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Epidemiology of cardiovascular disease in China: current features and implications


Cardiovascular disease (CVD) is the leading cause of death in China. To develop effective and timely strategies to cope with the challenges of CVD epidemics, we need to understand the current epidemiological features of the major types of CVD and the implications of these features for the prevention and treatment of CVD. In this Review, we summarize eight important features of the epidemiology of CVD in China. Some features indicate a transition in CVD epidemiology owing to interrelated changes in demography, environment, lifestyle, and health care, including the rising burden from atherosclerotic CVD (ischaemic heart disease and ischaemic stroke), declining mortality from haemorrhage stroke, varied regional epidemiological trends in the subtypes of CVD, increasing numbers of patients with moderate types of ischaemic heart disease and ischaemic stroke, and increasing ageing of patients with CVD. Other features highlight the problems that need particular attention, including the high proportion of out-of-hospital death of patients with ischaemic heart disease with insufficient prehospital care; the wide gaps between guideline-recommended goals and levels of lifestyle indicators; and the huge number of patients with undiagnosed, untreated, or uncontrolled hypertension, hypercholesterolaemia, or diabetes mellitus.

Key points

  • Eight important features of the epidemiology of cardiovascular disease (CVD) in China are identified in this Review.

  • An increasing burden of atherosclerotic CVD, declining mortality from haemorrhage stroke, and regional variations in CVD are features of the evolving epidemic of CVD.

  • An increasing number of patients with moderate types of ischaemic heart disease (IHD) or ischaemic stroke and the increasing age of patients have brought new challenges to CVD prevention and treatment.

  • The high proportion of out-of-hospital deaths of patients with IHD with insufficient prehospital care remains a problem with little improvement.

  • Despite some lifestyle indicators having shifted in a beneficial direction, the gaps between guideline-recommended targets and current levels of these indicators remain large.

  • A huge number of individuals have undiagnosed, untreated, or uncontrolled statuses for hypertension, hypercholesterolaemia, or diabetes mellitus.

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Fig. 1: Trends in mortality and incidence of cardiovascular disease in China.
Fig. 2: Regional differences in mortality from ischaemic heart disease in China.
Fig. 3: Change in mortality from ischaemic heart disease between 1990 and 2015 in regions of China.
Fig. 4: Regional differences in stroke epidemiology in China.
Fig. 5: Life expectancy and healthy life expectancy.
Fig. 6: Mortality from coronary heart disease in China according to age.


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Reviewer information

Nature Reviews Cardiology thanks Y. Zhang and the other anonymous reviewer(s), for their contribution to the peer review of this work.

Review criteria

Articles were identified using the online PubMed database, citation tracking, books, and open database of websites. The search scope was confined mostly to articles in the English language, but also included articles in Chinese. The disease-related search terms included: “cardiovascular disease”, “ischemic heart disease”, “coronary heart disease”, “acute coronary syndrome”, “myocardial infarction”, “stroke”, “cerebral haemorrhage”, “cerebral infarction”, and their synonyms, variations, or abbreviations; other search terms included “death”, “mortality”, “prevalence”, “incidence”, “disease burden”, and “epidemiology”. Risk factor-related search terms included: “hypertension”, “diabetes”, “diabetic”, “obesity”, “dyslipidemia”, “smoke”, and their synonyms or variations; “prevalence”, “control”, “treatment”, and “epidemiology”.

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D.Z., X.Z., and M.Z. researched data for the article, and all the authors discussed its content. D.Z. wrote the manuscript, and all the authors reviewed and edited it before submission.

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Correspondence to Dong Zhao.

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Zhao, D., Liu, J., Wang, M. et al. Epidemiology of cardiovascular disease in China: current features and implications. Nat Rev Cardiol 16, 203–212 (2019).

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