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Heart Disease, Strokes Are Growing Global Problems

Once considered concerns mostly for the West, both killers are becoming more common in developing nations, U.N. study says.

October 18, 2002|Thomas H. Maugh II | Times Staff Writer

Heart disease and stroke, long considered diseases of industrialized nations, are making major inroads throughout the rest of the world as well, killing as many as 12 million people prematurely each year, according to the World Health Organization.

But that death toll could be halved in as little as five years through a combination of simple, cost-effective national actions -- such as lowering the amount of salt in processed foods and increasing tobacco taxes -- and the widespread use of inexpensive drugs, according to a WHO report to be issued this month.

If such actions are not taken, the number of premature deaths will increase 25% by 2010, the study says.

"The world once thought of cardiovascular disease as a Western problem, but clearly that is not the case," said Dr. Anthony Rodgers of the University of Auckland in New Zealand, one of the report's primary authors. "We are seeing that conditions like high blood pressure and high cholesterol are much more prominent in developing countries than previously thought, and contribute significantly to their overall disease burden."

Building on research during the last decade, the report concluded that high blood pressure and cholesterol levels are responsible for as much as 75% of cardiovascular disease, far higher than the one-third to one-half previously thought.

Obesity, inactive lifestyles, tobacco use and low fruit and vegetable consumption are also important factors.

High blood pressure is a particular problem.

"The global disease burden due to blood pressure is twice as much as was previously thought," said Dr. Gro Harlem Brundtland, director general of WHO.

Overall, 10% to 30% of adults in almost all countries suffer from high blood pressure, the report said, and an additional 50% to 60% would be in better health if they lowered their blood pressure. Even small reductions in blood pressure would reduce their heart attack and stroke risk, Rodgers said. A similar pattern occurs for cholesterol as well, he added.

That problem could be attacked immediately with a regimen of three drugs: aspirin, cholesterol-lowering drugs called statins, and blood pressure drugs called diuretics and beta-blockers. Such a regimen could be made widely available for as little as $14 per year per person, according to the report.

"This drug combination could cut death and disability rates from cardiovascular disease by more than 50% among people at risk," said Dr. Christopher Murray, executive director of WHO's Cluster on Evidence and Information Policy. "More people at high risk for cardiovascular disease should start taking the combination now, before they have heart attacks and strokes."

"Even $14 is too much for many countries now, however," Rodgers said, and there are other approaches that should be given the highest priority. Most critical is the reduction of fat and, especially, salt in processed foods. Levels of both are much too high in the cheapest foods, which are what the urban poor subsist on.

The report notes that bread and crackers are commonly about 50% as salty as sea water, many breakfast cereals are as salty, and soups are often three times as salty.

"That comparison really brought it home to me that you don't have to eat that much to get a really high salt intake in the diet," Rodgers said. Most people get 75% of their salt from processed foods.

If governments could get food manufacturers to reduce salt content by 5% per year for five years, he said, people would never notice the change in taste and "it could bring surprisingly large benefits across the population."

Rodgers cited the case of Japan which, in the late 1960s, "had extraordinarily high levels of salt intake and the highest stroke rates the world has ever seen." The government convinced food processors to reduce salt levels and instituted other blood pressure measures, and the stroke rate has dropped by 80%.

"That's quite an extraordinary success story," he said.

Another easy way to increase cardiovascular health is to raise tobacco taxes.

"A $7 pack of cigarettes will go a long way toward persuading smokers to quit and nonsmokers not to start," Murray said.

Such approaches "are very inexpensive, so that even countries with limited health budgets can implement them and cut their cardiovascular disease rate by 50%," said Dr. Derek Yach, executive director of WHO's Cluster on Noncommunicable Diseases and Mental Health.

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