Original Investigation
Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

https://doi.org/10.1016/j.jacc.2017.04.052Get rights and content
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Abstract

Background

The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.

Objectives

The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.

Methods

CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.

Results

In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75.

Conclusions

CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.

Key Words

cause of death
epidemiology
global health

Abbreviations and Acronyms

CVD
cardiovascular disease
DALY
disability-adjusted life-year
IHD
ischemic heart disease
PAD
peripheral arterial disease
RHD
rheumatic heart disease
SDI
sociodemographic index
UI
uncertainty interval
YLD
years lived with disability
YLL
years of life lost

Cited by (0)

The Institute for Health Metrics and Evaluation received funding from the Bill & Melinda Gates Foundation. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Dr. Ärnlöv has received lecturing fees from AstraZeneca. Dr. Fowkes has served on the advisory boards of AstraZeneca, Merck, and Bayer. Dr. Hankey has received honoraria from Bayer for lecturing at sponsored scientific symposia about stroke prevention in atrial fibrillation. Dr. Khubchandani has received research funding from Merck Laboratories. Dr. Lotufo has received honoraria from Amgen Brazil and AbbVie Brazil. Dr. Rahimi’s research is supported by grants from the National Institute for Health Research Oxford Biomedical Research Centre, National Institute for Health Research Career Development Fellowship, and Oxford Martin School. Dr. Schutte is a speaker to general practitioners and cardiologists on hypertension guidelines (funded by Boehringer Ingelheim), to cardiologists on health behaviors and cardiovascular diseases (funded by Novartis), and to nurses and pharmacists on arterial stiffness and blood pressure (funded by Omron Healthcare and I.E.M.). Dr. Watkins is funded by Medtronic Foundation through support to RhEACH and RHD Action, and by the Disease Control Priorities Network grant from the Bill and Melinda Gates Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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© 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.