Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment

Abstract

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010.

Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates.

Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain.

Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases.

Funding: UK Medical Research Council, US National Institutes of Health.

Figure 1

Deaths attributable to the individual and combined effects of high body mass index, blood pressure, cholesterol, and glucose by region and (A) sex and (B) age group.

Figure 1

Deaths attributable to the individual and combined effects of high body mass index, blood pressure, cholesterol, and glucose by region and (A) sex and (B) age group.

Figure 2

Age-standardised death rates attributable to the combined effects of high body mass index, blood pressure, cholesterol, and glucose by region.

Figure 3

Deaths attributable to the individual and combined effects of high body mass index, blood pressure, cholesterol, and glucose in 2010, by disease.

Figure 4

Percent of deaths from cardiovascular diseases, diabetes, and chronic kidney disease attributable to individual and combined effects of high body mass index, blood pressure, cholesterol, and glucose by country in 2010. Note that the scales differ by panel to enhance visibility.

Figure 5

Age-standardized death rates from cardiovascular diseases, diabetes, and chronic kidney disease attributable to individual and combined effects of high body mass index, blood pressure, cholesterol, and glucose by country and sex, in 2010. Results are not shown for women in Afghanistan because despite relatively low PAFs (Figure 4), they had the highest worldwide death rates attributable to these risk factors due to very high CVD death rates in the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. See Webfigure 1 for the version of figure that also includes results for women in Afghanistan.

Figure 6

Ten countries with the largest number of deaths attributable to high BMI, blood pressure, cholesterol, and glucose in 1980 and 2010.