Distribution and temporal trends of predicted ten-year and lifetime atherosclerotic cardiovascular disease risk in Chinese adults, 2013-2023: national cross-sectional surveys

Background Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of health burden in China. Previous studies have focused on and depicted the prevalence and trends of individual risk factors for ASCVD, while comprehensive indices integrating relevant indicators could provide a more intuitive assessment of overall future risk. However, representative data on national trends in predicted cardiovascular risk are limited, with a notable gap in lifetime risk estimates. Aims Based on a nationally representative sample, the study aimed to comprehensively depict trends of predicted 10-year and lifetime ASCVD risk during 2013 and 2023 among adults in mainland China aged 20 and above, as well as individuals from different demographic, socioeconomic, and geographical subgroups, supporting the formulation of targeted strategies for cardiovascular disease (CVD) prevention. Methods The study was conducted based on the nationally representative data from the China Chronic Disease and Risk Factor Surveillance in 2013, 2018, and 2023. Adults aged 20-74 years without prevalent ASCVD and with complete risk factor data were included, with total sample size of 158553 in 2013, 156471 in 2018, and 154833 in 2023. Ten-year and lifetime ASCVD risks were estimated using the sex-specific Prediction for ASCVD Risk in China (China-PAR) equations and were classified into low (<5.0%), intermediate (5.0%-9.9%), and high (≥10.0%) 10-year risk, and low (<32.8%) or high (≥32.8%) lifetime risk stratification. Distribution and temporal trends in weighted average risk and high-risk proportions were analyzed overall and by age, education, income, region, residence, and provincial socio-demographic index (SDI). Results The average estimated 10-year ASCVD risk significantly increased from 4.2% (95% confidence interval[CI]=4.1%-4.2%) in 2013 to 4.3% (95%CI=4.2%-4.3%) in 2023 (Δ=0.1%; 95%CI=0.02%-0.18%; Ptrend=0.011), and the proportion of high 10-year risk increased from 12.7% to 13.3% (Δ=0.61%; 95%CI=0.21%-1.00%; Ptrend=0.003). Among adults aged 20-59 years with low-to-moderate 10-year risk, 6.4% (95%CI=6.1%-6.7%), 6.8% (95%CI=6.5%-7.1%), and 7.1% (95%CI=6.8%-7.5%) were classified as high lifetime risk in 2013, 2018, and 2023, respectively (Ptrend=0.001). Overall, risks were higher among low-income individuals, low-educated individuals, and those from high SDI regions. Notably, a similar upward trend in predicted ASCVD risk was observed at the provincial level across the three surveys. Nevertheless, the regional heterogeneity persisted, with the average 10-year risk varying from 2.1% (95%CI=1.9%-2.2%) in Tibet to 6.8% (95%CI=6.5%-7.1%) in Liaoning in 2023. Conclusion Over the past decade, Chinese adults experienced rising predicted ASCVD risks. Therefore, there is an urgent need to actively promote population-based and prevention-first strategies and develop more targeted prevention and control plans incorporating population-specific characteristics.