Cardiovascular disease risk reduction in rural China: a clustered randomized controlled trial in Zhejiang

31,708 adults aged 50 to 74 years with a calculated 10-year CVD risk of 20% or higher (using the Asian Equation) or diagnosed diabetes, across 67 township hospitals in rural Zhejiang, China. Excludes patients with prior severe CVD events (acute coronary events, acute myocardial infarction, ischemic or hemorrhagic cerebrovascular events).

Systematic CVD risk reduction package delivered by family doctors, including: 1) healthy lifestyle counseling (smoking cessation, salt, oil, and alcohol reduction); 2) prescription of a combination of drugs from the essential drug list (antihypertensives, low-dose aspirin, and a statin); and 3) adherence support (monthly meetings, peer educators, mobile phone reminders) over 24 months.

Usual care for hypertension and diabetes management at individual clinicians' discretion, according to current national guidelines, with no specific adherence support or systematic health education.

Incidence of severe CVD events (acute coronary events, acute myocardial infarction, sudden cardiac death, and other deaths due to coronary and vascular disease, and ischemic or hemorrhagic cerebrovascular events) over 24 months of follow-up, defined according to WHO MONICA definitions.hard clinical