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(Circulation. 2009;119:1850-1852.)
© 2009 American Heart Association, Inc.

Editorial

Is the Horse Already Out of the Barn in Rural India?

Thomas A. Gaziano, MD, MSc

From Harvard Medical School, Cardiovascular Medicine, Brigham & Women’s Hospital, Boston, Mass.

Correspondence to Thomas A. Gaziano, MD, MSc, Assistant Professor, Harvard Medical School, Cardiovascular Medicine, Brigham & Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail tgaziano@partners.org

Key Words: Editorials • coronary disease • epidemiology • myocardial infarction • prevention • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The 20th century saw unparalleled¹ increases in life expectancy and a major shift in the causes of illness and death throughout the world. A century ago, cardiovascular disease (CVD) accounted for fewer than 10% of all deaths; today, it accounts for approximately 30% worldwide.^2,3 The increase in CVD, through a proliferation of risk factors that are heavily influenced by lifestyle choices, is the new challenge for many developing countries.

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At the end of the last century, investigators projected the future epidemic of CVD in developing countries.^1,4 Many of the projections were for regions determined by economic and geographic factors according to World Health Organization (WHO)¹ and World Bank⁵ definitions; however, these regions are supranational and thus beyond the scope of the units of government in which decision making to combat the CVD burden occurs, either at the national or state/provincial level. A country or provincial level of information is required for planning. Both health ministers who are in the process of developing systems of primary care for chronic diseases and the financial and commercial leaders who are trying to understand the size of future labor forces or government programs (such as social security later in life) are in need of better sources of data.

Furthermore, what few estimates we have of the CVD burden in developing countries are based on urban centers, where the highest concentrations of providers and healthcare facilities are found.^6,7 Much less is known about rural areas of developing countries, where up to 70% . . . [Full Text of this Article]