By the middle of the next century, cardiovascular disease will be the #1 killer worldwide, which makes it imperative that the prevention of heart disease become a priority in the developing and the industrialized world, according to experts meeting at the XXIst Congress of the European Society of Cardiology in Barcelona, Spain. Cardiovascular disease already represents 30% of all mortality worldwide, said Arun Chockalingam, MS, PhD, coauthor of the World Heart Federation’s white book on the Impending Global Pandemic of Cardiovascular Diseases, Challenges and Opportunities for the Prevention and Control of Cardiovascular Diseases in Developing Countries and Economies in Transition. “Approximately 50 million people die from cardiovascular disease in the world each year,” he said. “Nine million of those are in the developing countries. In the future, this will become even more of a worldwide problem.”
The stark disparity between health expenditures in various countries demonstrates, in part, the kind of major problem this represents, said Dr Chockalingam. If just 5% of the gross national product were spent on health care, it would mean that approximately $5 would be spent in Ethiopia and $429 in Slovenia. Yet, most developing countries spend less than this on their health budgets, which contrasts starkly with industrialized nations. For example, the United States spends >$4000 per person per year on health care.
Even determining the extent of the problem in developing countries is difficult because of a lack of data about the status of health there. Most data that are currently available come from Eastern European nations. However, according to Tak-Fu Tse, FRCP, FHKCP, president of the Geneva-based World Heart Federation, one thing is clear: prevention will the key to solving the epidemic. “Even the developed countries are finding it difficult to provide clinical care,” he said. “We are going to prevention as much as possible.”
There is a need for primary prevention and clinical programs and a high degree of partnership between the developing and developed world. The Twin Centres program, already underway, pairs a developing country with one in the industrialized world. Already, Spain has been paired with Lebanon, Portugal with Mozambique, and the United States of America with India.
Dr Tse said that countries in the developing world need advice on nutrition, smoking, trends in urbanization, and exercise. They also need help with the pricing of drugs used to treat cardiovascular disease and help with providing accessible health care.
To bring more attention to the issue of cardiovascular disease, the World Heart Federation also plans to pair with United Nations Educational, Scientitic, and Cultural Organization (UNESCO) to sponsor the first World Heart Day on September 24, 2000.
“Tobacco control is the first thing we have to work on,” said Dr Tse. “We hope to influence governments to have the political will to ban or reduce tobacco use.” He hoes that worldwide organizations, such as UNESCO, the World Health Organization, and the World Bank will also bring their influence to bear on the problem. In addition, the project will not be successful without the help of doctors themselves. Prevention will be key in the next millennium for the industrialized and the developing world, because it is getting to the point where even the developed nations are finding it nearly impossible to afford the costs of curative care.
Optimizing the use of such treatments would help reduce costs, said M.L. Simoons, MD, president-elect of the European Society of Cardiology and past president of the World Heart Federation. In a survey, he and his colleagues found unexplained differences in the ways intervention is used throughout Europe, in much the same way that variations in treatment patterns have been identified in the United States.
According to Dr Simoons, however, major differences exist in the rate of disease throughout Europe. Eastern countries have the highest rates of cardiovascular disease, and Mediterranean nations have the lowest, for reasons that have yet to be clearly defined. Dramatic differences also exist in the rates of hospitalization, but there is no clear relationship between the prevalence of disease and the rate of hospitalization.
For example, pacemakers are used in the Czech republic at rates that far outstrip those of all surrounding nations, including Germany. Yet Germans are more likely to use percutaneous transluminal angioplasty than their neighbors, and coronary artery bypass grafting is used most frequently in the Scandinavian countries and Ireland. Dr Simoons said that the role of the European Society of Cardiology is to attempt to bring some logic to the use of such procedures to ensure that health resources are being used wisely. A similar effort is underway in the United States under the direction of the American Heart Association and the American College of Cardiology.
According to Dr Simoons, without such efforts, the costs of treating cardiovascular diseases worldwide will skyrocket, and almost any nation “will go broke” in trying to keep up with the demand.
- Copyright © 1999 by American Heart Association