CVD remains leading cause of death globally
Click Here to Manage Email Alerts
A multinational collaborative report of global disease trends and risk factors shows CVD remains the leading cause of death and hypertension remains the leading modifiable risk factor for premature CV death worldwide, researchers reported.
In an almanac-style report assessing data from 204 countries and territories from the Global Burden of Cardiovascular Diseases Collaboration, researchers also found that Central Asia and Eastern Europe had the highest rates of CVD mortality, whereas hypertension, high cholesterol, dietary risks and air pollution were leading causes of CVD worldwide.
The collaboration is an alliance between the Journal of the American College of Cardiology, the Institute for Health Metrics and Evaluation and the NHLBI.
“The burden of cardiovascular disease continues to increase globally,” Gregory A. Roth, MD, MPH, associate professor in the division of cardiology and director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation at the University of Washington, told Healio. “High blood pressure remains the leading risk factor driving this increase, primarily through its effect on coronary heart disease, stroke and hypertensive heart disease. But CVD and its risk factors vary remarkably by world region, and this report now tracks that in detail.”
Global data analysis
Roth and colleagues assessed deaths using vital and sample registration data and produced estimates for the 15 leading environmental risks for CVD, including air and household pollution, lead exposure, low and temperatures, as well as metabolic risks for CVD such as systolic BP, LDL, BMI and fasting plasma glucose, and behavioral risk factors for CVD such as diet quality, smoking, alcohol use and physical activity. CVD mortality rates were stratified by location, age, sex and time categories since 1990.
The report also looked at disability-adjusted life-years, the years of life lost due to premature mortality, and years lived with disability.
In high-income regions of North America, researchers found that age-standardized CVD mortality rates ranged from 102.1 to 224.8 per 100,000 in 2021, reflecting a 2.6-fold difference. Hypertensive heart disease had the largest percent increase in CVD cause-specific age-standardized mortality rate since 1990 (53.3%), whereas rheumatic heart disease had the largest percent decrease (61.2%). After ischemic heart disease and stroke, hypertensive heart disease had the highest age-standardized DALY rate of 226.4. Among all CVD risks, hypertension accounted for the largest proportion of DALYs at 40.5%.
Globally, the report noted that ischemic heart disease is the leading cause of CV death, accounting for 9.44 million deaths in 2021 and 185 million DALYs.
Hypertension is the leading modifiable risk factor for CV death; all-cause DALYs attributed to hypertension were 2,770 per 100,000 people, according to researchers.
Data also showed a reduction in CVD for some regions. Australia had the largest percent reduction in age-standardized CVD per 100,000 at 64.2%; the percent decrease was highest for ischemic heart disease at 71.8%.
“Blood pressure lowering appears to be a particularly important strategy to delay progression to incident heart failure in at-risk individuals,” the researchers wrote in an introduction. “Intensive blood pressure control is projected to extend life expectancy by up to 3 years when initiated in middle age, and antihypertensive treatment optimization appears cost-effective at common willing-to-pay thresholds. Taken together, these data underscore the importance of public health strategies to promote early screening, detection and treatment of hypertension.”
Inexpensive interventions needed
Roth said the data may serve as a new resource for those developing effective strategies for disease prevention.
“There are several inexpensive and cost-effective interventions to consider,” Roth told Healio. “Recent studies show that a polypill approach to treating high BP works very well. Studies have shown that BP can be treated even in very remote settings where health care systems don't exist, using community health workers and mobile technology. Studies also show that educational programs for very young children can effectively teach a healthy lifestyle and prevent risk factors like high BP and diabetes. In the end, there will need to be multiple strategies and a public health approach will be important.”
For more information:
Gregory A. Roth, MD, MPH, can be reached at rothg@uw.edu.
Perspective
Back to Top
These data back up what we are seeing clinically and in other reports. We are doing a poor job of controlling BP in the United States. We are not alone; many countries struggle with hypertension burden. This is concerning, as we now have many classes of medicines that are generic and widely available, yet we are still failing. Hypertension is not only common, but contributes to the burden of ischemic heart disease, stroke risk and left ventricular hypertrophy.
Cardiologists and primary care physicians must avoid treatment inertia. We cannot be complacent when we see a systolic BP of 140 mm Hg. How do we make a dent in this? Research shows community-level interventions and pharmacist-led interventions can work on a small scale, but this is not a small-scale problem. The FDA has put forward some voluntary guidance on sodium reduction for food manufacturers. We also have to think about solutions that are accessible to all members of the global community, including low-income countries. Are their digital solutions that can utilize, for example, text messaging? We need all hands on deck for this problem. BP continues to increase, CVD is not going away, and this is a modifiable risk factor, where even small changes can make a big difference in terms of overall, population-wide CV risk reduction.
Perspective
Back to Top
Seth S. Martin, MD, MHS, FACC, FAHA, FASPC
This report provides a clear overview of the global burden of CVD and risk factors. A strength of the report is the use of the Global Burden of Diseases, Injuries, and Risk Factors study to track trends in CVD. This is an impressive collaborative study of more than 8,000 investigators around the globe that spans 204 countries and territories. Such global collaboration at scale has enabled tracking global, regional and national trends in death and disability since 1990 through standardized and replicable methods. The report ranks the causes of death and quantifies the number of deaths and DALYs per 100,000 people attributable to each cause. Ischemic heart disease and ischemic stroke remain at the top of the global ranking of causes of death. The report also includes rankings of modifiable risk factors and their contribution to the burden of CVD. The top three factors are high systolic BP, dietary factors and high LDL.
The results, while not surprising, clearly show that we are not moving fast enough in addressing modifiable risk factors for CVD. There is a critical need for revised national policies and health systems approaches to accelerate implementation of what we already know works, such as the strategies for cholesterol lowering detailed in the recent World Heart Federation Cholesterol Roadmap. For the top risk factor, high systolic BP, the authors call attention to innovative community-based interventions and the need for public health measures to address inequities in access to care. Currently, there is also movement upstream to prevent risk factors in the first place, as is being done in the work of the American Heart Association’s Health Equity Research Network on Prevention of Hypertension.
Collaboratively, creativity at scale will be necessary to address the enormous burden of CVD worldwide. The message is clear and the time is now to act on these results.
Collapse
Click Here to Manage Email Alerts