Cardiovascular disease remains the leading cause of death across the globe, according to a new “almanac”-style special issue of JACC published Dec. 12. The issue, which looks at data addressing 18 specific cardiovascular conditions and 15 risk factors from 204 countries and territories, highlights the leading global modifiable cardiovascular risk factors, their contribution to disease burden and recent prevention advancements.

“It is truly exciting to see this multi-year Global Burden of Cardiovascular Diseases Collaboration culminate into a dedicated issue of the Journal to inform the global cardiovascular community,” said JACC Editor-in-Chief Valentin Fuster, MD, PhD, MACC. “This issue focuses both on the modifiable risk factors, as well as the global cardiovascular disease and death rates in 21 regions across the world.”

Serving as an update to “The Global Burden of Diseases, Injuries, and Risk Factors Study 2019,” the 2022 publication is intended to provide a broad view of the global burden of cardiovascular disease. The report assesses deaths using vital and sample registration data and provides estimates for the 15 leading environmental (air pollution, household air pollution, lead exposure, low temperature, high temperature), metabolic (systolic blood pressure, LDL-cholesterol, body mass index, fasting plasma glucose, kidney dysfunction) and behavioral (dietary, smoking, secondhand smoke, alcohol use, physical activity) risks for cardiovascular diseases. Additionally, cardiovascular disease mortality rates are broken down by location, along with age, sex and time categories since 1990. The report also looked at disability-adjusted life years (DALYs), the years of life lost due to premature mortality, and years lived with disability.

“We need to keep shining a light on the current state of cardiovascular health across the globe. Cardiovascular health has a major impact on our quality of life and the health care system as a whole,” said Gregory A. Roth, MD, MPH, FACC, senior author of the paper. “Over 80% of cardiovascular disease is preventable. With this update, we are measuring some alarming global trends and reviewing the current interventions that can help countries make good, evidence-based choices for their health systems.”

Key takeaways from the report include:

• While cardiovascular disease rates are high globally, Central Asia and Eastern Europe were estimated to have the highest rates of cardiovascular disease mortality.
  
  
• Ischemic heart disease is the leading cause of cardiovascular death, accounting for 9.44 million deaths in 2021 and 185 million DALYs.
  
  
• High blood pressure, high cholesterol, dietary risks and air pollution are among the leading causes of cardiovascular disease worldwide.
  
  
• High systolic blood pressure remains the leading modifiable risk factor for premature cardiovascular deaths, accounting for 10.8 million cardiovascular disease deaths and 11.3 million deaths overall in 2021. The all-cause DALYs due to high blood pressure were 2,770 per 100,000 people. Of note, hypertension control rates in the U.S. have progressively declined in the U.S.
  
  
• Dietary risks accounted for 6.58 million cardiovascular disease deaths and 8 million deaths overall in 2021. Dietary risks include food types that are under-consumed globally (fruits, vegetables, legumes, whole grains, nuts and seeds, milk, fiber, calcium, omega-3 fatty acids and poly unsaturated fatty acids) and over-consumed (red and processed meats, sugar-sweetened beverages, trans-fatty acids and sodium). All-cause DALYs due to dietary risks were 2,340 per 100,000 people.
  
  
• Central Asia, Central Sub-Saharan Africa and Eastern Europe were the regions with the highest rates of cardiovascular disease burden attributable to elevated systolic blood pressure. The regions with the highest rates of cardiovascular disease burden attributable to dietary risk were Central Asia, Oceania and Eastern Europe.
  
  
• Central Asia had the highest age-standardized total cardiovascular disease mortality at 516.9 deaths per 100,000. In contrast, high-income Asia Pacific had the lowest age-standardized total cardiovascular disease mortality at 76.6 deaths per 100,000 people.
  
  
• Since 1990, Australasia had the largest percent reduction (64.2%) in age-standardized cardiovascular disease per 100,000 out of all other regions. This percent decrease was highest in ischemic heart disease at 71.8%.

“This visual atlas serves as a timely reminder about the importance of modifiable risk factors for heart disease, like high blood pressure,” said George A. Mensah, MD, FACC, an author of the paper and director of the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute. “Deaths due to hypertension have steadily increased in the U.S. for the past 20 years, which mirrors trends in other regions and leaves researchers eager to find practical and innovative solutions.”

The Global Burden of Cardiovascular Diseases Collaboration is an alliance between JACC, the Institute for Health Metrics and Evaluation, and the National Heart, Lung, and Blood Institute.

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Exercise, Hypertension, Smoking

Keywords: Secondary Prevention, ACC International, Kidney, Smoking, Fatty Acids, Omega-3, Delivery of Health Care, Exercise, Myocardial Ischemia, Hypertension, Heart Disease Risk Factors, Cost of Illness, Air Pollution, Risk Factors, Milk, Global Burden of Disease, Cause of Death, Cholesterol, Dietary, Quality Indicators, Health Care, Cholesterol, LDL, Sugar-Sweetened Beverages, Sodium, Fabaceae, Tobacco Smoke Pollution, Implementation Science, Quality of Life, Whole Grains, Body Mass Index, Air Pollutants, Mortality, Premature, Lead, Calcium, Blood Glucose, Blood Pressure, Trans Fatty Acids, Vegetables, Cardiovascular Diseases

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