healthy diet and lifestyle should be elevated to a national public policy priority” – and not just in China.
