Premature Mortality from Cardiovascular Disease in the Americas – Will the Goal of a Decline of “25% by 2025” be Met?

<div><p>Background</p><p>Cardiovascular diseases (CVD) are the underlying cause 1.6 million deaths per year in the Americas, accounting for 30% of total mortality and 38% of by non-communicable deaths diseases (NCDs). A 25% reduction in premature mortality due four main NCDs was targeted by the 2011 High-level Meeting of the General Assembly on the Prevention and Control of NCDs. While overall CVD mortality fell in the Americas during the past decade, trends in premature CVD mortality during the same period have not been described, particularly in the countries of Latin America and the Caribbean.</p><p>Methods</p><p>This is a population-based trend-series study based on a total of 6,133,666 deaths to describe the trends and characteristics of premature mortality due to CVD and to estimates of the average annual percentage of change during the period 2000–2010 in the Americas.</p><p>Findings</p><p>Premature mortality due to CVD in the Americas fell by 21% in the period 2000–2010 with a -2.5% average annual rate of change in the last 5 year—a statistically significant reduction of mortality—. Mortality from ischemic diseases, declined by 25% - 24% among men and 26% among women. Cerebrovascular diseases declined by 27% -26% among men and 28% among women. Guyana, Trinidad and Tobago, the Dominican Republic, Bahamas, and Brazil had CVD premature mortality rates over 200 per 100,000 population, while the average for the Region was 132.7. US and Canada will meet the 25% reduction target before 2025. Mexico, Costa Rica, Venezuela, Dominican Republic, Panama, Guyana, and El Salvador did not significantly reduce premature mortality among men and Guyana, the Dominican Republic, and Panama did not achieve the required annual reduction in women.</p><p>Conclusions</p><p>Trends in premature mortality due to CVD observed in last decade in the Americas would indicate that if these trends continue, the Region as a whole and a majority of its countries will be able to reach the goal of a 25% relative reduction in premature mortality even before 2025.</p></div

Adjusted Odds Ratios (aORs) comparing albuminuria among consumers of 2+ vs. 0–1 sugary soft drinks per day, stratified by body mass index (BMI) category.

<p>Trend line shows a quadratic model fit to the aORs; vertical lines represent 95% Confidence Intervals. The aORs are adjusted for age, race, ethnicity, and poverty status, but not BMI. BMI is used only as a stratification variable. Figure excludes subjects with BMI<17.5 kg/m² (n = 61).</p

Proportion consuming 2+ sugary sodas (cells) by quartile of energy intake (rows) and body mass index (BMI) category (columns).

<p>Note: “Column differences” χ² p-value assess whether sugary soda consumption differs by level of caloric consumption within each BMI category. “Row differences” χ² p-value assess whether sugary soda consumption differs by BMI category within each level of energy intake.</p

Prevalence of albuminuria among NHANES 1999–2004 non-diabetics age 20 and over, unadjusted and adjusted for age, according to sugary soft drink consumption.

<p>Prevalence of albuminuria among NHANES 1999–2004 non-diabetics age 20 and over, unadjusted and adjusted for age, according to sugary soft drink consumption.</p

Distribution of attributes, National Health and Nutrition Examination Survey 1999–2004, overall and by albuminuria status.

<p>P values use t-test for differences in means, and Wald chi-square test for proportions.</p>*<p>Note that values in the table are weighted to take into account the complex survey design; however, the counts of number of subjects with (n = 1326) and without albuminuria (n = 8032) are not weighted for the survey design.</p>†<p>Triglyceride levels available only for the subset (n = 4457) with fasting morning blood draw.</p

Unadjusted and adjusted Odds Ratios (OR) and 95% Confidence Intervals (95%CI) for albuminuria.

<p>Unadjusted and adjusted Odds Ratios (OR) and 95% Confidence Intervals (95%CI) for albuminuria.</p

Varying R² and P_SNP cutoffs for the ADRA1 Pathway.

<p>Varying R² and P_SNP cutoffs for the ADRA1 Pathway.</p

Adjusted Odds Ratios (aORs) comparing albuminuria among consumers of 2+ vs. 0–1 sugary soft drinks per day, according to interaction with body mass index (BMI).

<p>Adjusted for diet soda consumption, age, race, ethnicity, poverty status, BMI, and BMI-squared.</p

Pathway Association Results.

*<p>p-value is significant after correction for multiple testing.</p>†<p>ADRA1, -receptors is the same pathway as ADRA1, with the ADRA1 receptor genes removed from the model.</p><p>Adjustment was made for sex, age, age² and BMI for all models.</p

Descriptive characteristics of phenotypes among study participants.

<p>Values are expressed as mean±SD.</p