Gregory A Roth1, Grant Nguyen2, Mohammad H Forouzanfar2, Ali H Mokdad2, Mohsen Naghavi2, Christopher J L Murray2. 1. From Division of Cardiology, Department of Medicine and Institute for Health Metrics and Evaluation (G.A.R.), and Institute for Health Metrics and Evaluation (G.N., M.H.F., A.H.M., M.N., C.J.L.M.), University of Washington, Seattle. rothg@uw.edu. 2. From Division of Cardiology, Department of Medicine and Institute for Health Metrics and Evaluation (G.A.R.), and Institute for Health Metrics and Evaluation (G.N., M.H.F., A.H.M., M.N., C.J.L.M.), University of Washington, Seattle.
Abstract
BACKGROUND: United Nations member states have agreed to reduce premature cardiovascular disease (CVD) mortality 25% by 2025. Global CVD risk factor targets have been recommended. We produced estimates to show how selected risk factor reduction would affect CVD mortality for different regions and countries. METHODS AND RESULTS: We used mortality, risk factor, and relative risk data from the Global Burden of Disease, Risk Factors, and Injuries (GBD) 2013 study to project CVD mortality for 188 countries up to the year 2025. We disaggregated observed CVD mortality in 1990 and 2013 into deaths attributable and unattributable to hypertension, tobacco smoking, diabetes mellitus, and obesity using an age- and sex-specific population-attributable fraction. Risk factors were projected to 2025 assuming that current trends continue. Counterfactual scenarios were then constructed reflecting CVD premature mortality if United Nations risk factor targets are achieved in the year 2025, adjusting for joint effects of risk factors. We estimate 7.8 million premature CVD deaths in 2025 if current risk factor trends continue. Premature CVD deaths would be reduced to 5.7 million if these risk factors targets are achieved as a result of a 26% reduction for men and a 23% reduction for women in the global risk of premature CVD death. Globally, decreasing the prevalence of hypertension accounted for the largest risk reduction, followed by a reduction in tobacco smoking for men and obesity for women, but these results varied by region. The impact of meeting all risk factor targets on CVD mortality varied widely by region and sex. CONCLUSIONS: The United Nations target of a 25% reduction in premature CVD mortality by the year 2025 appears achievable for some countries, but more aggressive risk factor targets may be required if all regions are to reach this goal. Without these reductions in CVD risk factors, many countries will see no change or even an increase in premature CVD mortality.
BACKGROUND: United Nations member states have agreed to reduce premature cardiovascular disease (CVD) mortality 25% by 2025. Global CVD risk factor targets have been recommended. We produced estimates to show how selected risk factor reduction would affect CVD mortality for different regions and countries. METHODS AND RESULTS: We used mortality, risk factor, and relative risk data from the Global Burden of Disease, Risk Factors, and Injuries (GBD) 2013 study to project CVD mortality for 188 countries up to the year 2025. We disaggregated observed CVD mortality in 1990 and 2013 into deaths attributable and unattributable to hypertension, tobacco smoking, diabetes mellitus, and obesity using an age- and sex-specific population-attributable fraction. Risk factors were projected to 2025 assuming that current trends continue. Counterfactual scenarios were then constructed reflecting CVD premature mortality if United Nations risk factor targets are achieved in the year 2025, adjusting for joint effects of risk factors. We estimate 7.8 million premature CVD deaths in 2025 if current risk factor trends continue. Premature CVD deaths would be reduced to 5.7 million if these risk factors targets are achieved as a result of a 26% reduction for men and a 23% reduction for women in the global risk of premature CVD death. Globally, decreasing the prevalence of hypertension accounted for the largest risk reduction, followed by a reduction in tobacco smoking for men and obesity for women, but these results varied by region. The impact of meeting all risk factor targets on CVD mortality varied widely by region and sex. CONCLUSIONS: The United Nations target of a 25% reduction in premature CVD mortality by the year 2025 appears achievable for some countries, but more aggressive risk factor targets may be required if all regions are to reach this goal. Without these reductions in CVD risk factors, many countries will see no change or even an increase in premature CVD mortality.
Authors: Andrea Ruiz-Alejos; Rodrigo M Carrillo-Larco; J Jaime Miranda; Robert H Gilman; Liam Smeeth; Antonio Bernabé-Ortiz Journal: Public Health Nutr Date: 2019-06-04 Impact factor: 4.022
Authors: Ali H Mokdad; Katherine Ballestros; Michelle Echko; Scott Glenn; Helen E Olsen; Erin Mullany; Alex Lee; Abdur Rahman Khan; Alireza Ahmadi; Alize J Ferrari; Amir Kasaeian; Andrea Werdecker; Austin Carter; Ben Zipkin; Benn Sartorius; Berrin Serdar; Bryan L Sykes; Chris Troeger; Christina Fitzmaurice; Colin D Rehm; Damian Santomauro; Daniel Kim; Danny Colombara; David C Schwebel; Derrick Tsoi; Dhaval Kolte; Elaine Nsoesie; Emma Nichols; Eyal Oren; Fiona J Charlson; George C Patton; Gregory A Roth; H Dean Hosgood; Harvey A Whiteford; Hmwe Kyu; Holly E Erskine; Hsiang Huang; Ira Martopullo; Jasvinder A Singh; Jean B Nachega; Juan R Sanabria; Kaja Abbas; Kanyin Ong; Karen Tabb; Kristopher J Krohn; Leslie Cornaby; Louisa Degenhardt; Mark Moses; Maryam Farvid; Max Griswold; Michael Criqui; Michelle Bell; Minh Nguyen; Mitch Wallin; Mojde Mirarefin; Mostafa Qorbani; Mustafa Younis; Nancy Fullman; Patrick Liu; Paul Briant; Philimon Gona; Rasmus Havmoller; Ricky Leung; Ruth Kimokoti; Shahrzad Bazargan-Hejazi; Simon I Hay; Simon Yadgir; Stan Biryukov; Stein Emil Vollset; Tahiya Alam; Tahvi Frank; Talha Farid; Ted Miller; Theo Vos; Till Bärnighausen; Tsegaye Telwelde Gebrehiwot; Yuichiro Yano; Ziyad Al-Aly; Alem Mehari; Alexis Handal; Amit Kandel; Ben Anderson; Brian Biroscak; Dariush Mozaffarian; E Ray Dorsey; Eric L Ding; Eun-Kee Park; Gregory Wagner; Guoqing Hu; Honglei Chen; Jacob E Sunshine; Jagdish Khubchandani; Janet Leasher; Janni Leung; Joshua Salomon; Jurgen Unutzer; Leah Cahill; Leslie Cooper; Masako Horino; Michael Brauer; Nicholas Breitborde; Peter Hotez; Roman Topor-Madry; Samir Soneji; Saverio Stranges; Spencer James; Stephen Amrock; Sudha Jayaraman; Tejas Patel; Tomi Akinyemiju; Vegard Skirbekk; Yohannes Kinfu; Zulfiqar Bhutta; Jost B Jonas; Christopher J L Murray Journal: JAMA Date: 2018-04-10 Impact factor: 56.272