OBJECTIVES: This study aims to estimate the burden of ischemic heart disease (IHD) and stroke, and quantify impacts of reducing LDL-C and five modifiable risk factors in China.

METHODS: Burden of disease models were developed to estimate (1) the burden of IHD and stroke among people aged ≥20 years; (2) the impact of reducing modifiable risk factors (including tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity) in accordance with World Health Organization (WHO) targets; (3) the impact of reducing LDL-C through increased access to more effective lipid lowering therapies for two high risk populations: heterozygous familial hypercholesterolemia (FH) and secondary prevention (SP), with a focus on patients with LDL-cholesterol >100 mg/dL. Review of literature and government publications was conducted to generate model inputs that include population forecast, disease and risk factor prevalence, CVD event rates, disease-related mortality, treatment effectiveness and costs. Direct costs to the public health care system and indirect costs from lost productivity due to hospitalizations and premature mortality were included.

RESULTS: The number of people with IHD and stroke in China would increase from 31 million in 2017 to 47 million in 2035 (average IHD:stroke ratio for prevalence= 47%:53%). The economic burden of IHD and stroke would increase from CNY¥228 billion in 2017 to CNY¥463 billion in 2035 (average IHD:stroke ratio= 47%:53%). In people aged ≥20 years, achieving the WHO risk factor targets would, on average, save 359,289 lives and CNY¥23 billion annually. In the high-risk populations (accounting for <7% of IHD and stroke populations), LDL-C reduction by increased access to more effective treatment would save 330,964 lives and CNY¥28 billion annually.

CONCLUSIONS: The burden of IHD and stroke in China is significant and growing. Efforts to achieve WHO risk factor targets and, particularly, lowering LDL-C in high-risk populations through effective treatments would reduce the burden.