Cardiovascular Disease in the Developing World

Globally, cardiovascular disease is the number one cause of death, and in 2005 cardiovascular disease was responsible for approximately thirty percent of deaths worldwide. Cardiovascular disease is a broad term that encompasses such varied illnesses as coronary artery disease, peripheral arterial disease, cerebrovascular disease, rheumatic heart disease, congenital heart disease, and congestive heart failure.

Scope of the Problem

Cardiovascular disease rates are largely influenced by lifestyle patterns, and risk factors that have a proven link to the development of cardiovascular disease are hypertension, hyperlipidemia, tobacco use, hyperglycemia, and overweight and obesity. Cardiovascular disease rates and risk factor prevalence are increasing in the developing world, leading to death and disability. Cardiovascular-related illness tends to occur in middle-aged people who are often the primary breadwinners for their families. As a result, families spiral into the cycle of poverty as they lose primary breadwinners to death and disability.

Approximately forty-three percent of all cardiovascular disease deaths are due to ischemic heart disease, while an estimated thirty-three percent of cardiovascular deaths are caused by cerebrovascular disease, and another twenty three percent of cardiovascular deaths are caused by hypertensive heart disease and related complications. Eighty percent of cardiovascular disease-related deaths occur in low and middle-income countries. This premature death and disability is having a catastrophic impact on developing nations--individuals, families, and societies suffer when primary breadwinners are stricken by cardiovascular illnesses. If current trends continue, by 2020, nineteen million people in the developing world will die from cardiovascular causes, as compared to nine million in 1990. And if unchecked, by 2020, forty percent of all deaths in the developing world will be due to cardiovascular disease.

Why are Rates of Cardiovascular Disease Increasing in the Developing World?

Social and economic changes have a profound effect on the development of cardiovascular disease due to lifestyle factors. In the developing world, an increase in westernized diets and physical inactivity in concert with a tendency towards increasing life expectancy have led to increased blood pressures, high blood sugars, and elevated lipid levels. And as globalization has led to expansion of the tobacco trade, there has been a notable increase in the prevalence of smoking. This increase in risk factor prevalence has in turn led to an increase in the prevalence of cardiovascular events. The trend towards high carbohydrate, high saturated fat, low nutrient diets, combined with physical inactivity have increased cardiovascular risk. High sodium intake is closely correlated with hypertension, another risk factor for cardiovascular disease. Risk factors brought on by a sedentary, unhealthy lifestyle choices cluster, leading to high rates of cardiovascular illness. Individuals in the developing world have the 'double whammy' of increased chronic disease prevalence combined with persistently high rates of infectious diseases, leading to exceedingly high overall morbidity and mortality.

What Can Be Done?

Individuals who have already experienced a cardiovascular event, such as a heart attack or stroke, have numerous interventions available to them, including aspirin use, blood pressure modification, statin medication for hyperlipidemia, and lifestyle modifications. In addition, there are a number of intensive techniques that are used in patients with cardiovascular disease, such as coronary stenting and coronary artery bypass grafting for ischemic disease, and thrombolytics for cerebrovascular disease. However, the most effective and cheapest way of dealing with cardiovascular illness is primary prevention through risk factor modification. Lifstyle changes that positively impact cardiovascular health include cessation of tobacco use, exercise of at least thirty minutes daily, and diet low in sodium, carbohydrates, total fats and more weighted towards unsaturated fats, fruits, vegetables, whole grains, and omega-3 fatty acids. While these interventions are proven ways to decrease cardiovascular risk, the most cost-effective method of cardiovascular disease prevention are population-wide initiatives instituting economic incentives and policies for decrease in risk factor prevalence. Population-wide initiatives decreasing consumption of saturated fats and sodium, targetting and penalizing tobacco use, and promoting physical activity have been shown to have far-reaching effects.

Until recently, cardiovascular disease has been largely absent from the international consciousness, overshadowed by public health concerns about HIV/AIDS and other infectious diseases. As recently as 2000, cardiovascular disease was conspicuously absent from the United Nation’s Millennium Development Goals. Although many incidents of chronic disease can be effectively and inexpensively prevented with basic interventions, public health strategies and evidence-based risk factor intervention programs are needed to ensure that these interventions reach the individuals most at risk. The World Health Organization has called for a global partnership of nationwide public health campaigns and high-risk intervention strategies. Organizations such as ProCor, Heartfile, and the International Cardiovascular Health Alliance (ICHA) are working in underresourced communities to establish and implement cardiovascular risk factor intervention programs at both local and global levels.

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References

1. Anderson GF, Chu E. Expanding priorities--confronting chronic disease in countries with low income. N Engl J Med. 2007 Jan 18;356(3):209-11.

2. Preventing chronic diseases: a vital investment — WHO global report. Geneva: World Health Organization, 2005.

3. Disease control priorities in developing countries. 2nd ed. Washington, DC: World Bank, 2006.

4. World Health Organization Global Strategy on Diet, Physical Activity and Health: http://www.who.int/dietphysicalactivity/publications/facts/cvd/en/.

External Links

• ProCor
• Heartfile