Cardiometabolic diseases of civilization: history and maturation of an evolving global threat. An update and call to action

Abstract

Despite striking extensions of lifespan, leading causes of death in most countries now constitute chronic, degenerative diseases which outpace the capacity of health systems. Cardiovascular disease is the most common cause of death in both developed and undeveloped countries. In America, nearly half of the adult population has at least one chronic disease, and polypharmacy is commonplace. Prevalence of ideal cardiovascular health has not meaningfully improved over the past two decades. The fall in cardiovascular deaths in Western countries, half due to a fall in risk factors and half due to improved treatments, have plateaued, and this reversal is due to the dual epidemics of obesity and diabetes type 2. High burdens of cardiovascular risk factors are also evident globally. Undeveloped nations bear the burdens of both infectious diseases and high childhood death rates. Unacceptable rates of morbidity and mortality arise from insufficient resources to improve sanitation, pure water, and hygiene, ultimately linked to poverty and disparities. Simultaneously, about 80% of cardiovascular deaths now occur in low- and middle-income nations. For these reasons, risk factors for noncommunicable diseases, including poverty, health illiteracy, and lack of adherence, must be targeted with unprecedented vigor worldwide. Key messages In developed and relatively wealthy countries, chronic "degenerative" diseases have attained crisis proportions that threaten to reverse health gains made within the past decades. Although poverty, disparities, and poor sanitation still cause unnecessary death and despair in developing nations, they are now also burdened with increasing cardiovascular mortality. Poor adherence and low levels of health literacy contribute to the high background levels of cardiovascular risk.

Cardiovascular Risk Management Must Always Consider Social Determinants of Health: Past Lessons, Data, Proposals and Challenges

“…The need for acute care will always persist, and hence the two approaches are not mutually exclusive. However, in order to improve control of cardiovascular risk, interventions with an exclusively clinical and individual scope are insufficient [7,26,34]. Continuing to conceptualize these choices as dichotomous may imperil an important opportunity which should not be overlooked.…”

“…Motivation, collaboration, resolve, and persistence by all stakeholders are essential [41]. These assets transcend the boundaries of the health sector, and require the conscious and unconditional support of all facilities, particularly governmental agencies and non-governmental organizations [2,3,7,8,22,26,24,31,34,37].…”

“…Rose postulated that differences in the distribution of risk factors among populations have more influence upon cardiovascular mortality than the differences between individuals within the same population; further, that the subpopulation at low-to medium-risk gives rise to more cardiovascular deaths than those at high-risk, since the former is a vastly larger subgroup [7,32]. Although some circumstances have changed and Dr. Rose's views have been challenged, his population strategy remains valuable to improve overall population health and reduce social inequalities in the instant application [28].…”

“…The acute care model of managing disease developed and was matched to illnesses common in the past century, typically pretransition ailments such as infections and trauma [7]. Rapidly growing prevalence of chronic, degenerative "Diseases of civilization" have now extended globally to affect non-Western countries as "noncommunicable diseases" (NCDs).…”

“…After a period of decline, the USSR dissolved in 1991; it was a major trading partner with Cuba and a prominent member of the Counsel of Mutual Economic Help (CAME, for its acronym in Spanish) of the socialist countries [1][2][3][4][5][6][7][8][9][10]. This sudden absence of support began a "Special Period" in Cuba, characterized by a severe shortage of oil, transportation, electricity, and food.…”