Cardiovascular disease is the leading cause of death worldwide. According to the Prospective Urban Rural Epidemiology (PURE) study, led by the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences, cardiovascular disease (CVD) is the leading cause of death among middle-aged adults worldwide. However, deaths from cancer are twice as frequent in high-income countries as deaths from CVD.
The PURE study is the first large prospective international study to use a standardized approach to document the frequency of common diseases and death rates in high-, middle- and low-income countries. It looked at more than 162,500 adults aged 35 to 70 from 21 countries over the course of about 9.5 years.
“The fact that cancer deaths are now twice as frequent as CVD deaths in high-income countries indicates a transition in the predominant causes of death in middle age,” said principal investigator Salim Yusuf, executive director of PHRI and a professor of medicine at McMaster.
“As CVD declines in many countries because of prevention and treatment, cancer mortality will likely become the leading cause of death globally in the future,” he continued. “The high mortality in poorer countries is not due to a higher burden of risk factors, but likely other factors including lower quality and less health care.”
These high-income countries mentioned in the study were Canada, Saudi Arabia, Sweden and the United Arab Emirates. Middle-income countries (MIC) were Argentina, Brazil, Chile, China, Columbia, Iran, Malaysia, Palestine, Philippines, Poland, Turkey and South Africa. And lower-income countries were Bangladesh, India, Pakistan, Tanzania and Zimbabwe.
CVD was the most common cause of death worldwide at 40%, however that ranged from only 23% in high-income countries, 41% in middle-income countries, and 43% in low-income countries, even though CVD risk factors were the highest in high- and low-income countries.
Cancer was the second most common cause of death at 26%, and was responsible for 55% of deaths in high-income countries.
“The implications are that in [higher-income countries], while continued efforts to prevent and treat CVD should continue, new efforts to reduce cancer are required,” said Darryl Leong, the co-lead author of the study, scientist at PHRI, and assistant professor of medicine at McMaster University.
“If ways of lowering CVD deaths that have been effective in high-income countries are implemented in middle- and lower-income countries, we could expect large drops in CVD deaths there as well over time,” said lead author Gilles Dagenais, professor emeritus of medicine at Laval University. “If that happens, we might also expect that cancer will become relatively more common as a cause of death.”
This research is published in The Lancet.
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