The Factors Behind the Shifting Trends of Ischemic Heart Disease and Stroke

Incidence of stroke and ischemic heart disease are declining around the world, except for in a handful of regions, according to research in the open access journal PLOS Global Public Health. Wanghong Xu of Fudan University and colleagues find that in East and West Sub-Saharan Africa, East and Central Asia and Oceania, ischemic heart disease is increasing, which may be attributed to eight factors that include diet, high BMI, household air pollution and more.

Cardiovascular disease is a leading cause of death and disability worldwide, and ischemic heart disease and stroke accounted for 16% and 11% of total deaths in 2019 respectively. Over time both have decreased in incidence, but the distribution of this decline varies and in some regions there is an upward trend.

The team analyzed global data from 1990-2019 for incidence of ischemic heart disease and stroke and for exposure to 87 potential attributable factors. The authors describe the incidences and trends at a global, regional and national level, and find higher rates of ischemic heart disease than stroke. Over three decades ischemic heart disease reduced from 316 to 262 per 100,000 people and stroke declined from 181 to 151 per 100,000. The increases of ischemic heart disease seen in some regions may be associated with the shifting distribution of eight factors: a diet high in trans-fatty acids; diet low in calcium; high BMI; household air pollution from solid fuels; non-exclusive breastfeeding; occupational ergonomic factors; vitamin A deficiency; and, occupational exposure to particulate matter, gases and fumes, which were determined by the World Bank income levels.

The results indicate how the potential socioeconomic development of some countries is affecting rates of cardiovascular disease and stroke, and that places experiencing rapid economic transitions – and rapidly changing lifestyle changes – may also be experiencing higher rates of disease. This study and provides insight into mechanisms involved and the potential for targeted interventions.

The authors add: “This study profiles the significantly different incidence trends of ischemic heart disease and stroke across countries, identifies eight potential contributors to the disparities, and reveals the pivotal role of socioeconomic development in shaping the country-level associations of the risk factors with the incidences of the two cardiovascular diseases.”