Cardiovascular disease risk reduction in rural China – policy recommendations

POLICY BRIEF

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. In China, CVD accounts for 38% of total mortality. CVD events are predicted to increase by 23% from 2010 to 2030, resulting in an additional 21.3 million CVD events and 7.7 million deaths. Meta-analysis has indicated that CVD risk reduction by treating hypertension or diabetes is not sufficient. A comprehensive approach based on drug therapies and lifestyle is needed. Based on preliminary effects of an exploratory study, in a rural primary healthcare setting in Zhejiang, China, we initiated a pragmatic, cluster randomised controlled trial (cRCT) to assess the health effects of the interventions over 2 years.

This is, to our knowledge, the first pragmatic cRCT that implements a comprehensive package at the primary healthcare level for high CVD risk hypertensive or diabetic patients.

Findings (all compared with control arm)

  • Better drug adherence in the intervention arm (66% vs. 47%);
  • Smoking rates were significantly reduced in the intervention arm (4% reduced vs. 2% increased);
  • More patients in the intervention arm took less salt (50% vs. 34%);
  • Patients in the intervention arm reported drinking less alcohol and had more exercise (32% vs. 15%, and 31% vs. 18%, respectively);
  • Prescribing and taking of statins and aspirin, and prescribing (but not taking) of anti-hypertensives, were substantially higher.

Recommendations

  1. Raising coverage for essential medicines for hypertension and diabetes in primary care facilities;
  2. More intensive training of doctors;
  3. Innovative patient education;
  4. Improved health insurance cover for outpatients.

For more information, contact Simin Deng at: dengsimin2012@126.com

This brief is informed by the following research:

Zou, G, Wei, X, Gong, W, Yin, J, Walley, J, & Yu, Y. et al. (2014). Evaluation of a systematic cardiovascular disease risk reduction strategy in primary healthcare: an exploratory study from Zhejiang, China. Journal of Public Health, 37(2).

Wei, X, Zou, G, Gong, W, Jia, Y, Yu, Y, & Walley, J. et al. (2013). Cardiovascular disease risk reduction in rural china: a clustered randomized controlled trial in Zhejiang. Trials, 14(1), 1-10.

Wei, X, Walley, J, Zhang, Z, Zou, G, Gong W, & Deng, S. et al. Implementation of a Comprehensive Intervention for Patients at High Risk of Cardiovascular Disease in Rural China: a Pragmatic Cluster Randomized Controlled Trial.