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Urgent need for cost-effective programmes for reducing cardiovascular death

A new paper, published in the Journal of the American College of Cardiology, indicates that the number of people dying from cardiovascular disease is steadily rising. According to the paper, which reviewed the total magnitude of cardiovascular disease burden and trends over 30 years, cardiovascular disease accounted for one-third of all deaths (on a global scale) in 2019. The data reflect an urgent need for countries to establish cost-effective public health programmes aimed at reducing cardiovascular risk through modifiable behaviours.

The Global Burden of Diseases, Injuries, and Risk Factors Study 2019, from which this 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 to 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.

In the new paper, Dr Gregory A Roth (The Institute for Health Metrics and Evaluation, the University of Washington School of Medicine, Seattle, USA) and colleagues look at the specific impact of cardiovascular disease within the Global Burden of Diseases study to examine the extent to which population growth and ageing 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.

Findings highlighted in the paper 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 ischaemic heart disease and stroke, increasingly steadily from 1990. The global trends for disability-adjusted life years and years of life lost also increased significantly while years of life lost doubled from 17.7 million 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 six million of these deaths occurred in people between the ages of 30 and 70. The highest number of cardiovascular disease deaths occurred in China, followed by India, Russia, the USA and Indonesia.

The paper also discusses challenges in prevention and treatment of cardiovascular disease and risks globally. George A Mensah (Translation Research and Implementation Science, the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, USA), co-author of the paper, says: “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. 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 behaviours 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 non-communicable disease by 2030. In the face of a global viral pandemic, we still must emphasise 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,” says Valentin Fuster (Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, New York, USA), senior author of the paper.

The mission of Arrhythmia Alliance, and its sister charities AF Association and STARS, is to work together — with people with arrhythmias and healthcare professionals — to improve the diagnosis, treatment and quality of life for all those affected by arrhythmias (and related conditions). This includes raising awareness of the importance of risk factor modification, to reduce the risk of conditions such as atrial fibrillation from developing, and the need for early detection. The Know Your Pulse to Know Your Heart Rhythm campaign, for example, teaches people how to take their pulse and that knowing their pulse “could save their life”.

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