2022 Report on Global Burden of Cardiovascular Diseases and Risk Published

December 12, 2022—The American College of Cardiology (ACC) announced the publication of “The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health,” an almanac-style special issue of the Journal of the American College of Cardiology (JACC). 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.

ACC stated that the document—by Gregory A. Roth, MD; George A. Mensah, MD; Valentin Fuster, MD; et al—looks at 18 specific cardiovascular (CV) conditions and 15 risk factors across 21 global regions to provide a broad view of the global burden of CV disease (CVD), which remains the leading cause of death across the globe. The report’s introduction in JACC was authored by Muthiah Vaduganathan, MD, et al (2022;80;2361-2371). The summary of the study methods is also published in JACC (2022;80:2372-2425).

The 2022 publication, which is an update to “The Global Burden of Diseases, Injuries, and Risk Factors Study 2019,” includes data from 204 countries and territories, highlighting the leading global modifiable CV risk factors, their contribution to disease burden, and recent prevention advancements.

According to ACC, CVD rates are high globally with Central Asia and Eastern Europe estimated to have the highest rates of CVD mortality. High blood pressure, high cholesterol, dietary risks, and air pollution were the leading causes of CVD worldwide.

The ACC advised that the investigators assessed deaths using vital and sample registration data and produced estimates for the 15 leading risks for CV diseases in three categories: environmental (air pollution, household air pollution, lead exposure, low temperature, high temperature); metabolic (systolic blood pressure, low-density lipoprotein cholesterol, body mass index, fasting plasma glucose, kidney dysfunction); and behavioral (dietary, smoking, secondhand smoke, alcohol use, physical activity).

The CVD 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 because of premature mortality, and years lived with disability.

As summarized by ACC, the report’s key findings include:

• Ischemic heart disease is the leading cause of CV death, accounting for 9.44 million deaths in 2021 and 185 million DALYs.
• High systolic blood pressure remains the leading modifiable risk factor for premature CV deaths, accounting for 10.8 million CV deaths and 11.3 million deaths overall in 2021. The all-cause DALYs attributed to high blood pressure were 2,770 per 100,000 people.
• Dietary risks accounted for 6.58 million CV 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 attributed 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 CVD burden attributable to elevated systolic blood pressure. The regions with the highest rates of CVD burden attributable to dietary risk were Central Asia, Oceania, and Eastern Europe.
• Central Asia had the highest age-standardized total CVD mortality at 516.9 deaths per 100,000. In contrast, high-income Asia Pacific had the lowest age-standardized total CVD mortality at 76.6 deaths per 100,000 people.
• Since 1990, Australasia had the largest percent reduction (64.2%) in age-standardized CVD per 100,000 out of all other regions. This percent decrease was highest in ischemic heart disease at 71.8%.

Dr. Roth, who is senior author of the paper, commented in the ACC press release, “We need to keep shining a light on the current state of CV health across the globe. CV health has a major impact on our quality of life and the health care system as a whole.” He continued, “Over 80% of CVD 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.” Dr. Roth is Associate Professor in the Division of Cardiology and Director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, Washington.

Dr. Fuster, who is editor-in-chief of JACC as well as coauthor of the report, stated in the press release, “It is truly exciting to see this multi-year Global Burden of Cardiovascular Diseases Collaboration culminate into a dedicated issue of the JACC to inform the global CV community. This issue focuses both on the modifiable risk factors, as well as the global CVD and death rates in 21 regions across the world.” Dr. Fuster is Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital in New York, New York.

Dr. Mensah, added, “This visual atlas serves as a timely reminder about the importance of modifiable risk factors for heart disease, like high blood pressure. Deaths due to hypertension have steadily increased in the United States for the past 20 years, which mirrors trends in other regions and leaves researchers eager to find practical and innovative solutions. Of really great concern is the finding that high blood pressure control rates have progressively declined in the United States over the last decade.” Dr. Mensah is director of the Center for Translation Research and Implementation Science at the National Heart, Lung, and Blood Institute in Bethesda, Maryland.