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 1991 2002,National BP Survey Cooperative Group Chinese J Hypertension Gu D Hypertension 2002 1995, 3(suppl):9-13 40:920-927,(%) 2000-2001,30,24,6,(%) 1991 VS 2002,Age 15-74 Age 35-74,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,* =200 mg/dl. BJ: Beijing worker BJF: Beijing farmer SYF: Shanxi farmer SZF: Shaanxi farmer JJF: Jiangsu farmer GWF: Guangxi farmer GZW: Guangzhou worker GZF: Guangzhou farmer ZZFs:Zhejiang fishermen Wu YF. Chinese Journal of Cardiology 2001, 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,He J, Gu D. Circulation 2004;110 :405-11,Hazard ratio,Mean usual total cholesterol (mmol/l),血清胆固醇和心血管病关系,TC 上升 +1 mmol/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,Number of Participants,%,%,1984,258,422,61.0,261,178,4.2,1996,65,000,63.0,57,000,3.8,a: Weng X, et al: Data from 1984 National Smoking Survey. b: Yang G. Smoking and Health in China: 1996 National Prevalence Survey of Smoking Pattern. Beijing, China Science and Technology Press, 1997. C: Wang L, ed. Series report #1, Chinese Nutrition and Health Status Report, p49, 2005,Number of Participants,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,*p0.001 Standardized on the basis of the year 2000 age distribution of the Chinese population.,中国心血管疾病发病率和死亡率， 和发展趋势,19572000年中国前10位死因死亡构成比,心脑血管疾病、肿瘤是中国成人主要死因,N Engl J Med. 2005,我国成人前五位死因的年龄标化死亡率19912000,男性,女性,N Engl J Med. 2005,中国五种主要心血管死亡原因的年龄标化死亡率,我国成年人(35-74岁)的心血管病患者数(百万）,*,*,*,*,*,*,*,*,不同国家中，25-45%的死亡是由心血管疾病所致。 心血管疾病死亡率（每10万人）： 中国位列第12，分别为400人。 美国位列第15，分别为360人。,中国高血压和糖尿病病人出院人数1980-2006,Diabetics Hypertension,中国卫生统计年报 (1980-2007). 中国卫生部,中国5种主要心脏病病人出院人数, 1980-2006,中国心血管病和脑血管病人出院人数, 1980-2006,Hemorrhagic Ischemic,Hemorrhagic Ischemic,中国主要心血病出院人数排序变化, 1980-2006,冠心病发病率和死亡率与总死亡率趋势: 1991-1999,总死亡,冠心病死亡率,冠心病发病率,心脑肺血管病巨大公共卫生问题,2600万 糖尿病 20000万 血脂异常 20000万 高血压 26000万 超重/肥胖 30000万 吸烟,2002全国营养与健康调查资料； 中国心血管健康多中心合作研究；,7700万 代谢综合征 300万 心肌梗死 700万 脑卒中 400万 心力衰竭 320万 心脑肺血管 疾病死亡/年,中国和世界其他地区成人高血压病例数, 2025年,Lancet 2005;365:217-223 ； J Hypertens. 2004 22:11-9,2025年我国成人高血压患病率27.4% ；高血压患者近3亿；,中国35-64岁和65-84岁男性 冠心病年度死亡人数预测 2000-2029年,Moran A, Zhao D, Gu D, et al. BMC Public Health. 2008;8(1):394,结 论,中国心血管病长期变化趋势 在过去20年间，心血管病危险因素水平不断上升. 这些危险因素的趋势表明21世纪中国冠心病和中风的发病率将会进一步显著增加.,结 论,中国高血压和高胆固醇血症的知晓、治疗和控制率异常之低. 加强针对血脂异常、高血压、糖尿病、吸烟和超重等危险因素的预防、检测和治疗，可以大大降低将来中国成年人心血管疾病的负担。,谢 谢,Cardiovascular Diseases: Burden and Epidemiology in CHINA,Dongfeng Gu M.D Fu Wai Hospital & Cardiovascular Institute, Chinese Academy of Medical Sciences National Center of CVD, China,Background,Facing a low death rate, a long life expectancy, 73 years, and an aging population with 8.0% of total population, over 100 million people aged 65 year at the end of 2007. Although the prevalence of some CVD risk factors has decreased in developed countries, the corresponding prevalence has increased in China. China is currently undergoing rapid demographic, social, and economic changes that may further increase the burden of CVD.,Prevalence of Hypertension in China 1959-2002 from 4 national surveys,The Awareness, Treatment and Control Rate of Hypertension in China 1991 2002,National BP Survey Cooperative Group Chinese J Hypertension Gu D Hypertension 2002 1995, 3(suppl):9-13 40:920-927,(%) 2000-2001,30,24,6,(%) 1991 VS 2002,Age 15-74 Age 35-74,Men,Women,Trends in age-adjusted prevalence of hypercholesterolemia* in past 2 decades,* =200 mg/dl. BJ: Beijing worker BJF: Beijing farmer SYF: Shanxi farmer SZF: Shaanxi farmer JJF: Jiangsu farmer GWF: Guangxi farmer GZW: Guangzhou worker GZF: Guangzhou farmer ZZFs:Zhejiang fishermen Wu YF. Chinese Journal of Cardiology 2001, 29(2):74-79.,Percentage Distribution of Serum Total Cholesterol in Adult Population Aged 35-74 Years in China, 2000-2001, 240,He J, Gu D. Circulation 2004;110 :405-11,TC and fatal CHD, fatal and non fatal ischemic and haemorrhagic stroke in Asia,Hazard ratio,Mean usual total cholesterol (mmol/l),TC and haemorrhagic stroke,+1 mmol/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,TC and ischemic stroke,TC incresing +1 mmol/L CHD risk 32 ischemic stroke risk 23 haemorrhagic stroke 19,Circulation. 2004;110:2678-86 Ann Epidemiol 2005;15:504-13,Age-standardized Prevalence of Overweight/ Obesity among Adults Aged18, China National Nutrition and Health Survey, 2002,Prevalence of Smoking in China,Men,Women,Number of Participants,%,%,1984,258,422,61.0,261,178,4.2,1996,65,000,63.0,57,000,3.8,a: Weng X, et al: Data from 1984 National Smoking Survey. b: Yang G. Smoking and Health in China: 1996 National Prevalence Survey of Smoking Pattern. Beijing, China Science and Technology Press, 1997. C: Wang L, ed. Series report #1, Chinese Nutrition and Health Status Report, p49, 2005,Number of Participants,2002,73,193,53.9,87,360,3.1,Age-Standardized Prevalence of Major CVD Risk Factors in China and the United States,*p0.001 Standardized on the basis of the year 2000 age distribution of the Chinese population.,CVD Incidence and Mortality and Their Trends in China,Proportionate Mortality for the Ten Leading Causes of Death in China, 1957-2000,He J 11:1124-1134,1957,2000,Heart disease,stroke,Age-standardized Mortality for the Five Leading Causes of Death in Adults,He J 11:1124-1134,Women,Men,CPHD-chronic pulmonary heart disease; CHD-coronary heart disease; HF-heart failure; RHD-rheumatic heart disease,Age-standardized Mortality for the Five Leading Causes of Vascular Death,Number of Patients with cardiovascular diseases in Adult Population Aged 35-74 Years in China, 2000-2001,*,*,*,*,*,30% causes of death by CVD World-wide CVD mortality rate /100,000 ： China 12th，400/100,000; USA 15th，360/100,000;,Number of Patients with Diabetics and Hypertension Discharged from Hospitals, 1980-2006,Diabetics Hypertension,China Health Statistics Yearbook (1980-2007). Ministry of Health, P.R.China,Number of Patients with Five Major Heart Diseases Discharged from Hospitals, 1980-2006,Number of Patients with CVD and CBVD Discharged from Hospitals, 1980-2006,Hemorrhagic Ischemic,Hemorrhagic Ischemic,1991-1999 Trends in CHD Incidence and Mortality, in Comparison to Total Mortality: China MUCA Study,All death,CHD death,CHD incidence,Burden and Challenges: Major Public Health Issues in Adults, China,26 m. DM 200 m. Dyslipidemia 200 m. Hypertension 260 m. Overweight/OB 300 m. Smoking,2002 National Nutrition and Health Survey 2002 InterAsia Study 2000-2001,77 m. MS 3 m. MI (0.6 %) 7 m. Stroke (1.4 %) 4 m. Heart Failure 3.2 m. die of CVD per year,Projected Global Burden of Hypertension in 2025,The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion). Most of this rise can be attributed to an expected increase in economically developing countries (1.15 billion