Cardiovascular risk profiles and outcomes of Chinese living inside and outside China.
OBJECTIVE
To assess whether cardiovascular risk differs among the Chinese living inside and outside mainland China.


RESULTS
Three thousand, four hundred and eighty-two East Asians were enrolled in the REduction of Atherothrombosis for Continued Health Registry in mainland China, Hong Kong/Singapore/Taiwan, Western Europe, and North America. Baseline demographics, medication use, risk factor control, and 30-month cardiovascular outcomes of the 2938 patients with atherothrombotic disease were compared. Rates of hypertension, hypercholesterolemia, diabetes, abdominal obesity, and body mass index ≥25 kg/m² were lowest in mainland China, were increased in Hong Kong/Singapore/Taiwan, and were highest in Western Europe and North America. Diabetes prevalence was 23% in mainland China, approximately two-fold lower than the other regions. Antihypertensive, antidiabetic, and antiplatelet agent use was similar in all regions. Risk factor control was significantly poorer in Western Europe and, except for glucose control, significantly better in North America. Thirty-month nonfatal stroke rates were highest in mainland China and fell in a stepwise manner in more westernized societies. Conversely, nonfatal myocardial infarction rates increased in more westernized societies.


CONCLUSIONS
Obesity and other risk factors progressively worsen as patients move from mainland China to Hong Kong/Singapore/Taiwan and overseas. Despite similar medication use, risk factor control and cardiovascular outcomes were significantly different. The magnitude of these changes is larger than formerly estimated, suggesting population differences in cardiovascular risk and disease prevalence, likely to be more closely associated with lifestyle and cultural habits than genetic differences.
Chiu
John F
JF
University of Alberta, Edmonton, Alberta, Canada. jfchiu@ualberta.ca
Bell
Alan D
AD
Herman
Robert J
RJ
Hill
Michael D
MD
Stewart
John A
JA
Cohen
Eric A
EA
Liau
Chiau-Suong
CS
Steg
P Gabriel
PG
Bhatt
Deepak L
DL
D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality; D002681:China / Q000453:epidemiology; D003466:Cultural Characteristics; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
D002317:Cardiovascular Agents