Abstract

Objective: Lifestyle changes associated with the rapidly developing economy increase cardiovascular disease (CVD), myocardial infarction (MI) and risk factors (CVRFs) in China. The distribution of the 9 INTERHEART CVRFs, their relationship to MI and the CVD epidemic in China were assessed and compared regionally and with other regions of the world to determine how this may influence the future of CVD in China.

Results: Patients with first AMI (n=3030) and age and sex-matched controls (n=3056) were enrolled from 26 centres in China. Northern Chinese had higher rates of smoking and hypertension, whereas Southern Chinese reported lower fruit and vegetable intake and higher rates of depression. Compared to other regions, participants from China were older, with lower BMI and waist to hip ratios, lower total and LDL cholesterol levels, ApoB lipoprotein and ApoB to ApoA-1 ratios, but higher HDL cholesterol and ApoA-1. All 9 INTERHEART CVRFs, education and income were significantly associated with MI in the Chinese cohort. There was significant heterogeneity in the strength of association between certain CVRFs and MI for China versus other regions with stronger associations for Chinese for diabetes (OR 5.10 vs 2.94), depression (2.27 vs 1.37) and permanent stress (2.67 vs 2.06); and lower for Chinese for abdominal obesity (1.33 vs 2.62) (p for heterogeneity, all <0.0001).

Conclusions: Diabetes and psychosocial factors have strong associations with risk of MI in China, indicating future increases in these risk factors with societal change in China may hasten rapid increases in CVD.