Table 2 Landmark clincial trials of cardiometabolic risk factors in China

Da Qing Diabetes Prevention Study [69]

1986–2016

577 adults aged 25–74 with impaired glucose tolerance

Lifestyle intervention groups (diet and/or exercise) vs. no intervention

Primary outcomes: CVD events, HR = 0.74 (95% CI = 0.59, 0.92)

Microvascular complications, HR = 0.65 (95% CI = 0.45, 0.95)

CVD mortality, HR = 0.67 (95% CI = 0.48, 0.94)

All-cause mortality, HR = 0.74 (95% CI = 0.61, 0.89)

Secondary outcomes: Stroke, HR = 0.75 (95% CI = 0.59, 0.96)

Coronary heart disease, HR = 0.73 (95% CI = 0.51, 1.04)

Hospital admission for heart failure, HR = 0.71 (95% CI = 0.48, 1.04)

Diabetes, HR = 0.61 (95% CI = 0.45, 0.83)

Retinopathy, HR = 0.60 (95% CI = 0.38, 0.95)

Nephropathy, HR = 0.68 (95% CI = 0.36, 1.28)

Neuropathy, HR = 0.57 (95% CI = 0.24, 1.36)

China Stroke Primary Prevention Trial (NCT00794885) [70]

2008–2013

20 702 adults aged 45–75 years with hypertension and without a history of CVDs

Folic acid plus enalapril vs. enalapril

Primary outcome: Stroke, HR = 0.79 (95% CI = 0.68, 0.93)

Secondary outcomes: CVD events, HR = 0.80 (95% CI = 0.69, 0.92)

Ischemic stroke, HR = 0.76 (95% CI = 0.64, 0.91)

Hemorrhagic stroke, HR = 0.93 (95% CI = 0.65, 1.34)

MI, HR = 1.04 (95% CI = 0.60, 1.82)

All-cause mortality, HR = 0.94 (95% CI = 0.81, 1.10)

China Salt Substitute and Stroke Study (NCT02092090) [71]

2014–2020

20 995 adults who had a history of stroke or were aged ≥ 60 years and had hypertension

Salt substitute vs. regular salt

Primary outcome: Stroke, rate ratio = 0.86 (95% CI = 0.77, 0.96)

Secondary outcomes: Major CVD events, rate ratio = 0.87 (95% CI = 0.80, 0.94)

All-cause mortality, rate ratio = 0.88 (95% CI = 0.82, 0.95)

Chinese Coronary Secondary Prevention Study [72]

1996–2003

4 870 adults aged 18–70 years with a history of MI

Xuezhikang vs. placebo

Primary outcome:

Major coronary events, relative risk, 0.55

Secondary outcomes:

CVD morality, relative risk = 0.70 (95% CI = 0.54, 0.89)

All-cause mortality, relative risk = 0.67 (95% CI, 0.52, 0.82)

Coronary revascularization, relative risk = 0.64 (95% CI = 0.47, 0.86)

Change in lipoprotein lipids,− 10.9% for total cholesterol,− 17.6% for LDL cholesterol,− 16.6% for non-HDL cholesterol,− 14.6% for triglycerides, and 4.2% for HDL cholesterol

Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (NCT03015311) [73]

2017–2020

8511 patients aged 60–80 years with hypertension

Intensive treatment (a systolic blood-pressure target of 110 to less than 130 mm Hg) vs. standard treatment (a target of 130 to less than 150 mm Hg)

Primary outcome: CVD events, HR = 0.74 (95% CI = 0.60, 0.92)

Secondary outcomes: Stroke, HR = 0.67 (95% CI = 0.47, 0.97)

Acute coronary syndrome, HR = 0.67 (95% CI = 0.47, 0.94)

Acute decompensated heart failure, HR = 0.27 (95% CI = 0.08, 0.98)

Coronary revascularization, HR = 0.69 (95% CI = 0.40, 1.18)

Atrial fibrillation, HR = 0.96 (95% CI = 0.55, 1.68)

CVD mortality, HR = 0.72 (95% CI = 0.39, 1.32)

Acarbose Cardiovascular Evaluation (NCT00829660) [74]

2009–2015

6522 patients with coronary heart disease and impaired glucose tolerance

Acarbose vs. placebo

Primary outcome: CVD events, HR = 0.98 (95% CI = 0.86, 1.11)

Secondary outcomes: CVD events, all-cause mortality, CVD mortality, impaired renal function, not significantly different between arms

Diabetes, rate ratio = 0.82 (95% CI = 0.71, 0.94)