To the Editor:
I would like to echo the sentiments of Smaha in the “Message from China”1 and add some personal comments.
The prevalence of coronary heart disease has changed considerably in China in the past 5 decades, rising from the fifth most common form of heart disease in 1948 to 1957 to the second most common form of heart disease from 1958 to 1979, and to the most common form of heart disease in 1980 to 1989, where it remains.2 The fact that diet plays a major role is evident by the progressive rise of “normal” serum cholesterol levels in free-living Chinese men from 155 mg/dL in 1958 to 191 mg/dL in 1981.3
Besides the increase in dietary fat intake in young people from Western fast food restaurants opening in China and the increasing rates of diabetes in the elderly population, cigarette smoking also plays an important role. China ranks as the first in the world in its population and also in its output of cigarette products. China today has the largest smoking habit in the world.2 One of every 3 cigarettes manufactured in the world is consumed in China. Three of every 5 Chinese smokers begin smoking at the age of 15 to 20 years.4 China is about at the stage where the United States of America was in the 1940s and 1950s, when the smoking rate was very high. Because China’s modernization program calls for catching up with Americans, if the Chinese smoke like Americans, then they will die like Americans.
Another risk factor for coronary heart disease created by modernization is, as Smaha remarked, reduced physical exercise. Bicycles used to be the principal means of transportation in China. Now, there is an 8- to 10-fold increase in the number of automobiles in Beijing.1 Besides causing more traffic congestion, more air pollution, and less opportunity for exercise, automobiles in China are also responsible for a 41-fold increase in accidents, a 28-fold increase in injuries, and a 75-fold increase in deaths from 1951 to 1993.5
There is a price that developing countries must pay for modernization. However, let the price the Chinese pay not exceed the benefits derived from modernization. Can we achieve a utopian stage in the 21st century in which the modern Chinese retain their ancestral low rates of cardiovascular disease while adapting the positive aspects of a modern Western lifestyle?
- Copyright © 2001 by American Heart Association
Smaha L. Message from China. Circulation. 2000;102:e67–e68.
Cheng TO. Coronary heart disease in China. Hosp Med. 1999;60:456.
Tung CL, Cheng TO. The changing incidence of heart disease in modern China. In: Cheng TO, ed. The International Textbook of Cardiology. New York: Pergamon Press; 1987:10–14.