This month, The Lancet Neurology published an article stating that 90.2% of the burden of stroke is due to modifiable risk factors and that China has one of the highest proportions of stroke risk factors in the world! Stroke was chosen because the researchers believe that the burden of stroke and the factors that influence it are broad enough to best reflect and predict the short- and long-term health of society as a whole. The measure of stroke burden used in this study is the disability-adjusted life year (DALY) for stroke, which is the total number of healthy life years lost from onset to death. What are the controllable risk factors? The current study lists 17 controllable risk factors for stroke, including: 1. Air pollution and environmental factors: ambient PM2.5 pollution, household solid fuel combustion pollution, lead exposure; 2. Dietary risks: high nano diet, high intake of sugary sweetened beverages, low intake of fruits, low intake of vegetables, low intake of whole grains, alcohol consumption; 3. Physical activity factors: low physical activity; 4. Tobacco factors: smoking, secondhand smoke; 5. Physiological factors: high BMI, high fasting blood sugar, high systolic blood pressure (SBP), high cholesterol, low glomerular filtration rate (GFR). Among them, air pollution contributes up to 33.7% to the burden of stroke for low- and middle-income countries, and 29.2% worldwide. This is the first time in history that air pollution has had such a large impact on the burden of stroke, reaching the top three risk factors for stroke DALYs. The first and second places are behavioral risk factors and metabolic risk factors, respectively. How many risk factors does China actually account for? China again largely leads the way in the above controllable factors contributing to stroke burden, with a large number of hits: (The chart above indicates the proportion of risk factors contributing to stroke burden, with cooler colors indicating lower proportions and warmer colors indicating higher proportions.) China is clearly well over 90%, at around 94%. That is, 94% of the stroke burden in China is caused by controllable factors that can be avoided. This result is not too surprising when compared to the risk factors listed above. China is in the midst of a major diabetes explosion, with a dramatic rise in obesity, a complete failure of tobacco control, a serious lack of national physical activity (up to 80% of the population does not meet minimum activity standards), a habitual high-napping diet, and statistics from a while back showing that fruit intake in the Chinese diet is also below average. Alcohol consumption is not necessarily low, and of course, there is air pollution, which we all understand. Among the main controllable factors, researchers have made separate graphs: 1, high systolic blood pressure The burden of stroke, China is in a high level segment in the world. 2, low fruit intake is also more of a problem in China. 3, high BMI From the overall data, Chinese BMI looks relatively reassuring, but in fact China has the largest number of fat people in the world with a BMI above 30, and at the same time, the same BMI, due to higher body fat content, Chinese people are more likely to suffer from cardiovascular and endocrine diseases than Caucasians is already a foregone conclusion. Therefore, using the same BMI criteria for disease-related statistics is not very appropriate. That is to say, even if our country presents a pleasing blue color on this chart, it has not reached the point where we can relax our vigilance in practice. 4, high Na diet Many regions in Asia (including China) are consuming diets with high Na content, and some studies have concluded that this diet structure is prone to hypertension. 5, smoking China’s smoking situation is far from good, in fact, the overall failure of tobacco control, more and more smokers, has reached the point where 1 million people die every year due to smoking, 100,000 people die due to second-hand smoke. An article in The Lancet predicts that the number of smoking deaths in China will reach 3 million per year by 2030. The graph shows that the smoking situation in China is far worse than in developed countries such as Europe, the United States and Australia, and even worse than in Russia. Trends in risk factors Globally, from 2009 to 2013, the following risk factors are on the rise: ① High BMI, up more than 46%; ② Low physical activity, up more than 39%; ③ High fasting glucose, up about 44%; ④ High SBP, up more than 39%; ⑤ High intake of sugary sweetened beverages, up more than 63%; ⑥ High cholesterol, up about 24%; and (7) Environmental PM2.5 pollution, up by more than 33%; (8) Alcohol consumption, up by more than 32%; (9) Low GFR, up by about 25%; (10) High sodium diet, up by more than 34%; (11) Low intake of vegetables, up by more than 23%; and (12) Smoking, up by more than 10%. Overall, the global picture is very bad in terms of controlling the controllable risk factors that contribute to the burden of stroke. The situation in China may be even worse, because in addition to the above risk factors, all of which are increasing in China, secondhand smoke, a risk factor that is on the decline globally, is also increasing in China. After all, the above risk factors, except air pollution is difficult to change by personal power, various other factors can be controlled through health departments and doctors to patients and high-risk groups of health education, since 94% can be avoided, why not give it a try.