Cardiovascular disease (CVD) is now the most common cause of death worldwide. Before 1900, infectious diseases and malnutrition were the most common causes and CVD was responsible for less than 10% of all deaths. Today, CVD accounts for approximately 30% of deaths worldwide, including nearly 40% in high-income countries and about 28% in low- and middle-income countries.


The global rise in CVD is the result of an unprecedented transformation in the causes of morbidity and mortality during the twentieth and twenty-first centuries. Known as the epidemiologic transition, this shift is driven by industrialization, urbanization, and associated lifestyle changes and is taking place in every part of the world among all races, ethnic groups, and cultures. The transition is divided into four basic stages: pestilence and famine, receding pandemics, degenerative and human-made diseases, and delayed degenerative diseases. A fifth stage, characterized by an epidemic of inactivity and obesity, may be emerging in some countries (Table 225-1).

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Table 225–1. Five Stages of the Epidemiologic Transition 

Malnutrition, infectious diseases, and high infant and child mortality rates that are offset by high fertility mark the age of pestilence and famine. Tuberculosis, dysentery, cholera, and influenza are often fatal, resulting in a mean life expectancy of about 30 years. Cardiovascular disease, which accounts for less than 10% of deaths, takes the form of rheumatic heart disease ...

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