Heart Disease a Global Health Threat

　　Mike Mitka

　　Billions of individuals are experiencing longer and healthier lives because of advances in medical technology and improving economic conditions in developing nations—but the cloud in this silver lining is that heart disease is on the rise.

　　In a report released on April 26, researchers call cardiovascular disease an urgent threat to global health and predict that by 2020, it will become the leading cause of death and disability worldwide. The report, A Race Against Time: The Challenge of Cardiovascular Disease in Developing Economies (http://www.earthinstitute.columbia.edu/news/2004/images/raceagainsttime_FINAL_0410404.pdf), was sponsored by the Australian Health Policy Institute at the University of Sydney, Columbia University in New York City, and the World Health Organization (WHO).

　　A 20-year window is now open to take action to curb heart disease in developing nations, the report's authors argue. This opportunity exists because developing countries with emerging robust economies generally have younger populations that have yet to experience actual heart disease—although risk factors are mounting. These conclusions were reached by studying heart disease patterns in Brazil, China, India, Russia, and South Africa and using statistics from Portugal and the United States as baselines representing developed countries.
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　　The report is complemented by a special communication (see p 2616) from the WHO about the global burden of chronic disease that calls for a greater emphasis on treating chronic illnesses, including cardiovascular disease (JAMA. 2004;291:2616-2622).

　　"INTOLERABLE BURDEN" LOOMING

　　However, if no action is taken in developing countries, aging populations that have adopted poor lifestyle choices seen in industrial nations, such as smoking, overeating, and less exercise, will face an "intolerable burden" of death, disability, and economic loss, the report said.

　　"During these 20 years . . . there will be a period when [cardiovascular disease] is causing its principal social problems among those of working age," the authors wrote.

　　Ischemic heart disease mortality in developing countries is projected to increase by 120% for women and 137% for men. But even a younger population is no protection against cardiovascular disease in developing countries. In a foreward to the report, Derek Yach, MBChB, MPH, representative of the director-general of the WHO, noted the proportion of cardiovascular death occurring during prime labor years in developing countries will exceed that of industrialized nations—and with higher mortality comes higher morbidity and lower productivity.
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　　Stephen Leeder, MB, PhD, coauthor of the report and a professor of public health at the University of Sydney in Australia, said that cardiovascular disease in developing nations should be fought with a three-pronged attack: reducing risk, through drug treatment for hypertension and dyslipidemia and smoking cessation programs; promoting healthy lifestyles through educational efforts; and encouraging the private sector to promote a healthier environment (such as more healthful food products and healthier workplaces). 

　　Cardiovascular disease mortality rates of working-age individuals in developing countries are often equal to or greater than rates seen in the same population in industrialized nations, where prevention efforts have reduced heart disease. In Russia, the exceptionally high heart disease mortality rates are related to such risk factors as alcohol intake and tobacco use.

　　ECONOMIC SELF-INTEREST来源：www.examda.com

　　Governments can use tools such as taxes to combat heart disease. For example, the Polish government cut subsidies for and imposed taxes on animal fats, raising their price. The action caused citizens to purchase more heart-healthy vegetable oils, and the change in food consumption habits lowered heart disease mortality in the 1990s.

　　Economic self-interest can also spur businesses to embrace cardiovascular health initiatives. For example, employers who provide smoke-free workplaces may lower sick-day costs.

　　"This is not to argue that individual choice is unimportant, but to recognize that the social, educational, and economic context in which individuals operate powerfully shapes the degree to which they can exercise healthy choices," Leeder said.