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Risk factors
The majority of cardiovascular disease (CVD) is caused by risk factors that can be controlled,
treated or modified, such as high blood pressure, cholesterol, overweight/obesity, tobacco use,
lack of physical activity and diabetes. However, there are also some major CVD risk factors that
cannot be controlled.
In terms of attributable deaths, the leading CVD risk factor is raised blood pressure (to which 13
per cent of global deaths is attributed), followed by tobacco use (9 per cent), raised blood
glucose (6 per cent), physical inactivity (6 per cent) and overweight and obesity (5 per cent).1
DALY- disability-adjusted life year is a measure of overall disease burden expressed as the number of years lost due to ill-health, disability or
early death.
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Unhealthy diet
High dietary intakes of saturated fat, trans-fats and salt, and low intake of fruits, vegetables
and fish are linked to cardiovascular risk.1
Approximately 16 million (1.0 per cent) DALYs and 1.7 million (2.8 per cent) of deaths
worldwide are attributable to low fruit and vegetable consumption.1
The amount of dietary salt consumed is an important determinant of blood pressure levels
and overall cardiovascular risk and the WHO recommends a population salt intake of less
than 5 grams/person/day to help the prevention of CVD.1
Frequent consumption of high-energy foods, such as processed foods that are high in fats
and sugars, promotes obesity compared to low-energy foods.1
High consumption of saturated fats and trans-fatty acids is linked to heart disease;
elimination of trans-fat and replacement of saturated with polyunsaturated vegetable oils
lowers coronary heart disease risk.1
Adequate consumption of fruit and vegetables reduces the risk of CVD.1
A healthy diet can contribute to a healthy body weight, a desirable lipid profile and a
desirable blood pressure.1
It is estimated that decreasing dietary salt intake from the current global levels of 912
grams/day to the recommended level of 5 grams/day would have a major impact on blood
pressure and CVD.1
Cholesterol/lipids
Raised blood cholesterol increases the risk of heart disease and stroke.1
Globally, one third of ischaemic heart disease is attributable to high cholesterol.1
Overall, raised cholesterol is estimated to cause 2.6 million deaths (4.5 per cent of total) and
29.7 million DALYS, or 2 per cent of total DALYS globally.1
In 2008, the prevalence of raised total cholesterol among adults defined as total cholesterol
of 6.2 mmol/l (240 mg/dl) or higher was 9.7 per cent (8.5 per cent for males and 10.7 per
cent for females).1
Lowering raised blood cholesterol reduces the risk of heart disease.1
In 2008, the global prevalence of raised total cholesterol among adults was 39 per cent (37
per cent for males and 40 per cent for females).1
The prevalence of raised total cholesterol noticeably increases according to the income level
of the country. In low-income countries, around 25 per cent of adults have raised total
cholesterol, while in high-income countries, over 50 per cent of adults have raised total
cholesterol.1
Overweight and obesity
Obesity is strongly related to major cardiovascular risk factors such as raised blood pressure,
glucose intolerance, type 2 diabetes and dyslipidaemia.1
Worldwide, at least 2.8 million people die each year as a result of being overweight or obese,
and an estimated 35.8 million (2.3 per cent) of global DALYs are caused by overweight or
obesity.1
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In 2008, 34 per cent of adults over the age of 20 were overweight with a body mass index
(BMI, a measure of weight relative to height).1
In 2008, 9.8 per cent of men and 13.8 per cent of women were obese (with a BMI greater
than or equal to 30 kg/m2), compared to 4.8 per cent for men and 7.9 per cent for women in
1980.1
To achieve optimal health, the median BMI for adult populations should be in the range of
2123 kg/m2, while the goal for individuals should be to maintain a BMI in the range 18.5
24.9 kg/m2.1
The prevalence of raised BMI increases with income level of countries, up to upper-middleincome levels. The prevalence of overweight in high-income and upper-middle-income
countries was more than double that of low- and lower-middle-income countries.1
For obesity, the difference more than triples from 7 per cent obesity for both males and
females in lower-middle-income countries to 24 per cent in upper-middle- income countries.1
1 Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization (in
collaboration with the World Heart Federation and World Stroke Organization), Geneva 2011.
2 World Health Organization. Regional Office for Southeast Asia. Hypertension fact sheet. Last accessed at
http://www.searo.who.int/linkfiles/non_communicable_diseases_hypertension-fs.pdf [April 2012]
3 Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease. Hypertension. 2001;37:10531059.
4 Teo KK, Ounpuu S, Hawken S, et al. INTERHEART Study Investigators. Tobacco use and risk of myocardial infarction in 52 countries in the
INTERHEART study: a case-control study. Lancet. 2006;368(9536):647658.
5 Centers for Disease Control and Prevention. The health consequences of smoking: A Report of the Surgeon General. Atlanta, Ga. U.S.
Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and
Health. 2004.
6 Centers for Disease Control and Prevention. Women and Smoking: A Report of the Surgeon General. Atlanta, Ga. U.S. Department of Health
and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2001.
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