Get your blood lipids tested regularly as an adult, every 2 to 5 years before 40 and every year from 40; if you have high blood pressure or high cholesterol, take your medicine regularly as prescribed and don't stop on your own

Cost

Blood pressure pills and statins bought through volume-based procurement (集采) cost a few to a few dozen CNY a month. You take them once a day, which takes little time. The hard part is that you keep taking them for good, and don't stop because you feel fine. A blood lipid test takes one blood draw. People 65 and older get one free checkup a year, which includes blood lipids; see §6.18 (general checkup package).

What you get

Pooling several randomized trials: for every 10 mmHg drop in systolic pressure, the risk of death is about 13% lower (RR 0.87). Systolic pressure is the higher of the two numbers in a blood pressure reading. Major cardiovascular events are about 20% lower (RR 0.80). Stroke is about 27% lower (RR 0.73). Heart failure is about 28% lower (RR 0.72). Statins lower low-density lipoprotein cholesterol (LDL). For every 1.0 mmol/L drop in LDL, the risk of death is about 10% lower (RR 0.90). The same drop lowers major vascular events by about 22% (RR 0.78). In addition, pooling several follow-up studies (observational, not assigning groups), people who took their medicine as prescribed at 80% or more had a lower risk of death than people who often missed doses. For statins it was about 45% lower (RR 0.55). For blood pressure drugs it was about 29% lower (RR 0.71). On how often to test blood lipids, the Healthy China Action (健康中国行动) recommends: people under 40 with normal lipids, every 2 to 5 years. People 40 and older, at least once a year. People at high risk of heart and brain vessel disease, every 6 months. The 2023 Chinese guideline on lipid management words it the same way for before and after 40, and changes it for high-risk people to testing as each person needs.

Notes

Only people whom a doctor has judged should take medicine should follow this; healthy people don't need it. How often to test blood lipids is an official recommendation; no trial has compared how many years apart is best. If someone in a family has familial hypercholesterolemia (an inherited disease of extremely high cholesterol from birth), all of that person's first- and second-degree relatives should have their blood lipids tested. Some children should be tested too: those whose parents have total cholesterol ≥6.2 mmol/L, or who have a first- or second-degree relative who had a heart attack, stroke or sudden death before 55 for men or 65 for women. The “keep taking it” numbers come from follow-up studies, and people who manage to keep taking medicine are also more disciplined in general, so the benefit is overstated. The two sets of randomized-trial numbers earlier are more reliable. This section has no separate item on controlling blood sugar: the evidence that pushing blood sugar lower reduces overall deaths is not as consistent as it is for blood pressure and cholesterol. For people with high blood pressure or diabetes, a yearly kidney test, see §16.13 (urine albumin-to-creatinine ratio).

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Ettehad D et al. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. https://doi.org/10.1016/S0140-6736(15)01225-8
2. Cholesterol Treatment Trialists' (CTT) Collaboration (2010). Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet. https://doi.org/10.1016/S0140-6736(10)61350-5
3. Chowdhury R et al. (2013). Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. European Heart Journal. https://doi.org/10.1093/eurheartj/eht295
4. Healthy China Initiative Promotion Committee (2019). Healthy China Initiative (2019-2030) [in Chinese], Action 11: Cardiovascular and Cerebrovascular Disease Prevention and Control (republished by the Hunan Provincial Health Commission). https://wjw.hunan.gov.cn/wjw/ztzl/knowledge/tzggzcfg/202003/t20200303_11359594.html
5. Joint Committee on the Chinese Guidelines for Lipid Management (2023). Chinese Guideline for Lipid Management (2023 edition) [in Chinese]. Chinese Journal of Cardiology [in Chinese], 51(3), 221-255. https://doi.org/10.3760/cma.j.cn112148-20230119-00038
6. Li JJ et al. (2023). 2023 Chinese guideline for lipid management. Frontiers in Pharmacology, 14, 1190934 (English version of the previous guideline; the Chinese original was not obtained, and the relevant content was checked against the English version). https://doi.org/10.3389/fphar.2023.1190934

Translated from the Chinese original. Original book, section 2, tip 12. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer