Author + information
- Received May 16, 2008
- Revision received July 31, 2008
- Accepted August 5, 2008
- Published online December 2, 2008.
- Rohina Joshi, MBBS, MPH, PhD⁎,⁎ (, )
- Stephen Jan, MEc, PhD⁎,
- Yangfeng Wu, MD, PhD† and
- Stephen MacMahon, DSc, PhD, FACC, FAHA, FCSANZ⁎
- ↵⁎Reprint requests and correspondence:
Dr. Rohina Joshi, The George Institute for International Health, University of Sydney, P.O. Box M201, Missenden Road, Sydney, NSW 2050, Australia
Cardiovascular disease (CVD) was the leading cause of death globally in 2005, responsible for 17.5 million deaths, more than 80% of which occurred in low- and middle-income countries (LMIC). In these regions, CVD occurs at a much younger age than in high-income countries, thereby contributing disproportionately to lost potential years of healthy life as well as lost economic productivity. Many effective interventions for CVD prevention and management are now affordable for all but the very poorest countries, but large treatment gaps still exist because of poor prescribing practices, limited availability of medicines, and lack of appropriately skilled health care providers. Despite the increasing awareness of the growing epidemic of CVD in LMIC, this public health priority has received little attention from those who determine the international health agenda. Although the burden of CVD is already enormous in developing countries, there exists a window of opportunity to prevent the epidemic reaching its full potential magnitude. This requires the rapid deployment of strategies already proven to be effective in high-income countries. Such strategies need to be tailored for LMIC for them to be affordable, effective, and accessible to disadvantaged groups and the burgeoning middle classes. Ideally, the control of CVD in these countries would involve a dual approach in which evidence-based clinical strategies for CVD prevention and treatment are complemented by evidence-based population level strategies. We propose that upgrading primary health care services is a central requirement for the control of the CVD epidemics facing the developing world.
Dr. Jan is the recipient of a National Health and Medical Research Council of Australia Career Development Award (2007–2011). This work was supported by a National Health and Medical Research Council of Australia Program Grant (2005–2009). This article is based on the 2007 Paul Dudley White International Lecture delivered by Dr. MacMahon at the 2007 Scientific Sessions of the American Heart Association, Orlando, Florida.
- Received May 16, 2008.
- Revision received July 31, 2008.
- Accepted August 5, 2008.
- 2008 American College of Cardiology Foundation