Protecting a Billion Hearts

Abstract

GLOBAL HEART © 2014 Published by Elsevier Ltd. on behalf of World Heart Federation (Geneva). VOL. 9, NO. 4, 2014 ISSN 2211-8160/$36.00. http://dx.doi.org/10.1016/ j.gheart.2014.12.004 Several innovations have saved billions of lives [1] over the years including the following: 1) staving of hunger with the development of the synthetic fertilizer [2,3] and the Green Revolution [4]; 2) the chlorination of water; 3) the identification of blood groups and the introduction of blood transfusions; 4) prevention of communicable disease with vaccinations against small pox, measles, and polio; 5) development of antibiotics such as penicillin; 6) use of oral rehydration for acute diarrheal diseases; and 7) introduction of aspirin, statins, and coronary angioplasty for treatment of coronary artery disease. Prevention of death from cardiovascular diseases has the potential to make an impact of a similar magnitude [5,6]. The United Nations [7] estimates that the world’s population will increase to 9.1 billion by 2050. Half of this increase will occur in 9 nations including the United States and in some of the least developed countries including India, China, Pakistan, Nigeria, the Democratic Republic of Congo, Bangladesh, Uganda, and Ethiopia. Of the 7.1 billion people worldwide, 0.8% die every year [7]; of these, 7.4 million people died of ischemic heart disease and 6.7 million of stroke. Ischemic heart disease and stroke are not only the leading cause of mortality worldwide, but they also account for an annual loss of 129 million [8,9] and 102 million [10] disability-adjusted life years, respectively. In 2010, Eastern Europe and Central Asia had the highest mortality rates due to ischemic heart disease, and more deaths due to ischemic heart disease occurred in South Asia than in any other region of the world [11]. Moreover, this increase in mortality due to ischemic heart disease in South Asia, North Africa, the Middle East, and Sub-Saharan Africa occurred at a younger age than in most other regions [12]. The World Health Organization projects that by 2020, 71% of ischemic heart disease deaths and 75% of stroke deaths will occur in developing countries [13]. In addition, the burden of nonfatal ischemic heart disease also continues to grow in part due to aging of the population—there was an increase in the burden of ischemic heart disease by 29 million disability-adjusted life-years (29% increase) worldwide between 1990 and 2010 [14]. At the current rate, over a billion individuals will either be disabled or succumb to ischemic heart disease and stroke over the next decade worldwide. This special issue of Global Heart is focused on atherosclerotic cardiovascular disease in lowerand middle-income countries (LMIC). Bedi et al. [15] discuss the utility of B-mode ultrasound in detection and management of subclinical atherosclerosis, whereas Zhao et al. [16] discuss the evidence for using calcium screening for