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1、1WORLD HEARTREPORT 2023CONFRONTING THE WORLDS NUMBER ONE KILLERWORLD HEART REPORT 20232CONTENTSACKNOWLEDGEMENTSThis is an official publication of the World Heart Federation(WHF).The World Heart Federation would like to thank all authors and reviewers for their contributions:Authors:Mariachiara Di Ce
2、sare,Honor Bixby,Thomas Gaziano,Lisa Hadeed,Chodziwadziwa Kabudula,Diana Vaca McGhie,Jeremiah Mwangi,Borjana Pervan,Pablo Perel,Daniel Pieiro,Sean Taylor,Fausto Pinto.Reviewers:Victor Aboyans,lvaro Avezum,Rick Chazal,Jean-Luc Eisel,Naomi Herz,Andre Pascal Kengne,Angela Koh,Amam Mbakwem,Jagat Narula,
3、Gregory Roth,Saate Shakil.Editor:Edward Fox.The World Heart Report 2023 was made possible through support from Novartis Foundation.Executive Summary 3Introduction 4Global burden of cardiovascular disease mortality 5Cardiovascular disease deaths by sex 9Cardiovascular disease deaths by cause 10Relati
4、onship between cardiovascular disease mortality and health expenditure 11Cardiovascular disease premature mortality 12Risk factors for cardiovascular diseases 14-Physical activity 16-Sodium intake 18-Alcohol consumption 20-Tobacco smoking 22-Obesity 26-Raised blood pressure 28-Diabetes 30-Lipids 32-
5、Ambient air pollution 34Comparative levels of risk factors by country and region 36The WHF Policy Index 37Key findings 39Key recommendations 40Appendix Supplementary Figures 41 Suggested citation:World Heart Report 2023:Confronting the Worlds Number One Killer.Geneva,Switzerland.World Heart Federati
6、on.2023.3CONFRONTING THE WORLDS NUMBER ONE KILLERMore than half a billion people around the world continue to be affected by cardiovascular diseases,which accounted for 20.5 million deaths in 20211 close to a third of all deaths globally and an overall increase on the estimated 121 million CVD death
7、s.Up to 80%of premature heart attacks and strokes can be prevented.The world has the tools and knowledge to mitigate harms to cardiovascular health,particularly with the advances in cardiovascular medicine in the last 50 years.But too often the tools that can help diagnose,prevent,and treat CVDs are
8、 not benefitting the communities who need them most.Around 4 in every 5 CVD deaths occur in low-and middle-income countries and progress in cardiovascular health is increasingly concentrated in High-Income countries-a glaring health inequity that must urgently be addressed.There is no one-size-fits-
9、all approach to improving cardiovascular health globally.Every population is susceptible to different risk factors based on where they live and their lifestyles.Whether thats having higher prevalence of tobacco and alcohol use and higher sodium intake or being more exposed to dangerous levels of air
10、 pollution and having lower levels of physical activity.This means that decision makers and stakeholders must look closely at the risk factor prevalence in their countries and regions to fully understand what policy areas need more focus to get CVD health moving in the right direction.There are,howe
11、ver,baseline approaches that every country should implement to lay the foundation from which to build tailored activities to tackle CVDs.This includes implementing major policy initiatives that are essential to improving CVD healthsuch as National Tobacco Control Programmes,securing the availability
12、 of CVD drugs,and creating an Operational Unit in the Ministry of Health responsible for tackling non-communicable diseases(NCDs).Additionally,it requires adequately funding health systems and initiatives so that all communities can access the care they need.The stalling progress in CVD health is no
13、t unique.Almost every health initiative around the world suffered because of the COVID-19 pandemic and countries are now grappling with which areas to prioritise as they aim to boost and protect the health of their populations.Given the severe burden of CVDs both in terms of mortality and morbidity,
14、this area of health cannot be neglected.The world will struggle to meet the ambitious targets it set to reduce premature mortality from NCDs by 25%compared to 2010 levels,by 2025.There is still time,however,to accelerate action toward meeting the Sustainable Development Goal 3.4 of reducing by one-t
15、hird premature mortality from NCDs,including cardiovascular diseases.This goal aligns with the World Heart Federations(WHF)World Heart Vision 2030.EXECUTIVE SUMMARYWHF,with its membership of more than 200 heart foundations,scientific societies,and patient organizations across more than 100 countries
16、,is a committed partner to resuscitating progress on CVDs.To help promote action at every level against CVDs,this report provides the following key recommendations:1.Countries and other relevant stakeholders should continue efforts to improve data for CVDs and their risk factors,particularly in LMIC
17、s where data gaps exist.This will help to understand why certain populations are at higher risk for certain CVDs.2.Countries should ensure that their health expenditure as a percentage of GDP is at least 5%,in line with recommendations from the World Health Organization.3.Countries should implement
18、policies to combat CVDs,guided by the burden of disease and predominant risk factors,and ensure that their implementation is adequately resourced and monitored for progress.4.As a matter of urgency,countries should prioritise coverage of interventions for the prevention and management of CVDs in Uni
19、versal Health Coverage(UHC)benefit packages to help minimize out-of-pocket expenditure.5.Lessons-learned in improving CVD prevention,management and improved access to care and therapies need to be implemented across all regions to address inequities and the uneven progress in CVD mortality declines.
20、Global progress against cardiovascular disease(CVD)is flatlining.Though rates of CVD deaths globally have fallen in the last three decades,this trend has begun to stall and,without concerted efforts,is at risk of reversing.1This report largely relies on 2019 data throughout,as that is the most recen
21、t year with the level of disaggregation required for analyses undertaken.WORLD HEART REPORT 20234INTRODUCTIONINTRODUCTIONFor decades,CVDs have been the leading cause of death globally.In 2021,20.5 million people died from a cardiovascular condition,a figure that accounted for around one-third of all
22、 global deaths and was a significant increase from the 12.1 million CVD deaths recorded in 1990.Ischaemic heart disease3 is now the leading cause of premature death in 146 countries for men and 98 countries for women.While CVD deaths have increased overall in the last three decades,globally the age-
23、standardised death rate has fallen4,indicating that some progress is being made.However,a closer look at the data reveals this progress is uneven and beginning to stall.The decline in death rates4 for CVDs has been much faster in High-Income countries(HICs)compared to low-and middle-income countries
24、(LMICs),where more than 80%of CVD deaths occur globally.In addition to disparities between countries,inequalities in cardiovascular outcomes within countries is also staggering,with research showing disparities according to sex,ethnicity and socioeconomic status,among others.The world is far from ac
25、hieving the equitable distribution of prevention,diagnosis,treatment,and management of CVDs.The high-level trends are clear but marked variations by region and sex for CVD death rates and risk factors show a more complex picture.Ultimately,these complexities have important implications for policy at
26、 the country,regional and global level,particularly when determining the drivers of CVDs and responses that will bring mortality and case rates down and protect peoples health.At the global level,there is an important foundation to build from in making progress against CVDs.In May 2012,the World Hea
27、lth Assembly(WHA)adopted a resolution setting the goal of reducing premature mortality from noncommunicable diseases(NCDs)6 by 25%by 2025.One year later,the NCD Global Monitoring Framework was launched to help drive progress in the prevention and control of NCDs and ensure that political commitment
28、remains in tackling them.The Framework includes nine voluntary global targets focused on combating behavioural and metabolic risk factors and strengthening national health system responses7.Unfortunately,the current pace of decline in CVD death rates is insufficient to achieve the goal of a 25%reduc
29、tion in mortality by 2025,despite the work of international organisations and country governments in recent years.There are myriad reasons behind this,from a lack of funding to challenges securing the political commitments necessary to comprehensively tackle an issue as far-reaching as CVDs.Further,
30、the impact of the COVID-19 pandemic on health systems and policies means many countries are assessing how to prioritise as they attempt to reignite progress across multiple health initiatives and recover from the economic impact of the pandemic.This first-ever World Heart Report is aimed at equippin
31、g policymakers and advocates around the world with the information needed to help reduce CVD deaths and accelerate progress in cardiovascular health.The report findings highlight the main differences between geographies in terms of CVD burden and risk factors,as well as structural barriers and inequ
32、ities in CVD health,with the goal of guiding policymakers at national and international levels toward the priorities they should seek to address.Key policies to tackle CVD and its risk factors are also summarized.Future World Heart Reports,along with WHFs data hub the World Heart Observatory8,will a
33、im to provide easy access to CVD data to inform research and advocacy.The report begins with a comprehensive overview of the main dimensions of cardiovascular Cardiovascular diseases(CVDs)affect the heart or blood vessels and can be caused by a combination of socio-economic,metabolic,behavioural,and
34、 environmental risk factors.These include high blood pressure,unhealthy diet,high cholesterol,diabetes,air pollution,obesity,tobacco use,kidney disease,physical inactivity,harmful use of alcohol and stress.2Lindstrom M,DeCleene N,Dorsey H,et al.Global Burden of Cardiovascular Diseases and Risks Coll
35、aboration,1990-2021.J Am Coll Cardiol.2022 Dec,80(25)237224253Ischaemic heart disease,also referred to as coronary heart disease,are problems caused by narrowed coronary arteries that supply blood to the heart muscles.4Age-standardisation is a technique used to better compare disease outcomes,such a
36、s death rates,across populations.See page 6 for a more detailed description.5Any reference to death rates in this document refers to age-standardized rates.6The resolution covers NCDs broadly,and specifically mentions CVD,cancer,diabetes and chronic respiratory diseases.7World Health Organization.NC
37、D Global Monitoring Framework.Available from:https:/www.who.int/publications/i/item/ncd-surveillance-global-monitoring-framework(last accessed 10 May 2023).8The World Heart Observatory can be accessed via the WHF website;www.worldheart.org5CONFRONTING THE WORLDS NUMBER ONE KILLERhealth,bringing toge
38、ther epidemiological,policy and economic data.It then provides assessment of policy implementation through the WHF Policy Index,and provides relevant policy recommendations.Throughout the report,the latest comprehensive sources for which data disaggregated by country,age and sex are available have b
39、een used.(Appendix Figure 1).Global,regional9,and country level estimates from 2019 relevant to atherosclerotic CVDs10 are presented in this report,as these are the most comprehensive and recent data set available.We acknowledge that some of these sources use modelling to develop estimates,and that
40、there are important gaps in the data that inform these models,particularly in certain geographies.For example,approximately 85%of countries in the Sub-Saharan Africa region do not have Vital Registration Survey data available to inform models11.We acknowledge that COVID-19 had an important impact on
41、 CVDs;however,because of limited data,it is outside the scope of this report12.CVDs are the leading cause of mortality and a major contributor to disability.Globally,the estimated number of deaths due to CVDs increased from around 12.1 million in 1990(equally distributed between males and females)to
42、 18.6 million(9.6 million males and 8.9 million females)in 2019(Figure 1).Figure 1:Global trends in number of deaths due to cardiovascular diseases,1990-2019.Source:Institute for Health Metrics and Evaluation(IHME).GBD Compare Data Visualization.Seattle,WA:IHME,University of Washington,2020.Availabl
43、e from http:/vizhub.healthdata.org/gbd-compare.(18 March 2023).GLOBAL BURDEN OF CARDIOVASCULAR DISEASES MORTALITY 9Super-regions,as reported by the Global Burden of Disease.See Appendix for a detailed explanation of the regional classification.10Atherosclerosis is the thickening or hardening of the
44、arteries caused by the build-up of fats,cholesterol and other substances in the artery walls.Atherosclerotic CVDs,including coronary heart disease and stroke,represent 85%of all deaths from CVD,and are the leading cause of death worldwide.11Murray,C.J.L.The Global Burden of Disease Study at 30 years
45、.Nat Med 28,20192026(2022).https:/doi.org/10.1038/s41591-022-01990-1.12A separate methodological supplement,explaining in greater detail the analytical approach and data sources used to develop this report,is available on the WHF website:www.worldheartfederation.orgWORLD HEART REPORT 20236The number
46、 of deaths due to CVDs in 2019 represented 33%of all global deaths,with ischaemic heart disease(9.1 million deaths)and stroke(6.6 million deaths)totalling 85%of all CVD deaths worldwide.While the number of deaths due to CVDs over the last 30 years has increased globallyin large part due to an ageing
47、 and growing populationthe age-standardised death rate has declined by one third,from 354.5 deaths per 100,000 people in 1990 to 239.9 deaths per 100,000 people in 2019 (Figure 2).Figure 2:Global trends in age-standardised cardiovascular disease death rate(per 100,000 people),1990-2019.Source:Instit
48、ute for Health Metrics and Evaluation(IHME).GBD Compare Data Visualization.Seattle,WA:IHME,University of Washington,2020.Available from http:/vizhub.healthdata.org/gbd-compare.(18 March 2023).Age-standardization is a technique used to better compare disease outcomes,such as death rates,across popula
49、tions.It calculates what the disease outcome would be if the population age-structure were the same for all countries.This allows an assessment of whether the observed differences are due to factors related to the disease,rather than the age structure of the population.7CONFRONTING THE WORLDS NUMBER
50、 ONE KILLERCVD death rates declined across all regions in this period,though the decline has been slowing in the past decade and is uneven across regions(Figure 3).The High-Income region,for example,experienced the fastest average rate of decline for both males and females from 1990 to 2019(average
51、annual rate of change of 2.6%).The slowest rate of decline in both sexes was observed in the Southeast Asia,the South Asia,East Asia and Oceania,and the Sub-Saharan Africa regions.Almost no improvement in CVD death rate for males was observed in these regions.Underscoring the disparities in progress
52、,the death rate in the Sub-Saharan African region was 1.2 times higher than the High-Income region in 1990,whereas by 2019 the gap had grown to a death rate 2.1 times higher in Sub-Saharan Africa than in the High-Income region.The High-Income region had the lowest CVD death rate overall(102.1 and 15
53、3.8 deaths per 100,000 people for females and males respectively).Only the Latin America and the Caribbean region achieved a decline in female death rates in 2019 that reached the rate the High-Income region had registered in 1990.For males,in 1990 the lowest levels of CVD death rate were recorded i
54、n Latin America and the Caribbean,Sub-Saharan Africa,and High-Income regions with South Asia only achieving a decline in 2019 that reached those levels.The Central Europe,Eastern Europe and Central Asia region had the highest age-standardized CVD death rates for males and females in both 1990(670.2
55、and 467.2 deaths per 100,000 people respectively)and 2019(524.1 and 345.7 deaths per 100,000 people respectively).The North Africa and Middle East region had the second highest rates for males and females in 2019(376.7 and 339.8 deaths per 100,000 people for males and females respectively).Figure 3-
56、Regional trends in age-standardised cardiovascular disease death rate(per 100,000 people),1990-2019.National age-standardised CVD death rates are shown in Figure 4.Source:Institute for Health Metrics and Evaluation(IHME).GBD Compare Data Visualization.Seattle,WA:IHME,University of Washington,2020.Av
57、ailable from http:/vizhub.healthdata.org/gbd-compare.(18 March 2023).WORLD HEART REPORT 20238Figure 4:National age-standardised cardiovascular disease death rate(per 100,000 people,both sexes),2019.Countries and territories without data are shown in grey.Source:Institute for Health Metrics and Evalu
58、ation(IHME).GBD Compare Data Visualization.Seattle,WA:IHME,University of Washington,2020.Available from http:/vizhub.healthdata.org/gbd-compare.(18 March 2023).9CONFRONTING THE WORLDS NUMBER ONE KILLERFigure 5 Male-female difference in age-standardised cardiovascular disease death rate (per 100,000
59、people)in Sub-Saharan Africa by country,2019.Source:Institute for Health Metrics and Evaluation(IHME).GBD Compare Data Visualization.Seattle,WA:IHME,University of Washington,2020.Available from http:/vizhub.healthdata.org/gbd-compare.(18 March 2023)CARDIOVASCULAR DISEASE DEATHS BY SEXGlobally,males
60、have a higher age-standardized CVD death rate(280.8 deaths per 100,000 people in 2019)than females(204.0 deaths per 100,000 people in 2019)(Figure 2),though this difference is not consistent across all countries.In 2019,CVD death rates were higher in males than females in all countries in the High-I
61、ncome region,the Central Europe,Eastern Europe,and Central Asia region,and the South Asia region.Females had higher CVD death rates than males in the following:Six of 21 countries in the North Africa and Middle East region,with the highest differences in Qatar(464.6 compared to 301.9 deaths per 100,
62、000 people for females and males respectively),Egypt(600.0 compared to 491.6 deaths per 100,000 people),and Algeria(447.7 compared to 371.5 deaths per 100,000 people).Thirteen of 46 countries in the Sub-Saharan Africa region,with the highest gaps observed in Mali,Mauritania,Congo(Congo-Brazzaville),
63、Ghana,and Sierra Leone(Figure 5).WORLD HEART REPORT 202310Figure 6 Cause-specific regional age-standardised cardiovascular disease death rate,2019.Source:Institute for Health Metrics and Evaluation(IHME).GBD Compare Data Visualization.Seattle,WA:IHME,University of Washington,2020.Available from http
64、:/vizhub.healthdata.org/gbd-compare.(18 March 2023).In all regions,ischaemic heart disease is the leading cause of CVD mortality across males and females,except for females in the Sub-Saharan Africa region and both males and females in South Asia where stroke is the leading cause of CVD mortality(Fi
65、gure 6).Stroke is on average the second leading cause of CVD mortality across regions.CARDIOVASCULAR DISEASE DEATHS BY CAUSE 11UNCOVERING THE GLOBAL IMPACT OF CARDIOVASCULAR DISEASETable 1 Proportion of countries spending at least 5%of GDP on health,2019.Sources:Institute for Health Metrics and Eval
66、uation(IHME).GBD Compare Data Visualization.Seattle,WA:IHME,University of Washington,2020.Available from http:/vizhub.healthdata.org/gbd-compare.(18 March 2023);World Health Organization,Global Health Expenditure Database.Available from https:/apps.who.int/nha/database/Select/Indicators/en.(13 April
67、 2023)Many across civil society have long called for countries to invest a minimum of 5%of their Gross Domestic Product(GDP)into health,with the aim of reducing out-of-pocket expenditure and improving service coverage in pursuit of Universal Health Coverage.This level of investment is consistent wit
68、h recommendations from WHO13;however,there are significant variations between regions in the proportion of countries reaching this target(Table 1).RELATIONSHIP BETWEEN CARDIOVASCULAR DISEASE MORTALITY AND HEALTH EXPENDITURERegion%High-Income97Central Europe,Eastern Europe,and Central Asia85Latin Ame
69、rica and Caribbean71North Africa and Middle East53Southeast Asia,East Asia,and Oceania50Sub-Saharan Africa45South Asia140 Countries that spend more on healthcare as a percentage of GDP on average have lower CVD death rates,whereas countries that spend less as a percentage of GDP on average have high
70、er death rates(Figure 7).A positive correlation is observed regarding peoples out-of-pocket expenditure.In countries where people spend more out-of-pocket on their healthcare,the CVD death rates are on average higher(Figure 8).Figure 7 National age-standardised cardiovascular disease death rate(per
71、100,000 people),2019,by current health expenditure(CHE)as share of national income(GDP).Note:Each dot represents a country,coloured by region.The dashed line shows the negative linear association between CVD death rates and national health expenditure(Pearsons correlation coefficient=-0.15,p=0.052).
72、13World Health Organization.The World Health Report 2010.Available from:https:/www.who.int/publications/i/item/9789241564021(last accessed 10 May 2023).14In South Asia,where no countries reach the 5%target,the percentage of GDP allocated for health expenditure is 2.6%in Bangladesh,3.6%in Bhutan,2.9%
73、in India,4.4%in Nepal and 2.8%in Pakistan.WORLD HEART REPORT 202312Premature mortality from NCDs refer to deaths between the ages of 30 and 70 years of age.In addition to the tragedy of this loss of life,these deaths impact societies,and economies more broadly.Overall,38%of premature deaths from NCD
74、s were caused by CVDs in 201515.Ischaemic heart disease was the leading cause of premature death among all NCDs in most countries for both men and women.CARDIOVASCULAR DISEASE PREMATURE MORTALITY Figure 8 National age-standardised cardiovascular disease death rate(per 100,000 people),2019,by out-of-
75、pocket(OOP)health expenditure as share of current health expenditure(CHE).Source:Institute for Health Metrics and Evaluation(IHME).GBD Compare Data Visualization.Seattle,WA:IHME,University of Washington,2020.Available from http:/vizhub.healthdata.org/gbd-compare.(18 March 2023);World Health Organiza
76、tion,Global Health Expenditure Database.Available from https:/apps.who.int/nha/database/Select/Indicators/en.(13 April 2023).The highest risk of premature mortality16 from ischaemic heart disease in 2015 was seen in countries in the Central Europe,Eastern Europe,and Central Asia region(men in Belaru
77、s recorded the highest risk of premature mortality,with a 20.2%probability of premature death),and in the North Africa and Middle East region.Ischaemic heart disease in men was also highest in the Central Europe,Eastern Europe and Central Asia region(Figure 9).The risk of premature mortality due to
78、haemorrhagic stroke was as high as 10.3%in Mongolia and 9.6%in Turkmenistan among men and 6.4%in Mongolia and 5.9%in Sierra Leone among women.The highest risk of premature mortality due to ischaemic stroke for women was observed in countries in the Sub-Saharan Africa region(around 3.0%probability of
79、 premature death),particularly Western African countries,such as Ghana,Sierra Leone,and Cte dIvoire.For all other cardiovascular diseases,the risk of premature mortality among women was similarly highest in the Sub Saharan Africa region.Note:Each dot represents a country,coloured by region.The dashe
80、d line shows a positive association between CVD death rates and OOP health expenditure as a share of national health expenditure(Pearsons correlation coefficient=0.23,p=0.002).15The latest year for which data on the risk of premature mortality is available.16Expressed as the probability of dying fro
81、m CVD between exactly 30 years and exactly 70 years of age.The probability of death is calculated in the absence of competing causes of death so that only the risk of dying from the specific cause is measured.13CONFRONTING THE WORLDS NUMBER ONE KILLERFigure 9-Probability of dying prematurely(between
82、 30 and 70 years of age)from ischaemic heart disease,by sex,2015.Countries and territories without data are shown in grey.MaleFemaleWORLD HEART REPORT 202314RISK FACTORS FOR CARDIOVASCULAR DISEASES There are several modifiable risk factors for cardiovascular diseases,including:Behavioural factors,su
83、ch as insufficient physical activity,high sodium intake,high alcohol consumption,and tobacco smoking.Metabolic factors,such as high blood pressure,high fasting plasma glucose,high body-mass index,high levels of low-density lipoprotein(LDL)cholesterol,and diabetes.Environmental factors,such as ambien
84、t air pollution.Some risk factors(e.g.,family history)cannot be modified,while others(e.g.,tobacco use,high blood pressure)can be modified with preventive actions or treatment.In 2021,according to the Global Burden of Disease Study,high blood pressure was the leading modifiable risk factor globally
85、for mortality and contributed to 10.8 million CVD deaths worldwide.15CONFRONTING THE WORLDS NUMBER ONE KILLER Elevated LDL cholesterol17 (3.8 million deaths)High fasting plasma glucose 2.3 million deaths)Air pollution(4.8 million deaths)High body-mass index(2.0 million deaths)Tobacco use(3.0 million
86、 deaths)Low physical activity(397 000 deaths)Raised blood pressure(10.8 million deaths).Modifiable risk factors that contributed to CVD deaths in 2021 include:17This is one type of blood lipid.WORLD HEART REPORT 202316Policy resources:The WHO Global Action Plan on Physical Activity 2018-2030 sets ou
87、t 20 policy actions to improve physical activity,which are designed to be universally applicable to all countries.These policies act at multiple levels and aim to challenge social norms and attitudes around physical activity,create maintaining environments that promote physical activity,improve acce
88、ss to programmes for people of all ages,and strengthen leadership and government.The forthcoming WHF Policy Brief on Physical Activity(to be published summer 2023)will provide further context on the impact of physical inactivity on CVDs and guidance for policymakers,WHF members,and individuals.PHYSI
89、CAL ACTIVITY The following exploration of select risk factors provides an overview of how they contribute to CVDs in men and women by region and country,and we highlight select international policy initiatives to help mitigate them.Measure:Age-standardised total physical activity(MET-min/week).The M
90、etabolic Equivalent of Task(MET)metric measures how much energy an activity consumes compared to being at rest.The amount of MET minutes per week expresses how much energy one has expended while performing various activities throughout the whole week.Data:Global Burden of Disease,2019Countries in th
91、e North Africa and Middle East region had the lowest levels of age-standardized physical activity,while countries in the Central Europe,Eastern Europe,and Central Asia region and South Asia region had the highest levels for males and females respectively(Figure 10).The age-standardised levels of phy
92、sical activity18 among adults aged 25 years and older were higher among males compared to females in 75%of countries.The lowest levels of physical activity among adults were observed in Iraq for males(2416.7 MET-min/week)and Malta for females(2048.7 MET-min/week).Both males and females in Kenya had
93、the highest levels of physical activity(9 381.8 MET-min/week and 10 321.5 MET-min/week respectively).18 As expressed in Total Physical Activity(MET-min/week).17CONFRONTING THE WORLDS NUMBER ONE KILLERFigure 10:National age-standardised total physical activity(MET-min/week)for individuals aged 25 yea
94、rs and above,by sex,2019.Countries and territories without data are shown in grey.MenWomenWORLD HEART REPORT 202318SODIUM INTAKEMeasure:Mean dietary sodium intake expressed in grams/day among individuals aged 25 years and olderData:Global Burden of Disease,2019In most countries,dietary sodium intake
95、 far exceeds the recommended levels of less than 2 grams/day(Figure 11a and 11b).The daily individual dietary sodium intake rate is highest in the Southeast Asia,East Asia,and Oceania region compared to other regions,at 6.7 grams/day for men and 5.6 grams/day for women.For men globally,the rate is l
96、owest in Sub-Saharan Africa(2.6 grams/day)and for women globally,the rate is lowest in the North Africa and Middle East region 2.1 grams/day.In 92%of countries,the daily individual dietary sodium intake rate is higher among males compared to females.There is notable variation between countries,with
97、intake in men ranging from a low of 1.7 grams/day in Kenya to a high of 7.6 grams/day in China and from 1.7 grams/day in Turkey to 6.5 grams/day in China among women.Figure 11a National mean dietary sodium intake(grams/day)by sex,2019.Countries and territories without data are shown in grey.Men19CON
98、FRONTING THE WORLDS NUMBER ONE KILLERFigure 11b-Regional trends in mean dietary sodium intake(grams/day)for individuals aged 25 and above from 1990 to 2019,by sex.Policy resources:All the“best buys”for reducing unhealthy diet,as outlined in WHOs recommendations for the most cost-effective policies t
99、o tackle NCDs,relate to sodium reduction.Reformulation of food products,interventions in public institutions such as hospitals and schools,behaviour change campaigns and front-of-pack labelling schemes are all effective interventions that can be implemented at low cost.The WHO SHAKE package provides
100、 a more detailed framework for creating a successful salt reduction strategy at the national level,covering surveillance of salt use,engaging with industry,adopting labelling and marketing standards,educating and empowering individuals to reduce intake and promoting healthy eating environments.Furth
101、er recommendations for sodium reduction programmes are available through the Resolve to Save Lives Sodium Reduction Framework,which includes implementation tools and examples of successful programmes.WomenWomenMenWORLD HEART REPORT 202320ALCOHOL CONSUMPTIONMeasure:Mean age-standardized alcohol consu
102、mption expressed in grams/dayData:Global Burden of Diseases,2019Among males,levels of alcohol consumption were on average highest in the Southeast Asia,East Asia and Oceania region(mean age-standardized consumption of 23.2 grams/day)followed by the Latin America and Caribbean region(19.8 grams/day)a
103、nd the High-Income region(19.0 grams/day).The lowest levels of alcohol consumption were found in the North Africa and Middle East region(3.18 grams/day).Across countries,daily mean consumption for males ranged from a low of 0.9 grams/day in Pakistan to a high of 61.8 grams per day in Puerto Rico.Amo
104、ng females,levels of alcohol consumption were on average highest among countries in the Southeast Asia,East Asia and Oceania region(mean of 15.4 grams/day)followed by the High-Income region(12.2 grams/day)and the Latin America and Caribbean region(10.6 grams/day).Countries with the lowest levels of
105、alcohol consumption were in in the North Africa and Middle East region(2.0 grams/day).Across countries,daily mean consumption for females ranged from a low of 0.8 grams/day in Pakistan to a high of 36.1 grams/day in Puerto Rico(Figure 12).In 97%of countries(198 out of 204)males consumed more alcohol
106、 per day than females.Countries with the largest differences in mean age-standardized alcohol consumption include Puerto Rico(61.8 grams/day for males vs 36.1 grams/day for females),Guyana(31.0 grams/day for males vs 6.7 grams/day for females),Federated States of Micronesia(49.8 grams/day for males
107、vs 26.3 grams/day for females),Guam(53.0 grams/day for males vs 30.9 grams/day for females)and Chad(45.3 grams/day for males vs 24.0 grams/day for females).Countries where females consumed more alcohol per day than males in descending order are Nepal(16.0 grams/day for females vs 8.9 grams/day for m
108、ales),Armenia(13.1 grams/day for females vs 9.2 grams/day for males),Indonesia(7.1 grams/day for females vs 4.1 grams/day for males),Liberia(21.0 grams/day for females vs 19.6 grams/day for males),United Arab Emirates(2.2 grams/day for females vs 1.4 grams/day for males),and Senegal(6.5 grams/day fo
109、r females vs 6.0 grams/day for males).21CONFRONTING THE WORLDS NUMBER ONE KILLERPolicy resources:According to WHO,the most cost-effective interventions to reduce the harmful use of alcohol include increasing excise tax(taxes on the sale of specific goods),bans or comprehensive restrictions on alcoho
110、l advertising,and restricting the availability of alcohol retail(e.g.though reduced hours of sale).The WHF Policy Brief on The Impact of Alcohol Consumption on Cardiovascular Health provides a summary of effective alcohol policies and recommendations for how national cardiovascular societies can adv
111、ocate for better alcohol control measures.Figure 12 National age-standardised mean alcohol consumption(grams of alcohol/day),by sex,2019.Countries and territories without data are shown in grey.MaleFemaleWORLD HEART REPORT 202322TOBACCO SMOKINGMeasure:Age-Standardized smoking prevalence(%)among indi
112、vidual aged 15 and olderData:Global Burden of Disease,2019The prevalence of tobacco smoking declined in all regions for males between 1990 and 2019,with the fastest rate of decline observed in the Latin America and Caribbean region and the slowest in the North Africa and Middle East region.The faste
113、st rate of decline in females was observed in the Latin America and the Caribbean region followed by the South Asia region.Prevalence of tobacco smoking for females increased in the Central Europe,Eastern Europe,and Central Asia region in the first decade of the 21st century but declined thereafter(
114、Figure 13a and Figure 13b).For males,age-standardized smoking prevalence was almost 50%in the Southeast Asia,East Asia,and Oceania region,with the next highest levels in the Central Europe,Eastern Europe,and Central Asia region(39.5%),and the lowest observed in the Sub-Saharan Africa region(17.5%)an
115、d Latin America and Caribbean region(17.1%).For females,age-standardized smoking prevalence was highest in the High-Income region(17.6%)and Central Europe,Eastern Europe,and Central Asia region(15.5%)and lowest in the Sub-Saharan Africa region(2.9%).For males,the five countries with highest prevalen
116、ce were Timor-Leste(64.6%),Kiribati(63.8%),Federated States of Micronesia(62.2%),Indonesia(58.3%)and Armenia(55.3%).The five with the lowest prevalence were Peru(7.3%),Nigeria(7.4%),Sao Tome and Principe(7.8%),United States Virgin Islands(8.3%)and Guinea Bissau(8.5%).For females,the five countries w
117、ith the highest prevalence were Greenland(42.3%),Nauru(40.3%),Serbia(37.8%),Federated States of Micronesia(36.4%)and Kiribati(35.1%).).Those with the lowest prevalence were Eritrea(0.7%),Egypt(1.1%),Morocco(1.1%),Guinea Bissau(1.1%)and Nigeria(1.2%).In all countries except Sweden and Ireland,the age
118、-standardised prevalence of tobacco smoking was higher in males than females.23CONFRONTING THE WORLDS NUMBER ONE KILLERFigure 13a-National age-standardised smoking prevalence(%)for individuals aged 15 and above,by sex,2019.Countries and territories without data are shown in grey.MaleFemaleWORLD HEAR
119、T REPORT 202324Figure 13b-Regional trends in age-standardised smoking prevalence(%)for individuals aged 15 and above from 1990 to 2019,by sex.Policy resources:Resources to monitor progress and support the implementation of the WHO Framework Convention on Tobacco Control(WHO FCTC)allow for the sharin
120、g of lessons learned and for identifying barriers to policy implementation.The FCTC was the first treaty negotiated under the auspices of WHO and entered into force in 2005.To date,182 states are party to the Convention,covering 90%of the worlds population.Parties are legally bound to the FCTCs prov
121、isions,which include measures relating to the pricing and taxing of tobacco products,packaging and labelling,protection of exposure to tobacco smoke in indoor spaces and restriction of tobacco advertising and promotion.The WHF Roadmap for Reducing Cardiovascular Mortality Through Tobacco Control pro
122、vides further guidance on how the cardiovascular community can support policy implementation and tackle roadblocks.25CONFRONTING THE WORLDS NUMBER ONE KILLERIn all countries except Sweden and Ireland,the age-standardised prevalence of tobacco smoking was higher in males than females.WORLD HEART REPO
123、RT 202326OBESITYMeasure:Age-standardised prevalence of obesity for adults aged 20 years and older(Body Mass Index(BMI)=30 kg/m2)Data:NCD Risk Factor Collaboration,2016 Obesity prevalence exceeded 20%in women in almost two-thirds of countries worldwide and exceeded the same level for men in 43%of cou
124、ntries(Figure 14).The prevalence was lowest in Vietnam(1.7%in men and 2.7%in women)but reached upward of 55%in men and 60%in women in both American Samoa and Nauru.Regionally,obesity prevalence was highest in women in the North Africa and Middle East region and the Latin America and Caribbean region
125、,where prevalence was more than 25%in over 85%and 96%of countries,respectively.Obesity prevalence in men was more than 25%in about half of countries in both the High-Income region and North Africa and Middle East region.Obesity prevalence was lower in South Asia where the rates in men ranged from 2%
126、in Bangladesh to 6%in Pakistan and in women ranged from 5%in Bangladesh to 12%in Pakistan.From 1975 to 2016,age-standardised obesity prevalence increased in all countries worldwide and by as much as 33 percentage points in women and 36 percentage points in men in Tuvalu.However,rates of increase var
127、ied substantially across countries and regions.In the Latin America and Caribbean region,all countries experienced at least a 13 percentage points rise in obesity prevalence in women and at least a 9 percentage points rise in men.By contrast,in South Asia,obesity prevalence in all countries increase
128、d by less than 7 percentage points in men and 12 percentage points in women.Policy initiatives:The Joint Position Paper on Obesity and Cardiovascular Disease by the World Heart Federation and World Obesity Federation highlights the direct and indirect links between obesity/being overweight and CVD a
129、nd includes recommendations for national cardiovascular societies and clinicians to reduce the risk of obesity-related CVD and mortality.The WHO“best buys”provide several recommendations to improve nutrition,which include measures to tackle obesity.These include taxation on sugar-sweetened beverages
130、,subsidies to increase fruit and vegetable intake,and reducing portion and package sizes.27CONFRONTING THE WORLDS NUMBER ONE KILLERFigure 14-National age-standardised prevalence of obesity(%)for individuals aged 20 years and above,by sex,2016.Countries and territories without data are shown in grey.
131、MenWomenWORLD HEART REPORT 202328RAISED BLOOD PRESSUREMeasure:Age-standardised prevalence of raised blood pressure for adults aged 18 years and older(SBP 140 mmHg or DBP 90 mmHg).This definition does not include people who have hypertension but whose blood pressure is controlled by taking medication
132、(i.e.,taking anti-hypertensive medications and whose blood pressure is=7.00 mmol/L or history of diagnosis with diabetes or or use of insulin or oral hypoglycaemic drugs)Data:NCD Risk Factor Collaboration,2014In China and India alone,there were over 420 million adults living with diabetes in 2014,ac
133、counting respectively for 24%and 15%of all cases globally.The prevalence was lowest in men in Burundi(4%)and in women in Switzerland(3%),and highest in American Samoa(31%in men and 33%in women).Diabetes prevalence was high in many countries of the Southeast Asia,East Asia,and Oceania region,but ther
134、e were large differences between countries within the region.Prevalence ranged from 5%in men in Timor-Leste and in women in Vietnam to 31%in men and 33%in women in American Samoa.Diabetes prevalence was lower in the Sub-Saharan Africa region,where rates in both men and women ranged from 4%in Burundi
135、 to 10%in Gabon in men and 13%in women in South Africa.From 1980 to 2014,the age-standardised prevalence of diabetes increased globally by 5%in men and 3%in women.Increases were seen in most countries worldwide and remained unchanged in only a few,mostly High-Income,countries.The largest increases w
136、ere in Tokelau(18%increase in women and 19%increase in men).Policy initiatives:The WHO Global Diabetes Compact is a multi-stakeholder mechanism to drive action to improve diabetes prevention and care.By bringing together WHO member states,people living with diabetes,academia and the private sector,t
137、he Compact seeks to improve knowledge and develop collaborations that will improve integration of diabetes prevention and management in primary health care,advance research and improve access to diabetes diagnostics,medicines,and health products,among other goals.The WHF Roadmap for CVD and Diabetes
138、 provides stakeholders a range of solutions and best practices to improving CVD prevention,diagnosis and management in people living with diabetes.31CONFRONTING THE WORLDS NUMBER ONE KILLERFigure 16 National age-standardised prevalence of diabetes(%)for individuals aged 18 years and above,by sex,201
139、4.Countries and territories without data are shown in grey.MenWomenWORLD HEART REPORT 202332LIPIDSMeasure:Age-standardised mean non-high-density lipoprotein(non-HDL)cholesterol(mmol/L)for adults aged 18 years and older Data:NCD Risk Factor Collaboration,2018Mean non-HDL ranged from 2.4 mmol/L in men
140、 and 2.6 in women in Lesotho to 4.2 mmol/L in both men and women in Malaysia and women in Tokelau in 2018.Mean non-HDL levels were higher than 3 mmol/L in both men and women in all countries of the Central Europe,Eastern Europe,and Central Asia and Southeast Asia,East Asia and Oceania regions.Levels
141、 were lower in the Sub-Saharan Africa region,where mean non-HDL ranged from lows in Lesotho(see above)to 3.2 mmol/L in men and 3.4 mmol/L in women in Ghana.There was significant variability in levels and trends across regions.Non-optimal cholesterol was previously a distinct feature of High-Income c
142、ountries in north-western Europe,North America,and Australasia,whereas the highest cholesterol-related risk was now observed in middle-income countries in East and Southeast Asia,as well as some countries in Southeast Asia and central Latin America.19From 1980 to 2018,levels of non-HDL improved mark
143、edly in the High-Income region with declines as large as 1.7 mmol/L in men and women in Belgium.In contrast,mean non-HDL increased in both men and women in all countries in the South Asia region and most countries in the Sub-Saharan Africa region.Some of the largest increases were by as much as 0.8
144、mmol/L in both women in Cambodia and in men in Tokelau.Not only did High-Income countries benefit from decreasing non-HDL cholesterol levels,but they also had higher mean HDL cholesterol than low-and middle-income countries.Policy initiatives:The WHF Roadmap for Cholesterol provides a conceptual fra
145、mework for the development of national policies and health systems approaches,so that potential roadblocks to cholesterol management and atherosclerotic CVD prevention can be overcome.These include better promotion of primordial prevention,available and affordable testing,improved risk stratificatio
146、n in care settings and wider availability of cholesterol-lowering therapies.A forthcoming Global Coalition for Circulator Health Position Paper on Universal Health Coverage(to be published in Spring 2023)will provide recommendations on essential circulatory health interventions that should be includ
147、ed in packages of basic health interventions in primary care.These are an essential component of improving detection and management of cholesterol and other CVD risk factors.19NCD Risk Factor Collaboration(NCD-RisC).Repositioning of the global epicentre of non-optimal cholesterol.Nature 582,7377(202
148、0).https:/doi.org/10.1038/s41586-020-2338-133CONFRONTING THE WORLDS NUMBER ONE KILLERFigure 17 National age-standardised mean non-HDL cholesterol(mmol/L)for individuals aged 18 years and above,by sex,2018.Countries and territories without data are shown in grey.MenWomenWORLD HEART REPORT 202334AMBIE
149、NT AIR POLLUTIONMeasure:Population weighted average of particulate matter PM2.5,g/m3Data:Global Burden of Diseases,2019Trends in ambient air pollution show little decline over time,with the South Asia region having both the highest level of ambient particulate pollution in 2019(5.9 times higher than
150、 in the High-Income region)and an increasing trend.Globally,ambient particulate matter pollution ranged from 5.6 mg/m3 in Finland to 83.1 mg/m3 micrograms per cubic meter in India(Figure 18).Countries with the highest levels of ambient particulate matter pollution are in the South Asia region(mean p
151、articulate matter=66.2 mg/m3)followed by the North Africa and Middle East region(mean particulate matter=44.0 mg/m3)and Sub-Saharan Africa region(mean particulate matter=39.5 mg/m3).Countries with the lowest levels are in the High-Income region(mean particulate matter=11.2 mg/m3)followed by the Sout
152、heast Asia,East Asia,and Oceania region(mean particulate matter =15.2 mg/m3).Figure 18a National ambient fine particulate matter concentration(PM2.5)(g/m),2019.Countries and territories without data are shown in grey.35CONFRONTING THE WORLDS NUMBER ONE KILLERFigure 18b-Regional trends in ambient fin
153、e particulate matter concentration(%)(PM2.5)(g/m)from 1990 to 2019.Policy Recommendations:WHFs air policy brief,Clean Air,Smart Cities,Healthy Hearts identifies a range of actions that stakeholders at all levels can take to act on air pollution.Scientific societies can play a role by raising awarene
154、ss of air pollution among health professionals and the public,and highlighting what can be done to protect people at risk from air pollution exposures.Policies such as implementing low emissions zones,improving public transport and infrastructure for walking and cycling,and penalties for excessive p
155、roduction of air pollution waste,can all help mitigate the health impacts of ambient air pollution.WORLD HEART REPORT 202336For each of the previously reported cardiovascular risk factors,we ordered countries from the highest to the lowest level.In the Appendix,we can see the quintile into which eac
156、h country falls for each risk factor.This can help policymakers and stakeholders identify the risk factors that are particularly high in their context and define priorities for action(Appendix Figure 2).COMPARATIVE LEVELS OF RISK FACTORS BY COUNTRY AND REGIONCentral Europe,Eastern Europe and Central
157、 AsiaIn the Central Europe,Eastern Europe,and Central Asia region,most countries have high levels of sodium intake,raised blood pressure and non-HDL cholesterol in men,and high levels of sodium intake and tobacco smoking in women.Within the region,countries in Central and Eastern Europe generally ha
158、ve higher levels of risk factors overall than countries in Central Asia.High-IncomeIn the High-Income region,most countries are characterised by high-levels of behavioural risk factors,namely high levels of sodium and alcohol consumption,high levels of tobacco smoking,and low physical activity.They
159、also have high levels of non-HDL cholesterol in both sexes,and high obesity levels in men.Latin America and CaribbeanThe Latin America and Caribbean region is more heterogeneous compared to other regions,though low physical activity is a significant risk factor across many countries of the region.Ge
160、nerally,Caribbean countries have higher risk factor levels than other countries in the region.North Africa and Middle East The North Africa and Middle East region is characterised by high levels of metabolic risk factors,especially diabetes and obesity.Air pollution and physical activity are also si
161、gnificant risk factors in this region.In general,Middle Eastern countries have higher risk factor levels than those in North Africa.South AsiaAir pollution levels are high in all countries in South Asia.Sodium intake,raised blood pressure and diabetes are also high in both sexes.Southeast Asia,East
162、Asia and OceaniaIn the Southeast Asia,East Asia and Oceania region,countries in Oceania have high levels of diabetes,obesity,tobacco smoking,and low levels of physical activity.They also have some of the highest levels of non-HDL cholesterol in women.All countries in Southeast Asia and East Asia hav
163、e high levels of sodium intake and non-HDL cholesterol.Sub-Saharan AfricaIn the Sub-Saharan Africa region,most countries have higher levels of raised blood pressure.Air pollution levels are also high across the region,and particularly in countries in the Sahel.Generally,countries in southern Sub-Sah
164、aran Africa have the highest risk factor levels in the region.37CONFRONTING THE WORLDS NUMBER ONE KILLERTHE WHF POLICY INDEXWhat it isWhat it doesHow it is calculatedWhy we need itAn analysis of the level to which national governments have implemented eight policies that are critical for CVD health.
165、Note:The analysis does not correlate to CVD mortality.For example,a country with a high policy score(i.e.,it has implemented a number/all the policies to mitigate CVDs)will not necessarily have a low CVD death rate.It combines data20 on whether the following policies/measures have been implemented:1
166、)National tobacco control programmes2)Action plan for CVDs 3)Operational Unit in Ministry of Health with responsibility for NCDs 4)Guidelines for the management of CVDs 5)Action plan to reduce physical inactivity 6)Action plan to reduce unhealthy diet related to NCDs 7)Action plan to reduce the harm
167、ful use of alcohol8)Availability of CVD drugs(e.g.,ACE inhibitors,aspirin,and Beta blockers)in the public health sector.For each policy implemented,a score of 1 is assigned.The Index is calculated by adding up each countrys overall score,ranging from 0(none of the policies are implemented)to 8(all t
168、he polices are implemented).The source of data for each country is the WHO Global Health ObservatoryTo help policymakers and stakeholders identify policy gaps in tackling CVDs.Globally,106 countries(64%of 166 countries with available information),have implemented at least 7 of the 8 policies outline
169、d above.The largest proportion of countries with the maximum score(8)were in the South Asia region(80%),the Central Europe,Eastern Europe,and Central Asia region(68%),and the High-Income(62%)region.The Sub-Saharan Africa region had the highest proportion of countries(16%)with a score of 2 or below a
170、nd the lowest proportion(13%)of countries with the maximum score.The only other regions with countries scoring 1 or 2 were the Latin America and Caribbean region,and the Southeast Asia,East Asia,and Oceania region(Figure 20).20All data taken from the WHO Global Health Observatory.WORLD HEART REPORT
171、202338Figure 20 Number of key policies implemented to address cardiovascular diseases,by region(%of countries).Globally,national tobacco control programmes were the most implemented policy21 (implemented in 91%of countries),followed by guidelines/protocols/standards for the management of CVDs(86%),a
172、nd policy/strategy/action plan to reduce unhealthy diet related to NCDs(85%).Existence of an action plan to reduce the harmful use of alcohol had the lowest level of implementation globally(70%).Over 50%of countries in the Sub-Saharan Africa region do not have a CVD plan,an NCD Unit or availability
173、of CVD drugs in the public sectors.Existence of an action plan to reduce the harmful use of alcohol was lowest in the North Africa and Middle East region.The Latin America and Caribbean region had the lowest implementation of action plans to reduce physical inactivity and to reduce unhealthy diet re
174、lated to NCDs.Country-level information on policies implemented is included in the Appendix Figure 3.21For national tobacco control programmes,the last year for which data was available was 2018.39CONFRONTING THE WORLDS NUMBER ONE KILLERKEY FINDINGSCVD mortality CVDs are the leading cause of mortali
175、ty and amount to about a third of all global deaths.The estimated number of deaths due to CVDs globally increased from around 12.1 million in 1990(equally distributed between males and females)to 18.6 million(9.6 million males and 8.9 million females)in 2019.While the number of deaths due to CVDs ov
176、er the last 30 years has increased globallyin large part due to an ageing and growing populationthe age-standardised death rate has declined by one third,from 354.5 deaths per 100,000 people in 1990 to 239.9 deaths per 100,000 people in 2019.This decline has slowed in recent years and is beginning t
177、o stall in some regions.The decline in death rates for CVDs has been much faster in High-Income countries(HICs)compared to low-and middle-income countries(LMICs),where more than 80%of CVD deaths occur globally.The world is far from achieving the equitable distribution of prevention,diagnosis,and tre
178、atment of CVDs.In 2019,for females,no region,other than Latin America and the Caribbean,had registered a decline in the CVD death rate to the level registered in the High-Income region in 1990.The highest levels of age-standardised CVD death rates occur in the Central Europe,Eastern Europe,and Centr
179、al Asia region and the North-Africa and Middle East region.Ischaemic heart disease is the leading cause of CVD mortality in all regions except for females in Sub-Saharan Africa and for both males and females in South Asia(where stroke is the main cause).In most regions,age-standardised CVD death rat
180、es are higher in males than in females;however,in a large proportion of West African countries,females are at a higher risk of dying due to CVD than males.There is a correlation between lower expenditure on health as a percentage of GDP and higher CVD mortality.In addition,the higher the proportion
181、of out-of-pocket expenditure for health,the higher the CVD mortality.CVD risk factors Raised blood pressure is the leading CVD risk factor globally and contributed to about 10.8 million deaths in 2021.Most CVD risk factors,including physical inactivity,alcohol consumption,tobacco smoking,raised bloo
182、d pressure,and diabetes are higher in males in comparison to females.Obesity is the only risk factor that is higher in females.The distribution of CVD risk factors varies markedly by region.For example,countries in the Sub-Saharan Africa region are among those with the highest prevalence of raised b
183、lood pressure,while countries in the Southeast Asia,East Asia and Oceania region have among the highest sodium consumption and prevalence of diabetes.Countries in South Asia are among those with the highest levels of ambient air pollution.The distribution of CVD risk factors varies by sex.For exampl
184、e,for males the prevalence of smoking is highest in the Southeast Asia,East Asia,and Oceania region while for females it is highest in the High-Income region.The North Africa and Middle East region had the highest prevalence of obesity for females and the Southeast Asia,East Asia,and Oceania had the
185、 highest for males.Non-HDL levels are highest in the Central Europe,Eastern Europe and Central Asia region for males and females.WHF Policy Index The WHF Policy Index showed that the lowest implementation of key policies for improving CVD health is in the Sub-Saharan Africa region,where over 50%of t
186、he countries do not have availability of CVD drugs in public health facilities,a CVD National Plan or an NCD Unit.Globally,106 countries(64%of 166 countries with available information),have implemented at least 7 of the 8 policies.The largest proportion of countries with the maximum score(8)were in
187、the South Asia region(80%),the Central Europe,Eastern Europe,and Central Asia region(68%),and the High-Income(62%)region.WORLD HEART REPORT 202340KEY RECOMMENDATIONSTo help promote action at every level against CVDs,WHF recommends the following,which are complementary to other key recommendations in
188、cluded in recent policy briefs and reports:1.Countries and other relevant stakeholders should continue efforts to improve data for CVDs and their risk factors,particularly in LMICs where data gaps exist.This will help to understand why certain populations are at higher risk for certain CVDs.2.Countr
189、ies should ensure that their health expenditure as a percentage of GDP is at least 5%,in line with recommendations from the World Health Organization.3.Countries should implement policies to combat CVDs,guided by the burden of disease and predominant risk factors,and ensure that their implementation
190、 is adequately resourced and monitored for progress.4.As a matter of urgency,countries should prioritise coverage of interventions for the prevention and management of CVDs in Universal Health Coverage(UHC)benefit packages to help minimize out-of-pocket expenditure.5.Lessons-learned in improving CVD
191、 prevention,management and improved access to care and therapies need to be implemented across all regions to address inequities and the uneven progress in CVD mortality declines.All countries and stakeholders must urgently unite to accelerate efforts on improving CVD health and get progress back on
192、 track so that Sustainable Development Goal 3.4 of reducing by one-third premature mortality from NCDs can be achieved.This goal aligns with the World Heart Federations(WHF)World Heart Vision 2030.41CONFRONTING THE WORLDS NUMBER ONE KILLERAPPENDIX SUPPLEMENTARY FIGURES Figure 2:Comparative levels of
193、 risk factors by country and region The figures display the global quintile into which each country falls for each risk factor presented in the Report.This can help policymakers and stakeholders identify the risk factors that are particularly high in their context and define priorities for action.Ri
194、sk Factors are labelled in the same order in which they appear in the Report:RF1 Physical activityRF2 Sodium intakeRF3 Alcohol consumptionRF4 Tobacco smokingRF5 ObesityRF6 Raised Blood PressureRF7 DiabetesRF8 LipidsRF9 Ambient air pollutionFigure 1:Regional classification(based on the Global Burden
195、of Disease super regions)WORLD HEART REPORT 202342Central Europe,Eastern Europe and Central AsiaHigh-Income43CONFRONTING THE WORLDS NUMBER ONE KILLERLatin America and the CaribbeanNorth Africa and Middle EastWORLD HEART REPORT 202344South AsiaSoutheast Asia,East Asia and Oceania45CONFRONTING THE WOR
196、LDS NUMBER ONE KILLERSub-Saharan Africa WORLD HEART REPORT 202346Central Europe,Eastern Europe and Central AsiaHigh-IncomePolicy implementation per countryPolicies are labelled in the same order in which they appear in the report:P1-National tobacco control programmes P2-Action plan for CVDs P3-Oper
197、ational Unit in Ministry of Health with responsibility for NCDs P4-Guidelines for the management of CVDs P5-Action plan to reduce physical inactivity P6-Action plan to reduce unhealthy diet related to NCDs P7-Action plan to reduce the harmful use of alcohol P8-Availability of CVD drugs(e.g.,ACE inhi
198、bitors,aspirin,and Beta blockers)in the public health sector.Figure 3:Policy Implementation by country and region47CONFRONTING THE WORLDS NUMBER ONE KILLERLatin America and the CaribbeanSouth AsiaNorth Africa and Middle EastWORLD HEART REPORT 202348Sub-Saharan AfricaSoutheast Asia,East Asia and Ocea
199、niaWORLD HEART REPORT49CONFRONTING THE WORLDS NUMBER ONE KILLER49WORLD HEART REPORTWORLD HEART REPORT 2023WORLD HEART FEDERATION32,rue de Malatrex,1201 Geneva,Switzerland(+41 22)807 03 20infoworldheart.orgwww.worldheart.org World Heart FederationworldheartfedWorld Heart Federationworldheartfederation