The Devil Is in the Details
Achieving Reductions in Global Cardiovascular Disease Mortality
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Achieving historic reductions in global cardiovascular disease (CVD) mortality will require attention to detail in 4 areas: a clear understanding of current trends in CVD mortality, an appreciation of what has influenced positive trends in CVD mortality, a knowledge of which interventions are cost-effective, and an ability to scale the interventions. Globally, CVD mortality has increased,1 but this statistic belies significant successes that have already occurred. Although CVD mortality overall has increased, the reasons require a devil is in the details look at various trends that give us this summary statistic.2 First, the world population is aging in part because of our successes in managing many of the challenges of previous centuries, including improved control of infectious diseases and increased food supplies to the starving. Second, the overall world population is growing. Third, we have recently developed and implemented successful solutions to control more recent afflictions, such as HIV/AIDS.
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A better statistic for evaluating success than total mortality is age-adjusted mortality where we have also seen tremendous reductions in age-adjusted CVD mortality. Recent estimates suggest that age-standardized death rates because of ischemic heart disease dropped from over 200 per 100 000 to <150 per 100 000 over the last 30 years.3 Here again, a closer look suggests different trends by country within an overall global aggregate decline. In high-income countries (HICs), such as the United States and Finland, there have been dramatic declines in age-adjusted death rates from >300 per 100 000 to nearly 100 per 100 000 over the same time frame. In comparison, less dramatic declines occurred in most other countries and even increases in age-adjusted ischemic heart disease mortality occurred in some Latin American and many Eastern European countries, such as Russia.
With such varying experiences in age-adjusted mortality rates, …