我国心血管疾病流行和负担.ppt

我国心血管疾病：流行和负担,顾东风,中国医学科学院阜外心血管病医院卫生部心血管病防治研究中心,背景,我国目前面临低出生率、低死亡率和较高期望寿命（73岁）,和人口老龄化，在2007年底，8.0%的人口年龄65岁,达1亿。重要心脑肺血管疾病患病率和危险因素水平在发达国家已经降低，如高血压和吸烟患病率但我国还在继续上升。我国目前正处于人口、社会和经济高速发展变化的阶段，这将进一步加重心血管病负担。,中国高血压患病率全国性调查1959-2002,中国高血压知晓率、治疗和控制率19912002,NationalBPSurveyCooperativeGroupChineseJHypertensionGuDHypertension20021995,3(suppl):9-1340:920-927,(%)2000-2001,30,24,6,(%)1991VS2002,Age15-74Age35-74,Men,Women,在过去20年，年龄调整的高胆固醇血症患病率变化趋势,*=200mg/dl.BJ:BeijingworkerBJF:BeijingfarmerSYF:ShanxifarmerSZF:ShaanxifarmerJJF:JiangsufarmerGWF:GuangxifarmerGZW:GuangzhouworkerGZF:GuangzhoufarmerZZFs:ZhejiangfishermenWuYF.ChineseJournalofCardiology2001,29(2):74-79.,男性,女性,中国35-74岁成年人中血清胆固醇发布百分比,2000-2001,240,HeJ,GuD.Circulation2004;110:405-11,Hazardratio,Meanusualtotalcholesterol(mmol/l),血清胆固醇和心血管病关系,TC上升+1mmol/L冠心病危险32上升缺血性中风危险上升23出血性中风下降19,中国18成年人的年龄调整的超重肥胖患病率全国营养和健康调查,2002,中国成年人吸烟率,男,女,NumberofParticipants,%,%,1984,258,422,61.0,261,178,4.2,1996,65,000,63.0,57,000,3.8,a:WengX,etal:Datafrom1984NationalSmokingSurvey.b:YangG.SmokingandHealthinChina:1996NationalPrevalenceSurveyofSmokingPattern.Beijing,ChinaScienceandTechnologyPress,1997.C:WangL,ed.Seriesreport#1,ChineseNutritionandHealthStatusReport,p49,2005,NumberofParticipants,2002,73,193,53.9,87,360,3.1,中美人群CVD危险因素年龄标化患病率,*p=200mg/dl.BJ:BeijingworkerBJF:BeijingfarmerSYF:ShanxifarmerSZF:ShaanxifarmerJJF:JiangsufarmerGWF:GuangxifarmerGZW:GuangzhouworkerGZF:GuangzhoufarmerZZFs:ZhejiangfishermenWuYF.ChineseJournalofCardiology2001,29(2):74-79.,PercentageDistributionofSerumTotalCholesterolinAdultPopulationAged35-74YearsinChina,2000-2001,240,HeJ,GuD.Circulation2004;110:405-11,TCandfatalCHD,fatalandnonfatalischemicandhaemorrhagicstrokeinAsia,Hazardratio,Meanusualtotalcholesterol(mmol/l),TCandhaemorrhagicstroke,+1mmol/L:1.23(1.12-1.35),4.5,5.0,5.5,6.0,6.5,0.50,1.00,2.00,4.00,TCandischemicstroke,TCincresing+1mmol/LCHDrisk32ischemicstrokerisk23haemorrhagicstroke19,Circulation.2004;110:2678-86AnnEpidemiol2005;15:504-13,Age-standardizedPrevalenceofOverweight/ObesityamongAdultsAged18,ChinaNationalNutritionandHealthSurvey,2002,PrevalenceofSmokinginChina,Men,Women,NumberofParticipants,%,%,1984,258,422,61.0,261,178,4.2,1996,65,000,63.0,57,000,3.8,a:WengX,etal:Datafrom1984NationalSmokingSurvey.b:YangG.SmokingandHealthinChina:1996NationalPrevalenceSurveyofSmokingPattern.Beijing,ChinaScienceandTechnologyPress,1997.C:WangL,ed.Seriesreport#1,ChineseNutritionandHealthStatusReport,p49,2005,NumberofParticipants,2002,73,193,53.9,87,360,3.1,Age-StandardizedPrevalenceofMajorCVDRiskFactorsinChinaandtheUnitedStates,*p0.001Standardizedonthebasisoftheyear2000agedistributionoftheChinesepopulation.,CVDIncidenceandMortalityandTheirTrendsinChina,ProportionateMortalityfortheTenLeadingCausesofDeathinChina,1957-2000,HeJ11:1124-1134,1957,2000,Heartdisease,stroke,Age-standardizedMortalityfortheFiveLeadingCausesofDeathinAdults,HeJ11:1124-1134,Women,Men,CPHD-chronicpulmonaryheartdisease;CHD-coronaryheartdisease;HF-heartfailure;RHD-rheumaticheartdisease,Age-standardizedMortalityfortheFiveLeadingCausesofVascularDeath,NumberofPatientswithcardiovasculardiseasesinAdultPopulationAged35-74YearsinChina,2000-2001,*,*,*,*,*,30%causesofdeathbyCVDWorld-wideCVDmortalityrate/100,000：China12th，400/100,000;USA15th，360/100,000;,NumberofPatientswithDiabeticsandHypertensionDischargedfromHospitals,1980-2006,DiabeticsHypertension,ChinaHealthStatisticsYearbook(1980-2007).MinistryofHealth,P.R.China,NumberofPatientswithFiveMajorHeartDiseasesDischargedfromHospitals,1980-2006,NumberofPatientswithCVDandCBVDDischargedfromHospitals,1980-2006,HemorrhagicIschemic,HemorrhagicIschemic,1991-1999TrendsinCHDIncidenceandMortality,inComparisontoTotalMortality:ChinaMUCAStudy,Alldeath,CHDdeath,CHDincidence,BurdenandChallenges:MajorPublicHealthIssuesinAdults,China,26m.DM200m.Dyslipidemia200m.Hypertension260m.Overweight/OB300m.Smoking,2002NationalNutritionandHealthSurvey2002InterAsiaStudy2000-2001,77m.MS3m.MI(0.6%)7m.Stroke(1.4%)4m.HeartFailure3.2m.dieofCVDperyear,ProjectedGlobalBurdenofHypertensionin2025,Thenumberofadultswithhypertensionin2025waspredictedtoincreasebyabout60%toatotalof1.56billion(1.54-1.58billion).Mostofthisrisecanbeattributedtoanexpectedincreaseineconomicallydevelopingcountries(1.15billionor80%),KearneyPM,WheltonM,ReynoldsK,MuntnerP,WheltonPK,HeJ.Lancet2005;365:217-223,AnnualCHDdeathsinChinesemen35-64and65-84yearsoldforecastedfrom2000-2029,MoranA,ZhaoD,GuD,etal.BMCPublicHealth.2008;8(1):394,Conclusions,SecularTrendsofCVDinChinaIncreasingtrendsofCVDriskfactorsinpast20yearswereobserved.ThesetrendspredictedthattheincidenceofstrokeandCHDeventswillincreasemarkedlyinthe21stcentury,mainlyduetoaging.,Conclusions