Heart disease - A Race Against Time

[Guest guest]

Hi All,

" A Race Against Time "

http://www.earthinstitute.columbia.edu/news/2004/images/raceagainsttim

e_FINAL_0410404.pdf

covers everything in this pdf-available JAMA MEDICAL NEWS &

PERSPECTIVES

below.

MEDICAL NEWS & PERSPECTIVES

JAMA, June 2, 2004—Vol 291, No. 21 2533

Heart Disease a Global Health Threat

Mike Mitka,

BILLIONS OF INDIVIDUALS ARE EX-periencing

longer and healthier

lives because of advances in

medical technology and improving eco-nomic

conditions in developing na-tions—

but the cloud in this silver lin-ing

is that heart disease is on the rise.

In a report released on April 26, re-searchers

call cardiovascular disease an

urgent threat to global health and pre-dict

that by 2020, it will become the lead-ing

cause of death and disability world-wide.

The report, A Race Against Time:

The Challenge of Cardiovascular Dis-ease

in Developing Economies

(http://www.earthinstitute.columbia.edu/news/2004/images/raceagainstti

me_FINAL_0410404.pdf),

was spon-sored

by the Australian Health Policy In-stitute

at the University of Sydney, Co-lumbia

University in New York City, and

the World Health Organization (WHO).

A 20-year window is now open to take

action to curb heart disease in develop-ing

nations, the report's authors argue.

This opportunity exists because devel-oping

countries with emerging robust

economies generally have younger

populations that have yet to experi-ence

actual heart disease—although risk

factors are mounting. These conclu-sions

were reached by studying heart

disease patterns in Brazil, China, India,

Russia, and South Africa and using sta-tistics

from Portugal and the United

States as baselines representing devel-oped

countries.

The report is complemented by a spe-cial

communication (see p 2616) from

the WHO about the global burden of

chronic disease that calls for a greater

emphasis on treating chronic ill-nesses,

including cardiovascular dis-ease

( JAMA. 2004;291:2616-2622).

" INTOLERABLE BURDEN " LOOMING

However, if no action is taken in devel-oping

countries, aging populations that

have adopted poor lifestyle choices seen

in industrial nations, such as smoking,

overeating, and less exercise, will face an

" intolerable burden " of death, disabil-ity,

and economic loss, the report said.

" During these 20 years ...therewill

be a period when [cardiovascular dis-ease]

is causing its principal social prob-lems

among those of working age, " the

authors wrote.

Ischemic heart disease mortality in

developing countries is projected to in-crease

by 120% for women and 137%

for men. But even a younger popula-tion

is no protection against cardiovas-cular

disease in developing countries.

In a foreward to the report, Yach,

MBChB, MPH, representative of the di-rector-

general of the WHO, noted the

proportion of cardiovascular death oc-curring

during prime labor years in de-veloping

countries will exceed that of

industrialized nations—and with higher

mortality comes higher morbidity and

lower productivity.

Leeder, MB, PhD, coauthor

of the report and a professor of public

health at the University of Sydney in Aus-tralia,

said that cardiovascular disease in

developing nations should be fought

with a three-pronged attack: reducing

risk, through drug treatment for hyper-

tension and dyslipidemia and smoking

cessation programs; promoting healthy

lifestyles through educational efforts;

and encouraging the private sector to

promote a healthier environment (such

as more healthful food products and

healthier workplaces).

ECONOMIC SELF-INTEREST

Governments can use tools such as

taxes to combat heart disease. For ex-ample,

the Polish government cut sub-sidies

for and imposed taxes on ani-mal

fats, raising their price. The action

caused citizens to purchase more heart-healthy

vegetable oils, and the change

in food consumption habits lowered

heart disease mortality in the 1990s.

Economic self-interest can also spur

businesses to embrace cardiovascular

health initiatives. For example, em-ployers

who provide smoke-free work-places

may lower sick-day costs.

" This is not to argue that individual

choice is unimportant, but to recog-nize

that the social, educational, and

economic context in which individu-als

operate powerfully shapes the de-gree

to which they can exercise healthy

choices, " Leeder said.

Cardiovascular disease mortality rates of working-age individuals in

developing countries are

often equal to or greater than rates seen in the same population in

industrialized nations, where

prevention efforts have reduced heart disease. In Russia, the [male -

AP] exceptionally high heart disease

mortality rates are related to such risk factors as alcohol intake

and tobacco use.