From Division of Cardiology, Department of Medicine and Institute for Health Metrics and Evaluation (G.A.R.), and Institute for Health Metrics and Evaluation (G.N., M.H.F., A.H.M., M.N., C.J.L.M.), University of Washington, Seattle.
Circulation. 2015 Sep 29;132(13):1270-82. doi: 10.1161/CIRCULATIONAHA.115.016021.
United Nations member states have agreed to reduce premature cardiovascular disease (CVD) mortality 25% by 2025. Global CVD risk factor targets have been recommended. We produced estimates to show how selected risk factor reduction would affect CVD mortality for different regions and countries.
We used mortality, risk factor, and relative risk data from the Global Burden of Disease, Risk Factors, and Injuries (GBD) 2013 study to project CVD mortality for 188 countries up to the year 2025. We disaggregated observed CVD mortality in 1990 and 2013 into deaths attributable and unattributable to hypertension, tobacco smoking, diabetes mellitus, and obesity using an age- and sex-specific population-attributable fraction. Risk factors were projected to 2025 assuming that current trends continue. Counterfactual scenarios were then constructed reflecting CVD premature mortality if United Nations risk factor targets are achieved in the year 2025, adjusting for joint effects of risk factors. We estimate 7.8 million premature CVD deaths in 2025 if current risk factor trends continue. Premature CVD deaths would be reduced to 5.7 million if these risk factors targets are achieved as a result of a 26% reduction for men and a 23% reduction for women in the global risk of premature CVD death. Globally, decreasing the prevalence of hypertension accounted for the largest risk reduction, followed by a reduction in tobacco smoking for men and obesity for women, but these results varied by region. The impact of meeting all risk factor targets on CVD mortality varied widely by region and sex.
The United Nations target of a 25% reduction in premature CVD mortality by the year 2025 appears achievable for some countries, but more aggressive risk factor targets may be required if all regions are to reach this goal. Without these reductions in CVD risk factors, many countries will see no change or even an increase in premature CVD mortality.
联合国会员国已同意到 2025 年将过早的心血管疾病（CVD）死亡率降低 25%。已经推荐了全球 CVD 风险因素目标。我们制作了估计值，以显示选择的风险因素减少将如何影响不同地区和国家的 CVD 死亡率。
我们使用来自 2013 年全球疾病、风险因素和伤害负担研究（GBD）的死亡率、风险因素和相对风险数据，对 188 个国家到 2025 年的 CVD 死亡率进行了预测。我们将 1990 年和 2013 年观察到的 CVD 死亡率分为归因于高血压、吸烟、糖尿病和肥胖的死亡和归因于这些因素的死亡，使用特定年龄和性别的人群归因分数。假设目前的趋势继续下去，那么到 2025 年，风险因素就会被预测出来。然后构建反事实情景，反映如果 2025 年联合国实现风险因素目标，CVD 过早死亡的情况，同时调整风险因素的联合效应。我们估计，如果目前的风险因素趋势继续下去，2025 年将有 780 万例过早的 CVD 死亡。如果由于男性 CVD 过早死亡率全球风险降低 26%，女性降低 23%，从而实现这些风险因素目标，过早的 CVD 死亡人数将减少到 570 万。从全球范围来看，降低高血压的患病率占风险降低的最大比例，其次是男性减少吸烟和女性减少肥胖，但这些结果因地区而异。实现所有风险因素目标对 CVD 死亡率的影响因地区和性别而异。
对于一些国家来说，到 2025 年将过早的 CVD 死亡率降低 25%的联合国目标似乎是可以实现的，但如果所有地区都要实现这一目标，可能需要更积极的风险因素目标。如果不减少 CVD 风险因素，许多国家将不会看到过早的 CVD 死亡率的变化，甚至可能会增加。
