Reducing the Global Burden of Cardiovascular Disease, Part 1

The epidemiological transition in the 20th century was accompanied by a fall in deaths and disability from communicable diseases and an increase in noncommunicable diseases (NCDs). Of the NCDs, cardiovascular disease (CVD) is now the leading cause of mortality and morbidity worldwide. In 2013, the World Health Organization launched the 25×25 Global Action Plan, an ambitious road map for countries to reduce NCD-related premature mortality by 25% by 2025. The global action plan focuses on strengthening health services and public policy to prevent and manage 4 major NCDs (CVD, cancer, diabetes mellitus, and chronic respiratory diseases), which contribute most to global morbidity and mortality, and 4 main health-related behaviors: tobacco use, diet, physical activity, and alcohol. Of these 4 diseases, CVD deaths are among the most amenable to rapid change, suggesting that if the ambitious target is to be achieved, it will be necessary to reduce CVD deaths by >25%. This international commitment is now enshrined in the Sustainable Development Goals, which form the basis for measuring the progress of countries to improve health outcomes at all levels of development until 2030. However, effective action requires reliable global data on CVD, its main risk factors, and information on major barriers to effective CVD treatment and prevention if evidence-based health policy is to be designed and implemented. The first part of this review summarizes the global epidemiology of CVD and its risk factors, noting how epidemiological data inform the 25×25 Global Action Plan, as well as the need to improve global CVD epidemiology data if we are to achieve these goals. We draw extensively on the work undertaken by the Institute of Health Metrics Global Burden of Disease (GBD) project and on the PURE study (Prospective Urban Rural Epidemiology), a prospective, multinational cohort study across >25 countries (with 190 000 participants) examining individual-, community-, and societal-level health determinants of NCDs. Review