Up to 80% of premature heart attacks and strokes can be prevented
Deaths from cardiovascular disease (CVD) jumped globally from 12.1 million in 1990 to 20.5 million in 2021, according to a new report from the World Heart Federation (WHF). CVD was the leading cause of death worldwide in 2021, with four in five CVD deaths occurring in low- and middle-income countries (LMICs).
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, alcohol use, and stress.
The World Heart Report – launched at the 2023 World Heart Summit – provides the first in-depth analysis of CVD risk and mortality data worldwide, and unique analysis of country-level policy implementation to mitigate CVDs.
The highest CVD death rates occur in the Central Europe, Eastern Europe, and Central Asia region.
Though the overall number of CVD deaths increased in the last three decades – largely due to an ageing and growing population – the CVD death rate fell globally from 354.5 deaths per 100,000 people in 1990 to 239.9 deaths per 100,000 people in 2019.
This decline was however uneven across regions; the fastest decline in death rate was experienced in high-income countries.
Professor Fausto Pinto, co-author of the report and former WHF President, said, according to WHF press release:
The data doesn’t lie. This report confirms the serious threat that cardiovascular disease poses all over the world, particularly in low- and middle-income countries. Up to 80% of premature heart attacks and strokes can be prevented. It’s vital that countries prioritise rolling out tools and policies to protect people from CVD.”Professor Fausto Pinto, co-author of the World Heart Report and former World Heart Federation President
Leading contributors to CVD deaths
The report highlighted that high blood pressure, air pollution, tobacco use, and elevated LDL cholesterol were among the leading contributors to CVD deaths. Overall, a key finding is that risk factors vary across regions, making it vital that countries be aware of their risk profile.
It also found that countries that invest more in healthcare as a percentage of gross domestic product (GDP) have lower CVD death rates, while CVD death rates are higher in countries where people pay more out-of-pocket for healthcare.
Investing in healthcare saves lives,” said Professor Mariachiara Di Cesare of the Institute of Public Health and Wellbeing at the University of Essex, which compiled and analysed the data in collaboration with WHF.
This evidence is indisputable. In line with WHO recommendations, countries must invest at least 5% of their GDP to help bring down CVD death rates and morbidity,”Professor Mariachiara Di Cesare, Institute of Public Health and Wellbeing, University of Essex
Country-level policy solutions
In its analysis of country-level policies to improve CVD health, WHF found that 64% of countries have implemented at least seven of eight recommended policies, including national tobacco control programmes, availability of CVD drug treatments, and operational units within Ministries of Health.
The lowest level of policy implementation was found in Sub-Saharan Africa, where over 50% of countries do not have availability of CVD drugs in primary care facilities, a CVD National Plan, or a Non-communicable diseases (NCD) Unit.
The report includes five recommendations to get progress on CVD health back on track. These recommendations cover implementing all key policies to combat CVD, ensuring CVD health interventions are adequately funded, and continuing efforts to improve data on CVDs and their risk factors, particularly in LMICs.
Good data can help drive good policy – the report’s recommendations make clear that the opportunity is still there to accelerate action toward the goal of reducing premature mortality from NCDs by one-third by 2030,” said Pinto, as per WHF press release.Professor Fausto Pinto, co-author of the World Heart Report and former World Heart Federation President
Alcohol as one of nine major risk factors for cardiovascular disease
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. 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.
There are several modifiable risk factors for cardiovascular diseases including:
Behavioural factors such as insufficient physical activity, high sodium intake, high alcohol consumption, and tobacco smoking.
Metabolic factors such as high blood pressure, high fasting plasma glucose, high body-mass index, high levels of low-density lipoprotein (LDL) cholesterol, and diabetes.
Environmental factors such as ambient air pollution.
Some risk factors (e.g., family history) cannot be modified while others (e.g., tobacco use, high blood pressure, alcohol use) can be modified with preventive actions or treatment.
In 2021 according to the Global Burden of Disease Study, high blood pressure was the leading modifiable risk factor globally for mortality and contributed to 10.8 million CVD deaths worldwide.
Modifiable risk factors that contributed to CVD deaths in 2021 include:
- Raised blood pressure (10.8 million deaths),
- Air pollution (4.8 million deaths),
- Elevated LDL cholesterol (3.8 million deaths),
- Tobacco use (3.0 million deaths),
- High fasting plasma glucose (2.3 million deaths)
- High body-mass index (2.0 million deaths), and
- Low physical activity (397,000 deaths).
The World Heart Report 2023 does not mention alcohol’s contribution to CVD mortality.
But research from 2018 showed:
Globally in 2016, alcohol caused more than 590,000 CVD deaths (3.3% of all CVD deaths) and 13 million CVD DALYs (3.2% of all CVD DALYs).
CVDs were responsible for 19.8% and 9.8% of all alcohol-attributable deaths and DALYs lost respectively.
A ground-breaking report on alcohol and blood pressure, released in March 2023, summarizes the best scientific research and provides a state-of-the-art overview of alcohol’s substantial causal role in the genesis of hypertension and related diseases.
Alcohol is a significant contributing cause of hypertension. Hypertension itself is the leading cause of heart disease, stroke, type 2 diabetes and dementia.
This clearly makes alcohol one of the leading risk factors for CVD mortality in the world.
What the 2023 World Heart Report says about alcohol and heart disease
The 2023 World Heart Report contains a section on alcohol and heart disease, similar to those on tobacco and other major CVD risk factors.
The reports provides an overview of alcohol consumption levels and patterns across world regions and by genders, from the 2019 Global Burden of Disease study.
And it offers policy solutions:
According to WHO the most cost-effective interventions to prevent and reduce alcohol harm include
- increasing excise tax (taxes on the sale of specific goods),
- bans or comprehensive restrictions on alcohol advertising, and
- restricting the availability of alcohol retail (e.g. though reduced hours of sale).
The WHF Policy Brief on The Impact of Alcohol Consumption on Cardiovascular Health provides a summary of effective alcohol policies and recommendations for how national cardiovascular societies can advocate for better alcohol control measures.
Country- and region risk profiles
For each of the main cardiovascular disease risk factors WHF ordered countries from the highest to the lowest level. In the World Heart Report Appendix readers can find the quintile into which each country falls for each risk factor. This can help policymakers and stakeholders identify the risk factors that are particularly high in their context and define priorities for action (see Appendix Figure 2).
In the High-Income region most countries are characterised by high-levels of behavioural risk factors namely high levels of sodium and alcohol consumption, high levels of tobacco smoking, and low physical activity. They also have high levels of non-HDL cholesterol in both sexes and high obesity levels in men.
Number of key policies implemented to address cardiovascular diseases by region
The World Heart Report also analyzes the number of key policies implemented to address CVDs by region.
The analysis shows that globally national tobacco control programmes were the most implemented policy (implemented in 91% of countries), followed by guidelines/ protocols/ standards for the management of CVDs (86%), and policy/ strategy/ action plan to reduce unhealthy diet related to NCDs (85%).
The existence of an action plan to prevent and harm due to alcohol had the lowest level of implementation globally (70%).
Over 50% of countries in the Sub-Saharan Africa region do not have a CVD plan, an NCD Unit, or availability of CVD drugs in the public sectors.
The existence of an action plan to prevent and reduce harm due to alcohol was lowest in the North Africa and the Middle East region.
The Latin America and Caribbean region had the lowest implementation of action plans to reduce physical inactivity and to reduce unhealthy diet related to NCDs.
The WHF Policy Index summary
- 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 of the 2023 World Heart Report
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.
To help promote action at every level against CVDs, the World Heart Report 2023 recommends the following actions, that complements other key recommendations included in recent policy briefs and reports:
- 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.
- 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.
- 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.
- 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.
- 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.
More resources about alcohol and heart disease
Movendi International has produced a number of Special Features to compile latest evidence about alcohol and heart disease:
The Alcohol Issues Special Feature from March 2023 on Alcohol and Heart Disease provides a state of the art overview of what we know about alcohol’s role in multiple heart conditions and alcohol as contributing cause to heart disease risk factors.
And the Alcohol Issues Special Feature from January 2022 illustrated that the evidence is growing stronger and stronger, showing that any amount of alcohol use is bad for cardiovascular health. Even low dose alcohol increases health risks such as for the heart, compared to not having alcohol at all.
In their latest policy brief, the World Heart Federation (WHF) establishes the evidence base that no amount of alcohol is good for the heart.
This Special Feature on Alcohol and Heart Disease summarizes the latest scientific state of the art.
A brand new report on alcohol and blood pressure summarizes the best scientific research and provides a state-of-the-art overview of alcohol’s substantial causal role in the genesis of hypertension and related diseases.
Movendi International addresses the potential of alcohol policy to help prevent hypertension and related diseases and suggests three concrete solutions.