What is the epidemiology of cardiovascular disease in a given location?

Epidemiology of Cardiovascular Disease

Global Burden and Mortality

Cardiovascular diseases remain the leading cause of death and disability worldwide, with 19.2 million deaths and 437 million disability-adjusted life years (DALYs) in 2023, representing a dramatic increase from 13.1 million deaths and 320 million DALYs in 1990. 1

• The absolute number of CVD deaths continues to rise despite declining age-standardized mortality rates in many regions, driven primarily by population growth and aging 2, 1
• CVD affects an estimated 626 million people globally as of 2023, more than doubling from 311 million prevalent cases in 1990 1
• Approximately 50% of all coronary heart disease deaths are sudden and unexpected, occurring shortly after onset of clinical symptoms 3

Geographic Distribution and Regional Disparities

The burden of CVD has shifted dramatically from high-income to low- and middle-income countries, where 88% of hypertension-related deaths now occur. 4, 5, 6

High-Income Countries

• Age-standardized CVD mortality has declined substantially in affluent nations since the 1970s-1990s 5
• In the United States, CHD affects approximately 20.1 million people (11 million men and 9.1 million women) 3
• CVD remains the main cause of premature death in European women (42% of deaths below 75 years) and men (38% of deaths at 75 years) 5

Low- and Middle-Income Countries

• Age-standardized CVD DALY rates are highest in low and low-middle Socio-demographic Index (SDI) settings 1
• Blood pressure levels are now substantially higher in sub-Saharan Africa, South Asia, and Central/Eastern Europe compared to high-income regions 4
• Eastern European countries show persistently high CVD and coronary heart disease mortality rates 5
• The Western Pacific region accounted for 39% of cerebrovascular deaths, followed by Europe (29%) and South East Asia (21%) 6

Disease-Specific Epidemiology

Ischemic Heart Disease

• Ischemic heart disease predominates in the Americas, Europe, Eastern Mediterranean, Eastern Europe, Middle East, and Southeast Asia, representing 60% of heart failure etiology in these regions 5
• Ischemic heart disease is among the leading cardiovascular causes of DALYs globally in 2023 1

Heart Failure

• Heart failure affects 64.3 million people worldwide as of 2017, with prevalence expected to continue rising 4, 6
• In the United States, approximately 6.0 million Americans aged ≥20 years had heart failure between 2015-2018, increasing from 5.7 million in 2009-2012 4
• Regional variations in heart failure etiology are striking: ischemic heart disease causes 60% of cases in developed regions, while hypertension accounts for 35% in Africa, 21% in South America, and 15% in India/Southeast Asia/China 5

Stroke

• Stroke is the second-leading cause of death globally (fourth in the United States), with 5.5 million deaths annually 6
• Among stroke survivors, 5 million are left permanently disabled 6
• The burden of stroke is projected to grow from 38 million DALYs in 1990 to 61 million in 2020 6
• In China, hypertension accounts for approximately half of total stroke mortality 6
• A 10 mmHg increase in systolic blood pressure increased hemorrhagic stroke risk by 72% in Asians compared with 49% in Australians and New Zealanders 6

Rheumatic Heart Disease

• Rheumatic heart disease remains a major burden in Sub-Saharan Africa and low-income countries, accounting for up to 40% of heart failure cases 5
• Symptomatic rheumatic heart disease incidence is 24.7 per 100,000 population per year in adults in Sub-Saharan Africa 5

Risk Factor Epidemiology

Approximately 79.6% of global CVD burden is attributable to modifiable risk factors, with high systolic blood pressure, dietary risks, high LDL cholesterol, and air pollution being the leading contributors. 1

Hypertension

• In 2015,8.5 million deaths were attributable to systolic blood pressure >115 mmHg, with 88% occurring in low- and middle-income countries 5, 6
• Hypertension prevalence is now higher in low- and middle-income countries than in high-income countries 4, 5, 6
• Mean blood pressure has declined in high-income regions since the 1970s but has risen in East, South and Southeast Asia, Oceania, and sub-Saharan Africa 6

Metabolic Risk Factors

• Since 1990, increases in high body mass index, high fasting plasma glucose, and low physical activity have led to higher CVD burden 1
• Traditional risk factors (tobacco use, lipids, elevated blood pressure) collectively represent more than 90% of CVD risks in epidemiological studies 7

Tobacco

• Reductions in tobacco usage have mitigated some increases in CVD burden since 1990 1

Demographic Variations

Age

• Population aging was responsible for adding 139 million CVD DALYs to the increase in burden since 1990 1
• Cardiovascular risk begins developing at very young ages, with evidence that exposure to risk factors before birth influences lifetime CVD risk 5

Sex

• CVD is underappreciated as the main cause of premature death in women 5
• In the United States, myocardial infarction prevalence is higher in men (4.3%) compared to women (2.1%) 3
• Angina pectoris affects 5.3 million men and 5.7 million women in the United States 3

Race and Ethnicity (United States Data)

• Non-Hispanic White men: 8.7% CHD prevalence, 4.4% MI prevalence 3
• Non-Hispanic Black men: 6.7% CHD prevalence, 3.9% MI prevalence 3
• Hispanic men: 6.8% CHD prevalence, 3.7% MI prevalence 3
• Non-Hispanic Asian men: 5.0% CHD prevalence, 2.7% MI prevalence 3
• Similar patterns exist for women across racial/ethnic groups, with generally lower prevalence rates 3

Economic Burden

• The total cost for heart failure was estimated at $30.7 billion in the USA in 2012, with projections suggesting an increase to $69.8 billion by 2030 4, 6
• Annual healthcare costs per heart failure patient amount to up to €25,000 in Western countries 6
• CVD generates a high socio-economic burden globally due to premature death and disability 7

Temporal Trends and Drivers of Change

Population growth and population aging are the main drivers of increasing CVD burden, adding 128 million and 139 million CVD DALYs respectively to the increase since 1990. 1

• The number of CVD deaths increased 1.5-fold from 1990 to 2023 1
• Despite declining age-adjusted CHD mortality, absolute numbers of cardiac deaths are not decreasing due to population growth and aging 3
• Changes in exposure to modifiable risk factors have had mixed effects, with metabolic risks (obesity, diabetes, physical inactivity) increasing burden while tobacco control has provided some mitigation 1

Critical Gaps in Surveillance

• Reliable data to estimate CVD burden are lacking in many regions, particularly Africa, South America, and parts of Asia, hampering establishment of nationwide prevention and management strategies 4, 2
• Considerable heterogeneity exists between epidemiological studies analyzing different populations from distinct geographical and socio-economic settings with disparate methods 4
• Treatment coverage and effectiveness of hypertension management vary substantially globally and remain particularly low in low- and middle-income countries 4