Summary of Chinese guidelines and aspirin

January 2020

The purpose of this document is to keep a working list of Chinese guidelines with information on aspirin. The guidelines themselves should be read for further information. 

Primary prevention of cardiovascular disease 

Cardiovascular disease (CVD) is a growing health burden in China and primary prevention strategies are important because over 70% of those experiencing a first Coronary Heart Disease (CHD) event in China died outside of the hospital setting1.

Primary prevention of CVD in China is a top priority, in particular lifestyle factors such as  smoking, diet, weight and increasing activity levels in order to reduce risk factors such as high blood pressure, high cholesterol and control diabetes2.

CVD risk assessment is an important way to identify those at high-risk of CVD in the Chinese population without current CVD. Specific risk assessment tools for the Chinese population have been developed based the Chinese Multi –provincial cohort study.

The 2012 China National Plan for Non-Communicable diseases [NCD] prevention and treatment3 has clear targets for CVD prevention.  As well as lifestyle interventions such as diet, exercise, low salt intake and smoking cessation the National Plan for NCD also has an ambition to limit the incidence of stroke to under 5% and decrease stroke related mortality by 5%. China’s Medium and Long Term Plan of Preventing and Controlling Chronic Diseases aims to achieve a 10% reduction in  CVD mortality rates by 2020 and 15% by 20254.  The 2016 China guidelines of dyslipidemia management and the 2017 Chinese guidelines for CVD prevention have new recommendations for risk assessment in China.

The 2016 China expert consensus advocates that for individuals with a ten year arteriosclerotic cardiovascular disease (ASCVD)5 risk of greater than or equal to 10%, aspirin should be used for the primary prevention of CVD.

Secondary prevention of stroke prevention in China

The Chinese clinical guidelines for the secondary prevention of ischemic stroke and TIA recommend an optimal dosage of aspirin between 75 and 150 mg/day. A combination of aspirin and clopidogrel for 21 days is recommended for patients with minor stroke or high-risk TIA within 24 hours of onset6. These recommendations are based on the CHANCE trial7.

References CVD prevention

1.Chin J Cardiol, March 2012; Vol 40 No 3.

2. Walker J, Hutchison P, Ge J et al 2018 Aspirin:120 years of innovation. A report from the 2017 Scientific Conference of the International Aspirin Foundation. ecancer 12 813 

3.The ministry of Health. China National Plan for NCD Prevention and Treatment 92012-2015).  [accessed Jan 2019].

4. The Office of State Council, PRC. China’s medium and long term plan of preventing and controlling chronic diseases (2017-2015). Index n0,: 000014349/2017-00030. cited by Jiang Y, Mao F and Li Y et al Construction of China cardiovascular health index  BMC Public Health 2018; 18: 937

5. ASCVD!/calculate/estimate

6. Wang Y, Liu M and Pu C 2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack. Int J Stroke 2017; 12(3):302-320.

7.Wang Y, Pan Y, Zhao X et al Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) Trial: One-Year outcomes [j]. Circulation 2015; 132(1):40-46.

Primary prevention of colorectal cancer/all GI cancers

To be developed