Blood pressure remains largest contributor to global CVD; mortality on the rise
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Key takeaways:
- The global burden of CVD mortality increased through 2022, especially in low- and middle-income countries.
- BP remained the strongest risk factor for CVD and ischemic heart disease the leading cause of CV death.
Global CV mortality and the prevalence of important cardiometabolic risk factors increased through 2022, with high BP remaining the strongest contributor, according to the 2023 update to the Global Burden of Disease special report on CVD.
The almanac-style report was assembled in collaboration between the Journal of the American College of Cardiology, the Institute for Health Metrics and Evaluation and the NHLBI.
Data were derived from Mensah GA, et al. J Am Coll Cardiol. 2023;doi:10.1016/j.jacc.2023.11.003.
“Cardiovascular diseases are a persistent challenge that lead to an enormous number of premature and preventable deaths,” 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, said in a press release. “There are many inexpensive, effective treatments. We know what risk factors we need to identify and treat. There are simple healthy choices that people can make to improve their health. This atlas provides detailed information on where countries stand in their efforts to prevent and treat cardiovascular diseases.”
Researchers identified five major trends in global CVD and risk factors.
Rising CVD deaths
Global CVD death increased from 12.4 million in 1990 to 19.8 million in 2022, and from 2015 to 2022, age-standardized CVD mortality increased in 27 countries.
In addition, age-standardized disability-adjusted life-years exceeded 500 per 100,000 life-years for CVD risk factors including high systolic BP, poor diet, air pollution, high LDL, high BMI, high fasting blood glucose and smoking, according to the document.
Rising burden of cardiometabolic disease
The researchers reported that estimated global levels of overweight and obesity may reach more than 4 billion people by 2035, compared with more than 2.6 billion in 2020, and the global prevalence of obesity alone is expected to increase from 14% to 24% by 2035.
The Global Burden of Disease 2021 Diabetes Collaborators estimated the number of people with diabetes will increase from 529 million in 2021 to 1.3 billion in 2050, according to the report.
Although the report features statistics on global trends in BP, LDL, BMI, fasting blood glucose and kidney dysfunction, the researchers reported that high BP was the largest contributor to attributable age-standardized CVD, with DALYs at 2,564.9 per 100,000 life-years.
Regional variation in CVD burden
High regionality was observed in CVD burden, where age-standardized CVD mortality rates ranged from 73.6 per 100,000 people in high-income Asia Pacific areas to 432.3 per 100,000 in Eastern Europe in 2022.
The age-standardized prevalence of CVD was highest in Central Asia at 11,342.6 per 100,000 people and lowest in South Asia at 5,881 per 100,000 people, according to the report.
Additionally, ischemic heart disease was the leading cause of CVD mortality, at a global age-standardized mortality rate of 108.8 per 100,000 people, followed by intracerebral hemorrhage and ischemic stroke.
Disparate CVD burden in low- and middle-income countries
The researchers added that more than 75% of the global CVD burden is observed in low- and middle-income countries in Oceania, Eastern and Central Europe, sub-Saharan Africa, North Africa and the Middle East, the Caribbean and East and South Asia.
Decline in CVD from household air pollution
Attributable age-standardized CVD DALYs observed for household air pollution — defined as pollution from solid fuels, lead exposure and nonoptimal temperature — decreased 65.1% from 1990 to 2022.
Similar reductions were observed during that time for years living with disability, years of life lost and CVD mortality, according to the report.
“Identifying sustainable ways to work with communities to take action to prevent and control modifiable risk factors for heart disease is essential for reducing the global burden of heart disease,” George A. Mensah, MD, FACC, FAHA, director of the Center for Translation Research and Implementation Science at the NHLBI, said in the release. “The 2023 Almanac represents an important resource for using locally relevant data to inform local-level actions for heart-healthy and thriving communities.”
As Healio previously reported, the 2022 report showed that CVD remained the leading cause of death and that hypertension was the leading modifiable risk factor for early CV death worldwide.
The 2023 version features several updates not present in prior iterations of the document:
- new mortality data including COVID-19 pandemic years in some countries;
- new estimates of all-cause mortality and population;
- an update to the estimation of the prevalence of years lived with disability due to ischemic heart disease;
- a new network meta-analysis that corrects systematic bias in health surveys; and
- new health facility administrative data to estimate rheumatic heart disease prevalence in nonendemic countries.
“We formed the Global Burden of Cardiovascular Diseases Collaboration 3 years ago to help bring state-of-the-art research to the forefront of the global cardiovascular community,” Valentin Fuster, MD, PhD, president of the Mount Sinai Fuster Heart Hospital, physician-in-chief of Mount Sinai Hospital and editor-in-chief of the Journal of the American College of Cardiology, said in the release. “We are excited to publish this 2023 Almanac as a dedicated issue of the Journal to inform the realities of CVD risk and inspire strategies for a heart-healthy world.”
Reference:
- New study reveals latest data on global burden of cardiovascular disease. https://www.acc.org/About-ACC/Press-Releases/2023/12/11/18/48/New-Study-Reveals-Latest-Data-on-Global-Burden-of-Cardiovascular-Disease. Published Dec. 11, 2023. Accessed Dec. 11, 2023.
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