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Global Trends in Cardiovascular Diseases: Insights from the 2023 Almanac

25 Jan 2024

In 2020, a collaboration involving the Journal of the American College of Cardiology (JACC), the National Heart, Lung, and Blood Institute (NHLBI), and the Institute for Health Metrics and Evaluation (IHME) was formed to focus on CVD trends. The 2023 Almanac results derived from the Global Burden of Disease (GBD) and spanning 1990 to 2022, were recently published in the Journal of American College of Cardiology. These data offer an updated analysis of health estimates pertaining to the worldwide, regional, and national impact of cardiovascular diseases (CVD) and associated risk factors. Hereby we present the major trends identified by the authors and their recommendations.

Major Trends in Global CVD and Risks

The 2023 Almanac presents crucial insights into the Global Burden of Disease (GBD) for the period 1990-2022, revealing five major trends in global cardiovascular diseases (CVD) and associated risks, each with profound implications for clinical practice and research.

1. Rising Global CVD Deaths

While the global age-standardized CVD mortality rate decreased by 34.9% from 1990 to 2022, actual CVD death counts rose due to population growth and aging. Between 2015 and 2022, age-standardized CVD mortality increased in 27 locations, with high burden attributable to metabolic, behavioral, and environmental risks.

Implications: Urgent research is needed to understand variations, emphasizing the modifiable nature of CVD risks. Strategies promoting healthy aging globally are crucial to mitigate the impact of population aging.

2. Growing Global Burden of Cardiometabolic Risks:

The 2023 World Obesity Atlas projects a significant rise in global overweight and obesity levels by 2035, leading to a surge in diabetes cases. Metabolic risks, including high systolic blood pressure, high LDL cholesterol, high BMI, high fasting plasma glucose, and kidney dysfunction, contribute substantially to age-standardized CVD disability-adjusted life years (DALYs).

Implications: a renewed focus on prevention, treatment, and control strategies is imperative to address the escalating burden of cardiometabolic risks.

3. Profound Regional Variation in CVD Burden

Regional disparities in age-standardized CVD mortality rates and prevalence are substantial, ranging from a 6-fold difference between regions. Age-standardized CVD mortality rates per 100,000 in 2022 varied from 73.6 in High-Income Asia Pacific to 432.3 in Eastern Europe. Incompletely understood complex inter-relationships contribute to variations, emphasizing the need for ongoing population science research to inform prevention and control strategies.

Implications: Global and regional actions, guided by proven-effective interventions, should be culturally and contextually attuned to address unique regional needs.

4. “Disproportionate Burden of CVD in LMICs”

Over 75% of the global CVD burden is found in Low- and Middle-Income Countries (LMICs), driven by population growth, aging, and epidemiologic transition. High systolic blood pressure stands out as a major risk factor, directly contributing to leading cardiovascular causes of death in LMICs.

Implications: Strategies for promoting heart-healthy living and improving access to safe and effective medications are vital to address the increasing burden in LMICs.

5. “Dramatic Declines in Attributable CVD Burden for Household Air Pollution”

Environmental risks, including household air pollution, contribute to CVD burden. Notably, there is a 65.1% decline in attributable age-standardized CVD DALYs for household air pollution from solid fuels from 1990 to 2022.

Implications: Sustaining declines requires practices and policies, such as adopting clean cookstoves, highlighting the importance of broad, sustained, impactful, and equitable implementation.

Interpretation

These trends underscore the urgency for global action, emphasizing evidence-based interventions and research to reduce the burden of CVD and associated risks, promoting a vision of heart-healthy, stroke-free, and thriving communities worldwide.

The findings have significant implications for clinical and public health practice and research. Persistent variations in CVD burden and trends highlight the need for further population science research. Strategies promoting healthy aging globally and addressing cardiometabolic risks are crucial, especially given the projected increase in the aging population.

Addressing Disparities and LMIC Challenges

Profound regional variation and the disproportionate burden of CVD in LMICs underscore the need for culturally attuned interventions. Strategies should focus on health-system strengthening, making safe and effective medications accessible, and tailoring approaches to unique regional needs.

Environmental Risks and Declines in Attributable CVD Burden

Environmental risks, including household air pollution, play a significant role. The Almanac notes a remarkable 65.1% decline in attributable age-standardized CVD disability-adjusted life years due to household air pollution from solid fuels between 1990 and 2022. Sustainable practices and policies are vital for continued reductions in CVD mortality.

Implications for Dissemination and Implementation Research

The Almanac emphasizes the role of dissemination and implementation research. Researchers are urged to use the data to design, implement, and evaluate CVD interventions globally. The partnership involving JACC, NHLBI, and IHME encourages the use of the data for regional, national, and subnational research to drive clinical, public health, and policy changes.

JACC-NHLBI-IHME Partnership and Interactive Tool

The collaborative effort between JACC, NHLBI, and IHME aims to disseminate the Global Burden of Cardiovascular Diseases and Risks findings. An interactive tool has been developed to help clinicians, researchers, and trainees explore the data visually, facilitating a deeper understanding of the global CVD burden.

Conclusion and Call to Action

The Almanac concludes by emphasizing the urgency for global action in reducing the burden of CVD and risks. It calls for the implementation of evidence-based interventions, using the provided data as a guide. The vision of heart-healthy, stroke-free, and thriving communities worldwide is achievable through proactive measures and collaborative efforts.

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Original article: Mensah GA et al. J Am Coll Cardiol. 2023 Dec, 82 (25) 2343–2349.

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