Risk Factors of Premature Atherosclerotic Cardiovascular Disease in China: A Longitudinal Analysis of the China Health and Nutrition Survey Cohort

The burden of premature atherosclerotic cardiovascular disease (ASCVD) has increased rapidly in China. Using the China Health and Nutrition Survey (CHNS) data, we assessed the risk factors of premature ASCVD (age of diagnosis: <55 years for men and <65 years for women). Propensity score matching was used to reduce selection bias. Multivariable Cox proportional-hazards analyses indicated that factors associated with increased risk of premature ASCVD included hypertension (adjusted hazard ratio [HRadj.] = 1.68, 95% confidence interval [CI] = [1.14, 2.48]), obesity (HRadj. = 1.64, 95% CI = [1.03, 2.61]), and high carbohydrate intake (HRadj. = 1.46, 95% CI = [1.03, 2.08]). Conversely, participants with medical insurance (HRadj. = 0.42, 95% CI = [0.28, 0.61]), high urbanization index (HRadj. = 0.53, 95% CI = [0.33, 0.85]), and high household income (HRadj. = 0.48, 95% CI = [0.33, 0.71]) had lower risk of premature ASCVD. When comparing premature vs non-premature ASCVD participants, those who were obese (HRadj. = 2.08, 95% CI = [1.14, 3.80]) or living in more urbanized areas had higher hazards of early onset (HRadj. = 2.29, 95% CI = [1.33, 3.94]).