Cardiovascular disease prevention strategies and challenges

At present, cardiovascular disease is the leading cause of death among Chinese residents, accounting for more than 40% of total deaths, which seriously threatens the life and health of the Chinese people. The CPC Central Committee and the State Council attach great importance to the prevention and treatment of cardiovascular diseases, and have included it in important policy documents such as the Outline of the "Healthy China 2030" Plan and the Medium- and Long-Term Plan for the Prevention and Treatment of Chronic Diseases in China (2017-2025). In the "Healthy China Action (2019-2030)", the "Cardiovascular and Cerebrovascular Disease Prevention and Treatment Action" is listed as a special action, and it is clearly stated that by 2030, the mortality rate of cardiovascular diseases will be reduced to 190.7/100,000 or below. To achieve the prevention and treatment goals set for cardiovascular diseases, zero-level prevention, primary prevention and secondary prevention strategies should be adopted for different target populations.

Zero level prevention

Zero-level prevention is the most upstream prevention strategy of cardiovascular disease prevention strategy and an important manifestation of the forward-moving cardiovascular disease prevention strategy. Its target population is people who do not have major cardiovascular risk factors such as hypertension, dyslipidemia, diabetes and smoking. The main population is children, adolescents and young people. The goal of prevention is to prevent or delay the occurrence of risk factors and maintain cardiovascular health. The eight indicators of ideal cardiovascular health currently advocated internationally are the ideal goals of zero-level prevention. These eight goals include four behavioral indicators: not smoking, maintaining healthy eating habits, maintaining regular physical activity and good sleep; and four physiological indicators: maintaining ideal weight, blood pressure <120/80 mmHg (1 mmHg=0.133 kPa) without medication, serum total cholesterol less than 200 mg/dl (5.17 mmol/L) without medication, and fasting blood sugar less than 100 mg/dl (5.6 mmol/L) without medication.

Primary prevention

Primary prevention is to reduce the risk of cardiovascular disease and death in individuals and populations by effectively reducing and controlling the level of cardiovascular disease risk factors. The target population is those who already have one or more cardiovascular disease risk factors (such as hypertension, dyslipidemia, smoking, diabetes and obesity) but have no history of coronary heart disease or stroke. Since most adults in my country have one or more risk factors, primary prevention is currently the main strategy for cardiovascular disease prevention. With the increasing aging of the Chinese population and the prevalence of unhealthy lifestyles, the number of people in the primary prevention population is expected to continue to increase. The goal of the primary prevention strategy is to reduce the risk of cardiovascular and cerebrovascular disease and death in individuals and populations, reduce the disease burden, and improve health status by actively and effectively treating and controlling existing cardiovascular disease risk factors.

Secondary prevention

The target population for secondary prevention is patients who already have cardiovascular disease, including patients with coronary heart disease, stroke or peripheral vascular disease. Their main risk is recurrence of acute coronary heart disease or stroke leading to hospitalization, disability or death. These patients often have severe atherosclerotic lesions and structural and functional damage to the heart, brain and kidneys, and are at extremely high risk in the cardiovascular disease risk stratification. The main goal of secondary prevention is to control the progression of the disease, reduce the risk of recurrence, disability and death, and restore the patient's ability to live, work and quality of life to a certain extent.

Challenges in cardiovascular disease prevention

The total number of people with single or multiple cardiovascular risk factors is estimated to exceed 500 million. In addition, my country is about to enter an aging society, and the proportion of elderly people suffering from cardiovascular metabolic disease risk factors is significantly higher than that of young and middle-aged people. In the case of the coexistence of multiple risk factors, the risk of serious diseases such as acute myocardial infarction, cerebral infarction, and renal insufficiency will increase exponentially. Unfortunately, the awareness, treatment and control rates of these risk factors are still low, which brings greater challenges and difficulties to prevention work.

Although the current situation of cardiovascular disease prevention and control is quite severe, it is gratifying that the government, all sectors of society and the public are paying more and more attention to the hazards and prevention and control of cardiovascular disease. I believe that under the leadership of the CPC Central Committee, with the support of the government's health policies and the unremitting efforts of the majority of cardiovascular disease medical workers, we will continue to improve the level of cardiovascular disease prevention at all levels in my country through the prevention and control of multiple risk factors for cardiovascular disease and multidisciplinary collaboration, as well as the strengthening of health education and health science activities, and through long-term efforts.