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      Is Open Access

      Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

      , MD, MPH a , , , PhD a , , MPH b , , MD c , , MSc d , , MS d , , MPH, MBA e , , MD f , , MPH a , , PhD g , , PhD h , , PhD i , , MD j , , PhD k , , PhD l , , PhD m , , MSc d , , PhD n , , MSc o , , DPhil p , , PhD q , , MD r , , MD s , , MD t , , MSc d , , PhD u , , MPH d , , PhD, MBBS v , , MPH w , , MBBS, PhD x , , PhD y , , MD, PhD z , , MSc aa , , MPH bb , , PhD cc , , PhD dd , , DMSCi ee , , MD ff , , MD gg , , MD, MPH hh , , MD ii , , PhD jj , , MD a , kk , , PhD a , kk , , MD, PhD, MPH ll , , MD mm , , MD, DM, MSc nn , , MPhil oo , , MPH a , , MD, PhD pp , , MD qq , , MD rr , , MD ss , , PhD r , , PhD tt , , ScD r , , PhD uu , , MPH e , , MD r , , MSc a , , PhD vv , , MD, PhD ww , , MSc xx , , MD rr , , MBA d , , MSc d , , MD x , , MPH yy , , MS e , , PhD y , , DSc a , u , , MPH zz , , PhD aaa , , PhD bbb , , MD, MPH ccc , , PhD ddd , , PhD nn , , MBA, MPH eee , , MD fff , , MD ggg , , MD hhh , , PhD rr , , ShD iii , , MD jjj , , MD kkk , , MD lll , , MBBS, MPH, MBA mmm , , MBBS, PhD nnn , , DrPH ooo , , MD ppp , , MD qqq , , BA a , , PhD kk , , MD rrr , , MD kk , , PhD l , , MD MPH, DrPH sss , , MS, PhD g , , DrPH ttt , , MBBCh pp , , MD rr , , PhD uuu , , PhD vvv , , MPH d , , MD www , , PhD g , , MSc d , , PhD xxx , , MD yyy ,   , PhD zzz , , MD, MPH aaaa , , MD bbbb , , MD, PhD cccc , , MBChB, PhD dddd , , MSc eeee , , MPH a , , PhD ffff , , MBBS, MSc, DMed gggg , , MD g , , MS hhhh , , PharmD, PhD iiii , , PhD jjjj , , DM u , , MPH kkkk , , PhD llll , , MD z , , PhD mmmm , , PhD r , , PhD ttt , , MD, MSc, PhD q , , PhD nnnn , , PhD oooo , , MD, PhD, MPH rr , , MD, MPH, MA, MS pppp , , PhD qqqq , , DO, MPH f , , MPH rrrr , , PhD ssss , , MD, MPhil, PhD tttt , , MD, PhD uuuu , , MD vvvv , , PhD cc , , MS yy , , MSc d , , MD wwww ,   , PhD xxxx , , PhD yyyy , , MD, PhD, DMSc zzzz , , PhD aaaaa , , MD bbbbb , , PhD ccccc , , PhD ddddd , , MD eeeee , , DrPH fffff , , MSc e , , MD, MPH a , , MBBS ggggg , , PhD hhhhh , , PhD hhhhh , , PhD iiiii , , MD jjjjj , , MPH e , , PhD kkkkk , , MD lllll , , PhD mmmmm , , MPH nnnnn , , DhPH ooooo , , PhD ppppp , , PhD a , , PhD a , , DPhil a

      Journal of the American College of Cardiology

      Elsevier Biomedical

      cause of death, epidemiology, global health, CVD, cardiovascular disease, DALY, disability-adjusted life-year, IHD, ischemic heart disease, PAD, peripheral arterial disease, RHD, rheumatic heart disease, SDI, sociodemographic index, UI, uncertainty interval, YLD, years lived with disability, YLL, years of life lost

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          Abstract

          Background

          The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.

          Objectives

          The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.

          Methods

          CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.

          Results

          In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75.

          Conclusions

          CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.

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          Most cited references 24

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          National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants.

          Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP). We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5·4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative. In 2008, age-standardised mean SBP worldwide was 128·1 mm Hg (95% uncertainty interval 126·7-129·4) in men and 124·4 mm Hg (123·0-125·9) in women. Globally, between 1980 and 2008, SBP decreased by 0·8 mm Hg per decade (-0·4 to 2·2, posterior probability of being a true decline=0·90) in men and 1·0 mm Hg per decade (-0·3 to 2·3, posterior probability=0·93) in women. Female SBP decreased by 3·5 mm Hg or more per decade in western Europe and Australasia (posterior probabilities ≥0·999). Male SBP fell most in high-income North America, by 2·8 mm Hg per decade (1·3-4·5, posterior probability >0·999), followed by Australasia and western Europe where it decreased by more than 2·0 mm Hg per decade (posterior probabilities >0·98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0·8-1·6 mm Hg per decade in men (posterior probabilities 0·72-0·91) and 1·0-2·7 mm Hg per decade for women (posterior probabilities 0·75-0·98). Female SBP was highest in some east and west African countries, with means of 135 mm Hg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mm Hg or more. Men and women in western Europe had the highest SBP in high-income regions. On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries. Funding Bill & Melinda Gates Foundation and WHO. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators.

            A World Health Organization Working Group has developed a major international collaborative study with the objective of measuring over 10 years, and in many different populations, the trends in, and determinants of, cardiovascular disease. Specifically the programme focuses on trends in event rates for validated fatal and non-fatal coronary heart attacks and strokes, and on trends in cardiovascular risk factors (blood pressure, cigarette smoking and serum cholesterol) in men and women aged 25-64 in the same defined communities. By this means it is hoped both to measure changes in cardiovascular mortality and to see how far they are explained; on the one hand by changes in incidence mediated by risk factor levels; and on the other by changes in case-fatality rates, related to medical care. Population centres need to be large and numerous; to reliably establish 10-year trends in event rates within a centre 200 or more fatal events in men per year are needed, while for the collaborative study a multiplicity of internally homogeneous centres showing differing trends will provide the best test of the hypotheses. Forty-one MONICA Collaborating Centres, using a standardized protocol, are studying 118 Reporting Units (subpopulations) with a total population aged 25-64 (both sexes) of about 15 million.
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              Global and regional patterns in cardiovascular mortality from 1990 to 2013.

              There is a global commitment to reduce premature cardiovascular diseases (CVDs) 25% by 2025. CVD mortality rates have declined dramatically over the past 2 decades, yet the number of life years lost to premature CVD deaths is increasing in low- and middle-income regions. Ischemic heart disease and stroke remain the leading causes of premature death in the world; however, there is wide regional variation in these patterns. Some regions, led by Central Asia, face particularly high rates of premature death from ischemic heart disease. Sub-Saharan Africa and Asia suffer disproportionately from death from stroke. The purpose of the present report is to (1) describe global trends and regional variation in premature mortality attributable to CVD, (2) review past and current approaches to the measurement of these trends, and (3) describe the limitations of existing models of epidemiological transitions for explaining the observed distribution and trends of CVD mortality. We describe extensive variation both between and within regions even while CVD remains a dominant cause of death. Policies and health interventions will need to be tailored and scaled for a broad range of local conditions to achieve global goals for the improvement of cardiovascular health.
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                Author and article information

                Contributors
                Journal
                J Am Coll Cardiol
                J. Am. Coll. Cardiol
                Journal of the American College of Cardiology
                Elsevier Biomedical
                0735-1097
                1558-3597
                04 July 2017
                04 July 2017
                : 70
                : 1
                : 1-25
                Affiliations
                [a ]University of Washington, Seattle, Washington
                [b ]University of Queensland, Brisbane, Queensland, Australia
                [c ]Cairo University, Cairo, Egypt
                [d ]Mekelle University, Addis Ababa, Ethiopia
                [e ]Jimma University, Jimma, Ethiopia
                [f ]Cleveland Clinic, Cleveland, Ohio
                [g ]University of Melbourne, Melbourne, Victoria, Australia
                [h ]University of Lorraine, Nancy, France
                [i ]Universidad de Cartagena, Cartagena, Colombia
                [j ]Oregon Health & Science University, Portland, Oregon
                [k ]Zahedan University of Medical Sciences, Zahedan, Iran
                [l ]Uppsala University, Uppsala, Sweden
                [m ]Qom University of Medical Sciences, Qom, Iran
                [n ]National Institute of Public Health, Cuernavaca, Mexico
                [o ]Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
                [p ]University College London, London, United Kingdom
                [q ]University of Belgrade, Belgrade, Serbia
                [r ]Harvard University, Boston, Massachusetts
                [s ]University of Gothenburg, Gothenburg, Sweden
                [t ]College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
                [u ]University of Oxford, Oxford, United Kingdom
                [v ]Aga Khan University, Karachi, Pakistan
                [w ]Wolaita Sodo University, Wolaita Sodo, Ethiopia
                [x ]The University of Western Australia, Perth, Western Australia, Australia
                [y ]Karolinska Institutet, Stockholm, Sweden
                [z ]Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
                [aa ]Instituto Nacional de Salud, Bogotá, Colombia
                [bb ]Caja Costarricense de Seguro Social, San José, Costa Rica
                [cc ]University of València/INCLIVA Health Research Institute and CIBERSAM, València, Spain
                [dd ]Seoul National University Hospital, Seoul, South Korea
                [ee ]Bispebjerg University Hospital, Copenhagen, Denmark
                [ff ]University of Salerno, Salerno, Italy
                [gg ]Mayo Clinic, Rochester, Minnesota
                [hh ]University of California, San Diego, California
                [ii ]Long Beach, California
                [jj ]Eduardo Mondlane University, Maputo, Mozambique
                [kk ]Public Health Foundation of India, New Delhi, India
                [ll ]Republican Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
                [mm ]University of Peradeniya, Peradeniya, Sri Lanka
                [nn ]Centre for Chronic Disease Control, Gurgaon, India
                [oo ]International Institute for Population Sciences, Mumbai, India
                [pp ]Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
                [qq ]University of Philippines Manila, Manila, Philippines
                [rr ]Tehran University of Medical Sciences, Tehran, Iran
                [ss ]University of Louisville, Louisville, Kentucky
                [tt ]Auckland University of Technology, Auckland, New Zealand
                [uu ]University of Edinburgh, Edinburgh United Kingdom
                [vv ]University of Massachusetts Boston, Boston, Massachusetts
                [ww ]Eternal Heart Care Center and Research Institute, Jaipur, India
                [xx ]University of Groningen, Groningen, the Netherlands
                [yy ]Mizan-Tepi University, Mizan Teferi, Ethiopia
                [zz ]Nevada Division of Public and Behavioral Health, Carson City, Nevada
                [aaa ]Baylor College of Medicine, Houston, Texas
                [bbb ]George Mason University, Fairfax, Virginia
                [ccc ]Denver Health/University of Colorado, Denver, Colorado
                [ddd ]University of Aberdeen, Aberdeen, United Kingdom
                [eee ]International Center for Research on Women, New Delhi, India
                [fff ]Ruprecht-Karls Universitaet Heidelberg, Heidelberg, Germany
                [ggg ]Society for Education, Action and Research in Community Health, Gadchiroli, India
                [hhh ]Case Western University Hospitals, Cleveland, Ohio
                [iii ]Jordan University of Science and Technology, Irbid, Jordan
                [jjj ]University of Louisville, Louisville, Kentucky
                [kkk ]Seoul National University, Seoul, South Korea
                [lll ]New York Medical College, Valhalla, New York
                [mmm ]Al-Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
                [nnn ]Ball State University, Muncie, Indiana
                [ooo ]Northeastern University, Boston, Massachusetts
                [ppp ]Brown University, Providence, Rhode Island
                [qqq ]Health Policy and Humanities, National Institute of Health Research and Development, Jakarta, Indonesia
                [rrr ]Boston University School of Medicine, Boston, Massachusetts
                [sss ]University of Haifa, Haifa, Israel
                [ttt ]University of São Paulo, São Paulo, Brazil
                [uuu ]Chinese Academy of Sciences, Beijing, China
                [vvv ]Martin Luther University Halle-Wittenberg, Halle, Germany
                [www ]National Institutes of Health, Bethesda, Maryland
                [xxx ]Pacific Institute for Research & Evaluation, Beltsville, Maryland
                [yyy ]Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
                [zzz ]Ahmadu Bello University, Zaria, Nigeria
                [aaaa ]Columbia University, New York, New York
                [bbbb ]University of Science Malaysia, Penang, Malaysia
                [cccc ]The Mount Sinai Hospital, New York, New York
                [dddd ]The George Institute for Global Health, Newtown, New South Wales, Australia
                [eeee ]Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
                [ffff ]American University of Beirut, Beirut, Lebanon
                [gggg ]College of Medicine, University of Ibadan, Ibadan, Nigeria
                [hhhh ]University of Porto, Porto, Portugal
                [iiii ]University of Illinois at Chicago, Chicago, Illinois
                [jjjj ]Alborz University of Medical Sciences, Karaj, Iran
                [kkkk ]Society for Health and Demographic Surveillance, Birbhum, India
                [llll ]Imperial College London, London, United Kingdom
                [mmmm ]Maragheh University of Medical Sciences, Maragheh, Iran
                [nnnn ]University of KwaZulu-Natal, Durban, South Africa
                [oooo ]North-West University, Potchefstroom, South Africa
                [pppp ]Independent Consultant, Islamabad, Pakistan
                [qqqq ]Korea University, Seoul, South Korea
                [rrrr ]Haramaya University, Dire Dawa, Ethiopia
                [ssss ]Federal University of Santa Catarina, Florianópolis, Brazil
                [tttt ]University of Yaoundé, Yaoundé, Cameroon
                [uuuu ]Luxembourg Institute of Health, Strassen, Luxembourg
                [vvvv ]Indian Council of Medical Research, New Delhi, India
                [wwww ]Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [xxxx ]Monash University, Melbourne, Victoria, Australia
                [yyyy ]Jagiellonian University Medical College, Kraków, Poland
                [zzzz ]University of Copenhagen, Copenhagen, Denmark
                [aaaaa ]Universitat de Barcelona, CIBERSAM, Barcelona, Spain
                [bbbbb ]Federal Teaching Hospital, Abakaliki, Nigeria
                [ccccc ]University of Warwick, Coventry, United Kingdom
                [ddddd ]UKK Institute for Health Promotion Research, Tampere, Finland
                [eeeee ]National Research University Higher School of Economics, Moscow, Russia
                [fffff ]Norwegian Institute of Public Health, Oslo, Norway
                [ggggg ]Royal Children’s Hospital, Melbourne, Victoria, Australia
                [hhhhh ]Federal Institute for Population Research, Wiesbaden, Germany
                [iiiii ]Cochrane South Africa, Tygerberg, South Africa
                [jjjjj ]King’s College London, London, United Kingdom
                [kkkkk ]Nanjing University School of Medicine, Nanjing, China
                [lllll ]Northwestern University, Chicago, Illinois
                [mmmmm ]University of Hong Kong, Pokfulam, Hong Kong
                [nnnnn ]Kyoto University, Kyoto, Japan
                [ooooo ]Jackson State University, Jackson, Mississippi
                [ppppp ]Wuhan University, Wuhan, China
                Author notes
                [] Address for correspondence: Dr. Gregory A. Roth, Division of Cardiology, Department of Medicine, University of Washington, Institute for Health Metrics and Evaluation, 2301 5th Avenue, Suite 600, Seattle, Washington 98121.Division of Cardiology, Department of MedicineUniversity of Washington, Institute for Health Metrics and Evaluation2301 5th Avenue, Suite 600SeattleWashington 98121 rothg@ 123456uw.edu
                Article
                S0735-1097(17)37244-3
                10.1016/j.jacc.2017.04.052
                5491406
                28527533
                © 2017 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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                Original Investigation

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