Health Affairs, 26, no. 1 (2007): 12 doi: 10.1377/hlthaff.26.1.12 © 2007 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Trends

PROLOGUE

Trends In The Burden, Treatment, And Prevention Of Cardiovascular Disease

Attendees at the recent 2006 World Congress of Cardiology learned that 80 percent of the record 17.5 million deaths caused by heart attack and stroke in 2005 occurred in low- and middle-income countries. The rapidly mounting burden of CVD in developing nations is exacerbated by disproportionately high losses of adults in their most productive years. In the 2004 report A Race against Time: The Challenge of Cardiovascular Disease in Developing Economies, Columbia University’s Earth Institute cites CVD mortality rates among working-age people in India, South Africa, and Brazil that are one and one-half to two times as high as that of their American contemporaries. In South Africa, 41 percent of CVD deaths occurred among people ages 35–64.

Why the differences? As Thomas Gaziano explains, developing nations face challenges that have kept even the most inexpensive anti-CVD strategies largely out of reach. This situation that could be reversed by global and local initiatives to implement cost-effective interventions at the population and individual levels.

In contrast, developed countries have long been able to funnel prodigious resources into their efforts against CVD. In the United States, those efforts have cut into CVD risk factors, forestalled the development and lessened the impact of disease, and lowered the odds of recurrence. Myron Weisfeldt and Susan Zieman describe advances responsible for remarkable decreases in U.S. age-adjusted mortality and morbidity from CVD in the past thirty-five years alone. In their overview of U.S. CVD burden, George Mensah and David Brown simultaneously confirm these laudable public health triumphs and provide compelling evidence that we can ill afford to rest our hopes on them; the "big picture" is disconcerting, and current trends presage erosion of what progress has been made. Thomas Pearson identifies one of the central problems: We aren’t preventing CVD, just making it less lethal—an outcome with serious implications for present and future health care costs that should provoke a radical rethinking of current tactics.

Is the situation distressing? Absolutely. Hopeless? Definitely not, these contributors agree, provided we are willing to commit to a more balanced, diversified, and fiscally sound portfolio of anti-CVD investments.

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