CARDIOVASCULAR DISEASES IN THE CONTEXT OF GLOBAL HEALTH
Cardiovascular diseases (CVDs) are the most common cause of premature death in the world. Although there has been a steady decrease in mortality rates for CVDs beginning in the last third of the 20th century for high-income countries, many low- and middle-income countries (LMICs) have not benefited from this favorable trend. As a result, in 2013 more than 17 million people died from CVDs, and as a result of the large populations in many LMICs, nearly 70% of CVD deaths occurred in LMICs and 50% were in women. CVDs account for 50% of all noncommunicable disease (NCD) deaths in the world each year and represent a significant threat to human welfare and sustainable development. CVDs are the leading cause of death in every region of the world, with the exceptions of sub-Saharan Africa—where infectious diseases are still the leading cause of death—and South Korea and Japan, where cancers cause more deaths.
Despite this profound health burden, CVD has until recently been left out of the global health agenda by governments, development aid agencies, and foundations. Development aid for health for all NCDs taken together was no more than 2% of all aid funds delivered in 2014.1 Recently, there has been an increased global focus on NCD prevention and control. An international effort to address the burden of CVD was proposed at the 66th World Health Assembly and was endorsed by the World Health Organization (WHO). The WHO Global Action Plan for the Prevention and Control of NCDs (2013-2020) (resolution WHA66.10) stands as the first coordinated global effort toward the reduction of NCDs, including CVDs, cancer, chronic lung disease, and diabetes mellitus. The Global Action Plan is a paradigm shift for global health efforts, bringing broad attention to NCDs while simultaneously providing policy options for WHO member states. Member states have now agreed to meet nine NCD health and policy targets by 2025. These targets include a reduction in premature mortality from each NCD by 25% by 2025 as well as implementation of a monitoring framework with 25 indicators to track mortality and morbidity, assess progress in addressing risk factors, and evaluate the implementation of nation strategies and plans.2
This chapter is an introduction to the global burden of CVDs, aimed at health care providers and students, public health researchers, epidemiologists, and policymakers seeking to better understand this field. This overview emphasizes cause-specific and region-specific trends and associated risk factors as estimated for the Global Burden of Disease (GBD) study.3 GBD is an ongoing effort to compile, catalog, and integrate all available information for over a thousand disease states. GBD is a consortium of more than 1500 researchers in 120 countries working to produce annual estimates and collaborating with governments to implement evidence-based policies to improve health.
We provide an overview of trends in CVD starting with its two largest components, ischemic heart disease ...