Cardiovascular diseases: the world's Public Health Enemy No. 1 / Ivan Gyarfas

4 World Health • January-February 1992 Cardiovascular diseases: the world's Public Heohh Enemy No. 1 lvan Gyarfas C ardiovascular diseases are today the world's Public Health Enemy No. 1. Why? Firstly, they account for 12 million deaths - more than any of the infec- tious diseases - and disable millions more every year. About half this figure (6 million) are dying from cardiovascular diseases in the devel- oping countries. A quarter of all deaths throughout the world are attributable to cardiovascular diseases, which suggests that we are close to a global coronary catastrophe. In industrialized countries, they are the first cause of mortality, accounting for 50% of all deaths; in developing countries, they rank third, accounting for about 15 to 16%. Secondly, it has been projected that there will be more deaths from cardiovascular diseases than from a number of infectious diseases com- bined - among them diarrhoea! diseases, schistosomiasis, tuberculo- sis, measles and whooping cough - in the Third World in just a decade. This will make coronary heart disease and stroke the leading cause of deaths in developing countries, striking mainly the managerial and professional classes whose skills are greatly needed for economic growth and develop- ment The projections show that Latin America will report two to three times more deaths from cardio-vascular diseases than from infectious diseases, and Asia one and a half times more; only in Africa and the Middle East there will still be more deaths from the age-old killers such as infectious diseases. • In eastern Europe, there has been an upward swing in mortality from cardiovascular diseases over the past two decades. • In North America, western Europe, Japan, Australia and New Zealand, despite declining trends since the 1970s, the cardiovascular diseases are still the top killer. • According to WHO estimates, one half of all deaths worldwide are preventable - six million lives can be saved annually. Healthy living is the least expensive way of prevention There are no vaccines against diseases ofthe heart and arteries. There is only prevention. For developing countries as well as developed countries, the most practical and least expensive way of prevention is not through medicines but through healthy living. Over the past three decades in the USA, mortality from cardiovascular diseases declined by 40%. One third of that decline is attributable to technological advances such as clot- dissolving and anti-hypertensive drugs, intensive care units, coronary angioplasty and bypass surgery. Two-thirds are attributable to meas- ures such as diets to reduce calories, fats and salts, improved control of hypertension, the growing popularity of fitness exercises, and smoking cessation - all of which have nothing to do with drugs. These facts under- score the importance of non-pharma- cological prevention and the need for public health authorities to put new emphasis on preventive rather than curative medicine - beginning with the young - in order to save both lives and money. The increase of cardiovascular diseases is linked in part to the aging of populations. According to United Nations projections, life expectancy is expected to reach at least 60 years by the year 2000 in the vast majority of developing countries. Studies have shown that when life expectancy increases, when deaths from infectious diseases decline, and when death rates drop to below about 15 per 1000 population, then diseases of the heart and arteries become major problems. Such is the case in an increasing number of developing countries. The rise in cardiovascular diseases is also linked to life-style. Yet, according to a report by the World A consultation in Jamaica. In the developing countries of the Americas heart diseases are on the increase. World Health • Jonumy·Februory 1992 Bank, "few countries encourage low fat, low cholesterol, low salt diets; indeed few countries have a national nutritional policy of any kind." And exercise and fitness are not routinely encouraged in schools and places of work. Even worse, physicians in developing countries remain oriented towards acute care, rather than preventive care, the report says. MONICA- a WHO ten-year proiect In 1985, WHO launched a ten-year project called MONICA- a name derived from combining and shorten- ing two words "monitoring" and "cardiovascular" - to help the public health authorities determine whether prevention programmes are successful or not. One of the largest research projects ever undertaken, MONICA follows the trends in populations between the ages of 25 and 64 years in 26 countries through a network of 39 centres. Each centre keeps track of some 1200 people who are represen- tative of a total population of 15 million. The results so far show the presence of mortality differences by sex and race, and geographically between East and West, North and South, as well as within countries. For instance, in France there are differ- ences between populations studied in Lille, Strasbourg and Toulouse. Mort- ality rates in Toulouse were lowest because, according to the experts, the diet there is higher in oils, poly- unsaturated fats, vegetables and fruit, and lower in lipids of animal origin and saturated fats. Increasing exercise and adopting a balanced diet Results show that among the popula- tions studied, the least number of obese men and women are in Beijing, China (3% ), Gothenberg, Sweden (7% ), and Auckland, New Zealand (8% ). The fattest males were found in Malta (25% obese), followed by Bas- Rhin in eastern France and Kaunas, Lithuania (each with 22%). The plumpest females were found in Kaunas (45%), Novosibirsk in Siberia, 5 Nutrition education helps to combat heart diseases. Russian Federation (43%), and Malta ( 41% ). However, overweight was a characteristic of almost all the populations studied, thus pointing to the need to change unhealthy life- styles by increasing exercise and adopting a balanced diet. Among other WHO projects under way to prevent and control cardiovas- cular diseases are the following: • CARDIAC (Cardiovascular Diseases and Alimentary Compari- sons), a study in 22 developed and developing countries. The major aim is to determine the link between diets and high blood pressure. It is directed by the WHO Collaborating Centre at Shimane University, Izumo, Japan. • PEP (Patient Education Project), involving eight countries, whose major aim is to educate family doctors and nurses in methods of teaching patients with high blood pressure how to manage their condition. The World Hyper- tension League is a partner in the project. • PBDA Y (Patho-Biological Determinations of Atherosclerosis in Youth), a five-year study carried out through 20 centres in 16 areas of the world, whose major aim is to determine how atherosclerosis develops, by studying the clogging of arteries in the young. • The Global Cardiovascular Diseases Monitoring and Preven- tion Project, a recently established network comprising sites in developing countries linked to the MONICA sites, aims to assist these nations develop skills to carry out programmes of prevention. • Programme on Prevention of Rheumatic Fever and Rheumatic Heart Disease, a project in developing countries, aims to reduce the number of cases and deaths from these two diseases, whose victims are the young. The International Society and Federation of Cardiology is a partner in the project. It is clear that only a strong commit- ment by countries to provide funds, equipment and personnel for pro- grammes of prevention will avert the impending global epidemic of cardiovascular diseases. • Or /van Gyarfas is Chief of the Cardiovascular Diseases Unit at the World Health Organization in Geneva.