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Heart disease, stroke in women is increasing
No longer just a rich-nation disease, 82% of future increases in CHD mortality will occur in developing countries.
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ORLANDO — Heart disease and stroke are the leading causes of death and disability among women across the globe. Even in countries such as sub-Saharan Africa where most governments think that infectious diseases, parasitic diseases and nutritional deficiencies are the most pressing health concerns, the incidences of heart disease and stroke are increasing.
In most industrialized countries, the epidemic increases in mortality from heart disease and stroke in women peaked in the late 1960s and early 1970s, followed by a steep decline in mortality rates that has now slowed, according to George A. Mensah, MD, chief of the cardiovascular health branch at the CDC. In many Eastern European countries and in low- and middle-income countries, however, CHD and stroke mortality have increased since 1970. The epidemiologic transition is causing increasing CHD and stroke morbidity and mortality in developing countries.
The CDC and the World Health Organization (WHO) have estimated that 82% of the future increase in CHD mortality will occur in developing countries.
Data from China show the impact of Western influences in that country, where mortality from CHD and stroke have increased significantly between 1984 and 1999. Major risk factors in China now are hypercholesterolemia, obesity, diabetes and smoking. In China, there has been a fivefold increase in consumption of red meat and eggs, as well as a significant decrease in consumption of fruits and vegetables, Mensah said at the Second International Conference on Women, Heart Disease, and Stroke.
Global attention needed
Ruth Bonita, MD, PhD, director of surveillance for heart disease at the World Health Organization, said that a focus on heart disease and stroke “are lacking on the international agenda. We have no global fund for chronic diseases, like there is for HIV. The global and national capacity to respond to CVD epidemics has been woefully inadequate.
“It is important to deal with these scourges … and remember that there are 6 million middle-aged adults who die each year from heart disease and stroke,” a number that is greater than all the deaths due to malaria, tuberculosis, AIDS and other infectious diseases.
Three major risk factors — tobacco consumption, an unhealthy diet and a lack of physical activity — will account for the significant increase in heart disease over the next couple of decades, even in countries where heart disease and stroke have not been recognized as major health concerns until recently. Tobacco use is more dangerous for women than for men, with up to three times higher risk of MI for women who smoke.
Cultural factors
Worldwide, women have less time for exercise and are seeing increasing trends in obesity, Bonita said. In China, 6% of young women aged 13 to 15 are smokers, due to advertising and cultural changes. Advertising related to alcohol is also targeting young women.
“Turning the tide will require much more than a focus on individual responsibility and the notion that these conditions are caused by lifestyles totally under the control of individuals,” Bonita said. “It will require a recognition that social and economic conditions, together with the power of commercial interests, are largely responsible for unhealthy diets, tobacco smoking and physical inactivity.”
Martha Hill, PhD, RN, at the Johns Hopkins University School of Nursing, outlined the numerous socioeconomic barriers for women to get treatment for heart disease, including a low socioeconomic status, lack of access to healthcare, lack of insurance, lack of access to fresh and healthy food, lack of resources for physical activity, and social isolation.– by Kathy Holliman
For more information:
- Mensah GA. International trends in cardiovascular disease and stroke in women.
- Bonita R. Risk factors for heart disease and stroke across the globe.
- Hill MN. Barrers to treatement: Western perspective. All presented at the Second International Conference on Women, Heart Disease, and Stroke. Feb. 16-19, 2005. Orlando.
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