Global Cardiovascular Strategies

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CARDIOVASCULAR DISEASE PANDEMICS:
THE GLOBAL VIEW ON MORTALITY AND RISK FACTORS
E Farinaro, S Stranges, E Della Valle, G Guglielmucci, A Cajafa, M Triassi and A Chockalingam

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Epidemiological scenario

The secular analysis of mortality trends for infectious diseases, cardiovascular diseases and cancer can help explain the present epidemiological picture: over the past century infectious diseases have been more and more disappearing, above all in the industrialised nations, thanks to the general improvements in public sanitation, the discovery of antibiotics as well as the wide-spread use of vaccines (⁷). A reduction in mortality from infectious diseases has also taken place in the developing countries, but the entity of the diminution has been restrained by the appearance of “new” infectious diseases which have taken the scene in the last few years and that are today true health and social emergencies (AIDS, hepatitis C); moreover, even if a gradual hygienic progress has been noticed in this part of the World, yet a number of countries (sub-Saharan Africa and most of Asia) and numerous social groups in each area lack sanitation, housing and the availability of adequate nutrition.

Secular trends from cardiovascular and neoplastic mortality for the entire World, EME and DC are similar except for some differences regarding the more industrialised nations: in fact in the latter group the mortality from cardiovascular diseases has shown, since the end of the 70’s, lower rates and the present trend is a tendency towards stationary levels, while mortality from cancer has been continuously rising which denotes only a partial success of the preventive policies, therapeutical guidelines and research in this field. On the other hand, developing countries are paying a major burden to chronic-degenerative disorders, in relation to an increasing prosperity of some social classes and to the consequential acceptance of Western life-styles thus leading to slight changes in the demographic structure of these countries. The great importance of this happening is well clear if we consider the large amount of population involved in the transition: as a matter of fact, in absolute numbers, already today the major contribution to cardiovascular deaths comes from the developing countries (64%, corresponding to 9 million deaths out of 14 million total) where over 80% of the World population resides. The estimated rates for the next future (2020) give evidence for an increasing trend, about 75% of all cardiovascular deaths are estimated to occur in DC (18,4 million out of a total of 25). The determinants of this will be due partially to the growing life-expectancy and to the higher prevalence of some of the most important cardiovascular risk factors (tobacco smoking, serum lipids, hypertension, sedentary life-style) in relation to the increase in per capita income, but also and mainly to the effects of the overpopulation of this area which will pass from the actual population of five billion to over six and a half billion in 2020 (^{2, 8, 9}).