Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity worldwide. Determining the overall disease burden among the youth and young adults is imperative.
Identifying the risk factors associated with CVDs in this group of individuals will help formulate effective and targeted prevention strategies.
A recent BMC Medicine study focussed on estimating the incidence, prevalence, mortality rate, and disability-adjusted life years (DALY) of CVDs and their associated risk factors in youths and young adults aged between 15 and 39 years.
Study: Global, regional, and national burden of cardiovascular diseases in youths and young adults aged 15–39 years in 204 countries/territories, 1990–2019: a systematic analysis of Global Burden of Disease Study 2019. Image Credit: FarknotArchitect/Shutterstock.com
Background
CVDs inflict significant social and economic impacts. According to the Global Burden Disease, Injuries, and Risk Factors Study (GBD) data, the total number of CVD cases and DALY have substantially increased worldwide between 1990 and 2019.
CVDs have been recorded in high-, middle- and low-income countries. However, low- and middle-income countries lack proper healthcare resources to combat the disease burden.
Therefore, there is an urgent need to develop effective strategies to prevent the incidence of CVDs, particularly in low- and middle-income countries.
In most cases, CVDs appear in middle age and older adulthood; however, in recent decades, there has been an increasing prevalence in younger age groups.
More specifically, an increased prevalence of rheumatic heart disease and atherosclerosis has been observed in individuals between 20 and 29 years of age.
Furthermore, DALYs associated with alcoholic cardiomyopathy rapidly increased from 25 years of age onwards. Recent studies have revealed that youth with CVDs represent a substantial share of the mortality burden.
The International Childhood Cardiovascular Cohort (i3C) Consortium study has identified the metabolic risk factors associated with CVDs in youth (3–19 years of age).
Some risk factors from childhood to adulthood that predict fatal or nonfatal CVD in midlife are high body mass index, high cholesterol, and high systolic blood pressure.
Based on the GBD data, the prevalence of DALY and mortality rate due to CVDs in youths (between 10 and 24 years of age) have significantly decreased in the EU Member States between 1990 and 2019. However, this finding cannot be generalized to other countries worldwide.
There has been a lack of evidence regarding the global burden of CVDs in young people. In addition, not much evidence has been documented regarding the potential risk factors for CVDs among this group of individuals.
About the study
Based on 2019 GBD data, the epidemiological trends in age-standardized incidence, prevalence, mortality rate, and DALY linked to specific CVDs, and their attributable risk factors in youths (15–39 years of age) were estimated.
This analysis considered 204 countries/territories at global, regional, and national levels from 1990 to 2019. The incidence of CVDs in youths was estimated based on the sociodemographic index (SDI), age, sex, region, and country.
Study findings
The age-standardized DALY and mortality rate of overall CVDs decreased in the study period. In contrast, an increase in the prevalence and incidence of CVDs was observed in the targeted group worldwide.
In the context of type-specific CVDs, the prevalence and incidence rates of rheumatic and ischemic heart disease and endocarditis increased from 1990 to 2019.
The highest prevalence rate was observed in countries/territories with low and low-middle SDI. Notably, the overall burden increased rapidly in countries/territories with high and high-middle SDI.
Men aged between 25 and 39 exhibited the highest prevalence, incidence, DALY, and mortality rate of endocarditis. In contrast, women between the age of 30 and 39 revealed an increase in DALY and mortality rate of atrial flutter and fibrillation.
This study identified the three most important factors associated with DALY for CVD: high systolic blood pressure, increased low-density lipoprotein cholesterol, and high body mass index.
Furthermore, particularly in low and low-middle SDI countries/territories, DALY for CVDs also manifested due to household air pollution from solid fuels. Due to increased smoking, men were more likely to be affected by all risk factors than women.
Conclusions
Based on the data from 204 countries and territories, an overall increase in the incidence and prevalence of CVDs was found in the study group.
However, between 1990 and 2019, there was a decrease in DALY and the mortality rate of CVDs among youth and young adults aged 15–39.
Considering the study findings, there is a need for effective targeted strategies and measures to prevent and manage CVDs among youth and young adults.
Public health approaches, such as implementing digital clinical decision-making tools, health-promoting school-based programs, promoting better healthcare services using inter-professional teamwork, and developing affordable rehabilitation facilities, particularly for youth and young adults, could help considerably alleviate the burden of CVDs.
Primary care clinicians key to achieving optimal cardiovascular health