| Background:Cardiovascular disease(CVD)is the primary cause of death in the world,and its burden is becoming increasingly serious.With the process of population aging and social urbanization,the incidence and prevalence of CVD among Chinese population are still rising.In recent years,the government has made reducing the burden of CVD a key task in the Healthy China Initiative,striving to reduce the mortality rate of CVD from 238.4 per 100000 in 2015 to 209.7 per 100000 in 2022 and 190.7 per 100000 in 2030,respectively.To achieve this goal,on the one hand,it is necessary to predict the natural trend of the incidence and mortality of CVD in the next 10 years,on the other hand,it is also necessary to consider the impact of developing and implementing interventions on the development of disease burden.Objective:(1)Describing the trend and distribution characteristics of cardiovascular risk factors in Chinese population;(2)Using an agent-based model to develop a CVD risk simulation model and to estimate the temporal trend of CVD morbidity and mortality risk in the ChinaHEART cohort and the whole Chinese population;(3)Predicting and evaluating the effectiveness of various interventions.Methods:Based on the Health Evaluation And risk Reduction through nationwide Teamwork(ChinaHEART),residents aged 35 to 75 years who were screened in 31 provinces nationwide from 2014 to 2020 in the cohort and had complete variable information were included.Using follow-up data from high-risk populations and repeated measurement data from non high-risk populations,calculate the trend of risk factors,and conducted geographical distribution description and subgroup analysis.Agent-based models are also developed to simulate the temporal trend of CVD incidence and death risk of the Chinese HEART population and estimate the risk of cardiovascular disease after sex-age normalization.Finally,referring to the effectiveness of successful measures for CVD prevention and control at home and abroad,the effects of various interventions on the risk of CVD incidence and death in the Chinese population are simulated.Results:A cohort of 101171 people from 340 districts in 31 provinces was formed based on population composition ratio sampling,with high-risk groups accounting for 18.8%.The average age is 55.3 ± 9.5 years old,with 61.3%being female,51.5%residing in the north,61.7%from rural areas,18.4%currently smoking,18.3%receiving antihypertensive treatment,and 13.8%with hyperglycemia.After 3 years of follow-up,the cohort showed an average annual increase in systolic blood pressure of 1.58(1.54,1.61)mmHg,an average annual increase in total cholesterol of 0.03(0.03,0.03)mmol/L,an average annual decrease in BMI of 0.02(0.02,0.01)kg/m2,and a net change rate from hyperglycemia to normal blood sugar of 5.8(5.5,6.1)%.In terms of lifestyle,the net smoking cessation rate was 6.1(5.8,6.3)%,and the net abstinence rate was 10.6(10.3,11.0)%.Accordingly,the risk of cardiovascular disease among 35-75 year olds in ChinaHEART is predicted to increase slightly from 2021 to 2030,with the incidence rate of cardiovascular disease gradually increasing from 0.73%in 2021 to 0.85%in 2030.After gender-age normalization,the incidence of cardiovascular disease still shows a slow increase,from 0.73%in 2021 to 0.80%in 2030,while the risk of cardiovascular disease death shows a trend of increasing first and then stabilizing after 2024,from 369 per 100,000 in 2021 to 477 per 100000 in 2024,and by 2030.After sex-age normalization,the trend of cardiovascular disease mortality risk shows a more stable state,with a risk of 378 per 100000 in 2021 and 400 per 100000 in 2030.It is expected that after implementing interventions to reduce smoking rates,average SBP,average TC,promote comprehensive interventions for high-risk groups of CVD,reduce hospital mortality rates,and increase hospital treatment rates for critically ill patients,the risk of CVD and CVD death will be reduced in different levels compared to the current trend,especially with comprehensive risk factor control and continuous improvement of medical service.Conclusion:The study developed an agent-based model to predict the risk of CVD morbidity and mortality and found that over the decade 2021-2030,the risk of CVD is expected to show a slow and steady linear increase in both the ChinaHEART cohort and the Chinese population aged 35-75 years.If strengthened behavioral and metabolic risk factor control is applied to the population,as well as related intervention measures such as improving treatment accessibility and quality,it is expected to significantly reduce the risk of CVD in the population,which is necessary to achieve the "Healthy China Intiative" goal. |
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