Global Heart: The Prime Journal for Global Cardiovascular Research Findings, Implementation and Interpretation

摘要

Over the last decades the world has witnessed a transition from a global burden of disease dominated by infectious and maternal/child conditions to a new world in which CVD and other no communicable diseases (NCDs), notably cardiovascular diseases (CVD), are responsible for a growing proportion of preventable loss of healthy years of life, especially in the world's low- and middle-income regions [1]. More than ever is there a need to understand the driving forces behind this transition to be able to cope with the epidemic of CVD. While decreasing age-adjusted trends have been observed in most Westernized societies, some of the largest low- and middle-income countries (LMICs) (populations >100 million people) had increases in CVD burden rate; in decreasing order of percent burden increase, these included: Bangladesh (27.4%), the Philippines (25.3%), Mexico (19.7%), India (15.4%), Indonesia (8.8%), and China (6.6%) [1]. The geographically shifting epidemic shows differences and similarities to what happened in Europe and North America in the second half of the last century. The risk factors are largely known with some notable new insights such as air pollution now recognized as a major risk factor following hypertension, hyperlipidemia and smoking. The dynamics and context are, however, markedly different. Awareness, diagnosis and treatment of cardiovascular risk factors in Western countries occurred when the epidemic was already reverted. In LMIC's the epidemic is still on the increase and any action is an uphill battle. CVD in LMIC's is claiming a priority in public health and clinical medicine while many of these countries face an unfinished agenda of infectious diseases and high perinatal maternal and child mortality; the double burden. This puts increased strain on budgets, capacity and public health policies and requires a rethinking of preventive strategies that can work in low resource settings. Collaborative efforts of scientists, health care providers, health care administrators, companies and politicians are needed to find innovative solutions. Innovative solutions include disruptive technologies such as scalable digital alternatives for human work force. We need to develop new views on capacity building and task shifting and, importantly, education and empowerment of health care providers, patients and populations.