The editorial is issued in conjunction with World Heart Day – September 29 – a day sponsored by the Geneva-based World Heart Federation, of which the American Heart Association is a founding member. Leaders of the American Heart Association, the Centers for Disease Control and Prevention and the National Heart, Lung, and Blood Institute wrote the editorial.
"We must do a more effective job of translating scientific advances into programs that can save lives in all parts of the world. These advances have led to enormous gains in cardiovascular disease knowledge, but a gap remains in implementing this knowledge. The message must be loud and clear to world leaders, health-care providers and the public that much of the death and disability from cardiovascular disease is preventable," says Robert O. Bonow, M.D., president of the American Heart Association and lead author of the editorial.
The editorial attacks a myth that atherosclerosis, the narrowing of the arteries that underlies heart disease and most strokes, is a disease of affluence. World Heart Federation statistics show that 80 percent of cardiovascular disease deaths occur in low-to-middle income countries, such as China, Russia and Poland.
Heart disease and stroke killed 17 million people worldwide in 1999, which is about 30 percent of all deaths. This is significantly higher than the 14.7 million cardiovascular deaths reported in 1990. The underlying causes include an increasingly overweight, diabetic, sedentary, tobacco-smoking world population.
"In the United States, we are already facing a crisis in cardiovascular disease, with an obesity and diabetes epidemic, an aging, sedentary population and a widening access-to-care gap. Internationally, these problems are worse – the access-to-care gap is growing so quickly in certain countries that it will soon be an unbridgeable chasm," says Bonow. "The answer is deceptively simple – population-based, culturally tailored prevention programs."
According to the authors, the international event is timely. "World Heart Day is a driving force for encouraging global cardiovascular disease prevention," says Claude Lenfant, M.D., director of the National Heart, Lung, and Blood Institute in Bethesda, Md. "Concerned physicians cannot close their eyes to the expanding pandemic of cardiovascular disease which respects no borders. With strategic, collaborative international partnerships, we can more effectively address the issue."
To combat what the authors term a "true cardiovascular pandemic" and global burden, the World Heart Federation has created the World Heart Forum, an international panel of 50 organizations that includes the American Heart Association, the National Heart, Lung, and Blood Institute, and the Centers for Disease Control and Prevention.
The World Heart Forum has set four goals: to foster research into a better understanding of international cardiovascular disease population trends; to develop prevention guidelines with common principles that can be tailored to a country's unique cultural patterns; to develop programs in medical schools focusing on prevention of cardiovascular disease; and to explore advocacy initiatives to address regional issues of tobacco, exercise, nutrition and access to care.
In many countries, the rise of cardiovascular disease is due in part to the Westernization of native cultures. Fruits, vegetables and whole grains are being replaced by easily accessible foods that are high in saturated fats, calories and added sugars. "Obesity is as troublesome in low-income countries as in more affluent countries," says George A. Mensah, M.D., head of the cardiovascular health program at the Centers for Disease Control and Prevention in Atlanta.
An estimated one billion people around the world are overweight or obese. Obesity is a risk factor for coronary heart disease, and is a major contributor to the global surge of diabetes mellitus, another major risk factor for cardiovascular disease, which affects 150 million people worldwide. According to the report, the prevalence of diabetes, especially among younger people is expected to double in the next 25 years.
Worldwide, 22 million children under age five are overweight. "That translates to 22 million children at risk of developing elevated blood cholesterol, high blood pressure or type 2 diabetes by the time they are teen-agers," says Mensah.
A worldwide reduction in physical activity is an important cause of the rising prevalence of obesity. An estimated 60 percent of the world's population is not adequately physically active, and among women is especially acute.
"Ironically, the decrease in physical activity in some regions is due to an increase in prosperity," says Mensah. "People who were forced by economic circumstance to walk or ride bicycles, enjoy the convenience of motor vehicles when they achieve a measure of prosperity."
The prevention and control of hypertension (high blood pressure) is another important issue, according to Mensah. The editorial notes that, of the 690 million people who have hypertension worldwide, most remain untreated or uncontrolled, despite the availability of safe and effective strategies for prevention. A renewed commitment to emphasize prevention strategies and increased access to low-cost drugs for hypertension control is needed, adds Mensah.
The editorial also indicates that tobacco use is increasing throughout the world. It predicts the number of smokers will increase by 500 million throughout the world in the next quarter century. Underscoring this alarming trend, the authors note, is the reality that excess mortality from cardiovascular disease and stroke is two- to three-fold higher among smokers than non-smokers. The World Heart Federation reports that 90 countries are expected to participate in the third annual World Heart Day, which will encourage healthy lifestyles through increased physical activity and the prevention and control of cardiovascular risk factors.
Other authors are Lynn Smaha, M.D., Ph.D. and Sidney C. Smith, Jr., M.D., of the American Heart Association.
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