In Reply Dr Cooper and colleagues suggest that coronary heart disease remains infrequent to rare in sub-Saharan Africa and Asia. We disagree. The empirical evidence behind their claim is unclear as they only cite a few older studies.
In contrast, the GBD study relied on a larger and more recent set of primary sources regarding mortality due to ischemic heart disease (IHD) in these regions.1 For sub-Saharan Africa, we used vital registration and verbal autopsy data from 11 countries, which showed the fraction of deaths due to IHD in sub-Saharan Africa was between 2% and 10% of deaths, among the lowest in the world but hardly rare. For Asia, the GBD study added 5 million deaths reported annually through the China Center for Disease Control Cause of Death reporting system from 2004 through 2014, helping to show that the fraction of deaths due to IHD varied widely in Asia based on location, ranging from 5% to 47%.
Roth GA, Murray CJL. Global Burden of Disease Attributable to Hypertension—Reply. JAMA. 2017;317(19):2018–2019. doi:10.1001/jama.2017.4216
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