33. Cardiovascular Disease


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Richard Lord, www.rlordphoto.com

As developing countries begin to reap the benefits of economic development, they are becoming increasingly vulnerable to an insidious byproduct of the modern world?cardiovascular disease (CVD). The leading cause of death in developing countries, CVD is associated with a number of risk factors linked to lifestyle and behavioral patterns that can be changed. Ischemic heart disease, stroke, and congestive heart failure account for at least 80 percent of the burden of CVD worldwide, and CVD deaths are expected to increase in precisely those parts of the world that have made gains in combating infectious disease and malnutrition.

The economic impact of CVD in developing countries?in Asia, the Pacific, the former Soviet states, Latin America, the Middle East, and Africa?is significant because working–age adults account for a high proportion of the CVD burden. Not only have mortality rates increased, but in some countries, like Russia, life expectancy actually has declined because of CVD. In Sub–Saharan Africa, CVD is becoming a leading killer among those over the age of 30. The vast majority of CVD is attributed to such risk factors as obesity, which is escalating in the developing world at an alarming pace, high blood pressure and high cholesterol, extensive tobacco and alcohol use, and low vegetable and fruit consumption.

Effective interventions to reduce risk factors in developing countries likely will involve a mix of treatment and education. Cost–effective medical interventions include ACE (angiotensin–converting enzyme) inhibitors, beta–blockers and off–patent statins, and aspirin. Compliance could be improved and costs reduced by incorporating several medications into a "polypill" for long–term use. Above all, education is essential. Health care workers need training to implement clinical guidelines, and patients need to be educated about the importance of adhering to their medical regimens. These interventions can reap future savings in terms of reduced medical costs and improved quality of life and productivity.