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      Epidemiology of dyslipidemia in Chinese adults: meta-analysis of prevalence, awareness, treatment, and control

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          Abstract

          Background

          Numerous epidemiology studies on dyslipidemia have been conducted in China. However, a nationally representative estimate for dyslipidemia prevalence is lacking. The aim of this study is to appraise the nationwide prevalence, awareness, treatment, and control rates of dyslipidemia in adults in China.

          Methods

          We performed a systematic review of the related observational studies published since 2003 by searching English and Chinese literature databases. Meta-analyses were conducted in eligible studies using a random effect model to summarize the dyslipidemia prevalence, awareness, treatment, and control rates. Heterogeneity and publication bias were analyzed. Sensitivity analyses were performed to explain heterogeneity and examine the impact of study quality on the results of meta-analyses.

          Results

          Thirty-eight papers were included for meta-analyses, with a total sample size of 387,825. The prevalence, awareness, treatment, and control rates of dyslipidemia were 41.9% (95% CI: 37.7% – 46.2%), 24.4% (95% CI: 14.4% – 38.4%), 8.8% (95% CI: 7.7% – 10.0%), and 4.3% (95% CI: 4.1% – 4.5%), respectively. The prevalence of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, low levels of high-density lipoprotein cholesterol, and high levels of low-density lipoprotein cholesterol were 10.1% (95% CI: 5.8% – 16.9%), 17.7% (95% CI: 14.0% – 22.1%), 5.1% (95% CI: 3.1% – 8.2%), 11.0% (95% CI: 8.0% – 15.0%), and 8.8% (95% CI: 4.1% – 17.8%), respectively. Sensitivity analyses revealed that males had a higher prevalence of dyslipidemia (43.2%) than females (35.6%). Study samples of age 30 and above in the eastern region tended to have higher prevalence of dyslipidemia. The quality of the studies has a slight impact on the pooled estimates.

          Conclusions

          The overall pooled prevalence of dyslipidemia in Chinese adults was estimated to be 41.9%, with males having a higher rate than females.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12963-014-0028-7) contains supplementary material, which is available to authorized users.

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          Most cited references70

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          Fixed- versus random-effects models in meta-analysis: model properties and an empirical comparison of differences in results.

          Frank L. Schmidt, In-Sue Oh, Theodore L. Hayes (2009)
          Today most conclusions about cumulative knowledge in psychology are based on meta-analysis. We first present an examination of the important statistical differences between fixed-effects (FE) and random-effects (RE) models in meta-analysis and between two different RE procedures, due to Hedges and Vevea, and to Hunter and Schmidt. The implications of these differences for the appropriate interpretation of published meta-analyses are explored by applying the two RE procedures to 68 meta-analyses from five large meta-analytic studies previously published in Psychological Bulletin. Under the assumption that the goal of research is generalizable knowledge, results indicated that the published FE confidence intervals (CIs) around mean effect sizes were on average 52% narrower than their actual width, with similar results being produced by the two RE procedures. These nominal 95% FE CIs were found to be on average 56% CIs. Because most meta-analyses in the literature use FE models, these findings suggest that the precision of meta-analysis findings in the literature has often been substantially overstated, with important consequences for research and practice.
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            Overview of obesity in Mainland China.

            C. Chen (2008)
            This overview describes the study of obesity issues over the last 8 years in Mainland China. A disease risk-based body mass index classification for Chinese adults was developed and verified by the results of the 2002 China Nationwide Nutrition and Health Survey. Age and gender-specific BMI cut-offs for Chinese children and adolescents aged 7-18 years were also developed. As the first step in the obesity control effort, the public health implications of the prevalence of overweight and obesity were set out and publicized by the government of China. The overweight prevalence in 2002 was 22.8% and for obesity 7.1%, these having increased by 40.7% and 97.2%, respectively, since 1992. In children, dramatic increases in overweight/obesity have occurred with a two- to threefold increase in Beijing and Shanghai between 1985 and 1995; the prevalence of overweight plus obesity in 7- to 12-year-old boys approached 29% in 2000 and in girls 15-17%. The rapid development of overweight/obesity in China will undoubtedly push up the prevalence of chronic disease. The relative risk for adult hypertension and diabetes in the overweight and obese populations was 2-5 in 2002. In adolescents, the relative risk of hypertension in the overweight was 3.3 and in the obese 3.9, with a clustering of cardiovascular risk factors in the obese Chinese children of whom 90.5% had evidence of abdominal obesity. Even the overweight group had 15.8% with abdominal obesity. Based on the population attributable risks of overweight and obesity in 2002 and data on the direct medical costs of hypertension, diabetes, stroke and coronary heart disease, 25% of these comorbidity costs could be attributed to overweight and obesity. As the improvement in linear growth of young children is usually slower than their improvements in weight during the economic development of China, the long-term adult implications of having a problem of 'Stunted obesity' rather than simple obesity in young children are raised. Analysis of the associations between adult obesity with the individuals' fetal and early nutrition highlights the need for further investigation.
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              Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA): gender, ethnicity, and coronary artery calcium.

              Yao-Hung Tsai, Holly Kramer, D Goff … (2006)
              To assess the implementation challenge facing the Third Report of the Adult Treatment Panel (ATP III) of the National Cholesterol Education Program, we determined the prevalence, treatment, and control of dyslipidemia, including ethnic and gender differences, in persons free of known clinical cardiovascular disease (CVD). In addition, this report provides information about the presence of coronary artery calcium (CAC) across groups defined by risk and recommendations for the use of lipid-lowering drugs. The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of 6814 persons aged 45 to 84 years who were free of clinical CVD at baseline (2000-2002). Participants with complete fasting lipid profiles (n=6704) were evaluated for CVD risk and self-reported use of lipid-lowering therapy. CAC was assessed by CT. Drug treatment thresholds and goals were defined according to ATP III. Models were constructed to adjust for age, clinic site, risk factors, socioeconomic characteristics, and healthcare access variables with the use of Poisson regression. Overall, 29.3% (1964/6704) had dyslipidemia, among whom lipid-lowering drug therapy was reported by 54.0% (1060/1964). Control to ATP III goal was observed in 75.2% (797/1060) of participants with treated dyslipidemia and 40.6% (797/1964) of participants with dyslipidemia. Men were more likely than women to qualify for drug therapy and less likely to be treated and controlled. Relative to non-Hispanic whites, Chinese Americans were less likely to qualify for drug treatment, but no differences in treatment and control rates were observed. Black and Hispanic Americans had prevalence of dyslipidemia that was comparable to that of non-Hispanic whites but were less likely to be treated and controlled. Ethnic disparities were attenuated substantially by adjustment for healthcare access variables; however, the gender disparities persisted despite adjustment for risk factors, socioeconomic characteristics, and healthcare access variables. Control of dyslipidemia was achieved less commonly in the CVD high- and intermediate-risk groups than in the low-risk group. Among high-risk individuals, 19.7% of those who did not qualify for lipid-lowering drug treatment had CAC >400. The proportion of drug treatment-qualifying persons who were not treated differed by presence and severity of CAC, with 48.0%, 46.8%, and 39.6% of eligible persons with no CAC, with CAC >0 and 400 not receiving treatment, respectively (P for difference=0.04). Dyslipidemia is common among persons without CVD. The quality of care for dyslipidemia is suboptimal in general and variable by CVD risk group, ethnicity, and gender. The utility of incorporating CAC screening into the risk stratification and treatment process should be investigated in light of the substantial proportions of persons with CAC who are currently classified as not requiring treatment. Research and quality improvement programs are needed to optimize management of dyslipidemia.
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                Author and article information

                Contributors
                Yuanxiu Huang: huangyx02@qq.com
                Lin Gao: 373276421@qq.com
                Xiaoping Xie: XiaoPing.Xie@pfizer.com
                Seng Chuen Tan: sctan@sg.imshealth.com
                Journal
                Journal ID (nlm-ta): Popul Health Metr
                Journal ID (iso-abbrev): Popul Health Metr
                Title: Population Health Metrics
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1478-7954
                Publication date (Electronic): 28 October 2014
                Publication date PMC-release: 28 October 2014
                Publication date Collection: 2014
                Volume: 12
                Issue: 1
                Electronic Location Identifier: 28
                Affiliations
                [ ]School of Public Health, Central South University, Changsha, China
                [ ]Outcomes Research, Pfizer Investment Co. Ltd, Beijing, China
                [ ]Health Economics & Outcomes Research, IMS Health Asia Pacific, 8 Cross Street, #21-01/02/03 PWC Building, Singapore, 048424 Singapore
                Article
                Publisher ID: 28
                DOI: 10.1186/s12963-014-0028-7
                PMC ID: 4219092
                PubMed ID: 25371655
                SO-VID: 14482ea6-bbc2-4d7d-8ba8-2ec1a79c88c1
                Copyright © © Huang et al.; licensee BioMed Central Ltd. 2014
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 12 March 2014
                Date accepted : 1 October 2014
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2014

                ScienceOpen disciplines: Health & Social care
                Keywords: dyslipidemia,prevalence,awareness rate,treatment rate,control rate,meta-analysis
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: dyslipidemia, prevalence, awareness rate, treatment rate, control rate, meta-analysis

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