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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 <10% of all deaths. In 2015, CVD accounted for ~17.9 million deaths worldwide (32%), including nearly 34% of deaths in high-income countries and about 32% in low- and middle-income countries.


image The global rise in CVD is the result of an unprecedented transformation in the causes of morbidity and mortality during the twentieth century. 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 man-made diseases, and delayed degenerative diseases. A fifth stage, characterized by an epidemic of inactivity and obesity, is emerging in some countries (Table 233-1).

TABLE 233-1Five Stages of the Epidemiologic Transition

The age of pestilence and famine is marked by malnutrition, infectious diseases, and high infant and child mortality that are offset by high fertility. Tuberculosis, dysentery, cholera, and ...

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