The global burden of disease attributable to tobacco smoking including second-hand smoke has changed little, with decreases in high-income regions offset by increases in regions such as south east Asia and, to a lesser extent, east and south Asia. The burden attributable to alcohol use has increased substantially in eastern Europe since 1990, mainly because of a rise in the effects of heavy drinking on cardiovascular diseases.181 The high burden in eastern Europe was also identified in the 2000 comparative risk assessment but the data for patterns of alcohol consumption and their effects were weaker, whereas now they are supported by more surveys and epidemiological studies.182 High blood pressure, high body-mass index, and high fasting plasma glucose are leading risk factors for disease worldwide, with blood pressure having large effects on population health in all regions, including low-income regions in sub-Saharan Africa and south Asia. This finding is consistent with previous comparative risk assessment analyses. The disease burden in south Asia and sub-Saharan Africa, caused by increased blood pressure,70 has increased its absolute and relative importance in risk factor rankings.
