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Poor diet is top contributor to heart disease deaths globally

Nutrition, Malnutrition and Heart Disease
Risk Factors and Prevention

Sophia Antipolis, 16 Oct 2020:  More than two-thirds of deaths from heart disease worldwide could be prevented with healthier diets. That’s the finding of a study published today in European Heart Journal – Quality of Care and Clinical Outcomes, a journal of the European Society of Cardiology (ESC).1

The findings come on World Food Day, which highlights the importance of affordable and sustainable healthy diets for all.

“Our analysis shows that unhealthy diets, high blood pressure, and high serum cholesterol are the top three contributors to deaths from heart attacks and angina – collectively called ischaemic heart disease,” said study author Dr. Xinyao Liu of Central South University, Changsha, China. “This was consistent in both developed and developing countries.”

“More than six million deaths could be avoided by reducing intake of processed foods, sugary beverages, trans and saturated fats, and added salt and sugar, while increasing intake of fish, fruits, vegetables, nuts and whole grains. Ideally, we should eat 200 to 300 mg of omega 3 fatty acids from seafood each day. On top of that, every day we should aim for 200 to 300 grams of fruit, 290 to 430 grams of vegetables, 16 to 25 grams of nuts, and 100 to 150 grams of whole grains,” she added.

The study analysed data provided by the Global Burden of Disease Study 2017, which was conducted in 195 countries between 1990 and 2017.2 In 2017, there were 126.5 million individuals living with ischaemic heart disease, and 10.6 million new diagnoses of the condition. Ischaemic heart disease caused 8.9 million deaths in 2017, which equates to 16% of all deaths, compared with 12.6% of all deaths in 1990.

Between 1990 and 2017, age-standardised prevalence, incidence, and death rates per 100,000 people decreased by 11.8%, 27.4%, and 30%, respectively. But absolute numbers almost doubled. Dr. Liu said: “While progress has been made in preventing heart disease and improving survival, particularly in developed countries, the numbers of people affected continues to rise because of population growth and ageing.”

The investigators calculated the impact of 11 risk factors on death from ischaemic heart disease. These were diet, high blood pressure, high serum low-density lipoprotein (LDL) cholesterol, high plasma glucose, tobacco use, high body mass index (BMI), air pollution, low physical activity, impaired kidney function, lead exposure, and alcohol use. Specifically, they estimated the proportion of deaths that could be stopped by eliminating that risk factor.

Assuming all other risk factors remained unchanged, 69.2% of ischaemic heart disease deaths worldwide could be prevented if healthier diets were adopted. Meanwhile, 54.4% of these deaths could be avoided if systolic blood pressure was kept at 110–115 mmHg, while 41.9% of deaths could be stopped if serum LDL was kept at 0.7–1.3 mmol/L. About a quarter of deaths (25.5%) could be prevented if serum fasting plasma glucose was kept at 4.8–5.4 mmol/L, while eradicating smoking and second-hand smoke could stop one-fifth (20.6%) of deaths from ischaemic heart disease.

Notably, tobacco use ranked as fourth highest contributor to ischaemic heart disease deaths in men but only seventh in women. Between 1990 and 2017, the global prevalence of smoking decreased by 28.4% in men and 34.4% in women. High BMI was the fifth highest contributor to ischaemic heart disease deaths in women and sixth in men. For women, 18.3% of deaths from ischaemic heart disease could be prevented if BMI was kept at 20–25 kg/m2. In both sexes, the percentage contributions of air pollution and lead exposure to age-standardised ischaemic heart disease deaths increased as the country of residence became less developed.

Dr. Liu said: “Ischaemic heart disease is largely preventable with healthy behaviours and individuals should take the initiative to improve their habits. In addition, geographically tailored strategies are needed – for example, programmes to reduce salt intake may have the greatest benefit in regions where consumption is high (e.g. China or central Asia).”



Notes to editor

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Funding: This study was supported by the National Natural Science Foundation of China (81800393), and Hospital Pharmacy Research Fund of Guangdong (2019YX18). The funders of this research had no role in the design of the GBD estimation process, collection or analysis of data, interpretation of results, or in the writing of this manuscript.


Disclosures: None declared.



1Dai H, Much AA, Maor E, et al. Global, regional, and national burden of ischaemic heart disease and its attributable risk factors, 1990–2017: results from the Global Burden of Disease Study 2017. Eur Heart J Qual Care Clin Outcomes. 2020. doi:10.1093/ehjqcco/qcaa076.

2GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393:1958–1972.


About the European Society of Cardiology

The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.


European Heart Journal – Quality of Care and Clinical Outcomes

European Heart Journal – Quality of Care and Clinical Outcomes publishes original research and topical reviews from health scientists around the world, focusing on quality of care as it affects cardiovascular outcomes in hospitals, as well as at national international levels.