According to a new Global Cardiovascular Disease Atlas released by the World Heart Federation and published April 3 in Global Heart, between 1990 and 2010, wealthy countries across the world saw the burden of cardiovascular disease fall in their populations both in crude and age-standardized terms, while clusters of low and middle-income countries saw a rise in their cardiovascular disease burden as their respective populations endure behavioral and demographic changes, including increased life expectancy, poor diet, continued and increased tobacco smoking, and a more sedentary lifestyle.

The atlas "uses a measure called disability adjusted life years (DALYs) to measure the burden of cardiovascular disease in each region and country in the world, and measure the differences between 1990 and 2010 based on the Global Burden of Diseases, Risk Factors, and Injuries 2010 Study," says Jagat Narula, MD, PhD, MACC, one of the document's authors and editor-in-chief of Global Heart. "DALYs are a measure combining both premature deaths and years lived with disability. While total cardiovascular disease DALYs in any country or region show the absolute burden of cardiovascular disease, the Atlas also includes DALYs per 100,000 people so that changes over time and differences among countries and regions can be compared."

From a worldwide perspective, the findings show that the cardiovascular diseases that most contributed to the burden of disease in 2010 were ischaemic heart disease (5.2 percent of all DALYs lost) and stroke (4.1 percent of all DALYs lost). In 1990, 5,211,790 deaths were caused by ischaemic heart disease, increasing 35 percent to 7,029,270 in 2010. Combining all types, stroke deaths increased by 26 percent from 4,660,450 in 1990 to 5,874,180 in 2010. "For both stroke and ischemic heart disease, global age-standardized mortality has decreased, but population growth and aging have increased both the absolute number of cardiovascular disease deaths and survivors suffering with late effects of the two most important cardiovascular diseases," say the authors.

While many risk factors for cardiovascular diseases varied depending on the region – with alcohol use ranking fifth in Eastern Europe, or air pollution ranking fourth in East Asia – classic factors such as dietary risks, high blood pressure, and tobacco smoking – were leading causes throughout the majority of the world.

Across the globe's wealthier countries, the UK, Ireland, and Norway showed the most percentage improvement between 1990 and 2010, almost having their crude cardiovascular disease DALY burden per 100,000 people. "The reductions in cardiovascular disease burden per capita in high income regions are impressive, and have occurred despite aging populations," says co-author Andrew Moran, MD. "Other studies of cardiovascular disease trends suggest that cardiovascular disease 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."

On the other end of the spectrum were countries such as Russia, Belarus, Armenia, Kazakhstan, Albania, and Bangladesh, which all saw their cardiovascular disease DALY burden increase by more than 30 percent, contributed heavily by their populations' use of alcohol and tobacco. Elsewhere in the North Africa and Middle East regions, obesity, poor diet, and high blood pressure all caused sharp increases in their cardiovascular disease DALY burden.

With this new data, and the knowledge that 80 percent of non-communicable disease (NCD)- related deaths – which includes cardiovascular disease – occur in low- and middle-income countries, the World Heart Federation has adopted an overarching goal of a 25 percent reduction in pre-mature mortality from cardiovascular disease by the year 2025. This is consistent with the World Health Organization goal based on the 2011 United Nations High Level Summit on NCDs, of which the ACC played a pivotal role in the development of a plan for the global campaign to combat NCDs.

"The only way to achieve this goal will be to extend the cardiovascular disease control successes of the high-income world to low- and middle-income countries," adds Moran. "In some cases, this may mean adapting past successful programs; in other cases, locally tailored and innovative approaches will be needed."

Keywords: Myocardial Ischemia, Stroke, Life Expectancy, World Health Organization, Risk Factors, Developing Countries, Smoking, Heart Diseases, Mortality, Premature, Tobacco, Population Growth, Obesity, Sedentary Behavior, Diet, Hypertension, Quality-Adjusted Life Years