The Epidemic of Cardiovascular Disease in the Developing World: Global Implications

Abstract

Recent data highlight that cardiovascular disease accounts for approximately 16.7 million of total global deaths of 57 million. 87% of worldwide cardiovascular deaths occur in the developing countries and at a younger age than the developed world. In contrast, total deaths due to HIV, tuberculosis, and malaria were approximately 5 million. Future projections are a concern in that it is estimated that death rates from stroke and coronary heart disease in the developing countries would be two to threefold greater than in the developed world. The cost of countries dealing with the dual burdens of communicable and degenerative diseases in terms of loss of productivity and the impact upon the public and private sector is enormous and could be catastrophic. It is likely that the pace of the “epidemiologic transition” underlying at the epidemic will vary according to the rapidity of economic development or the lack thereof and the role of genetic vulnerability needs to be determined.

Nonetheless, the combination of a hostile cardiovascular environment as defined by changing diet, tobacco, lack of exercise, an aging society, air pollution, and the psychosocial and economic stresses in the developing worlds in conjunction with limited national resources and possible genetic vulnerability (the thrifty gene) is likely to lead to an explosion of the epidemic in the next 20 years.

The key question is whether population-based strategies based upon community public health programs and high risk clinic-based strategies can stem the tide or even halt the epidemic. It is likely that the epidemic will involve all developing countries in the future, but the time course is unpredictable, and there is a dire need for prospective data since the implications for resource allocation are profound. Not all developing nations are at the same stage of the “epidemiologic transition“ and the shifting of resources from dealing with communicable diseases to cardiovascular disease needs to be based upon actual as opposed to perceived needs.

The low priority of cardiovascular and chronic diseases on the global health agenda is a cause for concern and integrating the treatment and prevention of chronic diseases into health systems dealing with communicable diseases will contribute to the strengthening of weak health systems and overall community health.