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Younger age of escalation of cardiovascular risk factors in Asian Indian subjects

Rajeev Gupta*, Anoop Misra, Naval K Vikram, Dimple Kondal, Shaon Sen Gupta, Aachu Agrawal and RM Pandey

BMC Cardiovascular Disorders 2009, 9:28  doi:10.1186/1471-2261-9-28

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The rate of change is more important than change itself

justin zaman   (2009-07-14 11:39)  University College London and Hospital email

Developing countries undergoing economic changes are now facing the phenomenon of the epidemiological transition, resulting in cardiovascular diseases being the leading cause of mortality in these countries, and resulting in increasing levels of disability. However, differences exist in this more recent epidemiological transition to that previously experienced by developed countries. Those in lower-income brackets have an increasingly high prevalence of risk factors, inconsistent with the notion these are diseases of affluence,  whilst cardiovascular deaths in the developing countries are occurring at an earlier age compared with developed countries, with adverse implications on the health of the workforce.

The term ‘transition’ implies the act of passing from one state to the next. I think this is not helpful in today’s climate. There is an overlap now, the so-called ‘double burden’. The phenomenon of rate of change may of greater importance. It took 200 years for the ‘West’ to develop, yet developing countries are doing it in decades. This rate of change can itself be harmful – as in the macro-economic field in which countries that adopt neo-liberal markets without adequate infrastructure are teetering (or have already as in the case of Argentina) on the brink of collapse. Witness the drastic public health situation with the rapid economic collapse of the Soviet Union. A rapid uptake of lifestyle factors that predispose to cardiovascular disease without adequate public knowledge, public health controls and secondary care is surely analogous to this.

The rates of increase of non-communicable diseases are much higher in developing countries – this is due to a number of factors but broadly is down to the fact that countries are industrializing more quickly, partly as a result of the forces of globalisation - we live in an ever-faster society.  However, what we should also consider is that the rate of decline of communicable disease is slower. We can ruminate over why the rates differ – but why is it that communicable diseases are only slowly declining in the developing world?

Rather than trying to ‘stem’ an epidemic of non-communicable disease, we need to slow uptake of lifestyles that encourage it – as I think sadly we will never truly be able to stem it. Japan’s low rate of coronary disease is due to their slow uptake of Western diets and smoking, and now as cardiovascular risk factors slowly increase, they have the healthcare infrastucture in place to combat it. This paper shows an alarmingly fast trend that may soon be replicated all over the developing world.

Those in communicable and non-communicable disease must work together to change policy. The rate of increase of uptake of non-communicable disease risk factors must decline parallel to the rate of decline of communicable disease must also be quicker.

Competing interests

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