blood vessels of the brain (cerebrovascular disease), peripheral arteries (peripheral arterial disease), deep veins and
lungs (deep vein thrombosis and pulmonary embolism), pathologies damaging heart and valves due to rheumatic fever
(rheumatic heart disease) or malformations present at birth (congenital heart disease).
Data available to date defines a possible future scenario regarding the prevalence of CVD in developed
countries: smoking rates are now steady, risk factors are supposed to increase, and despite the augmented control on
them could enhance a lower mortality of CVD, the decline in mortality observed in the last decades from CVD is
now leveling (1).
The pattern of changes of disease prevalence among world population, according to the so-called “epidemiological
transition”, are predicting the future also of developing countries, that are now supposed to be in stage 3
(the age of degenerative and man-made diseases). In fact, the next step should be stage 4, as to say the situation
of developed countries, where life expectancy is greater than 70 years. In stage 4 CVD and cancer are the main
causes of death and premature cardiovascular events occur mainly to lower socioeconomic classes, while richer people
faces the CVD mainly in their old age.
By year 2020, it is estimated that Chinese and Indian economies will worthy account for almost 40% of the total value.
The average annual incidence rate of stroke in India in 2009 were 145 per 100,000 population, which is higher than in
the western nations (3). Also in China it is markedly important the prediction of CVD considering that Chinese population
(35-84 age range) trend in CVD risk factors, as systolic blood pressure, total cholesterol, smoking, body mass index (BMI)
and diabetes, were projected forward over the period 2010-2030. The expected aging and growing of Chinese people
will be sufficient to determine a consistent increase in the absolute value of coronary heart disease and stroke in the world (4).
Consumption of animal fats and sugar is declining in the western world but it is going to be introduced, even if
at low levels, in developing countries. Billion people will have soon access to new resources at their first and are going to
change their life style. Food consumption will increase and shift in dietary patterns will have considerable health
consequences as emerged from data derived by FAO food balance sheets (FBSs).
Therefore, despite the impressive decline in mortality from CVD during the latter half of the 20th century, CVD remains the
leading cause of death in the world and political, economic, social, and medical strategies and interventions are urgently
needed to prevent the increase of CVD prevalence.
In the so-called low and middle income countries (LAMI – know more looking at figure 1), 80% of worldwide deaths
caused by CVD occurs, as these countries present more risk factors together with less possibility to prevention and
less access to health services.
What seems to be clear is that the economic development is the major factor driving the epidemiological transition,
and vice versa, cardiovascular pathologies can affect the economic development, lowering the economic in growth of
nations. The burden of CVD is particularly high in LAMI, where stroke and diabetes reduce the gross domestic product
(GDP) of a percentage ranging from 1 to 5% (5).
To confirm data presented, it is important to mention The American Heart Association forecast for the healthcare costs
of CVD in USA, which will likely increase to 17% of the current national health expenditures and 15% of GDP by year 2030
(data of 2008). Considering no changes in the government politics, together with aging and increasing of the population,
by 2030 over 40% of Americans will likely present some kind of CVD and medical direct costs will probably
triple from $273 billion to $818 billion, while the indirect costs will increase of 61% due to less productivity (6).
Fig. 1. Countries by 2011 GDP (PPP) per capita, based on World Bank figures (7).
- Capewell SJ, Ford ES, Croft JB, Critchley JA, Greenlund KJ and Labarthe D – Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America – Bull. World Health Organ. (2010);88(2):120-130.
- Gersh BJ, Sliwa K, Mayosi BM, and Yusuf S – The epidemic of cardiovascular disease in the developing world: global implications – European Heart Journal (2010);31:642–648.
- Kaul S, Bandaru VC, Suvarna A, Boddu DB – Stroke burden and risk factors in developing countries with special reference to India – Indian Med. Assoc. (2009);107(6):367-70. 3(3): 243–252.
- Moran A, Gu D, Zhao D, Coxson P, Wang YC, Chen CS, Liu J, Cheng J, Bibbins-Domingo K, Shen YM, He J and Goldman L – Future cardiovascular disease in China: Markov model and risk factor scenario projections from the Coronary Heart Disease Policy Model-China – Circ Cardiovasc Qual Outcomes (2010);3(3):243–252.
- The Long-Term Budget Outlook – Congressional Budget Office. Nonpartisan analysis for the U.S. Congress (2010);http://www.cbo.gov/doc.cfm?index11579.
- Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, Finkelstein EA, Hong Y, Johnston SC, Khera A, Lloyd-Jones DM, Nelson SA, Nichol G, Orenstein D, Wilson PW, Woo YJ – Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association – Circulation (2011)1;123(8):933-44.
- http://data.worldbank.org/indicator/NY.GDP.PCAP.PP.CD/countries/1W?order=wbapi_data_value_2011%20wbapi_data_value%20wbapi_data_value-last&sort=desc&display=default – image author in Wikipedia: Quandapanda (http://en.wikipedia.org/wiki/File:Gdpercapita.PNG)