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(Circulation. 2005;112:3547-3553.)
© 2005 American Heart Association, Inc.

Heart Disease in Africa

Cardiovascular Disease in the Developing World and Its Cost-Effective Management

Thomas A. Gaziano, MD, MSc

From the Divisions of Cardiology and Social Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass.

Reprint requests to Thomas A. Gaziano, MD, MSc, Divisions of Cardiology and Social Medicine, Brigham & Women’s Hospital, Harvard Medical School, 1620 Tremont St, Boston, MA 02120. E-mail tgaziano@partners.org

Received September 27, 2005; accepted September 28, 2005.

Key Words: cost-benefit analysis • epidemiology • heart failure • myocardial infarction • prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
At the beginning of the 20th century, cardiovascular disease (CVD) was responsible for fewer than 10% of all deaths worldwide. Today, that figure is about 30%, with 80% of the burden now occurring in developing countries (Figure 1). In 2001, CVD was the No. 1 cause of death worldwide.^1–3 This article reviews the epidemiological transition that has made CVD the leading cause of death in the world, assesses the status of the transition by region, and shows the regional differences in the burden of CVD. Furthermore, this article reviews the economic burden placed on developing countries by CVD and the very limited resources available for its management. Finally, the cost-effectiveness of various interventions addressing the most relevant causes of CVD morbidity and mortality in sub-Saharan Africa and the other developing regions is reviewed. The focus is primarily on ischemic heart disease (IHD), stroke, and congestive heart failure, which contribute most to the burden of CVD globally. The cost-effectiveness of interventions for rheumatic heart disease is reviewed elsewhere.^4,5

View larger version (15K): [in this window] [in a new window]   Figure 1. CVD compared with other causes of death.

	The Epidemiological Transition

 
Over the last 2 centuries, the industrial and technological revolutions and the economic and social transformations associated with them have resulted in a dramatic shift in the cause of death from infectious diseases and malnutrition before 1900 to CVD and cancer currently in most high-income countries. Omran⁶ divided this epidemiological transition into 3 basic ages: pestilence and famine, receding pandemics, and degenerative and man-made diseases (Table 1). Olshansky and Ault . . . [Full Text of this Article]

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