The Heart of the World

Abstract

Cardiovascular diseases (CVDs) are the leading cause of mortality globally. Of the 20.5 million CVD-related deaths in 2021, approximately 80% occurred in low- and middle-income countries. Using data from the Global Burden of Disease Study, NCD Risk Factor Collaboration, NCD Countdown initiative, WHO Global Health Observatory, and WHO Global Health Expenditure database, we present the burden of CVDs, associated risk factors, their association with national health expenditures, and an index of critical policy implementation. The Central Europe, Eastern Europe, and Central Asia region face the highest levels of CVD mortality globally. Although CVD mortality levels are generally lower in women than men, this is not true in almost 30% of countries in the North Africa and Middle East and Sub-Saharan regions. Raised blood pressure remains the leading global CVD risk factor, contributing to 10.8 million deaths in 2019. The regions with the highest proportion of countries achieving the maximum score for the WHF Policy Index were South Asia, Central Europe, Eastern Europe, and Central Asia, and the High-Income regions. The Sub-Saharan Africa region had the highest proportion of countries scoring two or less. Policymakers must assess their country's risk factor profile to craft effective strategies for CVD prevention and management. Fundamental strategies such as the implementation of National Tobacco Control Programmes, ensuring the availability of CVD medications, and establishing specialised units within health ministries to tackle non-communicable diseases should be embraced in all countries. Adequate healthcare system funding is equally vital, ensuring reasonable access to care for all communities.

Keywords: CVD global data; CVDs risk factors; Cardiovascular health; WHF observatory; WHF policy index.

Figure 1

Global trends in number of deaths due to cardiovascular diseases, 1990–2019. Source: Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2020. Available from http://vizhub.healthdata.org/gbd-compare.

Figure 2

Global trends in age-standardised cardiovascular disease death rate (per 100,000 people), 1990–2019. Source: Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2020. Available from http://vizhub.healthdata.org/gbd-compare.

Figure 3

Regional trends in age-standardised cardiovascular disease death rate (per 100,000 people), 1990–2019. Source: Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2020. Available from http://vizhub.healthdata.org/gbd-compare.

Figure 4

Male-female difference in age-standardised cardiovascular disease death rate (per 100,000 people) in sub-Saharan Africa by country, 2019. Source: Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2020. Available from http://vizhub.healthdata.org/gbd-compare.

Figure 5

Probability of dying (reported as a percentage) in 2015 between 30 years and 70 years of age from ischaemic heart disease by sex. Note: Grey colour is used when no estimates were available (missing). Source: NCD Countdown [3].

Figure 6

Comparative levels of risk factors by country and region. Note (1): RF1 – Physical activity; RF2 – Sodium intake; RF3 – Alcohol consumption; RF4 – Tobacco smoking; RF5 – Obesity; RF6 – Raised Blood Pressure; RF7 – Diabetes; RF8 – Lipids; RF9 – Ambient air pollution. Note (2): The figures display the global quintile into which each country falls for each risk factor. Source: See Table 1.

Figure 7

Age-standardised cardiovascular disease death rate (per 100,000 people), 2019, by current health expenditure (CHE) as share of national income (GDP). Note: Each dot represents a country, coloured by region. The dashed line shows the negative linear association between CVD death rates and national health expenditure (Pearson’s correlation coefficient = –0.15, p = 0.052). Sources: Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2020. Available from http://vizhub.healthdata.org/gbd-compare; World Health Organization, Global Health Expenditure Database. Available from https://apps.who.int/nha/database/Select/Indicators/en.

Figure 8

Age-standardised cardiovascular disease death rate (per 100,000 people), 2019, by out-of-pocket (OOP) health expenditure as share of current health expenditure (CHE). Note: Each dot represents a country, coloured by region. The dashed line shows a positive association between CVD death rates and OOP health expenditure as a share of national health expenditure (Pearson’s correlation coefficient = 0.23, p = 0.002). Sources: Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, 2020. Available from http://vizhub.healthdata.org/gbd-compare; World Health Organization, Global Health Expenditure Database. Available from https://apps.who.int/nha/database/Select/Indicators/en.

Figure 9

Number of key policies implemented to address cardiovascular diseases, by region (% of countries). Sources: Global Health Observatory. Available from: https://www.who.int/data/gho.

Figure 10

Policy implementation per country. Note: P1 – National tobacco control programmes; P2 – Action plan for CVDs; P3 – Operational Unit in Ministry of Health with responsibility for NCDs; P4 – Guidelines for the management of CVDs; P5 – Action plan to reduce physical inactivity; P6 – Action plan to reduce unhealthy diet related to NCDs; P7 – Action plan to reduce the harmful use of alcohol; P8 – Availability of CVD drugs (e.g., ACE inhibitors, aspirin, and Beta blockers) in the public health sector. Sources: Global Health Observatory. Available from: https://www.who.int/data/gho.