It Is Time for Reducing Global Cardiovascular Mortality
Authors: Lisandro D. Colantonio, Paul Muntner
Journal: Circulation (2019)

It Is Time for Reducing Global Cardiovascular MortalityArticle, see p 715 I t has been known for many decades that cardiovascular disease (CVD) is the leading cause of death in high-income countries.However, it wasn't until the 1990 GBD (Global Burden of Disease) study that it became recognized that CVD is the leading cause of death worldwide, both in high-and low-income populations. 1,2This study estimated that ischemic heart disease and cerebrovascular disease accounted for 5.7 and 4.6 million deaths worldwide, respectively, in 1990. 2 These data corrected a perception that noncommunicable diseases were primarily diseases of affluent populations and stressed the need for addressing them in all world regions.After this first report, there have been subsequent waves of the GBD study that have continued to highlight a high, and growing, global burden of CVD.For example, the GBD study estimated that between 1990 and 2013, deaths attributable to ischemic heart disease and cerebrovascular disease increased by 42% and 41%, respectively, with approximately 70% of all CVD deaths worldwide in 2013 having occurred in low-or middle-income countries. 2Additionally, it has been estimated that CVD will account for >23 million deaths by 2030. 3 Despite being the leading cause of mortality worldwide, CVD is largely preventable through simple and inexpensive interventions.In the current issue of Circulation, Kontis et al 4 report on a study that estimated the number of deaths from CVD and other non-communicable diseases between 2015 and 2040 that could be delayed worldwide through the implementation of 3 population-based interventions:(1) scaling up treatment of high blood pressure to 70%, (2) reducing sodium intake by 30%, and (3) eliminating intake of artificial trans fatty acids.The authors used global surveys to derive data on current estimates and projected trends in systolic blood pressure and intake of sodium and trans fatty acids by country.Current estimates and trends in antihypertensive treatment coverage were derived from a meta-analysis of observational studies, whereas age-and sex-specific mortality from noncommunicable diseases were obtained from the World Health Organization Global Health Estimates.The effect of the 3 interventions on mortality attributable to CVD, kidney disease, and stomach cancer were modeled based on relative risks from meta-analyses of observational studies and clinical trials, accounting for both the level of the exposure and the time since the intervention was implemented.The authors also considered the joint effect of the interventions in their analysis.Kontis et al estimated that the implementation of the 3 population-based interventions could delay 94.3 (95% CI, 85.7-102.7) million deaths by 2040, 90.7% of them from CVD.This represents 7.7% of all deaths attributable to noncommunicable diseases worldwide.Increasing the coverage of treatment for high blood pressure to 70%, achieving a 30% reduction in sodium intake, and eliminating trans fatty acids intake was estimated to delay 39.4 (95% CI, 35.9-43.0),40.0 (95% CI,