Beijing ? Heart disease, cancer and stroke are now the top killers of middle-aged people in China, fueled by high blood pressure and smoking, which have developed alongside the communist country’s economy, according to one of the largest surveys of its kind.

The research into the major causes of death in adults found that over the past 45 years, China has undergone a huge health transition. Infectious disease has been replaced by the same chronic killers that plague the West.

The findings from the study of nearly 170,000 Chinese men and women over age 40 showed that about two-thirds of the 20,033 people who died during that time were killed by heart disease, cancer or stroke. Of those deaths involving people in their 40s to mid-60s – prime working years – Chinese mortality rates from each of the three categories topped deaths among the same age group in the United States.

High blood pressure was the top preventable contributing factor to the deaths, followed by cigarette smoking, physical inactivity and being underweight.