NR 98-4859 (Cir/Reddy)
DALLAS, Feb. 17 -- Developing nations, including China and India, face an epidemic of heart disease and stroke that could devastate their economies, researchers report in today's Circulation: Journal of the American Heart Association.
The lead author of the study, K. Srinath Reddy, M.D., D.M, says, "It will impede economic expansion within the countries." In addition, affluent residents in developing nations represent a growing market for medical products and services. "If a large number of people from the purchasing middle classes are going to be spending their money on expensive heart surgeries or angioplasties, how will they have the money to buy the global goods?"
The epidemic mirrors that of the United States and other industrialized nations 30 years ago, says Reddy, professor of cardiology at the All India Institute of Medical Sciences in New Delhi,
One reason for the epidemic of cardiovascular disease is the surge in life expectancy due to declines in infectious and nutritional deficiency diseases and the improved economic conditions that have characterized most developing countries. In India, for example, life expectancy rose from 41.2 years in 1951 to 61.4 years by 1996. Ironically, these extra years provide a longer time period for such risk factors as smoking, high-fat diet, and sedentary lifestyle to set the stage for heart attack and stroke.
Reddy warns that smoking, high-fat diets and other adverse lifestyle factors -- which tend to accompany industrialization and urbanization -- could make cardiovascular disease death and disability numbers rise at even more alarming rates than those predicted on the basis of the aging population.
"The industrialized nations had both the means and the time to cope with their epidemic; the developing countries have neither," he says. Calling the situation "urgent," Reddy says national and international health agencies must coordinate risk-reduction efforts to head off the current epidemic.
The projected increase in cardiovascular disease will be economically disastrous, Reddy says. Creating adequate facilities to care for millions of new heart disease and stroke patients would be beyond the abilities of most developing nations. Even at current levels, the high costs of treating these diseases consume a disproportionate share of health-care spending in countries that also are battling pre-industrialized infectious and nutritional deficiency diseases.
In 1990 cardiovascular disease caused an estimated 5.3 million deaths in developed countries and 8 to 9 million in developing nations. In urban China, the proportion of cardiovascular disease deaths tripled between 1957 and 1990, jumping from 12 percent to 36 percent of all deaths. In India, deaths from circulatory system diseases (heart, stroke and other cardiovascular diseases) are projected to rise by 103 percent in men and 90 percent in women between 1985 and 2015, based solely on demographic trends rather than lifestyle changes.
Deaths from cardiovascular disease, which includes heart attack and stroke, fell in Australia, Canada, France, the United States and Japan over the last several decades. "However, the emergence of the cardiovascular disease epidemic in the developing countries during those same decades has received little attention," says Reddy.
People in developing countries die from cardiovascular disease at younger ages than those in industrialized societies. In 1990 nearly 47 percent of cardiovascular disease deaths in developing countries were people younger than 70, compared to almost 27 percent for industrialized countries. As a result, the World Health Organization estimates the developing countries' contribution to the global burden of cardiovascular disease in terms of disability-adjusted years of life lost was 2.8 times that of developed countries.
"This whole process of change from infectious and nutritional deficiency diseases to chronic disease is called the modern epidemiological transition," Reddy says. "The developed countries have gone into a later stage of the transition in which they continue to have these diseases but at a later age, and the overall burden is decreased."
Reddy believes that developing countries need to apply knowledge acquired in the earlier epidemic to the present one. The challenge is not whether developing countries will experience the modern epidemiological transition, but whether the middle phase of the transition can be abbreviated so countries can arrive more quickly at the later stage when deaths occur at older ages.
With consumption of tobacco rising in developing countries, even as it falls in industrialized nations, tobacco control is seen as the highest public health priority. "Tobacco is the leading avoidable cause of death worldwide because it contributes to deaths from cancer and respiratory disease as well as from cardiovascular disease," he says. Developing countries face obstacles to eradicating tobacco use because of the industry's aggressive advertising and because tobacco is a significant cash crop in many of those countries, Reddy says. "Tobacco is addictive not only to persons but even more so to governments."
Large rural segments of the developing countries may be the place to start. Reddy suggests that the most cost-effective strategy would be to discourage high-risk behaviors in rural areas as soon as possible because the residents have not acquired adverse behaviors, but they are in imminent danger of doing so. Other sections (especially urban communities) that have already acquired a high-risk profile need to also be targeted for risk reduction.
Reddy's co-author is Salim Yusuf, D. Phil., director of the division of cardiology at McMaster University in Hamilton, Ont., Canada.
Media advisory: Dr. Reddy can be reached at 011-91-11-685-2899. His fax is 011-91-11-686-2663. Dr. Yusuf can be reached at (905) 527-7327. (Please do not publish telephone numbers.)
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