The Atlas of Heart Disease and Stroke © World Health Organization 2004
All rights reserved
First published 2004
1 3 5 7 9 10 8 6 4 2
WHO Library Cataloguing-in-Publication Data
Mackay, Judith.
The atlas of heart disease and stroke / Judith Mackay and George Mensah;
with Shanthi Mendis and Kurt Greenlund.
1.Heart diseases – epidemiology 2.Cerebrovascular accident – epidemiology
3.Risk factors 4.Atlases I.Mensah, George. II.Mendis, Shanthi.
III.Greenlund, Kurt. IV.Title.
ISBN 92 4 156276 8
(NLM Classification: WG 210)
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Contents
Foreword
by Dr LEE Jong-Wook, Director-General, World Health Organization 9
Preface 11
Acknowledgements 12
About the authors 15
Part One: CARDIOVASCULAR DISEASE 16
1 Types of cardiovascular disease 18
Different types of cardiovascular diseases. Global deaths from
cardiovascular diseases.
2 Rheumatic fever and rheumatic heart disease 20
Deaths from rheumatic heart disease. Cases of rheumatic heart
disease in children. Deaths among Aboriginal and nonAboriginal
populations
in Australia.
Part Two: RISK FACTORS 22
3 Risk factors 24
Overview of modifiable, non-modifiable and “novel” risk
factors. Percentage contribution of leading risk factors to
disease burden. Contributory factors in coronary heart disease
and ischaemic stroke.
4 Risk factors start in childhood and youth 26
Tobacco use in youth.Overweight youth.Overweight trends
in the USA.
5 Risk factor: blood pressure 28
Average systolic blood pressure worldwide. Trends of high
blood pressure in USA and India. Changes in blood pressure
with age in Gambia, and with education in South Africa.
6 Risk factor: lipids 30
Cholesterol levels in women worldwide. Trends in cholesterol
levels in Beijing, China. Current recommended lipid levels.
7 Risk factor: tobacco 32
Smoking rates worldwide. Cardiovascular risks of smoking and
passive smoking. Smokers’ lack of knowledge of the risks.
8 Risk factor: physical inactivity 34
Physical activity levels: energy expenditure in work, leisure and
transport. Time spent seated. Various physical activities with
similar health benefits. Physical inactivity by social class in India.
Participation in sport in Singapore. Motor vehicle ownership
and trends. Ratio of bicycles to cars in China and USA.
9 Risk Factor: obesity 36
Average adult body mass index (BMI) worldwide. Food
consumption trends. Apple shape at higher risk of CVD
than pear shape.
10 Risk factor: diabetes 38
Prevalence of diabetes worldwide. Diabetes trends to 2030.
11 Risk factor: socioeconomic status 40
Socioeconomic influences on cardiovascular risk factors and
diseases. Education, income levels and occupation in Canada,
China, India, Italy, Saudi Arabia, South Africa, Trinidad and
Tobago, Uganda and USA.
12 Women: a special case? 42
Similar and different risks in women compared with men.
Smoking, physical activity and hormone replacement therapy.
Part Three: THE BURDEN 44
13 Global burden of coronary heart disease 46
Healthy years of life lost to coronary heart disease. Leading
causes of disease burden by sex.
14 Deaths from coronary heart disease 48
Deaths from coronary heart disease. Comparison with other
causes of death. Trends in coronary heart disease.
15 Global burden of stroke 50
Healthy years of life lost to stroke. Stroke in young people.
Risks of the oral contraceptive pill.
16 Deaths from stroke 52
Deaths from stroke. Predictors of death from stroke in Italy.
Comparison with other causes of death. 17 Economic costs 54
Cost of cardiovascular diseases and their risk factors in selected
countries, regions and worldwide. Price of medications
compared with cheapest crop available. Lifetime costs of
coronary heart disease. Expenditure on cardiovascular
medications. Cost of risk factors.
Part Four: ACTION 56
18 Research 58
Number of publications on cardiovascular research by country.
Regional research. Clinical trials on humans: cardiovascular
disease compared with other health problems. Research funding
in the USA: CVD compared with other diseases.
19 Organizations 60
International and regional organizations involved with
cardiovascular disease. World conferences on cardiovascular
diseases.
20 Prevention: personal choices and actions 62
Personal choices in lifestyles and behaviours in children,
adolescents and adults: stopping smoking, eating more fruit and
cereals, reducing salt intake, physical activity, and prevention
and control of obesity and high blood pressure.
21 Prevention: population and systems approaches 64
Noncommunicable disease prevention and control. Availability
of basic equipment, medical professionals, and availability,
affordability, and local manufacture of drugs. Use of
medications in stroke and coronary heart disease. Profiles of
Finland, Japan, Mauritius and New Zealand. Dieticians in the
United Kingdom promote healthy eating.
22 Health education 66
World Heart Day participation, themes and trends. Medical
activities, physical activities and promotion of healthy diet.
Giving up smoking: the International Quit and Win campaign.
23 Policies and legislation 68
Smoke-free government buildings and private workplaces. The
first five countries to ratify the WHO Framework Convention
on Tobacco Control (FCTC). National plans for CVD
prevention and control. Tobacco, food and nutrition legislation.
Smoking ban in the USA led to reduction in heart attacks.
24 Treatment 70
Medication, devices, and operations. Simple secondary
prevention. Proportion of patients reaching blood pressure and
cholesterol treatment goals. Participation in cardiac
rehabilitation. Proportion of people with diabetes treated with
medication or diet. Trends in cardiovascular operations and
procedures in the USA.
Part Five: THE FUTURE AND THE PAST 72
25 The future 74
Predictions to 2030 of the cardiovascular disease epidemic, risk
factors, economic costs, research, UN Conventions, technology
and treatment.
Milestones in knowledge of heart and vascular disorders
History of key events, developments and research, including
epidemiology, risk factors, economic costs, inventions and
interventions.
BCE–1852 76
1856–1967 78
1969–2004 80
Part Six: World Tables 82
World data tables 84
Glossary 92
Sources 94
Useful contacts 109
Index 111
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