An estimated 16.7 million - or 29.2% of total global deaths - result from the various forms of cardiovascular disease (CVD), many of which are preventable by action on the major primary risk factors: unhealthy diet, physical inactivity, and smoking. More than 50% of the deaths and disability from heart disease and strokes, which together kill more than 12 million people each year, can be cut by a combination of simple, cost-effective national efforts and individual actions to reduce major risk factors such as high blood pressure, high cholesterol, obesity and smoking.
And these are no longer only diseases of the developed world: some 80% of all CVD deaths worldwide took place in developing, low and middle-income countries, while these countries also accounted for 86% of the global CVD disease burden. It is estimated that by 2010, CVD will be the leading cause of death in developing countries.
The major CVDs include:
Of the 16.7 million deaths from CVDs every year, 7.2 million are due to ischaemic heart disease, 5.5 million to cerebrovascular disease, and an additional 3.9 million to hypertensive and other heart conditions. As well, at least 20 million people survive heart attacks and strokes every year, a significant proportion of them requiring costly clinical care, which puts a huge burden on long-term care resources. CVD affects people in their mid-life years, undermining the socioeconomic development, not only of affected individuals, but families and nations. Lower socieconomic groups generally have a greater prevalence of risk factors, diseases and mortality in developed countries, and a similar pattern is emerging as the CVD epidemic matures in developing countries.
The time lag effect of risk factors for CVD means that the full effect of past exposure to behavioural risk factors, especially among children, will only be seen in the future. Unless preventive and management efforts are embraced worldwide, the global burden of CVD death and disease will continue to rise.
The rise in CVDs reflects a significant change in diet habits, physical activity levels, and tobacco consumption worldwide as a result of industrialization, urbanization, economic development and food market globalization. People are consuming a more energy-dense, nutrient-poor diet and are less physically active. Imbalanced nutrition, reduced physical activity and increased tobacco consumption are the key lifestyle factors. High blood pressure, high blood cholesterol, overweight and obesity - and the chronic disease of type 2 diabetes - are among the major biological risk factors. Unhealthy dietary practices include the high consumption of saturated fats, salt and refined carbohydrates, as well as low consumption of fruit and vegetables. These risk factors tend to cluster.
Those who have already had heart attacks and strokes are at high risk of recurrences and death. This risk can be substantially lowered with a combination of drugs - statins for cholesterol lowering and low-doses of common blood pressure lowering drugs and aspirin - given daily to people at elevated risk of heart attack and stroke.
However, the most cost-effective methods of reducing risk among an entire population are population-wide interventions, combining effective policies and broad health promotion policies. These should be the first to be considered in all settings. In many countries, too much focus is being placed on one-on-one interventions among people at medium risk for CVD. A better use of resources would be to focus on those at elevated risk and to use other resources to introduce population-wide efforts to reduce risk factors through multiple economic and educational policies and programs. These risk factors include diet and physical activity. The dietary intake of fats, especially their quality, strongly influences the risk of CVD like coronary heart disease and stroke, through effects on blood lipids, thrombosis, blood pressure, arterial function, arrythogenesis and inflammation. Excess salt has a significant impact on blood pressure levels.
Compelling evidence indicates that the following strategies are effective in preventing CVD, and in helping manage the disease:
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