Exporting failure? Coronary heart disease and stroke in developing countries

The burden of coronary heart disease (CHD) and stroke is considerable, representing 30% of all deaths worldwide, that is about 15 million deaths a year, of which 11 million are in developing or transitional countries.1 Commentators have pre-dicted a global epidemic of cardiovascular disease on the basis of current trends.2 One enthusiast has even stated that ‘In fact, cardiovascular disease is already the leading cause of death not only in developed countries but, as of the mid-1990s, in developing countries as well’,3 a statement not supported by data in the World Health Report 2000.4 Citing statistics in this way undoubtedly fuels the view that ‘something must be done’, promulgated by bodies such as the World Heart Federation.1 Clearly the absolute numbers of deaths should be related to the population at risk, which is substantially greater in developing countries of the world. The Global Burden of Disease study has attempted to provide a picture derived not only from mortality data but also from cardiovascular disability, some of which is consequent upon diseases other than coronary heart disease and stroke.5 This study demonstrated that while ischaemic heart disease and stroke were 5th and 6th in the 1990 league table of disability adjusted life years (DALYs), they contributed 20.4% of the DALYs in developed countries, but only 8.3% in developing countries.6 Concerns about the accuracy of international mortality data and the virtual absence of relevant incidence and disability data clearly need to be addressed urgently if the approach is to have validity.7