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Epidemiology and Natural History of Heart Disease

Cardio-vascular diseases (CVD) are the leading causes of death and disability both in the developed and the developing nations. It has been estimated that in 2001,17 million people died of CVD of all types. The most important causes were coronary artely disease (CAD), Hypertension and rheumatic heart disease (RHD),along with congenital conditions, cardio~nyopalhy and myocarditis and other related conditions. It is mostly the atherosclerotic diseases of the ~ardio-vascular system that account for the majority of Cardio-vascular deaths. The two majorPrever~tive Cardiology manifestations of atherosclerotic diseases are coronary artery disease (CAD) and stroke. While the presence and effect of these two conditions are felt throughout the world as a global pandemic, a disturbing feature in epidemiology is the disproportionate rise of these conditions in the developing countries. Global Burden of Diseases (GBD) study reported that in 2000, CVD accounted for 17.1 per cent of deaths in developing countries (CAD 9.1 per cent and strokes 8.0 per cent) and 46.3 per cent of deaths in developed countries (CAD 22.6 per cent and strokes 13.7.0 per cent). In absolute numbers the same study showed that in 1990 there were 5.2 million deaths from CVD in economically developed countries and 9.1 millioil deaths from the same causes in developing countries. However,whereas CVD deaths occui~ed in about 25 per cent of persons under 70 years of age in the developed world, they accounted for more than about hali of these deaths under 70 in the developing world. It has been predicted that by the year 2020, global Cardio-vascular disease burden will increase by almost 75 per cent and almost all of this increase will be in the developing countiies. The mortality attributable to CVD alone in India is expected to rise by 103 per cent in men and by 90 per cent in women fro111 1985 to 2015.

Global burden
In 2001, 17 million people died of CVD of all types. The most important causes were ischemic heart disease (IHD), Hypertension and rheumatic heart disease (RHD).

Ischemic heart disease: In 1998, 12.4 million died of heart attack and stroke (heart attack 7.3 million; stroke 5.1 million); of these, 78 per cent were in the low - and middle-income countries:The high-income countries had lower death rates because of better preventive and treatment programs.

Hypertension: There were 600 million hypertensives in the world at risk for heart attack, stroke and cardiac failure; 180 million in the high-income and 420 in the low- and middle-income countries.Rheumatic heart disease: There were 12 million young adults and children with RHD requiring secondary prophylaxis of whom 8 million were of school going age, mostly in low - and middle-income countries Source: WHO CVD Strategy 2001-2002

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