Burden and causes of cardiovascular diseases: with an emphasis on Asia

1
Burden and causes of cardiovascular
diseaseswith an emphasis on Asia

• Mark Woodward

2
Overview

• Burden of vascular disease
• Reasons for changing burden of vascular disease
• Current status of cardiovascular risk factors in
  the Asia-Pacific region
• Current status of CVD in the A-P region

3
Changing patterns of deathWorldwide 1990-2020
Chronic diseases and injuries
Infectious, maternal, perinatal and nutritional
conditions
Millions of deaths
Global Burden of Disease Project, 1996
4
Leading causes of deathWorldwide 1990-2020
1990
2020
Rank Cause Rank Cause
1 Ischaemic heart disease
12.4 1 Ischaemic heart disease
16.3 2 Cerebrovascular disease 8.7 2 Cerebrovascu
lar disease 11.2 3 Lower respiratory
infections 8.5 3 COPD 6.9 4 Diarrhoeal
diseases 5.8 4 Lower respiratory infections
3.7 5 Perinatal conditions 4.4 5 Respiratory
tract cancers 3.5 6 COPD 3.9 6 Road traffic
accidents 3.4 7 Tuberculosis 2.1 7 Tuberculosis 3
.4 8 Measles 2.1 8 Stomach cancer 2.3 9 Road
traffic accidents 1.9 9 HIV 1.8 10 Respiratory
tract cancers 1.9 10 Self inflicted injuries 1.8
Global Burden of Disease Study, 1996
5
Healthy life years lost to disease Worldwide
1990-2020
1990
2020
Rank Cause Rank Cause
1 Lower respiratory infections 8.2 1 Ischaemic
heart disease 5.9 2 Diarrhoeal diseases 7.2 2 Majo
r depression 5.7 3 Perinatal conditions 6.7 3 Road
traffic accidents 5.1 4 Major depression 3.7 4 Ce
rebrovascular disease 4.4 5 Ischaemic heart
disease 3.4 5 COPD 4.2 6 Cerebrovascular
disease 2.8 6 Lower respiratory
infections 3.1 7 Tuberculosis 2.8 7 Tuberculosis 3
.0 8 Measles 2.7 8 War 3.0 9 Road traffic
accidents 2.5 9 Diarrhoeal diseases 2.7 10 Congeni
tal abnormalities 2.4 10 HIV 2.6
Global Burden of Disease Study, 1996
6
Deaths worldwide 1990-2020

• Reported in 1990
• 50 million deaths worldwide from any cause
• Predicted for 2020
• 68 million deaths worldwide from any cause

Global Burden of Disease Study, 1996
7
Deaths worldwide 1990-2020

• Reported in 1990
• 50 million deaths worldwide from any cause
• 11 million in developed countries
• 39 million in developing countries
• Predicted for 2020
• 68 million deaths worldwide from any cause
• 14 million in developed countries
• 54 million in developing countries

Global Burden of Disease Study, 1996
8
Deaths from cardiovascular disease Worldwide
1990-2020

• Reported in 1990
• 14 million deaths worldwide (28)
• 5 million in developed countries
• 9 million in developing countries
• Predicted for 2020
• 25 million deaths worldwide (37)
• 6 million in developed countries
• 19 million in developing countries

Global Burden of Disease Study, 1996
9
Healthy life years lost to cardiovascular disease
Former Soviet Market Econ
50
40
DALYs (millions)
30
20
10
0
1990
2000
2010
2020
10
Healthy life years lost to cardiovascular disease
India China Africa Middle East South
America Other Asia
50
40
DALYs (millions)
30
20
10
0
1990
2000
2010
2020
11
Overview

• Burden of vascular disease
• Reasons for changing burden of vascular disease
• Current status of cardiovascular risk factors in
  the Asia-Pacific region
• Current status of CVD in the A-P region

12
World population change
10
8
6
World population (billions)
4
2
0
1700
1800
1900
2000
2100
United Nations 1999
13
Regional population change

• Population (billions)
• 2000 2050 Change
• Developing world 4.9 7.9 3.0
• Developed world 1.0 1.0 0.0
• Total 5.9 8.9 3.0

United Nations 1999
14
Ten largest populations

• 1950 2000 2050
• China China India
• India India China
• USA USA Pakistan
• Russia Indonesia USA
• Japan Brazil Nigeria
• Indonesia Russia Indonesia
• Germany Pakistan Brazil
• Brazil Japan Bangladesh
• UK Bangladesh Ethiopia
• Italy Nigeria Iran

United Nations 1999
15
More developed countries
United Nations 1999
16
Least developed countries
United Nations 1999
17
Population 60 years or over

• 1999 2050
• More developed 19 33
• Less developed 8 21
• World 10 22

United Nations 1999
18
World urban population
90 in developing countries
World development report 1999/2000
19
Global urbanisation

• Urban Rural
• China 30 70
• India 27 73
• USA 76 24

United Nations 1999
20
100 largest cities
Developing countries
Industrial countries
World development report 1999/2000
21
Trends in per capita cigarette consumption
1971-1991
3500
3000
High income countries
2500
Low middle income countries
Per capita cigarette consumption
2000
China
1500
1000
500
0
1971
1991
1981
The World Health Report, 1999 Making a Difference
22
Tobacco-related death and disability

• 1990 2020
• Deaths (millions) 3.0 8.4
• India 0.1 1.5
• China 0.8 2.2
• DALYS () 2.6 9.0

Global Burden of Disease Project, Lancet 1997
23
Trends in overweight/obesity (BMI 25 kg/m2)
24
Global distribution of diabetes
350
300
250
200
Millions
150
100
50
0
Developed
Developing
World
King et al. Diabetes Care 1998 211414-31
25
Overview

• Burden of vascular disease
• Reasons for changing burden of vascular disease
• Current status of cardiovascular risk factors in
  the Asia-Pacific region
• Current status of CVD in the A-P region

26
Prevalence of smokingin the AsiaPacific
APCSC, 2006
27
Prevalence of hypertension 140/90mmHg
28
Prevalence of obesity and overweight
29
Prevalence of, and predictions for, diabetes
30
Overview

• Burden of vascular disease
• Reasons for changing burden of vascular disease
• Current status of cardiovascular risk factors in
  the Asia-Pacific region
• Current status of CVD in the A-P region (compared
  with North America)

31
The 14 WHO mortality subregions
A very low child and adult mortality B low
child and adult mortality C low child, high
adult D high child, high adult E high child,
very high adult
32
Percentage of deaths due to stroke, 1999 The
World Health Report 2000, WHO
18
16
17
14
15
12

10
10
10
8
6
7
7
4
2
0
WprA
AmrA
WprB
All
SearB
SearD
Region
very low
very low
low
low
high
Child mortality
very low
very low
low
low
high
Adult mortality

Australia
USA
China
Indonesia
Includes
India
Bangladesh
Malaysia
Japan
Canada
Thailand
33
Percentage of cardiovascular disease deaths due
to stroke, 1999 The World Health Report 2000, WHO
60
55
50
45
40

42
30
33
20
21
17
10
0
WprA
AmrA
WprB
All
SearB
SearD
Region
very low
very low
low
low
high
Child mortality
very low
very low
low
low
high
Adult mortality

Australia
USA
China
Indonesia
Includes
India
Bangladesh
Malaysia
Japan
Canada
Thailand
34
Attributable risks for stroke

• Blood pressure 55-75
• Cholesterol 25-35
• High body mass index 20-30
• Low fruit vegetables 20-30
• Physical inactivity 10-20
• Tobacco 10-20
• Alcohol lt5
• Urban air pollution lt5
• Lead exposure lt5

Warning Western populations
Global Programme on Evidence for Health Policy
35
Relative risk (95 CI) for the association
between major risk factors and CVDAsia v
Framingham (US)
APCSC, J Epi Comm Health, 2006
36
Summary I

• Global epidemic of CVD the leading cause of
  death and disability
• About 11 million new cardiovascular deaths each
  year by 2020
• By 2020, 80 of cardiovascular deaths will occur
  in low and middle income countries
• About half of these deaths will occur in the
  Asia-Pacific region

37
Summary II

• Classic CVD risk factors act similarly in
  different populations
• These risk factors are already common in many
  low/middle-income countries, and are often
  increasing (e.g. Asia)

38
Summary III

• Substantial geographic variation in disease
  patterns
• Differences in disease patterns largely
  explicable on the basis of socio-demographic
  factors and their effects on established
  cardiovascular risk factors