Evaluation of a systematic cardiovascular disease risk reduction strategy in primary healthcare: an exploratory study from Zhejiang, China.
BACKGROUND
In China, cardiovascular disease (CVD) risk reduction strategies are not systematically implemented in primary healthcare (PHC). We conducted an exploratory study to evaluate the preliminary effectiveness of our systematic CVD risk reduction package in one township hospital of Zhejiang.


METHODS
Using the Asian Equation, we selected subjects aged 40-74 years with a calculated 10-year CVD risk of 20% or higher from the existing resident health records and research checkup. The subjects were provided, as appropriate, with the low-dose combination of CVD-preventive drugs (antihypertensive drugs, aspirin, statin), lifestyle modification and adherence strategies monthly. The intervention was piloted for three months in 2012, preceding the conduct of a cluster-based randomized controlled trial (RCT).


RESULTS
A total of 153 (40%) subjects were recruited, with an average total 10-year risk of CVD of 28.5 ± 7.9%. After intervention, the appointment rate was up to 90%. An upward trend was observed for the use of CVD-preventive drugs. The smoking rates significantly reduced from 38 to 35%, with almost no change for salt reduction. The systolic blood pressure (BP) and diastolic BP decreased slightly.


CONCLUSIONS
A holistic CVD risk reduction approach shows preliminary effects in a rural PHC setting of Zhejiang, China. However, further understanding is needed regarding its long-term effectiveness and feasibility in PHC practices. Our cluster-based RCT will provide the highest level of evidence for the policy development of preventing CVD in a rural PHC of China.
COMDIS Health Services Delivery Research Consortium, China Program, University of Leeds, Shenzhen, China.
Guanyang
G
Zou
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
Xiaolin
X
Wei
Zhejiang Centre for Disease Control and Prevention, Hangzhou, China.
Weiwei
W
Gong
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
Jia
J
Yin
Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
John
J
Walley
School of Public Health, Zhejiang University, Hangzhou, China.
Yunxian
Y
Yu
COMDIS Health Services Delivery Research Consortium, China Program, University of Leeds, Shenzhen, China.
Zhitong
Z
Zhang
Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
Rebecca
R
King
Zhejiang Centre for Disease Control and Prevention, Hangzhou, China.
Ruying
R
Hu
School of Public Health, Zhejiang University, Hangzhou, China.
Kun
K
Chen
Zhejiang Centre for Disease Control and Prevention, Hangzhou, China.
Min
M
Yu
D000328:Adult; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D002681:China / Q000453:epidemiology; D005260:Female; D006291:Health Policy; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011314:Preventive Health Services / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012424:Rural Population
D002317:Cardiovascular Agents
China; cardiovascular disease; primary healthcare; risk reduction