title: Risks and Population Burden of Cardiovascular Diseases Associated with Diabetes in China: A Prospective Study of 0.5 Million Adults.
abstract: In China, diabetes prevalence is rising rapidly, but little is known about the associated risks and population burden of cardiovascular diseases. We assess associations of diabetes with major cardiovascular diseases and the relevance of diabetes duration and other modifiable risk factors to these associations.
  
  
  
  A nationwide prospective study recruited 512,891 men and women aged 30-79 y between 25 June 2004 and 15 July 2008 from ten diverse localities across China. During ~7 y of follow-up, 7,353 cardiovascular deaths and 25,451 non-fatal major cardiovascular events were recorded among 488,760 participants without prior cardiovascular disease at baseline. Cox regression yielded adjusted hazard ratios (HRs) comparing disease risks in individuals with diabetes to those without. Overall, 5.4% (n = 26,335) of participants had self-reported (2.7%) or screen-detected (2.7%) diabetes. Individuals with self-reported diabetes had an adjusted HR of 2.07 (95% CI 1.90-2.26) for cardiovascular mortality. There were significant excess risks of major coronary event (2.44, 95% CI 2.18-2.73), ischaemic stroke (1.68, 95% CI 1.60-1.77), and intracerebral haemorrhage (1.24, 95% CI 1.07-1.44). Screen-detected diabetes was also associated with significant, though more modest, excess cardiovascular risks, with corresponding HRs of 1.66 (95% CI 1.51-1.83), 1.62 (95% CI 1.40-1.86), 1.48 (95% CI 1.40-1.57), and 1.17 (95% CI 1.01-1.36), respectively. Misclassification of screen-detected diabetes may have caused these risk estimates to be underestimated, whilst lack of data on lipids may have resulted in residual confounding of diabetes-associated cardiovascular disease risks. Among individuals with diabetes, cardiovascular risk increased progressively with duration of diabetes and number of other presenting modifiable cardiovascular risk factors. Assuming a causal association, diabetes now accounts for ~0.5 million (489,676, 95% CI 335,777-681,202) cardiovascular deaths annually in China.
  
  
  
  Among Chinese adults, diabetes is associated with significantly increased risks of major cardiovascular diseases. The increasing prevalence and younger age of onset of diabetes foreshadow greater diabetes-attributable disease burden in China.
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Bragg
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.|Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Liming
authors.initials: L
authors.lastname: Li
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Ling
authors.initials: L
authors.lastname: Yang
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Bian
authors.affiliation: China National Center for Food Safety Risk Assessment, Beijing, China.
authors.forename: Junshi
authors.initials: J
authors.lastname: Chen
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Rory
authors.initials: R
authors.lastname: Collins
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Peto
authors.affiliation: Tongxiang Centre for Disease Control and Prevention, Zhejiang, China.
authors.forename: Chunmei
authors.identifier: 0000-0003-0826-6762
authors.initials: C
authors.lastname: Wang
authors.affiliation: Gansu Centre for Disease Control and Prevention, Gansu, China.
authors.forename: Caixia
authors.initials: C
authors.lastname: Dong
authors.affiliation: Liuzhou Centre for Disease Control and Prevention, Liuzhou, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Pan
authors.affiliation: Jiangsu Centre for Disease Control and Prevention, Jiangsu, China.
authors.forename: Jinyi
authors.identifier: 0000-0001-6057-862X
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Liuyang Centre for Disease Control and Prevention, Hunan, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Zhengming
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors