Cardiovascular disease burden

 

Cardiovascular diseases (CVD), principally ischemic heart disease, and cerebrovascular disease (stroke) are leading causes of mortality and a major contributor to disability in countries of the Americas. The Pan American Health Organization, through the HEARTS in the Americas initiative, is providing technical cooperation to countries of the region to reduce the disease burden caused by CVD.

This visualization presents the level and trends of mortality and burden of cardiovascular diseases for all CVDs and 8 underlying causes of CVD mortality and disability by age, sex, and location (country, subregion, and region) in the Americas from 2000 to 2019.

Cardiovascular diseases (CVDs) remain the leading cause of disease burden in the Region of the Americas.

Mortality

  • In 2019, 2.0 million people died from CVD.
  • The age-standardized CVD death rates decreased from 203.3 deaths (95% UI: 176.0 to 227.1) per 100,000 population in 2000 to 137.2 deaths (95% UI: 110.3 to 165.5) per 100,000 population in 2019. 
  • The age-standardized CVD death rates vary substantially across countries from a high in Haiti (428.7 deaths per 100,000 population) to a low in Peru (73.5 deaths per 100,000 population).

Countries with the highest level of age-standardized CVD mortality rates:

  1. Haiti
  2. Guyana
  3. Suriname
  4. Dominican Republic
  5. Honduras
  6. Grenada
  7. Bahamas

Contribution of CVD causes to overall CVD mortality:

  1. Ischemic heart disease: 73.6 deaths per 100,000 population
  2. Stroke: 32.3
  3. Other circulatory diseases: 14.8
  4. Hypertensive heart disease: 10.6
  5. Cardiomyopathy, myocarditis, endocarditis: 5.1
  6. Rheumatic heart disease: 0.7

The burden of cardiovascular diseases

Cardiovascular diseases account for:

  • 40.8 million disability-adjusted life years (DALYs) each year
  • 36.4 million years of life lost (YLLs) due to premature deaths (89% of total CVD DALYs)
  • 4.5 million years lived with disability (YLDs)

The number of years of life lived with disability almost double in latest two decades.

Total CVD deaths and YLDs are likely to increase as a result of population growth and aging.

Ischemic heart disease and stroke are the two major underlying causes of CVD mortality and disability.  

CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized CVD rate has begun to rise in some locations where it was previously declining in high-income countries.

Suggested citation

Cardiovascular disease burden in the Region of the Americas, 2000-2019. ENLACE data portal. Pan American Health Organization. 2021.

DATA CLASSIFICATION

In the map and horizontal bar chart, the data is presented in five classes created using the quantile classification method. Each class contains 20% of countries, which is easy to interpret. The quintile intervals are labeled sequentially from Quintile 1, also called the bottom quintile which includes the lowest fifth (0 to 20%) of data points to Quintile 5 (or top quintile), which includes the top fifth (80% to 100%) of data points.

INDICATOR DEFINITION

Measure: Death, Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs), and Years of Life Lost (YLLs) due to premature death.  

Metric: Rate.

Unit of measurement: For mortality measures: deaths per 100,000 population. For measures of burden of disease: years per 100,000 population. 

Topic: Mortality and burden of disease.

Rationale: Measuring how many people die each year and why they died is one of the most important means – along with gauging how diseases and injuries are affecting people – for assessing the effectiveness of a country’s health system. Statistics of causes of death and disability help inform public health policy and planning.

Definitions:

Cardiovascular disease death rate: Number of deaths due to cardiovascular diseases in a year, divided by the population and multiplied by 100 000.

DALY rate: Number of DALYs due to cardiovascular diseases in a year, divided by the population and multiplied by 100 000.

YLD rate: Number of YLD due to cardiovascular diseases in a year, divided by the population and multiplied by 100 000.

YLL rate: Number of YLL due to cardiovascular diseases in a year, divided by the population and multiplied by 100 000.

Cardiovascular disease categories and ICD-10 codes:

The full list of cause categories and corresponding ICD-10 codes is detailed in the technical document WHO methods and data sources for country-level causes of death 2000-2019, Annex A, page 62.

The burden of disease cause list is organized in a hierarchical fashion with four levels of aggregation. The cause list is mutually exclusive and collectively exhaustive at every level of aggregation; causes not individually specified are captured in residual categories.   

Disaggregation: Age, Sex, Country, and Year.

The categories "All-ages", and "Age-standardized" from the dimension Age, combined with the metric "Rate" have the following meaning:

  • All-ages indicate that the rate is crude (without removing the effect of age distribution across population groups).
  • Age-standardized indicates that the rate refers to all ages but the rate was age-standardized by the direct method using the WHO world standard population.

Method of estimation: Mortality and burden of disease measures by cause, age, sex, year, and location (countries, the region of the Americas, and subregions) were extracted from the World Health Organization (WHO) Global Health Estimates 2000-2019 (GHE). These data represent the best and latest estimates of the WHO which have been computed using standard categories, definitions, and methods to ensure cross-country comparability, and may not be the same as official national estimates. 

Methodological details:

Data sources and methods for estimating causes of deaths and burden of diseases are described in the following documents:

Method of estimation of the regional and subregional aggregates: Calculated by aggregating the country values (both numerator and the population) using population estimates from the World Population Prospects 2019, produced by the UN Population Division, as denominators.

Preferred data sources: Civil Registration and Vital Statistics (CRVS) systems with complete coverage and medical certification of cause of death.

Behavioural risk factors of CVDs

The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. The effects of behavioural risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity. These “intermediate risks factors” can be measured in primary care facilities and indicate an increased risk of heart attack, stroke, heart failure and other complications.

Cessation of tobacco use, reduction of salt in the diet, eating more fruit and vegetables, regular physical activity and avoiding harmful use of alcohol have been shown to reduce the risk of cardiovascular disease. Health policies that create conducive environments for making healthy choices affordable and available are essential for motivating people to adopt and sustain healthy behaviours.

Underlying determinants of CVDs

These are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization and population ageing. Other determinants of CVDs include poverty, stress and hereditary factors.

In addition, drug treatment of hypertension, diabetes and high blood lipids are necessary to reduce cardiovascular risk and prevent heart attacks and strokes among people with these conditions. 

Interventions to reduce the burden of CVDs

The key to cardiovascular disease reduction lies in the inclusion of cardiovascular disease management interventions in universal health coverage packages, although in a high number of countries health systems require significant investment and reorientation to effectively manage CVDs.

Evidence from 16 countries participating in the HEARTS in the Americas initiative has shown that hypertension programmes can be implemented efficiently and cost-effectively at the primary care level which will ultimately result in reduced coronary heart disease and stroke.

Patients with cardiovascular disease should have access to appropriate technology and medication. Basic medicines that should be available include:

  • aspirin;
  • beta-blockers;
  • angiotensin-converting enzyme inhibitors; and
  • statins.

An acute event such as a heart attack or stroke should be promptly managed.

Sometimes, surgical operations are required to treat CVDs. They include:

  • coronary artery bypass;
  • balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage);
  • valve repair and replacement;
  • heart transplantation; and
  • artificial heart operations.

Medical devices are required to treat some CVDs. Such devices include pacemakers, prosthetic valves, and patches for closing holes in the heart.

Focus on implementing existing cost-effective policies and interventions are key if the Region of the Americas is to meet the targets for Sustainable Development Goal 3 and achieve a 33% reduction in premature mortality due to noncommunicable diseases.

  1. WHO. WHO methods and data sources for country-level causes of death 2000-2019. Geneva: World Health Organization; 2020. Available online (accessed 1 February 2021).
  2. WHO. WHO methods and data sources for global burden of disease estimates, 2000-2019. Geneva: World Health Organization, 2020. Available online (accessed 1 February 2021).
  3. PAHO. Methodological Notes, NMH Data Portal. Pan American Health Organization. 2021.
  4. WHO. Topic on cardiovascular diseases. World Health Organization. Available online (accessed 17 June 2021) 
  5. WHO. Factsheet: Cardiovascular Diseases. World Health Organization. Available online (accessed 17 June 2021).
  6. HEARTS in the Americas. Pan American Health Organization. Available online (accessed 17 June 2021).

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