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1. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study

Author

Roth, GA, Mensah, GA, Johnson, CO, Addolorato, G, Ammirati, E, Baddour, LM, Barengo, NC, Beaton, A, Benjamin, EJ, Benziger, CP, Bonny, A, Brauer, M, Brodmann, M, Cahill, TJ, Carapetis, JR, Catapano, AL, Chugh, S, Cooper, LT, Coresh, J, Criqui, MH, DeCleene, NK, Eagle, KA, Emmons-Bell, S, Feigin, VL, Fernández-Sola, J, Fowkes, FGR, Gakidou, E, Grundy, SM, He, FJ, Howard, G, Hu, F, Inker, L, Karthikeyan, G, Kassebaum, NJ, Koroshetz, WJ, Lavie, C, Lloyd-Jones, D, Lu, HS, Mirijello, A, Misganaw, AT, Mokdad, AH, Moran, AE, Muntner, P, Narula, J, Neal, B, Ntsekhe, M, Oliveira, GMM, Otto, CM, Owolabi, MO, Pratt, M, Rajagopalan, S, Reitsma, MB, Ribeiro, ALP, Rigotti, NA, Rodgers, A, Sable, CA, Shakil, SS, Sliwa, K, Stark, BA, Sundström, J, Timpel, P, Tleyjeh, II, Valgimigli, M, Vos, T, Whelton, PK, Yacoub, M, Zuhlke, LJ, Abbasi-Kangevari, M, Abdi, A, Abedi, A, Aboyans, V, Abrha, WA, Abu-Gharbieh, E, Abushouk, AI, Acharya, D, Adair, T, Adebayo, OM, Ademi, Z, Advani, SM, Afshari, K, Afshin, A, Agarwal, G, Agasthi, P, Ahmad, S, Ahmadi, S, Ahmed, MB, Aji, B, Akalu, Y, Akande-Sholabi, W, Aklilu, A, Akunna, CJ, Alahdab, F, Al-Eyadhy, A, Alhabib, KF, Alif, SM, Alipour, V, Aljunid, SM, Alla, F, Almasi-Hashiani, A, Almustanyir, S, Roth, GA, Mensah, GA, Johnson, CO, Addolorato, G, Ammirati, E, Baddour, LM, Barengo, NC, Beaton, A, Benjamin, EJ, Benziger, CP, Bonny, A, Brauer, M, Brodmann, M, Cahill, TJ, Carapetis, JR, Catapano, AL, Chugh, S, Cooper, LT, Coresh, J, Criqui, MH, DeCleene, NK, Eagle, KA, Emmons-Bell, S, Feigin, VL, Fernández-Sola, J, Fowkes, FGR, Gakidou, E, Grundy, SM, He, FJ, Howard, G, Hu, F, Inker, L, Karthikeyan, G, Kassebaum, NJ, Koroshetz, WJ, Lavie, C, Lloyd-Jones, D, Lu, HS, Mirijello, A, Misganaw, AT, Mokdad, AH, Moran, AE, Muntner, P, Narula, J, Neal, B, Ntsekhe, M, Oliveira, GMM, Otto, CM, Owolabi, MO, Pratt, M, Rajagopalan, S, Reitsma, MB, Ribeiro, ALP, Rigotti, NA, Rodgers, A, Sable, CA, Shakil, SS, Sliwa, K, Stark, BA, Sundström, J, Timpel, P, Tleyjeh, II, Valgimigli, M, Vos, T, Whelton, PK, Yacoub, M, Zuhlke, LJ, Abbasi-Kangevari, M, Abdi, A, Abedi, A, Aboyans, V, Abrha, WA, Abu-Gharbieh, E, Abushouk, AI, Acharya, D, Adair, T, Adebayo, OM, Ademi, Z, Advani, SM, Afshari, K, Afshin, A, Agarwal, G, Agasthi, P, Ahmad, S, Ahmadi, S, Ahmed, MB, Aji, B, Akalu, Y, Akande-Sholabi, W, Aklilu, A, Akunna, CJ, Alahdab, F, Al-Eyadhy, A, Alhabib, KF, Alif, SM, Alipour, V, Aljunid, SM, Alla, F, Almasi-Hashiani, A, and Almustanyir, S

Abstract

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside

Published
2020

2. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019

Author

Roth, GA, Mensah, GA, Johnson, CO, Addolorato, G, Ammirati, E, Baddour, LM, Barengo, NC, Beaton, AZ, Benjamin, EJ, Benziger, CP, Bonny, A, Brauer, M, Brodmann, M, Cahill, TJ, Carapetis, J, Catapano, AL, Chugh, SS, Cooper, LT, Coresh, J, Criqui, M, DeCleene, N, Eagle, KA, Emmons-Bell, S, Feigin, VL, Fernández-Solà, J, Fowkes, G, Gakidou, E, Grundy, SM, He, FJ, Howard, G, Hu, F, Inker, L, Karthikeyan, G, Kassebaum, N, Koroshetz, W, Lavie, C, Lloyd-Jones, D, Lu, HS, Mirijello, A, Temesgen, AM, Mokdad, A, Moran, AE, Muntner, P, Narula, J, Neal, B, Ntsekhe, M, Moraes de Oliveira, G, Otto, C, Owolabi, M, Pratt, M, Rajagopalan, S, Reitsma, M, Ribeiro, ALP, Rigotti, N, Rodgers, A, Sable, C, Shakil, S, Sliwa-Hahnle, K, Stark, B, Sundström, J, Timpel, P, Tleyjeh, IM, Valgimigli, M, Vos, T, Whelton, PK, Yacoub, M, Zuhlke, L, Murray, C, Fuster, V, Beaton, A, Carapetis, JR, Chugh, S, Criqui, MH, DeCleene, NK, Fernández-Sola, J, Fowkes, FGR, Kassebaum, NJ, Koroshetz, WJ, Misganaw, AT, Mokdad, AH, Oliveira, GMM, Otto, CM, Owolabi, MO, Reitsma, MB, Rigotti, NA, Sable, CA, Shakil, SS, Sliwa, K, Stark, BA, Tleyjeh, II, Zuhlke, LJ, Abbasi-Kangevari, M, Abdi, A, Abedi, A, Aboyans, V, Abrha, WA, Abu-Gharbieh, E, Abushouk, AI, Acharya, D, Adair, T, Adebayo, OM, Ademi, Z, Advani, SM, Afshari, K, Afshin, A, Agarwal, G, Agasthi, P, Ahmad, S, Ahmadi, S, Ahmed, MB, Aji, B, Akalu, Y, Akande-Sholabi, W, Aklilu, A, Akunna, CJ, Alahdab, F, Al-Eyadhy, A, Alhabib, KF, Alif, SM, Alipour, V, Aljunid, SM, Alla, F, Almasi-Hashiani, A, Almustanyir, S, Al-Raddadi, RM, Amegah, AK, Amini, S, Aminorroaya, A, Amu, H, Amugsi, DA, Ancuceanu, R, Anderlini, D, Andrei, T, Andrei, CL, Ansari-Moghaddam, A, Anteneh, ZA, Antonazzo, IC, Antony, B, Anwer, R, Appiah, LT, Arabloo, J, Ärnlöv, J, Artanti, KD, Ataro, Z, Ausloos, M, Avila-Burgos, L, Awan, AT, Awoke, MA, Ayele, HT, Ayza, MA, Azari, S, B, DB, Baheiraei, N, Baig, AA, Bakhtiari, A, Banach, M, Banik, PC, Baptista, EA, Barboza, MA, Barua, L, Basu, S, Bedi, N, Béjot, Y, Bennett, DA, Bensenor, IM, Berman, AE, Bezabih, YM, Bhagavathula, AS, Bhaskar, S, Bhattacharyya, K, Bijani, A, Bikbov, B, Birhanu, MM, Boloor, A, Brant, LC, Brenner, H, Briko, NI, Butt, ZA, Caetano dos Santos, FL, Cahill, LE, Cahuana-Hurtado, L, Cámera, LA, Campos-Nonato, IR, Cantu-Brito, C, Car, J, Carrero, JJ, Carvalho, F, Castañeda-Orjuela, CA, Catalá-López, F, Cerin, E, Charan, J, Chattu, VK, Chen, S, Chin, KL, Choi, J-YJ, Chu, D-T, Chung, S-C, Cirillo, M, Coffey, S, Conti, S, Costa, VM, Cundiff, DK, Dadras, O, Dagnew, B, Dai, X, Damasceno, AAM, Dandona, L, Dandona, R, Davletov, K, De la Cruz-Góngora, V, De la Hoz, FP, De Neve, J-W, Denova-Gutiérrez, E, Derbew Molla, M, Derseh, BT, Desai, R, Deuschl, G, Dharmaratne, SD, Dhimal, M, Dhungana, RR, Dianatinasab, M, Diaz, D, Djalalinia, S, Dokova, K, Douiri, A, Duncan, BB, Duraes, AR, Eagan, AW, Ebtehaj, S, Eftekhari, A, Eftekharzadeh, S, Ekholuenetale, M, El Nahas, N, Elgendy, IY, Elhadi, M, El-Jaafary, SI, Esteghamati, S, Etisso, AE, Eyawo, O, Fadhil, I, Faraon, EJA, Faris, PS, Farwati, M, Farzadfar, F, Fernandes, E, Fernandez Prendes, C, Ferrara, P, Filip, I, Fischer, F, Flood, D, Fukumoto, T, Gad, MM, Gaidhane, S, Ganji, M, Garg, J, Gebre, AK, Gebregiorgis, BG, Gebregzabiher, KZ, Gebremeskel, GG, Getacher, L, Obsa, AG, Ghajar, A, Ghashghaee, A, Ghith, N, Giampaoli, S, Gilani, SA, Gill, PS, Gillum, RF, Glushkova, EV, Gnedovskaya, EV, Golechha, M, Gonfa, KB, Goudarzian, AH, Goulart, AC, Guadamuz, JS, Guha, A, Guo, Y, Gupta, R, Hachinski, V, Hafezi-Nejad, N, Haile, TG, Hamadeh, RR, Hamidi, S, Hankey, GJ, Hargono, A, Hartono, RK, Hashemian, M, Hashi, A, Hassan, S, Hassen, HY, Havmoeller, RJ, Hay, SI, Hayat, K, Heidari, G, Herteliu, C, Holla, R, Hosseini, M, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Househ, M, Huang, J, Humayun, A, Iavicoli, I, Ibeneme, CU, Ibitoye, SE, Ilesanmi, OS, Ilic, IM, Ilic, MD, Iqbal, U, Irvani, SSN, Shariful Islam, Sheikh, Islam, RM, Iso, H, Iwagami, M, Jain, V, Javaheri, T, Jayapal, SK, Jayaram, S, Jayawardena, R, Jeemon, P, Jha, RP, Jonas, JB, Jonnagaddala, J, Joukar, F, Jozwiak, JJ, Jürisson, M, Kabir, A, Kahlon, T, Kalani, R, Kalhor, R, Kamath, A, Kamel, I, Kandel, H, Kandel, A, Karch, A, Kasa, AS, Katoto, PDMC, Kayode, GA, Khader, YS, Khammarnia, M, Khan, MS, Khan, MN, Khan, M, Khan, EA, Khatab, K, Kibria, GMA, Kim, YJ, Kim, GR, Kimokoti, RW, Kisa, S, Kisa, A, Kivimäki, M, Kolte, D, Koolivand, A, Korshunov, VA, Koulmane Laxminarayana, SL, Koyanagi, A, Krishan, K, Krishnamoorthy, V, Kuate Defo, B, Kucuk Bicer, B, Kulkarni, V, Kumar, GA, Kumar, N, Kurmi, OP, Kusuma, D, Kwan, GF, La Vecchia, C, Lacey, B, Lallukka, T, Lan, Q, Lasrado, S, Lassi, ZS, Lauriola, P, Lawrence, WR, Laxmaiah, A, LeGrand, KE, Li, M-C, Li, B, Li, S, Lim, SS, Lim, L-L, Lin, H, Lin, Z, Lin, R-T, Liu, X, Lopez, AD, Lorkowski, S, Lotufo, PA, Lugo, A, M, NK, Madotto, F, Mahmoudi, M, Majeed, A, Malekzadeh, R, Malik, AA, Mamun, AA, Manafi, N, Mansournia, MA, Mantovani, LG, Martini, S, Mathur, MR, Mazzaglia, G, Mehata, S, Mehndiratta, MM, Meier, T, Menezes, RG, Meretoja, A, Mestrovic, T, Miazgowski, B, Miazgowski, T, Michalek, IM, Miller, TR, Mirrakhimov, EM, Mirzaei, H, Moazen, B, Moghadaszadeh, M, Mohammad, Y, Mohammad, DK, Mohammed, S, Mohammed, MA, Mokhayeri, Y, Molokhia, M, Montasir, AA, Moradi, G, Moradzadeh, R, Moraga, P, Morawska, L, Moreno Velásquez, I, Morze, J, Mubarik, S, Muruet, W, Musa, KI, Nagarajan, AJ, Nalini, M, Nangia, V, Naqvi, AA, Narasimha Swamy, S, Nascimento, BR, Nayak, VC, Nazari, J, Nazarzadeh, M, Negoi, RI, Neupane Kandel, S, Nguyen, HLT, Nixon, MR, Norrving, B, Noubiap, JJ, Nouthe, BE, Nowak, C, Odukoya, OO, Ogbo, FA, Olagunju, AT, Orru, H, Ortiz, A, Ostroff, SM, Padubidri, JR, Palladino, R, Pana, A, Panda-Jonas, S, Parekh, U, Park, E-C, Parvizi, M, Pashazadeh Kan, F, Patel, UK, Pathak, M, Paudel, R, Pepito, VCF, Perianayagam, A, Perico, N, Pham, HQ, Pilgrim, T, Piradov, MA, Pishgar, F, Podder, V, Polibin, RV, Pourshams, A, Pribadi, DRA, Rabiee, N, Rabiee, M, Radfar, A, Rafiei, A, Rahim, F, Rahimi-Movaghar, V, Ur Rahman, MH, Rahman, Muhammad, Rahmani, AM, Rakovac, I, Ram, P, Ramalingam, S, Rana, J, Ranasinghe, P, Rao, SJ, Rathi, P, Rawal, L, Rawasia, WF, Rawassizadeh, R, Remuzzi, G, Renzaho, AMN, Rezapour, A, Riahi, SM, Roberts-Thomson, RL, Roever, L, Rohloff, P, Romoli, M, Roshandel, G, Rwegerera, GM, Saadatagah, S, Saber-Ayad, MM, Sabour, S, Sacco, S, Sadeghi, M, Saeedi Moghaddam, S, Safari, S, Sahebkar, A, Salehi, S, Salimzadeh, H, Samaei, M, Samy, AM, Santos, IS, Santric-Milicevic, MM, Sarrafzadegan, N, Sarveazad, A, Sathish, T, Sawhney, M, Saylan, M, Schmidt, MI, Schutte, AE, Senthilkumaran, S, Sepanlou, SG, Sha, F, Shahabi, S, Shahid, I, Shaikh, MA, Shamali, M, Shamsizadeh, M, Shawon, MSR, Sheikh, A, Shigematsu, M, Shin, M-J, Shin, JI, Shiri, R, Shiue, I, Shuval, K, Siabani, S, Siddiqi, TJ, Silva, DAS, Singh, JA, Mtech, AS, Skryabin, VY, Skryabina, AA, Soheili, A, Spurlock, EE, Stockfelt, L, Stortecky, S, Stranges, S, Suliankatchi Abdulkader, R, Tadbiri, H, Tadesse, EG, Tadesse, DB, Tajdini, M, Tariqujjaman, M, Teklehaimanot, BF, Temsah, M-H, Tesema, AK, Thakur, B, Thankappan, KR, Thapar, R, Thrift, AG, Timalsina, B, Tonelli, M, Touvier, M, Tovani-Palone, MR, Tripathi, A, Tripathy, JP, Truelsen, TC, Tsegay, GM, Tsegaye, GW, Tsilimparis, N, Tusa, BS, Tyrovolas, S, Umapathi, KK, Unim, B, Unnikrishnan, B, Usman, MS, Vaduganathan, M, Valdez, PR, Vasankari, TJ, Velazquez, DZ, Venketasubramanian, N, Vu, GT, Vujcic, IS, Waheed, Y, Wang, Y, Wang, F, Wei, J, Weintraub, RG, Weldemariam, AH, Westerman, R, Winkler, AS, Wiysonge, CS, Wolfe, CDA, Wubishet, BL, Xu, G, Yadollahpour, A, Yamagishi, K, Yan, LL, Yandrapalli, S, Yano, Y, Yatsuya, H, Yeheyis, TY, Yeshaw, Y, Yilgwan, CS, Yonemoto, N, Yu, C, Yusefzadeh, H, Zachariah, G, Zaman, SB, Zaman, MS, Zamanian, M, Zand, R, Zandifar, A, Zarghi, A, Zastrozhin, MS, Zastrozhina, A, Zhang, Z-J, Zhang, Y, Zhang, W, Zhong, C, Zou, Z, Zuniga, YMH, Murray, CJL, Roth, GA, Mensah, GA, Johnson, CO, Addolorato, G, Ammirati, E, Baddour, LM, Barengo, NC, Beaton, AZ, Benjamin, EJ, Benziger, CP, Bonny, A, Brauer, M, Brodmann, M, Cahill, TJ, Carapetis, J, Catapano, AL, Chugh, SS, Cooper, LT, Coresh, J, Criqui, M, DeCleene, N, Eagle, KA, Emmons-Bell, S, Feigin, VL, Fernández-Solà, J, Fowkes, G, Gakidou, E, Grundy, SM, He, FJ, Howard, G, Hu, F, Inker, L, Karthikeyan, G, Kassebaum, N, Koroshetz, W, Lavie, C, Lloyd-Jones, D, Lu, HS, Mirijello, A, Temesgen, AM, Mokdad, A, Moran, AE, Muntner, P, Narula, J, Neal, B, Ntsekhe, M, Moraes de Oliveira, G, Otto, C, Owolabi, M, Pratt, M, Rajagopalan, S, Reitsma, M, Ribeiro, ALP, Rigotti, N, Rodgers, A, Sable, C, Shakil, S, Sliwa-Hahnle, K, Stark, B, Sundström, J, Timpel, P, Tleyjeh, IM, Valgimigli, M, Vos, T, Whelton, PK, Yacoub, M, Zuhlke, L, Murray, C, Fuster, V, Beaton, A, Carapetis, JR, Chugh, S, Criqui, MH, DeCleene, NK, Fernández-Sola, J, Fowkes, FGR, Kassebaum, NJ, Koroshetz, WJ, Misganaw, AT, Mokdad, AH, Oliveira, GMM, Otto, CM, Owolabi, MO, Reitsma, MB, Rigotti, NA, Sable, CA, Shakil, SS, Sliwa, K, Stark, BA, Tleyjeh, II, Zuhlke, LJ, Abbasi-Kangevari, M, Abdi, A, Abedi, A, Aboyans, V, Abrha, WA, Abu-Gharbieh, E, Abushouk, AI, Acharya, D, Adair, T, Adebayo, OM, Ademi, Z, Advani, SM, Afshari, K, Afshin, A, Agarwal, G, Agasthi, P, Ahmad, S, Ahmadi, S, Ahmed, MB, Aji, B, Akalu, Y, Akande-Sholabi, W, Aklilu, A, Akunna, CJ, Alahdab, F, Al-Eyadhy, A, Alhabib, KF, Alif, SM, Alipour, V, Aljunid, SM, Alla, F, Almasi-Hashiani, A, Almustanyir, S, Al-Raddadi, RM, Amegah, AK, Amini, S, Aminorroaya, A, Amu, H, Amugsi, DA, Ancuceanu, R, Anderlini, D, Andrei, T, Andrei, CL, Ansari-Moghaddam, A, Anteneh, ZA, Antonazzo, IC, Antony, B, Anwer, R, Appiah, LT, Arabloo, J, Ärnlöv, J, Artanti, KD, Ataro, Z, Ausloos, M, Avila-Burgos, L, Awan, AT, Awoke, MA, Ayele, HT, Ayza, MA, Azari, S, B, DB, Baheiraei, N, Baig, AA, Bakhtiari, A, Banach, M, Banik, PC, Baptista, EA, Barboza, MA, Barua, L, Basu, S, Bedi, N, Béjot, Y, Bennett, DA, Bensenor, IM, Berman, AE, Bezabih, YM, Bhagavathula, AS, Bhaskar, S, Bhattacharyya, K, Bijani, A, Bikbov, B, Birhanu, MM, Boloor, A, Brant, LC, Brenner, H, Briko, NI, Butt, ZA, Caetano dos Santos, FL, Cahill, LE, Cahuana-Hurtado, L, Cámera, LA, Campos-Nonato, IR, Cantu-Brito, C, Car, J, Carrero, JJ, Carvalho, F, Castañeda-Orjuela, CA, Catalá-López, F, Cerin, E, Charan, J, Chattu, VK, Chen, S, Chin, KL, Choi, J-YJ, Chu, D-T, Chung, S-C, Cirillo, M, Coffey, S, Conti, S, Costa, VM, Cundiff, DK, Dadras, O, Dagnew, B, Dai, X, Damasceno, AAM, Dandona, L, Dandona, R, Davletov, K, De la Cruz-Góngora, V, De la Hoz, FP, De Neve, J-W, Denova-Gutiérrez, E, Derbew Molla, M, Derseh, BT, Desai, R, Deuschl, G, Dharmaratne, SD, Dhimal, M, Dhungana, RR, Dianatinasab, M, Diaz, D, Djalalinia, S, Dokova, K, Douiri, A, Duncan, BB, Duraes, AR, Eagan, AW, Ebtehaj, S, Eftekhari, A, Eftekharzadeh, S, Ekholuenetale, M, El Nahas, N, Elgendy, IY, Elhadi, M, El-Jaafary, SI, Esteghamati, S, Etisso, AE, Eyawo, O, Fadhil, I, Faraon, EJA, Faris, PS, Farwati, M, Farzadfar, F, Fernandes, E, Fernandez Prendes, C, Ferrara, P, Filip, I, Fischer, F, Flood, D, Fukumoto, T, Gad, MM, Gaidhane, S, Ganji, M, Garg, J, Gebre, AK, Gebregiorgis, BG, Gebregzabiher, KZ, Gebremeskel, GG, Getacher, L, Obsa, AG, Ghajar, A, Ghashghaee, A, Ghith, N, Giampaoli, S, Gilani, SA, Gill, PS, Gillum, RF, Glushkova, EV, Gnedovskaya, EV, Golechha, M, Gonfa, KB, Goudarzian, AH, Goulart, AC, Guadamuz, JS, Guha, A, Guo, Y, Gupta, R, Hachinski, V, Hafezi-Nejad, N, Haile, TG, Hamadeh, RR, Hamidi, S, Hankey, GJ, Hargono, A, Hartono, RK, Hashemian, M, Hashi, A, Hassan, S, Hassen, HY, Havmoeller, RJ, Hay, SI, Hayat, K, Heidari, G, Herteliu, C, Holla, R, Hosseini, M, Hosseinzadeh, M, Hostiuc, M, Hostiuc, S, Househ, M, Huang, J, Humayun, A, Iavicoli, I, Ibeneme, CU, Ibitoye, SE, Ilesanmi, OS, Ilic, IM, Ilic, MD, Iqbal, U, Irvani, SSN, Shariful Islam, Sheikh, Islam, RM, Iso, H, Iwagami, M, Jain, V, Javaheri, T, Jayapal, SK, Jayaram, S, Jayawardena, R, Jeemon, P, Jha, RP, Jonas, JB, Jonnagaddala, J, Joukar, F, Jozwiak, JJ, Jürisson, M, Kabir, A, Kahlon, T, Kalani, R, Kalhor, R, Kamath, A, Kamel, I, Kandel, H, Kandel, A, Karch, A, Kasa, AS, Katoto, PDMC, Kayode, GA, Khader, YS, Khammarnia, M, Khan, MS, Khan, MN, Khan, M, Khan, EA, Khatab, K, Kibria, GMA, Kim, YJ, Kim, GR, Kimokoti, RW, Kisa, S, Kisa, A, Kivimäki, M, Kolte, D, Koolivand, A, Korshunov, VA, Koulmane Laxminarayana, SL, Koyanagi, A, Krishan, K, Krishnamoorthy, V, Kuate Defo, B, Kucuk Bicer, B, Kulkarni, V, Kumar, GA, Kumar, N, Kurmi, OP, Kusuma, D, Kwan, GF, La Vecchia, C, Lacey, B, Lallukka, T, Lan, Q, Lasrado, S, Lassi, ZS, Lauriola, P, Lawrence, WR, Laxmaiah, A, LeGrand, KE, Li, M-C, Li, B, Li, S, Lim, SS, Lim, L-L, Lin, H, Lin, Z, Lin, R-T, Liu, X, Lopez, AD, Lorkowski, S, Lotufo, PA, Lugo, A, M, NK, Madotto, F, Mahmoudi, M, Majeed, A, Malekzadeh, R, Malik, AA, Mamun, AA, Manafi, N, Mansournia, MA, Mantovani, LG, Martini, S, Mathur, MR, Mazzaglia, G, Mehata, S, Mehndiratta, MM, Meier, T, Menezes, RG, Meretoja, A, Mestrovic, T, Miazgowski, B, Miazgowski, T, Michalek, IM, Miller, TR, Mirrakhimov, EM, Mirzaei, H, Moazen, B, Moghadaszadeh, M, Mohammad, Y, Mohammad, DK, Mohammed, S, Mohammed, MA, Mokhayeri, Y, Molokhia, M, Montasir, AA, Moradi, G, Moradzadeh, R, Moraga, P, Morawska, L, Moreno Velásquez, I, Morze, J, Mubarik, S, Muruet, W, Musa, KI, Nagarajan, AJ, Nalini, M, Nangia, V, Naqvi, AA, Narasimha Swamy, S, Nascimento, BR, Nayak, VC, Nazari, J, Nazarzadeh, M, Negoi, RI, Neupane Kandel, S, Nguyen, HLT, Nixon, MR, Norrving, B, Noubiap, JJ, Nouthe, BE, Nowak, C, Odukoya, OO, Ogbo, FA, Olagunju, AT, Orru, H, Ortiz, A, Ostroff, SM, Padubidri, JR, Palladino, R, Pana, A, Panda-Jonas, S, Parekh, U, Park, E-C, Parvizi, M, Pashazadeh Kan, F, Patel, UK, Pathak, M, Paudel, R, Pepito, VCF, Perianayagam, A, Perico, N, Pham, HQ, Pilgrim, T, Piradov, MA, Pishgar, F, Podder, V, Polibin, RV, Pourshams, A, Pribadi, DRA, Rabiee, N, Rabiee, M, Radfar, A, Rafiei, A, Rahim, F, Rahimi-Movaghar, V, Ur Rahman, MH, Rahman, Muhammad, Rahmani, AM, Rakovac, I, Ram, P, Ramalingam, S, Rana, J, Ranasinghe, P, Rao, SJ, Rathi, P, Rawal, L, Rawasia, WF, Rawassizadeh, R, Remuzzi, G, Renzaho, AMN, Rezapour, A, Riahi, SM, Roberts-Thomson, RL, Roever, L, Rohloff, P, Romoli, M, Roshandel, G, Rwegerera, GM, Saadatagah, S, Saber-Ayad, MM, Sabour, S, Sacco, S, Sadeghi, M, Saeedi Moghaddam, S, Safari, S, Sahebkar, A, Salehi, S, Salimzadeh, H, Samaei, M, Samy, AM, Santos, IS, Santric-Milicevic, MM, Sarrafzadegan, N, Sarveazad, A, Sathish, T, Sawhney, M, Saylan, M, Schmidt, MI, Schutte, AE, Senthilkumaran, S, Sepanlou, SG, Sha, F, Shahabi, S, Shahid, I, Shaikh, MA, Shamali, M, Shamsizadeh, M, Shawon, MSR, Sheikh, A, Shigematsu, M, Shin, M-J, Shin, JI, Shiri, R, Shiue, I, Shuval, K, Siabani, S, Siddiqi, TJ, Silva, DAS, Singh, JA, Mtech, AS, Skryabin, VY, Skryabina, AA, Soheili, A, Spurlock, EE, Stockfelt, L, Stortecky, S, Stranges, S, Suliankatchi Abdulkader, R, Tadbiri, H, Tadesse, EG, Tadesse, DB, Tajdini, M, Tariqujjaman, M, Teklehaimanot, BF, Temsah, M-H, Tesema, AK, Thakur, B, Thankappan, KR, Thapar, R, Thrift, AG, Timalsina, B, Tonelli, M, Touvier, M, Tovani-Palone, MR, Tripathi, A, Tripathy, JP, Truelsen, TC, Tsegay, GM, Tsegaye, GW, Tsilimparis, N, Tusa, BS, Tyrovolas, S, Umapathi, KK, Unim, B, Unnikrishnan, B, Usman, MS, Vaduganathan, M, Valdez, PR, Vasankari, TJ, Velazquez, DZ, Venketasubramanian, N, Vu, GT, Vujcic, IS, Waheed, Y, Wang, Y, Wang, F, Wei, J, Weintraub, RG, Weldemariam, AH, Westerman, R, Winkler, AS, Wiysonge, CS, Wolfe, CDA, Wubishet, BL, Xu, G, Yadollahpour, A, Yamagishi, K, Yan, LL, Yandrapalli, S, Yano, Y, Yatsuya, H, Yeheyis, TY, Yeshaw, Y, Yilgwan, CS, Yonemoto, N, Yu, C, Yusefzadeh, H, Zachariah, G, Zaman, SB, Zaman, MS, Zamanian, M, Zand, R, Zandifar, A, Zarghi, A, Zastrozhin, MS, Zastrozhina, A, Zhang, Z-J, Zhang, Y, Zhang, W, Zhong, C, Zou, Z, Zuniga, YMH, and Murray, CJL

Abstract

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019.Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019.Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside hi

Published
2020

3. From vulnerable plaque to vulnerable patient - A call for new definitions and risk assessment strategies: Part I

Author

Naghavi, M Libby, P Falk, E Casscells, SW Litovsky, S and Rumberger, J Badimon, JJ Stefanadis, C Moreno, P and Pasterkamp, G Fayad, Z Stone, PH Waxman, S Raggi, P and Madjid, M Zarrabi, A Burke, A Yuan, C Fitzgerald, PJ and Siscovick, DS de Korte, CL Aikawa, M Airaksinen, KEJ and Assmann, G Becker, CR Chesebro, JH Farb, A Galis, ZS and Jackson, C Jang, IK Koenig, W Lodder, RA March, K and Demirovic, J Navab, M Priori, SG Rekhter, MD Bahr, R and Grundy, SM Mehran, R Colombo, A Boerwinkle, E and Ballantyne, C Insull, W Schwartz, RS Vogel, R Serruys, PW Hansson, GK Faxon, DP Kaul, S Drexler, H and Greenland, P Muller, JE Virmani, R Ridker, PM Zipes, DP and Shah, PK Willerson, JT

Abstract

Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term “vulnerable patient” may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document focuses on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.

Published
2003

16. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.

Author

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, and Smith SC Jr

Published
2009
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35. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels.

Author

Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R, and Stresa Workshop Participants

Abstract

Foods with plant stanol or sterol esters lower serum cholesterol levels. We summarize the deliberations of 32 experts on the efficacy and safety of sterols and stanols. A meta-analysis of 41 trials showed that intake of 2 g/d of stanols or sterols reduced low-density lipoprotein (LDL) by 10%; higher intakes added little. Efficacy is similar for sterols and stanols, but the food form may substantially affect LDL reduction. Effects are additive with diet or drug interventions: eating foods low in saturated fat and cholesterol and high in stanols or sterols can reduce LDL by 20%; adding sterols or stanols to statin medication is more effective than doubling the statin dose. A meta-analysis of 10 to 15 trials per vitamin showed that plasma levels of vitamins A and D are not affected by stanols or sterols. Alpha carotene, lycopene, and vitamin E levels remained stable relative to their carrier molecule, LDL. Beta carotene levels declined, but adverse health outcomes were not expected. Sterol-enriched foods increased plasma sterol levels, and workshop participants discussed whether this would increase risk, in view of the marked increase of atherosclerosis in patients with homozygous phytosterolemia. This risk is believed to be largely hypothetical, and any increase due to the small increase in plasma plant sterols may be more than offset by the decrease in plasma LDL. There are insufficient data to suggest that plant stanols or sterols either prevent or promote colon carcinogenesis. Safety of sterols and stanols is being monitored by follow-up of samples from the general population; however, the power of such studies to pick up infrequent increases in common diseases, if any exist, is limited. A trial with clinical outcomes probably would not answer remaining questions about infrequent adverse effects. Trials with surrogate end points such as intima-media thickness might corroborate the expected efficacy in reducing atherosclerosis. However, present evidence is sufficient to promote use of sterols and stanols for lowering LDL cholesterol levels in persons at increased risk for coronary heart disease. [ABSTRACT FROM AUTHOR]

Published
2003

36. Comparison of the antioxidant effects of Concord grape juice flavonoids and alpha-tocopherol on markers of oxidative stress in healthy adults.

Author

O'Byrne DJ, Devaraj S, Grundy SM, and Jialal I

Abstract

BACKGROUND: Concord grape juice (CGJ) is a rich source of flavonoids, which have greater antioxidant efficacy in vitro than does alpha-tocopherol; however, the efficacies of flavonoids and alpha-tocopherol in vivo have not been compared. OBJECTIVE: We compared the in vivo antioxidant efficacy of CGJ with that of alpha-tocopherol in healthy adults. DESIGN: Subjects were randomly assigned to receive either 400 IU RRR-alpha-tocopherol/d (n = 17) or 10 mL CGJ x kg(-1) x d(-1) (n = 15) for 2 wk. Serum oxygen radical absorbance capacity, plasma protein carbonyls, urinary F(2)-isoprostanes, and resistance of LDL to ex vivo oxidation were measured before and after supplementation as markers of antioxidant status and oxidative stress. RESULTS: After supplementation, plasma alpha-tocopherol increased 92% in subjects who received alpha-tocopherol (P < 0.001); plasma total and conjugated phenols increased 17% (P < 0.01) and 22% (P < 0.001), respectively, in subjects who received CGJ. There was a significant change in plasma triacylglycerols in both groups, but the concentrations were within the normal range. CGJ supplementation was associated with significantly higher triacylglycerols than was alpha-tocopherol supplementation. Both supplementation regimens significantly increased serum oxygen radical absorbance capacity (P < 0.001) and LDL lag time (P < 0.001) and significantly decreased the LDL oxidation rate (P < 0.01), with no significant difference in effectiveness. Protein carbonyl concentrations in native plasma decreased 20% after CGJ supplementation, which was a significantly different response than that after alpha-tocopherol supplementation (P < 0.05). CONCLUSIONS: In healthy adults, 10 mL CGJ x kg(-1) x d(-1) increased serum antioxidant capacity and protected LDL against oxidation to an extent similar to that obtained with 400 IU alpha-tocopherol/d but decreased native plasma protein oxidation significantly more than did alpha-tocopherol. CGJ flavonoids are potent antioxidants that may protect against oxidative stress and reduce the risk of free radical damage and chronic diseases. Copyright © 2002 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

Published
2002
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37. ACC/AHA/NHLBI Clinical Advisory on the Use and Safety of Statins.

Author

Pasternak RC, Smith SC Jr., Bairey-Merz CN, Grundy SM, Cleeman JI, Lenfant C, Pasternak, Richard C, Smith, Sidney C Jr, Bairey-Merz, C Noel, Grundy, Scott M, Cleeman, James I, Lenfant, Claude, American College of Cardiology, American Heart Association, and National Heart, Lung and Blood Institute

Published
2002

38. AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee.

Author

Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, Franklin BA, Goldstein LB, Greenland P, Grundy SM, Hong Y, Miller NH, Lauer RM, Ockene IS, Sacco RL, Sallis JF Jr., Smith SC Jr., Stone NJ, Taubert KA, and Pearson, Thomas A

Published
2002

40. Translation of nutritional sciences into medical education: the Nutrition Academic Award Program.

Author

Pearson TA, Stone EJ, Grundy SM, McBride PE, Van Horn L, Tobin BW, and National Heart, Lung, and Blood Institute. Nutrition Academic Award Program Collaborative Group

Abstract

For the past 40 y the scientific community has decried the inadequacy of the training of physicians and other health professionals in the subject of human nutrition. In 1997 the National Heart, Lung, and Blood Institute developed the Nutrition Academic Award (NAA) Program, an initiative to improve nutrition training across a network of US medical schools. The purpose of this funding, which began in 1998, is to support the development and enhancement of nutrition curricula for medical students, residents, and practicing physicians to learn principles and practice skills in nutrition. The NAA recipients developed the Nutrition Curricular Guide for Training Physicians, a plan to incorporate clinical guidelines into physician practice skills, create educational and assessment practice tools, and evaluate curricula, materials, and teaching tools. Dissemination of NAA activities and materials will be facilitated by a national website, presentations and publications, and consultants and advisors from the NAA nutrition education programs. The NAA Program constitutes a major new effort to enhance nutrition knowledge and skills among health care providers and to effectively apply the science of human nutrition to clinical medicine. This article describes the purpose and aims of the NAA Program, the organizational structure of the network of recipients, a profile of the recipients and individual programs at 21 medical schools, the various strategies to overcome barriers in training physicians in human nutrition, and collaborative and dissemination efforts. Copyright © 2001 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

Published
2001

48. Effect of dietary supplementation with alpha-tocopherol on the oxidative modification of low density lipoprotein.

Author

Jialal, I and Grundy, SM

Abstract

Much data has accumulated supporting a proatherogenic role for oxidized low density lipoprotein (Ox-LDL). Micronutrient antioxidants such as alpha-tocopherol, the principal lipid-soluble antioxidant, assume potential significance because levels can be manipulated by dietary measures without resulting in side effects. Co-incubation of LDL in vitro with alpha-tocopherol inhibits its oxidative modification. Hence the effect of dietary supplementation with alpha-tocopherol on the time course of copper-catalyzed oxidation of LDL was tested in a randomized placebo-controlled single-blind study. Two groups of 12 male subjects were given either placebo or alpha-tocopherol (800 IU/day) for a period of 12 weeks. Alpha-tocopherol therapy did not result in any side effects or exert an adverse effect on the plasma lipid and lipoprotein profile. While the lipid standardized alpha-tocopherol levels were similar at baseline, the supplemented group had 3.3-fold and 4.4-fold higher levels compared to placebo at 6 and 12 weeks, respectively. In the 15 subjects in whom both plasma and LDL alpha-tocopherol levels were quantitated, there was a significant correlation (r = 0.79, P less than 0.0001). At baseline there were no significant differences in the time course curves of thiobarbituric acid-reacting substances (TBARS) activity or conjugated diene formation between the alpha-tocopherol and placebo groups. However, at both 6 and 12 weeks the mean levels of TBARS activity and conjugated diene formation were lower in the alpha-tocopherol group; the most significant differences were manifest at the 3-h time point. Also at both 6 and 12 weeks the mean rate of oxidation was lower in the alpha-tocopherol group.2+_

Published
1992
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49. AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology.

Author

Smith SC Jr., Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, and Taubert KA

Published
2001

50. Liver Transplantation to Provide Low-Density-Lipoprotein Receptors and Lower Plasma Cholesterol in a Child with Homozygous Familial Hypercholesterolemia

Author

Bilheimer, DW, Goldstein, JL, Grundy, SM, Starzl, TE, Brown, MS, Bilheimer, DW, Goldstein, JL, Grundy, SM, Starzl, TE, and Brown, MS

Abstract

A six-year-old girl with severe hypercholesterolemia and atherosclerosis had two defective genes at the low-density-lipoprotein (LDL) receptor locus, as determined by biochemical studies of cultured fibroblasts. One gene, inherited from the mother, produced no LDL receptors; the other gene, inherited from the father, produced a receptor precursor that was not transported to the cell surface and was unable to bind LDL. The patient degraded intravenously administered 125I-LDL at an extremely low rate, indicating that her high plasma LDL-cholesterol level was caused by defective receptor-mediated removal of LDL from plasma. After transplantation of a liver and a heart from a normal donor, the patient's plasma LDL-cholesterol level declined by 81 per cent, from 988 to 184 mg per deciliter. The fractional catabolic rate for intravenously administered 125I-LDL, a measure of functional LDL receptors in vivo, increased by 2.5-fold. Thus, the transplanted liver, with its normal complement of LDL receptors, was able to remove LDL cholesterol from plasma at a nearly normal rate. We conclude that a genetically determined deficiency of LDL receptors can be largely reversed by liver transplantation. These data underscore the importance of hepatic LDL receptors in controlling the plasma level of LDL cholesterol in human beings. (N Engl J Med 1984; 311: 1658–64.). © 1984, Massachusetts Medical Society. All rights reserved.

Published
1984

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