SHA24/079001

Joint Session The Saudi Heat Association & The American College of cardiology

The Global Burden of Cardiovascular Disease William A. Zoghbi MD, FACC

President, The American College of Cardiology William L. Winters Endowed Chair in CV Imaging The Methodist DeBakey Heart & Vascular Center Houston, Texas

No conflicts to report

Distribution of Major Causes of Death Worldwide

Global Burden of Disease CVD is the Leading cause of Death Worldwide Estimated global deaths by cause, all ages, 2005 20000000 C a rdio v a s c ula r dis e a s e s

18000000 16000000 14000000 12000000 10000000

C a nc e r

8000000 6000000 4000000 2000000

C hro nic re s pira t o ry dis e a s e s H IV / A ID S T ube rc ulo s is M a la ria

0

Source : WHO 2005: ÂŤPreventing Chronic Diseases: A Vital InvestmentÂť

D ia be t e s

Non Communicable Disease A Burden on the Developed and Developing World

An Urgent Development Issue • NCDs make the largest contribution to mortality both globally and in the majority of low- and middleincome countries (LMICs) • Worldwide, NCDs account for 60% (35 million) of global deaths • The largest burden - 80% (28 million) - occurs in LMICs, making NCDs a major cause of poverty and an urgent development issue

Death from CV Disease in the USA Age Adjusted Deaths per 100,000 population

600 500 400 300

1962 First betablocker 1958 1969 developed First Coronary arteriography 1961 (Black) description developed Risk of CABG (Sones) factors (Favolaro) defined

1961 Coronary 1954 care unit First open-heart developed procedure (Julian) (Gibbon)

1976 First HMG CoA reductase inhibitor described (Endo) 1980 First implantable cardioverterdefibrillator developed 1972 (Mirowski) NHBPEP 1985 TIMI 1

2009 Left ventricular assist device as destination therapy in advanced heart failure shown to be 2007 effective Benefit of cardiac resynchronization therapy in 2009 heart failure Genomewide demonstrated association in earlyonset MI described 1992 SAVE

1979 Coronary 1983 angioplasty CASS developed (Gr端ntzig)

1986 GISSI and ISIS-2 1985 1993 NCEP Superiority of primary PCI vs fibrinolysis in acute MI noted

200 100

2002 Efficacy of drug-eluting vs baremetal stents determined

2009 Deep gene sequencing for responsiveness to cardiovascular drugs performed

2002 ALLHAT

0 1950

1960

1970

1980

1990

Year Elizabeth G. Nabel, MD and Eugene Braunwald, MD N Engl J Med 2012;366:54-63

2000

2010

2020

Projected Mortality Trends NCD, Cardiovascular & Communicable Diseases

Global Increase in CV Diseases Impact • NCDs will cost the world $47 trillion over the next 20 years • Of this, heart disease represents 43% or $20 trillion

Sources: WEF, Harvard U & WHO

NCDs in the Emerging World • Exponential increase in morbidity and mortality, particularly in the Emerging countries – Doubling of NCD cases among Chinese people over 40 over the next two decades.

– India suffers the highest loss in potentially productive years of life due to deaths from cardiovascular disease in people aged 35–64 years (9.2 million years lost in 2000). By 2030, this loss is expected to rise to 17.9 million years—940% greater than the corresponding loss in the USA – In Brazil and Mexico, NCDs cause 72% and 75% of mortality respectively

Sources: WEF, Harvard U & WHO

editors: Shanthi Mendis, Pekka Puska and Bo Norrving 2011

Distribution of CVD Disease Death Etiology & Gender

Male

Female

Mortality Rates from Ischemic Heart Disease Age Standardized/100,000

Mortality Rates from Cerebrovascular Disease Age Standardized/100,000

Burden of Cardiovascular Disease DALYs, Age Standardized/100,000

Global distribution of the physician workforce (per 10,000 population), 2000-2009

Source: World Health Statistics - 2010, World Health Organization, 2010.

Prevalence of Daily Tobacco Smoking in Males Age Standardized Adjusted

Tobacco and the Global NCD Epidemic Tobacco and global health inequity Tobacco use kills 15,000 people a day around the world‌and second hand smoke exposure kills another 1,000.

70% of tobacco deaths occur in developing and middle-income countries, where tobacco use continues to rise.

Source: NCD Alliance (2011) The FCTC – and evidence-based tool to reduce the burden of disease

Prevalence of Raised BP in Males Ages 25+, Age Standardized

Prevalence of Raised BP in Females Ages 25+, Age Standardized

Prevalence of Raised Cholesterol or On Medication in Males Ages 25+, Age Standardized

Prevalence of Raised Cholesterol or On Medication in Females Ages 25+, Age Standardized

Ranking of 10 Selected Risk Factors of Cause of Death

Change over time in mean BMI, SBP and total cholesterol by Countries’ Income Category

Obesity Trends Among U.S. Adults 1990, 2000, 2010

(*BMI ≥30, or about 30 lbs overweight for 5’4” person) 2000

1990

2010 No data

20-2%

<10%

25-29%

10-14%

≥30%

15-19%

Source: Behavioral Risk Factor Surveillance System, CDC

Age-Standardized Prevalence of Diagnosed Diabetes per 100 Adult Population 1991

2003

<4%

4-4.9%

5-5.9%

Source: Behavioral Risk Factor Surveillance System, CDC

>6%

Status of the ABCS in the USA Aspirin

People at increased risk of cardiovascular disease who are taking aspirin

47%

Blood pressure

People with hypertension who have adequately controlled blood pressure

46%

Cholesterol

People with high cholesterol who have adequately controlled hyperlipidemia

33%

Smoking

People trying to quit smoking who get help

23%

Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60

The NCD Alliance

United by 4 Risk Factors Modifiable Causative Risk Factors

Non-communicable Diseases

Tobacco use

Unhealthy diets

Physical Inactivity

Harmful use of alcohol

Heart disease and stroke









Diabetes









Cancer









Chronic lung disease



UN Summit on Non-Communicable Diseases • First ever high-level UN meeting on Non Communicable Diseases was held on Sept.19 -- 20, 2011 • Second ever UN Summit on Health after AIDS summit in 2001 • CV Disease Voice: WHF, ACC, AHA, ESC

Political Declaration Outcome of Summit: Political Declaration that detailed the global strategy for combatting NCDs Called on the WHO to establish global targets for combatting NCDs during 2012

World Health Assembly 2012 Goal: 25% reduction NCD Mortality by 2025 After significant advocacy efforts by the ACC and its partner societies, the first global target was passed during the World Health Assembly meeting in Geneva in May calling for a 25% reduction in premature mortality from NCDs by 2025 From the WHO Website: Non-communicable diseases: The Health Assembly adopted several resolutions and decisions on non-communicable diseases (NCDs): Delegates approved the development of a global monitoring framework for the prevention and control of NCDs, including indicators and a set of global targets. Member States agreed to adopt a global target of a 25% reduction in premature mortality from non-communicable diseases such as cardiovascular disease, cancer, diabetes and chronic respiratory diseases by 2025.

The ACC in conjunction with the NCD Alliance is calling for 10 targets to be adopted in 2012 • • • • • • • • • •

25% reduction in Mortality by 2025 Tobacco smoking Dietary salt intake Blood pressure/Hypertension Physical activity Availability of essential medicines and technologies Prevention of heart attack and stroke Alcohol Elimination of industrially produced trans-fats from the food supply Obesity and Childhood obesity

September 2012 Advocacy Paper

On the anniversary of the UN Summit in Sept., the ACC, AHA, ESC, and WHF will partner on a paper titled: “Our Time – A call to save preventable deaths from cardiovascular disease (heart disease and stroke)” Paper will call on the global health community to enforce targets and strategies that will make a lasting, beneficial impact on CVD health

September, 2012

WHO Executive Board Meeting- Geneva January 2013

The WHO NCD Targets and WHF Priorities

Global Advocacy and Leadership

Risk Factors:

Treatment and Care

Ongoing Challenges and Opportunities

â&#x20AC;Ś.To Improve Heart Health

Improving Cardiovascular Health