Attributable burden and expenditure of cardiovascular diseases and associated risk factors in Mexico and other selected mega-countries

Abstract

Background Cardiovascular diseases (CVD) represent a health and economic threat globally. This paper aims to describe this problem in Mexico and other selected mega-countries through a review of published literature and the exploration of secondary datasets. Method Mega-countries with low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S./Japan) human development index (HDI) were included. The review was divided into two topics: prevalence of dyslipidemia and CVD economic impact. Search, screening, and filtering processes were conducted in electronic databases using MeSH terms by one trained researcher. Inclusion and exclusion criteria were considered for eligibility. Methods and results were reported according to the PRISMA statement. Information from datasets on epidemiologic CVD indicators was also extracted. Results Thirty-two studies were eligible. Heterogeneity in economic data and limited nationwide information on dyslipidemias prevalence in some countries were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared to other countries. Dietary risk factors have a higher contribution on cardiovascular mortality in developing countries: e.g. 8.1-13.8% Mexico, 11.3-13.0% India vs. 0.078-8.9% Japan, 6.5-10.7% the U.S. Probability of dying prematurely from CVD in 2016 was higher in lower HDI countries: 23.3-22.5% (low-middle), 17.0-15.7% (high), and 14.6-8.4% (very high). From 1990-2016, a greater decrease in cardiovascular mortality in developed countries was registered (-56.8% Japan/-11.1% India). In 2015, an expenditure of USD-PPP $11.2 billion due to hypertension, myocardial infarction, atrial fibrillation, and heart failure was reported in Mexico (4% from public health expenditure). CVD ranked first in health care expenditures in almost all these nations and this economic burden is expected to remain significant by 2030, especially in the most populated or developed countries. Conclusions The higher burden of CVD and its significant economic impact, coupled with poor clinical practice and epidemiological surveillance, represents a greater challenge for Mexico and other developing mega-countries. Thus, governments and academia should secure resources to assure an optimal monitoring of cardiovascular risk factors. Educational models and medical practice must be improved to optimize the diagnosis of CVD and the prescription and adherence of their pharmacological and lifestyle treatments. Long-term benefits are expected from strengthening strategies to modify the food system.