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Chapter 233: Epidemiology of Cardiovascular Disease

Thomas A. Gaziano; J. Michael Gaziano

INTRODUCTION

Cardiovascular disease (CVD) is now the most common cause of death worldwide. Before 1900, infectious diseases and malnutrition were the most common causes, and CVD was responsible for <10% of all deaths. In 2015, CVD accounted for ~17.9 million deaths worldwide (32%), including nearly 34% of deaths in high-income countries and about 32% in low- and middle-income countries.

THE EPIDEMIOLOGIC TRANSITION

image The global rise in CVD is the result of an unprecedented transformation in the causes of morbidity and mortality during the twentieth century. Known as the epidemiologic transition, this shift is driven by industrialization, urbanization, and associated lifestyle changes and is taking place in every part of the world among all races, ethnic groups, and cultures. The transition is divided into four basic stages: pestilence and famine, receding pandemics, degenerative and man-made diseases, and delayed degenerative diseases. A fifth stage, characterized by an epidemic of inactivity and obesity, is emerging in some countries (Table 233-1).

TABLE 233-1Five Stages of the Epidemiologic Transition
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TABLE 233-1 Five Stages of the Epidemiologic Transition
Stage Description Deaths Related to CVD, % Predominant CVD Type
Pestilence and famine Predominance of malnutrition and infectious diseases as causes of death; high rates of infant and child mortality; low mean life expectancy <10 Rheumatic heart disease, cardiomyopathies caused by infection and malnutrition
Receding pandemics Improvements in nutrition and public health lead to decrease in rates of deaths related to malnutrition and infection; precipitous decline in infant and child mortality rates 10–35 Rheumatic valvular disease, hypertension, CHD, and stroke (predominantly hemorrhagic)
Degenerative and man-made diseases Increased fat and caloric intake and decrease in physical activity lead to emergence of hypertension and atherosclerosis; with increase in life expectancy, mortality from chronic, noncommunicable diseases exceeds mortality from malnutrition and infectious disease 35–65 CHD and stroke (ischemic and hemorrhagic)
Delayed degenerative diseases CVD and cancer are the major causes of morbidity and mortality; better treatment and prevention efforts help avoid deaths among those with disease and delay primary events; age-adjusted CVD morality declines; CVD affecting older and older individuals 40–50 CHD, stroke, and congestive heart failure
Inactivity and obesity Overweight and obesity increase at alarming rate; diabetes and hypertension increase; decline in smoking rates levels off; a minority of the population meets physical activity recommendations 38 CHD, stroke, and congestive heart failure, peripheral vascular disease

Abbreviations: CHD, coronary heart disease; CVD, cardiovascular disease.

Source: Data from AR Omran: The epidemiologic transition: A theory of the epidemiology of population change. Milbank Mem Fund Q 49:509, 1971; and SJ Olshansky, AB Ault: The fourth stage of the epidemiologic transition: The age of delayed degenerative diseases. Milbank Q 64:355, 1986.

The age of pestilence and famine is marked by malnutrition, infectious diseases, and high infant and child mortality that are offset by high fertility. Tuberculosis, dysentery, cholera, and ...

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