Heart Disease and Stroke Are Global Problems: Where Will We Be One Decade From Now?

A seminal event occurred in September 2011 that has profound implications for global health. In an effort to reduce by 25% the risk of premature deaths from non-communicable diseases (NCDs), a high level meeting of the United Nations set key targets for nations to reach by 2025. This is referred to as the “25 x 25” goal and is a major focus of the World Health Organization (WHO). To help achieve the 25 x 25 goal, numerous organizations are collaborating and several task forces have been formed. The AHA is an active participant in these efforts through its collaborations with the WHO, the World Heart Federation (WHF), and groups such as the Global CVD Taskforce.

Tracking progress towards the 25 x 25 goal is key to shaping policy decisions and defining areas of focus at a national and regional level. Major efforts in this regard come from the Global Burden of Disease (GBD) Study – a multinational project that provides national and pooled data on diseases and death for all countries. The coordinating center for the GBD Study is at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, WA.1

The present report is a modeling study from the IHME using data from the GBD Study. The objective was to project trends in premature mortality (deaths between ages 30 and 70 years of age) from CVD through 2025, based on the present distribution of key risk factors and forecasting what would be observed if current trends in risk factors continued versus if the risk factor targets were achieved by 2025. The future scenarios that were modeled include: 1) no further rise in fasting plasma glucose, 2) no further rise in BMI, 3) a 25% reduction in the prevalence of a systolic BP >140 mmHg [population shift], and 4) a 30% reduction in the prevalence of tobacco smoking.

The modeling exercise showed that for men and women in high income countries, if the current favorable trends in risk factor patterns continue, it appears that the probability of premature CVD mortality will decrease by 25% between 2013 and 2025. The findings are not so encouraging for persons living in Eastern Europe/Central Asia, Sub-Saharan Africa, North Africa/Middle East, South Asia, East Asia/Pacific, or Latin American/Caribbean. For those regions, the 25 x 25 goal is potentially achievable, but depending on the region, aggressive efforts will be needed to achieve the risk factor scenarios noted above.

What will be needed to achieve the 25 x 25 targets in the regions at risk? What needs to be done to maintain the favorable trends in high income countries? As suggested by the authors, there must be a global commitment and strengthening of healthcare systems. Hopefully this will be stimulated by the anticipated incorporation of control of NCDs in the Sustainable Development Goals that are being discussed at the UN in September 2015.

Especially important efforts around the globe must be directed at key drivers that have the greatest impact on the risk of premature mortality for CVD – raised blood pressure and tobacco use. Some good news has just been announced regarding raised blood pressure – the NHLBI-sponsored SPRINT trial was stopped early because of a nearly 1/3 reduction in the rates of heart attack, heart failure, and stroke in subjects over age 50 treated to a systolic BP of <120 mmHg compared to the control arm that was treated to <140 mmHg.2 We await the details of the SPRINT report in the very near future.

The AHA is an international leader in tobacco control efforts through our policy statements, advocacy efforts, and collaborations with groups such s the Campaign for Tobacco-Free Kids.3,4 Our ongoing research efforts as one of the NIH/FDA-supported Tobacco Centers of Regulatory Science will help support the evidence base that will inform product regulation and reduce the deadly toll of tobacco-related diseases.5

The present report from the IHME provides not only a snapshot of where we are now in the control of NCDs but also lays out the roadmap for what needs to be accomplished to achieve our collective goal of lowering the global burden of heart disease and stroke.