Environmental risk factors and cardiovascular diseases: a comprehensive expert review

Cardiovascular diseases (CVDs), besides chronic respiratory and metabolic diseases, constitute a large part of non-communicable diseases (NCDs), including acute and chronic coronary artery disease, heart failure and arrhythmia, stroke and arterial hypertension. Importantly, 70% of annual global deaths (around 40 million people) can be attributed to NCDs and this share will further increase by 10% according to the World Health Organization (WHO) projections for the year 2030. NCDs account for 80.6% [95% confidence interval (CI) 78.2–82.5] of age-standardized years lived with disability in 2016, as indicated by data of the global burden of disease (GBD) study. CVDs are responsible for the majority of deaths that are caused by NCDs. In the GBD study (2019 update), the contribution of CVDs to overall global mortality continuously increased from 12.1 million in 1990 to 18.6 million in 2019.4 Interestingly, low- and middle-income countries have the highest share (86%) of premature deaths triggered by NCDs.



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