A leading killer
By Allan R. Handysides and Peter N. Landless
I read about the problem of coronary heart disease in industrialized countries. I live in Sub-Saharan Africa and am saddened by our significant problem with HIV and AIDS, but wonder whether this part of the world is at risk for the heart disease that seems so prominent in affluent countries. Do we who live in low- to middle-income countries need to be concerned about the problem of coronary heart disease?
Your question probes into the whole process of the changing face of heart disease in the world at large and in low- to middle-income countries in general. Cardiovascular disease (CVD) became the single largest cause of death worldwide in 2004, when it was estimated that it caused 17 million deaths. This figure continues to grow.
Low- and middle-income countries are seeing an alarming and accelerating increase in rates of cardiovascular disease. CVD now causes the most deaths in all developing regions, with the exception of Sub-Saharan Africa; in this part of the world CVD is the leading cause of death in those over 45 years of age. Infectious diseases such as HIV and AIDS, malaria, and lower respiratory tract infections continue to be the leading cause of death in the young in Sub-Saharan Africa.
There has been a change in the pattern of diseases over the past 150 years. Before 1900, infectious diseases and malnutrition were the leading causes of death in almost every part of the world. If one added to this the high infant and child mortality rates, the mean life expectancy was approximately 30 years. Heart diseases accounted for less than 10 percent of deaths, and these were mainly related to rheumatic heart disease (rheumatic fever) caused by streptococcal infections, and heart muscle damage (cardiomyopathies) related to other infections and malnutrition.
As nutritional knowledge increased, as public health measures improved sanitation, and as water cleanliness and immunization became common practices, there was a decrease in infectious diseases. Life expectancy increased dramatically, and in a number of countries the child and infant mortality rate declined. During this time cardiovascular diseases accounted for between 10 to 35 percent of deaths and included rheumatic valvular heart disease, hypertension (high blood pressure), coronary heart disease, and stroke.
It is sadly ironic that nutritional practices caused the pattern of diseases to change even further. In technical terms an epidemiologic transition took place: degenerative and human-made conditions (noncommunicable diseases) have come to the fore, and cardiovascular diseases now account for between 35 and 65 percent of deaths, mainly from coronary heart disease and stroke. The factors that are largely responsible for this change in disease pattern include the increased intake of saturated fats and calorie-dense foods (commonly known as junk foods), as well as decreased physical activity. These have fueled the emergence of high blood pressure and degenerative arterial disease (atherosclerosis). In many parts of the world, physical activity is declining, there is an epidemic of overweight and obesity, and the rates of high blood pressure, type 2 diabetes, and abnormal blood fat levels (cholesterol) are increasing—even in children.
Sub-Saharan Africa has not been left unscathed by this mega challenge of cardiovascular disease. Increased urbanization has led to changes in nutritional patterns, physical activity has decreased, and obesity is a growing problem. It is currently estimated that 40 percent of women in South Africa are overweight. Tobacco use also continues to increase in low- to middle-income countries, further increasing the risks for coronary heart disease.
Population risk-factor profiles of developing countries are mimicking the developed countries more and more. Regular exercise, a diet rich in fruits and vegetables, avoidance of saturated fats, and the avoidance of tobacco in all its forms are essential if you wish to avoid heart disease.
In short, practice the healthy Adventist lifestyle. Make wise choices—your heart will know the difference!
Allan R. Handysides, a board-certified gynecologist,
is director of the General Conference Health Ministries Department.
Peter N. Landless, a board-certified nuclear cardiologist,
is an associate director of the General Conference Health Ministries Department.