TAILIEUCHUNG - Cardiovascular Disease

Known as the epidemiological transition, this shift is highly correlated with changes in personal and collective wealth (the economic transition), social structure (the social transition), and demographics (the demographic transition). Omran (1971) provides an excellent model of the epidemiological transition that divides it into three basic ages: pestilence and famine, receding pandemics, and degenerative and human- created diseases (table ). Olshansky and Ault (1986) add a fourth stage: delayed degenerative diseases. The consistent pattern formost high-income countries going through the epidemiological transition has been initially high rates of stroke, mostly hemorrhagic. Only in the third phase, with the presence of increased resources, but coupled with increased diabetes and smoking rates and adverse lipid. | Chapter 33 Cardiovascular Disease Thomas A. Gaziano K. Srinath Reddy Fred Paccaud Sue Horton and Vivek Chaturvedi Cardiovascular disease CVD is the number one cause of death worldwide Mathers and others 2006 Murray and Lopez 1996 WHO 2002b . CVD covers a wide array of disorders including diseases of the cardiac muscle and of the vascular system supplying the heart brain and other vital organs. This chapter reviews the epidemiological transition that has made CVD the world s leading cause of death assesses the status of the transition by region and indicates regional differences in the burden of CVD. It also reviews the cost-effectiveness of various interventions directed at the most relevant causes of CVD morbidity and mortality. EPIDEMIOLOGY OF CVD At the beginning of the 20th century CVD was responsible for less than 10 percent of all deaths worldwide but by 2001 that figure was 30 percent. About 80 percent of the global burden of CVD death occurs in low- and middle-income countries. Murray and Lopez 1996 predicted that CVD will be the leading cause of death and disability worldwide by 2020 mainly because it will increase in low- and middle-income countries. By 2001 CVD had become the leading cause of death in the developing world as it has been in the developed world since the mid 1900s Mathers and others 2006 WHO 2002a . Nearly 50 percent of all deaths in high-income countries and about 28 percent of deaths in low- and middle-income countries are the result of CVD Mathers and others 2006 . Other causes of death such as injuries respiratory infections nutritional deficiencies and HIV AIDS collectively still play a predominant role in certain regions but even in those areas CVD is now a significant cause of mortality. Predominant Cardiovascular Diseases This chapter focuses on the most common causes of CVD morbidity and mortality ischemic heart disease IHD stroke congestive heart failure CHF . These diseases account for at least 80 percent of the burden of CVD in

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