HealthWatch
The Atlas of Heart Disease and Stroke
Reported by Erika Reinhardt
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Cardiovascular disease now ranks as the leading cause of death, resulting in one third of all deaths globally. The Atlas of Heart Disease
and Stroke, published by the World Health Organization (WHO) in conjunction with the United States Centers for Disease Control and Prevention (CDC), was launched on 26 September 2004 to coincide with the fifth annual World Heart Day, a major driving force for encouraging heart disease and stroke prevention worldwide. The report shows that heart disease and stroke are also becoming more deadly, with a projected combined death toll of 24 million by 2030. Both kill 17 million persons every year and are increasingly likely to afflict those in poor countries, WHO said.
Young people are increasingly adopting unhealthy lifestyles. Obesity, poor diets, smoking and physical inactivity—the leading causes of heart disease and stroke—are now being seen at an alarmingly early age. With children, adolescents and heart disease being the focus of the 2004 World Heart Day, WHO said that the young should be encouraged as early as possible to lead a healthy lifestyle, including diet and exercise, before they can develop any serious problems.
World Heart DayAround 100 countries took part in the fifth annual World Heart Day on 26 September 2004 in Geneva, with member societies organizing activities for everyone, including walks, runs, jump rope and fitness sessions, having a health check and learning about heart-healthy lifestyles from public talks, scientific forums and exhibitions. |
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Dr. Judith Mackay, co-author of the Atlas with Dr. George Mensah of CDC, said: “No matter what advances there are in high-technology medicine, the fundamental message is that any major reduction in deaths and disability from heart disease and stroke will come primarily from prevention, not just cure. This must involve robust reduction of risk factors through encouraging our children to adopt healthy lifestyle habits and by introducing appropriate policies and intervention programmes.”
According to Dr. Robert Beaglehole, Director of the WHO Chronic Diseases and Health Promotion, 80 per cent of the burden is in low- and middle-income countries, and heart disease and stroke not only take lives but also cause an enormous economic burden. He also stressed that the Atlas should be a significant new resource for global advocacy and education activity. It provides data for each country through maps, photographs and images, and provides risk-factor statistics for the occurrence of high blood pressure, tobacco use, physical inactivity, obesity, lipids and diabetes. Health policies and laws are also explained. The diverse elements of this global epidemic, including risk factors, similarities and differences between countries, the economic burden, prevention, policies and legislation, treatment and predictions, are chronicled. The report also contains a world data table with statistics for each country, as well as the number of healthy life years lost to heart disease and stroke, the prevalence of smoking and the status of policies and legislation.
"While heart disease and stroke are eminently preventable, decision-makers and government-funding agencies are overall neglecting this public health issue", said Janet Voute, Chief Executive Officer of the World Heart Federation, a non-governmental organization dedicated to the global prevention of these illnesses. “We know how to reduce the burden of heart disease and stroke, but what is needed now is the combination of necessary resources and political will by each country to take effective action.”
The Atlas is designed to inform health professionals, UN agencies, government officials, decision-makers, the media, researchers and the general public, and to provide an essential advocacy tool to stimulate vital action and help promote constructive decision-making.
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Over 100 risk factors have been associated with coronary heart disease and stroke and are now significant in all populations. In developed countries, at least one third of cardiovascular disease (CVD) is attributable to tobacco and alcohol use, high blood pressure, high cholesterol and obesity. In developing countries with low mortality like China, these risk factors are high on the top ten list. In developing countries with high mortality, such as in sub-Saharan Africa, high blood pressure, high cholesterol and tobacco and alcohol use, as well as low vegetable and fruit intake, are among the top risk factors. Some major risks can be prevented, treated and controlled by stopping smoking, reducing cholesterol and blood pressure, eating a healthy diet and increasing physical activity.
Risk factors, including dietary habits and smoking, are determined to a great extent by behaviours learned in childhood and are starting to appear earlier throughout the world. Physical activity decreases markedly in adolescence, particularly in girls, and obesity has increased substantially not only in Europe and North America but also in China and Japan where populations are traditionally slender. Type 2 diabetes is increasing in adolescents in North America, Japan and Thailand. .
Programmes to address childhood and youth risk factors are mostly confined to developed countries, but urgent action is required. Families, schools, communities, health professionals and policymakers all need to promote healthy lifestyles in children and young people. .
High blood pressure or hypertension is one of the most important preventable causes of premature death. In most countries, up to 30 per cent of adults suffer from it and another 50 to 60 per cent would be in better health if they reduced it by increasing physical activity, maintaining an ideal weight and eating more fruits and vegetables. Medication is available to control high blood pressure. .
High cholesterol causes around a third of all CVD worldwide. .
There is a larger risk of developing CVD than lung cancer from cigarette smoking. The risks are much higher in people who started smoking before the age of 16. .
People are becoming obese due to the availability of food, changes in the kind of food eaten, and decreased exercise. Industrialization, urbanization and mechanized transport have reduced physical activity, thus more than 60 per cent of the global population is not sufficiently active. In China, there are 70 million overweight persons; South Pacific populations that used to be physically active and slim now have some of the highest rates of obesity. .
Diabetes is a risk factor for coronary heart disease and stroke. Over 170 million persons worldwide have diabetes and the number is increasing. Changes in childhood diets and low levels of exercise are leading to an increasing prevalence of type 2 diabetes in children. It is more prevalent in developed countries, but modernization and lifestyle changes will likely result in a future epidemic in developing countries.
A low socio-economic status is associated with an
increased risk of CVD due to lifestyle and behaviour patterns, lack of access to health care and chronic stress. .
Cardiovascular disease is responsible for the loss of 10 per cent of disability-adjusted life years (DALYs), which indicate the total burden of a disease, as opposed to the resulting deaths. CVD is responsible for 10-per-cent DALYs lost in low- and middle-income countries and 18 per cent in high-income countries. .
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| Charts from the Atlas of Heart Disease and Stroke |
Heart disease mortality rates are also affected by differences in the major risk factors between countries. While genetic factors play a part, 80 to 89 per cent of persons dying from coronary heart disease have one or more major risk factors that are influenced by lifestyle. .
Death rates from coronary heart disease have decreased in North America and many western European countries. It is expected that 82 per cent of the increase in coronary heart disease mortality will occur in developing countries. .
The risk of heart attack changed when people migrated. Japan has a low rate of coronary heart disease, but the Japanese were found to have a gradually increasing risk after moving to the United States, eventually approaching that of those born in the United States. .
Annually, 15 million persons worldwide suffer a stroke: of these, 5 million die and 5 million are left permanently disabled, placing a burden on the family and community. The major risk factors are high blood pressure and tobacco use. The incidence of stroke is declining in many developed countries. Even where advanced technology and facilities are available, 60 per cent of those who suffer a stroke die or become dependent. With these statistics and the high cost of treatment, high priority should be given to preventive strategies. .
Permanent disabilities resulting from diabetes in Latin America and the Caribbean cost $50 billion in 2000, while that for insulin, hospitalization, consultations and care totalled $10.6 billion. .
Between 4 and 5 per cent of health budgets globally are spent on diabetes-related illnesses.
Health problems related to obesity, such as heart disease and type 2 diabetes, cost the United States an estimated $177 billion a year. .
The capacity of virtually all CVD control organizations, including NGOs, and numerous other partners is inadequate to meet the challenge of the CVD epidemic.
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