中国心血管病调查

China Heart survey - Call for Action Dayi Hu Peoples Hospital of Peking University 2008-4-11 The Primary Cause of Death: Cardio-Cerebral Vascular Diseases Stroke 10% 5.5m CAD 13% 7.2m Cancer 12% 7.1m Trauma 9% 5.2m Infection 7% 2.8m Other 27% 15.6m AIDS 5% 2.8m Malaria 2% 1.2m Diarrhea 3% 1.8m Perinatal factors 4% 2.5m COPD 5% 2.7m World Health Organization. Atlas of Heart Disease and Stroke. 2005 2 Major Risk Factors for CAD: Hypertension, Hyperlipidemia, Hyperglycemia 3 Although the emergence of new drugs and the release of many evidence-based research outcomes recently, are the mortality of cardio-cerebral vascular events fully reduced? Although the use of intervention therapy and drugs dramatically increased, the mortality of cardio-cerebral vascular diseases is still going up Source： Death and risk factors, epidemiology, trend and distribution in Chinese. Peking Union Medical College Press. Sep. 2005. Standard Mortality （ 1/10 thousand ） Mortality trend of cardio-cerebral vascular disease in Chinese between 1985 and 2005 CAD Cerebral vascular disease 5 Cause： “The therapy is separated” 6 Cause： Hyperglycemia a neglected risk factor of CVD CVD Risk factorFamily Fatness Sex Dyslipidemia Hypertension Age Hyperglycemia Smoke 7 China Heart Survey: Content Background Diabetes is as dangerous as CAD Patients with CAD are at the high risk for hyperglycemia Design Result Meaning 8 Diabetes is as dangerous as CAD Haffner SM et al. N Engl J Med. 1998;339:229-234. Events/100 person-yr Incidence of cardiovascular disease during seven-year follow-up (%) n=69 18.8 Nondiabetic subjectswithout prior MI Nondiabetic subjectswith prior MI Diabetic subjectswithout prior MI Diabetic subjectswith prior MI n=1304 n=169 n=890 3.0 0.5 7.8 3.2 3.5 45.0 20.2P 8 mmol/L in two testing 16 China Heart Survey: flow chart Previously known diabetes Newly diagnosed diabetes （ FPG） Newly diagnosed diabetes （ FPG） 773 OGTT 420 Previously known diabetes 41 1,234 Acute admission 2,279 Elective admission 3,513 random 3,687 screened 733 56 1,490 OGTT Da-Yi Hu, et al. European Heart Journal 2006;27:2573-2579. 17 China Heart Survey: content Background Diabetes is as dangerous as CAD Patients with CAD are at the high risk for hyperglycemia Design Result Meaning 18 China Heart Survey： 77% of patients with CAD had hyperglycemia Known diabetes Newly diagnosed diabetes (FPG) Normal glucose Prediabetes Newly diagnosed diabetes (OGTT) 33% 3% 23% 24% 17% n=3,513 19 Without the use of OGTT, over 80% of newly diagnosed diabetes and pre-diabetes will remain undiagnosed Normal IFG IGT Type 2 diabetes 人群比例 (%) OGTT OGTTFPG FPG Acute Selective 0 20 40 60 80 100 Percentage (%) missed missed 20 Conclusion n In the enrolled patients (n=3,513), the percentage of hyperglycemia (included diabetes and pre-diabetes) was about 80% The prevalence of diabetes was 52.92% (n=1,859)， of which 20.1%（ n=706） was newly diagnosed diabetes The prevalence of pre-diabetes was 26.38%（ n=927), all was newly diagnosed excepted one patient 21 If FPG was measured alone, without the use of OGTT 80% of 609 newly diagnosed diabetic patients will remain undiagnosed 70 of 926 newly diagnosed pre-diabetic patients will remain undiagnosed 75 of newly diagnosed diabetic and pre-diabetic patients will remain undiagnosed if FPG is measured alone. Conclusion 22 China Heart Survey: content Background Diabetes is as dangerous as CAD Patients with CAD are at the high risk for hyperglycemia Design Result Meaning 23 China Heart Survey: meaning CHS sound the alert for our cardiologists, neurologists and cardio-vascular surgeons, indicating that we should concern whether dysglycaemia exist in the admitted patients. As far as dysglycaemia concerned, no matter what is diabetes, IFG or IGT, early diagnosis and ear