Picture my heart: Reflections on cardiovascular care in developing countries

Abstract

China, India and Indonesia, three of the four most populous countries in the world, now account for over 40% of the world’s population [1]. Advancement in communication technology in the last decade of the 20th Century allowed for the emergence of a virtual global village, accelerating the socioeconomic development in these and other developing countries, particularly those in South and East Asia. Malaysia, with its balanced, multiethnic population (predominantly Chinese, Indian andMalay), is no stranger to this phenomenon – it envisages a developed country status by the year 2020, and has taken aggressive steps to achieving this target. Within the healthcare sector in developing countries, new challenges are emerging: improvement in infrastructure and per capita income has allowed more ready access of ever greater numbers of citizens to healthcare professionals. A gradual shift from a predominant agriculture based industry and adoption of more high-income industries, for example manufacturing and financial services, have resulted in proportionately more citizens adopting a more ‘urbanised’ lifestyle. Recently published studies have shown a high prevalence of cardiovascular risk factors in Asia: 9.7% with diabetes in China and 7.1% in India [2], 32.3%with hypertension and 20.7% with hypercholesterolaemia in Malaysia [3]. The alarming growth of cardiovascular risk factors is likely to be mirrored by a corresponding rise in cardiovascular events, principally acute coronary syndrome and stroke. Both shortand long-term outcomes of acute cardiovascular disease are directly related to speed of treatment and availability of tertiary level specialist medical services [4,5].