Rapid urbanization and a shift to more Westernized lifestyles are raising the blood pressure of Chinese, the key factor behind a 20-year increase in heart disease, according to a Harvard University study.

The study by the Harvard T.H. Chan School of Public Health suggests that major changes in Chinese society - including a dramatic shift to a more Western diet and lifestyle, along with urbanization and industrialization - may have contributed to the surge in cardiovascular diseases such as heart attack and stroke.

Also found were increases in high-cholesterol cases, obesity and Type 2 diabetes.

The study, published on Monday in the Journal of the American College of Cardiology, contends that increasing body mass index (BMI), lower physical activity, smoking and unhealthy diets have contributed to the rise in cardiovascular disease (CVD), the No 1 cause of death in China.

Tobacco use is falling in China, but 53.4 percent of the nation's men still smoke. In 2011, tobacco use was connected to 1.3 million CVD-related cases, the study found.

Low-grade cigarettes can be had for 3 yuan (49 cents) a pack in China, the world's largest cigarette market. China has 300 million smokers; the US has an estimated 60 million.

In 2015, Beijing city authorities passed anti-smoking legislation banning smoking in all indoor public places, workplaces and on public transportation.

The study's authors also noted that while the Chinese diet has improved in some areas - with more fiber, fruit, nuts and omega-3 fatty acids - the consumption of red meat and sugary beverages is growing.

High salt intake - which averaged 5.4 grams daily in 2011 - was blamed for 20 percent of CVD cases in China.

The increases in hypertension and BMI were more prevalent among younger people and rural residents, the authors said.

"Our estimates suggest that the continued rise in high blood pressure, an increasingly sedentary lifestyle, increasing obesity, and worsening dietary trends will add millions of new cases of heart attacks and stroke over the next two decades," said Yanping Li, a research scientist in the Department of Nutrition at Harvard's Chan School and the study's lead author.

The researchers analyzed data collected from 1991 to 2011, from 26,000 people in nine provinces, as part of the China Health and Nutrition Survey.

They looked at 17 dietary and lifestyle risk factors, including high systolic blood pressure, high cholesterol, high blood sugar, high BMI, low physical activity, smoking and 11 dietary factors - and analyzed data from the China Health Statistical Yearbook and the National Population Census.

The study found that high blood pressure, high cholesterol and high blood glucose accounted for most CVD disease cases in China in 2011. The three risk factors were associated with 3.1 million, 1.4 million and 0.9 million new cases, respectively, of heart attack or stroke.

Of the 6.8 million Chinese over age 35 who died in 2011, about 3 million - 44 percent - were related to CVD.

The researchers contend that high blood pressure was responsible for roughly 40 percent of heart attacks or stroke. In 1979, high blood pressure, or hypertension, was found in 7.7 percent of the population; by 2010, it was 33.5 percent - comparable to the rate among US adults.

"China is facing a rising epidemic of cardiovascular disease, and it shows no sign of abating," said senior author Frank Hu, professor of nutrition and epidemiology.

"It's imperative to continue to monitor the problem, which has serious social and economic consequences," he said. "Prevention of chronic diseases through promoting healthy diet and lifestyle should be elevated to a national public policy priority."

Other Harvard Chan School researchers involved in the study included Dong Wang, Sylvia Ley, Yuan Lu, and Goodarz Danaei. The Swiss Re Foundation provided funding for the study.

williamhennelly@chinadailyusa.com