Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment

Goodarz Danaei, Yuan Lu, Gitanjali M. Singh, Emily Carnahan, Gretchen A. Stevens, Melanie J. Cowan, Farshad Farzadfar, John K. Lin, Mariel M. Finucane, Mayuree Rao, Young Ho Khang, Leanne M. Riley, Dariush Mozaff Arian, Stephen S. Lim, Majid Ezzati, Geir Aamodt, Ziad Abdeen, Nabila A. Abdella, Hanan F.Abdul Rahim, Juliet AddoWichai Aekplakorn, Mustafa M. Afifi, Enrico Agabiti-Rosei, Carlos A.Aguilar Salinas, Charles Agyemang, Mohammed K. Ali, Mohamed M. Ali, Mohannad Al-Nsour, Abdul R. Al-Nuaim, Ramachandran Ambady, Emanuele Di Angelantonio, Pertti Aro, Fereidoun Azizi, Bontha V. Babu, Adil N. Bahalim, Carlo M. Barbagallo, Marco A. Barbieri, Alberto Barceló, Sandhi M. Barreto, Henrique Barros, Leonelo E. Bautista, Athanase Benetos, Peter Bjerregaard, Cecilia Björkelund, Simona Bo, Martin Bobak, Enzo Bonora, Manuel A. Botana, Pascal Bovet, Juergen Breckenkamp, Monique M. Breteler, Grazyna Broda, Ian J. Brown, Michael Bursztyn, Antonio Cabrera de León, Hannia Campos, Francesco P. Cappuccio, Vincenzo Capuano, Edoardo Casiglia, Maurizio Castellano, Katia Castetbon, Luis Cea, Chih Jen Chang, Noureddine Chaouki, Somnath Chatterji, Chien Jen Chen, Zhengming Chen, Jin Su Choi, Lily Chua, Renata Cífková, Linda J. Cobiac, Richard S. Cooper, Anna Maria Corsi, Michael C. Costanza, Cora L. Craig, Rachel S. Dankner, Saeed Dastgiri, Elias Delgado, Gonul Dinc, Yasufumi Doi, Guang Hui Dong, Eleonora Dorsi, Nico Dragano, Adam Drewnowski, Robert Eggertsen, Paul Elliott, Anders Engeland, Cihangir Erem, Alireza Esteghamati, Caroline H.D. Fall, Jian Gao Fan, Catterina Ferreccio, Leopold Fezeu, Josélia O. Firmo, Hermes J. Florez, Nélida S. Fornés, F. Gerry R. Fowkes, Guido Franceschini, Fredrik Frisk, Flávio D. Fuchs, Eva L. Fuller, Linn Getz, Simona Giampaoli, Luis F. Gómez, Juan M. Gomez-Zumaquero, Sidsel Graff -Iversen, Janet F. Grant, Ramiro Guerrero Carvajal, Martin C. Gulliford, Rajeev Gupta, Prakash C. Gupta, Oye Gureje, Hialy R. Gutierrez, Tine W. Hansen, Jun Hata, Jiang He, Noor Heim, Joachim Heinrich, Tomas Hemmingsson, Anselm Hennis, William H. Herman, Victor M. Herrera, Suzanne Ho, Michelle Holdsworth, Gunilla Hollman Frisman, Wilma M. Hopman, Akhtar Hussain, Abdullatif Husseini, M. Mohsen Ibrahim, Nayu Ikeda, Bjarne K. Jacobsen, Hashem Y. Jaddou, Tazeen H. Jafar, Mohsen Janghorbani, Grazyna Jasienska, Michel R. Joffres, Jost B. Jonas, Othman A. Kadiki, Ofra Kalter-Leibovici, Raoul M. Kamadjeu, Stephen Kaptoge, Ioannis Karalis, Mika J. Kastarinen, Joanne Katz, Lital Keinan-Boker, Paul Kelly, Omid Khalilzadeh, Stefan Kiechl, Ki Woong Kim, Yutaka Kiyohara, Junji Kobayashi, Maressa P. Krause, Ružena Kubínová, Pawel Kurjata, Yadlapalli S. Kusuma, Tai H. Lam, Arnulf Langhammer, Carlene M.M. Lawes, Cai Le, Jeannette Lee, Claire Lévy-Marchal, Sarah Lewington, Yanping Li, Yuqiu Li, T. O. Lim, Xu Lin, Cheng Chieh Lin, Hsien Ho Lin, Lars Lind, Lauren Lissner, Xiaoqing Liu, Patricio Lopez-Jaramillo, Roberto Lorbeer, Guansheng Ma, Stefan Ma, Francesc Macià, David R. Maclean, Stefania Maggi, Dianna J. Magliano, Marcia Makdisse, Giuseppe Mancia, Toshifumi Mannami, Pedro Marques-Vidal, Jean Claude N. Mbanya, Norma McFarlane-Anderson, Roberto Miccoli, Juhani Miettola, Hoang V. Minh, Juan F. Miquel, J. Jaime Miranda, Mostafa K. Mohamed, V. Mohan, Salim Mohanna, Ali Mokdad, Willem F. Mollentze, Dante D. Morales, Karen Morgan, M Muiesan Lorenza M Muiesan, Sergio Muntoni, Iraj Nabipour, Tomoko Nakagami, Vinay Nangia, Barbara Nemesure, Martin Neovius, Kjersti A. Nerhus, Flavio Nervi, Hannelore Neuhauser, Minh Nguyen, Toshiharu Ninomiya, Marianna Noale, Sang W. Oh, Takayoshi Ohkubo, Oliviero Olivieri, Ayse Emel önal, Altan Onat, Myriam Oróstegui, Hermann Ouedraogo, Wen Harn Pan, Demosthenes B. Panagiotakos, Francesco Panza, Yongsoo Park, Valeria M.A. Passos, Mangesh S. Pednekar, Pamela M. Pelizzari, Marco A. Peres, Pérez Cynthia Pérez, Román Pérez-Fernández, Rafael Pichardo, Hwee Pin Phua, Francesco Pistelli, Pedro Plans, Maria Polakowska, Neil Poulter, Dorairaj Prabhakaran, Qing Qiao, Masoud Rafiei, Olli T. Raitakari, Luiz R. Ramos, Sanjay Rampal, Lekhraj Rampal, Finn Rasmussen, Kanala K.R. Reddy, Josep Redon, Luis Revilla, Victoria Reyes-García, Ragab B. Roaeid, Carolyn A. Robinson, Fernando Rodriguez-Artalejo, Rosalba Rojas-Martinez, Kimmo Ronkainen, Luis Rosero-Bixby, Gregory A. Roth, Harshpal S. Sachdev, José R. Sánchez, Selim Y. Sanisoglu, Susana Sans, Nizal Sarraf-Zadegan, Marcia Scazufca, Beatriz D. Schaan, Norberto Schapochnik, Hedi Schelleman, Ione J.C. Schneider, C. Mary Schooling, Bernhard Schwarz, Cevad Sekuri, Martha S. Sereday, Lluís Serra-Majem, Jonathan Shaw, Abdul S. Shera, Zumin Shi, Rahman Shiri, Xiao Ou Shu, Diego Augusto Santos Silva, Eglé Silva, Leon A. Simons, Margaret Smith, Stefan Söderberg, Suharko Soebardi, Vincenzo Solfrizzi, Emily Sonestedt, Ahmet Soysal, Pär Stattin, Aryeh D. Stein, George S. Stergiou, Jochanan Stessman, Akihiro Sudo, Machi Suka, Valter Sundh, Kristina Sundquist, Johan Sundström, Andrew B. Swai, E. Shyong Tai, Kristian Tambs, Fikru Tesfaye, George N. Thomas, Margaret Thorogood, Reijo S. Tilvis, Martin Tobias, Liv E. Torheim, Peter Trenkwalder, Jaakko O. Tuomilehto, Josep A. Tur, Christophe Tzourio, Ana I. Uhernik, Flora A. Ukoli, Nigel Unwin, Stephen Vander Hoorn, Mark P. Vanderpump, Jose Javier Varo, Marit B. Veierød, Gustavo Velásquez-Meléndez, Monique Verschuren, Lucie Viet, Salvador Villalpando, Jesus Vioque, Peter Vollenweider, Stefano Volpato, Ningli Wang, Ya X. Wang, Mark Ward, Sarwono Waspadji, X Welin Lennart X Welin, Gary Whitlock, Lars Wilhelmsen, Johann Willeit, Mark Woodward, David Wormser, J Xavier André J Xavier, Fei Xu, Liang Xu, Akira Yamamoto, Gonghuan Yang, Xiaoguang Yang, Li Chia Yeh, Jin Sang Yoon, Qisheng You, Zhijie Yu, Jian Zhang, Lei Zhang, Wei Zheng, Maigeng Zhou

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Abstract

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health.

Original languageEnglish (US)
Pages (from-to)634-647
Number of pages14
JournalThe Lancet Diabetes and Endocrinology
Volume2
Issue number8
DOIs
StatePublished - Aug 2014

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ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Danaei, G., Lu, Y., Singh, G. M., Carnahan, E., Stevens, G. A., Cowan, M. J., Farzadfar, F., Lin, J. K., Finucane, M. M., Rao, M., Khang, Y. H., Riley, L. M., Arian, D. M., Lim, S. S., Ezzati, M., Aamodt, G., Abdeen, Z., Abdella, N. A., Rahim, H. F. A., ... Zhou, M. (2014). Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment. The Lancet Diabetes and Endocrinology, 2(8), 634-647. https://doi.org/10.1016/S2213-8587(14)70102-0