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The Big Heart Disease Lie

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"I never think of the future - it comes soon enough."

Albert Einstein (1879-1955)

Unlike Einstein, we have to think of the future, and plan now, to reduce the numbers of deaths from coronary heart disease and stroke.

Predictions are by their nature speculative. Nevertheless, this much is certain: the global epidemic of cardiovascular disease is not only increasing, but also shifting from developed to developing nations.

Action can work. There are currently about 800 million people with high blood pressure worldwide. Studies now indicate that in North America, Western Europe, and the Asia-Pacific region, each 10 mmHg lowering of systolic blood pressure is associated with a decrease in risk of stroke of approximately one-third, in people aged 60 to 79 years. Globally, if diastolic blood pressure (DBP) can be reduced by 2%, and by 7% in those with DBP over 95 mmHg, a million deaths a year from coronary heart disease and stroke could be averted by 2020 in Asia alone.

No matter what advances there are in high-technology medicine, the fundamental message is that any major reduction in deaths and disability from CVD will come from prevention, not cure. This must involve robust reduction of risk factors.

DALYs

Disability-adjusted life years combine years of potential life lost due to premature death with years of productive life lost due to disability.

DALYs

"Unless current trends are halted or reversed, over a billion people will die from cardiovascular disease in the first half of the 21st century. The large majority will be in developing countries and much of the life years will be lost in middle age. This would be an enormous tragedy, given that research in the last half of the 20th century showed that cardiovascular disease was largely preventable."

Anthony Rodgers, Clinical Trials Research Unit, University of Auckland, New Zealand, 2004

DALYs

Disability-adjusted life years combine years of potential life lost due to premature death with years of productive life lost due to disability.

DALYs

CVD DALYs

Annual number of DALYs

Burden of CVD

Percentage of all DALYs

CVD rankings globally in developing

DEATHS

CVD deaths

Annual number of deaths

CVD deaths

Percentage of all deaths

Coronary heart disease deaths

Percentage of all male deaths

Coronary heart disease deaths

Percentage of all female deaths

Stroke deaths

Percentage of all male deaths

Stroke deaths

Percentage of all female deaths

CVD deaths from cigarette smoking

Annual number of deaths

Burden of CVD

Percentage of all DALYs

CVD rankings globally in developing

by 2010

by 2020

by 2030

187 million

169 million

153 million

—-

V

11.6%

11.0%

10.4%

V

3rd: coronary

3rd: coronary

3rd: coronary

heart disease

heart disease

heart disease

5th: stroke

4th: stroke

4th: stroke

4th: coronary

3rd: coronary

3rd: coronary

heart disease

heart disease

heart disease

8th: stroke

6th: stroke

CVD deaths

Annual number of deaths

Stroke deaths

Percentage of all female deaths

CVD deaths from cigarette smoking

Annual number of deaths

by 2010

by 2020

by 2030

24.2 million

20.5 million

18.1 million

------ ▼

v—■

32.5%

30.8%

31.5%

V

-▼

14.9%

14.3%

___ay

13.1%

-

13.6%

13.1%

13.0%

9.8%

10.4%

9.2%

m

--▼

11.8%

11.5%

11.5%

M_

____

-V

2.6 million

1.9 million

Smokers

Number

Diabetes

Number of people aged 20 years and above

Miscellaneous

ECONOMIC

COSTS Obesity-related complications

Percentage of health care spending in the USA, people aged 50 to 69 years

RISK FACTORS

Smokers

Number

by 2010

by 2020

by 2030

1.3-1.4 billion

1.4-1.6 billion

1.4-1.8 billion

mm

—m

*—

■-▼

366 million

300 million

221 million

Serious increases

Short-term, long-

in LDL-cholesterol

term, and lifetime

in many

absolute risk of

developing

coronary heart

populations.

disease and stroke

routinely

calculated by

health care

providers for

everyone.

TREATMENT Miscellaneous

by 2010

by 2020

by 2030

25%

20%

15%

Full personal medical records stored on smart card.

Investigation

Genetics

ECGs, X-rays, ultrasound images, etc. transmitted electronically to diagnostic centres, often in another country.

Wireless ECGs.

CVD-modifying genes identified.

by 2020

Health systems driven by primary health care to ensure universal access to quality health care services.

Instantaneous computer language translation enables patients to be understood by doctors in any country.

Minuscule computer, with microsensors, automatically sensing and recording health data, could be everyday wear.

Biochemical inflammation and genetic markers used routinely in blood tests to screen patients for heart problems.

by 2030 Patients'

knowledge of their own health equals that of doctors in the 1990s.

"Trial and error" in drug prescription abandoned in favour of personalized prescription through pharmacogenomic testing for predictable responses to drugs.

Genetic manipulation to prevent and treat CVD, including postoperative prevention of re-stenosis of arteries.

ACTION by 2010

Research and development

New causal factors discovered for heart disease, including bacteria and viruses.

Conventions and Goals

Framework Convention on Tobacco Control (FCTC) ratified.

WHO Global Strategy on Chronic Diseases, Diet and Physical Inactivity (2004).

by 2020 by 2030

All newborn babies Bio-

discharged home with engineered

CD-ROM containing their tissues unique genomic maps, with available for summaries of CVD, of which all heart and they may be at increased vascular risk. structures.

External glucose sensor will drive insulin pumps to deliver continuous microdoses of insulin.

Vaccine produced to switch off nicotine receptors.

Convention on Food ratified Convention

(covering content, labelling, on universal taxation, advertising). access to essential

Millennium Development preventive

Goals (2015): access to health care, affordable essential drugs in and developing countries principles of provided, in cooperation equity in with pharmaceutical quality care companies. delivery.

Artificial body parts developed

Transplant surgery

High technology

Heart

Medication

Lungs Brain add-ons

Nerves to transplanted hearts

Xenotransplantation Pig-napping of with pig hearts soars personal as rejection problem transgenic pigs a

Nano-surgeons, or sub-microscopic robots, will crawl through arteries, scraping away fatty deposits and repairing damaged or diseased parts.

Angiogenesis, the growth of new blood vessels, may become an alternative to coronary bypass, angioplasty or clot-buster drugs.

new crime.

Computerized "auto-doc" machine externally detects and treats illness by magnetic resonance therapy.

Off-pump beating heart surgery predominates.

Automated external defibrillators offered as routine electronic options in new homes for persons at high risk of sudden death.

Six-drug "polypill" will reduce CVD by more than 80% if taken by everyone aged 55 and older, and everyone with existing CVD.

Drugs developed to raise HDL-cholesterol (as effective as statins are today for lowering LDL-cholesterol).

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