A report by Prospective Urban and Rural Epidemiologic (PURE) has shown that cancer is now the leading cause of death in high-income countries.

The report also showed that cardiovascular disease (CVD) has persisted in middle and low-income countries contributing to 17·7 million deaths that occurred in the world in 2017.

The 2019 PURE study published in The Lancet and presented together at the ESC Congress 2019 provided unique information on common disease incidence, hospitalization, and deaths.

According to the report, cancer is now responsible for twice as many deaths as CVD with experts attributing it to lack of quality health care. It also revealed that about 70% of CVD cases and deaths due to modifiable risk.

The report, which followed 162,534 middle-aged adults (aged 35 - 70, 58% women) in 4 HIC, 12 MIC and 5 LIC over a median of 9.5 years (between 2005 – 2016), found that “CVD related deaths were 2.5 times more common in middle-aged adults in LIC compared within HIC, despite LIC experiencing a substantially lower burden of CVD risk factors compared with wealthier countries.

“Higher CVD related mortality in LIC may be mainly due to lower quality of healthcare, given that the report found first hospitalization rates and CVD medication use to be both substantially lower in LIC and MIC, compared within HIC.”

Dr. Gilles Dagenais, Emeritus Professor at Laval University, Quebec, Canada and lead author of the first report, stated that findings show that cancer is fast becoming the leading cause of death worldwide.

“Our report found cancer to be the second most common cause of death globally in 2017, accounting for 26% of all deaths. But as CVD rates continue to fall, cancer could likely become the leading cause of death worldwide, within just a few decades,” Dr. Dagenais said.

Dr. Salim Yusuf, Professor of Medicine, McMaster University, and Principal Investigator of the study remarked: “While long-term CVD prevention and management strategies have proved successful in reducing the burden in HIC, a change in tack is required to alleviate the disproportionately high impact of CVD in LIC and MIC. Governments in these countries need to start by investing a greater portion of their Gross Domestic Product in preventing and managing non- communicable diseases including CVD, rather than focusing largely on infectious diseases.”

A further report from the PURE study, also published in The Lancet and presented simultaneously at the ESC Congress 2019, explored the relative contribution (population attributable factor, or PAF) of 14 modifiable risk factors to CVD, among 155,722 community-dwelling, middle-aged people without a prior history of CVD, within the same 21 HIC, MIC and LIC.

Overall, modifiable risk factors, including metabolic, behavioural, socioeconomic and psychosocial factors, strength and environment, accounted for 70% of all CVD cases globally. Metabolic risk factors were the largest contributory risk factor globally (41.2%), with hypertension (22.3%) the leading factor within this group.

However, the relative importance of risk factors for CVD cases and death varied widely between countries at different stages of economic development.

For deaths, the largest group of PAFs overall were for behavioural risk factors (26·3%), but in MIC and LIC, the importance of household air pollution, poor diet, low education, and low grip strength were substantially larger compared to their impact in HIC. In line with the findings of the first report [1], metabolic risk factors including high cholesterol, abdominal obesity or diabetes, played a larger role in causing CVD in HIC, compared within LIC.

“We have reached a turning point in the development of CVD prevention and management strategies,” said Annika Rosengren, Professor of Medicine from Goteborg, Sweden. Sumathy Rangarajan, who coordinated the study said “While some risk factors certainly have large global impacts, such as hypertension, tobacco, and low education, the impact of others, such as poor diet, household air pollution, vary largely by the economic level of countries.

Dr. Philip Joseph, Associate Professor of Medicine at McMaster University and the co-lead of the paper concluded: “Efforts to tackle CVD through focusing on a small number of behavioural risk factors, such as reducing smoking, are important, but these efforts should expand to better Blood Pressure control and better use of secondary prevention, with simple and effective low-cost medications.”

Countries analyzed in these two reports from the PURE Study included Argentina, Bangladesh, Brazil, Canada, Chile, China, Colombia, India, Iran, Malaysia, Pakistan, Palestine, Philippines, Poland, Saudi Arabia, South Africa, Sweden, Tanzania, Turkey, United Arab Emirates, Zimbabwe.

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