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Cardiovascular Disease in Developing Countries: Myths, Realities, and Opportunities

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Abstract

Summary. The burden of cardiovascular disease (CVD), especially ischemic heart disease and stroke, varies remarkably between regions of the world, with declining rates in Europe, North America, and Australia/New Zealand, burgeoning epidemics in the former socialist economies and India, and relatively lower impact in developing regions such as sub-Saharan Africa. The basis for a prediction of a global CVD epidemic lies in the “epidemiologic transition,” in which control of infectious, parasitic, and nutritional diseases allows most of the population to reach the ages in which CVD manifests itself. In fact, CVD is already the leading cause of death not only in developed countries but, as of the mid-1990s, in developing countries as well. A variety of myths have attempted to minimize the rationale for CVD control in developing countries. In reality, CVD affects men, not only the elderly, and the rich, but rather a broad spectrum of the population. Moreover, as a cause of disability it will be a world leader by 2020. Finally, there is evidence that the epidemic can be curtailed. Projections to the year 2020 predict an expansion of the CVD epidemic to the developing world, with CVD exceeding infectious and parasitic diseases in all regions except sub-Saharan Africa. These estimates, in fact, may be conservative, because several factors may allow multiplication of risk. In utero or early childhood deprivation, the use of disposable income for deleterious health behaviors (such as tobacco and a high fat/cholesterol diet), interactions between multiple coexisting risk factors, and the interaction between newly acquired health behaviors and genes may all inflate the risk to levels above those predicted. Efforts to control CVD should invest strategically in research to understand the prevalence of, and risks associated with, CVD risk factors, as well as in studies of new risk factors, measures to prevent or modify risk, and clinical trials to demonstrate the efficacy of these interventions. In lieu of this improved research base, a number of initiatives should go forward to prevent the dissemination of risk factors, to treat risk factors appropriately in high-risk subjects, and to develop case-management strategies shown to be both efficacious and cost effective. A global epidemic of CVD in developing countries may be inevitable unless there is a better understanding of its origins, a prediction of its magnitude, and the organization of preventive and case-management strategies early enough to control it.

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References

  1. Omram AR. The epidemiologic transition: A theory of the epidemiology of population change. Milbank Memorial Fund Q 1971;49:509–538.

    Google Scholar 

  2. Preston SH. Mortality Patterns in Human Populations, with Special Reference to Recorded Causes of Death. New York: Academic Press, 1976.

    Google Scholar 

  3. Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: The age of delayed degenerate diseases. Milbank Memorial Fund Q 1986;64:355–391.

    Google Scholar 

  4. Marmot M, Kogevinus M, Elston MA. Socioeconomic status and disease. In: Health Promotion Research: Towards a New Social Epidemiology. Copenhagen: WHO Regional Publications, European Series No. 37, 1991.

    Google Scholar 

  5. Bobadilla JL, Costello CA, Mitchell F (Eds). Premature Death in the Newly Independent States. Washington, DC: National Academy Press, 1997.

    Google Scholar 

  6. Notzon FC, Komarov YM, et al. Causes of declining life expectancy in Russia. JAMA 1998;279:793–800.

    Google Scholar 

  7. Reddy KS. Cardiovascular disease in India. World Health Stat Q. 1993:46:101–107.

    Google Scholar 

  8. Thom TJ. International mortality from heart disease: Rates and trends. Int J Epidemiol 1989;18:S20–S28.

    Google Scholar 

  9. Stone EJ, Pearson TA, et al. Community-based prevention trials: Challenges and directions for public health practice, policy, and research. Ann Epidemiol 1997; Suppl. 7:S113–S120.

    Google Scholar 

  10. Winkleby MA. Acclerating cardiovascular risk factor change in ethnic minority and low socioeconomic groups. Am Epidemiol 1997; Suppl. 7:S96–S103.

    Google Scholar 

  11. Dodu SRA. Emergence of cardiovascular diseases in developing countries. Cardiology 1988;75:56–64.

    Google Scholar 

  12. Pearson TA, Jamison DT, Trejo-Gutierrez J. Cardiovascular diseases. In: Jamison DT, Mosley WH, et al., eds. Disease Control Priorities in Developing Countries. New York: Oxford University Press, 1993.

    Google Scholar 

  13. Whelton PK, Brancati FC, Appel LJ, Klag MJ. The challenge of hypertension and atherosclerotic cardiovascular disease in economically developing countries. High Blood Pressure 1995;4:36–45.

    Google Scholar 

  14. Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation 1998;97:596–601.

    Google Scholar 

  15. Murray CJL, Lopez AD, eds. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Cambridge; MA: Harvard University Press, 1996.

    Google Scholar 

  16. World Health Organization. Health for All in the 21 st Century. Geneva: WHO, 1998.

    Google Scholar 

  17. Kaplan GA, Keil JE, Socioeconomic factors and cardiovascular disease: A review of the literature. Circulation 1993;88:1973–1998.

    Google Scholar 

  18. Rose G, Marmot MG. Social class and coronary heart disease. Br Heart J 1981;45:13–19.

    Google Scholar 

  19. Kunst AE, Groenhof F, Mackenback J, et al. Differences between occupational classes in cardiovascular disease mortality: A comparison of 11 European Countries. In: Report of the Conference in Socioeconomic Status and Cardiovascular Health and Disease. Bethesda, MD: National Heart, Lung, and Blood Institute, 1996, pp. 49–56.

    Google Scholar 

  20. Murray CJL, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997;349:1436–1442.

    Google Scholar 

  21. Higgins M, Thom T. Trends in CHD in the United States. Int J Epidemiol 1989;18:S58–S66.

    Google Scholar 

  22. Murray CJL, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997;349:1498–1504.

    Google Scholar 

  23. Barker DJP, Winter PD, Osmond C, et al. Weight in infancy and death from ischemic heart disease. In: Barker DJP, ed.: Fetal and Infant Origins of Adult Disease. London: British Medical Journal, 1992:141–149.

    Google Scholar 

  24. Barker DJP, Osmond C. Infant mortality, childhood nutrition, and ischemic heart disease in England and Wales. In: Barker DJP, ed: Fetal and Infant Origins of Adult Disease. London: British Medical Journal, 1992:23–27.

    Google Scholar 

  25. Mosley WH, Gray R. Childhood precursors of adult morbidity and mortality in developing countries: Implications for health programs. In: Gribble JN, Preston SH, eds. The Epidemiological Transition. Washington, DC: National Academy Press, 199fl:69–100.

  26. Peto R, Lopez AD, et al. Mortality from smoking in developed countries 1950–2000: Indirect estimates from National Vital Statistics. Oxford: Oxford University Press, 1994.

    Google Scholar 

  27. Peto R, Lopez AD, et al. Mortality from smoking worldwide. Br Med Bull 1996;52:12–25.

    Google Scholar 

  28. Popkin BM. The nutrition transition in low-income countries: An emerging crisis. Nutri Revi 1994;52:285–298.

    Google Scholar 

  29. Blackburn H. The concept of risk. In: Pearson TA, Criqui M, et al. eds. Primer in Preventive Cardiology. Dallas: American Heart Association, 1994:25–41.

    Google Scholar 

  30. Yuan J-M, Ross RK, et al. Morbidity and mortality in relation to cigarette smoking in Shanghai, China. JAMA 1996;275:1646–1650.

    Google Scholar 

  31. Neel JV. The thrifty gene. Am J Hum Genet 1962;14:353–362.

    Google Scholar 

  32. Zimmet PZ. Challenges in diabetes epidemiology—From West to the rest. Diabetes Care 1992;15:232–252.

    Google Scholar 

  33. McKeigue PM, Ferie JE, Pierpoint T, Marmont, MG. Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinism. Circulation 1993;87:152–161.

    Google Scholar 

  34. Enas EA, Garg A, et al. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J 1996;48:343–353.

    Google Scholar 

  35. Enas EA, Yusuf S, Mehta D. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol 1992;70:945–949.

    Google Scholar 

  36. Smith SC, Blair SN, Criqui MH, et al. Preventing heart attack and death in patients with coronary disease. Circulation 1995;92:2–4.

    Google Scholar 

  37. Fuster V, Pearson TA (Eds). 27th Bethesda Conference: Matching the intensity of risk factor management with the hazard for coronary disease events. J Am Coll Cordial 1996;27:957–1047.

    Google Scholar 

  38. Pearson TA, Smith SC, Jr., Poole-Wilson P. Cardiovascular specialty societies and the emerging global burden of cardiovascular disease. A call to action. Circulation 1998;97:602–604.

    Google Scholar 

  39. Muna WFT. Cardiovascular disorders in Africa. World Health Statist Qu 1993;46:125–133.

    Google Scholar 

Download references

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Pearson, T.A. Cardiovascular Disease in Developing Countries: Myths, Realities, and Opportunities. Cardiovasc Drugs Ther 13, 95–104 (1999). https://doi.org/10.1023/A:1007727924276

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