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INTRODUCTION

Cardiovascular diseases (CVDs) involving the heart and blood vessels are public health concerns around the world, particularly coronary or ischemic heart disease (CHD), hypertensive heart disease, and rheumatic heart disease. CHD remains the leading cause of adult death worldwide (Fig. 52-1), although its incidence differs widely and the mortality ascribed to it is changing (Fig. 52-2). While deaths from CVD have fallen substantially in industrialized nations, they are rising dramatically in others particularly in the developing world.1 Age-adjusted U.S. deaths ascribed to CVD declined dramatically for men and women during the first decade of the twenty-first century, (Fig. 52-3 and Fig. 52-4). mortality began to slow,2 most markedly for deaths from cerebrovascular disease. Though the exact reasons for this slowing are still unclear, population-level risk factors, such as obesity and diabetes, have continued to rise.3,4

FIGURE 52-1

Age-adjusted death rates for coronary heart disease by country and sex, ages 35–74, 2006–09. (Source: National Heart, Lung, and Blood Institute. Morbidity and mortality chart book on cardiovascular, lung, and blood diseases. Bethesda, Maryland: NIH Publication; 2012.)

FIGURE 52-2

Change in age-adjusted death rates for coronary heart disease in males and females by country, ages 35–74, 1999–2009. (Source: National Heart, Lung, and Blood Institute. Morbidity and mortality chart book on cardiovascular, lung, and blood diseases. Bethesda, Maryland: NIH Publication; 2012.)

FIGURE 52-3

Death from cardiovascular diseases, the United States, 1900–2010 (Source: National Heart, Lung, and Blood Institute. Fact Book. Bethesda, MD: NIH Publication; 2012.)

Deaths ascribed to hypertensive heart disease have diminished over recent decades in many industrialized countries.5 In West Africa, Latin America, and East Asia, however, the high prevalence still found in hospitals and clinics indicates the continued worldwide importance of hypertension.

Rheumatic fever and rheumatic valvular heart disease remain public health concerns in many developing countries and are still seen among disadvantaged peoples in affluent nations. Cardiomyopathies, often of unknown or infectious origin, constitute a common cause of heart disease in many regions, particularly Africa and Latin America. In the United States, as the “Baby Boomer” generation ages, the prevalence of illegal substance use among adults ages 50–65 has increased dramatically over the past decade, raising additional concerns about the cardiovascular effects of drugs and alcohol in this age group.6 Finally, congenital heart disease continues to contribute to the heart disease burden among youth and adults of all countries.

The worldwide public health potential for primary prevention of most CVD is established by several salient facts: (a) the large population differences in CVD incidence and death rates; CVD is rare in some countries and common in others; (b) dynamic ...

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