Perspective from Seth S. Martin, MD, MHS
Disclosures: This study was funded by the Bill and Melinda Gates Foundation. Fuster, Mensah and Roth report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
December 09, 2020
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Global burden of CVD rising, high BP remains greatest modifiable risk factor

Perspective from Seth S. Martin, MD, MHS
Disclosures: This study was funded by the Bill and Melinda Gates Foundation. Fuster, Mensah and Roth report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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The global rise in CVD and mortality since 1990 may represent the real-world manifestation of the unmet need for affordable interventions, patients’ level risk factor education and health policies, researchers reported.

In collaboration with the Global Burden of Disease and the NHLBI, the Journal of the American College of Cardiology published a review of the Global Burden of Diseases, Injuries and Risk Factors study 2019 that described the current global landscape for CVD and its risk factors and highlighted the existing challenges in CVD treatment and prevention.

Increased CVD incidence and mortality was observed on a global scale, with the greatest prevalence seen in China.
Valentin Fuster

“There is a pressing need to focus on implementing existing cost-effective interventions and health policies if the world is to meet the targets for Sustainable Development Goal 3 and achieve at least a 30% reduction in premature mortality due to noncommunicable disease by 2030,” Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief of the Mount Sinai Hospital in New York, said in a press release. “In the face of a global viral pandemic, we still must emphasize global commitments to reduce the suffering and premature death caused by CVD, which limits healthy and sustainable development for every country in the world.”

The Global Burden of Diseases, Injuries and Risk Factors study 2019 provided estimates of population health over time, using population-level data sources on incidence, prevalence, mortality and risk factors for CVD to produce estimates for 204 countries from 1990 to 2019. Researchers evaluated these data and conveyed findings relating to public policy, clinical practice and research.

Global prevalence of CVD and mortality

Overall cases of total CVD nearly doubled from 271 million in 1990 (95% uncertainty interval [UI], 257 million-285 million) to 523 million in 2019 (95% UI, 497 million-550 million) and CVD deaths increased from 12.1 million in 1990 (95% UI, 11.4 million-12.6 million) to 18.6 million in 2019 (9.6 million men; 8.9 million women; 95% UI, 17.1 million-19.7 million), according to the analysis. Approximately 6.1 million CVD deaths were among individuals aged 30 to 70 years.

Moreover, CVD was the underlying cause of death among approximately one-third of all deaths globally.

According to the report, the greatest prevalence of CVD deaths occurred in China, followed by India, the Russian Federation, the U.S. and Indonesia.

Investigators evaluated global trends for years lived with disability due to CVD, and observed a significant increase during the study period, from 17.7 million in 1990 (95% UI, 12.9 million-22.5 million) to 34.4 million in 2019 (95% UI, 24.9 million-43.6 million).

“Global patterns of total CVD have significant implications for clinical practice and public health policy development,” Gregory A. Roth, MD, MPH, associate professor in the division of cardiology and adjunct associate professor at the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine in Seattle, said in the release. “Prevalent cases of total CVD are likely to increase substantially as a result of population growth and aging, especially in Northern Africa and Western Asia, Central and Southern Asia, Latin America and the Caribbean, and Eastern and Southeastern Asia where the share of older persons is projected to double between 2019 and 2050. Increased attention to promoting ideal cardiovascular health and healthy aging across the life span is necessary. Equally important, the time has come to implement feasible and affordable strategies for the prevention and control of CVD and to monitor results.”

Additionally, the total number of disability-adjusted life years (DALYs) due to ischemic heart disease also increased since 1990, reaching 182 million in 2019 (95% UI, 170 million-194 million), approximately 9.14 million deaths due to ischemic heart disease (95% UI, 8.4 million-9.74 million) and 197 million prevalent cases of ischemic heart disease (95% UI, 178 million-220 million).

In other findings, the overall DALYs due to stroke also increased from 1990, reaching 143 million in 2019 (95% UI, 133 million-153 million), with approximately 6.55 million deaths (95% UI, 6 million-7.02 million) and 101 million prevalent cases of stroke (95% UI, 93.2 million-111 million).

Ranking of modifiable risk factors

The analysis of the Global Burden of Diseases, Injuries and Risk Factors study also yielded a ranking of modifiable risk factors associated with these trends in CVD and mortality:

  1. high systolic BP;
  2. dietary risks;
  3. high LDL;
  4. air pollution;
  5. high BMI;
  6. tobacco smoking;
  7. high blood glucose; and
  8. kidney dysfunction.

According to the analysis, rheumatic heart disease, driven by poverty and crowded housing conditions, and alcoholic cardiomyopathy, driven by unsafe patterns of alcohol consumption, are examples of other potential targets for CV risk reduction.

“There remains a large gap between what we know about CVD and risk factors and what we do in their prevention, treatment and control worldwide,” George A. Mensah, MD, director of the Center for Translation Research and Implementation Science at the NHLBI/NIH, said in the release. “The Global Burden of Diseases study continues to be a platform that allows tracking and benchmarking of progress in the reduction of CVD and risk factor burden. However, renewed focus is needed now on affordable, widely available and proven-effective implementation strategies for the prevention, treatment and control of CVD and risk factors and the promotion of ideal cardiovascular health beginning in childhood.”

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