Number Of Cardiovascular Disease Deaths Research Articles

Cardiovascular diseases burden attributed to low physical activity in China, 1990-2019

Objective: To analyze the burden of cardiovascular disease (CVD) attributed to low physical activity (LPA) and its changing trends in China from 1990 to 2019. Methods: On the basis of the province results of the Study of Global Burden of Disease 2019 in China, we described the distribution of CVD death and disability-adjusted life year (DALY) attributed to LPA by sex, age and province. Joinpoint 4.9.1.0 was used to calculate the average annual percentage change. Results: In 2019, the number of CVD deaths and DALY attributed to LPA in people aged ≥25 years were 0.127 million and 1.863 million person-years in China, respectively, The age-standardized mortality rate (ASMR) and standardized DALY rate of CVD attributed to LPA were slightly higher in men than in women, and much higher in ischemic heart disease patients than in ischemic stroke patients. The ASMR (8.85/100 000) and the standardized DALY rate (112.34/100 000) of CVD attributed to LPA in China in 2019 showed no obvious change compared with 1990, while decreased in the last decade. The largest increases in the mortality rate and DALY rate were observed in people aged ≥75 years from 1990 to 2019 (26.89%, 15.61%), but the mortality rate and DALY rate in people aged 60-74 years showed a decreasing trend. The mortality rate and DALY rate in men aged 25- 44 years showed the largest increases (37.50%, 35.49%), while women aged ≥75 years had the largest increases (31.00%, 18.02%). In 2019, the highest ASMR and standardized DALY rate of CVD attributed to LPA were found in Jilin, Inner Mongolia and Hebei. The largest increases were found in Qinghai (182.41%, 154.70%), Gansu (181.29%, 152.77%), and Chongqing (132.01%, 102.79%) and the largest decreases were found in Beijing (59.11%, 62.09%), Macau (41.89%, 39.37%) and Guangdong (36.93%, 40.72%) from 1990 to 2019. Conclusion: The disease burden of CVD attributed to LPA in China was quite high and showed gender, age and area specific differences.

The North-South difference of the relationship between cold spells and mortality risk of cardiovascular diseases in China

Objective: To analyze the North-South difference of the relationship between cold spells and mortality risk of cardiovascular diseases in China. Methods: The time series analysis method was used to collect the daily counts of cardiovascular mortality data, meteorological data and PM2.5 concentration in the cold season (November to March of the following year) from January 1, 2013 to December 31, 2018 in 280 districts and counties in China. The non-constrained distributed lag linear model was used to analyze the relationship between cold spells and mortality risk of cardiovascular diseases and its North-South difference in China. Results: From 2013 to 2018, the mean of daily average temperature of the cold season in 280 districts and counties was 5.4 ℃. The mean of daily average relative humidity was 64.4%, and the mean of daily average PM2.5 concentration was 73.7 μg/m3. The average cold spell days in each county was 11.7 days per year,the mean of daily average temperature on cold spell days was (-2.4±6.7) ℃, and M (Q1, Q3) was -1.5 (-5.1, 1.1) ℃. The average of daily number of cardiovascular disease deaths in each county/district was (6±5) cases, and M (Q1, Q3) was 5 (2, 8) cases. The percentage change (95%CI) in the South was 4.94% (3.69%, 6.20%) (lag 0 d), higher than that in the North [the percentage change (95%CI) was 1.49% (1.14%-1.84%) (lag 0-7 d)]. In the North, the mortality risk of ≥75 years old was relatively low among three age groups, with a percentage change (95%CI) about 1.63% (1.33%-1.93%) (lag 0-21 d). In the South, the mortality risk of ≥ 75 years old was relatively high among three age groups, with a percentage change (95%CI) about 5.18% (3.78%-6.59%) (lag 0 d). Conclusion: The mortality risk of cardiovascular diseases caused by cold spells in the South is higher than that in the North of China, and the risk peak occurs earlier in the South.

The Role of CXC Chemokines in Cardiovascular Diseases.

Cardiovascular disease (CVD) is a class of diseases with high disability and mortality rates. In the elderly population, the incidence of cardiovascular disease is increasing annually. Between 1990 and 2016, the age-standardised prevalence of CVD in China significantly increased by 14.7%, and the number of cardiovascular disease deaths increased from 2.51 million to 3.97 million. Much research has indicated that cardiovascular disease is closely related to inflammation, immunity, injury and repair. Chemokines, which induce directed chemotaxis of reactive cells, are divided into four subfamilies: CXC, CC, CX3C, and XC. As cytokines, CXC chemokines are similarly involved in inflammation, immunity, injury, and repair and play a role in many cardiovascular diseases, such as atherosclerosis, myocardial infarction, cardiac ischaemia-reperfusion injury, hypertension, aortic aneurysm, cardiac fibrosis, postcardiac rejection, and atrial fibrillation. Here, we explored the relationship between the chemokine CXC subset and cardiovascular disease and its mechanism of action with the goal of further understanding the onset of cardiovascular disease.

Second Primary Malignancies and Cardiovascular Mortality in Hodgkin disease Survivors — a Surveillance, Epidemiology, and End Results Registry Database Study

BackgroundOver the last few decades there has been significant improvements in survival in patients with Hodgkin disease (HD). But long-term HD survivors, especially those treated with radiation therapy (RT) have an increased risk of second primary malignancy and cardiovascular disease (CVD) related mortality. In this context, we conducted this population based study to analyze trends in CVD related mortality and incidence of lung and thyroid cancer in HD survivors treated with RT.Materials and methodsWe used the Surveillance, Epidemiology, and End Results 9 database to calculate the Standardized Incidence Ratio (SIR) and Excess Absolute Risk (EAR) of lung and thyroid cancer as second primary malignancies in survivors of HD diagnosed between 1973 and 2011, and who were treated with RT. Poisson regression models were used to calculate adjusted incidence of lung and thyroid cancer. We further divided the patients diagnosed with HD during this period into two groups based on if or not they received RT and calculated the mortality due to CVD for each group, by year of diagnosis. Poisson regression models were used to calculate adjusted CVD mortality by year of HD diagnosis for each group. In all three cases, trends in incidence or mortality were evaluated by calculating the Estimated Annual Percentage Change (EAPC) from the regression coefficient for year of diagnosis.ResultsWe identified 11,916 HD cases that received RT from the SEER database, who were followed up for a median duration of 160 months (range - 12 to 480 months). Table 1 provides characteristics of the study population. 319 patients developed lung cancer (SIR of 3.72, 95% CI 3.32 - 4.15; EAR of 13.19 per 10,000 person years at risk) and 86 patients developed thyroid cancer (SIR of 3.67, 95% CI 2.94 - 4.53; EAR of 3.54 per 10,000 person years at risk). Median ages at diagnosis of secondary lung and thyroid cancers were 59 years and 42 years respectively, with median latency periods of 16 years and 17 years respectively. 965 patients among 11,916 patients who received RT died from CVD while the number of CVD deaths was 1,182 among the 12,507 patients who were not administered RT.Using Poisson regression models, we calculated the adjusted incidence of secondary lung cancer and thyroid cancer and the adjusted mortality from CVD, by year of diagnosis. Year of diagnosis, age at diagnosis of HD and latency (time since diagnosis of HD) were the independent variables used in the regression model. Between 1973 and 2011, the adjusted incidence of lung cancer declined at an EAPC of -2.68 (95% CI -13.06 to -3.92) and that of thyroid cancer declined at an EAPC of -3.35 (95% CI -5.73 to -1.00) (Figure 1). Over the same period, CVD mortality per 10,000 person years at risk for patients who received RT declined at an EAPC of -4.34 (95% CI -4.97 to -3.73) and that of patients who did not receive RT declined at an EAPC of -1.92 (95% CI -2.47 to -1.39) (Figure 2).ConclusionWe observed a decline in incidence of lung and thyroid malignancies and CVD mortality in HD survivors over the study period. The decline in CVD mortality over time in patients who received RT was steeper compared to that of patients who did not receive RT. Though our study was limited by the lack of details regarding RT, chemotherapy and comorbidities, these findings are most likely a reflection of recent trends in use of reduced doses and field of RT. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Early menopause and risk of cardiovascular disease: an issue for young women

Despite an overall reduction in cardiovascular disease mortality in the past 40 years, cardiovascular disease remains the leading cause of death worldwide, with gender disparities. Women tend to present with cardiovascular disease up to 10 years later than men, although age-adjusted rates of cardiovascular disease mortality in women are similar to men, and account for more deaths than any other cause. Since women have a longer life expectancy than men, the absolute number of cardiovascular disease deaths is higher among women than men and increasing cardiovascular disease mortality rates have been observed in women younger than 55 years.1 Although gender differences with regard to risk factors, aetiology, and outcomes of cardiovascular disease are well established, a unique group of sex-specific risk factors associated with reproductive health have been identified in women. Previous evidence is inconsistent, but a number of factors including early menarche or menopause have been associated with future cardiovascular disease events in women.2 Up to 10% of women have early natural menopause,3 indicating a potentially important target population for early and tailored risk stratification. In The Lancet Public Health, Dongshan Zhu and colleagues4 report one of the largest studies to date to investigate the association between age at menopause and onset and timing of incident cardiovascular disease.

The Impact of Treatment Adherence for Patients With Diabetes and Hypertension on Cardiovascular Disease Risk: Protocol for a Retrospective Cohort Study, 2008-2018.

BackgroundCardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence.ObjectiveThis study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings.MethodsWe will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization’s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level.ResultsThe project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019.ConclusionsThe findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities.International Registered Report Identifier (IRRID)DERR1-10.2196/13571

Second Primary Malignancies and Cardiovascular Mortality in Hodgkin Disease (HD) Survivors – A SEER Database Study

Over the last few decades there has been significant improvements in survival in patients (pts) with HD. But long-term HD survivors, especially those treated with radiation therapy (RT) have an increased risk of second primary malignancy (SPM) and cardiovascular disease (CVD) related mortality. We conducted this population based study to analyze trends in CVD related mortality and incidence of lung and thyroid cancer (CA) in HD survivors treated with RT. We used the SEER 9 database to calculate the Standardized Incidence Ratio (SIR) and Excess Absolute Risk (EAR) of lung and thyroid CA as SPM in survivors of HD diagnosed between 1973 and 2011, who were treated with RT. Poisson regression models were used to calculate adjusted incidence of lung and thyroid CA. We also divided the pts diagnosed with HD during this period into two groups based on if or not they received RT and calculated the mortality due to CVD for each group, by year of diagnosis (YOD). Poisson regression models were used to calculate adjusted CVD mortality by YOD for each group. In all three cases, trends in incidence or mortality were evaluated by calculating the Estimated Annual Percentage Change (EAPC) from the regression coefficient for YOD. We identified 11,916 HD cases that received RT, who were followed up for a median duration of 160 months (range – 12 to 480 months). 319 pts developed lung CA (SIR of 3.72, 95% CI 3.32 – 4.15; EAR of 13.19 per 10,000 person years at risk (PYAR)) and 86 pts developed thyroid CA (SIR of 3.67, 95% CI 2.94 – 4.53; EAR of 3.54 per 10,000 PYAR). Median ages at diagnosis of secondary lung and thyroid CA were 59 yrs and 42 yrs, with median latency periods of 16 yrs and 17 yrs respectively. 965 pts among 11,916 pts who received RT died from CVD while the number of CVD deaths was 1,182 among the 12,507 pts who were not given RT. Using Poisson regression models, we calculated the adjusted incidence of secondary lung CA and thyroid CA and the adjusted mortality from CVD, by YOD. YOD, age at diagnosis of HD and latency (time since diagnosis of HD) were the independent variables used in the regression model. Between 1973 and 2011, the adjusted incidence of lung CA declined at an EAPC of -2.68 (95% CI -13.06 to -3.92) and that of thyroid CA declined at an EAPC of -3.35 (95% CI -5.73 to -1.00). Over the same period, CVD mortality per 10,000 PYAR for pts who received RT declined at an EAPC of -4.34 (95% CI -4.97 to -3.73) and that of pts who did not receive RT declined at an EAPC of -1.92 (95% CI -2.47 to -1.39). We observed a decline in incidence of lung and thyroid CA and CVD mortality in HD survivors over the study period. The decline in CVD mortality over time in pts who received RT was steeper compared to that of pts who did not receive RT. Though our study was limited by the lack of details regarding RT, chemotherapy and comorbidities, these findings are most likely a reflection of recent trends in use of reduced doses and field of RT.

Abstract P062: The Impact of High Fasting Plasma Glucose on Cardiovascular Health at the State-level in the United States

Introduction: High fasting plasma glucose (FPG) is an established risk factor for cardiovascular disease (CVD). However, the impact of FPG on CVD mortality and morbidity at the state-level in the US has not been systematically evaluated. Objective: To quantify the number of CVD deaths and disability adjusted life years (DALYs) attributable to high FPG by age, sex, year and state among US adults from 1990 to 2016. Methods: We used a spatio-temporal Gaussian process regression (ST-GPR) to estimate the mean FPG level by age, sex, year and state. The inputs to the ST-GPR model included data from National Health and Nutrition Examination Survey, state-specific prevalence of obesity, and per-capita lag-distributed income in each state. Using the mean FPG and prevalence of diabetes in each state, we characterized the distribution of the FPG at the state-level. Then, we used the Global Burden of Disease study comparative risk assessment framework to estimate the CVD deaths and DALYs attributable to high FPG. Results: In 2016, there were 180,440 CVD deaths attributable to high FPG in the United States: 77% due to ischemic stroke, 21% due to cerebrovascular disease, and <1% due to peripheral artery disease. Alaska had the lowest attributable death rate for both males and females (66.9 per 100,000 and 55.4 per 100,000, respectively) and West Virginia had the highest attributable death rate for both males and females (227.3 per 100,000 and 186.4 per 100,000, respectively). This is contrasted to DALYS, where Colorado had the lowest attributable DALYS rate for both males and females (1,732 DALYS per 100,000 1,379 DALYS per 100,000, respectively) and West Virginia had the highest attributable DALY rate for both males and females (5,219 DALYS per 100,000 and 3,965 DALYS per 100,000, respectively). (Figure) Conclusions: Our results highlight the need for evidence-based intervention to control FPG to effectively prevent CVD.

Estimating the future burden of cardiovascular disease and the value of lipid and blood pressure control therapies in China.

BackgroundLifestyle and dietary changes reflect an ongoing epidemiological transition in China, with cardiovascular disease (CVD) playing an ever-increasing role in China’s disease burden. This study assessed the burden of CVD and the potential value of lipid and blood pressure control strategies in China.MethodsWe estimated the likely burden of CVD between 2016 and 2030 and how expanded use of lipid lowering and blood pressure control medication would impact that burden in the next 15 years. Accounting for the costs of drug use, we assessed the net social value of a policy that expands the utilization of lipid and blood pressure lowering therapies in China.ResultsRises in prevalence of CVD risk and population aging would likely increase the incidence of acute myocardial infarctions (AMIs) by 75 million and strokes by 118 million, while the number of CVD deaths would rise by 39 million in total between 2016 and 2030. Universal treatment of hypertension and dyslipidemia patients with lipid and blood pressure lowering therapies could avert between 10 and 20 million AMIs, between 8 and 30 million strokes, and between 3 and 10 million CVD deaths during the 2016–2030 period, producing a positive social value net of health care costs as high as $932 billion.ConclusionsIn light of its aging population and epidemiological transition, China faces near-certain increases in CVD morbidity and mortality. Preventative measures such as effective lipid and blood pressure management may reduce CVD burden substantially and provide large social value. While the Chinese government is implementing more systematic approaches to health care delivery, prevention of CVD should be high on the agenda.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1420-8) contains supplementary material, which is available to authorized users.

Cardiovascular Health in Brazil: Trends and Perspectives.

Brazil is a large country, with an evolving economy, but marked social inequalities. The population is formed by an admixture of native Brazilians, Europeans, and Africans; is predominantly urban; and faces rapid aging. Time trends related to health behaviors show a substantial reduction in smoking rates, but a rising prevalence of overweight and obesity, unhealthy eating habits, and insufficient physical activity. The high prevalence of hypertension and the increasing prevalence of diabetes mellitus are also causes for concern. Cardiovascular disease (CVD) has been the leading cause of mortality since the 1960s and has accounted for a substantial percentage of all hospitalizations. In 2011, CVD was responsible for 31% of all deaths, with ischemic heart disease (31%) and cerebrovascular diseases (30%) being the leading CVD causes. Despite an increase in the overall number of CVD deaths, the age-adjusted mortality rates for CVD declined 24% between 2000 and 2011. Health care delivered by Brazil's universal public health system, which focuses on primary prevention, has contributed to this achievement. However, the decline in age-adjusted mortality differs according to race, sex, and socioeconomic status with black individuals and lower-income populations sustaining the greatest impact of CVD, especially at younger ages. With one of the world's largest public health systems in terms of population coverage, Brazil has the means to implement actions to confront the high burden of CVD, focusing on health promotion and comprehensive care. Insufficient funding, low education levels, and social inequalities remain as the main barriers to be overcome.

OP03 Predicting cardiovascular disease mortality rates in the united states in 2030: prospective modelling approaches

Background While cardiovascular disease (CVD) mortality has been reducing in the US since the 1970s, CVD remains the leading cause of mortality. This reflects reductions in population level risk factors assisted by evidence based medical treatments. Rates of reduction in CVD mortality may be slowing and large shifts in population characteristics are forecasted, creating uncertainty as to future trends in CVD mortality rates as well as uncertainty regarding race CVD inequalities. We therefore aimed to compare US CVD mortality projections to 2030 under contrasting scenarios. Methods We used a well-established hierarchical Bayesian Age Period Cohort (BAPC) model to model the age, period and cohort effects in CVD mortality from 1982 to 2012 stratified by age, gender and race. Data sources included the National Vital Statistics System, SEER single year population estimates, and the US Bureau 2012 National Population projections Using US population projections to 2030, we then projected coronary and stroke deaths to 2030 under contrasting scenarios. In SCENARIO A, we held the age, period and cohort effects components constant at 2012 values. In SCENARIO B, we allowed the age, period and cohort effects to continue along their recent, linear trends, and extrapolated the resulting trajectories to 2030. We then compared the number of CVD deaths forecasted in 2030. Results In scenario A, assuming that mortality rates would persist at 2012 levels, coronary and stroke deaths were projected to INCREASE by approximately 17.1% and 50.3% respectively by 2030 (equating to some 63,400 and 64,400 additional deaths per year). By contrast, scenario B, optimistically assuming that recent declines continue, coronary and stroke mortality might FALL by approximately 21.2% and 2.7%, equating to some 78,200 and 3,100 fewer annual deaths respectively by 2030. The burden of CVD mortality is unequal by race. These inequalities vary by age and gender, however CVD mortality rates in younger (35–55 years) black Americans is double that of age matched white Americans. Conclusion The large US declines in coronary heart disease mortality rates observed over recent decades are likely to continue. However, stroke mortality rates will fall more slowly. This has major health implications. Our BAPC models simultaneously estimate age, period and cohort effects to project future trends. They therefore offer more plausible future predictions than the conventional indirect standardisation approaches. These more sophisticated projection methods may therefore be potentially valuable to future researchers and to policy makers.

Health Promotion in Cardiac Rehabilitation Patients through the Use of a High-Intensity Interval Training Protocol

According to the American Heart Association’s (AHA) recent statistical update, over 2150 Americans die each day from cardiovascular disease (CVD), which equals approximately 1 death every 40 seconds; many of which were under the age of 65 years old [1]. In 2009, 386,324 people, 1 in 6 Americans, died as a result of coronary artery disease (CAD) alone [1]. They also estimate 150,000 people have “silent” heart attacks each year [1]. Even though the number of cardiovascular disease deaths has declined in the last 10 years, they still accounted for 32.3% of American deaths [1]. As a result, the AHA updated their 2020 goals to improve the nation’s cardiovascular health by 20% [1]. One of these methods is through the use of cardiac rehabilitation. Cardiac rehabilitation (CR) is a health promotion strategy to help return cardiac patients to their previous level of functioning, increase health, decrease comorbidities and promote education and lifestyle change. For select patients, another alternative exercise plan may exist to gain even better results. High intensity interval training (HIIT) has shown positive training results for athletes and many studies show that it may also be an effective exercise modality for many cardiac patients instead of the traditional circuit training method. This article will review current literature on the effects of HIIT on CR patients as well as a sample HIIT protocol for instituting this treatment with appropriate patients.

Declining Stroke and Myocardial Infarction Mortality Between 1989 and 2010 in a Country of the African Region

In low- and middle-income countries, the total burden of cardiovascular diseases is expected to increase due to demographic and epidemiological transitions. However, data on cause-specific mortality are lacking in sub-Saharan Africa. Seychelles is one of the few countries in the region where all deaths are registered and medically certified. In this study, we examine trends in mortality for stroke and myocardial infarction (MI) between 1989 and 2010. Based on vital statistics, we ascertained stroke and MI as the cause of death if appearing in any of the 4 fields for immediate, intermediate, underlying, and contributory causes in death certificates. Mortality rates (per 100 000, age-standardized to World Health Organization standard population) decreased from 1669/710 (men/women) in 1989 to 1991 to 1113/535 in 2008-10 for all causes, from 250/140 to 141/86 for stroke, and from 117/51 to 59/24 for MI, corresponding to proportionate decreases of 33%/25% for all-cause mortality, 44%/39% for stroke, and 50%/53% for MI over 22 years. The absolute number of stroke and MI deaths did not increase over time. In 2008 to 2010, the median age of death was 65/78 years (men/women) for all causes, 68/78 for stroke, and 66/73 for MI. Between 1989 and 2010, age-standardized stroke and MI mortality decreased markedly and more rapidly than all-cause mortality. The absolute number of cardiovascular disease deaths did not increase over time because the impact of population aging was fully compensated by the decline in cardiovascular disease mortality. Stroke mortality remained high, emphasizing the need to strengthen cardiovascular disease prevention and control.

Poverty and Human Development

Cardiovascular disease (CVD) is absent from the global development agenda. This absence is striking, because CVD is a major impediment to human development, imposing large health and economic burdens in low- and middle-income countries. These burdens have a reciprocal relationship in that poverty is a potent cause of CVD, whereas CVD contributes to poverty. The present editorial explores and seeks to explain the global neglect of CVD in pursuit of a strategy for its prevention and control worldwide. Chronic (noncommunicable) disease, principally CVD, cancer, chronic respiratory disease, and diabetes mellitus, caused 35 million deaths (60% of all deaths) in 2005. CVD (mainly heart disease and stroke) is the leading chronic disease, with 17 million deaths. The contribution of diabetes mellitus is underestimated; deaths due to diabetes are usually recorded as being due to heart disease or renal failure. CVD is also responsible for much disability, often for decades of a person’s life. Nearly half of the global burden of disease is caused by chronic diseases, and CVD is the leading contributor among these.1 Although the CVD burden and trends vary from country to country,2,3 from a human development perspective, 4 aspects of the burden of CVD are critical. First, the number of CVD deaths is similar in men and women, although the average age of onset is older in women than in men, so no gender bias exists in the burden of CVD that might remove it from development agendas.4 Second, the poorest countries are often deeply affected. CVD deaths are spread evenly among the developed and developing world; this is not a disease specific to wealthy nations. Of the world’s population, 80% of people live in developing nations, and 80% of all CVD deaths, occur in countries with a per capita income in 2001 of less …

Cardiovascular disease at the turn of the millennium: focus on Europe

Cardiovascular disease currently causes more than 4 million deaths each year in Europe alone. An acceleration in the cardiovascular disease epidemic has been predicted in developing countries, and the World Health Organization estimates that ischaemic heart disease will be the leading cause of disease/injury worldwide by the year 2020. Smoking. hyperlipidaemia and hypertension remain the most common risk factors, but the prevalence of obesity and diabetes has increased considerably in recent years. Traditionally, male gender was also considered to be an important risk factor. During the past 15 years, however, females have overtaken males with respect to the annual number of cardiovascular disease deaths.