Control of Cardiovascular Diseases in Developing Countries Research, Development, and Institutional Strengthening (1998) / Chapter Skim
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1 The Current Burden of Cardiovascular Diseases in Developing Countries
1 The Current Burden of Cardiovascular Diseases in Developing Countries
Pages 11-23
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From page 11... ...
Developing countries begin with a disease burden dominated by nutritional, perinatal, and infectious diseases and, in the process of development, make the transition to one dominated by noncommunicable diseases, particularly CVD (Olshansky and Ault, 1986; Omram, 19711. The four stages of that transition are shown in Table 1-1.
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From page 13... ...
The pattern of disease continues to be in transition for all but the most developed countries.
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From page 14... ...
They are clinically silent until the fourth decade of life, when they undergo fissuring, ulceration, and thrombosis, leading to the clinical syndromes of ischemic heart disease, stroke, and peripheral vascular disease. Although the manifestation differs with the artery involved, the clinical syndromes are all related to the same systemic disease process, atherosclerosis (Ross, 1993)
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From page 15... ...
(Figure 1-21. Nonmodifiable risk factors include age, male gender, and a positive family history of CVD with onset at an early age.
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From page 16... ...
rank first in most developing countries, in developed countries, and worldwide Moreover, CVD usually accounts for about half of all NCD deaths. The 10 major causes of death in developed and developing countries are listed in Table 1-2.
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From page 17... ...
Although CVD mortality is well known to be high for men and for older age groups, it is also the major cause of mortality in the economically productive age group of 30-69 years and in women (Table 1-3~. Not surprisingly, in 1990 CVD caused three times as many deaths in 30- to 69-year-old men and women as did infectious and parasitic diseases worldwide.
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From page 18... ...
Projections for the year 2020 place ischemic heart disease third and cerebrovascular disease fifth among the leading causes of disease burden measured in DALYs for developing countries (Murray and Lopez, 1996~. The broader category of CVD would rank even higher than these two subcategories in the global burden of disease and injury.
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From page 19... ...
i ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ i ~ i: ~ :~-~:~;~o~r~:~hype~rtO~n~s~ive~h~eart~diseass~.~Devel~opin~g~co~untri~es~coUld:::avoid:the:~es:c:a-: :::::~: ~:~-~ ~ I~;na~health~cam~osts~cu~rTre~ntl:v~ ~exos~rien~ced:: b:v~::~:develo:ned~: Countries:: it: i:: :1 TABLE 1-3 Deaths (thousands) Due to Cardiovascular Disease and to Infectious and Parasitic Diseases (IPDs)
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From page 20... ...
China and India have considerable mortality from rheumatic and inflammatory heart diseases. Sub-Saharan Africa continues to have more mortality from cerebrovascular disease than from ischemic heart disease.
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From page 21... ...
Region Rheumatic Inflammatory Cerebrovascular Other . Established market economies 20 65 788 633 Formerly socialist economies 25 39 639 341 India 70 83 448 490 China 163 66 1,272 305 Other Asian and Pacific Island 10 82 390 406 countries Sub-Saharan Africa 20 63 383 140 Latin America and Caribbean coun- 8 25 249 160 tries Middle Eastern Crescent 24 72 212 377 SOURCE: Murray and Lopez, 1997c.
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From page 22... ...
This is a function of the prevalence of a risk factor and of its relative contribution to CVD. A single risk factor can explain a large proportion of the disease, as in the case of African-American women for whom more than 50 percent of total mortality is attributable to hypertension, which is highly prevalent and contributes a large part of the risk for CVD (Deubner et al., 1975~.
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From page 23... ...
Control of CVD requires an understanding of the changing pattern of disease as a region develops and a focus on the risk factors that have so dramatically influenced CVD in the developed world. Where limited data are available in developing countries, as for atherosclerotic disease, the rich databases of developed countries can provide a strong starting point for addressing important risk factors.
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