《中国心血管病健康和疾病报告2019》正式发布！
2020-09-15
What are the trends of cardiovascular disease, which is the top cause of death among urban and rural residents in recent years? How effective is the prevention and treatment of cardiovascular diseases in my country? What factors affect the cardiovascular health of Chinese people in how? In the face of the status quo, what should we do... On September 11, the China Heart Conference hosted by the National Cardiovascular Disease Center was grandly held through a combination of online and offline methods. At the meeting, many authoritative experts in the domestic cardiovascular field jointly released and interpreted the "China Cardiovascular Disease Health and Disease Report 2019".
Who is "buying mine" for our cardiovascular system
Cardiovascular health is in desperate situation, and it is mostly a long-term unhealthy lifestyle "buying mine". Academician of the Chinese Academy of Engineering and Professor Gao Runlin of Fuwai Hospital of the Chinese Academy of Medical Sciences combined with the "Report" prompts that factors such as tobacco use, reasonable diet, physical activity, overweight and obesity, and health and psychology should be given priority as the main influencing factors of Chinese cardiovascular health attention.
The "Report" shows that from 2010 to 2018, the smoking rate of people aged 15 and over in my country has shown a downward trend. Among them, males have dropped from 52.9% to 50.5%, and females have always been low. In 2018, the smoking cessation rate of smokers aged 15 and over in my country was 20.1%, which was higher than 18.7% in 2015. However, the smoking cessation rate of people in the low-age group (15-24 years old) was relatively low. Gao Runlin said that this indicates that the smoking rate of Chinese residents has shown a downward trend, but it is necessary to further strengthen tobacco control work, advance the barrier, and pay more attention to the popularization of tobacco control science and health education for young people.
The "Report" shows that from 1992 to 2012, the dietary structure of Chinese residents changed significantly. The average carbohydrate function ratio dropped from 66.2% to 55.0%, and the fat function ratio rose from 22.0% to 32.9%. However, corresponding to this, the overall physical activity level of Chinese people has declined, and overweight and obesity have increased. From 1991 to the present, the total physical activity of adults has dropped by nearly half. From 2016 to 2017, although the national primary and secondary school students’ physical activity compliance rate increased to a certain extent, from 29.9% to 34.1%, the increase was mainly concentrated in the elementary and junior high school stages, and there was no change in the high school stage. From 2002 to 2012, the overweight rate of residents over 18 years old rose from 22.8% in 2002 to 30.1%, and the obesity rate rose from 7.1% to 11.9%. Gao Runlin said that research has confirmed that obesity, overweight and insufficient exercise are high-risk factors for cardiovascular disease. The unoptimistic trends revealed in the "Report" suggest that people should develop a more active and healthy lifestyle in terms of eating habits and physical activity.
Gao Runlin also pointed out that the data show that the prevalence of depression in patients with acute myocardial infarction in my country is 21.66%, which is significantly higher than the 10.36% of healthy people. Although my country's above two data are lower than other 51 countries and regions in the world, the correlation between depression and acute myocardial infarction is higher than other countries. The study also found that the prevalence of major depression in Chinese residents is 0.6%, and major depression is one of the risk factors for heart disease. Gao Runlin said that these data require clinicians to attach great importance to not only the physical diseases of patients such as cardiovascular diseases, but also their psychological and mental states, and comprehensive diagnosis and treatment of both body and mind.
Has the cardiovascular disease "alarm value" changed?
When you have high blood pressure, dyslipidemia, diabetes, sleep disorders, this may be an alarm for the arrival of cardiovascular disease. Professor Gu Dongfeng, a member of the Chinese Academy of Sciences and Fuwai Hospital of the Chinese Academy of Medical Sciences, combined with the analysis of the "Report". In recent years, the changes in some of the "alarm" values have been mixed.
Repeated hypertension flow regulation shows that the prevalence of adult hypertension in my country continues to increase. At the same time, the awareness rate, treatment rate and control rate of hypertension have also shown a continuous increase in recent years. The awareness rate rose from 27% in 1991 to 51.6% in 2015, the treatment rate rose from 12.0% to 45.8%, and the control rate rose from 3.0% to 16.8%.
Gu Dongfeng said that let patients know their blood pressure and give them scientific guidance, so as to prompt them to take action to achieve blood pressure through effective drugs and lifestyle. In the past 30 years, the rate of hypertension control in my country has increased fivefold. In a country with a large population, such an achievement is commendable. These achievements are largely due to the advancement of national health promotion related work and actions. The next step is to continue to increase efforts in this area, and at the same time to further improve the standardization, effectiveness, and economic benefit evaluation of treatment.
At the same time, the prevalence of hypertension in children and adolescents between the ages of 7 and 17 (different from the evaluation index for adults) has also shown an upward trend, from 10.0% in 1993 to 12.9% in 2011. Gu Dongfeng said that increased blood pressure in childhood will lead to a certain proportion of adult hypertension. This suggests that the prevention of hypertension should be advanced to children and adolescents.
From 2002 to 2012, the adult dyslipidemia rate in my country rose from 18.60% to 40.40%. At the same time, although the awareness rate and treatment rate of dyslipidemia have increased, the level of progress is limited regardless of the rate of increase in prevalence or the level of prevention and treatment of hypertension. It suggests that more attention should be paid to hyperlipidemia in the prevention and control of the "three highs" in the future.
What are the new developments in clinical diagnosis and treatment
The "Report" shows that the prevalence of cardiovascular diseases in China is on a continuous rise. It is estimated that there are 330 million people suffering from cardiovascular diseases, including 13 million strokes, 11 million coronary heart diseases, 5 million cor pulmonales, 8.9 million heart failures, 2.5 million rheumatic heart diseases, 2 million congenital heart diseases, and lower extremity arteries. There were 45.3 million diseases and 245 million hypertension. In 2017, the death rate of cardiovascular diseases still ranked first, higher than that of tumors and other diseases. The death rate of cardiovascular diseases in rural areas has exceeded and continued to be higher than that in cities since 2009. In 2017, rural cardiovascular deaths accounted for 45.91% of all causes of death; urban cardiovascular deaths accounted for 43.56% of all causes, both higher than the previous year.
Cardiovascular diseases are coming fiercely, will the level of diagnosis and treatment improve when the clinical "hands-to-hands"? Professor Han Yaling, academician of the Chinese Academy of Engineering and the General Hospital of the Northern Theater of the Chinese People's Liberation Army, introduced that since 2001, the proportion of acute myocardial infarction (STEMI) patients in my country for emergency percutaneous coronary intervention (PCI) has increased significantly. From 2009 to 2018, the number of PCI treatment cases in mainland China rose from 228,400 to 915,300. In recent years, the mortality rate during PCI has been declining, and the mortality rate in 2018 was 0.26%. In 2018, the total number of interventional treatments for coronary heart disease was 915,256, and the average number of stents was 1.46. Emergency interventional treatments accounted for 45.9%. At the same time, the hospital mortality of patients with heart failure has dropped significantly.
In terms of surgical diagnosis and treatment, Professor Hu Shengshou, academician of the Chinese Academy of Engineering, director of the National Center for Cardiovascular Diseases, and Professor Hu Shengshou from Fuwai Hospital of the Chinese Academy of Medical Sciences, China Cardio Surgery Registration (CCSR) 2018 data show: China's tertiary hospitals (104) The median mortality of hospital-related diseases related to road transplantation is 0.8% (0.5%~1.7%), but the gap between different hospitals is still large. From 2008 to 2018, the postoperative hospital stay was shortened from 11 days to 9 days, and the total hospital stay was shortened from 22 days to 19 days. In the field of congenital heart disease, the number of interventional treatments for congenital heart disease in local hospitals in my country in 2018 was 32,961, the treatment success rate was 98.4%, the serious complication rate was 0.12%, and the mortality rate was 0.01%. In 2019, cardiologists across the country completed approximately 2,000 transcatheter aortic valve replacement (TAVI) procedures. A study of 101 patients showed that the Venus-A Valve system was used for TAVI with a success rate of 84.2%, and the relevant quality data did not fall into the international advanced level.
What does the trend of stroke suggest?
“In our country, at least one in every five deaths died from cerebrovascular disease. In 2018, the crude death rate of Chinese residents from cerebrovascular disease was 149.49/100,000, and cerebrovascular disease accounted for 22% of the total deaths.” Professor Wang Yongjun, a disease expert and Beijing Tiantan Hospital affiliated to Capital Medical University, said that if cardiovascular disease is the most important "killer" for Chinese people’s health, then stroke is the most lethal among them, and from 2005 to 2018, Chinese residents’ cerebrovascular disease The crude disease mortality rate is on the whole slowly increasing, mainly due to the aging of the population. Hypertension and smoking are the primary risk factors in stroke prevention and management, followed by dyslipidemia and diabetes.
The type of stroke differs greatly between high altitude areas and plain areas. The National Hospital Quality Monitoring System (HQMS) included 3.01 million stroke inpatients in 2018, and ischemic stroke accounted for approximately 82%. However, in high-altitude areas, the proportion of hemorrhagic stroke is even higher. Among stroke patients in Tibet, the proportion of hemorrhagic stroke is as high as 61%, and that of Qinghai is 44%. This suggests that the diagnosis and treatment characteristics of stroke are different in different altitude areas.
Although stroke has claimed the most lives of Chinese people, the standard of treatment of inpatients needs to be improved. Wang Yongjun selected the guideline intervention indicators for stroke inpatients. The comprehensive score of the intervention indicators for ischemic stroke patients following the guideline was 0.77 (out of 1 point), of which the standard rate of thrombolysis was 24.2%, and the atrial fibrillation anticoagulation rate was 43.8% ; Patients with cerebral hemorrhage follow the guideline intervention index comprehensive score of 0.72, of which the comprehensive score of subarachnoid hemorrhage is only 0.59. This suggests that there is still a long way to go to standardize stroke treatment.
Do we have more knowledge and weapons?
In addition, the "Report" also suggests that in the face of cardiovascular disease, our cognitive level and weapons are constantly upgrading. In terms of basic research, the academician of the Chinese Academy of Engineering and Professor Zhang Yun of Qilu Hospital of Shandong University combined with the analysis of the "Report", and China's high-level cardiovascular basic research started after 2005. The research team established in the early days is dominated by scientists returning from overseas, and the annual average number of papers published has gradually increased; after 2015, the number of research papers of the Chinese team has increased rapidly, and both broke through double digits in 2018.
In terms of cardiovascular device R&D, Professor Ge Junbo, Academician of the Chinese Academy of Sciences and Fudan University Zhongshan Hospital, introduced that from January 1, 2018 to August 31, 2019, the National Medical Products Administration approved a total of 77 medical devices into the review of innovative medical devices Channel, 35 of which are cardiovascular products, indicating that the innovation in the cardiovascular field is dominant in China's medical device innovation field, accounting for 45.5%; and there are 27 domestic original products, accounting for 77.1%.
It is reported that, as an authoritative report in the field of cardiovascular disease prevention and control in my country, since 2005, the National Cardiovascular Disease Center has organized national experts in related fields to compile the "Chinese Cardiovascular Disease Report" every year. The revised version is "China Cardiovascular Health and Disease Report", which adds cardiovascular health behaviors, rehabilitation, technological innovation and transformation, etc., and strives to advocate cardiovascular health management throughout the life cycle. The selected materials for this year’s report are representative, published, high-quality research results such as large cross-sectional and cohort population epidemiological surveys, randomized controlled clinical studies, large sample registration studies, and typical cases of community prevention and treatment. A collective discussion with experts from the editorial board.
Note: This article is reproduced from Healthy China, used for sharing information, invaded and deleted.
