April 3rd, 2014

Cardiovascular Disease Declines in Rich Countries but Grows Elsewhere

A new Global Cardiovascular Disease (CVD) Atlas portrays a divided world where rich countries are gradually freeing themselves from the yoke of CVD but where many poor and middle-income countries are still struggling.

Ischemic heart disease and stroke were the two biggest contributors to the global burden of disease in 2010, accounting for 5.2% and 4.1%, respectively, of all disability adjusted life years (DALYs). From 1990 to 2010 the global age-standardized mortality rates of heart disease and stroke decreased, but the absolute number of deaths increased from 5,211,790 to 7,029,270 deaths for heart disease and from 4,660,450 to 5,874,180 deaths for stroke.

Diet, high blood pressure, and tobacco were the three leading risk factors worldwide. Tobacco’s role was much larger in East Asia and Southeast Asia than in Australasia, Western Europe, and North America, where efforts to curb smoking have been successful. Alcohol was the fifth most important risk factor in Eastern Europe, but ranked no higher than 10th in other regions.  In East Asia air pollution was the fourth most important risk factor. High body mass index was the third most important risk factor in Australasia, North America, Europe, Central Asia, Latin American/Caribbean, North Africa, and the Middle East.

From 1990 to 2010 Norway, Ireland, the U.K., and Israel nearly cut in half the crude DALY burden per 100,000 people.  “The reductions in CVD burden per capita in high income regions are impressive, and have occurred despite aging populations,” said Andrew Moran, the first author of a summary published in Global Heart. “Other studies of CVD trends suggest that CVD reductions in the high income world are due to a combination of reduced smoking, improved risk factor control, and improved treatments. Some changes in diet, lifestyle, and broader social and economic forces may play a role too, but are harder to measure.”

By contrast, the countries of the former Soviet Union had large increases of at least 30% in their DALY burden.  Said Moran, “the big contributions of alcohol and tobacco points to underlying social and economic forces at work.”

Obesity, poor diet, and high blood pressure have caused increases in the burden of CVD in North Africa and the Middle East. In Kuwait the incidence of CVD DALYs increased by 28%.

In the U.S., per capita DALYs decreased by 33% between 1990 and 2010, but the overall crude DALY rate of 4485.86 per 100,000 people left it in the middle of the pack of high-income countries. In 2010, Brunei had the lowest rate in this group — 2321.97  per 100,000 — while Greece had the highest rate — 6455.03 per 100,000.

Moran said that the only way to lower the high burden of CVD in much of the world “will be to extend the CVD control successes of the high income world to low and middle income countries. In some cases this may mean adapting past successful programs; in other cases locally tailored and innovative approaches will be needed.”


4 Responses to “Cardiovascular Disease Declines in Rich Countries but Grows Elsewhere”

  1. Paul De Groot, MD, PhD says:

    My conclusion: serum cholesterol is no longer a risk factor of CVD!?

  2. Karen Politis, MD says:

    Just 35 years ago, the burden of cardiovascular disease in Greece was low. Then the Greeks came into money, acquired automobiles, increased smoking and alcohol consumption, and drifted away from their Mediterranean diet. Behold the results! And in just one generation! Champions!

  3. Vasiliy Vlassov, MD says:

    Please not forget that developing countries enjoy the longer life now. It is a good return for the increased CVD mortality

  4. Antonio H. Reis, Ph.D says:

    The case of Greece deserves scrutiny:

    Consumption of statins has increased from 18 to 88% in between 1995 and 2007 and mean blood cholesterol decreased from 5.8 mmol/ in 1995 to 4,9 mmol/l in (see European Cardiovascular Disease Statistics 2012 edition ; http://www.escardio.org/about/documents/eu-cardiovascular-disease-statistics-2012.pdf). On the other hand:”Greeks more avid meat eaters than the Americans “(http://www.thetoc.gr/eng/family-health/article/greeks-more-avid-meat-eaters-than-the-americans)