Cardiovascular disease in the developing world and its cost-effective management

TA Gaziano - Circulation, 2005 - Am Heart Assoc
TA Gaziano
Circulation, 2005Am Heart Assoc
regions are East Asia and the Pacific, Europe and Central Asia, Latin America and the
Caribbean, Middle East and North Africa, South Asia, and sub-Saharan Africa. The stage of
the transition that each region finds itself in varies widely (Table 1). As a result of the
epidemiological transition outlined above, CVD is the leading cause of death in all World
Bank developing regions (Figure 2) with the exception of sub-Saharan Africa. 1 Despite
large regional variations, sub-Saharan Africa remains largely in the first phase of the …
regions are East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, Middle East and North Africa, South Asia, and sub-Saharan Africa. The stage of the transition that each region finds itself in varies widely (Table 1). As a result of the epidemiological transition outlined above, CVD is the leading cause of death in all World Bank developing regions (Figure 2) with the exception of sub-Saharan Africa. 1 Despite large regional variations, sub-Saharan Africa remains largely in the first phase of the epidemiological transition. Although human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is the leading overall cause of death in this region, CVD is the second-leading killer and is the first among those over the age of 30 years. Hypertension has emerged as a major public health concern and has resulted in stroke being the dominant form of CVD. 9 Rheumatic heart disease and cardiomyopathies are also important causes of CVD mortality and morbidity. Most other developing regions appear to be following a similar pattern as the developed countries, with an initial rise in stroke and then a predominance of CHD, but the transition has occurred at a more compressed rate than in the highincome countries. Between 1990 and 2020, CHD alone is anticipated to increase by 120% for women and 137% for men in developing countries, compared with age-related increases of between 30% and 60% in developed countries. 10 East Asia and the Pacific region appear to be straddling the second and third phases. A geographic gradient has emerged, with higher CVD rates in northern China than in southern China. The Europe and Central Asia region is firmly in the peak of the third phase of the transition, with CVD representing 60% of all deaths. Croatia, Belarus, and the Ukraine saw an increase of 40% to 60% in CHD death rates between 1988 and 1998 (Figure 3). The Europe and Central Asia region has a rate of 690 CVD deaths per 100 000, more than double that of the high-income countries. Within the Middle East and North Africa region, the majority of the Middle Eastern Crescent appears to be entering the third phase of the epidemiological transition; increasing economic wealth has been accompanied by a rapid increase in CVD. As a whole, the Latin America and the Caribbean region appears to be in the third phase also, but this region, as defined by the World Bank, includes all of South America, where residents of some countries are still at risk of contracting malaria and dengue fever, and those portions are still in the first transitional phase. Heterogeneity is also apparent throughout the rest of
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