Use of drug treatment for secondary prevention of cardiovascular disease in urban and rural communities of China: China Kadoorie Biobank Study of 0.5 million people.
OBJECTIVE
Relatively little is known about the use of medication for the secondary prevention of cardiovascular disease (CVD) events in China, and the relevance to it of socioeconomic, lifestyle and health-related factors.


RESULTS
We analysed cross-sectional data from the China Kadoorie Biobank (CKB) of 512,891 adults aged 30-79 years recruited from 1737 rural and urban communities in China. Information about doctor-diagnosed ischaemic heart disease (IHD) and stroke, and the use of medication for the secondary prevention of CVD events, were recorded by interview. Multivariate logistic regression was used to estimate odds ratios (ORs) for use of secondary preventive treatment, adjusting simultaneously for age, sex, area and education. Overall, 23,129 (4.5%) participants reported a history of CVD (3.0% IHD, 1.7% stroke). Among them, 35% reported current use of any of 6 classes of drug (anti-platelet, statins, diuretics, ACE-I, β-blockers or calcium-channel blockers) for the prevention of CVD events, with the rate of usage greater in those with older age, higher levels of income, education, BMI or blood pressure. The use of these agents was associated positively with history of diagnosed hypertension (OR 7.5; 95% confidence intervals: 7.08-8.06) and diabetes (1.40; 1.28-1.52) and inversely with self-rated health status, but there was no association with years since diagnosis.


CONCLUSIONS
Despite recent improvements in hospital care in China, only one in three individuals with prior CVD was routinely treated with any proven secondary preventive drugs. The treatment rates were correlated with the existence of other risk factors, in particular evidence of hypertension.
Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK. Electronic address: yiping.chen@ctsu.ox.ac.uk.
Yiping
Y
Chen
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China. Electronic address: lmlee@vip.163.com.
Liming
L
Li
Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Qiuli
Q
Zhang
Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Robert
R
Clarke
China National Centre For Food Safety Risk Assessment, Chaoyang District, Beijing, China.
Junshi
J
Chen
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
Yu
Y
Guo
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
Zheng
Z
Bian
Hainan CDC, No.44 Haifu Road, Haikou, Hainan, China.
Xianhai
X
Pan
Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Richard
R
Peto
NCDs Prevention and Control Department, Jiangsu CDC, No.172 Jiangsu Road, Nanjing, Jiangsu, China.
Ran
R
Tao
Tongxiang CDC, No.64 Maodun East Road, Wutong Town, Tongxiang, Zhejiang, China.
Kunxiang
K
Shi
Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Rory
R
Collins
NCDs Prevention and Control Department, Suzhou CDC, No.72 Sanxiang Road, Suzhou, Jiangsu, China.
Liangcai
L
Ma
NCDs Prevention and Control Department, Huixian CDC, South Loop Road (west), Huixian, Henan, China.
Huarong
H
Sun
Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Zhengming
Z
Chen
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D016017:Odds Ratio; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D014505:Urban Population / Q000706:statistics & numerical data*
Cardiovascular medication; China; Ischemic heart disease; Rural and urban communities; Secondary prevention; Stroke