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J Am Heart Assoc. 2018 Jan 26;7(3). pii: e007462. doi: 10.1161/JAHA.117.007462.

Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States.

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Center for Outcomes Research and Evaluation, Yale-New Haven Hospital Yale School of Medicine, New Haven, CT.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Yale School of Public Health, New Haven, CT.
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Baptist Health South Florida, Miami, FL.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital Yale School of Medicine, New Haven, CT
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.



The reasons for China's high stroke prevalence are not well understood. The cardiovascular risk factor profiles of China and the United States have not been directly compared in nationally representative population samples.


Using data from the CHARLS (China Health and Retirement Longitudinal Study) and the NHANES (US National Health and Nutrition Examination Survey), we compared cardiovascular risk factors from 2011 to 2012 among people aged 45 to 75 years between the 2 countries (China, 12 654 people; United States, 2607 people): blood pressure, cholesterol, body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, and high-sensitivity C-reactive protein. Compared with the United States, China had a lower prevalence of hypertension but a higher mean blood pressure and a higher proportion of patients with severe hypertension (≥160/100 mm Hg) (10.5% versus 4.5%). China had substantially lower rates of hypertension treatment (46.8% versus 77.9%) and control (20.3% versus 54.7%). Dyslipidemia was less common in China, but lipid levels were not significantly different because dyslipidemia awareness and control rates in China were 3- and 7-fold lower than US rates, respectively. High-sensitivity C-reactive protein, body mass index, and waist circumference were significantly lower in China than in the United States. Clustering of hypertension with other cardiovascular risk factors was more common in China.


Hypertension is more common in the United States, but blood pressure levels are higher in China, which may be responsible for China's high stroke prevalence. The low rates of awareness, treatment, and control of hypertension provide an exceptional opportunity for China to reduce risk in its population.


cardiovascular diseases prevention; cardiovascular diseases risk factors; global disparities; international comparison

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