中国心血管疾病及其危险因素的变化特征：2019 年全球疾病负担研究的二次分析。
Changing profiles of cardiovascular disease and risk factors in China: a secondary analysis for the Global Burden of Disease Study 2019.
机构信息
Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China.
Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
出版信息
Chin Med J (Engl). 2023 Oct 20;136(20):2431-2441. doi: 10.1097/CM9.0000000000002741. Epub 2023 Jun 25.
BACKGROUND
Understanding the changing profiles of cardiovascular disease (CVD) and modifiable risk factors is essential for CVD prevention and control. We aimed to report the comprehensive trends in CVD and risk factors in China from 1990 to 2019.
METHODS
Data on the incidence, death, and disability-adjusted life years (DALYs) of total CVD and its 11 subtypes for China were obtained from the Global Burden of Disease Study 2019. The CVD burden attributable to 12 risk factors was also retrieved. A secondary analysis was conducted to summarize the leading causes of CVD burden and attributable risk factors.
RESULTS
From 1990 to 2019, the number of CVD incidence, death, and DALYs considerably increased by 132.8%, 89.1%, and 52.6%, respectively. Stroke, ischemic heart disease, and hypertensive heart disease accounted for over 95.0% of CVD deaths in 2019 and remained the top three causes during the past 30 years. Between 1990 and 2019, the age-standardized rate of stroke decreased significantly (percentage of decreased incidence: -9.3%; death: -39.8%; DALYs: -41.6%), while the rate of ischemic heart disease increased (percentage of increased incidence: 11.5%; death: 17.6%; DALYs: 2.2%). High systolic blood pressure, unhealthy diet, tobacco, and air pollution continued to be the major contributors to CVD deaths and DALYs (attributing to over 70% of the CVD burden), and the high body mass index (BMI)-associated CVD burden had the largest increase between 1990 and 2019.
CONCLUSIONS
The significant increases in the number of CVD incident cases, deaths, and DALYs suggest that the CVD burden is still a concern. Intensified strategies and policies are needed to maintain promising progress in stroke and to reduce the escalating burden of ischemic heart disease. The CVD burden attributable to risk factors has not yet made adequate achievements; even worse, high BMI has contributed to the increasing CVD burden.
背景
了解心血管疾病（CVD）不断变化的发病情况和可改变的危险因素对于 CVD 的预防和控制至关重要。本研究旨在报告 1990 年至 2019 年期间中国 CVD 及危险因素的综合变化趋势。
方法
我们从 2019 年全球疾病负担研究中获取了中国 CVD 及 11 种亚型的发病、死亡和伤残调整生命年（DALYs）数据，并获取了归因于 12 种危险因素的 CVD 负担数据。我们还进行了二次分析，以总结 CVD 负担的主要原因和归因危险因素。
结果
1990 年至 2019 年，CVD 的发病、死亡和 DALYs 分别增加了 132.8%、89.1%和 52.6%。2019 年，脑卒中、缺血性心脏病和高血压性心脏病占 CVD 死亡的 95.0%以上，在过去 30 年中一直是前三位死因。1990 年至 2019 年，脑卒中的年龄标准化发病率显著下降（发病率下降百分比：-9.3%；死亡率：-39.8%；DALYs：-41.6%），而缺血性心脏病的发病率则有所上升（发病率上升百分比：11.5%；死亡率：17.6%；DALYs：2.2%）。高收缩压、不健康饮食、烟草和空气污染仍然是 CVD 死亡和 DALYs 的主要原因（占 CVD 负担的 70%以上），1990 年至 2019 年期间，高 BMI 相关 CVD 负担的增幅最大。
结论
CVD 发病例数、死亡例数和 DALYs 的显著增加表明 CVD 负担仍然是一个关注点。需要加强策略和政策，以保持在脑卒中方面取得的有希望的进展，并减少缺血性心脏病负担的不断增加。归因于危险因素的 CVD 负担尚未取得足够的成效；更糟糕的是，高 BMI 导致 CVD 负担增加。
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