A China study has found a substantial incident burden of cardiovascular disease (CVD) in the general population, with the highest prevalence seen among males and older adults. Geographic disparities and seasonal variations in CVD incidence have also been observed.
“Targeted policies and precise public health programs are needed to mitigate these disparities and reduce the national disease burden,” according to the researchers, who used data from the China CVD Surveillance System, covering 400 districts across 31 provinces.
Incident CVD events included stroke and coronary heart disease (CHD). The research team calculated the age-standardized incidence rates using the 2001 WHO World Standard Population (WSR) and the 2020 Seventh Chinese National Census population (CSR).
A total of 944,984 new cases of CVD diagnosed in Chinese adults (mean age 69.7 years, 58.9 percent male) in 2023 across 262 surveillance sites were included in the analysis. [J Am Coll Cardiol 2026;87:1453-1465]
The estimated crude CVD incidence rate in 2023 was 620.33 per 100,000, with age-standardized rates of 526.24 (WSR) and 635.81 (CSR). For stroke, the crude incidence rate was 490.96 per 100,000, with WSR and CSR of 416.11 and 513.28, respectively. For CHD, the crude incidence rate was 129.38 per 100,000, with age-standardized rates of 110.14 (WSR) and 137.16 (CSR).
Of note, men were more likely than women to be diagnosed with CVD and its subtypes, except for subarachnoid haemorrhage (p<0.001 for all). An age-dependent increase was also seen in the incidence rate of CVD (ptrend=0.011), with a noticeable elevation for ages 55 years and above.
Furthermore, rural areas recorded higher crude incidence rates for CVD than urban areas (719.38 vs 550.60 per 100,000; p<0.001). The crude CVD incidence rate was also higher in western and central than in eastern China (639.68 and 630.18 vs 612.25 per 100,000), while age-standardized rates were elevated in the central and eastern regions (p<0.001 for all).
In addition, the CVD incidence rate tended to vary by season, peaking from January to March.
Implications
These findings have “profound implications” for the prevention and control of CVD in China, according to the researchers. Initially, “we should prioritize strengthening primary prevention strategies, which require systematic prevention and management of modifiable risk factors (eg, hypertension, obesity).”
Secondly, healthcare systems must improve both acute care capacity for timely patient treatment and infrastructure for rehabilitation and management of chronic diseases, given the country’s high stroke incidence, which sees an age-dependent increase.
Thirdly, geographic disparities in CVD incidence need to be addressed by establishing regional medical treatment partnership systems and county-level medical communities and by developing more stroke and chest pain centres.
Fourthly, the seasonal peak in CVD incidence during the winter months requires the creation of cold wave and low temperature early warning systems, along with targeted public education, “to strengthen resilience against extreme weather and protect vulnerable populations from health impacts both current and future,” the researchers said.
Fifthly, “learning from Canada’s Heart Health Strategy and Action Plan, we recommend establishing evidence-based policies and regulations (such as food quality improvement, specifically reducing trans fats, sodium, and saturated fats, and salt-substitution initiatives) to create CVD-healthy environments,” they added. [Can J Cardiol 2009;25:451-452; N Engl J Med 2021;385:1067-1077]
Finally, to enhance the effectiveness of these interventions, the translation of surveillance data into evidence-informed policies needs to be improved, and targeted investments in prevention and care services, particularly in high-incidence regions and during winter months, must be prioritized, according to the researchers.