FACT, ARTHEROSCLEROSIS IN CARDIOVASCULAR DISEASES

Consequences of atherosclerosis are grouped under the broad phrase “cardiovascular diseases,” which is made up of coronary heart disease, cerebrovascular disease, and other circulatory disorders. These afflictions include the many manifestations of coronary heart disease, such as myocardial infarction, acute coronary syndromes, and heart failure, and the consequences of peripheral disease, such as stroke, peripheral vascular disease, aortic disease, and renal failure. Myocardial infarction and stroke have become the major global causes of death and disability around the world. Much is now known about the natural history and pathophysiology of atherosclerosis. The disorder begins in childhood and the lesions in the arterial vasculature develop over many decades. The clinical sequelae appear in middle age or later life. Cardiovascular disorders are becoming more common and dominate patterns of disease in most countries primarily because of the epidemiologic transition from communicable (infectious disease) to noncommunicable disease (chronic diseases) as the major cause of death and disability around the world.7,8 With the decline of infectious diseases, particularly in the young, life expectancy, the global population, and the proportion of elderly persons in most countries has increased. In 1950, the global population was 2.5 billion. In 2000, it was 6.0 billion, and it is estimated to reach 9.0 billion by 2050. These demographic changes are the second major cause of the increase in the impact of cardiovascular disease.

The size of the problem around the world is difficult to estimate. Whereas reliable figures may be available in developed countries, in many parts of the world, there is not sufficient organizational capacity to obtain accurate figures. The diagnosis may be used to explain deaths to the satisfaction of grieving relatives with little attention to accuracy. In many countries, coronary artery disease is a socially acceptable cause of death. Without postmortem evidence, the diagnosis may be in error. Equally, it may be overlooked particularly in patients dying suddenly where often the diagnosis is in fact acute myocardial ischemia. A further difficulty can arise in some countries because health authorities have no interest in coronary artery disease, regarding it as a disease of the elderly, a pleasant way to die, a personal responsibility, a disease of affluence, and a problem limited to the male gender. All five of these beliefs and attitudes are serious misconceptions and untrue. The consequences of atherosclerosis in causing cardiovascular deaths have been estimated by the World HealthOrganization (WHO)

Changing Pattern of Disease Around

the World

The 20th century saw a most remarkable increase in public health. Life expectancy measured in years accrued is possibly the crudest but simplest measure of public health. Over the last century, life expectancy in what are now developed countries increased from about 40 years to almost 80 years. In general, women have a life expectancy 1 or 2 years greater than men, and that greater longevity has been maintained as life expectancy has increased. The large increase in life expectancy has been brought about partly as a result of

medical treatments, but also as a consequence of social and hygienic change reducing the impact of infectious diseases. One consequence is that the proportion of elderly persons in populations is changing rapidly and will do so for the next several decades. Such an alteration in the demography

of society has major implications for economic and social change in many countries. A second consequence is that in developed countries there has been a major switch in the causes of death. The pattern of disease whereby infections were the dominant causes of death has been replaced by chronic diseases, and notably atherosclerosis, as the primary cause. That epidemiologic transition in health is common around the world. However, in poorer countries noncommunicable diseases continue to be the dominant cause of death

. Those countries can be expected to change their pattern of disease as public health improves.

It is a common belief that poverty and economic prosperity are closely linked to health, but it is not so. Among countries with a high life expectancy, there is considerable variation in income per capita. Among countries with a low income per capita, there is a large difference in life expectancy. The precise reasons are many and complex.

Risk Factors cardiovascular diseases

The so-called risk factors for coronary heart disease are well known. These risk factors appear to be similar across all countries regardless of gender, geography or ethnicity.  Variation in the prevalence of heart disease among countries can be largely explained on the basis of the degree to which any particular risk is present. One study19 claims that nine risk factors can account for 90% of cardiovascular events. Furthermore, these risk factors are the same risk factors that are related to cancer, diabetes, and respiratory diseases. The consequence for public health policy is that the modification of risk factors may bring greater benefit to a country than the treatment of specific diseases.