Public Health AffairsOn the occasion of World Heart Day 2005 [Archives:2005/879/Health]

September 22 2005

By Dr. Saleh Al-Habshi
Msc. in Public Health

With the theme “Healthy Weight, Healthy Shape”, and collaborating with the World Health Organization (WHO) and other United Nations (UN) organizations, the World Heart Federation (WHF) will be celebrating World Heart Day (WHD) on 25 September, 2005, aiming at strengthening the global cardiovascular diseases (CVD) preventive efforts.

CVD represent the major health burden in the industrialized countries and a rapidly growing health problem in developing countries. They affect people in their peak mid-life years, disrupting the future of the families dependent on them and undermining the development of nations by depriving them of workers in their most productive years.

According to WHO estimates 16.7 million people around the globe die of CVD each year, While CVD became the responsible for every third death globally, Coronary Heart Disease (CHD) is already the number one killer in the world, which accounts for 7.22 million deaths. Previously CVD were considered an existing and threatening health problem in developed world as a result of industrialization and technology development. Later on, change in quality of life, strengthening of surveillance systems and analytical studies of CVD risk factors exposed the growing incidence of that problem in developing countries as well. Adopting inactive life style and unhealthy habits by populations in addition to hereditary traits all made most communities more likely to be affected by CVD. Today, men, women and children are at risk. Reports indicate that 80% of CVD burden is in low-and middle-income countries. The increase of CVD began in various times in different countries. In the United States (US), epidemics began in the early 1920s; in the United Kingdom (UK) in the 1930s; in several European counties, still later. And now the developing countries are catching up the threatening danger of CVD. Epidemiological projections suggest that for CHD, the mortality for all developing countries will increase by 120% for women and 137% for men. Predictions for the next two decades include tripling of CHD and stroke mortality in Latin America, the Middle East and even Sub-saharan Africa, a rate of increase, which exceeds that for any other region, except for Asian and Pacific Islands countries. By contrast, the increase in more-developed nations, largely attributable to an expansion of the population of older people at risk, will range between 30% and 60%. As the leading cause of death out of CVD, the WHO predicts 11.1 million deaths from CHD by 2020 globally.

The magnitude of the problem in Europe is showing an upward trend, CVD account for 4 million deaths annually (49% of all deaths in Europe). A statistical fact sheet from the American Heart Association stated that CVD are more prevalent among men than women in most European countries, with the highest in Finland (835 per 100000). About 268000 heart attacks (myocardial infarction) occur annually in the UK. In both developed and developing countries, 40 to 75 percent of all heart attacks victims die before reaching the hospital.

CVD cost the Canadian economy about $ 18.4 billion annually. Every seven minutes, a Canadian dies of heart disease and stroke. The number of elderly Canadians has been increasing. As a result, the number of deaths due to CHD and stroke increased. This trend is expected to continue for the next 15 years.

Many researches conducted in China and India have shown that the two Asian countries with the highest population density, experience the threatening health and economic burden of CVD. Death rates over there are more than the recorded in the US and UK, which rates once were considered of the highest. A WHO report (2003) stated that CVD are now more prevalent in China and India than all economically developed countries in the world combined.

In the Eastern Mediterranean Region the annual number of CVD deaths is more prominent in countries with higher population. It accounts for 154338, 103829, and 81983 in Pakistan, Egypt and Iran respectively. In Gulf countries, which economically stepped ahead to be considered as developed countries, CVD deaths appear to be high and increasing in a threatening manner. The highest annual number of deaths is the Kingdom of Saudi Arabia (16438), while the lowest is in the state of Qatar (238). Taking in consideration the population pyramid of each Gulf country, certainly these figures pose a big health and economic burden, which needs urgent response and intervention.

Efforts done by the UN organizations to support surveillance of disease in Yemen seemed to be fruitful. They led to better provision of information about many health problems including CVD. The alarming annual number of CVD deaths in Yemen (16217) reported by WHO (2003) requires a planned comprehensive multisectorial approach. The problem of CVD in Yemen should be addressed seriously, so as to alleviate the suffering of population exhausted by other health problems, and put down the economic burden caused by that major health problem.

The etiology of CVD is multifactorial. The main risk factors had been identified by the beginning of the 70's. Economic transition, urbanization, industrialization and globalization brought about lifestyle changes that promoted CVD. These risk factors include tobacco use, physical inactivity, unhealthy diet, excess use of alcohol and psychosocial stress. Some of them lead to diseases and health conditions, which pose another risk for CVD and worsen the condition. For example: physical inactivity and unhealthy diet may lead to the development of obesity, which by itself considered a risk factor for many diseases, from them CVD and Diabetes Mellitus. Diabetic angiopathy (a pathology affecting blood vessels) increases death rates from CHD. Hence the comprehensive meaning of the theme “Healthy Weight, Healthy Shape”, chosen for WHD 2005 translates many objectives formulated for CVD prevention.

Smoking is an important CVD risk factor in both men and women. Despite that fact, worldwide trends show more young smokers, especially young women. The consumption of cigarettes and other tobacco products and exposure to tobacco smoke are the world's leading preventable cause of death. Age, sex, family history, genetic factors and type of personality are also encountered among CVD risk factors. The presence of risk factors place an individual in a high-risk category for developing CVD. The greater the number of risk factors present, the more likely one is to develop CVD. Some of risk factors are modifiable, others immutable.

Since the etiology of CVD is multifactorial, the approach to prevention should be also multifactorial, aimed to preventing the emergence and spread, controlling or modifying as many risk factors as possible. The aim should be to change the community as a whole, not the individual subjects living in it. A population approach to CVD prevention has been formally outlined by the WHO. It embraces both the systematic practice of screening and education for high risk, where national priorities can afford such practice, and broad public health policy and programs in health promotion of communities. Strategies for CVD preventive practice are now widely available.

The WHD is a program of WHF, which was initiated at a critical stage of the epidemiological transition; WHD is a key advocacy tool of WHF. It has helped to build national capacity, particularly in member foundations and societies in low-and middle-income countries. WHD has assisted professional societies and heart foundations to step up health promotion; disease prevention and control activities at the population level in countries and galvanized their advocacy efforts. National and community partnerships has been created and expanded over time. In several cases, the primary healthcare sector has become engaged and involved. The WHD is more than just a day. It has galvanized the WHF board, members and partners and has enriched them capitalizing on sharing of experience.

This is just the beginning of a long and sustained effort to prevent and control CVD in industrialized and in low-and middle-income countries. In the future WHD must become a permanent fixture on the calendars of the WHF members and UN organizations. Beyond that, each regional and national member must work to place WHD on the government's annual calendar. Once the public and policy makers become actively involved in the prevention and control of CVD worldwide.