Nrcardio 2012 194

RESEARCH HIGHLIGHTS
Nature Reviews Cardiology 10, 59 (2013); published online 8 January 2013; doi:10.1038/nrcardio.2012.194
PUBLIC HEALTH
Global burden of cardiovascular disease

The Global Burden of Disease Study 2010, with age. The overall burden was similar
published in seven articles in the Lancet, around the world, but regional disparity
“is the largest ever systematic effort to in the underlying disease might exist. For
describe the global distribution and causes example, 37.7 million cases of heart failure
of a wide array of major diseases”. The were associated with 4.2 million YLDs;
executive summary goes on to state that however, ischaemic heart disease and
“infectious diseases, maternal and child chronic obstructive pulmonary disease
illness, and malnutrition now cause were leading causes of YLDs in developed
fewer deaths and less illness regions, whereas hypertensive heart disease,
than they did 20 years ago rheumatic heart disease, cardiomyopathy,
... as noncommunicable and myocarditis were larger contributors in
diseases, such as cancer and some developing areas, especially in Africa.
heart disease, become the In a fourth paper, the investigators
© Zoonar | Thinkstock
dominant causes of death identified ischaemic heart disease as the
and disability worldwide”. The leading cause of global DALYs in 2012, an
investigators collated and analysed leading causes of death in increase of 29% from fourth rank in 1990.
a prodigious quantity of data and modelled 2010 were ischaemic heart disease (13.3%) Stroke increased by 19% over this period,
the numbers of years lived with disability and stroke (11.1%), but the proportion of and was the third-leading cause of DALYs in
(YLDs), years of life lost (YLLs), and deaths deaths for which these conditions were 2010. Of the 2.49 billion DALYs, 54% were
and disability-adjusted life years (DALYs— responsible had increased from one‑fifth attributable to noncommunicable diseases,
the combination of YLDs and YLLs) for a to one‑quarter over the 2 decades. The 11.8% of which resulted from cardiovascular
comprehensive range of ages and countries. number of global YLLs from ischaemic heart disease (5.2% ischaemic heart disease, 2.5%
In 2010, four of the five leading risk disease and stroke increased by 28% and haemorrhagic stroke, 1.6% ischaemic stroke,
factors for disease—high blood pressure, 17%, respectively, over the 20‑year period, and 0.6% hypertensive heart disease).
tobacco smoking including second-hand resulting in these conditions becoming The Global Burden of Disease Study
smoke, alcohol use, and diets low in fruits— the first and third causes of YLLs. Deaths 2010 provides a plethora of epidemiological
were recognized causes of adult chronic attributed to atrial fibrillation or flutter data. “Public policy to improve the health
disease, particularly cardiovascular diseases. increased by 233.9%. of populations will be more effective if
These risk factors were estimated to be Again, the data reflect a global transition it addresses the major causes of disease
responsible for 7.0%, 6.3%, 5.5%, and 4.2% in diseases, with important regional burden,” conclude the researchers. “Even
of global DALYs, respectively. By contrast, heterogeneity. Substantial mortality from small reductions of ... exposure to large
in 1990, high blood pressure ranked as the infectious diseases (diarrhoeal illnesses, risks will yield substantial health gains.”
fourth-highest cause of DALYs, behind HIV/AIDS, and malaria) persists in most
being underweight during childhood, of sub-Saharan Africa, compared with a Gregory B. Lim
household air pollution, and smoking. predominance of cardiovascular diseases
The rise in cardiovascular risk factors and cancers elsewhere. In the Middle Original articles Lim, S. S. et al. A comparative risk
between 1990 and 2010 is indicative of a East and North Africa, reports Dr Nizal assessment of burden of disease and injury attributable
global epidemiological transition, but masks Sarrafzadegan from Isfahan, Iran, “there to 67 risk factors and risk factor clusters in 21 regions,
1990–2010: a systematic analysis for the Global Burden
important regional disparities. In general, is a big transition from communicable to
of Disease Study 2010. Lancet 380, 2224–2260 (2012) |
high blood pressure, tobacco smoking, noncommunicable diseases. Cardiovascular Lozano, R. L. et al. Global and regional mortality from 235
alcohol use, and elevated BMI ranked highly diseases are [now] the main reason for causes of death for 20 age groups in 1990 and 2010: a
as risk factors throughout North and South mortality and morbidity ... in this region.” systematic analysis for the Global Burden of Disease Study
America, Europe, and the Asia–Pacific, The researchers also estimated the YLDs 2010. Lancet 380, 2095–2128 (2012) | Vos, T. et al.
but being underweight during childhood, as a consequence of 1,160 sequelae from Years lived with disability (YLDs) for 1160 sequelae of
289 diseases and injuries 1990–2010: a systematic
household air pollution from solid fuels, 289 diseases. The main contributors to analysis for the Global Burden of Disease Study 2010.
suboptimal breast feeding, and iron global YLDs were mental and behavioural, Lancet 380, 2163–2196 (2012) | Murray, C. J. L. et al.
deficiency remained leading causes musculoskeletal, and diabetic or endocrine Disability-adjusted life years (DALYs) for 291 diseases and
of disease in most regions of Africa. disorders. Cardiovascular and circulatory injuries in 21 regions, 1990–2010: a systematic analysis
Globally, 52.8 million deaths were diseases accounted for only 2.8% of all YLDs, for the Global Burden of Disease Study 2010. Lancet 380,
2197–2223 (2012)
recorded in 2010. As in 1990, the two but their importance increased progressively
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RESEARCH HIGHLIGHTS

Global burden of cardiovascular disease

NATURE REVIEWS | CARDIOLOGY VOLUME 10 | FEBRUARY 2013

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