Cardiovascular health status in Chinese Cardiologists: China Cardiologist Heart Survey II : Cardiology Plus

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Cardiovascular health status in Chinese Cardiologists: China Cardiologist Heart Survey II

Yu, Shikai1; Zhang, Yi1; Peng, Wenhui1; Zhao, Dong2; Shi, Hong3; Zhang, Shuning4; Huo, Yong5; Xu, Yawei1,*; Ge, Junbo4,*

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doi: 10.1097/CP9.0000000000000022
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Abstract

Introduction

Cardiovascular disease (CVD) is the most common chronic non-communicable disease in China[1,2]. Currently, there are 330 million CVD patients in China, and this number is still growing[3,4]. The primary care system in Chinese mainland is not well developed. As a result, nearly all patients with CVD seek medical care from cardiologists in tertiary or secondary hospitals, placing heavy burden to a limited number of cardiologists[5]. Burnout is highly prevalent in cardiologists, particularly in interventional cardiologists[6–8]. The stresses and busy lifestyle place the Chinese cardiologists at a high risk of CVD. On the other hand, cardiologists represent a subset of the population with the highest degree of awareness to CVD and the knowledge to reduce modifiable cardiovascular risks.

The status of cardiovascular health has been well studied in patient population in Chinese mainland[9]. However, few studies have been conducted in Chinese cardiologists. The earliest survey was conducted in 2010, and evaluated the 10-year CVD risk in 4,032 Chinese cardiovascular physicians aged between 35 and 59 years in Chinese mainland[10]. This survey emphasized sub-optimal awareness of their own cardiovascular risk. In 2016, the Chinese College of Cardiovascular Physicians and China Cardiovascular Association initiated the China Cardiologist Heart Survey (CCHS), a nation-wide cross-sectional survey. The first cycle of CCHS (CCHS I) was undertaken between September 2016 and August 2017, and reported unsatisfying management of hypertension in Chinese cardiologists[11]. The second cycle of CCHS (CCHS II) started in 2020, and added lifestyle and workload items in the questionnaire. Results are reported below.

Methods

Study design and participants

CCHS II was undertaken between August 2020 and November 2021 in Chinese mainland. Taiwan, Hong Kong, and Macau were not included in this study. The survey was carried out via an online self-administered questionnaire based on Wechat, a widely used social media in China. Invitation of participating the survey was sent to all licensed cardiologists from the official WeChat account of China Cardiovascular Association (subscribed by most cardiologists in China) and announced in scholarly conferences of national and local levels. All items in the questionnaire must be completed before the “submission” was activated. For quantitative variables, reasonable limits were set to safeguard data reliability. This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and was approved by the Ethics Committee of Tongren Hospital, Shanghai Jiaotong University, School of Medicine (approval No.2015-017-01; date: June 15, 2015). All physicians signed the informed consent form before completing the questionnaire.

A total of 20,357 cardiologists from over 2,000 hospitals from 31 provinces, autonomous regions, and municipalities in Chinese mainland were accessible, of whom 17,010 submitted the questionnaire. The present study only included those aged between 25 and 60 years and practicing in tertiary or secondary hospitals (n = 15,827). Age and geographical distribution of the participants are displayed in Supplemental Digital Content 1, Figures S1 and S2, https://links.lww.com/CARDIOPLUS/A6, respectively.

Questionnaire

The questionnaire included the following items: a) demographic and personal information, including birth date, sex, education level, type of hospital, professional title, subspecialty, body height, and weight; b) lifestyle and work habits, including physical activity, smoking, alcohol, coffee, diet, daily work duration, overtime, and nightshift; c) relevant health status, including hypertension, diabetes, dyslipidemia, coronary artery disease, myocardial infarction, stoke, and medications; d) key laboratory measures, including blood pressure, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein, triglyceride, and fasting blood glucose. Age was calculated based on birth date; body mass index (BMI) was calculated based on body height and weight.

Definitions

Healthy diet was defined as having ≥2 components of the following: a) fish ≥200 g/week; b) vegetables and fruits ≥500 g/day; c) bean products ≥125 g/day; red meat ≤125 g/day; and tea ≥50 g/month. Frequent nightshift was defined as nightshift at least once a week. Physically active was defined as meeting the level of physical activity recommended by WHO (150–300 minutes of moderate-intensity, or 75–150 minutes of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week)[12]. The family history of premature CVD was considered when any first-degree relatives experienced a fatal or nonfatal myocardial infarction and/or coronary angioplasty/coronary artery bypass surgery prior to the age of 55 years in men and 65 years in women. Overweight was defined as BMI >24 kg/m2 and <28 kg/m2; obesity was defined as BMI ≥28 kg/m2, using the criteria recommended for Chinese population[13]. Hypertension was defined as self-reported history of hypertension or systolic/diastolic BP ≥140/90 mmHg, and diabetes as self-reported history of diabetes or fasting serum glucose ≥7.0 mmol/L. Dyslipidemia was defined as a self-reported history of dyslipidemia.

Statistical analysis

Continuous variables are presented as mean ± SD for those with normal distribution or median (interquartile range) for those with skewed distribution; categorical variables are presented as absolute numbers and percentage in parenthesis. Group comparison was conducted using Student’s t test for independent samples or Mann-Whitney U-test as appropriate for continuous variables, and using the chi-square test for categorical variables. Age-standardized prevalence was adjusted using data from the Sixth National Population Census of China published in April 2011. Data on the prevalence of hypertension were available for analysis at the province level. Accordingly, the choropleth map was generated using FineBI software (Fanruan Software, China) to display the geographical variation in the age-standardized prevalence of hypertension (Tibet and Ningxia Hui Autonomous Region were excluded because of lack of sufficient data). All analyses were conducted using SAS software, version 9.4 (SAS Institute, Cary, NC, USA). Statistical significance was defined as P <0.05.

Results

Characteristics of study participants

Characteristics of study participants are presented in Table 1. The median age of the study population was 38 years (interquartile range 33–45 years). Eight thousand six hundred fifty (54.7%) participants were women, 10,627 (67.4%) worked in a tertiary hospital, and 7,642 (48.3%) were interventional cardiologists. In contrast to female cardiologists, male cardiologists were older [39 (34–46) vs. 36 (32–44) years; P < 0.001] and had higher BMI [20.83 (19.35–22.62) vs. 17.48 (16.13–19.09) kg/m2; P < 0.001]. Compared to non-interventional cardiologists, interventional cardiologists were older [39 (34–46) vs. 36 (31–45) years; P < 0.001] and had higher BMI [20.35 (18.52–22.09) vs. 18.40 (16.67–20.59) kg/m2; P < 0.001], and 78.5% of interventional cardiologists were men.

Table 1 - Characteristics of study participants by sex and subspecialty
Variables Entire population (n = 15,827) Sex Subspecialty
Men (n = 8,650, 54.7%) Women (n = 7,177, 45.4%) P Non-intervention (n = 8,185, 51.7%) Intervention (n = 7,642, 48.3%) P
Age, years 38 (33–45) 39 (34–46) 36 (32–44) <0.001 36 (31–45) 39 (34–46) <0.001
Body mass index, kg/m2 19.38 (17.34–21.51) 20.83 (19.35–22.62) 17.48 (16.13–19.09) <0.001 18.40 (16.67–20.59) 20.35 (18.52–22.09) <0.001
SBP, mmHg* (n = 11,662) 120 (110–128) 125 (120–130) 110 (105–120) <0.001 120 (110–125) 120 (116–130) <0.001
DBP, mmHg* (n = 11,662) 75 (70–80) 80 (70–82) 70 (65–78) <0.001 72 (70–80) 78 (70–80) <0.001
FBG, mmol/L* (n = 10,755) 5.2 (4.9–5.6) 5.4 (5.0–5.7) 5.1 (4.7–5.5) <0.001 5.2 (4.8–5.6) 5.3 (5.0–5.60) <0.001
LDL-C, mmol/L* (n = 5,126) 2.56 (2.00–3.12) 2.60 (2.10–3.20) 2.40 (2.00–3.00) <0.001 2.50 (2.00–3.10) 2.60 (2.10–3.16) <0.001
Sex, n (%)
 Men 8,650 (54.7) / / 2,655 (32.4) 5,995 (78.5) <0.001
 Women 7,177 (45.4) / / 5,530 (67.6) 1,647 (21.6)
Academic degree, n (%)
 Junior college 517 (3.3) 187 (2.2) 330 (4.6) <0.001 432 (5.3) 85 (1.1) <0.001
 Bachelor 8,487 (53.6) 4,682 (54.2) 3,805 (53.0) 4,890 (59.7) 3,597 (47.1)
 Master 5,047 (31.9) 2,697 (31.2) 2,350 (32.7) 2,253 (27.5) 2,794 (36.6)
 Doctor 1,752 (11.1) 1,072 (12.4) 680 (9.5) 591 (7.2) 1,161 (15.2)
 Others 24 (0.2) 12 (0.1) 12 (0.2) 19 (0.2) 5 (0.1)
Hospital level, n (%)
 Secondary 5,155 (32.6) 2,882 (33.3) 2,273 (31.7) 0.03 3,416 (41.7) 1,739 (22.8) <0.001
 Tertiary 10,627 (67.4) 5,768 (66.7) 4,904 (68.3) 4,769 (58.3) 5,903 (77.2)
Professional title, n (%)
 Resident physician 2,971 (18.8) 1,503 (17.4) 1,468 (20.5) <0.001 1,503 (17.4) 1,468 (20.5) <0.001
 Attending physician 5,444 (34.4) 2,982 (34.5) 2,462 (34.4) 2,982 (34.5) 2,462 (34.3)
 Associate chief physician 3,942 (24.9) 2,507 (29.0) 1,435 (20.0) 2,507 (29.0) 1,435 (20.0)
 Chief physician 2,419 (15.3) 1,514 (17.5) 905 (12.6) 1,514 (17.5) 905 (12.6)
 Others 1,051 (6.6) 144 (1.7) 907 (12.6) 144 (1.7) 907 (12.6)
Subspecialty, n (%)
 Intervention 7,642 (48.3) 5,995 (69.3) 1,647 (23.0) <0.001 / /
 Non-intervention 8,185 (51.7) 2,655 (30.7) 5,530 (77.1) / /
Coffee, n (%) 2,492 (15.8) 1,127 (13.0) 1,365 (19.0) <0.001 1,233 (15.1) 1,259 (16.5) 0.01
Alcohol, n (%) 6,599 (41.7) 5,334 (61.7) 1,265 (17.6) <0.001 2,397 (29.3) 4,202 (55.0) <0.001
Physically active, n (%) 1,775 (11.2) 1,136 (13.1) 639 (8.9) <0.001 886 (10.8) 889 (11.6) 0.11
Healthy diet, n (%) 8,632 (54.5) 4,716 (54.5) 3,916 (54.6) 0.96 4,500 (55.0) 4,132 (54.1) 0.25
Daily work duration, n (%)
 <8 h 2,229 (14.1) 1,016 (11.8) 1,213 (17.0) <0.001 1,510 (18.5) 719 (9.4) <0.001
 8–10 h 8,212 (51.9) 4,282 (49.5) 3,930 (54.8) 4,470 (54.6) 3,742 (49.0)
 ≥10 h 5,386 (34.0) 3,352 (38.8) 2,034 (28.3) 2,205 (26.9) 3,181 (41.6)
Overtime work, n (%)
 Frequent 9,979 (63.1) 6,004 (69.4) 3,975 (55.4) <0.001 4,351 (53.2) 5,628 (73.7) <0.001
 Infrequent 5,848 (37.0) 2,646 (30.6) 3,202 (44.6) 3,834 (46.8) 2,014 (26.4)
Frequent nightshift, n (%) 10,290 (65.0) 5,622 (65.0) 4,668 (65.0) 0.95 5,221 (63.8) 5,069 (66.3) <0.001
Continuous variables were presented as median (interquartile range) as they are skewed distributed.
*Not all participants provided these data and the corresponding numbers were provided in parentheses.
DBP: Diastolic blood pressure; FBG: Fasting blood glucose; LDL-C: Lower-density lipoprotein cholesterol; SBP: Systolic blood pressure.

Lifestyle and workload

As shown in Table 1, 2,492 (15.8%) and 6,599 (41.7%) participants reported regular consumption of coffee and alcohol, respectively. One thousand seven hundred seventy-five (11.2%) participants met the recommended level of physical activity by WHO guideline. Eight thousand six hundred thirty-two (54.5%) participants reported healthy diet. Heavy workload was reported by majority of the participants: 85.9% worked for more than 8 hours daily in average and 65.0% had nightshift at least once in a week. In comparison to non-interventional cardiologists, interventional cardiologists had longer average daily work hours.

Cardiovascular risk factors, sub-clinical organ damage, and diseases

In comparison to female cardiologists, male cardiologists had significantly higher crude prevalence of smoking (13.2% vs. 0.1%, P < 0.001), hypertension (18.5% vs. 5.1%, P < 0.001), diabetes (3.3% vs. 1.2%, P < 0.001), dyslipidemia (14.1% vs. 6.4%, P < 0.001), and overweight (10.1% vs. 1.4%, P < 0.001), but a lower prevalence of family history of premature CVD (19.0% vs. 22.2%, P < 0.001) (Table 2). The treatment rate of hypertension, diabetes, and dyslipidemia was similar between sexes. In comparison to non-interventional cardiologists, interventional cardiologists had significantly higher crude prevalence of cardiovascular risk factors.

Table 2 - Cardiovascular risk factors, sub-clinical organ damage, and histories of diseases by sex and specialty
Variables Entire population (n = 15,827) Sex Subspecialty
Men (n = 8,650, 54.7%) Women (n = 7,177, 45.4%) P Non-intervention (n = 8,185, 51.7%) Intervention (n = 7,642, 48.3%) P
Cardiovascular risk factors, n (%)
 Smoking 1,148 (7.3) 1,140 (13.2) 8 (0.1) <0.001 370 (4.5) 778 (10.2) <0.001
 Hypertension 1,963 (12.4) 1,600 (18.5) 363 (5.1) <0.001 774 (9.5) 1,189 (15.6) <0.001
  Antihypertensive treatment 1,365 (69.5) 1,111 (69.4) 254 (70.0) 0.84 525 (67.8) 840 (70.7) 0.18
 Diabetes 373 (2.4) 289 (3.3) 84 (1.2) <0.001 179 (2.2) 194 (2.5) 0.15
  Antidiabetic treatment 278 (74.5) 220 (76.1) 58 (69.1) 0.19 126 (70.4) 152 (78.4) 0.08
 Dyslipidemia 1,675 (10.6) 1,218 (14.1) 457 (6.4) <0.001 712 (8.7) 963 (12.6) <0.001
  Lipid-lowering treatment 553 (33.0) 399 (32.8) 154 (33.7) 0.72 240 (33.7) 313 (32.5) 0.60
 Overweight 970 (6.1) 870 (10.1) 100 (1.4) <0.001 335 (4.1) 635 (8.3) <0.001
 Obesity 340 (2.2) 196 (2.3) 144 (2.0) 0.26 212 (2.6) 128 (1.7) <0.001
Family history of premature CVD 3,231 (20.4) 1,639 (19.0) 1,592 (22.2) <0.001 1,788 (21.8) 1,443 (18.9) <0.001
Sub-clinical organ damage, n (%) 886 (5.6) 632 (7.3) 254 (3.5) <0.001 379 (4.6) 507 (6.6) <0.001
 Carotid plaque 537 (3.4) 377 (4.4) 160 (2.2) <0.001 230 (2.8) 307 (4.0) <0.001
 Microalbuminuria 197 (1.2) 151 (1.8) 46 (0.6) <0.001 90 (1.1) 107 (1.4) 0.09
 Left ventricular hypertrophy 64 (0.4) 52 (0.6) 12 (0.2) <0.001 26 (0.3) 38 (0.5) 0.08
 Others* 254 (1.6) 185 (2.2) 69 (0.7) <0.001 98 (1.2) 156 (2.0) <0.001
Diseases, n (%) 3,716 (23.5) 2,692 (31.1) 1,024 (14.3) <0.001 1,584 (19.4) 2,132 (27.9) <0.001
 Coronary artery disease 70 (0.4) 57 (0.7) 13 (0.2) <0.001 34 (0.4) 36 (0.5) 0.60
 Cerebral vascular diseases 33 (0.2) 21 (0.2) 12 (0.2) 0.30 20 (0.2) 13 (0.2) 0.31
 Cardiomyopathy 14 (0.1) 7 (0.1) 7 (0.1) 0.73 8 (0.1) 6 (0.1) 0.68
 Valvular heart disease 15 (0.1) 8 (0.1) 7 (0.1) 0.92 9 (0.1) 6 (0.1) 0.52
 Congenital heart disease 24 (0.2) 7 (0.1) 17 (0.2) 0.01 15 (0.2) 9 (0.1) 0.29
 Myocarditis 25 (0.2) 11 (0.1) 14 (0.2) 0.28 11 (0.1) 14 (0.2) 0.28
 Pulmonary heart disease 8 (0.1) 3 (0.03) 5 (0.1) 0.33 5 (0.1) 3 (0.04) 0.54
 Peripheral vascular disease 38 (0.2) 22 (0.3) 16 (0.2) 0.69 17 (0.2) 21 (0.3) 0.39
 Arrhythmia 488 (3.1) 274 (3.2) 214 (3.0) 0.50 250 (3.1) 238 (3.1) 0.83
 Atrial fibrillation 44 (0.3) 34 (0.4) 10 (0.1) 0.003 16 (0.2) 28 (0.4) 0.04
 COPD 17 (0.1) 12 (0.1) 5 (0.01) 0.19 10 (0.1) 7 (0.1) 0.56
 OSAS 354 (2.2) 326 (3.8) 28 (0.4) <0.001 110 (1.3) 244 (3.2) <0.001
 Chronic kidney disease 24 (0.2) 15 (0.2) 9 (0.1) 0.44 14 (0.2) 10 (0.1) 0.52
 Malignant tumors 52 (0.3) 20 (0.2) 32 (0.5) 0.02 33 (0.4) 19 (0.3) 0.09
 Rheumatoid diseases 47 (0.3) 22 (0.3) 25 (0.4) 0.28 26 (0.3) 21 (0.3) 0.62
 Mental disorder 33 (0.2) 14 (0.2) 19 (0.3) 0.16 24 (0.3) 9 (0.1) 0.02
*Eyeground arteriosclerosis, brain atherosclerosis, and abnormal ankle-brachial index/pulse-wave velocity were combinedly reported because (1) just a few participants reported these data and (2) these parameters were not commonly examined in routine.
COPD: Chronic obstructive pulmonary disease; CVD: Cardiovascular disease; OSAS: Obstructive sleep apnea syndrome.

Carotid plaque was the most common organ damage (3.4%), followed by microalbuminuria (1.2%). Eight hundred eighty-six (5.6%) participants had damage to at least one organ, with significantly higher rate in male and interventional cardiologists.

Three thousand seven hundred sixteen (23.5%) participants had at least one type of diseases, with significantly higher rate in male and interventional cardiologists for all types of diseases. Except for hypertension, diabetes, and dyslipidemia, the most common disease was arrhythmia (3.1%), followed by obstructive sleep apnea syndrome (2.2%), coronary artery disease (0.5%), malignant tumors (0.3%), and others (<0.3% for each).

Age-standardized prevalence of cardiovascular risk factors

The age-standardized prevalence was 15.2% for hypertension, 3.1% for diabetes, 12.3% for dyslipidemia, 7.7% for smoking, 8.1% for overweight/obesity, 56.5% for healthy diet, and 12.9% for moderate/rigorous-intensity physical activity (Table 3). Comparison of these results to the information in the general Chinese population are shown in Figure 1. Age-standardized prevalence of hypertension across geographical locations is shown in Figure 2. Participants in northern and central China seemed to have a higher rate of hypertension versus other parts of the Chinese mainland.

Table 3 - Age-standardized prevalences of the seven factors included in the Life’s Simple Seven in Chinese cardiologists (%)
Factors Category Age group Age-standardized prevalence
25–34 years 35–44 years 45–54 years 55–60 years
Hypertension Total 3.3 11.0 22.7 35.9 15.2
Men 5.6 16.5 29.5 43.3 20.4
Women 1.0 3.4 12.5 21.1 7.5
Diabetes Total 0.4 1.5 4.7 9.9 3.1
Men 0.5 2.0 6.1 12.4 4.0
Women 0.4 0.8 2.7 5.0 1.7
Dyslipidemia Total 4.1 10.3 17.3 25.1 12.3
Men 6.4 14.0 20.7 23.8 14.9
Women 2.1 5.3 12.3 27.7 9.2
Smoking Total 4.6 8.1 9.0 10.9 7.7
Men 9.8 14.0 14.9 16.2 13.4
Women 0.1 0.1 0.2 0.0 0.1
Overweight/obesity Total 8.4 8.8 7.9 6.1 8.1
Men 13.6 13.0 11.0 8.0 12.0
Women 4.1 2.9 3.3 2.2 3.2
Healthy diet Total 48.4 53.1 62.6 70.5 56.5
Men 45.3 52.3 64.1 71.8 56.0
Women 50.9 54.1 60.3 67.9 56.6
Physically active Total 6.6 9.4 18.3 24.2 12.9
Men 8.0 10.8 19.8 24.8 14.2
Women 5.4 7.5 16.1 23.0 11.2

F1
Figure 1.:
Comparison of age-standardized prevalence of cardiovascular risk factors between cardiologists and general population. *Data on general Chinese population adapted from Summary of the 2018 Report on Cardiovascular Diseases in China[ 4 ].
F2
Figure 2.:
Age-standardized prevalence of hypertension among cardiologists across provinces of Chinese mainland.

Discussion

Key findings from the present study include: a) a considerable number of participants reported smoking, regular alcohol consumption, physically inactive, and heavy workload; b) in comparison to the general Chinese population, participants in this study had significantly lower prevalence of cardiovascular risk factors; c) male and interventional cardiologists had significantly higher prevalence of cardiovascular risk factors and sub-clinical organ damage.

Cardiologists represent the subset of population with the highest degree of awareness that healthy lifestyle is an important part in the prevention (either primary or secondary) of CVDs[14]. Despite of such knowledge, 7.7% of the cardiologists were regular smokers; 41.7% reported regular alcohol consumption; only 11.2% met the recommended level of physical activity by WHO guideline[12]. Such findings are alarming, and may partly attributed to maladaptive behaviors used by the cardiologists to cope with the high level of stress and heavy workload.

Heavy workload and the related health problems in physicians are increasingly recognized in China. In April 2021, a set of long-term measures to limit the workload an promote the health of medical personnel were proposed by the authorities[15]. The results from the current study suggested that the current efforts are far from sufficient. More pragmatic programs with enforceable details are needed.

The age-standardized prevalence in the current study was 15.2% for hypertension, 3.1% for diabetes, and 12.3% for dyslipidemia. The prevalence of coronary artery disease and stroke was 0.4% and 0.2%, respectively. These numbers are significantly lower than that reported in the general Chinese population[4], and consistent with the findings reported in cardiologists in the United States[16] and Italy[17]. A previous nation-wide survey of licensed cardiologists aged 35 and 59 years in China by Hu et al reported a similar prevalence of hypertension (12.6%) and diabetes (3.4%) despite of some difference in participant characteristics[10]. For example, the participants in the current study were younger (mean age 38 vs. 44 years) and had lower BMI (19.4 vs. 23.0 kg/m2). The current study also had much lower rate of dyslipidemia (12.3% vs. 35.9% in the Hu et al study), likely due to the reliance on self-report rather than laboratory testing results.

Sub-clinical organ damage has not been reported in Chinese cardiologists. The rate of sub-clinical organ damage in the current study was 3.4% for carotid plaque, 0.4% for left ventricular hypertrophy, and 1.2% for microalbuminuria. These number are relatively low, and may reflect healthier lifestyle and lower cardiovascular risk factors in cardiologists than in the general population. Data must be interpreted with caution, however, since the results were based on self-report in the current study.

Consistent with the well-documented higher incidence of CVDs in men than in women of the same age before menopause[18,19], male cardiologists in this survey had higher rate of cardiovascular risk factors. Interestingly, a higher rate of cardiovascular risk factors was also noticed in interventional versus non-interventional cardiologists. Since the interventional cardiologists had higher percentage of men as well as older age, the apparent difference between interventional and non-interventional cardiologists may be an artifact due to sex difference. Whether accelerated vascular aging and early atherosclerosis[6] contributed to the higher rate of cardiovascular risk factors is unknown. The higher rate of cardiovascular risk factors in interventional cardiologists may also, to some degree, reflect sleep deprivation and subsequent metabolic changes caused by emergency procedures[20].

A strength of the current study is the relatively large sample size. More than 15,000 cardiologists were included in our study. This sample represents close to 50% of all cardiologists in Chinese mainland (33,000)[5]. Also, the crude prevalence was standardized based on the population age. The current study also has several limitations. First, blood pressure, fasting blood glucose, and lipid profile were based on self-report rather than the dicer laboratory test. Missing data were common for many variables. Accordingly, the prevalence of risk factors may be underestimated. Third, the control rate of hypertension, diabetes, and dyslipidemia was unknown. Fourth, although it is clear that cardiologists represent a subset of the population with the highest degree of awareness to CVDs, it remains unknown to what extent the findings from the current study are applicable to the general population.

To conclude, the present study showed a lower age-standardized prevalence of cardiovascular risk factors and CVDs in cardiologists than reported for the general Chinese population. Having said that there is substantial room for further improvement. The fact that 7.7% of the cardiologists were smokers, and only 12.9% had moderate/rigorous-intensity physical activity is intriguing, and may suggest maladaptive behaviors associated with the high stress level and workload, as well as culture in workplace.

FUNDING

This study was supported by the National Nature Science Foundation of China (No. 82170388), Clinical Research Plan of SHDC (No. SHDC2020CR1040B), Shanghai Technology Research Leader Program (No. 21XD1434700), Shanghai Three-year Plan for Biobank Construction Project (No. SHDC2020CR5009; No. SHDC2020CR5015-002), and the Cardiac Rehabilitation Fund by the International Medical Exchange Foundation (No. Z-2019-42-1908-3). Dr. Shikai Yu was supported by Talent Program of Shanghai Tenth People’s Hospital Affiliated to Tongji University (No. 2021SYPDRC043).

AUTHOR CONTRIBUTIONS

SY and YZ performed literature search and data analysis and drafted the manuscript. WP, DZ, HS, and SZ formulated the analysis and interpreted the results. JG, YH, and YX conceived the idea, designed the study, interpreted the results, and revised the manuscript.

CONFLICTS OF INTEREST STATEMENT

Junbo Ge is the Editor-in-Chief of Cardiology Plus. Dong Zhao, Yong Huo, and Hong Shi are the Editorial Board members of Cardiology Plus. The article was subject to the journal’s standard procedures, with peer review handled independently of these Editorial Board members and their research groups.

ACKNOWLEDGMENT

We thank all cardiologists who participated in this survey.

DATA SHARING STATEMENT

Research data will be available to other researchers upon request to the corresponding author.

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Keywords:

Cardiovascular health; Cardiologists; Cardiovascular risk factor; Sub-clinical organ damage

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