Burden and trends of ischemic heart disease attributable to high body mass index and low physical activity among older adults in China from 1990 to 2023_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xuanda ,  CUI Anfu

Department of Liberal Education, Southern Medical University, Guangzhou, 510515, P. R. China;

Corresponding?author：

CUI Anfu, Email: 31665850@qq.com

Keywords：

Older adults; ischemic heart disease; high body mass index; low physical activity; disease burden

DOI：

10.7507/1007-4848.202604024

Video：

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Objective To assess the burden of ischemic heart disease attributable to low physical activity and high body mass index among the population aged 60 years and above in China from 1990 to 2023, and to predict the changing trends of the corresponding burden from 2024 to 2038, so as to lay a theoretical foundation for formulating comprehensive prevention and control measures. Methods We utilized the estimated annual percentage change (EAPC) to analyze the trends in disability-adjusted life years (DALYs) and mortality burden of ischemic heart disease attributable to high body mass index and low physical activity among the elderly population in China, along with exploring sex and age-group differences in the related burden. Furthermore, the Bayesian age-period-cohort model was employed for predictive analysis. Results EAPC analyses indicated that the age-standardized mortality rate (ASMR) and age-standardized DALYs rate of ischemic heart disease attributable to low physical activity and high body mass index among the Chinese elderly population increased from 1990 to 2023. Regarding sex differences, the burden caused by low physical activity was more severe in elderly females, while the burden attributed to high body mass index was heavier in elderly males. During the projection period, only the ASMR due to low physical activity in elderly males was expected to present a decreasing trend, while all other types of burdens were forecast to rise. Conclusion The burden of ischemic heart disease attributable to the above two modifiable risk factors continues to escalate among the elderly population in China. Therefore, it is necessary to implement precision prevention and control strategies ranging from the macro level to the individual level, with full consideration of sex heterogeneity, so as to alleviate the disease burden effectively.

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18.	Miao Y, Wang Y, Wan Q. Association between TyG index with obesity indicators and coronary heart disease: a cohort study[J/OL]. Sci Rep, 2025, 15(1): 8920. DOI: 10.1038/s41598-025-93922-5.
19.	Fan C, Feng Q, Wang J, et al. Physical activity patterns across life domains in Chinese older adults aged 60-79 years - China, 2020[J]. China CDC Wkly, 2025, 7(6): 195-200.
20.	Liu C, Zhang Z, Wang B, et al. Impact of low physical activity on cardiovascular disease across regions and demographic groups: insights from the Global Burden of Disease Study[]. Eur Heart J Qual Care Clin Outcomes, 2025, 11(4): 477-488.
21.	Siegrist M, Bakker EA, Timmermans EJ, et al. The role of physical activity in an obesogenic environment for cardiovascular risk reduction across the lifespan. A scientific statement of the European Association of Preventive Cardiology of the ESC[J/OL]. Eur J Prev Cardiol, 2026. DOI: 10.1093/eurjpc/zwag033.
22.	Jiang X, Zhao Y, Yang Q, et al. Gender differences in associations between obesity and hypertension, diabetes, dyslipidemia: evidence from electronic health records of 3.5 million Chinese senior population[J/OL]. BMC Public Health, 2025, 25(1): 405. DOI: 10.1186/s12889-025-21534-9.
23.	Zhu J, Yang Z, Li X, et al. Association of periaortic fat and abdominal visceral fat with coronary artery atherosclerosis in Chinese middle aged and elderly patients undergoing computed tomography coronary angiography[J/OL]. Glob Heart, 2021, 16(1): 74. DOI: 10.5334/gh.1078.
24.	陽靜, 朱晨燕, 袁璐, 等. TyG指數及TyG-肥胖聯合指數與缺血性心臟病發生風險的關聯研究[J]. 四川大學學報(醫學版), 2024, 55(5): 1123-1132.Yang J, Zhu CY, Yuan L, et al. Association between triglyceride glucose index and triglyceride glucose-obesity composite indices and the risk of ischemic heart disease[J]. J Sichuan Univ (Med Sci), 2024, 55(5): 1123-1132.
25.	Zhu Y, Kilian C, Lemp J, et al. Additive interactions of smoking with obesity on ischemic heart disease mortality: a national prospective cohort study in the United States[J/OL]. Int J Epidemiol, 2025, 54(6). DOI: 10.1093/ije/dyaf190.
26.	Lin B, Zhang Z, Zhang W, et al. Associations of physical activity types and intensity with cardiovascular diseases by age and gender among 18, 730 Chinese adults[J/OL]. Sci Rep, 2023, 13(1): 14623. DOI: 10.1038/s41598-023-41768-0.
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1. Jensen RV, Hjortbak MV, B?tker HE. Ischemic heart disease: an update[J]. Semin Nucl Med, 2020, 50(3): 195-207.
2. Elshorbagy A, Vallejo-Vaz AJ, Barkas F, et al. Overweight, obesity, and cardiovascular disease in heterozygous familial hypercholesterolaemia: the EAS FH Studies Collaboration registry[J/OL]. Eur Heart J, 2025, 46(12): 1127-1140. DOI: 10.1093/eurheartj/ehae791.
3. Lai Z, Wu G, Yang Y, et al. Interactive effects of physical activity and sarcopenia on incident ischemic heart disease: results from a nation-wide cohort study[J/OL]. Atherosclerosis, 2024, 388: 117396. DOI: 10.1016/j.atherosclerosis.2023.117396.
4. Li Y, Zhang J. Disease burden and risk factors of ischemic heart disease in China during 1990-2019 based on the Global Burden of Disease 2019 report: a systematic analysis[J/OL]. Front Public Health, 2022, 10: 973317. DOI: 10.3389/fpubh.2022.973317.
5. Zhang C, Chen Q, Yin F, et al. Burden, trends, and predictions of low physical activity-related diseases in China: analysis from the Global Burden of Disease Study, 1990-2021, with projections to 2035[J/OL]. Front Public Health, 2025, 13: 1461554. DOI: 10.3389/fpubh.2025.1461554.
6. Xue P, Lin L, Li P, et al. Global, regional, and national epidemiology of ischemic heart disease among individuals aged 55 and above from 1990 to 2021: a cross-sectional study[J/OL]. BMC Public Health, 2025, 25(1): 985. DOI: 10.1186/s12889-025-22193-6.
7. 蘇未, 張穎, 馬爽. 1990—2019年中國和全球缺血性心臟病疾病負擔變化趨勢與發病預測分析[J]. 中國全科醫學, 2024, 27(19): 2375-2381, 2387.Su W, Zhang Y, Ma S. Trend and prediction analysis of the changing disease burden of ischemic heart disease in China and worldwide from 1990 to 2019[J]. Chin Gen Pract, 2024, 27(19): 2375-2381, 2387.
8. Yang L, Xing Y, Gao X, et al. Burden of ageing spectrum of diseases in China, 1990–2021: a systematic analysis of Global Burden of Disease Study 2021[J/OL]. Front Public Health, 2025, 13: 1611901. DOI: 10.3389/fpubh.2025.1611901.
9. Wu H, Wang Y, Zhang H, et al. An investigation into the health status of the elderly population in China and the obstacles to achieving healthy aging[J/OL]. Sci Rep, 2024, 14(1): 31123. DOI: 10.1038/s41598-024-82443-2.
10. GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023[J]. Lancet, 2025, 406(10513): 1873-1922.
11. Zhang T, Jiang H, Xu X, et al. Non-communicable disease burden in China, 1990–2023: evidence from the Global Burden of Disease Study 2023[J]. Chin Med J (Engl), 2026, 139(1): 48-57.
12. Global Burden of Cardiovascular Diseases and Risks 2023 Collaborators. Global, regional, and national burden of cardiovascular diseases and risk factors in 204 countries and territories, 1990-2023[J]. J Am Coll Cardiol, 2025, 86(22): 2167-2243.
13. Yang X, Zhao ZP, Shi Y, et al. The evolving burden of heart failure in China: a 34-year subnational analysis of trends and causes from the Global Burden of Disease Study 2023[J]. Mil Med Res, 2025, 12(1): 65.
14. Gu Q, Nong S, Liu C, et al. Trends and predictions of the global burden of ischemic heart disease in women of childbearing age attribute to high body mass index and hypertension, 1990–2021: a systematic analysis for the Global Burden of Disease Study[J]. BMC Cardiovasc Disord, 2025, 25(1): 360.
15. Li H, Liang L, Song Z, et al. Global, regional, and national burden of cardiovascular disease attributable to high body mass index from 1990 to 2021 and projection to 2045[J/OL]. Front Endocrinol (Lausanne), 2025, 16: 1546176. DOI: 10.3389/fendo.2025.1546176.
16. 曹慧, 王琰軍, 張愛梅. 1990-2021年中國與全球缺血性心臟病疾病負擔特征及預測研究[J]. 疾病監測, 2026, 40(5): 682-688.Cao H, Wang YJ, Zhang AM. Characteristics and prediction of ischemic heart disease burden in China and the world, 1990?2021[J]. Dis Surveill, 2025, 40(5): 682-688.
17. 史佳琪, 何麗, 琚臘紅, 等. 2002—2015年中國老年人超重肥胖變化趨勢[J]. 中國食物與營養, 2025, 31(2): 81-88.Shi JQ, He L, Ju LH, et al. Trends of overweight and obesity among the elderly in China in 2002—2015[J]. Food Nutr China, 2025, 31(2): 81-88.
18. Miao Y, Wang Y, Wan Q. Association between TyG index with obesity indicators and coronary heart disease: a cohort study[J/OL]. Sci Rep, 2025, 15(1): 8920. DOI: 10.1038/s41598-025-93922-5.
19. Fan C, Feng Q, Wang J, et al. Physical activity patterns across life domains in Chinese older adults aged 60-79 years - China, 2020[J]. China CDC Wkly, 2025, 7(6): 195-200.
20. Liu C, Zhang Z, Wang B, et al. Impact of low physical activity on cardiovascular disease across regions and demographic groups: insights from the Global Burden of Disease Study[]. Eur Heart J Qual Care Clin Outcomes, 2025, 11(4): 477-488.
21. Siegrist M, Bakker EA, Timmermans EJ, et al. The role of physical activity in an obesogenic environment for cardiovascular risk reduction across the lifespan. A scientific statement of the European Association of Preventive Cardiology of the ESC[J/OL]. Eur J Prev Cardiol, 2026. DOI: 10.1093/eurjpc/zwag033.
22. Jiang X, Zhao Y, Yang Q, et al. Gender differences in associations between obesity and hypertension, diabetes, dyslipidemia: evidence from electronic health records of 3.5 million Chinese senior population[J/OL]. BMC Public Health, 2025, 25(1): 405. DOI: 10.1186/s12889-025-21534-9.
23. Zhu J, Yang Z, Li X, et al. Association of periaortic fat and abdominal visceral fat with coronary artery atherosclerosis in Chinese middle aged and elderly patients undergoing computed tomography coronary angiography[J/OL]. Glob Heart, 2021, 16(1): 74. DOI: 10.5334/gh.1078.
24. 陽靜, 朱晨燕, 袁璐, 等. TyG指數及TyG-肥胖聯合指數與缺血性心臟病發生風險的關聯研究[J]. 四川大學學報(醫學版), 2024, 55(5): 1123-1132.Yang J, Zhu CY, Yuan L, et al. Association between triglyceride glucose index and triglyceride glucose-obesity composite indices and the risk of ischemic heart disease[J]. J Sichuan Univ (Med Sci), 2024, 55(5): 1123-1132.
25. Zhu Y, Kilian C, Lemp J, et al. Additive interactions of smoking with obesity on ischemic heart disease mortality: a national prospective cohort study in the United States[J/OL]. Int J Epidemiol, 2025, 54(6). DOI: 10.1093/ije/dyaf190.
26. Lin B, Zhang Z, Zhang W, et al. Associations of physical activity types and intensity with cardiovascular diseases by age and gender among 18, 730 Chinese adults[J/OL]. Sci Rep, 2023, 13(1): 14623. DOI: 10.1038/s41598-023-41768-0.
27. 程釗, 宇傳華. 全球視角的中國老年人口與疾病負擔現狀及趨勢[J]. 公共衛生與預防醫學, 2025, 36(3): 1-6.Cheng Z, Yu CH. The current status and trends of population and disease burden in China's elderly people from a global perspective[J]. J Public Health Prev Med, 2025, 36(3): 1-6.
28. 新華社. 中共中央國務院印發《“健康中國2030”規劃綱要》[J]. 中華人民共和國國務院公報, 2016, (32): 5-20.Xinhua News Agency. The Communist Party of China Central Committee and the State Council issued the "Healthy China 2030" planning outline[J]. Gaz State Counc China, 2016, (32): 5-20.
29. 國家衛生健康委, 全國愛衛辦, 教育部, 等. 關于印發“體重管理年”活動實施方案的通知[EB/OL]. [2026-03-10].National Health Commission, National Patriotic Health Campaign Committee Office, Ministry of Education, et al. Notice on issuing the implementation plan for the "Weight Management Year" campaign[EB/OL]. [2026-03-10].
30. 體育總局辦公廳, 發展改革委辦公廳, 財政部辦公廳, 等. 關于印發《全民健身場地設施提升行動工作方案(2023-2025年)》的通知[EB/OL]. [2026-03-10].General Office of the General Administration of Sport, General Office of the National Development and Reform Commission, General Office of the Ministry of Finance, et al. Notice on issuing the work plan for the National Fitness Venue and Facility Upgrade Campaign (2023-2025)[EB/OL]. [2026-03-10].
31. Ding M, Zhou Y, Li C, et al. Can the WHO's recommendations of physical activity volume decrease the risk of heart disease in middle and older aged Chinese people: the evidence from a seven year longitudinal survey[J/OL]. BMC Geriatr, 2022, 22(1): 596. DOI: 10.1186/s12877-022-03276-0.

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Latest ArticlesBurden and trends of ischemic heart disease attributable to high body mass index and low physical activity among older adults in China from 1990 to 2023

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