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Nation Moves to Stem Incidence of Strokes and Heart Attacks

China is now experiencing its second high tide of cardiovascular and cerebrovascular diseases, which are presently killing about 2.6 million people a year, or one death every 12 seconds, a senior Chinese expert on heart diseases stated.

And the death rate keeps going up annually at a rate of 2.3 per cent for males and 1.6 per cent for females, said Hu Dayi, director of the heart disease department of the People's Hospital affiliated with Peking University.

According to Hu, who has been engaged in the research and treatment of heart disease for over three decades, the dominant problem in the first wave, which started in the 1960s, was cerebral haemorrhages, or strokes, which are mainly caused by hypertension.

The introduction of hypertension medicines helped reduce the incidence and mortality rate of such ailments. But towards the end of the 1990s, a second tide started, which has witnessed a rapid increase of myocardial infarction, or heart failure, which is caused by high cholesterol levels, and at the same time the incidence of hypertension-related strokes remains high.

Medical scientists have come to a consensus that "not all cholesterol is bad." In fact, it is produced naturally in people's liver and it helps with important body functions.

High cholesterol levels are the result of people getting too much "bad" low-density lipoprotein (LDL) cholesterol in their physical systems which can lead to heart disease. The tendency to produce bad cholesterol, or LDL, can be inherited from one's family or a result of one's own body chemistry.

LDL can also be the result of a diet high in saturated fats, lack of exercise or diabetes.

Researchers have found that the number of Chinese with high "bad" cholesterol levels has increased from 17 per cent for males and 9 per cent for females in the early 1980s to 33 per cent and 32 per cent, respectively, at the end of 1990s.

The country could face a disastrous onslaught of cardiovascular and cerebrovascular diseases if preventative actions are not taken promptly, Hu stressed in an interview.

Data from the World Health Organization (WHO) shows that cardiovascular and cerebrovascular diseases have become a major threat to public health worldwide, with about 17 million people dying from such illnesses in the year 2000, and the figure might climb to 25 million by 2020, with 80 per cent of the deaths expected to be in developing nations.

Research on hypertension and heart disease in the late 1990s shows that the ratio between strokes and myocardial infarctions in China stood at 8:1 in the 1980s, 4:1 in the 1990s, and is expected to have dropped to about 2:1 at present and to gradually approach a 1:1 level, as has already happened in some developed countries, according to Hu.

Hu recalled that even big hospitals like the People's Hospital and Tongren Hospital in Beijing saw few myocardial infarction cases in the 1960s.

"Medical workers were very 'excited' about getting such patients because they wanted to learn more about the illness," he said.

However, presently both hospitals mentioned above have more than 300 such patients every year, and the patients are becoming younger.

In the 1960s and early '70s, most of the patients were above 65 years old, but now it is not uncommon to see people in their 30s and 40s suffering from cardiovascular and cerebrovascular diseases.

Hu blames the increase on changes in lifestyle such as increased consumption of high-fat, high-cholesterol and high-calory foods, less physical exercise and increasing pressures in the workplace.

The increase of patients with obesity, diabetes and high-cholesterol levels leads to an increase in the incidence of heart disease. And smoking may also cause such heart illnesses.

It is estimated that China now has some 270 million people who are overweight or suffering from obesity. In some cities in South China, such as Guangzhou, in Guangdong Province, about 10 to 15 per cent of the local population is now overweight, the figure gets as high as 30 to 40 per cent in some cities in North China.

A WHO report indicated that diabetes cases in China might double by the year 2020 from the present 30 million patients.

The expert called for more attention from both the government and individuals in an effort to get cardiovascular and cerebrovascular diseases under control, saying that they are preventable if people maintain healthy lifestyles and also if they are diagnosed and treated at an early stage, he said.

Treatment of hypertension can reduce the incidence of strokes by 39 per cent and that of myocardial infarctions by 16 per cent, while treatment of high cholesterol problems could further reduce the incidence of strokes by 27 per cent and of myocardial infarctions by 36 per cent, said Hu.

Doctors in many countries have found that medicines of the "atorvastatin" family can greatly lower cholesterol levels. But the earlier the treatment starts the better the results, and the medicines must be taken regularly, just like those for hypertension.

In the United States, at least 55 million people should be taking medicine to maintain normal cholesterol levels, yet no more than a third of them do so, and the situation in China is even worse, according to Hu.

Hu is happy to see that the health authorities and medical research institutions have got ready to meet the new tide of cardiovascular and cerebrovascular diseases.

In 1998, the Ministry of Health, with support from the US-based pharmaceutical researcher Pfizer (China) Pharmaceutical Ltd, launched a National Hypertension Day, which has been observed every year since then on October 8 to educate the general public.

All patients above 35 years old are now given hypertension tests, and hypertension awareness has been promoted in communities and enterprises.

Most recently, the Ministry of Health has initiated another 10-year China Cholesterol Education Programme which is designed to take full advantage of the clinical research results on cholesterol-related heart diseases and carry out training for medical professionals nationwide so that they can diagnose high-cholesterol ailments correctly and therefore give the patients treatment at an early stage.

Also, with funding from Pfizer, a programme which was formally launched late last month is expected to train 5,000 doctors in over 20 cities nationwide this year.

(China Daily  June 2, 2004)

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