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Global CVD Atlas: Heart disease burden declined in wealthy countries
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New global statistics suggest that the burden of CVD decreased in high-income countries worldwide between 1990 and 2010, but increased in low- and middle-income countries.
The data are from the Global CVD Atlas, which was launched by WHO. The Atlas uses disability-adjusted life years to measure the burden of CVD in each region and country in the world and to measure differences between 1990 and 2010 based on the Global Burden of Diseases, Risk Factors and Injuries 2010 study, according to a press release.
Global disease burden
Worldwide, the CVDs that contributed most to the global burden of disease in 2010 included ischemic heart disease (5.2% of all disability-adjusted life years lost) and stroke (4.1% of all disability-adjusted life years lost), according to data published in Global Heart. Other major CVDs included in the atlas were hypertensive heart disease, cardiomyopathies, rheumatic heart disease, atrial fibrillation, aortic aneurysm, peripheral vascular disease and endocarditis.
The global age-standardized mortality rates for ischemic heart disease and stroke decreased from 1990 to 2010, but the absolute number of CVD-related deaths and number of patients experiencing late effects of ischemic heart disease and stroke increased during the study period. In 1990, 5,211,790 deaths worldwide were related to ischemic heart disease, which increased by 35% to 7,029,270 deaths in 2010. Stroke deaths also increased by 26% from 4,660,450 in 1990 to 5,874,180 in 2010, according to the release.
In addition, the incidence and prevalence of AF increased from 1990 and 2010, and AF-related mortality doubled during the study period.
Burden by region
The burden of CVD was greatest in Eastern Europe and Central Asia.
High-income regions experienced a substantial decline in CVD burden from 1990 to 2010. Among high-income countries, the greatest improvements to CVD burden were reported in Ireland, Israel, Norway and the United Kingdom, all of which nearly halved their burden as indicated by disability-adjusted life years lost per 100,000 people, according to the release. In the United Kingdom, the overall CVD burden based on disability-adjusted life years lost was reduced by 43%, from 7,777 per 100,000 people in 1990 to 4,376 per 100,000 people in 2010.
Among the 33 high-income countries included in the Global CVD Atlas, the biggest climb toward a lower per-capita CVD burden from 1990 to 2010 was reported in Ireland, the United Kingdom, New Zealand and Norway. Countries with lower rankings included Malta, Andorra and Japan. Brunei had the lowest burden of CVD disability-adjusted life years per 100,000 of all high-income countries, followed by Israel, South Korea and Chile. Greece had the highest per-capita burden, followed by Germany, Andorra and Finland. The United States reduced per-capita disability-adjusted life years by 33% from 1990 to 2010, but its rank among the 33 Global CVD Atlas high-income countries remained stable (No. 18 in 1990; No. 19 in 2010), according to the release.
CVD risk factors
Risk factors related to the global CVD burden were similar in all evaluated regions, with common factors including diet, elevated BP and tobacco use.
“It comes as no surprise that classic risk factors responsible for global CVD burden — dietary risks, high blood pressure and tobacco smoking — were leading risk factors around the world. Tobacco smoking was ranked comparatively lower as a CVD risk factor in Australasia, Western Europe and North America, likely due to both aggressive tobacco control measures and shifts in societal attitudes toward tobacco use in recent decades. Elsewhere, in some of the world’s most populous regions, like East Asia and Southeast Asia, smoking prevalence remains high, and tobacco is the third leading risk factor behind dietary risks and high blood pressure,” the researchers wrote.
The researchers attributed much of the observed increase in CVD burden, despite decreases to age-standardized incidence and mortality rates, to the aging and growth of the population, as well as an increase in life expectancy. In particular, they indicated the potential for a “growing epidemic of CVDs” throughout North Africa and the Middle East in the coming years, citing a younger population coupled with an average life expectancy older than 70 years.
Need for improved surveillance
The researchers stressed the importance of reliable surveillance data for CVD prevention and control, but noted that few countries worldwide have completely linked community, inpatient/outpatient and mortality data registries. In several low-income areas worldwide, all-cause and cause-specific death registries are not yet complete, and sources of data are sparse in various regions, particularly sub-Saharan Africa and smaller countries throughout Oceania, they wrote.
Although the ideal CV surveillance system has yet to be established, the researchers outlined the following criteria for such a system:
- The ability to track treatment efficiency by collecting data on cost and health outcomes.
- A population focus, requiring the implementation of surveys sampling on the school, employer, institution and household levels.
- The ability to rapidly incorporate new indicators and metrics.
- Expansion of the measurement of biomarkers, which is currently incorporated in relatively few WHO surveys.
- Improved methods of integrating multiple data sources, correcting bias and calculating for uncertainty.
“The only way to [reduce CVD burden] will be to extend the CVD control successes of the high-income world to low- and middle-income countries,” Andrew Moran, MD, from Columbia University, stated in the release. “In some cases this may mean adapting past successful programs; in other cases, locally tailored and innovative approaches will be needed.”
Disclosure: The researchers report no relevant financial disclosures.
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