CVD remains leading cause of death globally

 I can't tell if they have the definition of cardiovascular disease correct or not.

(You're that out-of-date that you missed that

(stroke has been called neurological disease by the WHO since 2006)

instead of CVD? And you're still employed in the medical field?)

CVD remains leading cause of death globally

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.

Data were derived from Lindstrom M, et al. J Am Coll Cardiol. 2022;doi:10.1016/j.jacc.2022.11.001.

The collaboration is an alliance between the Journal of the American College of Cardiology, the Institute for Health Metrics and Evaluation and the NHLBI.

Gregory A. Roth

“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.