Over the last 30 years, deaths and disability from cardiovascular disease have been steadily rising across the globe. In 2019 alone, the condition, which includes heart disease and stroke, was responsible for a staggering one-third of all deaths worldwide.
Then came the COVID-19 pandemic.
In the early months of the coronavirus pandemic, cardiovascular disease quickly emerged as a risk factor for the severe cases of COVID-19—the ones often ending in hospitalization and death.
“Cardiovascular diseases are chronic conditions that can cause very poor outcomes from COVID-19 and they are the upswing around the world,” said George A. Mensah, M.D., director of NHLBI’s Center for Translation Research and Implementation Science (CTRIS), and one of the researchers analyzing the data on the global burden of cardiovascular diseases. “Importantly, it didn’t have to be this way, since we have the knowledge and tools to prevent, treat, and control cardiovascular diseases.”
Decades of dramatic declines in death rates from cardiovascular disease “lulled us into a false sense of security,” Mensah said, but “truthfully, those declines have stalled.”
The problem, according to a new paper by Mensah and others in the Journal of the American College of Cardiology (JACC), is that many clinical and public health research findings that led to those improvements have not been consistently and effectively translated into routine clinical practice and public health. And that, the researchers argued, must change—and urgently.
“Translating what we already know about cardiovascular diseases and risk factors into practice is relatively low-hanging fruit we should have picked a long time ago,” Mensah said. Not doing so has resulted not only in a rise in cardiovascular diseases globally, he explained, but also a rise in death, disability, and healthcare costs. “And much of this burden could be prevented by implementing proven cost-effective clinical and public health measures that lower risks.”
The paper’s analysis is based on data from The Global Burden of Diseases, Injuries, and Risk Factors Study 2019, or GBD 2019 Study, a multinational collaboration that estimates the global, regional, and national disease burden, which helps frame key public health challenges within countries, and for entire global regions.
The authors honed in on cardiovascular disease, the leading cause of death around the world and a huge contributor to disability and rising health care costs, to understand its specific impact, as well as to explain the rising trend.
“The global picture is complex, especially for cardiovascular diseases, but countries can work together, share best practices and examples of success,” said Gregory A. Roth, M.D., M.P.H., lead author of the paper and associate professor in the Division of Cardiology at the University of Washington School of Medicine and also adjunct associate professor at UW’s Institute for Health Metrics and Evaluation.
Studies often focus on rates of disease to facilitate comparisons across different places and groups of people, “but if you are running a national health system, you need the total number of cases,” Roth explained. “How many hospital beds, heart laboratories, surgeons and pills do you actually need to purchase? How will that number change over time?”
The GBD Study provides this global snapshot. Around the world, 9.6 million men and 8.9 million women died of cardiovascular disease in 2019, and more than six million of them were between ages 30-70. The highest number of deaths occurred in some of the most populated countries in the world—China, followed by India, Russia, the United States, and Indonesia.
The trend indicates that cases of cardiovascular disease are likely to increase substantially as a result of population growth and aging, according to the researchers. “More people means more heart attacks, strokes, and heart failure hospitalizations,” Roth said.
On the other hand, “aging is a very complex phenomenon,” he added. For example, in some countries, people have a shorter life expectancy due to other diseases and socioeconomic factors. Yet in others with rapidly aging populations, health care is simply not keeping up with the demand for services, the researcher said. In still others, health systems have managed to do something right. In Japan, for example, mortality rates for people with cardiovascular disease were six times lower in 2019 than in 1990.
“Japan is an example of a place where the health care system has been able to reduce cardiovascular disease despite aging, which is really the success we should all aim for,” Roth said. “Aging doesn’t have to mean more cardiovascular disease – healthy aging without heart disease is the goal.”
The question remains: how to translate knowledge into action in places that are not as successful?
For Mensah, the answer is clear because it is central to the mission of CTRIS. “We need a renewed focus on affordable, widely available, and proven-effective implementation strategies that help prevent, treat, and control cardiovascular diseases and related risk factors,” he said. “We also need strategies that promote ideal cardiovascular health beginning in childhood, so that we can ensure healthy aging for all,” he said.
That’s because atherosclerosis starts early, Roth explained, “and we know that a really healthy lifestyle will help you avoid most of the complications later in life. And our oldest adults need support to achieve healthy aging, which means a system that understands how to take care of older people with multiple diseases, and how to focus on cost-effective ways to help them stay active,” Roth said.
“Turning discovery into health is the NIH’s maxim for a reason—findings cannot be left on shelves. The prescription for preventing and treating cardiovascular diseases is not new,” Mensah said, “we just need to commit to doing it, and ensure that it is available, accessible, and affordable for all.”