Use of preventive cardiovascular drugs ‘markedly insufficient’ in China

A national cardiovascular disease screening project in China revealed fewer than 3 percent of high-risk participants were taking either statins or aspirin—a finding researchers described as a “wake-up call” for middle- and low-income countries which are struggling to combat their worsening CVD risk profiles.

Cardiovascular disease accounted for 40 percent of all deaths in China in 2015, lead author Jiapeng Lu, MD, PhD, and colleagues wrote Feb. 19 in the Annals of Internal Medicine. And the burden of CVD in the country is expected to increase due to the aging population and the growing prevalence of hypertension, diabetes and smoking.

To gauge the current state of CVD risk in China, Lu et al. performed a screening study of nearly 1.7 million adults aged 35 to 75, with an eye on the prevalence of key risk factors as well the use of preventive medications among those considered high risk. Individuals were considered to have high CVD risk if their 10-year estimated risk for CVD exceeded 10 percent, based on a chart developed by the World Health Organization (WHO) that accounted for age, sex, smoking status, systolic blood pressure, diabetes and total cholesterol levels.

Overall, 9.5 percent of participants fell into this category, including 11.8 percent of men and 8 percent of women. But only 0.6 percent of these individuals were taking statins and 2.4 percent reported using aspirin. Antihypertensive medications were taken by 31.8 percent of participants with blood pressures above 140/90 mm Hg, but even those rates are “markedly insufficient,” according to the authors of an accompanying editorial.

“The report by Lu and colleagues is an important call to action,” wrote Paul K. Whelton, MB, MD, MSc, and Lisandro D. Colantonio, MD, PhD. “It also should serve as a wake-up call for many other highly populated middle- and low-income countries where the CVD risk factor profile is worsening faster than the current health sector can respond to it. We hope that it will motivate these nations to take more decisive action.”

Lu et al. noted hypertension was the most prevalent risk factor among high-risk individuals at 96.2 percent, followed by dyslipidemia (54.9 percent), diabetes (51.6 percent) and smoking (29.7 percent). Several subgroups were found to have a greater proportion of individuals with high CVD risk, including rural residents, Han ethnicity, older individuals and those with lower income and education levels.

“Because hypertension control is ubiquitously poor across population subgroups in China, an improved national strategy of prevention and screening is needed to curb the harmful effects of elevated blood pressure,” wrote Lu, with the National Center for Cardiovascular Diseases in Beijing, and co-authors. “Our previous study revealed that 1 in 12 primary health care sites stocked no antihypertensive medications and that few guideline-recommended, low-cost medications were prescribed in primary health care settings in China (about 10% of all prescription records).

“Therefore, better access to antihypertensive medications and standardization of physician practice also are necessary to prevent and treat hypertension.”

Lu and colleagues said statin and aspirin use was self-reported which may have led to an underestimation of how many people actually took those medications. Also, the analysis only focused on primary prevention, but improving secondary prevention among those with a history of CVD is also important to reduce the burden of the disease in China.

Still, the results paint a sobering picture of the state of CVD prevention in the country, but also represent an “immense opportunity” for curbing health risks in such a population, Lu et al. wrote.

The authors’ risk prediction charts were developed from data almost 20 years old, so a more recent and locally validated tool such as the China-PAR (Prediction for ASCVD Risk in China) might provide a more accurate estimate of CVD risk, the editorialists suggested. Whereas the WHO chart used in the study only predicts the risk of stroke and MI, the China-PAR also incorporates coronary heart disease events due to other causes.  

“The fact that the estimates reported by Lu and colleagues very likely underrepresent the true burden of illness due to CVD in China underscores the importance of the authors' conclusion that CVD risk identification and targeted therapy are urgently needed in China,” Whelton and Colantonio wrote. “Regardless of that country’s true CVD risk, it is too high and the trajectory is headed toward progressive worsening unless steps are taken to drastically improve awareness, treatment, and control of CVD risk factors.”