A wave of cardiovascular disease is poised to sweep through the developing world, and the best way for those countries to cope is not with high-tech medical gadgetry but with low-cost investments in education and prevention programs, says a University of Rochester expert at a meeting this week on preventive cardiology.
"These countries can either deal with the coming epidemic now, with prevention programs, or they can deal with it later, when people cry for bypass surgery and angioplasty," says Thomas Pearson, Albert D. Kaiser Professor and Chair of the Department of Community and Preventive Medicine.
Pearson is speaking in Montreal at the 4th International Conference on Preventive Cardiology, which is sponsored by several Canadian and U.S. organizations, including the American Heart Association's Council on Epidemiology and Prevention, which Pearson chairs.
Many physicians in the developing world look to the United States as a model for coping with cardiovascular disease, which includes heart disease, heart attacks, and strokes -- after all, coronary disease rates in the U.S. have been nearly halved since 1968, and the mortality from stroke has fallen even more. Too often, says Pearson, doctors are wowed by technology and fail to take advantage of much less expensive but more effective prevention programs that are just as much a part of treatment in America.
"While the U.S. does have procedures like bypass and angioplasty, we also put a huge emphasis on prevention. Low-cost methods like education have been widely implemented and have reduced the incidence of disease greatly. The U.S. model as perceived by many visiting doctors, with our coronary care units, catheterization labs, angioplasty suites, bypass surgeons, and implantable defibrillators, is not the best one for most of these countries."
In a recent paper in the journal Evidence-Based Cardiovascular Medicine, Pearson traces the development of cardiovascular disease in different parts of the world through four stages. Prosperity is usually the harbinger of the worst stage, the third, where the disease reaches epidemic proportions as cardiovascular disease causes up to two-thirds of deaths, often at a young age. In this stage food becomes more plentiful, often leading to high-fat diets; people have more disposable income, leading to the marketing of items like cigarettes; and more extensive transportation systems lead to sedentary lifestyles.
This is where America stood in the late 1960s, and Western Europe in the early 1970s, when the disease spiked. Soon after, these nations advanced to the final stage, springing into action with an enhanced medical response as well as extensive public education programs urging people to get more exercise, to eat healthier foods, and to quit smoking. The rate of disease dropped dramatically. Yet even today in the United States, the disease is the leading cause of death, accounting for 51% of total deaths in women and 48% in men. Costs annually are more than $130 billion.
Now other parts of the world, particularly Eastern Europe and Southeast Asia, are in the midst of their own epidemic. In Russia, for example, largely because of heart disease, life expectancy for men has fallen in just a few years from 68 to 57, "the most remarkable decline in life expectancy in the absence of war and famine in modern history," says Pearson. "Visit a hospital in Southeast Asia and you'll see wards full of coronary patients in their late 30s or early 40s, during what should be their most productive years economically and socially."
Less widely recognized is the coming wave of cardiovascular disease in the developing world, where the disease recently surpassed infections as the No. 1 killer. Pearson and other epidemiologists say parts of Asia, Africa and South America are on the verge of their own epidemic. Briefly, the reasons include a more affluent lifestyle; the number of people who were born with a low birth weight, putting them at much higher risk of heart disease as adults; a greater number of people living into old age, giving heart disease more time to develop; and the possibly harmful genes of populations that have only recently had plentiful food, allowing a harmful heredity trait to be expressed.
Epidemiologists expect these and other factors to come together to make cardiovascular disease as prevalent or more so as it was in the U.S. 30 years ago. They predict that the rate of death due to cardiovascular disease in India, for example, will double from 1990 to 2020. Even now, Americans of Indian descent have the highest coronary rate of any group in the U.S.
Pearson says the best way to fight the coming epidemic is through extensive education programs about the importance of lowering cholesterol and controlling blood pressure, along with lifestyle changes such as quitting smoking, better nutrition, and getting more exercise.
"If someone with symptoms of heart disease walks through your door, you can give them inexpensive medications to reduce blood pressure and cholesterol, give them an aspirin a day, and get them to quit smoking and to start walking. Right there you have 80 to 90 percent of the best care in the world, for just a small cost.
"These methods already reduce the incidence of disease greatly in the most advanced nations. The United States may be a high-tech model, but it's also a low-tech model as well."