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Original research
Secondary prevention of cardiovascular disease in China
  1. Jiapeng Lu1,
  2. Lihua Zhang1,
  3. Yuan Lu2,
  4. Meng Su1,
  5. Xi Li1,
  6. Jiamin Liu1,
  7. Haibo Zhang1,
  8. Khurram Nasir2,
  9. Frederick A Masoudi3,
  10. Harlan M Krumholz2,
  11. Jing Li1,
  12. Xin Zheng1
  1. 1National 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
  2. 2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Heaven, Connecticut, USA
  3. 3Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  1. Correspondence to Dr Jing Li, 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; jing.li{at}fwoxford.org; Dr Xin Zheng, 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; xin.zheng{at}fwoxford.org

Abstract

Objective We aimed to estimate the current use of secondary prevention drugs and identify its associated individual characteristics among those with established cardiovascular diseases (CVDs) in the communities of China.

Methods We studied 2 613 035 participants aged 35–75 years from 8577 communities in 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, a government-funded public health programme conducted from 2014 to 2018. Participants self-reported their history of ischaemic heart disease (IHD) or ischaemic stroke (IS) and medication use in an interview. Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of individual characteristics with the reported use of secondary prevention therapies.

Results Among 2 613 035 participants, 2.9% (74 830) reported a history of IHD and/or IS, among whom the reported use rate either antiplatelet drugs or statins was 34.2% (31.5% antiplatelet drugs, 11.0% statins and 8.3% both). Among the 1 530 408 population subgroups, which were defined by all possible permutations of 16 individual characteristics, reported use of secondary prevention drugs varied substantially (8.4%–60.6%). In the multivariable analysis, younger people, women, current smokers, current drinkers, people without hypertension or diabetes and those with established CVD for more than 2 years were less likely to report taking antiplatelet drugs or statins.

Conclusions The current use of secondary prevention drugs in China is suboptimal and varies substantially across population subgroups. Our study identifies target populations for scalable, tailored interventions to improve secondary prevention of CVD.

  • heart disease
  • stroke
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Footnotes

  • JL and LZ are joint first authors.

  • Correction notice Since this article was first published online, middle initials have been added to Professors Krumholz and Masoudi.

  • Contributors HK and JiapL designed the study. XZ, JingL, HK, JiapL and LZ conceived of this article. JiapL and LZ wrote the manuscript with further contributions from XZ, JingL, YL, MS, XL, JiamL, HZ, KN, FM and HK. JiapL completed all the statistical analysis. All authors interpreted data, contributed to critical revisions and approved the final version of the article.

  • Funding This project was supported by the National Key Research and Development Program (2017YFC1310801 and 2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-2-002, 2017-I2M-B&R-02, 2016-12M-1-006 and 2016-12M-2-004); the Ministry of Finance of China and National Health Commission of China.

  • Disclaimer The funder of the study had no role in study design, data collection, data analysis, data interpretation, or the decision to submit the manuscript for publication.

  • Competing interests HK discloses that he is a recipient of research agreements from Medtronic and from Johnson & Johnson (Janssen), through Yale, to develop methods of clinical trial data sharing; is the recipient of a grant from the Food and Drug Administration and Medtronic, through Yale, to develop methods for postmarket surveillance of medical devices; works under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures; chairs a cardiac scientific advisory board for UnitedHealth; is a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science and the Physician Advisory Board for Aetna; and is the founder of Hugo, a personal health information platform. FAM has a contract with the American College of Cardiology for his role as the Chief Scientific Advisor of the NCDR. All other authors declare no competing interests.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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