Impact of Cardiometabolic Risk Factors on Cardiovascular Disease Mortality and Morbidity in China: Findings From the PURE-China Cohort

Abstract BACKGROUND To investigate the associations of cardiometabolic risk factors with cardiovascular disease morbidity and mortality and quantify the population attributable burden in the Chinese population. METHODS This study analyzed data from the Prospective Urban Rural Epidemiology-China (PURE-China) cohort, including 39,693 participants aged 35–70 years from 115 urban and rural communities across 12 provinces in China. The subjects were recruited from 2005 to 2009 and followed up every 3 years until April 2021. Multifactorial Cox fragility models were used to evaluate the associations of hypertension, diabetes, dyslipidemia, and abdominal obesity with cardiovascular disease outcomes. The population attributable risk score was calculated to estimate the burden of these risk factors. RESULTS The mean age of the cohort was (50.41 ± 9.62) years. After a median follow-up of 11.9 years, 2,086 (5.3%) all-cause deaths and 688 (1.7%) cardiovascular deaths as well as 3,112 (7.8%) cardiovascular events were recorded. Diabetes and hypertension were the two most important metabolic risk factors. The hazard ratio (HR) of diabetes was 1.665 [95% confidential interval (CI): 1.459–1.899, P < 0.001] for all-cause mortality. Hypertension was significantly associated with cardiovascular mortality (HR: 2.388, 95%CI: 2.002–2.849, P < 0.001) and morbidity (HR: 1.983, 95%CI: 1.833–2.146, P < 0.001). Cardiometabolic risk factors collectively accounted for 18.2% of all-cause and 49.7% of cardiovascular mortality, and 42.0% of cardiovascular events, with hypertension contributing the most (13.3%, 36.1%, and 28.6%, respectively). CONCLUSION Cardiometabolic risk factors, particularly hypertension and diabetes, are significantly associated with cardiovascular events and death. Comprehensive management of hypertension, diabetes, and other metabolic disorders is essential for reducing the burden of cardiovascular diseases in China.