World Heart Report 2023
World Heart Federation Report 2023:
CARDIOVASCULAR DISEASE: Worlds Number 1 Killer.
Full article\report located at: https://world-heart-federation.org/wp-content/uploads/World-Heart-Report-2023.pdf
https://world-heart-federation.org/
Features:
Definition: Cardiovascular diseases (CVDs) affect the heart or blood vessels and can be caused by a combination of socio-economic, metabolic, behavioural, and environmental risk factors. These include high blood pressure, unhealthy diet, high cholesterol, diabetes, air pollution, obesity, tobacco use, kidney disease, physical inactivity, harmful use of alcohol and stress.
For decades, CVDs have been the leading cause of death globally. In 2021, 20.5 million people died from a cardiovascular condition, a figure that accounted for around one-third of all global deaths and was a significant increase from the 12.1 million CVD deaths recorded in 1990. Ischaemic heart disease is now the leading cause of premature death in 146 countries for men and 98 countries for women
Global progress against cardiovascular disease (CVD) is flatlining. Though rates of CVD deaths globally have fallen in the last three decades, this trend has begun to stall and, without concerted efforts, is at risk of reversing.
More than half a billion people around the world continue to be affected by cardiovascular diseases, which accounted for 20.5 million deaths in 2021 – close to a third of all deaths globally and an overall increase on the estimated 121 million CVD deaths.
Up to 80% of premature heart attacks and strokes can be prevented. The world has the tools and knowledge to mitigate harms to cardiovascular health, particularly with the advances in cardiovascular medicine in the last 50 years. But too often the tools that can help diagnose, prevent, and treat CVDs are not benefitting the communities who need them most. Around 4 in every 5 CVD deaths occur in low- and middle-income countries and progress in cardiovascular health is increasingly concentrated in High-Income countries - a glaring health inequity that must urgently be addressed.
There is no one-size-fits-all approach to improving cardiovascular health globally. Every population is susceptible to different risk factors based on where they live and their lifestyles. Whether that’s having higher prevalence of tobacco and alcohol use and higher sodium intake or being more exposed to dangerous levels of air pollution and having lower levels of physical activity. This means that decision makers and stakeholders must look closely at the risk factor prevalence in their countries and regions to fully understand what policy areas need more focus to get CVD health moving in the right direction
Primary Risk factors for cardiovascular diseases
a) Physical activity (lack thereof)
b) Sodium intake
c) Alcohol consumption
d) Tobacco smoking
e) Obesity
f) Raised blood pressure
g) Diabetes – 1 in 11 Adults are affected by Type 2 diabetes worldwide: Type 2 diabetes mellitus is a major global health threat. It affects 425 million people with the overall figure predicted to rise to 629 million by 2045, and accounts for approximately 90% of all patients with diabetes. All of those living with diabetes are at heightened risk of CVD making the prevention of CVD onset a major priority. In 2015, the global economic burden of type 2 diabetes mellitus was estimated to be $1.3 trillion, or 1.8% of the global GDP; and it is estimated that this burden will increase to $2.1 – $2.5 trillion by 2030. Twelve percent of global health expenditure is spent on diabetes ($727 billion). Despite the high prevalence and burden of diabetes worldwide, diagnosis and treatment continue to fall behind required levels.
h) Lipids
i) Ambient air pollution
KEY FINDINGS
CVD mortality
• CVDs are the leading cause of mortality and amount to about a third of all global deaths.
• The estimated number of deaths due to CVDs globally increased from around 12.1 million in 1990 (equally distributed between males and females) to 18.6 million (9.6 million males and 8.9 million females) in 2019.
• While the number of deaths due to CVDs over the last 30 years has increased globally—in large part due to an ageing and growing population—the age-standardised death rate has declined by one third, from 354.5 deaths per 100,000 people in 1990 to 239.9 deaths per 100,000 people in 2019. This decline has slowed in recent years and is beginning to stall in some regions.
• The decline in death rates for CVDs has been much faster in High-Income countries (HICs) compared to low- and middle-income countries (LMICs), where more than 80% of CVD deaths occur globally. The world is far from achieving the equitable distribution of prevention, diagnosis, and treatment of CVDs.
• In 2019, for females, no region, other than Latin America and the Caribbean, had registered a decline in the CVD death rate to the level registered in the High-Income region in 1990.
• The highest levels of age-standardised CVD death rates occur in the Central Europe, Eastern Europe, and Central Asia region and the North-Africa and Middle East region.
• Ischaemic heart disease is the leading cause of CVD mortality in all regions except for females in Sub-Saharan Africa and for both males and females in South Asia (where stroke is the main cause).
• In most regions, age-standardised CVD death rates are higher in males than in females; however, in a large proportion of West African countries, females are at a higher risk of dying due to CVD than males.
• There is a correlation between lower expenditure on health as a percentage of GDP and higher CVD mortality. In addition, the higher the proportion of out-of-pocket expenditure for health, the higher the CVD mortality.
CVD risk factors
• Raised blood pressure is the leading CVD risk factor globally and contributed to about 10.8 million deaths in 2021.
• Most CVD risk factors, including physical inactivity, alcohol consumption, tobacco smoking, raised blood pressure, and diabetes are higher in males in comparison to females. Obesity is the only risk factor that is higher in females.
• The distribution of CVD risk factors varies markedly by region. For example, countries in the Sub-Saharan Africa region are among those with the highest prevalence of raised blood pressure, while countries in the Southeast Asia, East Asia and Oceania region have among the highest sodium consumption and prevalence of diabetes. Countries in South Asia are among those with the highest levels of ambient air pollution.
• The distribution of CVD risk factors varies by sex. For example, for males the prevalence of smoking is highest in the Southeast Asia, East Asia, and Oceania region while for females it is highest in the High-Income region. The North Africa and Middle East region had the highest prevalence of obesity for females and the Southeast Asia, East Asia, and Oceania had the highest for males. Non-HDL levels are highest in the Central Europe, Eastern Europe and Central Asia region for males and females.
WHF Policy Index
• The WHF Policy Index showed that the lowest implementation of key policies for improving CVD health is in the Sub-Saharan Africa region, where over 50% of the countries do not have availability of CVD drugs in public health facilities, a CVD National Plan or an NCD Unit.
• Globally, 106 countries (64% of 166 countries with available information), have implemented at least 7 of the 8 policies.
• The largest proportion of countries with the maximum score (8) were in the South Asia region (80%), the Central Europe, Eastern Europe, and Central Asia region (68%), and the High-Income (62%) region.
KEY RECOMMENDATIONS
All countries and stakeholders must urgently unite to accelerate efforts on improving CVD health and get progress back on track so that Sustainable Development Goal 3.4 of reducing by one-third premature mortality from NCDs can be achieved. This goal aligns with the World Heart Federation’s (WHF) World Heart Vision 2030.
To help promote action at every level against CVDs, WHF recommends the following, which are complementary to other key recommendations included in recent policy briefs and reports:
1. Countries and other relevant stakeholders should continue efforts to improve data for CVDs and their risk factors, particularly in LMICs where data gaps exist. This will help to understand why certain populations are at higher risk for certain CVDs.
2. Countries should ensure that their health expenditure as a percentage of GDP is at least 5%, in line with recommendations from the World Health Organization.
3. Countries should implement policies to combat CVDs, guided by the burden of disease and predominant risk factors, and ensure that their implementation is adequately resourced and monitored for progress.
4. As a matter of urgency, countries should prioritise coverage of interventions for the prevention and management of CVDs in Universal Health Coverage (UHC) benefit packages to help minimize out-of-pocket expenditure.
5. Lessons-learned in improving CVD prevention, management and improved access to care and therapies need to be implemented across all regions to address inequities and the uneven progress in CVD mortality declines.