Cardiovascular disease (CVD) is the main cause of morbidity and mortality worldwide. In 2017, CVD caused an estimated 17.8 million deaths worldwide, corresponding to 330 million years of life lost and another 35.6 million years lived with disability (1, 2). The burden of disease caused by CVD has been gradually increasing in China, and CVD caused almost 4 million deaths in 2016 (3). Nearly 80% of global CVD deaths occur in low- and middle-income countries (4). Gansu Province is located in northwestern China and has well-developed animal husbandry, agriculture, and mining industries, ranking third in the northwestern region (5). However, its per capita income and educational level are not high, its gross domestic product (GDP) ranked 27th in China in 2022 (5), and its primary medical and health resources are insufficient (6). Due to the geographical characteristics of Gansu Province, residents in different regions often consume strongly flavored foods such as pork, beef, and lamb, which are high in salt, fat, and calories, as well as drink for warding off cold temperatures (7). Therefore, investigating the prevalence and influencing factors of CVD in Gansu Province has epidemiological value.

Early identification of high-risk individuals is a crucial strategy in the primary prevention of CVD, based on the availability of appropriate CVD risk assessment models and guideline recommendations (8). Improving the main risk factors that can be changed is the current goal of CVD control (9). In addition, it is also crucial to identify the differences in the distribution of the main risk factors and the clustering of high-risk types of CVD and how these are associated with different regions. However, for CVD risk in Gansu Province, previous studies have included small sample sizes, have focused on a narrow spectrum of risk factors, or have not distinguished between different regions (10).

To fill these knowledge gaps, the aim of the present study was to investigate the prevalence rate and influencing factors of subjects at high risk for CVD in different regions of Gansu Province. The findings of this study can serve as a reference for CVD prevention in Gansu Province, China.

To our knowledge, this study is the first to examine the prevalence rate of subjects at high risk for CVD and to analyze the influencing factors associated with high-risk subjects of CVD in different regions of Gansu Province from 2017 to 2022. First, the overall prevalence rate of subjects at high risk for CVD was 19.7%, and the prevalence rate in the HeXi region was greater than that in other regions. Second, the prevalence rates were 14.0%, 58.2%, 34.9%, and 5.7% for cardiovascular history, hypertension, dyslipidemia, and WHO-assessed risk ≥20%, respectively. The prevalence rate of cardiovascular history type was the highest in the HeXi region, hypertension and dyslipidemia types were the highest in the LongZhong region, and WHO-assessed risk ≥20% was the highest in the LongDong region. Third, male, higher education level, smoking status, snoring status, overweight and obesity status, central obesity status, and subjects with disease history were risk factors. There were some differences among the different regions in terms of age, annual household income, farmer status, rural/urban status, and drinking status.

The prevalence rate of subjects at high risk for CVD in Gansu Province (19.7%) was lower than that at the national level (26.3%) (16) and that in Jiangsu Province (25.0%) (17), but higher than that in Sichuan (17.6%) (18) and Hainan Provinces (17.7%) (19), which may be related to differences in the selection of screening tools, the unequal distribution of community health resources, the climate and environment, and lifestyles. Gansu Province is in the northwestern region of China, and has relatively scarce health resources (6). The distribution of screening techniques and tools and community health resources was uneven among the different project sites. It is imperative to strengthen the capacity building of medical staff, improve the quality of medical services, and improve early screening coverage. Among the four high-risk types of CVD, the prevalence rate of hypertension was the highest, which was consistent with the findings of the studies of Wu et al. (17), Chang et al. (20), and Yue et al. (21). Hypertension is an independent and important risk factor for CVD, and blood pressure is closely related to the risk of CVD occurrence and death (22). For every 20 mmHg increase in SBP or 10 mmHg increase in DBP, the risk of CVD development doubles (23). If all hypertensive patients were treated, there would be a reduction of 803,000 CVD events per year and 1.2 million health-adjusted life years gained (24). Therefore, the prevention and control of hypertension should be prioritized.

We found that there were differences in the prevalence rates of the four high-risk types among the subjects at high risk for CVD in different regions. The disparity may be mainly due to differences in demographic and socioeconomic characteristics (such as the proportion of farmers, annual household income, and education), geographical features, climatic conditions, endemic diseases, lifestyles, etc. For example, the HeXi region was mainly related to a high proportion of non-farmers, overweight and obese subjects, annual household income >50,000 yuan, drinkers, and subjects with self-reported cardiovascular and cerebrovascular history. However, the LongZhong region was associated with a high proportion of drinkers, overweight and obese subjects, and subjects with a history of hypertension and dyslipidemia. The LongDong region had a high proportion of farmers, smokers, and subjects with a history of hypertension and dyslipidemia. The LongDong and LongZhong regions are dominated by the Loess Plateau, while the HeXi region has a flat terrain (5). The climate in the LongDong region is humid, that in the LongZhong region is semiarid, and that in the HeXi region is arid (5). These reasons may have caused regional differences.

In the present study, the prevalence rate of subjects at high risk for CVD increased with increasing age, which was consistent with the previous studies (18, 19, 25). Increased age was a risk factor in the HeXi and LongDong regions, and younger age was a protective factor in the LongZhong region. With increasing age, physical function continues to deteriorate and damage and various high-risk CVD factors accumulate, overlap, and produce synergistic effects on the body (19). Being of male gender was a risk factor in different regions, and the percentage of male subjects was greater than that of females. This may be related to the lifestyle, diet, and physiological structure of males, who are more likely to be associated with high-risk CVD factors (26).

One of the exceptional findings of our study was that being a farmer and living in urban areas were risk factors for CVD in the HeXi region. Subjects with a college degree or above, annual household income ≤50,000 yuan, and living in rural areas were positively associated with high-risk of CVD in the LongZhong region. Having an annual household income >50,000 yuan and being a non-farmer were risk factors in the LongDong region. The HeXi region has a flat terrain, abundant resources, and developed agricultural, mineral, and tourism resources, and its GDP has always been at the forefront of that of Gansu Province (27). The LongZhong region has obvious geographical advantages, industrial cities and transportation hubs, intensive technology and human resources, and a high level of economic development, highlighting the economic development of Gansu Province (27). The economic development of the LongDong region is dominated by a small-scale peasant economy and natural economy, with backward production technology and a weak industrial foundation (27). For terrain and climate reasons, the farmers in the HeXi region were mainly involved in animal husbandry, and the farmers in the LongDong and LongZhong regions were mainly involved in agriculture. Urban and rural residents in these regions have different eating habits, such as those in the HeXi region, who like to eat beef and mutton (strongly flavored food), and those in the LongDong and LongZhong regions, who like to eat rice, wheat, and other foods (7). Moreover, differences in education level and economic status are closely related to differences in residents’ health status. On the one hand, when people with a high level of education and good economic conditions pay more attention to their own health issues, their understanding and implementation of health knowledge will also increase, medical and health resources will improve, and the demand and utilization of health services will increase (28, 29). On the other hand, socioeconomic status can also increase psychological stress and life pressure, thus affecting the incidence of CVD, such as in urban areas in the HeXi region.

In addition, smoking was a risk factor of subjects at high-risk for CVD (30, 31), which was consistent with our study. Nicotine, the primary ingredient of tobacco, is a sympathetic stimulant that acts on the central and peripheral nervous systems to stimulate the release of catecholamine and other neurotransmitters. It leads to cardiovascular consequences, such as elevated heart rate, blood pressure, and cardiac output (32). However, drinking was negatively associated with high risk of CVD only in the HeXi region. This may be related to the lifestyle of the HeXi region, such as residents indulging in moderate drinking. The relationship between CVD and alcohol intake is complex and responds to hormetic behavior, as reflected by U- or J-shaped relationships, with low–moderate intake being more protective than abstention or abusive drinking (33). We also found that snoring was a risk factor for CVD, but some studies reported that snoring was not associated with increased risk for CVD (34, 35), whereas others reported an increased risk for CVD events (36, 37). The exact mechanisms linking snoring to the development of cardiovascular disorders have not been completely elucidated. Snoring might increase the risk of CVD through atherosclerosis (38) and is also linked to hypertension, diabetes, metabolic syndrome, and obesity, all of which may increase the risk of cardiovascular disorders (39).

Another important finding of this study is that being overweight and obese were positively associated with high risk of CVD, which is in agreement with the findings of other studies (40, 41). This might be because individuals with obesity have greater circulating blood volume, which in turn increases cardiac output, leading to an increased burden on the heart and resulting in a series of CVD events (40). Obesity is not only an independent risk factor for CVD but also closely associated with several other risk factors, such as hypertension and diabetes (41). In this study, subjects with a history of hypertension, diabetes, and dyslipidemia were observed to be at a higher risk for CVD than those without the history, while CVD was also a risk factor for chronic diseases, and various risk factors interact with each other.

Only the Xinjiang Uygur Autonomous Region, Tibet Autonomous Region, and Ningxia Hui Autonomous Region in the western areas of China did this study, and the prevalence rates of subjects at high risk for CVD were 22.1%, 22.1%, and 18.8%, respectively, and other results were similar to those in Gansu Province (42, 43). Interestingly, different provinces in western China have different landforms, climates, and ethnic characteristics, which need to be explored according to different characteristics. Other epidemiologists could consider conducting in-depth research based on terrain, climate, and ethnic characteristics. Similar research has not been conducted in Gansu Province before; therefore, this study identified directions for future research on different regions and populations and could serve as a reference for CVD prevention in Gansu Province, China.

This study has several strengths. First, this study is the first to compare the prevalence and influencing factors for subjects at high risk for CVD in the HeXi, LongDong, and LongZhong regions of Gansu Province. These findings are of great significance to the prevention and treatment of CVD in Gansu Province. Second, the data we used were from the China PEACE MPP with good data quality, and the sample used in our study was large enough to reflect the prevalence rate and influencing factors of high-risk subjects of CVD in Gansu Province to some extent. However, some limitations should be noted. First, the data used are cross-sectional in nature. Thus, causality cannot be inferred. Second, a questionnaire survey was used in this study, which may have led to recall bias. Third, the definitions of several covariates (e.g., smoking and drinking) were defined in two categories (yes/no) without a more detailed definition. These variables were also self-reported, and there was a certain bias in the reliability of the data. Caution is needed when interpreting such results. Fourth, our study did not include data on specific geographic environments, climatic conditions, or endemic diseases, and further studies on the effects of these characteristics on the risk of cardiovascular disease in different regions are needed.

This study showed that although the prevalence rate of subjects at high risk for CVD was lower than the national level, it is still relatively high in Gansu Province, and the subjects at high risk for CVD in different regions of Gansu Province have different characteristics. Therefore, in the future, we should combine the high-risk strategy with the whole population strategy and take targeted preventive strategies and measures for different regions. We should strengthen publicity and education to promote healthy lifestyles, such as not smoking or drinking, and preventing obesity. We can also identify high-risk subjects through early screening in areas with a high incidence of CVD, especially those who are already at high risk for hypertension or diabetes.