In the JournalsPerspective

CVD remains main cause of death worldwide

One-third of all deaths worldwide are attributed to CVD such as stroke and heart diseases, even with declines in the past 25 years due to sociodemographic changes, according to a study in the Journal of the American College of Cardiology.

“It is an alarming threat to global health,” Gregory A. Roth, MD, MPH, assistant professor of cardiology at the University of Washington in Seattle, said in a press release. “Trends in CVD mortality are no longer declining for high-income regions, and low- and middle-income countries are also seeing more CVD-related deaths.”

Data analysis

Researchers analyzed data from 133 countries from 1990 to 2015. Ten different causes of CVD-related deaths were reviewed, including ischemic stroke, ischemic heart disease, and hemorrhagic and other stroke.

Disability-adjusted life-years were also analyzed, which combined data on years of life lost and years lived with disability. The researchers developed a sociodemographic index to measure changes in CVD burden as global epidemiologic changes occurred.

An estimated 422.7 million cases of CVD were seen globally in 2015 (95% uncertainty interval [UI], 415.53 million-427.87 million). CVD-related deaths increased from 12.59 million in 1990 (95% UI, 12.38 million-12.8 million) to 17.92 million in 2015 (95% UI, 17.59 million-18.28 million).

After age adjustment, numerous countries did not show significant changes in the prevalence of CVD from 1990 to 2015, which may have been due to minimal data availability. CVD significantly declined after age adjustment in countries such as the United States, Canada, Australia, Brazil, Japan, New Zealand, South Korea, Cambodia, Kenya, India, Laos and those in Western Europe. CVD mortality typically declined in high-income regions, but has leveled out recently, according to the researchers.

CVD trends

In countries with a sociodemographic index above 0.25, the highest CVD mortality rates shifted from women to men, according to the researchers. Countries with a sociodemographic index above 0.75 had a decrease in CVD mortality in both men and women.

Ischemic heart disease was the prominent cause of global health loss in 2015, with 7.29 million acute MIs (95% UI, 6.8 million-7.81 million) and 110.55 million cases of ischemic heart disease (95% UI, 100.68-121.8). Prevalence for ischemic heart disease was highest in Eastern Europe (4,140 cases per 100,000 persons; 95% UI, 3,811-4,499), followed by Central Asia and Central Europe.

The second and third largest global CVD-related causes of disability-adjusted life-years were hemorrhagic and other stroke, and ischemic stroke, respectively. They were also the fourth and 13th largest overall causes.

“It is concerning that large reductions in atherosclerotic vascular disease mortality, a crowning achievement for public health, are no longer apparent in many world regions, despite impressive advances in technical capacity for preventing and treating CVD,” Roth and colleagues wrote.

Dariush Mozaffarian
Dariush Mozaffarian

In a related editorial, Dariush Mozaffarian, MD, DrPH, dean of the Tufts Friedman School of Nutrition Science and Policy, wrote: “These findings provide clear confirmation that prevention of CVD can no longer be a priority of only wealthy nations. Even in low-income countries, CVD risk factors are widely prevalent in most urban areas and even may rural areas. Based on present findings, middle-income nations are now facing an onslaught of CVD with corresponding health care costs for governments and businesses, lost workforce productivity and personal and familial insolvency. With rising obesity and diabetes globally, these threats will only worsen.” – by Darlene Dobkowski

Disclosure: The researchers and Mozaffarian report no relevant financial disclosures.

 

One-third of all deaths worldwide are attributed to CVD such as stroke and heart diseases, even with declines in the past 25 years due to sociodemographic changes, according to a study in the Journal of the American College of Cardiology.

“It is an alarming threat to global health,” Gregory A. Roth, MD, MPH, assistant professor of cardiology at the University of Washington in Seattle, said in a press release. “Trends in CVD mortality are no longer declining for high-income regions, and low- and middle-income countries are also seeing more CVD-related deaths.”

Data analysis

Researchers analyzed data from 133 countries from 1990 to 2015. Ten different causes of CVD-related deaths were reviewed, including ischemic stroke, ischemic heart disease, and hemorrhagic and other stroke.

Disability-adjusted life-years were also analyzed, which combined data on years of life lost and years lived with disability. The researchers developed a sociodemographic index to measure changes in CVD burden as global epidemiologic changes occurred.

An estimated 422.7 million cases of CVD were seen globally in 2015 (95% uncertainty interval [UI], 415.53 million-427.87 million). CVD-related deaths increased from 12.59 million in 1990 (95% UI, 12.38 million-12.8 million) to 17.92 million in 2015 (95% UI, 17.59 million-18.28 million).

After age adjustment, numerous countries did not show significant changes in the prevalence of CVD from 1990 to 2015, which may have been due to minimal data availability. CVD significantly declined after age adjustment in countries such as the United States, Canada, Australia, Brazil, Japan, New Zealand, South Korea, Cambodia, Kenya, India, Laos and those in Western Europe. CVD mortality typically declined in high-income regions, but has leveled out recently, according to the researchers.

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CVD trends

In countries with a sociodemographic index above 0.25, the highest CVD mortality rates shifted from women to men, according to the researchers. Countries with a sociodemographic index above 0.75 had a decrease in CVD mortality in both men and women.

Ischemic heart disease was the prominent cause of global health loss in 2015, with 7.29 million acute MIs (95% UI, 6.8 million-7.81 million) and 110.55 million cases of ischemic heart disease (95% UI, 100.68-121.8). Prevalence for ischemic heart disease was highest in Eastern Europe (4,140 cases per 100,000 persons; 95% UI, 3,811-4,499), followed by Central Asia and Central Europe.

The second and third largest global CVD-related causes of disability-adjusted life-years were hemorrhagic and other stroke, and ischemic stroke, respectively. They were also the fourth and 13th largest overall causes.

“It is concerning that large reductions in atherosclerotic vascular disease mortality, a crowning achievement for public health, are no longer apparent in many world regions, despite impressive advances in technical capacity for preventing and treating CVD,” Roth and colleagues wrote.

Dariush Mozaffarian
Dariush Mozaffarian

In a related editorial, Dariush Mozaffarian, MD, DrPH, dean of the Tufts Friedman School of Nutrition Science and Policy, wrote: “These findings provide clear confirmation that prevention of CVD can no longer be a priority of only wealthy nations. Even in low-income countries, CVD risk factors are widely prevalent in most urban areas and even may rural areas. Based on present findings, middle-income nations are now facing an onslaught of CVD with corresponding health care costs for governments and businesses, lost workforce productivity and personal and familial insolvency. With rising obesity and diabetes globally, these threats will only worsen.” – by Darlene Dobkowski

Disclosure: The researchers and Mozaffarian report no relevant financial disclosures.

 

    Perspective
    Ian J. Neeland

    Ian J. Neeland

    These findings provide a much-needed global perspective on CVD prevalence and mortality. It is striking that although CVD mortality rates have generally declined in the last decade in the United States, this seems to be a phenomenon limited to well-developed, high-income populations. Most of the world, including Central Asia and Oceania, continue to have a significant burden of mortality related to CVD. These findings should spur the medical community to look outside of our own “home” and refocus our efforts on battling the global public health burden of CVD.

    Better access to health care and lifesaving and sustaining treatments, especially for those in disadvantaged regions, is certainly one strategy that can help reverse the negative trends in the developing world.

    Obesity, which is growing to be a global epidemic rather than just one localized to North America or well-developed countries, is probably the No. 1 health concern that will slow down our progress in prevention and treatment of CVD. Poor nutrition and lack of physical activity continue to be problems in the modern era of technology and fast food. These major risk factors for obesity will continue to drive the obesity epidemic, especially in the developing world.

    • Ian J. Neeland, MD, FAHA
    • Cardiology Today Next Gen Innovator University of Texas Southwestern Medical Center, Dallas

    Disclosures: Neeland reports consulting for Advanced MR Analytics AB and consulting and speaking for Boehringer Ingelheim.

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