Editorials
Years of Life Lost Analysis May Promote Governmental Policy to Prevent Atherosclerotic Cardiovascular Disease
2019 Volume 83 Issue 5 Pages 965-966
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2019 Volume 83 Issue 5 Pages 965-966
Atherothrombosis is the leading cause of death in the world. Each year, 17.7 million people die from cardiovascular diseases (CVD), which was estimated to be 31% of all deaths worldwide in 2015, including ischemia-reperfusion (I/R), heart failure, hypertension, atherosclerosis, and pulmonary artery hypertension.1 In Japan, cases of atherosclerotic cardiovascular disease (ASCVD) are recently increasing because of aging of society and diffusion of the Western diet; CVD is now the second highest cause of death.2 Among the elderly population over 75 years of age, deaths from cerebral apoplexy and circulatory disease exceed those from cancer. It is noteworthy that a recent investigation has revealed that the years of life lost (YLL) because of ASCVD were comparable to those for cancer.3
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YLL is a key element in measuring disease burden (Figure). Components of YLL estimation include disease prevalence, disease mortality by age or age group, and general population mortality by age or age group. YLL is calculated as a total for all people with the disease. In this issue of the Journal, Arai et al3 seek to understand the burden of ASCVD, myocardial infarction (MI), and stroke via estimations of YLL at the overall disease level, and the average person YLL (PYLL). PYLL was calculated as the burden per person with the disease. PYLL and YLL were also estimated for cancer. The authors calculated YLL by use of variable inputs such as disease prevalence, disease-related mortality by age and general population mortality by age and sex, through searching public databases of disease surveillance. Disease-specific prevalence and mortality were taken from the Institute for Hearth Metrics and Evaluation Global Disease Burden study, and background mortality data were from Japanese life tables published by the Ministry of Heath, Labour and Welfare.2
Years of life lost (YLL): a key element in measuring disease burden.
With an estimated ASCVD population of 8,128,004 in Japan, total YLL for ASCVD was estimated to be 2,703,711 in 2017. Using the Japan life tables as a reference, PYLL was 10.85 for an individual with ASCVD. The total YLL because of MI in Japan was estimated to be 1,785,800 in 2017, and the patient-level burden was 11.99 PYLL. For stroke, the total YLL in 2017 was estimated to be 907,443, and a patient with stroke was expected to lose an average of 9.39 years of life. For comparative purposes, the authors also estimated the PYLL and YLL for the overall cancer population in Japan from 2017 to 2021. Although the total YLL was greater than that for ASCVD because of the higher prevalence of cancer, the average PYLL for a patient with cancer (14.88) was comparable to that for the cardiovascular conditions studied.
Atherosclerosis has long been considered in relation to circulatory diseases such as coronary artery disease (CAD), cerebrovascular disease (CVD) or peripheral artery disease (PAD), together with the organ derangements caused by them. However, a recent study showed that atherosclerosis could progress to affecting the blood vessels in the entire body, and the concept of polyvascular disease has been introduced.4 According to the Reduction of Atherothrombosis for Continued Health Registry (REACH Registry), PAD occurs as a complication in 10.6% of CAD cases and vice versa in 51.6% of PAD cases: polyvascular disease, which is atherothrombosis in multiple vascular beds, is the primary factor in ischemic events in the later stage.5,6 These background factors suggest the seriousness of YLL in CAD cases represented by arteriosclerosis. To reduce the YLL of arteriosclerotic disease patients and improve their prognosis, management of arteriosclerosis in the entire body as polyvascular disease is crucial without question; in short, the vital key is how to prevent ASCVD.
As society ages in Japan, we are facing recently emerging issues: estrangement in life expectancies in average life and healthy life, and an increase in medical expenses for the aging population. Because cerebral apoplexy and circulatory diseases are currently one-quarter of the primary causes of long-term care requirement and comprise 20% of the total medical expenses, establishing control measures for cerebral apoplexy and cardiac disease requires immediate action. Therefore, the Japanese Circulation Society has been working with other academic societies in full cooperation and support to enact the “Basic Act on Cerebral Apoplexy, Cardiac Disease, and Other Circulatory Diseases Measures for the Extension of Healthy Life Expectancy” (hereinafter referred to as the Basic Act on Cerebral Apoplexy and Circulatory Diseases Measures) as soon as possible. The goal of this particular Act enacted in December 2018 is not only to prolong the average life expectancy but also to extend healthy life expectancy as well improving patients’ quality of life. It would undoubtedly lead to reducing the total medical cost burden, in addition to improving the health of citizens against cerebral apoplexy and circulatory diseases. Our present research investigation report shows that the YLL in CVD cases is more severe than for other diseases with poor prognosis, which should be significant supporting evidence to strongly drive the endeavor forward.
