Global Burden of Cardiovascular Disease Global Efforts in Achieving 25 x 25

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1 Global Burden of Cardiovascular Disease Global Efforts in Achieving 25 x 25 William A. Zoghbi MD, MACC Elkins Family Distinguished Chair in Cardiac Health Professor and Chairmen, Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston, Texas

2 Distribution of Major Causes of Death Worldwide

3 Non Communicable Disease A Burden on the Developed and Developing World

4 Mortality Rates from Ischemic Heart Disease Age Standardized/100,000

5 Burden of Cardiovascular Disease DALYs, Age Standardized/100,000

6 An Urgent Development Issue NCDs make the largest contribution to mortality both globally and in the majority of low- and middle- income countries (LMICs) Worldwide, NCDs account for 60% (35 million) of global deaths The largest burden - 80% (28 million) - occurs in LMICs, making NCDs a major cause of poverty and an urgent development issue

7 Global Increase in CV Diseases Impact NCDs will cost the world $47 trillion over the next 20 years Of this, heart disease represents 43% or $20 trillion Sources: WEF, Harvard U & WHO

8 Deaths per 100,000 population Trends in CV Mortality in the US Coronary arteriography 1954 First open-heart procedure 1961 Risk factors 1961 Coronary care unit 1962 betablocker 1969 First CABG 1972 NHBPEP 1976 HMG CoA reductase inhibitor 1979 Coronary angioplasty 1980 First ICD 1983 CASS 1985 TIMI NCEP 1986 GISSI and ISIS SAVE 1993 Superiority of primary PCI in acute MI 2002 drug-eluting vs bare-metal stents 2002 ALLHAT 2007 CRT 2009 LVAD 2009 Genomewide association in early- MI 2009 gene sequencing for responsiveness to cardiovascular drugs Year Nabel E and Braunwald G N Engl J Med 2012;366:54

9 Age-Standardized Death Rates by Sex and Cause of Death in the United States, % per year 2.5% per year Source: Ma J, Ward EM, Siegel RL, Jemal A. Temporal trends in mortality in the United States, JAMA. 2015;314(16):1731

10 Projected Mortality Trends NCD, Cardiovascular & Communicable Diseases

11 Global distribution of the physician workforce (per 10,000 population), Source: World Health Statistics , World Health Organization, 2010.

12 Prevalence of Daily Tobacco Smoking in Males Age Standardized Adjusted

13 Tobacco and the Global NCD Epidemic Tobacco use kills 15,000 people a day around the world and second hand smoke exposure kills another 1, % of tobacco deaths occur in developing and middle-income countries, where tobacco use continues to rise. Source: NCD Alliance (2011) The FCTC and evidence-based tool to reduce the burden of disease

14 Ranking of 10 Selected Risk Factors of Cause of Death

15 Global Advocacy United Nations Summit on Non-Communicable Diseases First ever UN High Level Meeting on NCDs, September 2011 Second UN Summit on Health after AIDS summit in 2001 CV disease Voice: ACC,AHA,WHF Political declaration to establish targets for NCDs

16 Political Declaration Outcome of Summit: Political Declaration that detailed the global strategy for combatting NCDs Called on the WHO to establish global targets for combatting NCDs during 2012

17 World Health Assembly 2012 Approved Goal: 25% reduction in premature NCD mortality by 2025

18 September, 2012

19 WHO Meeting Geneva 2013

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21 Simultaneously In JACC, Circulation, EHJ and Global Heart Sept 22, 2014

22 2030 Agenda By 2030, reduce by 1/3 premature mortality from NCDs through prevention and treatment Achieve Universal health Coverage September 2015

23 Can 25x25 be Achieved? Impact of Reduction of 6 Risk Factors on Mortality from NCDs Kontis V et al Lancet 384: 427, 2014

24 Impact of Reduction of 6 Risk Factors on Mortality from NCDs Kontis V et al Lancet 384: 427, 2014

25 Circulation & Global Heart, May 2016

26 Global Probability of Premature CV Death Effect of Risk factors Modification Men Women Circulation & Global Heart, May 2016

27 Regional Probability of Premature CV Death Effect of Risk factors Modification High Income Countries Eastern Europe/Central Asia Middle East/North Africa Circulation & Global Heart, May 2016

28 Probability of 30% reduction in tobacco use by 2025 Source: Bilano V, Gilmour S, Moffiet T, et al. Global trends and projections for tobacco use, : an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control. The Lancet.385(9972):

29 Average Physical Activity (MET-hours/week) United States India Gaziano TA. Boston, MA Adapted from: Murray CJL, Lopez Brazil AD, eds. The global burden of disease. Cambridge, MA: Harvard School of Public China Health; Source: Ng et al Obesity Reviews 2013; 13

30 Mean age-standardized sodium intakes (g/day) in 1990 and 2010 Powles J, BMJ Open. 2013;3(12).

31 Use of Secondary Meds by Country income (%) Source: Yusuf, S., Islam, S., Chow, C. K., Rangarajan, S., Dagenais, G., Diaz, R., Teo, K. K. (2011). Lancet 378(9798),

32 NCD Agenda Is Core To Sustainable Development Source: NCD Alliance

33 How Can Health Care Professionals & CV Societies Contribute?

34 ACC International Presence & Activities

35 ACC s 38 International Chapters African Consortium Argentina Australia Bangladesh Brazil Canada Caribbean Central American Consortium Chile China Colombia Dominican Republic Egypt Germany Great Britain and Ireland Greece and Cyprus Hong Kong Indonesia Israel Istanbul Consortium Italy Japan Jordan Korea Lebanon Malaysia Mexico Pakistan Peru Philippines Saudi Arabia Serbia & Republic of Srpska Singapore Spain Taiwan Thailand United Arab Emirates Venezuela

36 International Membership Growth

37 Educational Programs 31 Programs Around the World reaching >30,000 cardiologists annually Bangladesh Brazil Chile China India Japan Mexico Nepal Oman Saudi Arabia UAE

38 Train the Trainer A top down teaching program with far reach and exponential growth ACC will train 50 KOLs who will then deliver content to 3,500 physicians around the China Train the Trainer in China

39 Fellows in Training (FIT) Programs Mexico February 2015 India October 2015

40 ACC Global Program on CVD Prevention An international comprehensive cardiovascular disease prevention curriculum that provides education and awareness to physicians/health care professionals throughout each participating country by: Partnering with ACC s local chapter to implement a three-part webinar series per year on cardiovascular disease prevention strategies and tools from prominent hospitals to a network of hundreds of health care institutions throughout the country Topic-based, interactive online education for cardiologists and cardiac care team members delivered through popular social media platforms

41 Global Program on CVD Prevention A Quick Snapshot of the China program 83% of participants satisfied or very satisfied with webinar education 3,378 physicians reached Broadcast to 342 hospitals 85% attended online, 15% in the live audience

42 Global Program on CVD Prevention Expanding in 2017 to the following countries: Russia UAE Saudi Arabia Egypt Mexico Argentina Vietnam Indonesia Malaysia

43 NCDR: A Global Initiative Assessing Quality

44 NCDR Global Footprint AUSTRALIA Queensland Paediatric Cardiac Service BAHRAIN Mohammed Bin Khalifa Cardiac Centre BRAZIL Complexo Hospitalar De Niteroi HCOR - Hospital Do Coracao Hospital Israelita Albert Einstein Hospital totalcor CANADA St. Paul's Hospital The Hospital For Sick Children PAKISTAN Tabba Heart Institute SAUDI ARABIA King Abdulaziz Medical City THAILAND Bangkok Heart Hospital UAE Dubai Health Authority

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46 2016

47 It is Essential to Engage with the Community & Promote CV Health Learn When To Listen To Your Heart: Signs, Symptoms and Risk Factors of Heart Disease

48 International Leadership Academy at ACC Growing Emerging Leaders

49 The Road Towards Achieving 25 x 25 Significant reduction in CV Risk factors, morbidity and mortality is achievable; It is regional, local, and difficult. It is multifactorial: aim at risk factor modification and availability of both treatments and policies to reduce CVD mortality Policy interventions will likely include a focus on tobacco and salt reduction Needs resources! Countries will need to improve access to medications and develop health systems that are capable of managing acute and chronic conditions Need champions and emerging leaders of health in government, community, and in the CV profession Professional societies can help partner for health (community, government, industry), educate health professionals and groom emerging leaders