Potential impact of the transition in risk factors for cardiovascular diseases in the population
Transition→
Changes in the risk profile for cardiovascular diseases→
Possible metabolic responses (which may vary between populations) →
Development of CVD
↓Mortality from infectious parasitic diseases
↑Tobacco use
Obesity
↑Life expectancy
↓Physical activity
Dyslipidemia
↑Urbanization
↑Dietary changes (i.e., fat, calories)
Hypertension
↑Stress
Diabetes mellitus
Coagulation abnormalities (i.e., fibrinolytic activity)
Such conditions coincide with the improved control of infectious and parasitic diseases, improved access to healthcare, and increased adult survival rates.
However, a whole new population group has been exposed to the conditions of an increasingly industrialized world. The inevitable consequences of that fact include increased daily intake of salt and saturated animal fats, higher dietary content of trans fats, increased tobacco use, and significant physical inactivity. Consequently, the incidence of hypertension, obesity, and diabetes mellitus has worsened.
Hypertension has shown increasing prevalence, and its future numbers are projected to be even more striking, particularly in less developed regions (Fig. 1).
These conditions have contributed to the progressive manifestation of atherosclerosis at an epidemic scale across the contemporary world. Most notably, the disease has reached, in absolute terms, less developed and more numerous populations [8] without easy access to education on the subject or even access to modern resources that mitigate the problem in more developed countries.
It is estimated that approximately nine million people died from cardiovascular diseases in developing countries and that five million died in developed countries in 1990, and the estimates for 2020 are six and 19 million people, respectively.
This prediction undoubtedly reiterates the widespread epidemic threat of cardiovascular disease in the contemporary world, especially in developing countries.
Although the entire transition process occurred in the early twentieth century, much time had elapsed until one could recognize the impact caused by non-communicable diseases in the underdeveloped or developing world, particularly cardiovascular diseases, as subsequently noted.
The World Health Organization began to warn about the problem in the mid-twentieth century.
The overview of socioeconomic disparities between areas affected by hunger and poverty and affluent regions, per se, has already hindered the establishment of uniform measures. The emergence of AIDS/HIV has worsened the situation.
Recently (2000), such events prompted a WHO policy, expressed in the Millennium Declaration [9], that prioritized measures against extreme poverty and hunger and aimed to promote universal primary education, protection of women, child mortality reduction, and control of HIV/AIDS, malaria, tuberculosis, and other diseases. Non-communicable diseases, including cardiovascular diseases, were not mentioned as a primary focus of attention.
Only in subsequent years, especially after the widely cited study conducted by Leeder et al. [10] has the focus shifted toward the prevention of cardiovascular diseases in less developed countries, which has affected global measures for health promotion and disease prevention, including two complementary actions for that purpose [11].
Current Status of Cardiovascular Diseases in Low-Income Countries
Considering the substantial number of inhabitants of underdeveloped areas worldwide, the contribution of these regions to global mortality is significant in absolute numbers, both in terms of non-communicable and communicable diseases, especially cardiovascular diseases.
Considering these diseases and using the mortality rate per 100,000 inhabitants as the only indicator, a value of more than 200 is obtained. The mortality rate of developing countries ranges from 200 to 300/100,000, while almost all underdeveloped countries remain above 300/100,000 in habitants for both men and women (Figs. 2 and 3).
Fig. 2
Mortality of women from cardiovascular diseases worldwide. Modified from the WHO [11]. Source: World Health Organization. Map: Public Health Information and Geographic Information Systems (GIS) World Health Organization. ®WHO 2011.The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WHO concerning the legal status of any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement
Fig. 3
Mortality in men from cardiovascular diseases worldwide. Modified from the WHO [11]. Source: World Health Organization. Map: Public Health Information and Geographic Information Systems (GIS) World Health Organization. ®WHO 2011.The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WHO concerning the legal status of any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement
The other relevant epidemiological indices, including disability-adjusted life years (DALY), among others, are equally impressive (Fig. 4).
Fig. 4
Disability-adjusted life years (DALY). Modified from the WHO 2004
Some cardiovascular diseases, including Chagas disease in South America and rheumatic fever in Africa and some regions of the Americas, among other less common types, including endomyocardial fibrosis, occur in some underdeveloped or developing regions.
Chagas disease, caused by the protozoan Trypanosoma cruzi, and transmitted by the insect Triatoma infestans(commonly known as the “barber bug”), among other insects, is a disease autochthonous to South America that affects approximately 16–18 million people, including 5 million in Brazil (Table 2).
Chagas disease status |
|---|
In Latin America • 16–18 million infected individuals |
In Brazil • 5 million infected individuals • 25 % developed Chagas heart disease within 10 years |
A quarter of the people affected with Chagas disease present or will present with severe forms of myocardiopathy.
Successful campaigns against the transmission agent have prevented the appearance of new cases, and some of the regions affected have been recognized as disease-free by the WHO.
Rheumatic heart disease still significantly contributes to morbidity and mortality from cardiovascular diseases in some parts of the developing world and has already been eradicated in many parts of the developed world.
This is a poverty-related disease, resulting from the crowding of children in precarious homes with few hygiene resources.
Improved housing and hygiene conditions are responsible for its eradication more than any other medical measure.
Ischemic heart disease and stroke are the leading causes of death worldwide in less developed regions.
The scenario is noticeably serious, especially in South America, and Brazil shows alarming rates (Table 3).
Country | Population (millions) 2005 | Age-standardized mortality rate from cardiovascular disease (per 100,000 inhabitants) |
|---|---|---|
Argentina | 32.6 | 2012 |
Bolivia | 9.2 | 260 |
Brazil | 186.4 | 341 |
Chile | 16.3 | 165 |
Colombia | 45.6 | 240 |
Equator | 13.2 | 244 |
Guiana | 0.7 | 526 |
Paraguay | 6.2 | 291 |
Peru | 28.0 | 190 |
Suriname | 0.4 | 421 |
Uruguay | 3.5 | 208 |
Venezuela | 26.6 | 241 |
The aforementioned epidemiological transition phenomenon and the lack of care for those already affected by the disease contribute to its severity.
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