Clustering Of Risk Factors And Risk Assessment For Cardiovascular Disease Among Adult Residents In Yunnan Province:A Cross-sectional Study

Objectives:Cardiovascular disease（CVD）is the leading cause of death and disability worldwide,with about 70%of cardiovascular disease cases and deaths attributable to modifiable risk factors.Clustering of CVD risk factors multiplies an individual’s risk of subsequent CVD events and death.At present,there is no representative sampling survey to reveal the risk factors and clustering epidemiological characteristics of CVD in Yunnan Province,and no evidence for further assessment of10-year risk stratification of Atherosclerotic Cardiovascular Diseases（ASCVD）.This study conducted a sampling survey among adult residents in 8 counties of Yunnan Province,aiming to clarify the exposure level and clustering characteristics of risk factors for CVD in Yunnan Province,and to evaluate the risk of ASCVD in the population,providing scientific basis for the development of public health prevention and control strategies for CVD according to local conditions.Methods:This study was a cross-sectional survey design.A total of 7,997residents aged 18 and above in eight counties/districts were selected as research objects by multi-stage stratified random sampling method from January to December 2021 in Yunnan Province to conduct questionnaire survey,physical examination and laboratory testing.Risk factors for CVD include hypertension,overweight or obesity,diabetes,dyslipidemia,smoking,alcohol consumption,insufficient physical activity,and insufficient intake of vegetables and fruits.Clustering was defined as the presence of any two or more risk factors in individuals.Describe the prevalence/detection rates and aggregation levels of the 8 risk factors listed above.Set of comparison between the Mann-Whitney U test,Chi-square test,Goodman-Kruskal Gamma and Wilcoxon rank and inspection.The log-binomial model and Poisson regression model based on robust estimator were used to investigate the 8 risk factors of CVD and the PR,IRR and 95%CI of aggregate and independent variables,respectively.In addition,the 10-year risk of ASCVD was predicted and stratified according to the Chinese Guidelines for the Prevention of Cardiovascular Diseases assessment model,and the association between the aggregation of risk factors for CVD and the risk of morbidity was explored.Results:1.A total of 7997 participants aged 18 and above were included in Yunnan Province,with an average age of 44.3±17.8 years old and 3925 males（49.1%）.The prevalence rates of metabolic risk factors were 33.04%（95%CI:31.79%-34.32%）,7.05%（95%CI:6.48%-7.66%）and 32.17%（95%CI:30.94%-33.44%）,36.98%（95%CI:35.66%-38.33%）.2.The detection rates of smoking,drinking,insufficient physical activity and insufficient intake of vegetables and fruits were 18.28%（95%CI:17.36%-19.24%）,16.36%（95%CI:15.48%-17.27%）,20.78%（95%CI:19.80%-21.81%）,49.01（95%CI:47.48%-50.56%）.3.Only 10.7%of adult residents in Yunnan Province had no risk factor for CVD,7144（89.3%,95%CI:87.3%-91.4%）had at least one risk factor,5000（62.5%,95%CI:60.8%-64.3%）had two or more risk factors,2935（36.7%,95%CI:35.4%-38.1%）had three or more risk factors,and 1380（17.3%,95%CI:16.4%-18.2%）had four or more risk factors.3,4,5 or more were 19.5%（95%CI:18.5%-20.4%）,11.0%（95%CI:10.3%-11.8%）and 6.2%（95%CI:5.7%-6.8%）,respectively.4.Poisson regression model showed that residence,gender,age,ethnicity,employment status and family economic income were related to the aggregation of CVD risk factors.Living in city（IRR=1.085,95%CI:1.054-1.117）,aged（35-44 years old,IRR=1.151,95%CI:1.099-1.207;45-54,IRR=1.317,95%CI:1.258-1.379;55-64,IRR=1.345,95%CI:1.279-1.415;≥65 years,IRR=1.531,95%CI:1.458-1.608）,ethnic minorities（IRR=1.036,95%CI:1.008-1.065）,high-income groups（IRR=1.084,95%CI:1.042-1.126）,the number of risk factors was relatively high（P<0.05）.Compared with male,employed and low family income,the number of CVD risk factors in female,vocational students and middle-income families was relatively small（all P<0.05）.5.The 10-year ASCVD risk was determined as high risk in 1142 cases,with a high risk rate of 14.3%（95%CI:13.5%-15.1%）.Those living in rural areas,male,Han Chinese,married,and jobless were more likely to be exposed to high risk of ASCVD（all P<0.05）.The proportion of high risk decreased with increasing education and household economic income level（all P<0.001）.6.After adjusting for confounders using Poisson regression models,the risk of developing ASCVD over the next 10 years was increased in those with one,two,three,four,five and more CVD risk factors compared to participants without risk factors（all P<0.001）.And for each additional CVD risk factor,the risk of developing ASCVD would increase by 83.5%(IRR=1.835,95%CI:1.749-1.926,P_trend<0.001).Conclusions:1.The four metabolic risk factors of hypertension,overweight or obesity,diabetes and dyslipidemia among adult residents in Yunnan Province were at the medium prevalence level in China,especially the prevalence rate of hypertension showed an increasing trend compared with that in the province from 2012 to 2018.Male age and low socioeconomic status were common risk factors.2.The four behavioral risk factors of smoking,drinking,insufficient physical activity and insufficient intake of vegetables and fruits were more common in people aged 18 and above.The risk of exposure to smoking and drinking was higher in ethnic minorities than in Han ethnic group.Living in urban areas,being female,being older,having a higher education and having a higher income are common risk factors for not being physically active and not eating enough vegetables and fruits.3.The clustering level of CVD risk factors was high in adult residents in Yunnan province,with an average of 2.14 CVD risk factors.The percentage of those with 2 or more risk factors was 62.5%,higher than other studies in other regions.People living in cities,35 years old and older,high-income groups,and ethnic minorities should be the key groups for comprehensive CVD intervention.4.The proportion of adult residents with high risk of ASCVD in the next 10 years in Yunnan Province is 14.3%.Early cardiovascular disease screening and risk assessment should be actively strengthened in rural areas,males,45 years old and above,and people with low socioeconomic status,and high-risk groups should be mainly managed to reduce the incidence of ASCVD.5.As the number of risk factors increased,the 10-year risk increased.It suggests the importance of comprehensive intervention for high aggregation,making full use of national basic public health service items to carry out high-quality primary health care services for hypertension and diabetes,providing adequate behavior and life style and guaranteeing the supply of chronic disease drugs,and moving the threshold of prevention and treatment of ASCVD forward to reduce the occurrence of severe adverse CVD.It is an important public health prospect to reduce the burden of CVD and improve life expectancy in Yunnan Province.