Reducing the Global Burden of Cardiovascular Disease: The Role of Risk Factors

James W. Levenson, MD, MPH, Patrick J. Skerrett, MS, J. Michael Gaziano, MD, MPH

Disclosures

Prev Cardiol. 2002;5(4) 

In This Article

Abstract and Introduction

During the last century, cardiovascular disease (CVD) has burgeoned from a relatively minor disease worldwide to a leading cause of morbidity and mortality. By 2020 it is projected that CVD will surpass infectious disease as the world's leading cause of death and disability. Some of this increase in the relative importance of CVD is due to improved public health measures and medical care leading to longer life spans and reduced mortality from other causes. However, a substantial portion of the increasing global impact of CVD is attributable to economic, social, and cultural changes that have led to increases in risk factors for CVD. These changes are most pronounced in the countries comprising the developing world. Because the majority of the world's population lives in the developing world, the increasing rate of CVD in these countries is the driving force behind the continuing dramatic worldwide increase in CVD. In order to blunt the impact of the global explosion in CVD, it will be crucial to attempt to understand and reduce the global increase in CVD risk factors. In this review, the authors describe the changes responsible for the global epidemic of CVD, with particular attention to the contributions of established risk factors and their impact on the growth of CVD among the world's various economic sectors. The authors outline the major challenges facing countries in different economic sectors, and discuss ways to address these challenges with the goal of reducing the global burden of CVD.

Over the last 100 years, cardiovascular disease (CVD) has shifted from a relatively inconsequential disease worldwide to a leading cause of morbidity and mortality. At the beginning of the 20th century, CVD accounted for less than 10% of all deaths worldwide. At the beginning of the 21st century, it accounts for nearly one half of all deaths in the developed world and 25% in the developing world; by 2020, it will claim 25 million deaths each year and will surpass infectious disease as the world's leading cause of death and disability (Figure 1).[1,2] What is driving this increase? One major factor is the projected 60% increase in population between 1990 and 2020. A second is the increasing average life expectancy, the result of improvements in public health and medical care that are reducing rates of communicable disease, malnutrition, and maternal and infant deaths. A third factor is the economic, social, and cultural changes that have led to increases in risk factors for CVD.

Distribution of major causes of mortality worldwide, 1990 and 2020[2]

Existing and developing knowledge regarding risk factors for CVD, especially potentially avoidable risk factors, such as cigarette smoking, hypertension, hyperlipidemia, and physical inactivity, suggest that it may be possible to muffle the explosion of global CVD. In this paper, we describe the changes responsible for the global epidemic of CVD, evaluate the contributions of various established risk factors, outline the major challenges facing countries in different economic sectors, and discuss ways to address these challenges.

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