Novel therapeutic concepts * The epidemic of cardiovascular disease in the developing world: global implications

Abstract

The epidemic of cardiovascular disease (CVD) is a global phenomenon, and the magnitude of its increase in incidence and prevalence in low- and middle-income countries (LIMIC) has potentially major implications for those high-income countries that characterize much of the developed world. Cardiovascular disease remains the leading cause of death in the world and approximately 80% of all cardiovascular-related deaths occur in LIMIC and at a younger age in comparison to high-income countries. The economic impact in regard to loss of productive years of life and the need to divert scarce resources to tertiary care is substantial. The 'epidemiologic transition' provides a useful framework for understanding changes in the patterns of disease as a result of societal and socioeconomic developments in different countries and regions of the world. A burning but as yet unanswered question is whether gains made over the last four decades in reducing cardiovascular mortality in high-income countries will be offset by changes in risk factor profiles, and in particular obesity and diabetes. Much of the population attributable risk of myocardial infarction is accountable on the basis of nine modifiable traditional risk factors, irrespective of geography. Developing societies are faced with a hostile cardiovascular environment, characterized by changes in diet, exercise, the effects of tobacco, socioeconomic stressors, and economic constraints at both the national and personal level in addition to exposure to potential novel risk factors and perhaps a genetic or programmed foetal vulnerability to CVD in later life. There are major challenges for primary and secondary prevention including lack of data, limited national resources, and the lack of prediction models in certain populations. There are two major approaches to prevention: public health/community-based strategies and clinic-based with a targeted approach to high-risk patients and combinations of these. There are concerns that in comparison with communicable diseases, cardiovascular and chronic diseases have a relatively low priority in the global health agenda and that this requires additional emphasis. The human race has had long experience and a fine tradition in surviving adversity, but we now face a task for which we have little experience, the task of surviving prosperity Alan Gregg 1890-1957, Rockefeller Foundation.

Prevalence and risk factors associated with peripheral arterial disease in an adult population from Colombia

“…16,17 Furthermore, our study confirms the role of traditional CVD risk factors on PA D prevalence (Table 1), which have been consistently reported as major predictors of morbidity and mortality, 18 and support the argument for PA D prevalence variation depending on the population distribution of CVD risk factors. 1,15 Finally, our results corroborate previously reported observations of a cross-sectional study conducted in Bucaramanga, Colombia. This established the prevalence of CVD risk factors in a random sample of the general population (2989 subjects, 15---64 years old), showing that smoking, hypertension, obesity, high cholesterol, and diabetes were significantly prevalent, calling for actions to control the ongoing CVD epidemic.…”

“…1 These gender-based prevalence differences could be related to ''unidentified risk factors'' or might represent a survival advantage for women, with men being more likely to experience death from concomitant coronary heart disease. 15 In addition, our study shows, as well as in many others, that the ABI increased with aging. 2 ---4 This is probably due to an increased prevalence of other atherosclerosis risk factors with aging, which also triggers the progression of PAD.…”

“…However, these differences may, in fact, reflect precisely across-countries variation on population exposure to know risk factors such as smoking, hypertension, dyslipidemia, diabetes, obesity and history of CVD. 15 As stated before, the migration from rural to urban settings is increasingly exposing the Colombian population to CVD risk factors, and thus, the observed PA D prevalence although low, raises important public health challenges to control and manage CVD burden.…”

Improved Animal Models for Testing Gene Therapy for Atherosclerosis

“…A therosclerosis is a leading cause of human morbidity and mortality (Gersh et al, 2010;Go et al, 2013). Gene therapy for atherosclerosis has shown promise in several preclinical studies (Rissanen and Yla-Herttuala, 2007;Williams et al, 2010); however, other than a pilot study of low-density lipoprotein receptor gene therapy to prevent premature atherosclerosis in patients with familial hypercholesterolemia carried out nearly two decades ago (Grossman et al, 1995), gene therapy for atherosclerosis remains at the preclinical stage (Williams et al, 2010).…”

Growth of Carotid Intima‐Media Thickness in Black and White Young Adults

“…Previous cross‐sectional studies in both adult and pediatric populations have shown a thicker IMT in blacks and males compared with whites and females 1, 12. These studies also have shown some associations of IMT with several anthropometric variables (eg, age, sex, race, BMI), chronic stress (eg, socioeconomic status), and hemodynamic variables (eg, blood pressure and pulse pressure).…”