The number of people dying from cardiovascular disease is steadily rising, and cardiovascular disease was the underlying cause of one-third of all deaths globally in 2019, according to new state of the art review published Dec. 9 in the Journal of the American College of Cardiology. The paper reviewed the total magnitude of cardiovascular disease burden and trends over 30 years around the world and highlights an urgent need for countries to establish cost-effective public health programs aimed at reducing cardiovascular risk through modifiable behaviors.

The Global Burden of Diseases, Injuries, and Risk Factors Study 2019, from which the paper uses data, is a multinational collaboration that estimates global, regional and national disease burden as part of an ongoing effort to provide consistent and comparable estimates of health from 1990-2019. It uses all available population-level data sources on incidence, prevalence, case fatality, mortality and health risks to estimate measures of population health for 204 countries and territories.

The authors specifically looked at the impact of cardiovascular disease within the Global Burden of Diseases study to examine the extent to which population growth and aging and cardiovascular disease risk factors explain the observed cardiovascular disease trends, sex differences and regional patterns, as well as how the epidemiology of the disease is evolving.

"Global patterns of total cardiovascular disease have significant implications for clinical practice and public health policy development," said Gregory A. Roth, MD, MPH, FACC, lead author of the paper. "Prevalent cases of total cardiovascular disease are likely to increase substantially as a result of population growth and aging, especially in Northern Africa and Western Asia, Central and Southern Asia, Latin America and the Caribbean, and Eastern and Southeastern Asia where the share of older persons is projected to double between 2019 and 2050. Increased attention to promoting ideal cardiovascular health and healthy aging across the lifespan is necessary. Equally important, the time has come to implement feasible and affordable strategies for the prevention and control of cardiovascular disease and to monitor results."

The paper includes 13 underlying causes of cardiovascular death and nine related risk factors. For each cause and risk factor, the authors identified which regions and countries have the highest and lowest prevalent cases and number of deaths, as well as summary measures including number of years of life lost (YLLs), number of years lived with disability (YLDs) and the amount and temporal trends in disability-adjusted life years (DALYs). The paper also addresses how the summary measures of each cardiovascular disease and risk highlighted inform investments in cardiovascular research, their implications for clinical practice, and suggestions for health system development and national and regional policy.

Results showed the prevalent cases of total cardiovascular disease nearly doubled from 271 million in 1990 to 523 million in 2019, while the number of cardiovascular disease deaths steadily increased from 12.1 million in 1990 to 18.6 million in 2019. In 2019, the majority of cardiovascular disease deaths globally were ischemic heart disease and stroke, increasingly steadily from 1990. The global trends for DALYs and YLLs also increased significantly while YLDs doubled from 17.7 in 1990 to 34.4 million in 2019.

In 2019, cardiovascular disease was the underlying cause of 9.6 million deaths among men and 8.9 million deaths among women, around a third of all deaths globally. Over 6 million of these deaths occurred in people between the ages of 30-70. The highest number of cardiovascular disease deaths occurred in China, followed by India, Russia, the U.S. and Indonesia.

At the country level, age-standardized mortality rates for total cardiovascular disease were lowest in France, Peru and Japan where rates were six-fold lower in 2019 than in 1990. The authors of the paper note that from 1990 to 2019, large declines in the age-standardized rates of death, DALYs and YLLs together with small incremental reductions in age-standardized rates for prevalent cases, and YLDs suggest that population growth and aging are big contributors to the increase in total cardiovascular disease.

The paper also discusses challenges in prevention and treatment of cardiovascular disease and risks globally.

"There remains a large gap between what we know about cardiovascular disease and risk factors and what we do in their prevention, treatment and control worldwide," said George A. Mensah, MD, FACC, co-lead author of the paper. "The Global Burden of Diseases study continues to be a platform that allows tracking and benchmarking of progress in the reduction of cardiovascular disease and risk factor burden. However, renewed focus is needed now on affordable, widely available and proven-effective implementation strategies for the prevention, treatment and control of cardiovascular disease and risk factors and the promotion of ideal cardiovascular health beginning in childhood."

Amid the current COVID-19 pandemic, there exists high rates of excess mortality, and according to the paper, much of this additional disease burden may be cardiovascular disease because of the effects of both viral infection and changes in the delivery of health care and health-seeking behaviors due to pandemic mitigation efforts. However, further research in this area is vitally needed.

"There is a pressing need to focus on implementing existing cost-effective interventions and health policies if the world is to meet the targets for Sustainable Development Goal 3 and achieve at least a 30% reduction in premature mortality due to noncommunicable disease by 2030," said Valentin Fuster, MD, PhD, MACC, editor-in-chief of JACC and senior author of the paper. "In the face of a global viral pandemic, we still must emphasize global commitments to reduce the suffering and premature death caused by cardiovascular disease, which limits healthy and sustainable development for every country in the world."

Clinical Topics: COVID-19 Hub, Geriatric Cardiology

Keywords: Aged, 80 and over, Mortality, Premature, Risk Factors, COVID-19, Pandemics, Quality-Adjusted Life Years, Longevity, Cardiovascular Diseases, Latin America, Prevalence, Japan, Population Growth, Indonesia, Benchmarking, ACC International

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