The present study is the first to identify, rank and characterize the T100 cited articles from the past ten years in Mainland China in the field of cardiovascular disease. The results offer invaluable insight into the evolution of popular opinion in the field of cardiovascular disease, which has undergone considerable change over the years around the world.

Citation analysis can reflect the articles’ influence in a specific field, help authors recognize important advances in some research area, and add useful perspective on historical developments in our specialty. In addition, journals often use it to attract manuscripts with high citation potential. Furthermore, an understanding of the characteristics inherent to highly cited work would be helpful for young researchers who wish to publish effectively. To date, there are increasing numbers of articles credited as “the most cited” or “top cited” in various medical fields. According to a report on Chinese Cardiovascular Disease in 2013, there were approximately 2.9 billion patients with cardiovascular diseases, and the associated mortality increased from 240.03/10 million in 2004 to 268.9/10 million in 2010 [11]. However, there is little information in the literature concerning the citation of articles about cardiovascular diseases in China. Recently, Shuaib et al. conducted a study to provide insight into the citation frequency of top cited articles published in cardiovascular medicine [12]. Unfortunately, however, no cardiovascular articles from China were included in that analysis. Therefore, it is necessary to analyze the top article citations in cardiovascular disease from Mainland China in the past ten years, which has seen great advances and changes in cardiovascular diseases over that period, to help readers or authors recognize the quality of the research work, discoveries, and the trends steering cardiology.

Fourteen cities contributed to the T100 cited articles, led by Beijing, the capital of China, followed by Shanghai. This confirms the important influence of both cities in relation to cardiovascular diseases and research in Mainland China. This was in concordance with many other citation analyses of other medical specialties from Mainland China, which reported that most studies that made the T100 list came from Beijing or Shanghai. The reason for this may be that these two cities have large numbers of cardiovascular communities and sufficient financial support from the country to perform basic or clinical research.

The IF represents the citation frequency of the average article published in a given journal in a particular year, and is always used to determine the quality of scientific or biomedical journals. Authors would prefer to send their research papers to journals with a high IF. In turn, this gives those journals a greater chance to receive high quality research articles, which will be cited more frequently after being published [13‐15]. In accordance with the research performed by Shuaib et al. [12], we also demonstrated that the IF was positively correlated with the number of T100 articles, and the number of citations. Although the evaluation of journals based on their IF involves potential bias and is under debate, there is presently no perfect or even better method for evaluating the merit of a scientific paper, and the IF and citation total are generally accepted as the best criteria.

Our results demonstrated that 38 % of these T100 cited articles were published in Circulation, the Journal of the American College of Cardiology, Circulation Research, or the European Heart Journal, all of which had an IF >11. However, the so-called high IF general medical journals, such as the Journal of the American Medical Association, The Lancet and The New England Journal of Medicine, only contributed 1 article to the list of T100 articles. In addition, journals with relatively lower IF also published highly cited articles (e.g. the 1st and 24th T100 journals, with IF of 3.4 and 5.8 respectively). This indicates a growing trend towards publishing highly influential articles in specialty journals that are dedicated solely to research into cardiovascular diseases, rather than in general medical journals. The present result was in accordance with other bibliometric analyses demonstrating that highly influential reports are often published in specialty journals [16‐18].

Generally, with increasing age, each article has more time to be cited, but in this analysis, most of the T100 articles (67 %) were published between 2006 and 2009. Among the articles with >100 citations, 62 % were published during this period. The present result was in agreement with the recent research by Shuaib et al. [12]. Those investigators indicated that 42 % of the T100 cited articles, a lower percentage than for articles from China in the same period, were published between 2006 and 2010 around the world; however, their results excluded research articles from China.

Among the clinical articles, it was observed that a large majority of the most highly cited articles in cardiovascular medicine were focused on coronary artery disease. This was in accordance with the morbidity of CAD according to the report on Chinese Cardiovascular Disease in 2013 [11], which demonstrated that in the past 10 years, the mortality of CAD continued to increase, up to 96/10 million in urban and 76/10 billion in rural areas. The high morbidity and mortality of CAD make it easy to recruit participants in research studies. However, although the prevalence of congenital heart diseases is increasing dramatically (about 200 millions at present), there was only 1 related study in the list. In addition, cardiac tumors, and cardiomyopathies were virtually unpresented in the list. Therefore, the present list could help point out the topics and subspecialties that have not been given due consideration, and should be the focus of future research.

China’s heavy burden of disease can actually be viewed as a fruitful clinical resource for physicians to design clinical research and collect clinical data. However, most T100 cited papers were focused on basic research. Furthermore, no guidelines were reported in the present analysis for Mainland China. This differed from other analyses, in which the leading type of T100 research report was clinical studies, rather than basic studies [7, 19]. The status of clinical research in Mainland China might be attributed to several reasons. First, many physicians do not have the skills, such as a familiarity with statistical analysis, to understand and carry out clinical research to an international standard. In addition, many hospitals in Mainland China do not have mature, integrated platforms or systems for clinicians to perform clinical research. In addition, insufficient funding, and a lack of available time are other important barriers to performing the clinical researches. Furthermore, many clinicians believe that clinical research conflicts with the accumulation of experience in clinical practice [20]. However, the environment is changing with respect to these issues. On June 8, 2013, the Chinese Government officially launched 13 national clinical research centers, which are led by prominent hospitals with strong clinical experience and research capacities, including two for cardiovascular diseases [21]. These centers aim to lead hospitals across China to strengthen their clinical research capacity, and to organize multicenter clinical research projects. This development is an important step in building China’s clinical research capacity. In the future, there will be a growing amount of important clinical research done by Chinese physicians, and these will not only contribute to Chinese clinical practice and health policies, but will also add to the knowledge that is essential for international guidelines. Recently, more clinical research articles originating from the mainland China, such as those by Huo Y et al. [22], Li J et al. [23] and Han Y et al. [24], have been published in high IF journals and provide important data from Chinese and international institutes.