CVD Burden Declining Among Rich Countries, Highest in Eastern Europe, Central Asia

April 08, 2014

NEW YORK CITY – The global burden of cardiovascular disease (CVD) is highest in Eastern Europe and Central Asia and continues to affect large populations in South Asia, North Africa, and the Middle East, where it often afflicts young, working-age adults, according to a new report[1].

In higher-income countries, including the UK, New Zealand, Ireland, Israel, and Norway, among a host of others, the number of disability-adjusted life-years (DALYs) lost to CVD is declining.

The new data are part of the global cardiovascular disease atlas, published April 4, 2014 in Global Heart, launched by the World Heart Federation.

The analysis, led by Dr Andrew Moran (Columbia University Medical Center, New York), found that ischemic heart disease accounts for more than 5% of DALYs lost to CVD, while stroke accounts for more than 4% of DALYs lost. The other major diseases that contribute to CVD burden include hypertensive heart disease, cardiomyopathies, rheumatic heart disease, atrial fibrillation, aortic aneurysm, peripheral vascular disease, and endocarditis.

In 1990, there were more than 5.2 million deaths from ischemic heart disease, a number that increased 35% to more than seven million deaths in 2010. Regarding stroke, the number of deaths increased 26% from 4.6 million in 1990 to 5.8 million in 2010. Although population growth and longer lifespans have increased the absolute number of deaths from ischemic heart disease and stroke, as well as increased the number of survivors, age-standardized mortality for both diseases has declined.

"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 across all world regions," report Moran and colleagues. "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."

In contrast, tobacco remains the third leading risk factor behind diet and blood pressure in East and Southeast Asia, geographic regions that contain some of the world's most populated countries. In Eastern Europe, alcohol remains one of the major causes of CVD, while air pollution contributes to CVD burden in East Asia. Obesity is almost a global problem, ranking as the third leading cause of CVD burden in North America, Europe, Australasia, Central Asia, Latin America, the Caribbean, North Africa, and the Middle East.

Among 33 countries designated with high-income status, the relative reduction in DALYs lost to CVD between 1990 and 2010 exceeded 40% in Norway, Ireland, the UK, Israel, Luxembourg, and New Zealand. For example, Norway and Ireland both had a 47% reduction in DALYs lost to CVD over the 20-year period, while the UK had a 44% reduction. Among the high-income countries, only Brunei and Japan saw an increase in DALYs lost to CVD between 1990 and 2010 (2% and 6% increase, respectively), although Brunei actually had the lowest crude number of DALYs per 100 000.

In an editorial[2], Dr Srinath Reddy, the president of the WHF, said the goal of the organization is to reduce the global burden of CVD 25% by 2025. This reduction is in line with the World Health Organization (WHO) goal of reducing premature mortality attributable to noncommunicable diseases by 25% by 2025. As part of this global plan, countries are urged to reduce the prevalence of hypertension by 25%, to reduce the prevalence of smoking/tobacco use by 30%, and to get at least 50% of eligible patients on drug therapy and/or counseling to reduce the risk of MI and strokes.

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