Prevention of premature cardiovascular death worldwide

• Published in: The Lancet (British edition) Vol. 395; no. 10226; pp. 758 - 760
• Main Authors: Read, Stephanie H, Wild, Sarah H
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 07-03-2020; Elsevier Limited
• Subjects: Aging; Air pollution; Cardiovascular disease; Cardiovascular Diseases; Cause of Death; Developed countries; Diabetes; Disease prevention; Economic development; Health care; Health risk assessment; Humans; Hypertension; Income; Life expectancy; Life span; Low income areas; Mortality; Mortality, Premature; Population growth; Population number; Prevention; Prospective Studies; Risk analysis; Risk Factors; Middle East; Africa
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(19)32034-3

Life expectancy is increasing in some countries and declining in others.1 Age-standardised cardiovascular disease incidence and mortality are declining in many populations, with more marked declines in more developed countries.2 However, more people die each year from cardiovascular disease than any other cause, with 31% of global deaths attributed to cardiovascular disease, partly as a consequence of increasing population size and ageing.3 Risk factor prevalence and the strength of associations between risk factors and cardiovascular disease and mortality are reasonably well described in high-income countries (HICs), but data for middle-income countries (MICs) and low-income countries (LICs) are more scarce. The WHO “STEPwise approach to surveillance” facilitates collection of comparable information on risk factor prevalence across countries but does not investigate associations with outcomes.4 The Global Burden of Disease Study provides national, regional, and global estimates of the burden of cardiovascular disease by modelling available data from heterogeneous sources over a wide time frame.1,2 It uses extensive extrapolation to cover countries for which data are not available, and most of these countries are LICs and MICs. The findings from the PURE study5 that indicate a large proportion of cardiovascular disease events and mortality can be attributed to a small number of modifiable risk factors are consistent with and extend the findings from several other large studies, including the Global Burden of Disease,2 INTERSTROKE,6 and INTERHEART studies.7 Taken together, the findings highlight the potential for further improvements in prevention of cardiovascular disease and premature mortality across the globe, through reductions in modifiable risk factors.